High-need contexts, such as those in postcolonial Southern Africa, require interventions that provide psychosocial and socioeconomic care and support. This comparative case study uses the lens of indigenous knowledge systems (IKS) to supplement predominantly Western knowledge of care and support interventions. Participatory reflection and action (PRA) were used in 7 conveniently selected Southern African regions reflective of bounded systems with high adversity and likely to portray indigenous belief systems on a regional basis (n = 430; elders = 240; youth = 190; men = 150 and women = 280). Interactive PRA sessions, focusing on generating narratives about traditional care and support strategies, were recorded and analyzed. It emerged that the IKS care and support interventions still being practised are fundamentally relational and pragmatic pathways of resource management, and include reciprocal donations, shared savings in societies, and partnerships and borrowing/lending. Rather than being outdated vestiges of previous times, these age-old structures continue to function as robust and sophisticated social technologies of care and support.