As we celebrate all the dynamic and dramatic improvements in human health care in the 21st century, life in much of Africa begins with and is sustained with the support of traditional medicinal knowledge. Research on traditional medicinal knowledge (TMK) is extensive, but rather few studies have been written about Traditional Healers' (THs') own perceptions about TMK and practices in relation to changing societal dynamics. The aim of this thesis is to examine how THs perceive on going socio-spatial transformation, including contemporary processes of urbanization, migration, commercialization and commodification of TMK, as well as changing dynamics of learning and knowledge systems between generations and genders and how these affect their medicinal healing practices in time and space. The thesis consists of four main empirical chapters, which derive from different data sources including literature, documentation review and qualitative interview material. The findings in this thesis can be summarised as follows: First that TMK today exists side by side with modern health systems, in what are seen as complex patterns of medical pluralism that provide evidence of an evolving role the TH plays in primary health care, in the rural and urban space. Youthful migrating population dynamics that are linked to historical processes, have effectively carved an emerging cross-sectoral role of the TH in the formal space. Secondly the developing legislation on IPR and ABS in parallel with the representation of an earlier official formal governance around TMK in Tanzania; and the difference in the sectors where TMK is anchored in the two contexts, could have paved way to some earlier collaborative mechanisms, that today provide space to enable a more natural engagement between formal and informal organizations involved in the governance of TMK in Tanzania. Thirdly, the practical ways in which TMK learning processes, which are characterized by learning systems in place, being sent and visiting sacred places that are lived by an apprentice over a number of years, have increasingly come under pressure. Fourthly the thesis shows approaches by THs, encouraging the youth to access conventional medicinal education followed by, or in parallel with TMK learned through traditional pedagogies employed by the THs themselves. The youth’s keen interest in learning TMK is seen to increase when they view improved livelihood possibilities due to the commercialization of medicinal plants. The future of TMK learning processes may be limited unless incentives are put in place for the youth regarding their future livelihoods. Fifth, gendered and generational dimensions suggest that older and some younger female THs reemphasize the values of the gift and TMK in a climate of increased commodification and commercialization of TMK, where TMK increasingly meets neoliberal processes, engaging an alternative paradigm than the gift economy, where a predominance of male TH’s in the urban space and places, increasingly define the diversification of the TMK livelihoods. The gift provided by a higher power and which is embedded in a particular cosmological view, to be used as a social service to help the community, is increasingly evolving as an emerging tested force in a changing ideological climate, with an increasing awareness of commodification, commercialization, IPR and ABS issues surrounding TMK. It implies awareness in relation to the increased benefits of commoditized and commercialized medicinal plant knowledge (which THs hold) for other individuals and institutions. The TH profession and TMK is seen as entering a contested IPR/ABS arena at a time when increasingly socio-spatial transformations are modifying its role from that of a gift to an owned commodity. However while the practice of TMK has changed over time and space, presenting new challenges as well as opportunities, it is also seen as a threat that anyone today can sell and market TMK products.