Traditional medicine in the South-East Asia Region
World Health House Indraprastha Estate, Mahatma Gandhi Marg, New Delhi-110002, India www.searo.who.int
Message from Dr Poonam Khetrapal Singh, Regional Director, WHO South- East Asia Region, on the occasion of the Ministerial Round Table on Traditional Medicine in South-East Asia Region Traditional medicine (TRM) is an important and often underestimated part of health care. Member States of the WHO South-East Asia Region have a long history and rich heritage of traditional medicine which contributes to the health and well-being of their people, particularly those in rural and remote areas. For instance, ten out of eleven Member States recognize some types of TRM and have national policies on TRM. Almost all Member States have integrated TRM into their national health-care systems to varying degrees and in different ways. Nine countries have public health facilities for providing TRM services and formal education system, and eight countries have research capacity in TRM. In term of human resources, 3.57 TRM practitioners for every 10 000 population on an average are available in the Region. Recently, the World Health Assembly endorsed the new WHO strategy on traditional medicine 2014–2023, in order to harness the potential contribution of TRM to health, wellness, people-centred health care within the broad framework of universal health coverage. The strategies aim to promote best practices in the use of safe and quality TRM through regulation, research and the integration of TRM products, practices and practitioners into the mainstream health system of countries as appropriate to their national policies and practices. In February 2013, there was an international conference on traditional medicine held in Delhi where the Delhi Declaration on TRM was adopted In a video message to the Delhi meeting, Dr Margaret Chan, Director General of WHO, said “traditional medicines of proven quality, safety and efficacy contribute to the goal of ensuring that all people have access to care. For millions of people, herbal medicines, traditional treatments, and traditional practitioners are the main, and sometimes, the only source of health care. It is also culturally acceptable and trusted by large numbers of people.”
One of the challenges to promote traditional medicines and practices is the concern, both by the public and the health authorities, on the safety, quality and efficacy of traditional medicine. Thus, one of the important questions regarding TRM in recent years is how to regulate TRM products, practices and practitioners in line with international standards. There is, therefore, the need to strengthen national regulatory capacity for TRM products and strengthen regulatory systems and educational mechanisms for TRM practices and practitioners. We need to develop generic protocols, clinical guidelines and benchmarks for TRM practices, and the monitoring of safety and quality of care of TRM services. In order to broaden our discussions around these issues, we have the privilege of having a panel of eminent persons who will lead the discussions on traditional medicines and exchange information and ideas from the experiences of Member States.
Dr Poonam Khetrapal Singh Regional Director
Programme for Ministerial Round Table on Traditional medicine in the WHO South-East Asia Region General objective Share information on possible key areas for action to implement the Delhi Declaration in line with the objectives of new WHO Traditional Medicine (TRM) strategy: 2014–2023
Specific objectives ●● ●● Date: Time: Introduce Delhi Declaration and its implementation; Share experiences of Member States in integrating TRM into health care delivery systems. 9 September 2014 04:00 pm – 05:00 pm
Venue: Ballroom in Hotel Pan Pacific Sonargaon, Dhaka, Bangladesh Time 04:00 pm– 04:15 pm Topic Welcome address Importance of Integration of TRM into the health care system in achieving UHC Delhi Declaration Address 04:15 pm– 04:35 pm Role of TRM in primary health care and its contribution to achieving UHC Integration of TRM into health care system with focus on regulation of TRM products Integration of TRM into health care system with regard to TRM practitioners Integration of TRM into health care system 04:35 pm– 05:00 pm Discussion Summing up and closing Dr. Zhang Qi, Coordinator TRM/WHO/HQ Dr. Margaret Chan, Director-General, World Health Organization H.E. Lyonpo Tandin Wangchuck, Minister of Health, Royal Government of Bhutan H.E Dr Thein Thein Htay, Deputy Health Minister, The Government of the Republic of the Union of Myanmar H. E Mr. Khaga Raj Adhikari, Minister of Health and population, Federal Democratic Republic of Nepal High level dignitary, Thailand Speaker Dr. Poonam Khetrapal Singh, Regional Director, WHO South-East Asia Region H.E Dr Harsh Vardhan, Minister of Health and Family Welfare, Government of India (Moderator)
