world health organization global atlas of traditional complementary 1 pot

ne WHO Cente for Health Development, Kobe, Japan, grateful othe flowing contib tors for their active particpaton and cllabracon at various stags in the preparation and publiction of the

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VNI VOLUME

G.Bodeker | C.K Ong | C

WHO GLOBAL ATLAS

OF TRADITIONAL, COMPLEMENTARY

AND ALTERNATIVE MEDICINE

G Bodeker | C.K Ong | C Grundy ¡ G Burford | K Shein

WORLD HEALTH ORGANIZATION

{WHO gol ts of tos complementary and aerate mec

“Meine Tadtanal 2Complementay therapies 3.Helh cư ones

‘Wor sth organization, he WO Cente for Hest evelopment, Kate, 2008

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ACKNOWLEDGEMENTS

ne WHO Cente for Health Development, Kobe, Japan, grateful othe flowing contib tors for their active particpaton and cllabracon at various stags in the preparation and publiction of the WHO Global Ada of Tadsional, Complementary and Alternative Medicine, WHO Arrican ReGion

Cameroon: Daiet N Lanuen, Martin Ekeke Monono: Ghano: Francis Keabens Oppong,Boachie Kenya: ick Gitte; Mozaribigue-Adcide Bela Agostino; Ngee Tok Fakeye, Kati S Gan niet, Abayomi Sofowors: SusaclandD Nilavana Maseke: Ugenda: joseph Tenywa: United Repu fic of Temcania: Ande Y Kits Rogsian Lemmy Anselm Mahunnah, Zachara H Mieambe, Paul Mhame, Sabina Malis, Mainen J Moshi, FebroniaC, iso

WHO REGION OF THE AMERICAS

Argentina: Sia Debenedeti, Maria A Rossel, Sasans Zacchino; Bolivia: Alberto Gime, Jose

“Antonio Pagés: Bros line Bisaberky: Canada: Michal John Smith, Tey Spacks hile Ana (Christina Nogucins Cos Ric: Philippe Lamy, Gerilo Alberto Mors: Guba: Fanscico Moro: emincon Republic Dalia Cas, Cais Roch: Feud Ximena Chirboga,Ferando Ona: Guatemate: Armando Caceres, Hilda Leal de Malina; Hondants Jonge A Mensors, Cristina Mer cedes Monto, Regis Moncada; Ncsigut Franco Hetes: Panama: Mahabie Prasad Gap, Joe De Gracs,Resaurs Jen, Ana bel Samant, Pablo Solis: Suyiname: Hanny Lvan de Lan

de, Lucien Kloof United Sates of Americ: Josep Basten, Rowan J.D Brey, Naney A Halen, Jack Kien, Karen E Kun

WHO Souti-East Asta REGION

Banglades Mabou Ara Umvnch Zola; Bhutan: Dori Wangehulks Duda 8.B Gaitonde, PNY Kurup, GS, Lek, Shoyphal B Shain, SK, Sharma; Indonesia: M Hayatie Amal, Rachmaniar Brahim, Hawdaningih, Sti Harsojo, Kustiani, Agnes M Loupay, Soezomo, Nani Sukasedit, Iemam Waluyo: Sv Lanka: Nileahi Nima Sirpala De Silva: Tailod: Tipsukon Bamnungsvong Anchalee Chuthapuc, Kunchana Decwised, Pennapa Subcharoen,

WHO Eurortan REGION,

Devnet: Esing Hog, Katen Wotm, Gera: Lali Dateshidae, Germany Guseus Bown, Tho-

‘mas Hofmana, Peer E Mathiesen, Susinne Mocbus, Ruse Federation: Andey V Gonyunoy, Alexey A Karpes, Vladimir V Tonkov, Pavel P Vtrnko, Andrey 8 Zakharevich: Suen: Torkel Falkenberg: United Kingdom: Hensetta Bidwell, Geral Bodeket, Gordon Brown, Gems But ford, Alison Daykin, Chis Grundy, Penny ean, Michael Mclnyre, Cors Neumann, Chi-Keong, (Ong, Kesrie Raggar, Mushi Rehina, Terence Ryan, Judith Thompson, Diana Walford

WHO Eastin MEDITERRANEAN REGION

agp: ly Bayoueni Hammad: demic Republic of Fen: Majid Choraghal, Ali aes, Mahmoud Monddegh, Faranch Naghibis Kiri Abdel Rahman Abdulla ALA, Ahmed Regai E-Gen=

Ay, Mohamad Sabir: Patan: AtharSaced Dil, Anwar Hasan Gilani, Hakeem Abd Han tan, Shahvad Huss, Farmar Malik; Saudi Anbia Tawlog A.Al-Howiiny, Abdullah M N A Beda: United Anuh Emit: Sasa Beha

WHO Westen Paciric REGION

‘Autraia: Alan Bensoussan, David Chapman-Smith, Stephen Myers: China: Dequan Ren, Ping, Yan Lam Baoysa Lis, Zhi Niang Shen, Jarme Sin, Niaopin Wang, Zhendou Wes, Jaging Zh

‘jc Nacanes Goneyal: Japan: Novi Ai, Kazuhiko As, Yahi Goda, Ken Hars, Masao Hor), Munckaza linuma, Takeasu Kimura, Hioaki Kiyohaa, Chiaki Nagase, Shins Sabai

Toriouka, Kichro Tsvtani, Haruki Yamada, Takahite Yaad, Kssuke Yoneds,Yositoku Yosh 1x; Lae Popes Denecraie Republi Roun Foong Sourthavong Malia: Abdul Aziz Mahino- tế: Aengyla: ina, Batches: Pape New Guinot: Urmadevi Ambibaipahar Philipines: Afonso

1 Lagia, Repu of Kore Jacks An, Chung-Whaa Byun, IlMoo Chang, Hyun-Woo Han, Seansamn Na, Pyong-Ui Rob, Yaoasook Yao: Singupoe Chis Cheah; Vier Nam: Tan Li Van Hien, Le Van Truyen, Chu Quoc Truong,

WORtp HrAtTli ORGANIZATION

WHO Cone fir Hel Deeelopment Ni Kin Shen, Yuki Machiee

WHO Headquarter: Xisrui Zhang, Steve Eber, anise Guigo

WHO Regional Ofce fr Afi: Rutaro Chavos, Osy MJ Kasilo, Marianne Ngoulla, Edoh Sou- rabey-Alley, Charen Wambse

auch

WHO Regional Offce fir the AmevcacPan American Sonvary Burau Sands Land, Rosario DiAleso,

W1HO Regional Off Sour Est Ai: Keiantha Wess

WHO Regional Offs fr Europe Kees de Jouchset

WHO Regional Off fr the Eater Modierancat: Mohatsed in Shahaa, Peter Graal

WHO Regional Offic forthe Wotern Pace: Seung hoon Choi, Ken Chen,

Contributions 19 the publication of this Global Ads by Rosamund Williams (WHO soe cling) June Moerion indesog), ae also gall acknowledged The WHO Centre for Health Developmen sao grail roll other contriburors in the preparation and publication ofthe Gla As

_ Dri Kawau fer Drs f WHO Cane a Heth Deepens, i ahmed fori comp

‘Kin Shein and Yuki MACH isis XỈ

WHO Airican Region Regional overview and selected country chapters

1 Regional overview: African Region

‘Ossy M Kasilo, Edoh Soumbey-Alley Charles Wambebe

4 Federal Republic of Nigeria

‘Kamniws 5, Gamaniel, Tolu Fakeve and Abayomi Sofowora 7

s United Republic of Tanzania

Mahunoah FC Uiso AY Kita, 7 H Mbwambo, M, | Moshi EMbameand$ Maaliva

WHO Region of the Americas Regional overview and selected country chapters

6 Regional Overview: Region ofthe Americas

‘Michael | Smith and Tracey Spack 7

9 United States af America

‘Rowan D Brivey, joseph Basten, Karen E Kun and jack Kien 63

WHO South-East Asia Region Regional overview and selected country chapters 10 Regional Overview: South-Fast Asia Region

‘hikaj 8, Gatonds and Paneerazakathu N,V Kurup 75

11 — KimsdomofBhuan

12 lic of

Chapter Page

13 Republic of indonesia

"ML Havatie Amal and Hardaningsih %

14 — KimsdomofThaiand

‘Pennaps Subcharoen and Anchalee Chuthaput 103

WHO European Region Regional overview and selected country chapters

15 Regional Overview: European Region

‘Chi-Keong Ong, Eling Hog, Gerard] Bodeker anc Genvma Burford 103

16 Kingdom of Denmark

17 _ Federal Republic of Germany ah # Moebus and Peter E Mathiesen

18 _Bussian federation

‘Alexey A Karpewy, Andrey V Gorvunoy and Vladimi V Tonkov 135

19 United Kingelom of Great Britain and Northern trlạnd

‘Chi:Keong Ong, Gerard Bodeker and Gemma Burford, 143

WHO Eastern Mediterranean Region Regional overview and selected country chapters

20 Regional Overview: Eastern Mediterranean Region

Alunesd Regai EFGend 153 21 _Islamic Republic ofan

“Mahmoud Moseadagh and Farzaneh Naghi 159

26 People’s Republic of China

Baovan Liu Naopin Wang, Dequan Ren and jiaging Zhu 137 27 _ Japan

tui aceamninancaiiiamnsmseien IE

28 Republic ofthe Philippines

‘Alionso 1 Lagaya 19

29 Socialist Republic of Viet Nam 7

TT—— Tin tên Hien an Chu Quac Huon 205

FOREWORD

ne Intemational Canference on Primary Health Cat, held in 1978 in Almai-Ata in she former Sovies Union, lnunched “Health for A a global moversent that he shaped the dynamics oF pbc health ever snc Yet, desi indispurable advances made, the sation remains as “heath for some" Iss sich a disparity in heth-ae coverage ack of equitable sexeible and ator able healthcare forall and problems with sili of reali nancial remurce for health cr

‘ees and medicines are daily realities fo the indigent the marginalized andthe pnderpiepet

The Wold Health Organization (WHO) estimates tha one-third ofthe wort population has no regular access to ese modern medicines: in some pars of Aca Asi, and Latin America s

‘much 2s half of the populaion fces these ersten shortages However in ches same sinarions,

‘he ich resources of rational remedics and practioner are avaiable and accesible

“Tadiional medicines play primary role in people's heath 8 they have for thousands of yea

“The eange of therapies and practices is wide, varying grey fom country co country atl from region co egion, The mast wel-known ate the Ayurveda of India and wdiional Chinese medicine and these systems of medicine have now spread o other counts,

‘The us of herbal meticins, and complementary and alreenative medicine is increasing in nds trazed counties, n connection with disease prevention and the maingenance of health, There isan emphais on slLempowerment and amore Holistic spprosch, in which life is nderstood

ae hoảng union of body, senses, mind and souk: and hel as being the combination of physi-

al, mental soil and spiritual wel being This approach x consistent with WHO's deiniton of| health The practices of tadton, complementary ad akernatve medicine focus onthe holistic approach nd include medicinal planes Herbal medicines te perceived a8" although in wait thee ate potential ks, auch asides, n he use of all mens The waive lowcost of tational remedies an sei rete acces conte with the sng ost and ited yi ability ofa number of even the most essential modern medicines

The WHO Global Ads of Tatiana, Complementary and Altemative Medicine relates well 0 one of WHOS ovenll teateycdicesions in traditional medicine for 2002-2005; that of acing exces moreley and movbidity especially among pooe and marginalized populations Tradiioal medicine’ acesibiltyand affordability ae key values for populasions tugging agaist comma able and aoncommuniable diseases, expecially in dir chuni For,

‘We have seen global resurgence af inert in he use of taditons, complementary and alters

