Meeting of Commonwealth Health Related NGO's Barbados 12th - 15th November, 1998
TRADITIONAL AND COMPLEMENTARY MEDICINE IN HEALTH SECTOR REFORM
Throughout the Commonwealth there is widespread use of traditional health care and complementary medicine (TH/CM). This field is demand driven rather than supply led and a consumer perspective is therefore needed in the development of this sector. This should take into account education and information needs as well as consumer protection.
Differences exist between developed and developing countries with respect to the status and role of TH/CM. In the industrialised countries of the Commonwealth complementary medicine predominates and is largely utilised by the more affluent members of society. In the non-industrialised countries, traditional medicine is the predominant form of healthcare and is more widely used by different sections of society, particularly the poor and rural communities.
Women serve as key custodians of traditional health knowledge and practice. This role needs to be recognised in all policies pertaining to the development and promotion of traditional health systems
Policies in TH/CM should reflect the pattern of demand from the community. Accordingly, there should be survey research to ascertain the patterns of use and availability of TH/CM services and the standards of practice and training of practitioners. Consumers often have no access to reliable information on healthcare options available in TH/CM. To improve this situation, there should be support for programmes providing research-based information to the public in this field.
There is a need for appropriate regulation of TH/CM systems. This should be based on a system of self- regulation overseen by a National Council of TH/CM with responsibility for recognition of the systems, standards of education, professional conduct, and good manufacturing practice. Such self-regulation can be a first step towards integration of TH/CM with conventional medicine. Examples of official integration exist in Commonwealth countries such as India and Sri Lanka. An exchange of experience among Commonwealth countries is recommended in the path to integration of TH/CM and conventional medicine.
There is a need for respectful dialogue and mutually beneficial collaboration between conventional and TH/CM practitioners. Such dialogue would recognise the spiritual basis of many TH/CM approaches. It would also address issues of safety and public health from the perspectives of both conventional and traditional/complementary medicine.
Courses in TH/CM should be available in undergraduate health science programmes. They should also be a required part of Continuing Professional Education. There is a need for public education on the nature and scope of a health system which incorporates TH/CM practitioners. TH/CM practitioners should be involved in curriculum design and instruction for all courses.
It is widely recognised that there has been a progressive erosion of indigenous knowledge which informs traditional health care systems. This has weakened the quality of traditional healthcare services. Substantial increases in government, Commonwealth and international allocations to the traditional health sector are urgently called for to support preservation of traditional health knowledge systems and their applications.
There is a need to design appropriate legislation to protect and promote intellectual property rights of TH/CM practitioners. Commercial use of traditional knowledge should result in benefit sharing with indigenous people and local communities in line with the UN Convention on Biodiversity.
There is a need for comprehensive documentation of the best traditional health practices for their potential to contribute to addressing health needs in Commonwealth countries. This could be enhanced through an international network that disseminates, validates and exchanges research results on TH/CM. Both government and non-government sources of finance can be mobilised to support this research.
Research needs and priorities should be identified through dialogue with stakeholders, take into account the paradigms of the systems being evaluated, and use appropriate methodologies for assessing these. Full recognition should be given to cultural and intellectual property rights and innovations associated with TH/CM systems.
Diet, nutrition and health promotion are cornerstones of TH/CM. Accordingly, it is recommended that Commonwealth countries develop strategies to promote local foods and dietary practices in the interest of disease prevention and health promotion.
The natural resources which are the source of the medicines for TH/CM health systems are under threat. This is due to over-harvesting of uncultivated medicinal plant resources, habitat loss due to degradation of natural environments, and changes in land use due to population increases. Medicinal plant conservation should, therefore, be seen as a key component of both biodiversity conservation programmes and an integrated approach to healthcare.
For the purpose of planning appropriate conservation programmes, it is recommended that Commonwealth countries give urgent priority to preparing a national inventory of medicinal plants used in local health traditions. Conservation should be community-based and include in situ and ex situ strategies. This will require development of a public education program on benefits and methods of conserving medicinal plants. Partnerships between government, NGOs, local communities and industry need to be encouraged to ensure conservation of medicinal plants.
Throughout the Commonwealth, the public are choosing TH/CM services, often paying out of pocket for these in addition to public sector services. It is timely, indeed it is overdue, that health policy should reflect this demand. The Commonwealth health-related NGOs call on the Health Ministers and the Commonwealth Secretariat to constitute immediately a Working Group to develop an action plan to promote and integrate TH/CM into national health services as an essential part of the agenda for health sector reform in the Commonwealth.
