REGIONAL COMMITTEE
Provisional Agenda item 10.4
Fifty-fifth Session 11-13 September 2002
SEA/RC55/13
16 July 2002
WHO STRATEGY FOR TRADITIONAL MEDICINE 2002-2005
CONTENTS
Page 1. INTRODUCTION..................................................................................................................1 2. DEFINITION OF TRADITIONAL MEDICINE.......................................................................1 3. TRADITIONAL MEDICINE IN THE DEVELOPED WORLD ...............................................1 4. POLICY ................................................................................................................................1 5. SAFETY, EFFICACY AND QUALITY IN THE TRADITIONAL MEDICINE STRATEGY. ......................................................................................................2 6. ACCESS ..............................................................................................................................3 7. RATIONAL USE...................................................................................................................3 8. CONCLUSION .....................................................................................................................4
1.
INTRODUCTION
The South-East Asia Region has a long history in traditional medicine (TM) as well as in its continuing use. Both at the Regional Committee as well as the Health Ministers Meeting TM has been discussed and WHO requested to assist countries in this area. Some countries have seen the Traditional Medicine sector advancing from individual practitioners in communities who have learnt through apprenticeship, to formal training of practitioners with the possibility of postgraduate training, and commercial production of the remedies. The WHO Traditional Medicine Strategy, published this year, provides a comprehensive framework for the Organization to collaborate with Member Countries. The strategy was developed through broad consultation with the WHO regional offices and Member Countries, WHO Expert Committees and Collaborating Centres for Traditional Medicine, as well as through work with a broad range of partners with diverse interests in TM. As in the WHO Medicines Strategy, the WHO Traditional Medicine Strategy incorporates four objectives: policy; safety, efficacy and quality; access and rational use.
2.
DEFINITION OF TRADITIONAL MEDICINE
With centuries of use throughout the world, it is difficult to give an all encompassing definition but the TM strategy provides a good working definition: ”Traditional medicine includes diverse health practices, approaches, knowledge and beliefs incorporating plant, animal and/or mineral-based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to maintain well-being, as well as to treat, diagnose or prevent illness.” In the SEA Region, the commonly practised systems are Ayurveda, Unani, Siddha, Yoga, Jamu (Indonesia), Koryo medicine (DPR Korea), and originating from other regions, Chinese medicine, acupuncture and homoeopathy. These varied systems use herbal medicines, manual and spiritual therapies and exercises. Some which had origins in the Region, such as Ayurveda and Yoga have spread beyond the Region, including to the developed world.
3.
TRADITIONAL MEDICINE IN THE DEVELOPED WORLD
Although allopathic medicine is mostly used in of health care in the developed world, some systems of traditional medicine are practised and are often referred to as Complementary and Alternative Medicine (CAM). In the developed world, CAM has raised issues similar to what is discussed below and in addition others, specific to that part of the world. The WHO Traditional Medicine Strategy addresses all these issues, but this paper focuses on issues in the strategy that are related to the SEA Region.
4.
POLICY
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A policy on TM would provide a sound basis for action. Currently, India, Sri Lanka and Indonesia in the Region have national policies which regulate herbal products, hospitals TM services as well as research and professional councils of the practitioners. Issues such as quality and extent of the training of providers, and standards of the products are best tackled within the framework of a national policy. A policy would also address the issue of defining the role of TM in national health care delivery; some countries provide traditional medicine alongside allopathic medicine in the same institution, whereas others have separate systems with separate hospitals. Others acknowledge the existence of the system but do not provide significant support. It is for each country to decide where it would place TM in health care and this should be articulated in a TM policy. The knowledge ingrained in TM has been generated throughout the centuries and has been the result of work by practitioners in treating patients from their own communities. This indigenous knowledge is owned by the community and is to be used for its benefit. Protection and preservation of this knowledge is obviously important and the responsibility of the countries. Protection of this knowledge requires a different system from the current agreement on Intellectual Property Rights which is driven by commercial short-term rewards, such as patents and monopoly rights for the innovator, with the ultimate aim of benefit to the society. Indigenous knowledge requires a different model. It has developed gradually and has no innovator and is owned by the community and should be freely available. However, any commercial product resulting from it should appropriately reward the community too and not only the manufacturer of the product. The development of digital TM libraries is one possible solution for protecting this indigenous knowledge. The TM policy of a country has an important role in the protection of indigenous knowledge.
5.
