AFRICAN UNION UNION AFRICAINE
Addis Ababa, ETHIOPIA P. O. Box 3243 Telephone +251115-517700 Fax : +251115-517844
Website : www.africa-union.org
TH4 SESSION OF THE AU CONFERENCE OF MINISTERS OF HEALTH
ADDIS ABABA, ETHIOPIA
4-8 MAY 2009
Theme: “Universal Access to Quality Health Services: Improve Maternal
Neonatal and Child Health”
MEETING OF EXPERTS
4-6 MAY 2009
PROGRESS REPORT ON THE AU DECADE OF
TRADITIONAL MEDICINE (2001-2010)
Review Report of End of Decade of ATM
1. About 80% of Africa’s population relies on traditional medicine or their basic health needs. In some cases traditional medicine is all the health care services available, accessible and affordable to many people on the continent. In this case the significant contribution of traditional medicine as a major provider of health care services in Africa cannot be underestimated.
2. It was in this context that the AU Summit of Heads of State and Government meeting in July 2001 in Lusaka Zambia adopted a declared 2001-2010 as the Decade for African Traditional Medicine (ATM). WHO-AFRO provided support to the AU during the process of making the declaration. Following this landmark commitment by Africa’s Leaders, the First AU Session of the Conference of Ministers on Health (CAMH1) held in April in Libya, adopted the plan of Action and implementation mechanism, which was later, endorsed by the AU Summit meeting in Maputo in 2003.
3. The main objective of the plan of Action of ATM is the recognition, acceptance, development and integration of Traditional Medicine by all Member States into the public care system on the continent by 2010. Additionally AU in collaboration with
stpartners declared 31 of August of each year as the day to commemorate ATM. During the last commemoration of ATM (31 August 2008) in Yaoundé Cameroon, Ministers of Health deliberated on the Mid-Term Review of the Decade of ATM. Among other recommendations, the Ministers emphasized that Member States should strengthen their political will and infrastructure commitments for institutionalization of ATM into national health systems at all levels. And that a national mechanism should be established whose objective is to promote a dialogue between traditional and conventional practitioners of medicine.
4. The Plan of Action of the AU Decade on African Traditional Medicine Identified eleven key areas for implementation by Member States. These areas were:
i. Sensitization and popularization of TM;
ii. Policy and Legislation on TM;
iii. Institutional arrangements;
iv. Information, education and communication;
v. Resource Mobilization;
vi. Research and Training;
vii. Cultivation and Conservation of Medicinal Plants;
viii. Local Production of Standardized ATM;
ix. Protection of traditional knowledge (TMK) and control access to biodiversity;
xi. Evaluation, monitoring and reporting.
5. The AU and WHO collaborated in drafting a Mid-Term Review (MTR) Report of the Decade. The contents of the MTR were based on analysis of responses received from Member States via questionnaires. The indicators of the analysis showed that Member States were committed to mainstreaming ATM in Primary Health Care Services. The indicators are summarized below. Thirty-four (84.8%) out of 46 AU members of WHO-AFRO responded to the questionnaires. There was no response from AU Members of WHO-EMRO.
Sensitization of Society and Popularization of TM
6. Commemoration of AATM was carried out in several countries. Commemoration events included seminars, exhibitions of T, music, press coverage, poems and drama. Some countries have even gone further to have a National Traditional Medicine Week (e.g. Burkina Faso, Congo, Mali and Ghana). Other countries have produced tools and guidelines, books, newsletters, bulletins and monographs of medicinal plants. For example in 2007, Cameroon produced monographs of medicinal plants used for the treatment of diarrhea, malaria, diabetes, sickle-cell anaemia and hypertension. Mali has published two books on indigenous veterinary medicine and ATM treatment.
Policy and Legislation on TM
7. Thirty-three (72%) out of 46 AU Member States of WHO-Afro have
laws/regulations on TM. Additionally, 37 (80%) out of the 46 (WHO-Afro) have established National TM in the Ministry of Health.
8. Fifteen (15) countries (32.7%) out of 46 have established various mechanisms to facilitate institutionalization of TM in health systems. WHO has supported countries in capacity building for National Drug regulatory Authorities for registration of TM.
Establishment/Strengthening of Centers of Excellence dealing with TM
9. Twenty (20) Countries (43.5%) out of 46 Member countries of WHO-Afro have established Centres of Excellence dealing with Traditional Medicine. To support such efforts Natural Products Research Network for East and Central Africa (NAPRECA) was established in 1984 from a realization that Africa was rich in bio-diversity by poor in Research & Development.
Information, Education and Communication (IEC)
10. In support of AU Member States in their efforts development IEC tools for ATM, WHO has sponsored several workshops on good manufacturing practices on ethnomedical evidence, ethropharmacology and Chinese TM. Additionally, consultative meetings have taken place whose aim is to develop harmonized policies and regulatory Framework for the WAHO sub region.
11. Perhaps the most exciting information about IEC is the Kasungu district (in Malawi) model, where a referral systems has been created between “Traditional
Medical Practitioners” and “bio-medical practitioners” who refer patients to each other for treatment.
12. One of the challenges facing Member States is the inadequate finance resources available for research in TM. On one hand ATM should purely be an African entity hence national governments must mobilize both public and private sector for resource to develop ATM. On the other hand, due to inadequate domestic funding for ATM, countries must develop project proposals by which they can use to solicit funding from donor agencies – most of who are external.