Delhi Declaration on Traditional medicine for South-East Asian Countries We, the Health Ministers of South-East Asian Countries, representing the Governments of Bangladesh, Bhutan, India, Nepal, Minister of Indigenous Medicine, Sri Lanka, and Vice Minister of Health, Timor-Leste, and the representatives of Democratic People’s Republic of Korea, Indonesia, Myanmar, Maldives and Thailand, Met in New Delhi during the “International Conference on Traditional Medicine for South-East Asian Countries”, and we: (1) Recalled the importance given at the International Conference on Primary Health Care at Alma Ata in 1978 for inclusion of access to traditional medicine in the planning and implementation of health care; Noted the progress of Traditional Medicine in the countries of South-East Asia Region, specifically after the World Health Organization (WHO) brought out the strategy for Traditional Medicine 2002-2005; Considered the importance of various resolutions of the World Health Assembly (WHA) and of the South-East Asia Regional Committee for promoting Traditional Medicine and Medicinal Plants, specifically WHA56.31, WHA62.13 and SEA/ RC56/R6; Appreciated the diversity and richness of Traditional Medical Systems, their courses of study, status of research and development, regulatory frameworks and medicinal flora in the South-East Asian Countries; Recognized that Traditional Medicine and Traditional Medicine Practitioners have substantial potential to contribute for improving health outcomes in various countries of the world; Acknowledged the fact that traditional medicine is culturally acceptable, generally available, affordable and widely used in various countries for the treatment of diseases; Noted the fact that for millions of people often living in rural areas in different countries, traditional medicine is a significant source of health care; Recognized the potential of traditional medicine in providing primary health care, and Expressed the need for sharing of experience and knowledge for securing reliance on traditional medicine for public health benefits.
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Declaration In the light of the above, we hereby agree for cooperation, collaboration and mutual support amongst the South-East Asian countries in all spheres of traditional medicine in accordance with national priorities, legislations and circumstances, and specifically agree to make collaborative efforts aiming at the following: (1) (2) To promote national policies, strategies and interventions for equitable development and appropriate use of traditional medicine in the health care delivery system; To develop an institutionalized mechanism for exchange of information, expertise and knowledge with active cooperation with WHO on traditional medicine through workshops, symposia, visit of experts, exchange of literature etc.; To pursue a harmonized approach for the education, practice, research, documentation and regulation of traditional medicine and involvement of traditional medicine practitioners in health services; To explore the possibility of promoting mutual recognition of educational qualifications awarded by recognized universities, pharmacopoeias, monographs and relevant databases of traditional medicine; To encourage development of common reference documents of traditional medicine for South-East Asian countries; To develop regional cooperation for training and capacity building of traditional medicine experts; To encourage sustainable development and resource augmentation of medicinal plants in the South-East Asian regional countries; To establish regional centres as required for capacity building and networking in the areas of traditional medicine and medicinal plants; and To exchange views, experiences and experts for integration of traditional medicine into national health systems in accordance with national policies and regulations.
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Strengths, weaknesses, opportunities and threats in traditional medicine in the region Strengths ● ● Long history/tradition with rich heritage of TRM in a majority of Member States in the South-East Asia Region Strong political commitment by a majority of Member States to TRM through adaptation of national TRM policy/regulations and integration of TRM as part of the health system. Majority of Member States in the Region have a certain institutional capacity of education/training and research (9 out of 11 Member States) and some countries like India, Indonesia, Thailand, Myanmar and Democratic People’s Republic of Korea have quite strong research capacity in TRM. These countries can help other Member States to carry out the capacity building up to international standards. Traditional medicine has strength in health maintenance and promotion, disease prevention and chronic disease management in a holistic manner. Some general guidelines including “general guidelines for methodologies on research and evaluation of traditional medicine” have been developed by WHO and are available.