SAFETY, EFFICACY AND QUALITY IN THE TRADITIONAL MEDICINE STRATEGY
Many TM products and practices have been used for a considerable period of time and are therefore thought to be safe and effective. However, with health care systems increasingly demanding evidence of measurable improvements in health before supporting a product or practice, TM too has to be assessed in a similar manner. Promoting research into the safety and efficacy of TM products and practices is the best means of generating this evidence. Most countries in the Region have research institutes for TM: a policy by encouraging appropriate research, would help in developing TM in the national health care system. The WHO monographs on selected medicinal plants are an example of the work of WHO in collating and disseminating scientific information on areas relevant to TM. Publications such as Guidelines on Basic Training and Safety in Acupuncture, General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine help to increase the evidence base in TM. WHO Collaborating Centres in Traditional Medicine have promoted TM in their countries through teaching and research and have also assisted in regional and global activities. With the increasing commercial use of TM, there is a need to assure the quality of both the products and the services. A registration system similar to that of western drugs is feasible to ensure that commercially available TM products have correct labelling, contain the correct ingredients and do not overstate efficacy. Manufacturers should be provided guidance and
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there should be regulations to ensure that appropriate standards are maintained. Commercial manufacture of herbal medicines has some similarity to the manufacture of western drugs; a TM policy could well borrow from the experiences in western medicine. The planned regional meeting in 2003 on Regulation of Herbal Medicines would help the countries to assist in their regulation of these products. An important aspect of many policies is regulation of commercial activities to provide a level playing field for the producer as well as the consumers and should be a part of the TM policy too. TM services have spread beyond health care institutions. TM emphasizes a holistic approach, equilibrium between the mind, body and environment and an emphasis on promoting health rather than disease; some of the therapies have naturally found a niche in hotels and resorts. For example, in some parts of India and Sri Lanka, Ayurvedic treatment is provided as part of a vacation package. While this is to be encouraged, it must be ensured that appropriately qualified personnel as well as facilities are available in such hotels and resorts. Regulatory aspects of the TM policy would provide guidance as well as the means of ensuring standards.
6.
ACCESS
In the SEA Region, the poorer segment of society uses TM disproportionately, partly due to its affordability and also due to its availability in their communities. Hence a TM strategy should encourage continued affordability and accessibility. Cooperation between primary health care workers and TM providers would facilitate this. The challenge is to bring the two groups together and to reinforce the advantages of each group for the benefit of the community. A TM provider would be a suitable person to deliver health messages. On the other hand, TM providers through lack of knowledge of primary health care may perform practices that carry health risks. Optimizing the health skills and knowledge of the TM provider along with the realization by the primary health worker that the TM provider is a useful community health resource, is a desirable but difficult-to-achieve balance. Much of the treatment in TM is based on plant materials. Hence the continuing supply of these materials will depend on a sustainable use of natural resources. The draft WHO Good Agricultural Practices (GAP) as well as the Good Sourcing Practices (GSP) in harvesting medicinal plants would provide the underpinning for this aspect in the TM strategy.
7.
RATIONAL USE
Traditional Medicine arising from the experiences of the past and embedded in the culture of each society cannot stand still and must change and develop. Along with allopathic medicine it shares issues in appropriate and rational use. This includes qualification and licensing of providers, proper use of good quality products, good communication between TM providers and patients and provision of scientific information and guidance to the public. The patient is the ultimate beneficiary of any system of medicine and therefore should have access to good scientific information. The provision of such information is a shared responsibility of TM providers, their professional associations and the government. In the education and training of TM providers, the first priority would be to ensure appropriate training and examination followed by a licensing system. This would be underpinned by legislation thus ensuring that only those that are qualified can practise TM and
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sell TM products too. If practitioners of other systems are to provide TM services, then their training too should have a component of TM. Some products of TM, such as dietary supplements, may be safe enough to be sold to the public without specific approval or instructions from health care providers – a situation analogous to vitamins in allopathic medicine. Hence, it is necessary to have a classification (general use, sale by TM provider) of these products and to educate the consumers on the proper use, especially of the former. Misuse of therapeutic products is ubiquitous and TM could well profit from the lessons learnt in other systems of medicine. Many TM practices and products have been used for a considerable period of time and are therefore considered safe. While this could in general be true, there are a growing number of reports documenting adverse effects that at times have caused deaths. The possible reasons for these adverse effects are many: misuse of the therapies, therapies for which information on safety is lacking, and interaction between TM products and allopathic medicines are some of them. Hence there is a growing need for health care providers to appreciate potential interactions of allopathic and traditional medicines and for consumers to be made aware too. The information, education and communication aspects of the WHO Traditional Medicine Strategy address these issues and provides a framework for action.
8.
CONCLUSION
In the past, WHO has responded to the requests of the countries for information, assistance and collaboration in TM on a case-by-case basis. The WHO Traditional Medicine Strategy now provides a well thought out, comprehensive framework for collaboration with the countries in TM. The strategy is not a fixed statement and will change with time. Given the considerable regional diversity in the use and role of TM, and the difficulties in defining a precise terminology for describing TM therapies and products, and in assessing the reliability of methodologies used to collect TM data, the strategy must be regarded as a working document that may later have to be modified. Nevertheless it is a beginning with great promise in an area that concerns the health of millions in the South-East Asia Region.