2. Steps for the Integration of Traditional Medicine in the National Health Care Delivery System 18 TH ICASA Special Session on Traditional Medicine 1 st December 2015, Harare, Zimbabwe Steps for the Integration of Traditional Medicine in the National Health Care Delivery System 18 TH ICASA Special Session on Traditional Medicine 1 st December 2015, Harare, Zimbabwe

3. Outline of presentation 1. Background 2. Access to traditional medicine 3. Steps and conceptual framework for integration 4. Priority interventions of the WHO Regional strategy 5. Key achievements and trends: TM policies, research and cultivation of medicinal plants 6. Key challenges 7. WHO support to countries

4. 1. Background (1) WHO defines traditional medicine as the sum total of the knowledge, skills, 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/index.html)http://www.who.int/medicines/areas/ traditional/definitions/en/index.html The terms “CAM and alternative" (and sometimes also "non-conventional" or "parallel") are used to refer to a broad set of health care practices that are not part of a country's own tradition, or not integrated into its dominant health care system.

5. 1. Background (2) A WHO Technical Brief gives a working definition for “integration”: “The organization and management of health services so that people get the care they need, when they need it, in ways that are user friendly, achieve the desired results and provide value for money”. This working definition is in line with the Regional Strategy on TM which promotes the integration into health systems of traditional medical practices and medicines for which evidence of quality, safety and efficacy is available and the generation of such evidence when it is lacking. It is generally acknowledged that such integration will result in an increase in health care coverage through collaboration, communication, harmonization and partnership building, while protecting intellectual property rights and indigenous knowledge..

6. 1. Background (3) Before1880s (Precolonial Period), 1880s-1960 (Colonial Period (1960s-date) The Postcolonial Period 1978: The Alma-Ata Declaration on PHC 2000: Adoption of the 1 st Regional Strategy on TM 2001: Declaration on 1 st Decade of African TM (2001-2010) 2003: Institution of the African TM Day, 31 st August 2015 2011: Declaration on 2 nd Decade of African TM (2011-2020) 2011: RC61 adopted progress report on strategy implementation 2013: Adoption of the 2 nd Regional Strategy on Traditional Med. Call: Integration of traditional medicine in national health systems

7. 2. Accessibility: African countries use traditional medicine to help meet primary health care needs Populations reliant on traditional medicine for primary health care

8. 3. Steps that could be used to achieve integration (1) Develop mechanisms for the institutionalization of African traditional medicine, Officially recognize the role of traditional health practitioners (including traditional birth attendants) in health care delivery, Promote registration of evidence-based traditional medicines, Establish a framework for research and development, manufacturing, marketing and distribution of traditional medicine products, Include traditional medicine in health insurance systems, Develop an enforceable institutional legal framework for intellectual property protection,

9. Establish mechanisms for education and training for all stakeholders within the cultural framework of African traditional medicine Officially institutionalize the practice of African traditional medicine within the existing national health systems.

10. 3. The fundamental structures of systems integration in mainstreaming healthcare and African TM (2) Mainstream health care systems Health care laws Registration and licensing of conventional health practitioners Professional practice physical locations – hospitals, health centres, clinics, etc Pharmaceutical manufacturing plants Health insurance system for patients Include aspects of traditional medicine in the training curricula African traditional medicine systems Regulatory framework for African traditional medicine Registration and regulation of traditional health practitioners Traditional health practitioners’ facilities Traditional health practitioners’ manufacturing units Official health insurance coverage Develop standardized training programmes as per the provisions of the regulatory framework

11. 3. The fundamental structures of services integration in mainstream healthcare and African TM systems (3) Mainstream health care services In-patient, out-patient services Recognition of the referral system with traditional health practitioners Willingness to recognize traditional health practitioners practices Traditional medicine health care services Holistic treatment practices Understanding of the referral procedures Recognizing limitations of the practice

12. 3. Priority Interventions of the Regional Strategy for the African Region (4) Accelerate the implementation of national TM policies, strategies and plans within national health systems. Develop frameworks for integrating TM in health systems; Promote R&D and protection of IPR and TMK; Strengthen human resources capacity of countries for development of TM. Promote and organize large-scale cultivation and conservation of medicinal plants Encourage local production of TM products by creating an enabling political, economic and regulatory environment Enhance collaboration among multi-sectoral stakeholders.

13. 4. Key ACHIEVEMENTS AND TRENDS: policies and legal frameworks (1)

14. 4. KEY ACHIEVEMENTS AND TRENDS: research and development and utilization of research results (2)

15. 4. CULTIVATION OF MEDICINAL AND AROMATIC PLANTS (3) 17 countries established either commercial/ community/ individual cultivation of medicinal plants 16 countries developed national policies on conservation of medicinal plants. 13 countries adopted the WHO guidelines on GACPs Practice. 12 Countries reported large-scale cultivation of Artemisia annua 11 countries involved in the promotion, conservation and cultivation of medicinal plants

16. 4. Protection of traditional medical knowledge (tmk) and intellectual property rights (IPRs) (4) Examples of countries with frameworks for the protection of TMK/IPRsYear established 1. Chad national framework for IPRs2002 2. South Africa developed IKS Policy2004 3. South Africa Biodiversity Act/IKS Office2006 4. Nigeria national legislation2006 5. Nigeria Traditional Knowledge Bill2007 6. Cameroon national framework for IPRs2007 7. Ghana national framework for IPRs2008 8. Botswana Industrial Property Act2010 9. Gambia Intellectual Property Framework2014

17. Summary of country progress in the implementation of the WHO Regional TM Strategy (2000-2012) (5)

18. 6. Key Challenges

19. 7. WHO support to countries 1. Production of tools, guidelines, protocols and monographs 2. Production of technical documents e.g. : – Tools for institutionalizing TM in health systems – Collaboration between THPs and CHPs – Policy guidance and legal framework for the protection of Intellectual Property Rights and traditional medicine knowledge – Regulation of practitioners, practices and products – Modules for training health sciences students – Modules for training THPs 3. Provision of technical/financial support to countries 4. Support strengthening of capacities for policy development and implementation, R&D and evaluation of TM safety, efficacy and quality; 5. Facilitate networking and information exchange

21. Tatenda, Masviita, Thank you