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Weaknesses ● ● ● Lack of awareness/recognition by conventional medical practitioners of the theories and the philosophy/principles of traditional medicine. Insufficiency of scientific evidence for the efficacy and safety of TRM owing to lack of research and innovation into various forms of traditional medicines. No generic research protocol for efficacy, safety and quality of TRM.
Opportunities ● ● ● ● Increased recognition and demand for TRM. Increased concern by both health authorities and the public on safety, efficacy and quality of TRM. Delhi Declaration on Traditional Medicine for the South-East Asia adopted at the international conference held in New Delhi in February 2013 New WHO Global TRM strategy: 2014–2023 endorsed through World Health Assembly resolution WHA67.18 in May 2014.
Threats ● ● ● Insufficient recognition of TRM by modern medical science, especially on the theories and principles of TRM. Risk of loss of traditional knowledge for maintaining health and health care of people in some countries. Insufficient resources allocated to ensure adequate regulation and monitoring of products, practices and practitioners
Current situation of TRM in the WHO South-East Asia Region Traditional medicine (TRM) is an important and often underestimated part of health care. Almost every country in the world has its own form of TRM and the demand for it is increasing. TRM of proven quality, safety and efficacy contributes to the goal of ensuring that all people have access to care. Many countries now recognize the need to develop a cohesive and integrated approach to health care, which allows governments, health-care practitioners and patients to access TRM in a safe, affordable and respectful way where TRM treatments of good quality are delivered according to best practices as defined by the leaders in the concerned TRM discipline. In the WHO South-East Asia Region, all Member States have a long history and rich heritage of TRM, which contributes to the health and well-being of their people. In 2003, the Fifty-sixth Regional Committee adopted resolution SEA/RC56/R6 on traditional systems of medicine, in line with the objectives of the first WHO Global TRM strategy, 2002–2005 launched in 2002. Since then, much effort has been made at the country and regional levels to promote the safe and effective use of TRM in the Region. Many countries, including Bhutan, the Democratic People’s Republic of Korea, India, Myanmar, Sri Lanka and Thailand, have developed monographs, pharmacopoeias and training manuals on the use of herbal medicines in primary health care with technical and financial support of WHO. TRM has been integrated into the national health-care systems to varying degrees and in different ways in different countries. Ten of the 11 countries have national policies on TRM, seven countries have regulations on TRM practices and nine have an education system for TRM. In some countries, TRM practitioners remain the main health-care providers for millions of people living in rural areas. A review of government documents, and inquiries to governments via the WHO country offices have revealed the following information. Bangladesh: Ayurveda, unani and homeopathy are practiced. There are formal degrees from Dhaka University and diploma courses by the Board of Traditional Medicine in ayuveda, unani and homeopathy. Posts for TRM doctors have been created and their recruitment in district hospitals is underway. Currently, there are 31 000 registered TRM practitioners (2.5 per 10,000 population), with 45 TRM hospitals and centres. Annual sales of TRM products in 2009 were 86 million USD. Bhutan: The TRM system is Sowa rigpa which is practiced together with allopathic medicine, there being 50 health facilities with TRM units. The country had 174 registered TRM practitioners as of 2013 (2.5 per 10 000 population), with a national formal educational system for TRM. The Democratic People’s Republic of Korea: The country has its own Koryo system of medicine, services for which coexist at all health service facilities from the central down to the primary healthcare level (one central and 12 provincial-level TRM hospitals, 213 country/district hospitals and 4500 Ri/Dong clinics nationwide). The number of Koryo doctors is about 5000 (2.2 per 10 000 population) and 5000 Koryo pharmacists. More than 50% of the population uses TRM for health care. There are 11 medical universities, each one of which has a traditional medicine faculty and an Academy of Koryo medicine in Pyongyang. India: The country has several TRM systems, including ayurveda, yoga, unani, siddha and homeopathy (AYUSH). There were 686 310 registered AYUSH doctors as on 1 January 2013 (5.5 per 10 000 population), 3204 AYUSH hospitals and 61 583 beds (5 beds per 100 000 population). There are 508 colleges, all recognized by central government, with an annual admission capacity of 25 586 undergraduate students as well as five research councils and eight national institutes
