This paper examines the multifaceted challenges that pastoral counselling faces in the context of health care utilisation across Africa. It explores historical, cultural, structural, and theological factors that shape help-seeking behaviours, the relationship between faith leaders and health systems, and barriers to accessing formal health care. Drawing on interdisciplinary perspectives from public health, sociology, theology, and anthropology, the paper analyses how pastoral counselling both complements and complicates health care utilisation. It concludes with recommendations to strengthen collaboration between pastoral actors and health care providers