COMMITTEE B AGENDA ITEM 5: HEALTH REFORMS FOR BETTER HEALTH RECOMMENDATIONS
How can traditional systems of health contribute to better health?
1. Ministers noted that traditional and complementary medicine is well established and widely practised across the Commonwealth and likely to assume increasing importance. Traditional medicine makes significant contributions to the health care and health status of the population, particularly in rural communities in some developing countries. The services they offer are demand-driven.
2. The Committee further noted that despite the extensive use of traditional medicine in some countries, very little public resources are made available to support them.
3. The practitioners included under the umbrella of 'traditional" and complementary medicine are many and varied with different practices, levels of skills, competence, and values. Ministers emphasised the importance of promoting best practice as the national standard and further noted that any regulations should include safeguards for consumers. National policies for health need to give greater consideration and recognition to the existence of traditional and complementary medicine and their value to health development and health sector reform.
4. In conclusion, the Ministers noted that traditional medicine should be seen as 'complementary' rather than 'alliterative', indicating the need for collaboration and partnerships with conventional/western medicine.
5. Ministers recommended that a Working Group made up of representatives of the Commonwealth Secretariat, governments and NGOs be constituted to develop an action plan to promote and integrate traditional systems of health and complementary medicine within national health systems giving consideration to:
* Policy Framework, including: provision of services; conservation of medicinal plants; and related intellectual property rights * Training of traditional and conventional practitioners * Development of standards of practice * Mechanisms for enhanced sharing of experiences in the Commonwealth * Regulation and safety, involving practitioners of traditional medicine in the process * Research: evidence-based research to promote mutual understanding and confidence, and establish efficacy * Management of the integration of traditional and conventional medicine.
6. Ministers noted that traditional medicine differs from one country to the next and that these differences should be taken into account by the Working Group. It was proposed that the Group should present its proposal to the pre-WHA [World Health Assembly] Health Ministers Meeting in 1999, including its detailed plans for how GIFTS of Health will raise the necessary funds to finance the Working Group. (A proposal for a Working Group on Traditional and Complementary Health Systems was subsequently outlined: See attached document, Appendix 1).
PROPOSAL FOR A WORKING GROUP ON TRADITIONAL AND COMPLEMENTARY HEALTH SYSTEMS
Membership Members should be drawn from member states, the Commonwealth Secretariat and NGOs. The following countries expressed interest in the working group and possible membership: * Countries: Australia, CARICOM (secretariat at health desk), Ghana, India, Malaysia, Namibia, New Zealand, South Africa, Swaziland, Tanzania, Tonga, Uganda, Zambia and Zimbabwe. * International NGOs: Commonwealth Health Research Inter-Regional Consultation; International Development Research Centre (IDRC), Canada; Global Initiative For Traditional Systems (GIFTS) of Health.
Working Group Secretariat This could be run by the Global Initiative For Traditional Systems (GIFTS) of Health and located in the GIFTS office in Oxford, UK.
Terms of Reference Members of the Working Group would oversee a comprehensive scoping exercise of the following areas: * Regulation and safety * Research: recording the traditional health heritages; efficacy, effectiveness and cost-effectiveness; inventories of medicinal plants; pharmacopoeia; conservation of medicinal plants, including issues related to biotrade, intellectual property rights and equitable sharing of benefits. * Management of integration with conventional medicine * Examples of best practice.
The above would lead to the provision of advice to Ministers, covering the following: * A range of options for the development of national policy frameworks to include the provision of health services and conservation and sustainable use of medicinal plants, that could be developed into guidelines; * Workforce and educational requirements; standards of practice, including regulation, accreditation systems and competencies, * A framework by which to proceed, gathering and sharing information amongst Ministers.
Immediate Plan of Action 1. Agree membership of the Working Group at the 12CHMM 2. By the time of the World Health Assembly in May 1999: (i) have provisional funding in place to begin the three-year programme of work (budget to be prepared for approval by the Working Group) (ii) have arrangements established in each member country of the Working Group to ensure local stakeholders (including traditional practitioners) are involved and able to contribute have the programme of work drawn up ready for agreement.
For further information please contact:
Dr Gerry Bodeker Director GIFTS of Health Health Services Research Unit Institute of Health Services University of Oxford Oxford, UK Tel: (44-1865) 22 68 80 Fax: (44-1865) 22 67 11 Email: gree0179(at)ermine.ox.ac.uk