Enhancing the Role of Traditional Medicine in Health Systems: A Strategy for the African Region

In line with Resolution AFR/RC50/ R3 (Promoting the role of traditional medicine in health systems: A strategy for the African Region; 2000); Member States took steps between 2001 and 2012 to promote traditional medicine by developing national policies and regulatory frameworks and by implementing some priority interventions. By 2012; a total of 40 countries had national policies; 19 had strategic plans and there were 28 national research institutes that conducted research on traditional medicine products used for malaria; HIV/ AIDS; sickle-cell disease; diabetes and hypertension. In addition; seven countries included traditional medicine products into their national essential medicines lists (NEML) and nine adopted national frameworks for the protection of intellectual property rights and traditional medicine knowledge related to practices and products. Despite the progress made; countries continue to face challenges in implementing Resolution AFR/RC50/R3. This article introduces an updated strategy ( Regional Strategy on Promoting the Role of Traditional Medicine in Health Systems reproduced at the end of this article) that proposes key interventions to address these challenges and builds on the successful promotion of the positive aspects of traditional medicine in national health systems. The focus is on strengthening of stewardship and governance; the development and use of tools; the cultivation of medicinal plants and conservation of biological diversity; research and development; local production; the protection of intellectual property rights and traditional medicine knowledge; intersectoral coordination and capacity building

The Ouagadougou Declaration on Primary Health Care and Health Systems in Africa: Achieving better Health for Africa in the New Millennium

The Ouagadougou Declaration on Primary Health Care and Health Systems in Africa focuses on nine major priority areas: 1) leadership and governance for health; 2) health services delivery; 3) human resources for health; 4) health financing; 5) health information systems; 6) health technologies; 7) community ownership and participation; 8) partnerships for health development; and 9) research for health. This paper describes a framework constructed for implementing the necessary activities in each of these priority areas; and proposes recommendations for consideration by Member States in the development of their own country frameworks. The frameworkfor implementing activities related to health information and research for health which have been taken into account in the Algiers Framework are discussed separately elsewhere in this issue

An Overview of the Traditional Medicine Situation in the African Region

"WHO estimates that about 80of the population in developing countries depends on traditional medicine for their Primary Health Care (PHC) needs. Traditional medicine and its practitioners were officially recognized by the Alma Ata Declaration in 1978 as important resources for achieving Health for All. Since then; member states and WHO governing bodies have adopted a number of resolutions and declarations on traditional medicine. Notable among these are resolution on ""Promoting the role of traditional medicine in health systems: A Strategy for the African Region"" adopted by the WHO Regional Committee for Africa in Ouagadougou; Burkina Faso; in 2000 and the declaration on the Decade of African Traditional Medicine (2001-2010) by the Heads of State and government in Lusaka in 2001. This article will focus on the achievements of countries in the implementation of the priority interventions of the Regional strategy since its adoption in 2000. The article will also cover the challenges countries are facing in implementing the Regional strategy and propose the way forward."

Overview of Traditional Medicine in ECOWAS Member States

Traditional medicine has been the main source of healthcare for the vast majority of people in the Economic Community of West African States (ECOWAS). It is currently estimated that between 70-80of West Africans use traditional medicine for the management of both communicable and non-communicable diseases. In 2007; the West African Health Organization (WAHO) conducted a situational analysis to assess the level of development of traditional medicine in its member states. The findings showed that although there was strong political will from West African governments for the development of traditional medicine; the disparities in the level of development among the countries were very huge. For instance; it was observed that whist some countries had advanced to the stage where they had established training institutions and had herbal medicines on their essential medicines lists; others had not even developed national traditional medicine policies and legal frameworks; codes of ethics and strategic plans for implementation of national policies. Although all countries have made very good progress in the area of sensitization and popularization of traditional medicine; some others have made good progress in the development of national traditional medicine policies (11 out of 15). However; no country has a health insurance coverage for TM; alternative and complementary medicine. Intellectual property is still a relatively new area and this situation delays the development of frameworks for the protection of traditional knowledge and access to biodiversity in majority of Member States

Regulation of Traditional Medicine in the WHO African Region

In many developing countries traditional medicine is still the main source of health care for about 80of the population; because of its cultural acceptability; affordability and accessibility. In the last few years; there has also been an upsurge of interest in the use of traditional medicine in developed countries; where it is usually referred to as complementary and alternative medicine. Owing to countries' efforts to institutionalize traditional medicine in health systems and calls made by the WHO Regional Office for Africa over the last two decades; more than half of the countries in the African Region have developed national policies on traditional medicine and regulation is one of the components of such policies. Eighteen countries have developednational codes of ethics to ensure the safety; efficacy and quality of traditional medicines. However; less than half of the countries are yet to implement these policies and therefore; only a few countries have developed regulations for traditional medicine. Twenty-one countries have developed legal frameworks that provide for accreditation; registration of traditional health practitioners (THPs) and the establishment of a THP Council for regulation of traditional medicine practice and products. Non-regulation of traditional and herbal medicines poses a health risk to the populations. This paper discusses the regulation of traditional medicine practices and products; and highlights the challenges posed by attempts to regulate the sector. It also outlines quality; safety and efficacy assessment; product registration; marketing; distribution and post-marketing surveillance