‘ve medicine ove the hs decade The Fify-ssh Woeld Health Asierhly formally scleaoeledgal this May 2003; Member Ses dicussed the WHO Traditional Medicine Steg 2002-2005 and sdopted resolution WHASG.1, These documents st ou quately the major challenge: the lack of exganized nenworks of traditional practioner the lack of sound evidence ofthe sey <f fcacy and quality of eadsonal medicines the need for measures to ensure proper ise of adtional

‘medicines and to protect and preserve tational and natural sources seventy foe thei sustain able aplication: and measures fo waning ad licensing of wadiional practitioner

“The Traditional Medicine Strategy tects both the value placed on traditional medicine sa source, and the challenges aed Ideals four dtetons fo our work h councicsjm thị hủ:

in the areas of policy (here we to broaden rengnition of raiconal medicine, sopping itsinepration into national health systems as appropiate, and protecting indigenous kaomledg: safe ellicay and quality {where our work so expand the knowiedge base on raditonal mi cine and aise is cree access (where we must work to increase sailbiliy and affordabilos,

‘especialy fo poor populations: and rational use (here the ak so ene appropriate and sus

‘ainable use of these medicines by consumers and provides, preserving and protecting medicinal plan resources and knowledge of traditional medicine,

‘Mapping che isues through this Aas gives hem fish impact, astatng graphically ce “gaps” and therefore the neds I this wa i điecdy supports the implementation of WHO'S state plans, For example, a map that shows only 25 countries as having 2 national policy for traditional

WOH

‘The Ass sam advocacy oot show che global community where aur forts ae mow requ and co simulate join responsibly for slsng she problems risa part of the solution The actal procs oft cumulation has in ie em # waa means oF rising the profile of tai tional mine globally In asking the questions and arGculating the sus, constructive ptngfes has aleady ben made in underlining de importance of wadional medicine inthe eld of public oih and hihlighing tall Member States where work still nes to be don,

“The Alas provide elise, evidence-based formation onthe use an practice of tadional medi- cin in the wold today, 4 timate decision making in hah sector development and reform

Ie provides eleence and rscarch too forall hose who are working co incense avaabilsy and 3seeshily ta caccfociuelemeles and methods of eaten; and to promote proper use and

to improve tsining and eduction of providers of tational ridicines, and complementary and slkenativedherapes bee thatthe succes ofthese eflots wil evenly ead to a more com prehensive health-care delivery which will in tn, bring us cower reduing “Heath for Allin the 21” century

Dr Wilfred Kreis!

Dieaor

"HO Cenue tr Hehh Development

Kobe, Japan

PREFACE

adional medicine (TM) has always maintained its populaiy word Bp addition, for ore than a decade there as een an increasing sea eomplementary an lerative me

‘ine (CAM) in many developed and developing counties, Ilse with increased international de

‘mand, the safer, eficacy and quality of che produce and practices ws in TMICAM have become iamportane concerns for bath health auchorves and due public Therefore, WHO Member Staten are ecking 1 xa policy frameworks sind deciding in what ways these products and practices

‘Should be regulated oenaue their sey, efficacy and quay n this conten, ie would be beneficial for Member Sates co share experiences in onder oasis eachother as they begin to develop their

‘own policies and regulations The compilation ofthe WHO Global Aras of Traditional, Compe mentury and Alenative Meicin his provided a aiechaninn far shaving evidence has info tion on the curtent tate of TM/CAM

BackGROUND To THE Data COLLECTION AND WorkKING Process

‘The Global Alas was designed to record and map che current setus of TMICAM around the sword, in terms af policy, regulation, education, research, practices and se, To this end WHO through its Cenee for Health Development (WHO Kole Centre) organize twa meetings Sep- tember 2001 and in fe 2003, Altogether 73 participa inclading national health aushorties, expen, and representatives of NGOs, fi 45 counties inthe six WHO regions, engage is a interavonal collaborative efoto propane dhe Clabal Ads

The meeting in 2001 reviewed and discussed the primary data available on the prevalence and uslzation of TMICAM, a well the development of working procedure to compile national in- formation and daa fr the Adhs Since TM/CAM snot been legally recognized in many counts and theres lack of das for mos countries, the paricipans decided tat che Global Aas would bbebased on data from secondary sources Ducto the lack ofan effective and generl-accepted ool forthe purposes of secondary data collection, three rypes of indicator were propose background, -wnietunln đulng s srtey qua auetementimlcwto9, and proces indicator ce Anns in the map volume) These idieator were employed to guher the demographic information, nf structural development of TMICAM at she national level and i uization and popula Before launching the global clleion of information, the fasbty of using the indicators wae Seld-tested in Indoness, Panama, Thailand, and Vie Nam in cooperation with national authorities seating to TM, In onder o gather these data, the WHO Kobe Centre sogether wit the Tonal

‘Medicine Team at WHO Headquarters and the sis WHO repona fies se up a working group in

‘each region The WHO European Region coordinators working a Global Iniacie for aditional Systems (GIFTS) of Heath at Oxford University, United Kingdom, were commissioned by the WHO Kobe Cenere ta cllit the information received from the sx regional working groups Each working group contacted ational focal points and/or working partners in ce counties of thie

‘especie eegon to cll information and data, Aer global das eolleton,analss and cll

‘on by the reiona working groups had ben completed, a meeting was conven in June 2003, 3¢

‘which it was agred char the Global Adis would consi ofa map volume and tex volume Afr the mecting the WHO Kobe Centre sn the fil draft of each county chapter to the respective

‘atonal health authorities for dei review and comments

UTIUZATION OF THE GuoBAl ATLAS

“The Global Alas fciiates an easy review of many aspects ofthe situation regain the se oF TM

‘CAM in diferent counties, which therapies ate mos popular worldwide, how many counties have already established policy and regulation of TM/CAM, ec Ir provides ch source of ito mation 1 assist Member Stats scking to develop chet nacional plicis on TMCAM, Hever, ieshould be noted tha the Global Atlas was prepared on che basis oF information and dat from secondary Soutces and tefeznees ae include at the appropri pots

‘One of the Four objectives of the WHO Traditional Medicines Sertegy 2002-2005 is to assist

seloping and implementing national TMUCAM policies and programmes, From the information {athe in an ongoing WHO global sure of nations policy and regulation of TM/CAM and Tetbal medicines, tle th he sation is eeoltng rapidly and that many conti ae cur remy engiged in eablihing national policies and eyustions

"Thus, in onde to cape this changing caro, the Glob Ads wil ned woe updated egal Meanie, provides an excellent oneview ofthe sition of TM/CAM inthe world today

De Xiaorui Zhang Coordinator, Traditional Medicine Deparment of Esenil Drugs a Medicines Poly World Health Onpinizaion, Genes, Sutretand

INTRODUCTION

Kin Shein' and Yuki Machiea?

Cooninato, atonal Medicine Programme, WHO Cente for Heath Devlopment,

Kobe 651-0073 gun

mal seine who orp

Techical Ofce, Tadtioal Medicine Proyanime, WHO Cente for Health Developer

Kobe 651-0073, pa,

mall: maehirayehwbo op

he developments an achicsements in biomedical disciplines and advances in modern med

‘al sciences in general in de prevention, contol and veasment of various discass and oser

‘medical conditions is unprecedented in the history of medicine However, the benefits derived from

‘hese developments are aot neces availble, accesible and aordable ro significant propor

‘ion of the people in many developing countries Under nich circumstances, eraitional medicine (FM) continues co play an important roe inthe provision of primary health eae i many cous ties For example, in Alri, upto 80%, and in India, 70% of the population depend or radial snedicine to help meet their health-care needs)

Inthe ac ro decades, many developed counties ave als been incest in rational medicine

Ws bing refered vo a complementary and skemative medicine (CAM) and therapies A many

48 42% of the people inthe USA, 48% sn Aseria, 70M in Canada and 77% in Germany used CCAM ar east onee inthe 19905 (7,

Various systems of taditional medicine ate usd i differant pare ofthe wold todays yet there i

ta reference information on thei ulation A need has been expres to bring together auch {informacion especially onthe populaely-ased TM, for beter undersanding of the various systems

of medicine conbuting to che pooples heath, The various modalities of therapies and practices templayed in TM/CAM, insofar ae thy are beneficial and ot harmful ro pooper health and well being, ate pocenial resources for heath car They esd tobe explored for thế poubleconti= butions ro health, cis crcl co understand their role because its importane co systemtize the contributions ofall systems of medicine inde development of "Health fr Allin dhe 21° ceneury

“Therefore sharing the counties informavion and experiences i necessary This Global Adas aims provide a ringe of information lating tothe use oF TMICAM, incading the national policy and regulation, populary-used cherapies, research and education, among thes

‘The Development of WHO Global Atlas,

‘on Traditional/Complementary and Alternative Medicine

Since 1999, the WHO Cente for Heath Development (WHO Kobe Cente/WKC) hasbeen

‘working inthe aca of TM 20 examine is valid contributions to heath system development in the 21 cenury (2 eis envisaged that modal of ueatmene in various stems of medicine—

‘whether conventional, tadiioal, complementary or aeratv, that ave been proven 1 be fective and ao bamnf to people heath and well-being when used prope ight cteibute a improve aces to prefered methods of health caren ational health nd weve systems

‘Ther is lck oF information and documentation on numberof diffrent systems af TMICAM Hence, the WHO Kobe Cente sanvened an intestinal conslative meting in Sepeember 2007 LH] se the fist step in de collecion of global information on practic and wtention of TMUCAM

“The iediewo foe she callection of inkormation were selected and fil tented in Indonci, Panam,

‘halland and Viet Nas Thera the collection of information was arid ou lal

In June 2003, the Centre ganized another insaational meting o review che data (4 This was tended by 48 experts and national health authorities fom 33 countries The pariipans reviewed the information collected and developed the structure of the Global Atlas, a brief description of

Purpose of the WHO Global Atlas The purpose of the WHO Global Aa + Provide the est information on she natu af ảadlepmen of TMICAM n the wold co the Meier Stats acalem,rescarchet the industry, NGOs and ater interested pris,

an + Provide information on commonly-ased TM/CAM in diferent coun, swell 3s doc menting ther global prevalence,

The Global Als consists of two volumes, ie the map volume and the txt volume () They are aranged to provide a more complete peste regaing peoples elance and dependence on dier- aia heal system

TThe map volume presents information 09 the cuzent satus of TM/CAM around dhe word by scans of aps, igure ad ables on th allearing aspects:

ional legislation and pole + Anaihbilryofpuble financing + Status of eduction and profesional regulation 1+ National egal ecoitinn af TMICAM practioner hy cheap + Conventional heah-ete professions ented to provide TM/CAM + Papulatos or we of ieee stems of FM/CAM around the word, The ex volume includes six eyional overview chapets and 23 selected county chapters on prac tices and agladen of TRMUCAM, vi a view o provide country-specific information Eom developing well developed counties,

Conclusion The salable of more complete information onthe heath systems prevalent in 3 country could live a mote comprehensive national heah-system development and/or health sector reform

‘where eis + necssry and desirable These developments ae impomant tothe endeavour of i tions around the work in theie quest co improve the health-care covetage and provision to ther chien safe, fective, frdabl, and culurly-acceptd therapies and practices

Glossary of selected terms

In onder to wad easly and we the information include, dfiiios of the terms cosmonly wed

in this Global Ada ate given below Te folowing definiions of key terms are quoted from ocher {WHO publications for consistency and have aleady ben used in the Member Seite,

Traditional Medicine (TM) Teadicional medicine he along history este sum toại ofthe knowledge sls and practices

‘based om the theories eles and experiences indigenous to dierent cleus, whether explicable

‘or nt nthe maintenance of heal, a wells in che prevention, diagnosis, improvement or tecaimens of physic and mendl illnesses (3)

Complementary and Alternative Medicine (CAM) The terms compementary/alrernatvelnon-sonventional medicine are wsed interchangeably with tradicional medisin i some contin The tem complementary and atemative medicine wed

in some couric to rect so 2 bund set of health cate practices thar ate no pe of the county

‘own tation and ate one integrated int the dominant heal car sytem (3) Herbal Medicines