for education, research and clinical studies. Annual exports of TRM medicines were worth more than US$ 2 billion in 2011. Indonesia: The TRM system is known as Jamu. The country has many medicinal plants due to its geographical characteristics; it has 30 000 out of the 40 000 species of plants worldwide, of which 9600 species are used as medicine and 300 species are used by industry as raw materials for manufacturing TRM. As of 2007, there were 1036 licensed TRM industries in total, and the estimated market value of TRM was above US$ 1 billion. There are also six institutes, nine hospitals and 13 centres dedicated to TRM. Myanmar: The country also has its own TRM system, which includes the Desana, Bhesijja, Netkhatta and Vijjadhara systems. There is a TRM council, a Directorate General in the MOH and more than 6000 TRM practitioners (1 per 10 000 population), 251 TRM hospitals, 10 518 TRM drugs and 1 985 registered manufacturers as of 2011. There is a university to train TRM practitioners and also a number of research institutes for TRM; research has been focused largely on six common diseases (diarrhoea, dysentery, malaria, tuberculosis, hypertension and diabetes). Nepal: Ayurveda, unani, homeopathy and Amchi are practiced. There are 2350 registered TRM practitioners (0.9 per 10 000 population), three TRM hospitals, 75 TRM centres and 391 dispensaries nationwide. Sri Lanka: The country has an indigenous system Deshiya chikitsa and also ayurveda and sidhha medicine are practiced. There are approximately 15 000 registered TRM practitioners (7.3 per 10 000 population) and 164 TRM hospitals and health centres and six TRM institutes nationwide. Thailand: The country has its own TRM system, certain services of which are covered under the universal health care coverage scheme. There were approximately 47 137 licensed TRM practitioners (covering medicine, pharmacy, midwifery, massage and applied practices) in 2009 (7.4 per 10 000 population). Standards for TRM services in the health-care system have been set and all 95 regional hospitals (100%), 689 of 726 community hospitals (94.9%) and 6368 of 9868 health centres (64.5%) have met the standards (66.9% on average).
Fact sheet on current situation of TRM in South-East Asia Region Member States Bangladesh Bhutan DPRK India Indonesia Maldives Myanmar Nepal Sri Lanka Thailand Timor-Leste #/Average TRM recognized Year 1972 1968 1948 1947 2009 1952 1980 1981 1941 1999 Not 10 Regulation Product Y Y Y Y Y Y Y Y Y Y Nil 10 Practice Nil Y Y Y Y Nil Y Y Nil Y Nil 7 Practitioner Nil Y Y Y Y Y Y Y Y Y Nil 9 # TRM practitioner (10 000 population) 2.5 2.5 2.2 5.5 N/A 0.7 1.0 0.9 7.3 7.4 Nil 3.57 # TRM service facilities 45 50 4 725 3 204 17 Nil 251 469 146 7 152 Nil 9 # Education institution 64 2 13 1 075 3 Nil 2 8 3 2 Nil 9 Research Institute Y Nil Y Y Y Nil Y Y Y Y Nil 8
Source: Country data DPRK: Democratic People’s Republic of Korea
Koryo traditional medicine in Democratic People’s Republic of Korea
Ministry of Public Health Pyongyang
Koryo traditional medicine in Democratic Peoples Republic of Korea 1. History of Koryo traditional medicine Koryo traditional medicine has a history of 5000 years. For instance, in 3000 B.C., a stone-needle therapeutic method was established in Korea in which diseases were treated with stone-needle recorded as “Phomsok”. These stone-needles were discovered in many historical sites of the country. Koryo traditional medicine was developed based on its unique theory i.e. Um and Yang, the five fundamental elements theory, four-constitution theory and on experiences indigenous to the culture of Korea, which contributes to the health of its people. The level of its development could be
“Hyangyakjipsongbang” written by Ro Jung Rye (?`1452
“Uibangryuchi” written by Kim Rye Mong
Ho Jun (1546~1615) and “Tonguibogam”
seen through the three main Koryo traditional medicine classics edited and issued during the 15th to 17th centuries, even though there are many other Koryo traditional medicine classics in history. They are “Hyangyakjipsongbang” (“Compendium of prescriptions from the countryside”), “Uibangruichi” (“Classified assemblage of medical prescriptions”) and “Tonguibogam” (“Treasured mirror in Eastern Medicine”).These are of great significance in the development of Koryo traditional medicine. The details of these three main Koryo traditional medicine classics are as follows: “Hyangyakjipsongbang” ( 85 volumes) is one of the three Koryo medical classics published by Ro Jung Rye, a famous Koryo medical doctor et al. in 1433, which describes about 10 706 herbal prescriptions for 959 diseases and 694 kinds of domestic herbal materials. “Uibangruichi” (266 volumes) was published by Kim Rye Mong et al. in 1477. It made a comprehensive compilation of successes achieved in the development of Koryo traditional medicine up to the beginning of 15th century, which was well known as a medical encyclopaedia worldwide in that time.