Clinical Practices of African Traditional Medicine

In African traditional medicine; the curative; training; promotive and rehabilitative services are referred to as clinical practices. These traditional health care services are provided through tradition and culture prescribed under a particular philosophy; e.g. ubuntu or unhu. Norms; taboos; tradition and culture; which are the cornerstones of clinical practice of traditional medicine; are the major reason for the acceptability of traditional health practitioners in the community they serve. The philosophical clinical care embedded in these traditions; culture and taboos have contributed to making traditional medicine practices acceptable and hence highly demanded by the population. This paper discusses the different traditional health care services; such as curative services; general traditional healthcare; mental healthcare; midwifery; bone setting; rehabilitative and promotional services that increases health awareness and developing positive attitudes and behaviour towards healthier living)

Collaboration between traditional health practitioners and conventional health practitioners: some country experiences

Since the early 1970s; the WHO has repeatedly advocated for the recognition of Traditional Health Practitioners (THPs) as Primary Healthcare (PHC) providers and for the integration of traditional medicine in national health systems. Several calls have been made on governments to take responsibility for the health of their people and to formulate national policies; regulations and standards; as part of comprehensive national health programmes to ensure appropriate; safe and effective use of traditional medicine. One of the priorities of the African Regional Strategy on Promoting the Role of TM in Health Systems is promotion of collaboration between practitioners of traditional and conventional medicine. However; despite the health benefits such collaboration could bring to the populations; decades of disregard of traditional medicine practices and products has created mistrust between the two sectors hampering all the efforts being made to promote this potentially useful partnership. This article outlines the strategies that have been adopted by the WHO to ensure the integration of traditional medicine into national health systems; examples of ongoing collaboration between research institutions and THPs based on research and management of patients; and between THPs and conventional health practitioners in HIV/ AIDS prevention and care and HIV/AIDS/STI/tuberculosis programmes; factors that have contributed to sustaining these partnerships as well as mechanisms for strengthening such collaborations

L' introduction de plantes medicinales dans le traitement de l'infection a VIH : une approche reussie au Burkina Faso

La recherche et le developpement de medicaments traditionnels anti-VIH/SIDA est un processus complexe qui integre de nombreux defis. Ce processus comprend les evaluations precliniques et cliniques ainsi que la valorisation industrielle; avec la mise sur le marche de medicaments respectant des normes de qualite; d'innocuite et d'efficacite therapeutique. Si de nombreuses plantes africaines ont deja fait l'objet d'evaluations precliniques avec des resultats encourageants; les etudes cliniques comparatives sont encore insuffisantes. L'espoir est cependant permis; comme nous le montre l'experience du Burkina Faso; notamment a travers le developpement de deux medicaments qui ont franchi aujourd'hui avec succes l'etape d'essai clinique Phase II; et surtout l'identification des plantes medicinales pouvant avoir une interference negative avec les traitements antiretroviraux

Promotion de la medecine traditionnelle du Burkina Faso : essai de developpement d'un medicament antidrepanocytaire; le FACA

La recherche et le developpement de medicaments antidrepanocytaires est une priorite en Afrique; ou vivent la grande majorite des personnes souffrant de drepanocytoses. C'est dans ce sens que le FACA a ete developpe au Burkina Faso; a partir de la Medecine Traditionnelle et avec le soutien du bureau regional de l'OMS. Les proprietes antifalciformantes; anti-inflammatoires; antipyretiques et myorelaxantes ont ete evaluees. Il en est de meme de la toxicite. Les plantes composant le FACA; agissent en synergie contre les principaux symptomes de la crise drepanocytaire. Administre en evaluation clinique; le FACA est bien tolere et reduit de maniere significative; la frequence des crises. Apres son autorisation de mise sur le marche; le FACA fait maintenant l'objet d'une production industrielle