Herbal mesicines (5) include herbs, herbal materi, evbal preparations and Snished helal

WHO Gions Ans Tame, Countuns np Aane Mens TEXT VOLUME Herbs

Heeb include cre plane material sch as leases, lowes, fut, sed, stom, wood bark, 1085

‘hizomes or other plane pats, which may be ent, lagmened or powdered

Herbal materials

Herbal materials incude, in ain co herbs es juices, guns, fed ols, essen ols esis and

cây pomdets of hsb In some counts, these materials maybe processed by various loa procedures,

‘sich a steaming, rosin, or tir-baking with hney alcoholic beverages or ther materials

Herbal preparations

Herbal preparations are she basis for Bnished herbal products and may include comminuted or

povidered herbal mae, or extracts, tinctures and fay els of herbal mares They ae pro

‘iced by extraction, factonaton, purication, concentration, or ater physical or biological proc

‘ewes They als include preparations made by steping or heating herbal maerals in aki

beverages and/or honey, fin other materi

Finished herbal products

Finished heal products consis of heral preparations made from one or more herb, KFmone than

‘one het i used, the term mixture hetbal product can alo be used, Finished herbal prodcts and

tmieute herbal products may contin excipients in addin to dhe ative ingeedioats However,

finished product or mixture products vo which chemically defined active subwances have be

saad, including synthetic compounds andlor isolated consiucnts from herbal mara, are not

‘considered tobe herbal

Ayurveda

‘Ayurveda (6 originate in che 10% cemury BC, hạt 1e catet foe ook shape beeen the

5? century BC and the 5 cenury AD In Sanit, Ayurveda means icence of HE” Ajuveie

loaphy ic mached o cred tent, the Vedas, and based onthe cary of Pancha

{oral object and Ing Boies ate composed af the Be base cements earth, water, Bea

du dy Simi, cere sa fandamena harmony between the environment and individ,

which is perceived asa macroconm and mirocoum relationship Ar such, acting on one inf

tees the other Ayurveda is not only asst of eine, bu also way of ng, hịb wed

to both prevent and cue dicate Ayurvedic medicine inches herbal medicines and minal

baths i widely practised in South Ai, expecially in Bangladesh, indi, Nepal, Paka, and

Sei Lanka

Chiropractic

Chiropractic was founded t the ead of the 198h century by Daniel David Palmer, 4 magnetic

therapist practising in lows, USA, Chiropractic is bated on an association beeen the ive and

‘he nervous sytem and on the sel-healing properties of che human body eis practised in every

region of che wodd Chiropractic taining progranmes are recognized bythe World Federation of

CChigoprctic i they adopt iterational standards of educaGon and requie a misimumy of four

ets of ul-cime univers level education fllowing entrance teqtement

Homeopathy

omncopaty was Fest mentioned by Hippocrates (462-377BC), but it was a German physician,

Hahnemann (1755-1843), who exablihed homeopathy’ basic principles of sili, dre

sion of cure principle of single remedy the theory of minimum dilued dose and the cherapy of

‘onic dicate (6 In homeopathy, dscse ae wear with remcis that ina healthy person

would prdacesympcoms ml to those of the deste, Rather than fighting te disease direc

medicines are intended to simulate the body to fight the disease By the lrter half of the 19%

century, homeopathy was practinedthroughotr Europe aswel a in Asia and North Ameria Ho

imeopathy has been integeated Ineo the national health cate systems of many couneres,inclading,

Traditional Chinese medicine

“The calest eco of raditional Chinese medicine (6) das hack che Sth century BC Diagnosis sind treatment ate Based on 3 holiicvew of che paticnt and the patient symproms, expres in teemsof the alanee of yin and yang, Via repent the ext, col, and femininity Yang represents the sy, heat and masclinisy The ations of yi and yang inuence the interactions ofthe five

‘ements composing the universe: metal wood, water, fe and earth, Practitioners of trdvonal

‘Chinese meine eck t conto the lesls fyi and yang ctough 12 meridians which bing en

‘ey 10 the body Traditional Chinese malicine canbe ied for promoting health swell a prevent ing and curing dicases Ie encompuses 2 range of practices, inclading acupunctare, moxbastion, heal medicines, manual therapies, exercises, breathing techniques, and diets, Sugery is rarely used Chinese mein, particularly acupunctre i the most widely-used eraiviona medicine, I

is prctisd in every eon of the word

Unani Medicine

nani (6) is hased om Hippocrates’ (462-377 BC) theory’ of the four ouiy humours: Blood, leg, yellow bile and black bie Galen (131-210 AD), Rhus (850-925 AD), and Avicenna (980-1057 AD) heavily influenced Cina foundation and formed es srurur Unani draws fom the teitonal sstems of medicine of Chins Egypt, Inia, rag, Tera (slamie Repblic of lan) and the Syian Arb Republi is so called Arabic medicine

(Medication therapies

Therapies employing medications include Aftcan medicine, Ayurveda, traditional Chinese medi-

<ine, heal medicine, homsopathy, Siddha medicine, Unani medicine and other taivonal medi-

‘ines which ae popula used worldwide (3),

Non-medication therapies

These therapies are aso calle “rational procedure-bsed therapis” in some counties Therapies that do not we medicines internally are acupuncture, chiropractic, onteopathy taditonal exes (eg Qigong Yogals manual dherapy (eg, Shits, and others (3,7)

References

1 WHO Trains Modine Sang 200.2005, Gena, Weld Heath Onrization, 2002 (WHO! TDM/TAAmnS.)

Trion Meine ~ i men beth dvapmenin he new comary Rigo

fn lerational Sppear, Kb Jpn 9 Neem’ 188 Rae, WHO Cente er Heh

Deopmens, Word Health Organon, 2000,

1 GlabelIfrmation n Tuẩnkươl MolcômlCanglenrueg audAherusie Melix Phi su Uhation Pred ofn Inertial Conair ering, Kab, oan, 19-21 Speer 201

he, WHO Cae fr Heal Dement, Weld Heal Oration 2001

4 Gol eof dine Bed Peng of Iason! Mig Kab, apa, 17-19 fue

13003 Kale, WHO Cone fr Health Developer, Wd Health Oration 2005

5 Thadtionl Meine ~ Growing Ne nd Prieta WHO By Pepsi on Malidnes Geuen, -Vodl HoNh Oagutaden, 2003 0WHOIEDM2DD4)

eel Ss of Tcl Medineand Complementary Aerie Meine ~ A Warde Rei

‘Genoa, Wok Health Orpaniaton, 2001 WHOVEDM/TRM@ 2001.2),

WHO AFRICAN REGION

REGIONAL OVERVIEW AND

SELECTED COUNTRY CHAPTERS

and Rufaro Chatora!

"Rona ‘World ath Organization Regional tice Adviser for Traditional Meicne, Division of Health Systems ad Service Development, or Arica, PO, Hox, Bazza, the Repub of fe Congo Email kalo ao ho it

» Regional Adviser for Heal Information Sytem, Division of Hea Systems and Service

Development, World Healt Orgnizaton Regional Ofc for Aca, PO Hos 6, azzaife the Repub ofthe Cong E.maittoumbryefufreboint

* ShoTer Professional inthe Tational Medicine Programme, Division of Heath Systems

and Senice Developmen World Healt Organization Regional Ofc for Aico, BO Hos 6, Brazzaville, the Republic of he Congo tm waded aoa

* Director Division of Health Systems and Senices Development, Worl Heath Organization Regional Oe for Arca, 20.86 Brazel, the Repub othe Congo it chamaySafeo nho ni

1.1 INTRODUCHON

ABieen Trndtienal Melidne(ATRM) ixembelded in th clure ofthe population I some com

‘munities, cis the only fom of health care satis avalable affordable and accesible: Only about 50% of the population in the WHO African Region (AFR) has regular acces oesenial pharm ceutical, whereas more than 80% «se ATRM (1), Afia is endowed with a rich biodiversiy ext

‘mated a 40000 plane species (2) and ATRM is 90% plant-based About 637 plane species ae used

in wopical Aca, of which more than 4000 species ae wsed medicinally (3) Traiinal knowledge iseansmiced mostly by ora ration, while some specif recpes are disclosed only family mem

‘ers who can be ested co kes such heritage,

tn recognition of the role tha ational medicine (TRM) ands practioner play inthe detdop- -ment of heath systems and services and dhe achievement of Heath for All’, WHO governing bod esa global and regional evel have adopecd several resolutions on TRM, These ince Resolution AFRIRCSO/R3 on Promoting the Role of Taditional Medicine in Health Systems A Strategy for

‘the Affcan Region adopted at the iit esion ofthe WHO Regional Commitee foe Mia, held

ân Ouagadougou, Burkina Faso, in 2000 (4); and Resolution WHASG.3 on waditonal medicine

at the Wordd Health Assembly in May 2003 (3)

‘More recently there has been a renewed politcal commitment ro TRM at both countey and WHO levels as evidenced by the institution, with effec from August 2003, of che ATRM Day for Advo

‘cy on 31 August each year - in Member Stats The frst such Day was launched in Peto South Afi in 2003 withthe theme Traditional Medicine: Our Culture, Our Future The Aftican Summic of Heads of State and Government declared in Abuja, Nigeria, in April 2001 that TRM

‘esearch was privity and in Lusaka, Zambia, i July 2001 i designated the period 2001-2010 as the Decade for the Development of ATRM A plan of ation, which resived WHO support, was adopted in Tipo Libyan Arab Jamahiriya, in April 2003 and endorsed in Maputo, Morambigs,

by dhe African Summit of Heads of State and Government in July 2003, The strategy for ti plementation ha been developed by WHO and was submitted to the Afcan Union in December

2003 Furthermore, the African Summit of Heads of tae and Government, beld ia Maputo in July 2003, declared tha ie would continue ro suppor the implementation ofthe plan of ation for

‘the Decade for ATRM, especially research in the tea of textment for HIVIAIDS, tuberculosis,

Couns wil nocd sme to capitalize on this renewed poi canumiemen: co enhance ATRM

in AFR Currndy,sbour half f the counts in the Region have formulated TRM policies and developed ronal sructures fr the practice of TRML

1.2, BackGROUND INDICATORS

1.2.1 Morbidity and mortality

The estimated tts population in AFR in 2002 was about 672258000, The average anna growth rate of the population i estimated at 2.2% The average ite expectancy a beh, hoth sexes con biaed is 48.9 yeas The per pita tal expendinre on health i itemational dolla, ange TRom $12 in she Demacatc Republic of the Cong to $770 in dhe Seychelles in 2008, with ana stage across AFR of $109.30 nfanc more rats in 2001 ranged from 13 pe 1000 lve irs in Sohdls so 182 pe 1000 lục brcs in Sierra Leone, while maternal moray rates ranged fom

1 per 100000 lise birt in Seychelles to 1837 per 100000 live birt inthe Democratic Republic

1.2.2 Numbers of prescribers and TCAM providers

The tral umber of precrber in AFR estimate during 1995-2003 was £22374, composed

DF physicians ~ 106685: midwives ~ 48044: mares ~ 4N5705: pharmacy ~ 3280: dentate

~ 17675 and osber heleh workers ~ 131.464 In 2003, Nigeria had 25000 physicians 10000 [haemacits and 8386 nurs, wheres in 1996, South Altca had 23855 phyiclan, no midwives,

200080 mares, [5794 pharmaco snd 7544 dems (8

The taal arabe tational complementary and alerative medicine (FCAM) providers with and ouside the conventional health syatem varies From one country vo another Mest of theta sre traliinal heath practitioners (THI) Survers conducted by WHO and other organizations shove dt many pars of Mca TH grey outnumber medical doctors Br example, 1982 edlberg and collegucs (reputed that shere were sbout 3000040000 THÍ and 600 medical doco in the United Republic of Tanzania A similar situation is oberved in other counctes.[n Ghana for example the tio of meal doctors ro the population is 120,000 and dạc of THs

tà the population 1-200 whereas a Mozambique dhe aio of medical doctors othe population is 1:50 000 and shar of THs te population 1:200 (10,

