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Traditional herbal medicine remains a vital component of healthcare across Africa, deeply rooted in indigenous cultural beliefs and practices. This systematic review employs the PRISMA framework to analyse regulatory frameworks, cultural significance, and practical challenges related to herbal medicine use in multiple African countries. Findings reveal that nations such as Ghana, Kenya, and Uganda have made notable progress in establishing regulatory agencies and legislative oversight, while others, including Ethiopia, exhibit weaker governance structures. The study highlights the critical role of cultural embeddedness, with traditional medicine addressing holistic health dimensions often absent in biomedical approaches. Despite the accessibility and affordability of herbal remedies, concerns about dosage inconsistencies, contamination, and lack of standardisation persist. Furthermore, uneven institutionalisation and generational knowledge loss threaten sustainability. The review underscores the need for harmonised regulatory standards, preservation of indigenous knowledge, increased research investment, and strengthened collaboration between traditional healers and biomedical practitioners. These measures are essential to safely integrate traditional medicine into formal healthcare systems and support universal health coverage across Africa.