13. According to a British anecdote “whoever pays, plays the tune”. In other words, whoever finances ATM development in Africa will be the one to control the results. The implication is that since all external donors have access to capacity and readymade technology, it will be easy for them to take ATM material to their countries for research and development of drugs. This may deprive Africa ownership of ATM.
14. Thus, to allow such donors to fund and control the results of ATM, will be an open door for them to use ATM to produce essential medicines in their countries – later
to be sold back to Africa. It is in this context that Ministers of Health attending the commemoration o ATM (31/08/08) in Yaoundé, Cameroon, called upon and urged Africa’s Leaders to find innovative ways of mobilizing domestic resources for the development of ATM.
Research and Training
15. Twenty-one (21) countries (45.6% out of 46 countries are conducting traditional medicine research on Malaria, HIV/AIDS, Sickle-cell anaemia, diabetes and hypertension.
Cultivation and Conservation of Medicinal Plants
16. Twenty-two (22) countries (47.8%) out of 46 are cultivating and conserving medicinal plants including Artemisia annua, chamomile and peppermint, etc. The cultivation and conservation of medicinal plants is done through training human resources, development of monographs – supported by the Association for African
Medicinal Plants Standards (AAMPs) based in South Africa.
Local production of Standardized African Traditional Medicine
17. Fourteen (14) countries (30%) out of 46 have manufacturing facilities for TM. In addition, most of the countries even those without manufacturing facilities have developed laws or regulations on herbal medicine. Eight countries registered a few TMs in their national essential medicines in their national essential medicines list.
Protection of Traditional Knowledge (TMK)
18. Ten (10) countries (21.7%) out of 46 have developed mechanisms and tools by which to protect traditional knowledge (TMK). WHO has supported such efforts by organizing regional workshops on regulatory framework for protecting TMK.
Evaluation and Monitoring
A Monitoring and Reporting mechanism was developed along with the Plan of Action of the Decade on ATM. Several meetings have been organized by AU on the issue. A Rapid Assessment Tool to aid Mid-term Review of the Decade was developed and sent to Member States for their use.
Recommendation for the Way Forward
i. Donors be approached to support the implementation of Pharmaceutical
Manufacturing Plan for Africa by strengthening the capacity of Laboratories
of excellence on a regional basis. In this way, the main input for research in
the laboratories would be ATM done under government-approved guidelines
by Africa’s doctors – in order to protect traditional knowledge and TRIPS.
ii. The emphasis on the need for clinical trials as a test of efficacy was a self-
imposed constraint by African researcher. Several medicinal plants which
have been in use for generations without proven serious side effects to the
patients have already proved their clinical worth. The challenge, therefore,
should be how to concentrate the essential molecule and make it into a
syrup or table form for delivery. The success of India’s and Chinese TM was
based on such an approach
iii. Several delegates raised the issue as to whether ATM should be referred to
as “Food Supplements” rather than as “Medicine” in the view of the fact that
both humans and animals depend on plants and grasses as sources of food.
Indeed it is well known that the higher the content of vegetables and fruit in
the human diet, the higher the potential for better health. In this regard,
purifying TM to specific molecule does deprive the TM of its vitamins,
minerals and fibre, which may be more essential for health than the molecule
by itself. It was then suggested that scientific research on TM should be
done, however preparations and dosage should be taken in a wholesome
rather than in a purified form.
iv. A Nigerian panelist coined a phrase “The Village Pharmacist”. The term
referred to the practice of harnessing the healing knowledge of herbs. He
did this to produce a malaria powder product called “MAMA Powder” for the
fight against malaria parasite plasmodium falciparum. Clinical trials proved
efficacious at every trial. Additionally his organization produced MAMA
PAEDIATRIC ANTIMALARIAL SYRUP, which after clinical trials involving
about 77,880 participants, there were no side effects. His biggest challenge
is the difficulty of getting government permits (from the same government
that gave him permits for research and clinical trials) for commercialization of
the two products perfected from ATM by 100% local capacity.
v. In order to mainstream the role of TM in the health sector, national
governments should set up a mechanism which should institutionalize a
sustainable dialogue between “bio-medical” and TM practitioners. The
Kasungu district (Malawi) model can be cited as an example of best practice
of such a dialogue. Kasungu District has established a referral system where
bio-medical and TM practitioners refer patients to each other during
vi. The emphasis on lack of resource for TM research and activities was cited
as another example of self-imposed constraint. In Cameroon, a bill has been
passed and endorsed by all stakeholders, whose aim is to institutionalize TM
in the health system at all levels making financing be part of the overall
health budget. The idea is to eliminate the perception that ATM is an
appendage of the health system.
vii. It was passionately emphasized that Africa had resources both in human and
financial forms; the problem was that there was lack of political will and
commitment to implement Decisions of AU Summit on ATM in order to
produce generic drugs in fulfillment of the Abuja Call for Access to affordable
19. Finally, the basic objective of popularizing the Decade on ATM is being achieved
at an accelerated pace. The challenge for the future after 2010 is to look at each of the
7 recommendations and draw up national programmes aimed at filling the gaps in order
for ATM to finally be integrated into Primary Health care in Africa.