1.2.3 Total Expenditure on Health

The otal expenditure inthe conventional health-care sector is illustrated in Table 1.1, Table 12 and Figure I Table 1.1 shows the expendinue by rype of provider, including nongovernmental

‘rganizatons (NGOs a for prof private secon in selested Esser and Souther Ais (ESA)

‘ours, Table 1.2 shows the health expenare hy level a ear in the public sector of EA coun: iec Figure 11 shows the breakdown of ec ae delsery expendtre by eve of eareacrss the region ata whole (8

There has always been doubt expresed imerationaly that hospital expenditure is too high in non to expendinue on primary beh cate in developing counties The evidence presented

in this comparative analy of dhe national ealth ascounts in ESA counties does ao, however, {cad go appt his concern, Table 1.1 shan thatthe proportion of ta expenditure devored 10 Tsp ie tends to desis in most counties with the addition ofthe private cer This i however eget dco expendtut in pharmacsuricl ot in the private ecto, which i dificue

to clas ina primary ate a others, In the eae of the United Repub of Taman, che high proportion ef expenditure on hospital canbe explained by the fat thất many hopiel rerun by

{WHO Gionu Anus Tomo, Counouisy 0 AvaNNs Moe TEXT VOLUME

Table 1.1, Total health expenditure in astern and Southern Africa (ESA)

countries by type of provider, including NGOs and for-profit private sectors (17)

Reseach 066 | 109] NA [NA

[ 189] 147| NA | NA | 197] 1259| NA [ NA [8A | na [ tar] NA| NA |

on] wh [aaa | asi] wa | as] Na

Table 1.2 Health expenditure in selected Eastern and Southern Africa (ESA)

‘countries, by level of care in the public sector only (8)

ers ns ny

by level of care in counties:

ETH | MAI | MOZ | RWA | SAF | UGA AFR

1.2.4, Expenditure in the Traditional Health Sector

Information on tot expendicare nthe raiional health seoor sang; soi đinh to make

‘meaningful comparisons between the formal an eraiional sets, bu afew examples can be cited, Figure 1.2 combines che results of a study on affordably (22) anda comparison of heath

“xpeaires (13) in KwaZae Natal Province in South Alia, which showed that the eximated nual cost of treatment per inv, paid by patents using hebal products nd consulting ax

‘itional heh practitioners, was les thin the proincl per capita annual health expenicure on pblichelth care nt pai by pains

igure 1.4 Breaidoin of eve care deliver expenditure by level of care

across the WHO African Region as a whole (public sector only) in

Simdlxh, Figure 1.3 shows results of sudy on comparative cos of malaria treatments in Dangine

‘West Distct, Ghana, where self reatment using hers and overshe-counter medications was ess expensive tr paienes than the cos of malaria treatment a clinic (1),

1.3.1 Official National TCAM Policies

Govesnmens ports and survey undertaken by WHO and other partners indicate hat at least 20 (56%) counties in AFR have an oficial national policy on TCAM, (nung ply whose en- Aorsemens hy Cabinct is pending) Those with pois ae mostly in western, southern and extern Africa, Those without polices incase a numberof eontis in ceneal and norehwestern Aiea, together with some ofthe suller counts in dhe south and east (Lesotho, Malawi, Seychelles and Swaziland),

Figure 1 Health expenditures (in USS) in KwaZulu-Natal Province, South

WHO Guan nso Toon Count 60 AtHSAne MOON TEXT VOLUME

Figure 1.3 Out-of-pocket expenditure (in USS) for malaria treatments in

Dangme - West District, Ghana (14)

ne, Swaziland, Togo and Zimbabwe Cetin forms of TRM are egulated in Borsa, Ethiopia, Ghana, Lesotho, Madagascar, Mauritius, Nigeria, Siera Leone, South Affca, Swaziland, Tog,

‘the United Republic of Tanzania, and Zimbabwe TCAM provider ar legally recognized in Bor: seam, Burkina Fso, Cameroon, the Congo, Ethiopia, Gambia, Ghana, Guinea, Kenya, Lesotho,

‘Mali, Mauritius, Namibia, Niger, Nigeria, Senegal, Sirsa Leone, South Affia, Swaziland, Togo, the United Republic of Tanzania nd Zimbabwe (0)

‘Curren, THI ate the most common profesional categony ented to provide TCAM in most

‘counties in AFR There ate thers however in Nigta, for example, chiropractors and ostcopaths

se recognized within the conventional heath system In Mauris, thre are no provisions for

“ATRM, bụt registred practioners of Ayurseds, homeopathy and taditional Chinese medicine ane legally recognized ln Mal chartered THDS, all medical staff, and retired paramedical staff may

‘open private TCAM consuladon clinics, Chartered medicinal plant selem, graduates ftom the Karibougow Rural Polycchnic Insitute or equivalent, and graduates from the Superior Normal School o is equivalent at allowed 1 open melictml he xores (1) Smilin South Acs, allopathic docrre retain the igh o practise homeopathy, regardless of thee level of homeopathic

‘cation, since these profesional ae legally recognized TCAM provides

1.3.3 Existence of a Ministry, Institution or National Expert Committee

‘Sixteen (44%) countries indicated that a national expert comminee on TCAM has ben established

‘whose mandate includes, among others, TCAM conta, education, information and/or research (able 1.3), Furthermore, 14 (39%) counties have established a national programme on TCAM,

‘Thiry-one countries (86%) indicated that a National Ofice of TCAM has heen established within the Ministry of Health, whereas 28 (78%) indicted thar TRM research is being carted out

1.3.4, National Voluntary Self-regulatory Bodies for TCAM

[National voluncay seleaulaory bodies foe TCAM, moetly THY! astocatinne: exits i: Ronin

HO AFRICAN REGION

‘Uganda, the United Republic of Tanzania, Zambia and Zimbabwe tis incerestng to note that in [ali học are over 32 THD associations, and a Federation of THD hasbeen established In most

‘countries, However, the numberof ssoxiations ranges om one in small countries to ve in ager

‘ones They ate mostly concentrated in wan aes

Table 1.3 Summary of selected structural indicators in the WHO

1057) 0ø) [ning ras or dina ih ada T55) 06:

|Loss famno or the practice of tational mexine 16153) 0)

‘oeal podicton of tational meses 1560, 6)

1.3.5, Public Sector Financing Mechanisms for TCAM

In mox cnunie of AFR, the free provision of healthcare in the pubic sector docs not include

‘TCAM therapies (2) Both herbalists and private practitioners of [CAM charge wer fes (17), For ceampl in South Afric, Zambia nd Zimbabwe, TCAM treatments ae not covered by insurance

In dhe Congo, an atte has been made to standardize fes for TCAM eeatment, but no patient

‘cimlburcment exists fo such fs Even in Niger whore health insurance programme ws into- duced for government healeh-<ae services, i does not cover any tatonal reatments (17) The

‘World Heath Repore 2003 indicates shat in 2001 social security expendivare a 2 percentage of snerl government expenditure on health accounted for 0.8% in Ethiopia, 0.1% ia Guinea Bis

Su 8.1% iy Maurits and 1.69 in Rwanda (8)

1.3.6 Education, Information and Advisory Services Relating to TAM

Reganding education and taining, some countries hve initiated training programmes to improve

‘the skills and public heleh-care knowlege of THPs, inching tradicional bith atendanes Some

‘others provide raining in TRM for pharmacists, doctors and murs and THs (Burkina Faso, Cameron, the Congo, Equatorial Guinea, Gambia, Ghana, Guinea, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali Rwanda, Senegal Sie Leone, South Aca, Uganda and the United Republic of Tana) Fr example, the Kwame Nkrumah Univesity in Ghana offers a bachelors

1s Kenya has established Karat Rol Service and School of Alern-

vai Medicine anda Bachelor of| Science degree in Natural Medicine: and Nigeria has established diploma courses fr tadtionl heals

Information and advisory services are available in Benin, the Cental Afdcan Republic, Congo,

‘Ghana, Guinea, Kenya, Mal, Mauritania, Mozambique, Senegal South Affi, Togo, Uganda and shoe ideal Restle of Pte: hi toc Ati, Bets ts dectoplay’a pula tacahe ional toe ok

[WHO Git Ans or Tape, Content a tetuntNipx re TĐT VOLUME ral plans In Ghana, Volume | ofthe Ghana Herbal Pharmacopoeia consi siete aforation con 50 medicinal plants (/8}, and a Second volume is currency in preparation, The Imerational Development Centre in Conky, Guinea, has conducted regional workshops for THPs of Fane phone Aca and in Senegal, NGOs such as ENDA (Environnement pour le Développement) and PROMETRA (Promotion des Médicines Tradtionnell) provide information on medicinal plane orice and scsmedicaton, and on al apects of TRM, incang ening oF FHP The Min-

‘sy of Health and Social Action in Sencgal has produced a publication on medicinal plants sold across the word (9) n central Ac, the National Cents of Tatonal Medicine inthe Congo promotes information exchange benwcen insiatons

Cate dhoie Equatoril Guia tinea | Danwcrati epic oihe Congo | Gabon

[Maurits [ Sout ‘Swaziland

bi United Republic oTanzania_| Zambia

Sierra Leone L a

Im eastern and southera Aca, Mozambique has a number of programmes sponsored by NGOs

in callabortion wit district o provincial health authorities, ane of which aime to coordinate research in TRMand co establish 4 reeuch-derhed infomadon bac about traditional bis and practices In South Afica, the Tadtonal Medidnc Programme atthe University of Cape

“Town was eased eo cary ouerescarch and provide appropriate informacion ro THs and ae heath professionals (7) In Uganda, 3 NGO called Traditional and Modern Health Practiioners

‘Togesher Against AIDS (THETA) has established a resource and wining centre fiiliate the collection and disemination of information on TRM (20) The Kenyan Society of Fshnoecolog, founded in 2000, promotes rscrch, field rps and information exchange on herbal medicine and other subjects elated to che rion se of plans nd holds an anal conference There isalso

4 Kenyan Resour Cente for Indigenous Knowledge Similarly, the Tanzanian Socery of Ethno- seiene, based at Sokoine University in Morogoro, United Republic of Tanzania, was established

jn 2002 wich UNESCO funding to promote resarch and information sharing in all branches

of ahnoticnoe, inlading TRM The Massand Resource Cente for Indigenous Knowledge (MARECIK) is bused in Arusha, United Republic of Tanzania, as are the NGOs Aang Serian and

“Terawate, which havea joint library on medicinal plant use and wadiional heal care (G Bur ford, personal communication, 2003)

1.3.7 TCAM User Surveys

-~eebesel in some of the counties of AFR in the past 20 years indicate that

10

sa Beoi the Democratic Republi of Congo and South Africa, 70% in Bein, Cre dvr, Ghana, Mali and Roan and inthe Congo, he United Republic of Fantans, and Uganda 1.4, Process INDICATORS

1.4.1 Estimated Prevalence of TCAM Use Within AFR 3 whole, over 8086 af the population uses radicional maticines for primary heath-

«ate neds OF he Give mone popular individual therapies ata repinal lew, the estimate % ofthe population using each ie fllins: heal medicines 8096 (ranges From 609% in some counties tô 559% in bers (spirit! thenpie 139: man drapes 58%: homeopathy and chiropractic les than 19,

1.4.2, Medical Determinants for TCAM Use

In mst countries, the patents seeking ectment with TRM ofen presen

to mobi including: malaria, HIVIAIDS and opportunistic infections; diarthoeal disease: {hildhood ines illness rated eproiv Healy ass: ase inctinal disor: ds tees hypertension: sekecll anaemia; mental lead epilepy

h cndicons related

1.4.3 Patient Satisfaction and Perceived Outcomes of TCAM Treatment Bcicnts are normally vợy sated with ndidomal thenpy snd the senice that they obra fom HPs a dese heath care providers listen go their problems, counsel them and rest their phys ssl scial and pashologcl illness ins heli manner Traditional medicines ae affordable and aecenible, Therefore, patents contin tn eon to TH (uy consukaton and eaten The cao of dhe eaten is usally good a they get elie Fior te sigs and symproms of thie ines, excep in very few cases when adverse reactions or interactions, poison