Ri Je Ma(1837~1900) and Human Constitution Medicine
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“Tonguibogam” published by Ho Jun, a famous Koryo medical doctor in 1611 comprises of total 25 volumes and describes Koryo medical therapeutic methods for diseases in all special departments and has information on about 1400 kinds of domestic herbal medicines. It not only played an important role in the development of Koryo traditional medicine at that time but is also of great practical significance in the development of traditional medicine even today. The three main Koryo traditional medical classics were reprinted several times either at home or abroad. In addition, Ri Je Ma, a famous Koryo traditional medical doctor wrote “Tonguisusebowon” (“Longevity and life preservation in eastern medicine”) in 1894 and put forward the constitution theory for the first time to establish the Koryo traditional medical therapeutic methods and prescriptions according to the human constitution, which has an important bearing on the development of Koryo traditional medicine.
2. National policy for Koryo traditional medicine Koryo traditional medicine, which has a long history and tradition enjoyed its golden age after liberation. The great President Kim Il Sung had stated after liberation in 1945 that it was an important policy to combine Koryo traditional medicine with the conventional one in development of national medicine. In May 5, 1948, Democratic People’s Republic of Korea recognized Koryo traditional medicine as a national indigenous traditional medicine through adoption of decree No.81 of the government on “Regulation on Koryo traditional medicine and its practitioners. The adoption of the public health law in the 4th session of the 6th Supreme People’s Assembly led to the development of Koryo traditional medicine backed by the party and state.
Koryo Medical Treatment is actively encouraged
“Chart of Meridian Nerve Points” developed by Scientists in Academy and Diplomas of Honor presented to it
3. Koryo traditional medicine service Today, in the Democratic People’s Republic of Korea, Koryo traditional medicine is making a significant contribution in realizing the universal Strengthened in Academy is Study on Meridians
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free medical service system by providing patients with Koryo treatment as well as allopathic treatment at the primary health care level. This has resulted in more choices for the patients and has increased patients’ accessibility to health care. There is an Academy of Koryo Medical Science as a Central Scientific Research and Therapeutic and Preventive institution, and the Pyongyang Municipal Koryo traditional medicine hospital in Pyongyang and provincial Koryo traditional medicine hospitals in each province (20 in total). In addition, all the modern medical facilities including central and provincial modern medicine hospitals (133 in total), and county and Ri hospitals/clinics at primary health care level (7871 in total), have a Koryo traditional medicine section and Koryo traditional medical doctors, who are providing Koryo medical service to the community. The number of Koryo traditional medicine doctors registered is 5249 (2.3 per 10 000 population) and Koryo pharmacists—1869 as of 2013. There are also 28 Koryo traditional medicine research institutions and 210 Koryo pharmaceutical factories in the country. At least 50% of health care is delivered with Koryo traditional medicine and the rest with allopathic treatments at the primary health care level in the country. Besides, in Democratic People’s Republic of Korea, there is a household doctor at the primary health care level. This unique primary health care service delivery system allows one household doctor to serve around 135 households in his/her catchment area on an average. All the household doctors are trained in both allopathic and Koryo traditional medicine in their medical education at the medical university. Therefore, household doctors are authorized to provide allopathic and certain types/ modalities of Koryo traditional medical treatment to the patients at the primary health care level. In general, the household doctors stay at the primary health care centre in the morning in order to attend to the patients at the centre and in the afternoon, they undertake family visits as per their duty schedule in order to provide medical consultation, health education and any other duties to the community, if necessary.