Recherche sur la medecine traditionnelle africaine: hypertension

Les institutions de recherche creees pour developper la medecine traditionnelle encouragees dans ce domaine par l'OMS menent des activites vers des maladies prioritaires comme le paludisme; le VIH/SIDA; la drepanocytose; le diabete et l'hypertension arterielle. La prise en charge de l'hypertension arterielle par les medicaments conventionnels est tres elevee amenant plusieurs patients a s'orienter vers la medecine traditionnelle dont les produits ayant l'innocuite; l'efficacite et la qualite prouvees doivent etre utilises. Differents organes des plantes utilisees par les tradipraticiens ont fait l'objet d'etudes phytochimiquediuretique; et antihypertensive au Departement de Medecine Traditionnelle a Bamako et a l'Institut de Recherche en Sciences de la Sante de Ouagadougou: Cymbopogon giganteus; Gynandropsis gynandra; Portulaca oleracea; Jatropha gossypiifolia et une recette de tradipraticien. L'infuse de Portulaca oleracea a la dose de 37;5 mg/kg avec une excretion urinaire de 163;10a donne une importante activite diuretique. Une elevation de la pression arterielle provoquee par l'adrenaline a la dose de 75?g/kg a ete inhibee par le macere aqueux de Jatropha gossipiifolia 94;64a la dose de 20mg/kg. Ces travaux viennent en complement des tests de toxicite pour permettre l'evaluation de l'evidence ethnomedicale sur des recettes a base de ces plantes suivie d'autres tests biologiques de formulation galenique et des essais cliniques. Peu de phytomedicaments de la medecine traditionnelle africaine ont obtenu l'autorisation de mise sur le marche a l'exception du Guinex-HTA produit en Guinee

Promoting African Medicinal Plants through an African Herbal Pharmacopoeia

Various resolutions adopted by the World Health Assembly and Regional Committee for Africa call upon Member States; among others things; to develop herbal pharmacopoeias and to develop and apply scientific criteria and methods for proof of safety and efficacy of medicinal plant products. However; only few countries have developed national herbal pharmacopoeias; limited plant species that provide medicinal herbs have been scientifically evaluated for their possible medical applications; and the safety and efficacy data are available for even fewer herbs. Without well documented information on the safety; efficacy and phytochemical characteristics of different compounds; it is difficult for external buyers to assess the likely utility or value of some new raw materials and extracts of African origin. In order to address these lacunae; the Association of African Medicinal Plants Standards is developing an African Herbal Pharmacopeia with trading standards which provide information and technical data on some 50 important medicinal plants. The objective of developing the monographs is to ensure that these plants become visible on the world market. The monographs lay emphasis on the quality control issues; dosage; use; efficacy; pharmacology and safety of important Africanmedicinal plants

Natural products research networks in sub-Saharan Africa

Networking is a means of calibrating the quality of work that a group of people is undertaking; fostering international collaboration; pooling of available resources to provide quality training and research in various scientific disciplines and ensuring rapid worldwide dissemination of research information. Several networks involved in research and development of medicinal plants exist in the various sub-regions of the African Region. However; this paper discusses only six such networks of African researchers which share certain common characteristics. These networks aim to foster research on natural products and their sustainable use in human health; and the dissemination of information on research into natural products among others. They also aim to enhance research training capabilities of institutions through national and Regional activities; promote collaboration and research partnerships and mentoring of young researchers in the advancement of natural products research and support the principles of biodiversity conservation. However; these networks have many challenges; mostly financial. A suggestion has been made for the African Network of Drug and Diagnostics Innovation to consider the involvement of other existing networks in its structure for synergizing the efforts to create health products

Towards sustainable local production of traditional medicines in the African Region

The majority of the population in the WHO African Region and other developing countries; particularly rural dwellers use plant-based traditional medicines for health care. Most developing countries are endowed with vast resources of medicinal and aromatic plants; which have been used over centuries for the treatment of diseases. The global resurgence of interest in herbal medicines has created a large market for plant derived remediesthat developing countries could exploit to their advantage; provided they could be produced with acceptable quality and safety specifications. This article highlights the current limitations of traditional medicinal productsin the Member States; the essential requirements for the local production of traditional medicines; the status of local production in WHO African Region; approaches to sourcing plant raw materials as well as challenges. Methods for value addition; processing and product improvement for the commercial utilization of medicinal plants are indicated

Intellectual property approaches to the protection of traditional knowledge in the African Region

Traditional knowledge has played a significant role in the healthcare systems in countries of the African Region for centuries. Traditional medicines are presently used by nearly 80of the population. Owing to the global resurgence in the use of natural products and the advent of the biotechnological industry; traditional knowledge is increasingly becoming a source of modern drug development and biotechnological inventions. Despite the important role of traditional knowledge; traditional communities are unable to protect their knowledge through the existing intellectual property system owing to the failure of the knowledge to satisfy the requirements for intellectual property protection; incompatibility in most cases between the traditional knowledge concepts and intellectual property as well as the prohibitive costs involved in patent registration. Studies conducted recently and the outcomes of global debates have suggested some policy and legal approaches that can be used to effectively protect traditional knowledge; including traditional medicine. This paper discusses conceptsof traditional knowledge and provides policy and legal measures that have been developed at the international and regional levels for the protection and utilization of traditional knowledge for the benefit of the knowledge holders and society at large