‘munologcal teactons occur Some of thes averse actions may be rclaed 0 inappropriate we tor overdose of tiditonal medicine,

1.4.4, Sociodemographic Characteristics of Consumers The use of TRM isa pare of che Arian clea bli system Thersfrs all sypex of consumers sith different sociodemographic characters inclang ra and urban dels ery poo, ow,

‘lean high-income eters, edad inclading religious lenders, almisiststors aa pli sans) and andacted people ase TRM Some ofthe elite tend o use TRM secretly consuling THs at wight

1.4.5 Out-of pocket Payments and Total National Expenditure Precise data on outof pocket parents andra ational expenditure on TCAM are not alae,

ss mo specific stay thi ie has been carte ot However, comsursers ad patients Who use TRM pay 100% of their mail lll out-of-pocket At present mont Member States in AFR do svc have National Het Insurance Pan, ln cases where such plans exist, they normaly exclude, for purposes of reimbursement, expenses related to the ws of TRM, Foal ational expenditares

đố TRM tdlzaton se đầu 0 estimate, Bevin im mind dst few countries have 3 nation budge forthe practice, oF for pines and consimers who gee tated ia hospitals de to ocx Sonal adverse reactions, interactions and poisoning Te cst of medicines, time and salaries pad

to hospital personne duting hospitalization of patents fected by these adverse eatin i alsa not budgerel

Ie is nox posible to make a meaning comparison beoveen traditional heihh sezor and conven- tional health scr expenditures because the Forme cons are not realy avilable, Furthermore, payment i or als it monetary terms in some cas it depends onthe ably to py, or om what the consumer shins he or she should pay; ot appreciation ean he demonsrsted in kind Or he

‘other han, boopital expendi in AFR in seacon so primary hea cae not as hs na thought Informacion on primary heath care expenditure is cenrl to pli rontoring and eal tion, This every ditficul thon so mucho the primary cre eel expendi cpeure by Ban

‘Gel wets Migker back, anh an Reins nt edb ster pentose eecioneee a 8 1?

W140 iow Aso Tome, Couns 9p Asmne Merw TEXT VOLUME

in the Region co improve thei accounting systems ro reflect esource ut atthe various lin the

heah-care system This wil yield beter xtimates of nacional hed accounts oir, monitor

and eluate policy decisions and altace eegonal eomparisos

1.5 Discussion

There are important diflerences between she counties in APR, wih regard oui degre of dc

‘pment of national policy and oganizational seuctutes forthe practice of TRM Thete ae some

‘countries in which few or aa structures aren place, whereas in edn considerable anganiatonal

‘A numberof counties ate moving toward lieendng tadidonal medicines, which ate being locdly

produced on 3 smal scale To is end, about 21 (589) countries in AFR have national laws of

‘egulations fr herbal masicines (J, 14) In order vo promot thevegiraion and marketing of se,

sflective and good quality ditional medicines (TRMs) in iy Memb Sates the WHO Regional

fie for Attica hss oganied roo Regional Workshops on Reyelation af Tadional Mediines

“These rok place in Johannesburg, Soanh Afi ram | to 3 April 2003, and in Mali, Spain in

conjunction with the Inernational Conference on Drug Regulatory Auhovies Gm 13 0 14

February 2004, respectively: Participants at the fst workshop reviewed and adopted guidlines on

regitration of TRMs i AFR: thec giđdine vợ then used for taining ce patcpanes fom

rational epulcory authorities inthe second Regional Workshop,

1 order wo suppor countries i instetionalzing TRM within thi national heath gems ard

establishing funeronal srgtars forthe practice of TRM within the framework of the African

Regional Stategy on Promoting the Rok of Tradronal Medicine in Heath Stems, the WHO

Regional Ofice for Afica has abo developed a numberof documents Thes can be used as rols

forthe folowing: policy formulation and nacional master plans fo he devslopmene of FRM: legal

Feamework for the practice of TRMs codes of ethics for THES; and eegistaion of ditional med:

‘ines nado, eel for continuing education of THPsin primary health caren fo allopathic

heath cae providers in TRM, and resarchmithadologis have been developed 10 support cou

tres in documenting sf, fBiacy and quai of twadtonal mevines se for dhe extent oF

prot diseases A so0l for documenting ATRM anda regional inellectua property flamewer or

the protection of waditionsl medical knowledge have also ben developed These documents ae st

various tages ofthe publication proces

"There are vere forces tht influence the negation of services and prfesonaliction of THD,

For example, due to che cultural acceptance al TRM, che major of the population in AFR uses

“TRMM fr primary health care needs However, in some commites TRM is the only fon of

health cae avilable to the population, For diseisex suchas HIVIAIDS that have no known cue

the majority of patients resort to extensive tse of TRM, 3 is aecensble and alordable to chem

Experience in some Alcan counts, sch as Buckina Faso, Ghana, Kena, Nigeria, Senegal South

‘Alica, Uganda, dhe United Republic of Tanzania and Zimbabwe, shows that allopathic health cre

providers have been collaborating with THPs in che use of TRM in esearch at well a in HIV

AIDS prevention actives, Reseatchers have obserse edaction ithe vt load ad increase in

the CD&CDS rai: impaosement of the cnc cndtion of patents ad in some cases ch

15 Burkina Faso), a weight increase of upto 20 hg Similar experiences have been reported bythe

NGOs THETA in Uganda and PROMETRA in Seg Esperience fom Chinese and Ayurveda

systems of meicne suggests that TRM i aparently more effective than allopathic medicines in

the management of chronic disoers,

1.6 CONCLUSIONS

“The renewed poltial interest in the development of TRM by Aftican leaders as well as WHO

cannot be underestimate, This politcal momentum has heen made evident bythe decarstons of

the various Aan Sarit of Heads of Sate and Government, These incl the announcement

oth period 2001-2010 asthe Decade for African Traditional Medicine, andthe institution, by

WHO, of Afean Taditionsl Medicine Day for Adsoracy Contes need to capitalize and bul

a the renewed potitial an! economic momentum, resulting from the recent lobal rewrennc= =

"

Mohan RLA ohn andconseraton of nediine sans in Ac: the nay andthe

‘et dade 21-2010, OAL Dead fr Ain Tadnal Medicine, Ped fe eo nein of th ne Aicen Eset Conia om Ans Tadd Mein and Mrinal Plann Aru, Tnzons 15-17 fen 202, Scene Technical Roca Common fhe Acar gen, Lage, 3091

Bosch CH eta Plt reveme fraps! Ace Ba lá ofp and commaiy reaping aperngen Mane Resourses of Fpl Aes [PROTA) Pra, 2002

Prag tere of adits medi elses ae te Ac Region Harr,

‘Work Heath Organon Rina Ofc for foc, 2001 (AFRURCSD and ecslsion (AFR CS)

Revlon WHA86.31 Taian mesic os Ff ssh ord Heh Ase Gone 19-28

My 200%, Genera, Wolé Heath Orion, 200%

Head of eae nd Govemment othe Acn Unio: Second onnary waa, Mapai, Mesambique, 10-12 fly 2003 Maputo dation on HIVIAIDS, Tru, Malaria od Other Red Infcins Diseases The fil et of thin fb delratons can be food www unin ong Rogol Heth Al Poly or he 2st Cry nthe Aca Rego: Ai 2020, Weld Hea COppanintion Regional Ofc for Afi, acumen SFRURCSO Resa esuion AFRIRCSOY The Wn Hee pre 2003: shaping te uu Gener, el ess Oizo, 2003

echerg eta Inventory of plas sed in criionl medicine Taz lanes ofthe fis

‘Acanthacae-Caruiaes Jnl of sapere, OH 29-60 (Charo Som pass of atonal mode nthe WHO Aca Raion, I: Word Hea (Oganzation Regional Ofc tin A Tatil medion ene, re Aen Hea Monto rave, Wold Health Oraneaion Reganal ice for Asx, nary), 203, Navona J Navona uh count x Ener and Scher Ais, Couey eps AFRO,

CGsen, EC The WHO Frum on Teonal Maine ia Heath Stems journo Aleman and Conpienry Mele 2000, 63) 39.382

Asano CE, Glee EM, Caen ath aurament, Sol Phibdhia Mos, 203, (Ghana Hesbl Pharmacopi cra, hans Pokey Reeth nd Siete ling ce, 1992 usin G or Tltlonal meine and HIVIAIDS in Ac rept om the Isa (Gonfenes on Metical Pats, Fxlonal Motte an Lal Gammon in Ale, Arnioe na Comploenany odin, 209, 6457-472

Kypune Petal Theol aon Beth practioner in neresing acre» HIVIAIDS preven and care: The Ugandan Experience tn: Weld Hea Oration Regal ice fc

Af Taino mado cea frre Afican Hea nity, 2008 (81-32 Bishaw M.Prommting rial msi n Epi ie imac al pli Sua case and Mee, 19} 33:93-20,

and Martin Ekeke Monona?

"Mesa Doctor, Profesor of Public Health, Consultant, PO, Box 4285, Nonghak Yaounde

Cameson, Email dlantumBcarnet.cm

Medical Doct, Director, Health Cote Oxtnizaton and Health Technology Miner of Healt, Yaounde, Cameroon,

2.1, IntropUCTION

The Republic of Cameroon has 2 land atea of 475000 km? and over 250 ethnic groups (2) in a

‘oral population of 15472557 inhabitans,

Cameroonian Teational Medicine has existed fom tiene immemorial 3s an important component

‘of social and cultural development It socks to prevent ile, promote genen well being and

‘any out diagnosis and eatment Traditional medicine (TRM) of Affica in general and that of Cameroon in pariclar isthe modicine of prsiclar peoples ethnic groups, and chú viie net parculrtes fom people to people and with differnt ecological zones Fret, savanna, srublan,

‘coastal and riverine ~ Cameroon being Affca in miniature) [eis part and parcel of the peoples culture (2) However, in urbaniing cosmopoian communities, TRM provides (medicine men) have migrated from the countryside to ive in new cts although thy sill depend om tir places

‘of origin for replenishment of supp (3)

‘The taining of practitioners of traditional medicine (wadi-practtones ssl lrgely informal

‘but ei continuous and well exablished to ensure a constant number in society Interested and

‘motivated indivdals move into the ld and work fll time, but due eo economic presses, sme lear other sills and acepe more lucrative job opportunities (3)

A numberof ses of Cameroonian mein plants and eradtionsl meine ae recorded, They fare summarized in Table 2.1 and have ben rpored in the draft document of dhe Nationa Strate-

ốc Plan (9) The objective ofthe Cameroon National Strategic Plan forthe development of TRM isto integrate this medicine ino the national hele-eare delivery system,

Ín 1979, unt for TRM was crated within che Department of Health and in 1981 Tadidonal

“Medicine Unie was set p in Cenral Hospital, Yaoundé This was ellowed in 1989 by the cextion

‘of Community Heal and Traditional Medicine Service with a Unit in charg of TRM In 1990 the Law on Fredom of Association was pass by the National Asembly, which led othe creation

‘of many Traditional Healers’ Associations inthe country and was ollowed ayer later by noe ued by che Minstr of Health requesting che collaboration between the adivonal healer and the Public heh sector In 2002, the Service for Traditional Medicine was established including wo ini one fr ethics and deoncology and another fr legjsation and contol Besides ches, there x3 scientific necworksub-departmene ¢o help promote medicinal planes in the Ministry of Public Heals Ae che same time as these official units were established, there were dectes exablishing formal institutions for esearch (ce section 25)