4. Education system for Koryo traditional medicine In Democratic People’s Republic of Korea, there are 13 medical universities at the central and provincial level and one Koryo traditional medicine pharmaceutical university. Each medical university has a Koryo traditional medicine faculty, where Koryo traditional medicine is taught. The duration of the course is seven years. The Koryo traditional medicine faculties in the country train a number of Koryo traditional medicine doctors annually who are Academy of Koryo Medical Science
Estimation of Internal Organs Based on the Auricular Acupoints Information
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also conversant with modern medicine. The textbooks in use teach the basic theories of Koryo traditional medicine, acupuncture, material medica, herbal prescriptions, Koryo internal medicine, surgery, gynaecology, paediatrics, ophthalmology, ENT, etc. The students who study Koryo traditional medicine are also taught some modern medicine subjects like anatomy, physiology and pathology, as well as clinical ones like internal medicine, surgery, paediatrics and gynaecology. Therefore, a graduate from the faculty is able to diagnose and treat with certain modern medicines for specific conditions as well as with Koryo traditional medicine and referral between the disciplines is facilitated.
5. Research and Academy of Koryo Medical Science
Making Koryo Herbal and other materials as Extract and Production of Various Herbal Preparations*
In Democratic People’s Republic of Korea, there are 28 Koryo traditional medicine research institutions. The Academy of Koryo Traditional Medical Science is one of the leading institutes engaged in research on Koryo traditional medicine. The academy was founded by direct initiation and care of the great President Kim Il Sung on 14 February 1961, with only six research departments. Today, the Academy has developed into a central scientific research centre and also provides therapeutic Koryo Medicine Center and Branch Center Established in Moscow, Russia Federation and preventive service on the basis of Koryo traditional medicine. The centre has eight research institutes and about 60 research departments and ambulatory polyclinics. In the academy, there are more than 200 members with academic degrees and titles and more than 500 experts on Koryo traditional medicine including researchers, doctors, pharmacists, IT experts and so on.
5.1 Research in Koryo Traditional Medicine The Academy is carrying out many research projects every year for developing Koryo traditional medicine and promoting its safety, efficacy and quality. A special attention is paid to the standardization of the process of preparing herbal materials as extracts in order to improve the dosage formulation and the quality of the herbal
* An antler which is cut in a humane way from a live deer without killing it.
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medicine and significant progress has been made in this area. In addition, recently, a lot of studies including “estimation/prediction on the function of internal organs based on auricular acupoints information”, “clinical trial of Koryo traditional medicine constitutional prescriptions according to the human constitution”, “Koryo traditional medicine therapeutic methods of disk herniation”, “preparations from hawthorn leaves and their clinical effects” have been carried out and Koryo traditional medicine therapies with proven efficacy have been introduced at the primary health care level nationwide. The Academy has the responsibility of providing technical guidance to research work and health care services in traditional medicine all over the country. The Academy also organizes national conferences on Koryo traditional medicine, sectional seminars, workshops and so on, through which success in scientific research is disseminated.
