WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTE
REGIONAL OFFICE FOR
THE WESTERN PACIFIC
BUREAU R~GIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMMITTEE Thirty-eighth session Beijing 8-14 September 1987 Provisional agenda item 18
WPR/RC38/14 24 June 1987
ORIGINAL:
ENGLISH
TRADITIONAL MEDICINE: PROGRESS, PROBLEMS AND FUTURE DIRECTION Report by the Regional Director
At its thirty-sixth session in 1985, the Regional Committee adopted resolution WPR/RC36.R6 on traditional medicine, calling for further action in the areas of programme formulation, training, .research and information exchange, particularly on herbal medicine and acupuncture. Traditional medicine was also the topic of the Technical Discussions held in conjunction with the same session of the Regional Committee. This report reviews the progress made during the biennium, reexamines the problems and proposes future activities for the further development of the traditional medicine programme. The Committee's attention is also drawn to resolution WHA40.33, adopted by the World Health Assembly in May 1987, which is attached as Annex 2.
WPR/RC38/14 page 2
1.
INTRODUCTIOlf
The Western Pacific Region is considered to have a long history of traditional medicine and is believed to have rich resources at its disposal. To serve as a policy basis for the ~10 traditional medicine programme, the World Health Assembly has adopted a number of resolutions: resolutions WHA29.72 and WHA32.42 support the use of traditional health workers in primary health care; resolution WHA30.49 urges Member States to utilize and promote their traditional medical care systems; resolution WHA31.33 draws attention to the importance of medicinal plants in the health care systems of developing countries. The Sub-Committee of the Regional Committee on Technical Cooperation among Developing Countries, meeting in July 1985, noted that, while the WHO programme on traditional medicine had made considerable progress in the area of acupuncture, not much had been achieved in herbal medicine. Following the recommendation of the Sub-Committee, the Regional Committee adopted resolution WPR/RC36.R6, calling for further action in the areas of programme formulation, research, training and information exchange (See Annex 1). Traditional medicine was also discussed at the Technical Discussions held in conjunction with the thirty-sixth session of the Regional Committee, where it was noted that the situation with regard to traditional medicine in the Region was generally encouraging.
2.
PROGRESS
Significant progress has been made during the past few years in the integration of traditional medicine into the health services, as well as in research, training and information exchange, particularly on herbal medicine and acupuncture. 2.1 Integration of traditional medicine into the health services
Countries in the Region· have continued to strengthen their traditional medicine activities. WHO collaborated in the conduct of national workshops on the integration of traditional medicine in primary health care in Fiji, Papua New Guinea, the Republic of Korea and Viet Nam in 1984 and 1985. The workshops reviewed the status of traditional medicine, determined training needs and discussed appropriate research methodologies with a view to developing national policies on the integration of traditional medicine into the health services.
WPR/RC38/14 page 3
In early 1987, following these workshops, coverage under the national health insurance scheme in the Republic of Korea was extended to include the practice of acupuncture and use of twenty-six traditional formulas. In Viet Nam where traditional medicine is already one of the key elements of the national health services, a national workshop in November 1986 reported on the successful application of traditional medicine in the fields of internal medicine, surgery, gynaecology and ophthalmology. A WHO-sponsored interregional seminar was held in Guangzhou, China, in October 1985 at which participants learnt about experience in integrating traditional medicine in primary health care in China. The State Administration of Traditional Chinese Hedicine was set up in China in 1986 to promote the further development of traditional medicine.