In adtion wo this atonal commizmens, the Republi of Cmperoon alo subscribed to the Lass Dedaration ofthe Affican Union Heads of Sate hed in Jly 2001, on she designation ofthe period 2001-2010 as the Decade for Aican Traditional Medicine and cits plan of ston for implemen tation adopted by the Ministers of Health Conference hd in Teipali, Libyan Arab Jamabitiys,

in April 2003 (5) The plan of ation and mechanisms for its implementation were endorsed by the Affican Union Summit of Heads of State and Government, which tok lone"

14 WHO AFRICAN REGION

Table 2.1 Some historical studies of TRM in the Cameroon (4)

| Georges Zenker, botanist rom the botanic garden in Naples, Italy

1889 sited Cameroon +1900 The Sultan of Bamun, Ibrahim Njoya recorded in his language some

traditional medicine used by his people Milread, ina study conducted inthe Cental part of Cameroon,

1913 noticed the use of 100 plants among which some were of medicinal

Santesson, in an ethnobotanie study conducted around Mount |

1926 | Cameroon, collected 42 species and in 1935 he listed ther local names

and thelr medicinal usage |

‘Canabis in the northeen part of Cameroon noticed some traditional

1941 phytatherapy acting on psychiatric disorders (cited by Saivet in 1975),

soso | Maly ced Sen 1973 eared he wage of 300 plas ibe] renin arcane iy eel oie mes

wo Selene cme sie aten

| case std a an i aracopc of Eves

| soet | wat! ste eure Tames prev rpyehant al py Chosoat Serie ako ead seat

C210 anc roste ct pens ea er ag ss70 | Siegal Span le ss mae ans yr euro

| are | Ste sine mew ofa dodo asap, Da

‘Their aim io gt wal by any means known eputable and affable, and especialy provided by somone who can pain she nature of heels, get do, and advise om how to avoid i (8) This indigenous medicine, which is very mạch 3 way of life and practised by all is spearheaded

by ie masters who are called trad-pacttiones, medicine men, or tational healers (9 1) In the urbanizing communi, thee maser ate found in large numbers alongside others who carry Forcgn cerifcates in homeopay, naturopathy, auton medicine, palmsty and other systems inluding Chinese medicine (7 They te popular inspite of public or sate hospitals, health cen- tes, maternity centres, pharmaceuisl dispensaries and mobile health education nd mas vaccina- tion campaigns which propagate allopathic medicine (27) The wad-practiioners of Oku and the Pygmies ofthe Congo basin are the mog xeputel 2,

Aihoogh 2 government policy to identify and count tad practoners and other aleratveheal- tsa ennai Cameroon since 1976, she structure for implementation was never prope put

jn place (DN Lancum, unpublished, 2003) However seats for allopathic meine are wall kept

1 Phecnere af Acrivties ofthe Heakth Miskery Sor rertew, periodic planning ond Inceting,

{WH aon Ao Ten, Constants Ans Mie TXT VOLUME 2.3 BACKGROUND INDICATORS

For purposes of communication, morbid and moray data mas be ported inthe language of allopathic medicine, hough TCAM has soe equivalent terms and many more besides (13,1 Farthermore, for dhe most past TCAM teats symptoms and symprom-compleses and wague ñH

jes 15) Occasionally, practitioners depend for speci diagnos on llopathic meine, but ofen associate social dimension since there isa socal aus wo every dscase (16) In gene agnosis among tad-practiiones is Lrgely sympeomatc

2.3.1 Causes of Morbidity

The mo common causes of morbidity vary fom clinic to clini, hospi vo hon] and by _gagrapic region ofthe county also by the spctc age groups of the patiens, by gender and by seston (17), However malaria was recorded ro top their a medial and past ward in al the hospital, poms and age group Tie was followed, intemal medicine wards, by bronchopne mosis, high blood presare,gatoentrt, peptic ules, HIVIAIDS, dishers melts, typhoid fever asthma, hepa coma an tberculeds, The surgical wards reported burs, snakebite, ra tures, plenc ropa, acetal wounds inguinal hernia, pects and petits x common causes of morbid

In the pacdatc services, common causes of morbidity often included, in descending oer of ee

‘quency malaria bronchopneumonia cerebral malaria, gastwoentrics, meningitis, severe anaemia, rmalaueidon, neonatal infection, measles, and sickle el disease (1)

In che matemiy services, the causes af morbidity includ, norma delivery, malaria, abortion, pos partum haemonlage,threuenel shorion, octal slferng ovata cas, extautri pregancy and peli inflammatory diese Asonding to gymecolgy/abscrc reco the rp en causes of ines

fr the Nowth Region were pelvic infections, threatened abortion, mala in pegancy, urebritiy uterine fibroid, secondary seri, ovarian cyt, extauerne pregnancies and primar infec

In all he regions of the Cameroon, the following disease ettes and symptoms figured among the most comms in taitional healers cand: malaria, dysentery conic weethit, aundic, witches, fracture, poison, ulcer, gas, protection, chance/misortune, spells, bxcon belly, sterilig arthritis, hacmorthoids, body pais, common infections, deus of the lng (2, 1

The above tens ae only for severe cases who at hoped The most common cases of no bidiy đeeibel in ambulanehaldh-care services include: mala, common cold, wounds, com:

‘mon infections, buceal problems, conjunc, pain and fevers, ue, skin ashes, incl worms urns, and diseases ofthe fung (18) Among ead practioner, che most common presen jing symptoms include fumiago, malarialever, diarehora, abstr nae, male imporencs jaundice constipation, athens, and wichertt or sorery ƠI

2.3.2 Causes of Mortality

As for mobi he cases of mortality vary with hospital, region, age group service uit and

‘ype of medicine (allopathic versus TCAM), Gastoontrt, severe anaemia, meningitis measles, cerebral malaria, leukaemia, malnatidon teanus,ntxicatons or acute poisoning and bronchop: reurnonia were al corded as common causes of morality in paeiic sevies (8), fn general medicine wards, malas, syphoid, HIV/AIDS, hypertension, taberculss, bronchopmcumon, rmeningis caniopathis, hepatoma and teams are common, while in surgical services septic ima, gngree, amputations exterdrl haematoma, muliple injuries, severe anaemia and cancer are the mos common cates of death,

Records of wadional healers and complementary medicine scarcely showed any causes of death since moribund cases are invariably cefered co public hospitals or managed in their own homes by

‘sng tad: practitioners and family members 2,

2.3.3, Total Number of TCAM Providers

[Apart census of tational healers hs been cased out fon which the taal number may be

‘estimated 0 about 10000 in Cameroon This is equivalent to 1 pet 700 inhabitanes but the

16

‘more than 6000 (1/2333 inhabitants) For census purposes a wad pratvioner is a ma hơi

er recognised by hisher communi since they do not ety any forma certicae or diploma Sswarde by she Seite In comparison in 2001, Cameroon had athe dispel, | medical doctor co

10083 inheliame and 1 qualiied mane w 2249 inhabitants with 3 significant diference from

2.3.4, Total Health Expenditure

‘Whereas mony isthe cans of payment in she formal public and private allopathic medicals tory, che system of compensation in TRM i adil dillerent, petting for payments in Kind {guar chickens, pal wine, services, spcialh-valued token gif, values of presi and precedence

‘c}(/2) As every cen isa member ofa community dhe community is committed a protect his {er hie anal welire by all eaonable man Irs noc pose to quan he con of this soil

‘ommitmene and crs However lot af mci plant elements arena sl in popu markers LG), Thạc am annwal xpsndivre of CFA 10 billion for TRM isa resonable estimate (20,

‘ery ctven knows some TRM 4 part of his practical vocabulary and ski, Hence all temps co abolish TRAM ise Filed,

Although the esining of che younger generation rns ta be by parents o thế hien, ified mat- ters oF TRM are well Anon csblished snes, and thei dwelling constiute informal school for inculcation by apprenticeship or paccpuntabservacion nication soften dane by these uaines ot

by pưene and community leaders eraliionol hele is fs ecconisd by his or er communiny before venruting ou (22), Hunined in another thnicenty he o te must be formally received and ognized bythe native community before cling downto practise wth confidence

In fact dese ae several tadisional hele xoeckidoncar die snd egpmallends Honeto they aren well organize and ser to Fight fr evenbip in the Bel, These diferent asaciatons have lot of servis, inlaing the esining of wer eavonal hel

Many tavona Reals apply ro the Ministry of Health for eves oficial authorization, Others secup some raditional techniques co improve presentation of thet preparations for paints Some tearional healers are osraclos and somevnses use moder diagnose inappropsiatly, merely for advertnement purpose

Legiaton ro promote TRRM system is sca ad inde it ethan to external presses, pandculsdytheac olthe World Health Organization, that TRM has come ony ofc respect ale spite fies ubiquitous presence and wis) Camneroan may be claaifidin the Inc sive Sytem of WHO whete TRA i ecogaized, but not comple integrate i all aypects ofthe heath system,

2.5 RESEARCH AND DEVELOPMENT OF TRADITIONAL MEDICINE IN CAMEROON,

Ân 979, a dececeorgainng the General Delegation of Technical an Scene Reseaeh, crested

4 Research Insitute of Medicine and the Stuy of Medicinal Plants, and in 1989 the 6rst Seminar

‘Workshop on Tadidonal Medicine and Cameroonian Pharmacopocia was organized

Ân 1983, 4 Cenoe le Reseich om Medisinal Plans and Traditional Medicine was created and today consi a numberof tradional medicines pending rrication bp the Mica NAME Heath census and identification of almost 200 species of plants has besa done, with the deter=

1m State Universities daring the lst 20 years, several scenic aude ate done every yar and have permitted the discovery of ancsepi,antnjcoi,ant-iflamatory and isce ling properties

of medicinal plans ia Cameroon (12

“Moreover an ethooboranic survey: conducted hy the Ongaization for Afcan Uni Seientilicsnd Technical Commission, and publhed in 1996, made i posible so collet interesting informa {on concerning more dhan 600 Cameroonian plans (23) Since the colonial perio, he sienic study of medicinal plants by ethnoboranss widely known, and rors are abundant (25) and 2

‘atonal herbarium exis However, these tude were nor carried out wth the incention of poo

‘moting tational medicine and its pratconers (26) The iid effin the study of TCAM hasbeen generally for purposes of expoation of midicnal plans eather than helping the growth and development of TCAM (27, eis not therefor, surprising that the sudy of TCA hasbeen

‘meeting round fr researchers of cer send diplne, including foresters, botanists, thư chemists, pharmacologis, physicians, ccologian, wonder workers, consereatonins,aninopalo ints, ecologists, social geographers pathologists and others (2

2.6 CoNcLUSIONS AND SUMMARY

“The TRM of Cameroun very rch ave spar of pope’ cle ec unfornate dat twas riven into clandewin practice uring the lng colonial period However, 2 number of ivounhle polices te bagnning w emerge which augur wel forthe Sure There ix poi wil to eeate the legion nccesary to give oficial tection, as well say down guidance fri operation

“This will give opportunites for TRM 1o ours even mre

The Alma-Atadesraton of 1978 created opportniis for integrating FRM into conventional health-care systems In Cameroon, this proces has boon slow hut steady snd ha gathered momen ram inthe se few yeas A number of major govenmens actions have ee eran

+ Encouragement of census of tid-practiiones

+ Provision for tad-practiiones robe meres of dilogue commits at Health Atea and Disc jurisdtion of healh care sevice

+ Authorization for seting up Chinese medicine hospitals in Camevoon eg Guile and Mbulmayo (ince 1970s)

+ Creation of service of aditional Medicine in the Health Minin 1995 (2

+ Acknowledgement shat TCAM can consibue to ighing against the HIVIAIDS epider (15), + aviation wera: practcones to he naional medical conference and organization of pe- cial sessions on TCAM in 2002 ~ 2003:

+ Offical implemenation of Fust Annual Celebration of Tadtional Medicine Day on 31 August 2003 (2)