Exchange and Cooperation with China in Traditional Medicine Field
5.2 Central therapeutic and preventive service Base in Koryo traditional medicine. The Academy provides medical services with Koryo traditional medical therapeutic methods including acupuncture, moxibustion, cupping, manual therapy, constitutional therapy and others. Incurable diseases including spinal and nervous diseases, cerebro-vascular diseases, metabolic diseases and noncommunicable diseases with modern medicine are treated and managed using a combinaton of Koryo traditional medicine and modern one. The Academy is actively introducing and generalizing achievements made in clinical research and practice to primary health care.
5.3 Training in Koryo traditional medicine The Academy provides training and practice to the students from the university of medicine and practicing doctors every year. In the Academy, there is a post-graduate course, through which a number of professionals in traditional medicine are trained every year.
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5.4 International cooperation and exchange in traditional medicine During the period 1988-2004, the Academy was designated as WHO Collaborating Centre and carried out two WHO projects and published seven references and eight annual reports on technical information in Koryo traditional medicine. The Academy is actively promoting international cooperation in the field of traditional medicine by standardizing the TRM therapeutic methods through the development of “chart of meridian nerve”, “dictionary of acupuncture and moxibustion”, “clinical manual for acupuncture, moxibustion and manual therapies”, “encyclopaedia of folk remedies” and other Koryo medical references. It plans to publish “clinical acupuncture and moxibustion and manual therapy”, “essential Koryo herbal medicines” and “medicinal plants and their use in Koryo traditional medicine” in English and has completed its preparatory work. The Academy is strengthening international exchange and cooperation in traditional medicine including research and education with other countries including China. Academy has signed an MoU and established Koryo traditional medicine centres in other countries and sent Korean experts to those countries including Russia, Mongolia , Kazakhstan, Poland, Brazil etc.
6. Summary Today, use of traditional medicine is becoming a global phenomenon and the demand for it is increasing due to its increasing popularity and efficacy and its unique holistic approach to health. Democratic People’s Republic of Korea is also one of the countries which signed the Delhi Declaration on Traditional Medicine for South-East Asia at the international conference on traditional medicine held in New Delhi in February 2013. The Ministry of Public Health together with the Academy of Koryo Medical Science will do its best to make Koryo traditional medicine contribute more effectively in managing and preventing diseases and in improving people’s health. The government of Democratic People’s Republic of Korea will actively cooperate with WHO and Member States in promoting the safety, quality and effectiveness of traditional medicine in line with the strategic objectives and directions of the new WHO Global TRM strategy: 2014-2023.
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Framework for assessing the TRM environment and integration with national health systems 3. Need for Integration If yes With which T/CAM 4.1 practices, providers or products? • Are there other T/ CAM practices or providers where there is no integration? 4.2 How is integration occurring? Give examples: • Consumer level • Practice and delivery level • Health system and policy level Consider Is drive for integration 4.2a from top-down or ground up? If no Is a program of 4.3 integration needed? • Could it facilitate items at 3.2? 4. Is Integration Occurring? 5. Actions for Integration Define Goal(s) of integration 5.1 Consider Equity, ethics, 5.2a innovation & standards • Policy, practice & delivery models b • Intellectual property Identify • Type of T/CAM for 5.3a integration b • Barriers and their remedies c • Champions of integration d • Areas where integration provides benefit e • Programs for development f • Funding Facilitate Change to promote 5.4 integration • Systems / policy • Practice & service delivery • Attitudinal / cultural • Information exchange Consider a. Who benefits from integration? b. Are there noncurrent examples of integration, e.g. from last century? • If yes, can they provide lessons for today? Provide Infrastructure 5.5 • Incl. legal & regulative • Education & training
1. Existing T/CAM* Environment
2. Institutional Context
Define What is T/CAM? 1.1
Identify Types of T/CAM: 1.2 • Practices • Products Is there ‘integrative’ medicine which combines T/CAM and western practice?
