INTEGRATION OF HERBAL MEDICINE IN GHANA’S HEALTHCARE PROGRAM

(PART 1)

National policies are the basis for defining the role of traditional medicines(herbal medicine) in
national health care programs, ensuring that the necessary regulatory and legal mechanisms are
established for promoting and maintaining good practice, assuring the authenticity, safety, and
efficacy of traditional medicines and therapies, and providing equitable access to health care
resources and their resource information (WHO 2005). Another fundamental requirement is
harmonization of the market for herbal medicines for industry, health professionals, and
consumers.

According to the WHO, Traditional medicine(TM) is “the knowledge, skills and practices based
on the theories, beliefs and experiences indigenous to different cultures, used in the maintenance
of health and in the prevention, diagnosis, improvement or treatment of physical and mental
illness”. There are many different systems of traditional medicine, and the philosophy and
practices of each are influenced by the prevailing conditions, environment, and geographic area
within which it first evolved, however, a common philosophy is a holistic approach to life,
equilibrium of the mind, body, and the environment, and an emphasis on health rather than on
disease. Generally, the focus is on the overall condition of the individual, rather than on the
particular ailment or disease from which the patient is suffering, and the use of herbs is a core
part of all systems of traditional medicine.

In Africa up to 90% and in India 70% of the population depend on traditional medicine to help
meet their health care needs. In China, traditional medicine accounts for around 40% of all health
care delivered and more than 90% of general hospitals in China have units for traditional
medicine. However, use of traditional medicine is not limited to developing countries, and during
the past two decades public interest in natural therapies has increased greatly in industrialized
countries, with expanding use of ethnobotanicals. In Ghana, integration of herbal medicine units
into the national healthcare delivery system has been as slow as molasses in January. Today, the
Traditional Medicine Policy (TMP) whose object is to provide a general policy direction or
framework within which government’s short to long term plans on TM would be based has been
gathering dust ever since it was written. According to the TMP, Traditional Medicine
Practitioners (TMPs) and Orthodox Medicine Practitioners (OMPs) who are operating separately
have mistrust amongst them. This was attributed to ignorance as both TMPs and OMPs lack
information and education on the roles of each practice. Thus, there is a very loose co-operation
between OMPs and TMPs. Also, there is this general feeling among TMPs that they are not
being accorded the needed recognition by their counterpart OMPs. Thus, there is resistance to
integration of herbal medicine practice with the national healthcare system which is skewed
towards allopathic practice.
Over the past 100 years, the development and mass production of chemically synthesized drugs
have revolutionized health care in most parts of the word. However, large sections of the
population in developing countries still rely on traditional practitioners and herbal medicines for
their primary care. According to a survey by the National Center for Complementary and
Alternative Medicine, herbal therapy or the usage of natural products other than vitamins and
minerals was the most commonly used alternative medicine (18.9%) when all use of prayer was
excluded. A survey conducted in Hong Kong in 2003 reported that 40% of the subjects surveyed
showed marked faith in TCM compared with Western medicine. The most common reasons for
using traditional medicine are that it is more affordable, more closely corresponds to the patient’s
ideology, allays concerns about the adverse effects of chemical (synthetic) medicines, satisfies a
desire for more personalized health care, and allows greater public access to health information.
The major use of herbal medicines is for health promotion and therapy for chronic, as opposed to
life-threatening, conditions. However, usage of traditional remedies increases when conventional
medicine is ineffective in the treatment of disease, such as in advanced cancer and in the face of
new infectious diseases. Furthermore, traditional medicines are widely perceived as natural and
safe, that is, not toxic. This is not necessarily true, especially when herbs are taken with
prescription drugs, over-the-counter medications, or other herbs, as is very common and can
result in adverse drug reactions.

In China, in 2003, traditional herbal medicines played a prominent role in the strategy to contain
and treat severe acute respiratory syndrome (SARS), and in Africa, a traditional herbal medicine,
the Africa flower, has been used for decades to treat wasting symptoms associated with HIV.
The WHO Programme on Traditional Medicine has joined WHO's global program on drug
management and policies because there is a need for recognition that an adequate technological
infrastructure must be in place to maximize plants for their medicinal value, especially in the
context of primary health care (PHC). PHC places traditional medicine high on its list of
priorities and emphasizes the availability and use of appropriate drugs. For example, 2 WHO
agencies are collaborating on identifying, preparing, and testing extracts for medicinal plants for
antiHIV capabilities. WHO favours developing the knowledge and skills of traditional health
practitioners within the framework of PHC. Further, interregional workshops promote selection
and use of traditional medicine in national PHC programs. Since there continue to be much
public interest in medicinal plants, accurate information must be disseminated to the public and
health professionals so they can know both the potential benefits and harmful effects of these
remedies.