‘The preparation of dhe National Sustgic Plan of Tational Medicine i wll under

References

1 age Cameroun da enor ngiy te Cameroon heb, 200,

2 Lantam ON Tonal modcnemen of Gomes: hee fbi ri med pre erie No.1, PBL (CUS Unieniy of Yaounde, Tad Ml Ocal Paper Ne 2, 18,1985

5 Bex fas Lage, "Medicinal Mant Sl Younde Mathers, Caoon in AP Sty

Leidtr Roseman Le medi dione ch a bea bf ds Cameron Tada

neki the bet dai) of Comeron Yl 1 Colas Ini thoes, au Vl and Kalen D~ $205 Skt Angin, 198"

1 Laneum DN he rad on of ion medi in Cameo pour ose meine

‘meiiomel an Caner, bis Cameo Cia Reien, No 39-9637 p79 197,

12 Ben lon lapnde An Bfanphzmastgtxl Sadyaf'Mufioel hơn Anane tệ ck Pg: che

“2 iepbo Roe, Cancun Dep of Fora, User of Dacian Lameupm, TM,

1, Eric ae Roy Nis ~ agen ek at (Ni = hh lo fart igh

Enels DoouneteAidoine bẩn CÍ Yoeunde [97A

1M, te de Ros: Le de ma eer fy Ail on wien Douala Cameron),

298,

15 Lancum DN “Rol of aon Matis meni he peevsnion nd cu sỹ HIV/AIDS

andemicin Acs in Badin ead Thepy, No 19 Decree 2002510

16, Gehnce Sper enum, Mieke Public Mesum Pobiesdom in Aneropsagy, No, 10, 1964

17 Dual Fankaoe Aiport de See de dine Idd Cra doa Rpt af training ee of ited mode te Cov Heal of nog] WIQ39? a4 2

18, Kona Engen Jain Kooga: Ripert of Intent Medien Bn Ban Hagial 6

gu 997 0 Eebaorr 199A

19 Lanta DN Titona maine ri ete province (Mfound, Malo and yong ct Seo?

Tro mes cenin opr sre No.2 PH Uni, UCHSICUSS, Unset of Yad, May

20 Fade ae Paci ts dcinans de sor a tins Sy om ascii and

Arce of mene the ere), MINSANTE, 2002

3: Mdinmedi Map onan gon end ater yA Doble Anchoe Book, 1948,

22, Geli M Mone ad atom i fn Ean § Livin Lid Edinb and London, 1964

2, Rapport tvs ens dR Miia dade de Planes Maina Repro etch and dr nso manage of edna pln, 20,

24, OAUIScic Tesh, An Recah Gnmision, Tedrinal meine and pharma conribation

‘action and Peri da Cameron, prise, CNPMIS BF 195 Dawa Nove BENIN,

Immediate Pst Director othe Cente for Scientific Research into Plant Medici,

P.O, Box 73, Mampong.Akwapers, UR, Ghana

mals oppongbaachieeyaho com

3.1, INTRODUCTION

‘The Republic of Ghana i located on West Aca Gul of Guinea just a ew degres north ofthe

‘equator Ic borders the North Adantic Ocean to the south, Buskina Faso tothe north, Ce droite tothe west and Togo to the eas Ir has ator area of 238540 kn of which 230020 km is lind snd the rest is covered by rivers A topical rin forest bel, spi by heavily forested hill, excends northward rom the shore near the Cte dvoitehorder This aca produces most of che countrys cocoa, minerals and timber Low bush, paket savanna and gray plains, where many medicinal plans and herbs an be found, cover the atea nowth of this hee

“The countrys divided admininteatvly into 10 regions and 110 local dsr and has a population

of some 18.8 millon peopl (7 la 2001, che average annul growth rate was 3%, with ape capita rss domestic product of USS 390 and an average life expectancy of 60 yeas (2h

“Tadiional complementary ad altemative medicine (TCAM) knowledge and practices in Ghana stem from some of the areas oldest traditions In recognition af his heritage, successive post inde- pendence governments have sought co develop TCAM serves s viable and necessary alternatives

tw allopathic heath care The fit ater to onganize che TAM sector wasn 1961 when the fist Praiden of Ghana, Osaycfo Dr Kwame Nkrumah, encouraged the formation f te Ghana By" chicand Taitional Healers Association The Ghana Federation of Tadtional Medical Praction-

«8 Asecations (GHAFTRAM) war tablished in 1999, and since chen ie has greatly advanced the case and development of TCAM in Ghana

3.2 BackGROUND INDICATORS

3.2.1, Leading Causes of Mortality

Various insiational data have revealed malaria, anaemia, stoke, peumonia,cuberculois (TB), injury, liver disease, HIVIAIDS, hypertension, darthoes, sickle cll and neonatal injury a che leading causes of death i Ghana Malaria and anaemia together account for up ro 40% of reported deaths in children aged 15 yeas and below while pneumonia and dirrhoes cause 3 significant numberof deaths inal ge groups Lise disease, HIVIAIDS and'TB are mje causes of death in the adule population ver 15 years old while seroke, hypertension and type 2 diabetes mls are the predominant causes of death ofboth men and women ove the age of 45 years (3) Lnjary and liver disease exac higher burden on men than women, in contrast to HIVIAIDS-telaed deaths, hich ae higher in women (2)

In Ghana, children under five years of age consuls than 20% ofthe poplaton and yer ac-

‘count for more than 50% ofthe estimated 192000 deaths each yea (2) The under Biv mortality tate is therefore generally considered 363 good overall indicator ofthe heath ofthe Ghanaian population Ghana under-fve moray eel rom 154 in 1988 10110 per 1000 birhs in 1998 (ya decline of 279% Generally children in rural areas ae 1.6 times more likely to die before thie Bil bedhday chan chose in urban ares

“Maternal mortality rater vary fom 214 per 100000 lve births in urban cetes to 740 per 100000 The binhsin rural communities, Leading causes of death are haemorrhage, hypertensive diseases in

20

Ieis projected that improvements in eduction and health technology will improve childhood and dale morality saris over the next 5-10 yrs

3.2.2, Leading Causes of Morbidity

“Morbid saistice Fons hospital data indicate chat the number ofatendance per peron pet year

ac outpatient deparments have increased from 0.32 in 1996 0 042 in 2000, Malaria, upper ex pintory tt inleeion (URT), darhoea, skin diseases, eye infections and injury are the leading

‘uss of vss to outpatient deparments, Malaria (129) and URTI (89%) account for half of the roa vss for both sexes and all age groups (3)

‘Aalmisions to public health facilis were about 24 per 1000 persons in 1999 wih difrences aos the regio of the county For example, regional amision in dhe Ashanti Region were 4

pe 1000 persons, s compared to 48 per 1000 persons inthe Cental Region At Karle-Bu Teach- tng Hospital in che Greater Accra Region, penal conditions account for 66.6% of infune admis

‘ions (6), which may be teibutel tà the ht that this hospi tertiary refer Injury represents 20% of amisions For both exes he 1-year age group Maternal and gynaccolog- cal disorders acounted for 788 of admissions of women age 1544 yar Stoke, injuries and Thar failure are the leading causes for admission ofthe cdl of both sexes

3.2.3, Epidemic and Other Causes of Mortality and Morbidity Environmentlly-rclaed diseases, epidemics and HIV/AIDS alo contribute to moray and mor- bidity At various mes ines history Ghana has experienced major epidemic of choles, cerebro spinal meningii, yellow fever, abies and HIVIAIDS Major cholera epidemis occur every 9-11 yeu The lest cholera epidemic was in 1999 when 9463 cass resulted in 259 deaths (7) The bast

“epidemic of cerebrospinal meningitis was in 1997 when 18703 cases and 1356 deaths occurred (8),

In 2000, te region eported biet oudrekc with en deaths eported in the Cenel Region (9) Guinea worm disease dslned by 969% from 17956 cass in 1989 ro 7403 in 2000 (2) Reported eoec of HIV/AIDS indresedfim 2 in 1986 co 6289 in 1999 (10) Tn 2000, the cums lative numberof eported AIDS cases cached 43587

3.2.4, Providers of Conventional Health Care

1999 annual report ofthe Ministry of Heath (MOH) in Ghana indicates the number and rype

of health facies a shown in Table 3.1 (2) The total numberof medical personnel recruited by [MOH to wok inthe public held seer is 30612 OF this number, the distebution of medical and paramedic safFby profession an region indicated in Table 3.2 (2

The wo teaching hosp (Kole-Bu Teaching Hospital in the Genter Acca Reon and Komfo Aokye Teaching Hospital inthe Ashanti Regan alone employ 469 or 42.1% of al qualified doc: tom and MOH headquarters employs 40 or 3.6% ofthe national oe leaving ery ew doctors 0

tee the needs the re ofthe country Te thre Table 3.1 Number and type of sorthem gions have ony 68 datos, or 6% of

health facilites in Ghana the naonl rule hasbeen recommended shat

public heh flies employ anaher 268 doc- tor, 5694 nus, 293 dentists 871 pharmacists,

| Teaching hospitals 2 36phyioeberpiss, 1206 clini laboratory ass

ans, 160 radiolgiss and 8708 oxher sea reach

Bang hanh, 2 the estimated optimum operational standards (2)

Distt spits on Clos 1085 3.2.5, TCAM Providers ier benpial ry The teo min types oF [CAM in Ghana are ee

litional medicine and alerative medicine A testi ontas, = talidomal modicine practioner i defined asa Ngemiy honee 320 person who possess the knowledge and skills of amr an holistic health care, an who is recognised ad

a ae accepted for health care based on indigenous

though generation fa Ghana asin other parts of Alia, ralional medial practioners include

heal healers, bone eter, atonal bith atendants, spiritual, shrine operators, ee special

is, roa pili, animal ite eas, eernary healers and surgeons eg, inci of eb id

disease prevention marks the hed)

‘Table 3.2 Numbers of MOH staif in Ghana for 1999

* Others include villige heath workers andl community-based distin,

[Altenative medicine practices are those practices and therapies outside allopathic and traditional

‘medicine, Altemative medicine involves cooperation with natural forces and the natural defence

smechanisins of he body and includes homeopathy, chiropractic, hydrotherapy, acupuncture,

naturopathy, rdionics and reflexology: Thes therapies ate recent adrions to health are in Ghana

an are mainly practise in urban ares sich as Accra, Kumi, Takoradi and Tem

In November 2002 and March 2003, the Tralional and Aleemative Mesiine Directorate of

MOH prodiood a draft eens epor of registered TCAM practioners forthe Ashanti, Centr,

Greater Accra, Nosthern, Upper Fast, Upper West and Western Regions respectively (1) The

‘overal objective ofthe census was to inate efetve planning and human resource management

‘within che radional medicine sector for eventual ntetition into the national heakh-<are delivery

system Although the draf repor of che remaining đưec rgion, namely Brong-Ahato, Paem,

And Vola, sy abe published, results rom the seven regions show similar tends Table 3.3 sum

rmarize some of the rends and shows tha inthe seven regions eitered TCAM practitioners are

‘hiefold more numerous tha allopathic physicians (17) This gure could rise with she inchsion

‘oF TCAM practioner otal om the remaining Eastern and Vols Regions Iemust be emphasized

thac there could be thousands of TCAM practitioners who ae na reitered

In he Ashanti, Central, Greater Accra and Western Regions, ofthe enumerated TCAM practiton-

<r (7999), 7633 or 954% considered indigenous medicine asthe primary or Secondary prfes-

Son, while 366 04.6% practiced sltemative medicine, TCAM practitioners who practice plant

‘or herbal indigenous medicine were by fr the lavgese group 3t 65.59 This was followed in de

Sscending order by adtional birth atendans (16.6%), psychic practitioners (13.49), hone seers

(3.990 and all thers (1.14) Similar trends were observe from the tice northern regions where

‘ofthe 3292 enumerated 41.99% or 1379 practice herbalism, 15.3% ate traditional beth attendants,