2.2
Herbal medicine
A meeting of the Scientific Group on Herbal Hedicine Research was held in Tokyo in Harch 1986 to discuss appropriate methodology to be applied in herbal medicine research. Three priority areas for research were defined: (a) identification of useful medicinal plants, especially those suitable for use in primary health care; (b) establishment of quality standards; and (c) validation of the safety and efficacy of herbal drugs based on the concepts of both modern medicine and traditional medicine. A national workshop on herbal medicine research was also held in Hanoi in January 1987. Inventory surveys of medi cinal plants have been carried out in the South Pacific. As a result of surveys in Fiji, Papua New Guinea, Samoa and Vanuatu in December 1985, a model list of twenty widely used medicinal plants in tropical Pacific areas was developed to serve as a basis for regi onal/subregional herbal formularies. An inventory survey of medicinal plants was also conducted i n Cook Islands in October 1986. In the Philippines, five essential medicinal plants were the subject of toxicological studies, including mutagenicity tests and clinical controlled trials. These have been shown to be safe and effective in their respective analgesic, antitussive, anticolic, diuretic or antihelmi nthic action. In Japan the Pharmaceuti cal Affairs Division of the Ministry of Health and Welfare issued new regulations in 1985, setting quality control standards for ready-to-use traditional drugs. Traditional drugs of standard quality became available on the market a year later, and are now being used by more than 40% of the physici ans in their routi ne practice. Information exchange on herbal medicine has been f urther strengthened through support for academic meetings on t r aditional medicine. In cooperation with ~10, the Fourth International
WPR/RC38/14 page 4
Conference of Oriental Uedicine was held in Kyoto, Japan, in October 1985, at which research on herbal medicine therapies for pain, bronchial asthma, hypertension and other diseases was reported. Most notable of these reports was the one on Rhei rhizoma as a ureanitrogen decreasing agent, in addition to its traditional use as a purgative. 2.3 Acupuncture
Efforts have continued to develop the programme on acupuncture. The second and third Regional Working Groups on the Standardization of Acupuncture Nomenclature were held in Hong Kong and Seoul in July 1985 and June 1987, respectively, to further develop a standard acupuncture nomenclature. A standard nomenclature was developed for seventeen extra acupuncture points located outside of the fourteen meridians. So far 48 extra acupuncture points have been adopted, including the nomenclature of eight extra meridians and basic technical terms in acupuncture. In the Philippines, acupuncture has been successfully integrated into the national health services. A WdO-supported national evaluation workshop on acupuncture training, held in Manila in February 1987, assessed the skills and knowledge of about eighty physicians who had attended a basic acupuncture course conducted by graduates of ·the previous year's advanced training course. It was shown that these graduates were capable of training others in acupuncture. Extensive acupuncture research has been carried out, particularly in China and Japan, where activities have focused on the meridian phenomenon and neuropharmacological and neurophysiological approaches.
3.
PROBLEMS
3.1
Social factors to integrate medicine by
The following social factors have impeded efforts traditional medicine into the health services: slow recognition of the value of traditional workers in the modern h~alth sector;
lack of the political, legal, material and other support needed from both governments and institutions/associations of modern medicine; fears that integration may threaten the status, freedom of action of those involved; lack of mutual respect and understanding practitioners of modern and traditional medicine. income or
between
WPR/RC38/14 page 5
3.2
Information Information is lacking in the following areas: existing traditional medical practices, the needs addressed by these practices and their potential resources, particularly in the South Pacific; safety and efficacy of traditional medicine; cost-effectiveness of traditional medicine.
Dissemination and exchange of information are also not well developed because of the existence of different systems of traditional medicine and language barriers. 3.3 Resources Resources are lacking in a number of areas: managers and field workers in the health servi ces capable of pioneering effective programmes; organizations representing traditional practitioners, especially of the simple systems of traditional medicine, e.g. folk medicine; financial resources, infrastructural facili ties, particularly for transport, storage, communications and supplies such as traditional drugs. Generally speaking, there is an unequal distribution of resources within countries between the centre and the periphery, where needs are greatest and resources the most lacki ng .
4.
FUTURE DIRECTION
The f ollowing activities are proposed aimed at t he further promotion of traditional medicine and its integration into the health services. 4.1 Development of an effective policy on the integration of traditional medicine into t he health services
If traditional medici ne and i ts practitioner s are t o become effectively integrated into the health ser vices, a clear and posit ive policy, backed up by appropriate legi slation, is needed. Development of such a policy depends upon recognit ion of the value of traditional medicine and the r ole of its practitioners.
WPR/RC38/14 page 6
4.2
Research promotion
The value of traditional medicine will be validated within the scientific framework. Evaluation of the efficacy and safety of traditional medicine is more important than investigation of the mechanisms of its therapeutic effects. This is because the former is of direct relevance to promotion of the use of traditional medicine in the health care services. Research on existing traditional medical practices, including inventory surveys of medicinal plants, as well as on costeffectiveness will also be promoted with a view to further utilization of resources. 4.3 Development of training will be medicine
Training of different categories of personnel strengthened, such as programme managers, traditional doctors, acupuncturists, herbalists and modern physicians.
In those countries wher e there are no training activities, national training programmes will be developed based on appropriate guidelines. International sharine of resources and transfer of technology can play a significant part in the development of training activities. 4.4 Information exchange
Information exchange wi ll be strengthened, both within and between countries, on what is known and considered useful in the practice of traditional medicine, ~articularly as regards the integration of traditional medicine in the health services. Information plays an important role in promoting cooperation between the groups concerned and should be disseminated through all availa ble m edia. I ncr eas ed use will be made of information provide d by collabora ting centres , other United Nations agencies s uch as UNESCO, FAO, UNIDO and UNICEF and nongovernmental organizations.
WPR/RC38/14 page 7
ANNEX 1 .. . . . . . MM&.TM CNI8ANIZATION
OAGANIMTION MONDIM.a N
U SANft
R llt. . IOHAL COMMITT&& POll TH&
E S 0
L
U
T
0
N eotlotl Til IIUICIIONAL DU PACtl'tQU& OCCIDDITAI.
