SAHR 2007 - Health Systems Trust

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Authors: Myles Mander i Lungile Ntuli i Nicci Diederichs i Khulile Mavundla i 13 Economics of the Traditional Medicine Trade in South Africa Abstract The trade in traditional medicines in South Africa is estimated to be worth R2.9 billion per year, representing 5.6% of the National <strong>Health</strong> budget. With 27 million consumers, the trade is vibrant and widespread. There are at least 133 000 people employed in the trade, with a large percentage of rural women. The plant trade is a key rural industry and business incubator. However, supply of plant material (some 771 species) and medicines is not sustainable. All plants are harvested from the wild, with popular species becoming locally extinct and being traded at very high prices. Much of the current research and development effort focuses on novel drugs research, with little effort being directed at improving the current harvesting, production, processing, storage and treatment technology. The future of the traditional medicines trade and its benefits are uncertain. i Futureworks! 189
Introduction Table 1: Levels of education of medicinal plant consumers in Durban The traditional medicines trade in South Africa is a large and growing industry. There are some 27 million consumers of traditional medicine and the trade of these medicines contributes to an estimated R2.9 billion to the national economy. For many people in South Africa, traditional medicine is not considered an inferior alternative to western medicine, but is thought to be desirable and necessary for treating a range of health problems that western medicine does not treat adequately. A survey by Mander indicated that some 84% of clinic patients in Durban used traditional medicines, with only 18% of the patients indicating that they may reduce their use of traditional medicine in the future. 1 However, 97% of traditional healers' patients indicated that their use of traditional medicines was by choice and not a result of access and cost issues associated with western medicines. This chapter describes the economics of the traditional medicines trade in South Africa, with a focus on the trade in traditional plant medicines. This chapter does not consider the trade in animal parts, or the services rendered by traditional healers, except in respect of the value that plant medicines add in prescriptions prepared by traditional healers. The demand, supply, trade chain, economic value and implications for health care of the medicinal plant trade are also discussed. The demand for traditional medicines Traditional medicinal plant consumers Seventy two percent of the Black African population in South Africa is estimated to use traditional medicine, accounting for some 26.6 million consumers. These consumers are from a diverse range of age categories, education levels, religions and occupations. The education levels of medicinal plant consumers in Durban is outlined in Table 1. Education level % of respondents surveyed at healers’ practices (n = 99) No schooling 7.8 Up to Grade 7 31.0 Up to Grade 10 26.0 Up to Grade 12 26.0 Tertiary qualification 8.7 Source: Mander, 1998. 1 The diversity in consumers show that consumption of traditional medicine is a common practice across most sectors of the Black African population, and that traditional medicine use is not confined to poor, rural and uneducated users. Furthermore, the survey conducted by Mander showed that traditional medicine was often more expensive than at local government clinics, dispelling the myth that traditional medicine is a cheaper alternative. 1 The average frequency of traditional medicine use per consumer in South Africa is 4.8 times per year, with an average mass of 157g plant material per treatment. Interestingly, the South African estimates are similar to Ethiopia, with Ethiopian consumers buying traditional medicine 6.1 times a year, with an average mass of 267g per treatment. 2 While 72% of Black South Africans consume traditional medicine, some 68% of the Ethiopian population use traditional medicine. This indicates that despite South Africa being one of the more developed countries in Africa and Ethiopia being one of the less developed countries, consumption patterns of traditional medicine for both African countries does not differ significantly. This indicates that throughout Africa, the consumption of traditional medicine appears to be a firmly entrenched cultural practice. The average South African consumer of traditional medicines uses 750g of medicinal plants a year. It is estimated that in South Africa some 128 million courses of traditional medicine treatments are prescribed per year, resulting in the consumption of approximately 20 000 tonnes of plant material, most of which is indigenous. The estimates in this chapter are based on a synthesis of research findings from four seminal surveys conducted in the trade in recent years. The calculations used in the synthesis are not discussed here for sake of brevity. However, in essence the approach adopted was to generate averages of particular variables from the four studies and then to extrapolate these sample averages to the broader population. The key surveys originate from multiple sources. 1,3,5,6 Any estimates which are not a product of the synthesis are referenced separately. Ongoing observations of the medicinal plant trade indicate that since some of the initial surveys in 1997 and 1998, the markets have continued to be buoyant, with street markets remaining well patronised and market demand for plants increasing. This is evident by a visible growth in the street trade of medicinal plants in both urban and rural markets in KwaZulu-Natal (KZN) and Mpumalanga. The HIV and AIDS 190
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South African Health Review 2007 LI
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Foreword The 12th edition of South
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12 Traditional and Complementary Me
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Other Funders for the Health System
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This response raises a number of qu
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ucts are currently sold without reg
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The authors conclude that mandatory
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servicing and inappropriate hospita
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systems is also critical; worrying
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Authors: Laetitia Rispel i Geoffrey
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Stewardship: Protecting the Public
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Introduction The importance of the
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diseases such as tuberculosis and t
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17 of 2002). This Act entirely repl
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(d) and any other matter relating t
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Year Act No. Title Objects 1997 90
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References 1 Department of Health.
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Purchasing of Health Care 33Pooling
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Introduction This chapter presents
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Medical schemes are the largest fin
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per person dependent on the public
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An increase in hospital expenditure
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private pharmacy do so for self-tre
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References 1 McIntyre D, Thiede M,
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Policy and legislative framework In
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Medical schemes and revenue collect
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There is evidence that when faced w
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are thus contributing factors to th
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Figure 2: Historic membership of me
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Solvency of the risk pools has beco
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Figure 4: 100 Proportion of risk be
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will retain that benefit for their
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There is a general sense (but often
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From a benefit design perspective t
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and towards competition based on ef
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37 Du Preez L. Registrar wants cura
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Introduction There has long been co
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an element of cream-skimming which
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Table 1: Distribution of health car
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isk equalisation mechanism were imp
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once the cost spiral in medical sch
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Revenue collection: Collecting orga
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Current debates A key area of ongoi
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References 1 Gluckman H. The Provis
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Authors: Patrick Matshidze i Lyn Ha
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Health Information Systems in the P
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Authors: Shahieda Adams i Reno Mora
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Health and Health Care in the Workp
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Author: Bettina Taylor i 8 Rationin
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Rationing of Medicines and Health C
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Glossary AFA AIDS ALP AMA ANC ART A
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Glossary KZN LFS LIMS LP LPP MAR MC
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Glossary SAPC SARS SASIM SASSA SEP
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Index A Acts (Legislation and Bills
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Index N and O National Health Refer
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SAHR 2007 - Health Systems Trust

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