11.496 are psychic healers, and 5.8% presented a honesetters, Acupuncture, mturopathy and chi

sopra scouted fo 0.03%, while “aor sate” and “hen” (eg practioner of warfation)

‘constituted the remaining 25.6% The sociodemographic distribution of TCAM neve

a

[Upperwen | 766 | aiiaa | 35057 | 06m 00003

<8 il ion

“Tra heal expenditure fom 1997 t0 2000 i shown in Table 3.4 Contributors are the Govern:

‘ment of Ghana, imtenaly-generate funds fom health flies, donors, and creditors The per

‘centage ofthe tora consbutions made by the Government was 42.8, 548, 50.4 and 60,5 inthe years 1997-2000, especie Total investment and recurrent expendinure Gnduding wages and salaries) fom 1997 ro 1999 are aso shown in Tale 34 (2)

Table 3.4, Total health expenditure (1997-2000)

“The capital expeniuce was disibutd ro che varios lees of healthcare namely; MOH Hexd-

«quarters, the teaching hospitals erie), the regions (secondary), andthe dsrcs (primary) fom

1997 co September 1999 as indicated in Table 3.5 (2) The dstrbucion i based mainly on che

‘numberof health personnel at each level of health eeand special needs eg control ofan epidemic

ra paniedhr led 3.3, TRADITIONAL MEDICINE POLICY AND OUTCOMES

3.3.1, Mission, Vision and Goals of TCAM

“The mission ofthe 2000 medium strategy document for TCAM aims co make tational

‘neath cara well-defined and recognized system, complementary to other health systems through:

‘out Ghana Ths serategy seeks to establish 2 held-care system, based on Ghanaian adios that

‘mds acceptable quality of cae The end goa iso improve the belch satus of al people living

{WHO ion Aso om, Counnuns 0 Arne pc TY VOLUME

“The strategy highlights tha the regulation and contol of TCAM practise isin part, he reponsi=

bil of the Tiaditonal and Alemative Medicine Council (TAMO), which is to ovesce che prac

fice and the practitioners throug reyineation, licensing and prescription of appropsiate codes of

«chic, in consukation with the ecogniad TCAM asiociations The TAMC is also mandated to

site «national experrcommiece on contol «cation, research and promotion of TCAM in

Ghana, The TAMC in collaboration wth the Food and Drugs Board, regulates the manufacea-

ing, ale and regseraton of seientfally asses cational products or commercial purposes The

MOH, through ies Traditional and Alreative Medicine Directorate, bạ 3 duty to develop policy

idles chat allow for growah ofthe tradiiona medicine eto

chronological summary ofthe insiusona, policy and regulatory structures that have worked to

advance TCAM in Gham indude:

+ cstablishment ofthe Centre for Scientific Reseach into Plane Medicine in 1973, which was

given stator recognition in 1975 (13)

instiation ofthe Directorate for Herbal Medicine at MOH in 1991;

formation af the Food and Drugs Board in 1997 (14):

+ establishment ofthe Tradiionl and Alternative Medicine Directorate at MOH in 1999:

formation of GHAFTRAM in 1999:

+ development ofa suaegic plan for eainal health care in Ghana in 2000 (15):

+ lnroducton of the Tiaditional Medicine Practice Act, 2000 (6):

instinatonalizaton ofan annual “eadtionl medicine week” for awareness and advocacy

+ development ofa tning manual for traểtdonal heath pracioner, including raion

birth autendans in primary belch care, nuurton, diagnosis, prevention of diseases and

proper recond-keping in 2002 (175,

‘+ drafting of the Alternative Medicine Practice Bill of 2002, presen before Psiamene (8):

+ publication of manual on procedures for atessng the safer, efficacy and quay of plant

‘medicines in Ghana (19) and

+ institution of Bachelor of Science Degree in Herbal Medicine a the Kwame Nksumah

Universi of Science and Technology (KNUST)

3.3.3 Research

Institutions suchas the Nogouchi Memorial Insitute of Medical Research, Departments in the

Universities of Ghana, Cape Coast, KNUST, and a few private entrepreneurs are furthering the

2B

24

3⁄4 Uses of TCAM 2.4.1 Medical determinants of use The 2002-2003 exnsus report oa the dice notthern rgions and Accra, Ashanti, Cental and

‘Western Regions (21) rove that TCAM practioner manage and trae muliple conditions or dìese in thei primary ccnlary a terciay ages of development The ype ad Frequency af

‘uration or dieses cen inpatients scking TCAM (383% of tol vin) ig ssw ax infericy (12.984), malaria 9.2%) convulsnn (8.590, bil.) tke (3.7%) abdominal pins (3.090), hrmis (3.0%), asthma (2.996), skin dscases (2.7%), alse pins (2.5%), meals 2.59%), snake bites (208), diabetes mel (1.5%), cough (1.2%), eye problem (1.14), diathoea (1.099),

(1), The wal (63.880), ade to which ate the woteportad ioe estimates tha 80% ofthe Ghanaian popula ris am TAM,

3.4.2, Out-oF pocket payments

“Th lagest single source of health exper, inlading formal and informal providers, govern rents, health acti anid pharmacy, comes rom patient wat of pocket spending Thi contr tts sou SOW of tonal spending and has created potential acces hater For the poor in Ghana

Ie shaped thar the eablishment ofa national heh insurance acheme wil greatly aid the poor and improve overall health in Ghana

Although che prictse of FCAM is widely tlerat and regulate it sn considered mainstream hth sersice, Bacau of thi, goverment financing tor TCAM i largely neglected This anomaly rust hesdresed

3.5 CONCLUSIONS AND SUMMARY Regulations on practice of TCAM in Ghans have been developed by che national goveroment Sates indicat thar TCAM providers in Ghana far ournmiber allopathic physicians, respective

‘of thse dit, TCAM se tobe formal rcopnibd, rut an contol, ei hoped tha the laudable recommendations put fon in Ghavas strategic plan for the developmen and eventual

af TCAM ine the Ghana Health Seeice wil be achieved, Theough thi i believed ple o! Ghana wold neti ae fly rom TCAM practices,

thar the ps

[WHO Gun Aso tas, Conran Aane Sun TEXT VOLUME 25

References

1 Ghana Home Pag hpstnnganave cn, ceed 22 Api 200)

2, Th hes of the mario: fin ese BrP er Heal Sn Pere of Werk 197-2001

Acer, Miy f Health Gaerne of hana 2604,

3 Report of Hear ond Diese nab Team Acca, Minty of Heh, Government of Gh,

ant

| Ghana Demagaphic aed Heth Sarg, Coes, Marya, Ghana Seni Service and Ma

Ineratonal oe, 9,

5 Wagea A Socioeconomic insu in child moves compton sro rie deneping

couric, li oft Word ath Omanzatinn 2100, 789-29,

{ Biineom RB, Guid J, Amaning AO Ptr of duo condon leading vo owaiation a

Kor Bo Teaching Php Ghana in (996, Gone Medi oar 2000, 197-208,

7 anna ipo, Accu, Pubic Heh Divisio, Misr of Health, Gost of Ghana, 1999

8, Wade CW cl Eman vcition guint pidemic mening n hans: implications fe he

enrol of meningococl den SA, Lane 240, 3530-31

9 Ana pr, Con Reionl Hea Rep, 200, Acer, Mini of Hes, Gover of Ghana

2n

10, AIDS Serine Report Acta, National AIDS Commision Programe, Mins of Hea,

Govemmens a Ghana, 19

1 Dg ene epar on hse nh ion and Acre, Cand an poet,

Tendon and Aemate Medicine Discorte, Mir of Fah, Gosrnriea sỹ ss

Noverber 2003 and Match 2003,

12, Famer M, ta In 198 eh acne plement eh sr finance ea

Minis of Heals, Government of Chana, 2008

1, NRC Drow 34, Navonl Redemption Council, Ghana, 1975

L4, PNDC Lao 105B Prins! National Defence Cel Ghana, 192

15, A Sing Pon fir Pads! Heh Cares Chane 2000-2004) Acr, Tonal and Aran

Malkine Decora, Minny of Heal, Goverment of Ghana, 19,

16, Traionl Mein Pacie Ae 575 Pannen of Chins, 2000

17, Du mining anual for raduional tbh praonn Act, Taonl and Abernatve Micine

Dirtorat Minny of Heh, Gonenmien of Ghana, 2000

18 Dif Atemaie Modine Posie Bil Ace Talons ad Atrative Metin Dito

Miia of Heth, Given of Ghana, 2000,

19 A mana of rane predate fr acing he fn iy a min of pl medicine in on

‘Acct Tnional and Alrnauve Modine Dstort, Minny of Hah, Goverment of Ghana

and Abayomi Sofowora!

" Director Department of Pharmacology an Toxicology, Nationale fr Pharmaceutical Research and Development NIPRD), PMB 2, Abuja, Nigeria Ema ygamatyahoo.com

» Coordinator, National Trational Medicine Development Programe, Federal Ministry of Heath, Ste Shag Way, PNLBLOBS, Cath, Abuja, Nigra, Ema akeye@homail com

» Profesor of Pharmacognosy, Department Awolowo Univers Hee, Nigera, Ema abayomsotawrayshoo com of Pharmacognosy, Faculty of Pharmac Ober

4.1 BAackGROUND

Te Federal Republic of Nigeria is stated along the Gull f Guna, in the eastern pat of the

‘West Afian subcontinent Ie extends over an aca of 923768 ka, making i the tenth largest country in the world The country has a wide diversity of habia, ranging from aid aes, cheough

‘many types of Forests, co swamps, Associated with the varied zone isan may of plane and animal species The major vegeation formations ae the mangrove forest and coastal swamps, feshwater ssvamps, lowland rainforest, derived savanna, Northern Guines savanna, Sudan svanna, Sahel,

‘montane, sub-montane forest and grasland A country report published in 2002 by the Federal Environmental Protection Agency (1) indicates that Nigeria poseses more than 5000 recorded species of plants: 22.090 specie of asimals, including inset: 889 species of binds: and 1489 species, cof microorganisms

Traditional medicine plays a significant role in mestng the health-care nce oỸ the majsrig o' Nigerians eal provide alielihood fora significant number af people who depend oni thr mai source of income A National Investigative Comite on Taitonal and Ahertsdte Medi cin cried out a nationwide survey of waditional medicine a 1985 under dhe aes of the Federal Ministry of Science and Technology nthe epor presente bythe commie (2) twas stated that

"75% to 8086 ofthe Nigerian population use the services of eration healer

‘Medicinal plants are dhe primary source of medicines used by tana healers in Nigeria Several

‘medicinal plants of global importance originate in dhe county For example, Calabar bean (Ph stig enenosam) was radially sed in Nigra as an "ordeal poison” in wal of wrong-docs From ithe major component physostigmine (esetne) and its deivarves have been discovered and are now used aginst intraocular pressure (glaucoma) (3) Nigeria hasbeen ranked leventh in Aft or plane diversity, Ou of dhe estimated 5000 plant species chat exist in he country, 205 ate considered endemic, making the country the ninth highest among the 42 African countries inthe level of endemic species () With an estimated population of ver 120 milion people, dsributed among over 250 distinc ethaic groups o tebe, the county is unigue in having high cultural di enlt and a significant share ofthe global biological diversi

“The Feral Government of Nigeria, through the Federal Ministry of Fleath(FME), declared its in- tention incorporate traditional medicine ino the national health-care sytem a ar back as 1992, and took immediate steps to acralne this intention Since then, the Government of Nigeria has putin place «numberof messes o support eadional medicine development and conto The

“questions tha remain are, fri, how much impact dese measures have had on the integration of tadidonal medicine ato the official health sector ofthe Nigerian economy; and secondly, whether there ae specific hotenecks thar must be addressed inorder 1 harness the fall benef of tad

‘ional medicine This chapter aims to give abe overview ofthe current situation in Nigeria, and 10