WllliHIIN PMPt'IC
WPR/RC36.R6 18 Septeaber 1985
SuB-COKHITTIE ON TiCBBICAL COOPERATION AMONG DEVELOPING COUNTRIES: TJW)lTION,AL.MBJliClR
The B.egional Having
~ittee,_
consider.~d
tbe repQrt of the Sub-CoiiiBliUee on lechnical
Cooperation •oaa Develop~na CQuntries; 1 Re_calling .resolutio11, WPit/JlCJ,.RJ; Noting resolution Wlf.t0&.23 qn t-.chnicsl cooperation among countries in support of the goal of health fC)r all; R.ecopizina that tra4itional medicine practices, particularly those of herbal 1Hdicine and a~up"lncture, dev~loping
constitute appropriate
tecbno~ogies
which
could be integrated into the national health strategies; Notio,a that her_bal -.oicine and acupuncture are subjects Which lend themselves particularly well to- technical c,QOperation among Member States of the Region; 1. ~S
the. Sub-eo..i.ttee on TecJmical Cooperation
QlQn8
Developing
Countries for its worJr.; 2. URGESMember St;atea: (1)
to review the status of herbal aedicine and acupunctur.e in the nee~s
light of the
arisi11g out ottheir bealth strategies and, where
. ne~essary, to initiate prog:r8QIIles for the.ir development;
•.. I
WPR/RC38/14 Annex. 1, ·page 8
WPR/RC36.R6 page 2
(2)
to undertake research in herbal medicine and a~upun~ture as
indicated by the status of development of these technologies; (3) to shat·e freely with each other their experiences in this field
as well as information available on the subject, including their national formularies and the results of completed research; (4) to incorporate relevant aspects of herbal medicine and
acupuncture in the training of their health workers; (5) to ensure the maintenance of high standards of training anri
practice in the field of traditional medicine, througb such measures as licensing or .the keeping of adequate records; 3.
REQUESTS the Regional Director: (I) to intensify efforts to promote among Member States greater
awareness and recognition of the value of herbal medicine and acupuncture; (2) to collaborate with Member States in the formulation and
implementation of progra1111Des for the development of herbal medicine and acupuncture; {3) to support the exchange of information ali!Ong Member States,
including collaboration in the documentation-of experiences, preparation of national herbal medicine formularies, or updating of existing ones; (4) , to encourage and support the conduct of research, including the investigation and evaluation ,of the efficacy and safety of herbal therapies;
... /
WPR/llCl8 /14 Annex 1 page §ho WPR/RC36.R6 page 3
(5)
to strengthen national institutions and to designate them, where
,appropriate, as collaborating centres, with a view to their active participation in technical cooperation activities with other 'countries, includi.na training couraea, rea.-rch and sharing of expertise; J6) to aobilize turt.h er resources in aupport of herbal JRedicine and
acupuncture in anticipation of the expaniiou of the traditional •edicine proara....
Fifth meeting, 18 Septeaber 1985 WPi/RC36/SR./5
FORTIETH WORLD HEALTH ASSEMBLY Agenda item 18.2
WPR/RC38/14 page 11
WHA40.33 15 May 1987
TRADITIONAL MEDICINE The Fortieth World Health Assembly, Aware that traditional systems of medicine play an important role in preventive, promotive and curative aspects of health, particularly in developing countries; Noting that there exists a vast reservoir of practitioners of traditional systems of medicine and an almost untapped wealth of medicinal flora; Recalling the earlier resolutions of the Assembly concerning health manpower (WHA29.72), training and research in traditional medicine (WHA30.49) and medicinal plants (WHA31.33) and the related recommendations of the Alma-Ata Conference; 1. URGES Member States: (1) to utilize optimally practitioners of their traditional systems of medicine in primary health care, whenever possible and appropriate; (2) to initiate comprehensive programmes for the identification, evaluation, preparation, cultivation and conservation of medicinal plants used in traditional medicine; (3) to ensure quality control of drugs derived from traditional plant remedies by using modern techniques and applying suitable standards and good manufacturing practices; (4) to support research into traditional ways of treating ailments and promoting family health, nutrition and well-being; (5) to extend cooperation and exchange of experts, skills and training in traditional systems of medicine and related fields, particularly between countries with a similar cultural background; 2. REQUESTS the Director-General: (1) to mobilize extrabudgetary funds to assist Members in implementing these activities; and (2) to promote intercountry seminars to improve mutual understanding, the dissemination of knowledge and the exchange of experience. Twelfth plenary meeting, 15 May 1987 A40/VR/12