SAHR 2007 - Health Systems Trust

Traditional medicine
The World Health Organization (WHO) defines traditional
medicine (TM) as “health practices, approaches, knowledge,
and beliefs incorporating plant, animal and mineral based
medicines, spiritual therapies, manual techniques and exercises,
applied singular or in combination, to treat, diagnose
and prevent illnesses or maintain well-being”. 1 Traditional
medicine in South Africa is not to be confused with complementary
and alternative medicine (CAM).
According to the WHO approximately 80% of the population
of African Member States use TM to meet their health care
needs. 2 TM has sustained the health of millions of Africans
over hundreds of years. In 1999, Pretorius noted, “In a sense
much more has transpired in the traditional medical sector
in the past five years [since 1994] than in the rest of this
century. The government has made good on its promise to
incorporate this sector into the national health system and
they have set the necessary procedures in motion. Despite
this major breakthrough, very little has changed on the
ground.” 3 In the period following the review by Pretorius there
have been substantial international and regional developments
in recognising and facilitating the role and forms of
healing other than the dominant allopathic model.
International policy and regional
commitments
The WHO Traditional Medicines Strategy 2002-2005
provides a framework for action to promote the use of TM/
CAM in reducing mortality and morbidity, especially among
impoverished nations. The strategy outlines four objectives. 4
1. Policy: To integrate TM/CAM into national health care
systems, where appropriate, by developing and implementing
national TM/CAM policies and programmes.
2. Safety, efficacy and quality: To promote the safety, efficacy
and quality of TM/CAM by expanding the knowledge
base of these remedies and by providing guidance
on regulatory and quality assurance standards.
3. Access: To increase the availability and affordability
of TM/CAM where appropriate, focusing on poorer
populations.
4. Rational use: To promote therapeutically sound use of
appropriate TM/CAM by providers and consumers.
The strategy aims to assist countries to:
➤ develop national policies on the evaluation and regulation
of TM/CAM practices. To this end several useful
documents on the legal status of TM/CAM around the
world have been published; 5,6
➤ create a strong evidence base on the safety, efficacy
and quality of TM/CAM products and practices;
➤ ensure availability and affordability of TM/CAM
including essential herbal medicines;
➤ promote therapeutically sound use of TM/CAM by
providers and consumers; and
➤ document traditional medicines and remedies.
The international People's Charter for Health is a statement
of shared vision, goals, principles and action and is
the most widely endorsed consensus document on health
since the Alma Ata Declaration. The People’s Charter calls
for the provision of universal and comprehensive primary
health care, irrespective of people’s ability to pay. It “calls
on people of the world to support, recognise and promote
traditional and holistic healing systems and practitioners
and their integration into Primary Health Care”. 7
The WHO African Regional Strategy on TM was adopted in
2000. 2 In 2001, the strategy was endorsed by the Assembly
of Heads of State and Government of the Organization of
African Unity (OAU) and the period 2001-2010 was declared
as the Decade for African Traditional Medicine. 8 An annual
African Traditional Medicine Day was also declared. As a
consequence of the OAU resolutions, the WHO Regional
Office for Africa established a 12-member WHO Regional
Expert Committee on TM to assist countries to accelerate the
implementation of policy decisions. 9
Using the WHO terminology, in countries where the dominant health
care system is based on allopathic medicine or where TM has not
been incorporated into the national health care system, TM is often
termed ‘complementary’, ‘alternative’ or ‘non-conventional’ medicine.
For example, Traditional Chinese Medicine and acupuncture would be
termed ‘Traditional Medicine” when used in China, but ‘Complementary
and Alternative Medicine’ when used in Europe, North America or South
Africa.
A review of the progress on the Decade for African Traditional
Medicine was placed on the agenda of the Third
Session of the African Union Conference of Ministers of
Health, which was held in Johannesburg in April 2007. The
report tabled at the meeting argued for urgent strategies to
accelerate the implementation of the plan and for significant
advocacy for TM. 10 Action has been lacking and a resolution
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