South Africa is blessed with vast plant resources and unique vegetation types. Indigenous South African medicinal plants have been well-harnessed to generate income in rural communities. Many of these plants have been processed into natural products to heal a variety of diseases, making them valuable export commodities. South Africa has one of the most effective bio-conservation policies in Africa, which has protected the South African indigenous medicinal vegetation. However, there is a strong link between government policies for biodiversity conservation, the propagation of medicinal plants as a source of livelihood, and the development of propagation techniques by research scientists. Tertiary institutions nationwide have played a crucial role in the development of effective propagation protocols for valuable South African medicinal plants. The government-restricted harvest policies have also helped to nudge natural product companies and medicinal plant marketers to embrace the cultivated plants for their medicinal uses, and thus have helped support the South African economy and biodiversity conservation. Propagation methods used for the cultivation of the relevant medicinal plants vary according to plant family and vegetation type, among others. Plants from the Cape areas, such as the Karoo, are often resuscitated after bushfires, and propagation protocols mimicking these events have been established through seed propagation protocols with controlled temperatures and other conditions, to establish seedlings of such plants. Thus, this review highlights the role of the propagation of highly utilized and traded medicinal plants in the South African traditional medicinal system. Some valuable medicinal plants that sustain livelihoods and are highly sought-after as export raw materials are discussed. The effect of South African bio-conservation registration on the propagation of these plants and the roles of the communities and other stakeholders in the development of propagation protocols for highly utilized and endangered medicinal plants are also covered. The role of various propagation methods on the bioactive compounds' composition of medicinal plants and issues of quality assurance are addressed. The available literature, media online news, newspapers, and other resources, such as published books and manuals, were scrutinized for information.
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