Identify Supporting government 2.1 or institutional infrastructures: • Policies • Legal & regulatory frameworks • Funding / investment • Reimbursement / subsidy • Programs • Safety & quality monitoring • T/CAM employment opportunities
Assess Existence of and 2.2 support for country level indicators from WHO Global Strategy for Traditional Medicine, 2014-2023 Consider Could integration of 3.2 T/CAM with national health systems: • Improve access or health outcomes? • Decrease or increase cost of health care? • Increase consumer satisfaction and compliance? • Increase employment or productivity? • Other?
Identify Regions served mainly 3.1 by: • T/CAM practitioners • Conventional medicine • Both T/CAM and conventional medicine • Integrative/integrated medicine • No health care Do some people use: • Only T/CAM? • Only conventional medicine? • Both T/CAM and conventional medicine? • Integrative/integrated medicine’? • None of the above
Map or identify for each type of 1.3 T/CAM: a. Usage • Level of support and reasons for use b. Organisation • Workforce • Professional/consumer representative groups • Practice delivery c. Resources • Personnel • Facilities • Funds • Third party recourse • Education, qualifications d. Research • Methodology? • Outcomes • Quality e. Support industry • Growers, suppliers, etc
Attitudes Of consumers, Monitor practitioners, policy2.3 makers • Towards T/CAM • Towards integration of T/CAM with national health systems
Quote: Rachel Canway, June 2014 A report for WHO-WPRO “Traditional & complementary medicine integration with national health systems. * T/CM: traditional and complementary medicine
New Global WHO TRM strategy 2014–2023 The new WHO global strategy for TRM has been endorsed by World Health Assembly resolution WHA67.18 in May 2014. The goals for the WHO Traditional Medicine Strategy: 2014 – 2023 are to support Member States in: ● ● Harnessing the potential contribution of traditional and complementary medicine to health, wellness, people-centred health care and UHC; Promoting safe and effective use of traditional and complementary medicine through the regulation, research and integration of traditional and complementary medicine products, practices and practitioners into the health system, as appropriate.
There are three strategic objectives in the new WHO Traditional Medicine Strategy: 2014–2023 i.e. (1) to build the knowledge base for active management of TRM through appropriate national policies with two strategic directions: (a) understand and recognize the role and potential of TRM and (b) strengthen the knowledge base, build evidence and sustain resources (2) to strengthen quality assurance, safety, proper use and effectiveness of TRM by regulating TRM products, practices and practitioners with two strategic directions: (a) recognize the role and importance of product regulation and (b) recognize and develop practice and practitioner regulations for TRM education and training, skills development, services and therapies, and (3) to promote universal health coverage by appropriate integration of TRM services into health care service delivery and self-health care with two strategic directions: (a) capitalize on the potential contribution of TRM to improve health services and health outcomes and (b) Ensure consumers of TRM can make informed choices about self-health care.
Traditional medicine in South-East Asia Definition of traditional medicine and complementary or alternative medicine Traditional medicine is the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness. (http://www.who.int/medicines/areas/traditional/ definitions/en/). The terms “complementary medicine” or “alternative medicine” refer to a broad set of health care practices that are not part of that country’s own tradition or conventional medicine and are not fully integrated into the dominant health-care system. They are used interchangeably with traditional medicine in some countries. (http://www.who.int/medicines/ areas/traditional /definitions/en/)
Viewpoint of the WHO Director-General towards integration of traditional medicine into national health care system The two systems of traditional and western medicine need not clash. Within the context of primary health care, they can blend together in a beneficial harmony, using the best features of each system, and compensating for certain weaknesses in each. This is not something that will happen all by itself. Deliberate policy decisions have to be made. But it can be done successfully – Quoted from the address by Dr. Margaret Chan, the Director-General of WHO, at the WHO Congress on Traditional Medicine held in Beijing, China, on 7 November 2008..
Types of traditional medicine in the WHO South-East Asia Region Ayurveda, Yoga, Unani, Siddha, Homeopathy, Deshiya chikitsa, Koryo TRM, Thai TRM, Jamu, Sowa rigpa, Myanmar TRM, Chinese TRM etc.