The prospects of fully integrating herbal medicine practice into the mainstream national
healthcare system in line with happenings in China, Cuba and India are many. One of which is to
do away with the charlatans or quacks in the system since their source of clientele will be
hampered significantly. On the whole western-trained physicians appear unwilling to allow TM
and their practitioners in the official medical system in most African countries. This is an
indication that not much is done in medical schools to encourage the teaching of TM as they
keep unfolding in some parts of the world. In fact, TM is taught as part of curriculum in medical
schools in USA and Cuba, although passionate ambivalence towards TM has been noted in
Ghana, about 70% of the population still depends on TM for the PHC.

INTEGRATION OF HERBAL MEDICINE IN GHANA’S HEALTHCARE PROGRAM

The integration of herbal medicine into Ghana’s national healthcare system can be done in one of
the following three ways: First, it can be incorporated as an integral part of a country’s formal
health care system, with each being separately recognized as legitimate forms of health care
within the same framework. Second, it can be practice integrated with modern medicine by
individual health care practitioners. Third, traditional and modern practices can be integrated as
two branches of medical science, with the ultimate incorporation of elements of both to form a
new branch. The incorporation of traditional and modern evidence-based medicine (EBM) as
integral parts of a country’s formal health care system is most likely to be achieved and has been
demonstrated to be practicable in many countries, particularly in Asian countries such as China,
Japan, Korea, and India, among others. On the other hand, the incorporation of traditional
medical modalities such as herbal medicine into modern or EBM by either the second or third
method of health care integration is not easily achieved for a host of reasons, including scientific,
cultural, educational, and legal. For decades, the People’s Republic of China has touted a system
of medical education in which its modern medicine practitioners have been required to receive
some formal training in traditional Chinese medicine (TCM), so that they are aware of suitable
approaches in TCM during their practice of Western medicines. However, documentation of its
successful integration in clinical practice is lacking. In Western countries, such as the United
States, Australia, Canada, and members of the European Union, the popular use of herbal
medicine in the form of complementary and alternative medicine (CAM) in the last two to three
decades has led to a multinational, multibillion dollar industry, professional and trade
organizations, national and international practice and research conferences, establishment of
specialized integrated medicine practices and clinics in pain management and adjunctive cancer
therapy, incorporation of CAM courses in conventional medical colleges, introduction of CAM
degree-level education programs, and establishment of research funding agencies such as the
U.S. National Institutes of Health(NIH) National Center for Complementary and Alternative
Medicine, and the Australian National Institute of Complementary Medicine. As a result of these
developments, the issue of integration of CAM medicine, including herbal preparations, into
modern medicine has been the subject of ongoing international discussions in the last few years.
However, proof of efficacy or safety for the vast majority of herbal medicine has not been fully
established through an evidence-based approach. Further, other issues, such as scientific,
cultural, educational, economical, and legal, need to be addressed.

There seem to be some kind of inertia when it comes to implementing policies when there is lack
of national direction and coordination. Thus, the Directorate of Traditional and Alternative
Medicines which has been tasked with strengthening coordination of Traditional Medicine
Practice in the Country must be up and doing. This notwithstanding, TM continues to grow in the
entire world. Therefore there is the need for political will on the part of African leaders to pay
serious attention to global trends in TM discourses for the benefit of all and sundry. This would
require that both TMPs and OMPs acknowledge their areas of strength and weakness from which
they operate in order to minimise the current distrust and the perceived paranoid between them.

By MH/Dr Ernest Aggrey, 0543999776/donmirage77@yahoo.com

References:
Benzie, I.F. and Wachtel-Galor, S. (2011).Herbal medicine: Bimolecular and Clinical

Aspects, Herbal Medicine; An Introduction to Its History, Usage, Regulation, Current

Abdullahi, A.A. (2011). Afr. J. Traditional Complementary and Alternative Medicine. 8(5

suppl):115-123Publised online 2011 Jul 3.doi: 10.4314/ajtcam.v8i5S.5