Background information

Indonesian practitioners of traditional medicine may be divided into four groups: herbalists; skilled practitioners, including traditional birth attendants, circumcisers, bonesetters, masseuses, and traditional dentists; spiritualists; and supernaturalists (189).

Statistics

The use of traditional medicine is increasing each year. Traditional medicine provides an important resource for self-care within the health services and through traditional medicine practitioners (189). Forty per cent of Indonesia's population uses traditional medicine, 70% in rural areas.

A 1995 Ministry of Health survey reported 281 492 practitioners of traditional medicine practising in Indonesia, a significant increase over the 112 974 reported in 1990 (189, 190). Of these practitioners, 96.2% use traditional Indonesian methods of treatment. The rest use medical treatments, such as acupuncture, that belong to the traditions of other countries (189). Among the 281 492 traditional medicine practitioners in Indonesia, 122 944 are traditional birth attendants, 51 383 are general traditional medicine practitioners, 25 077 are masseuses, 18 456 are circumcisers, 18 237 are tukang jamu gendong, 14 000 are herbalists, 12 496 are spiritualists, 10 118 are supernaturalists, and 8781 are bonesetters (189).

Traditional birth attendants are an important feature of Indonesian health care. According to national figures for the period 1983 to 1987, allopathic providers attended only 43% of childbirths. The remainder were either unattended or attended by traditional birth attendants (191). At least 91 427 traditional birth attendants have completed a training programme offered by the Ministry of Health.

At the end of 1999, there were 723 manufacturers of traditional medicines in Indonesia, 92 of which were large-scale industries. These companies produce thousands of registered traditional medicines (189).

Regulatory situation

Article 1 of Indonesia's Health Law Act 23-1992 (189) places traditional medicine as an integral part of curative and nursing care. Article 2 emphasizes the need for supervision of traditional medicine to ensure its safety and efficacy. Article 3 supports further development and improvement of forms of traditional medicine deemed safe and efficacious in order to fulfil the goal of optimal health for the community. The Health Law Act classifies traditional medicines (jamu) into two groups:

• The first group consists of traditional medicines produced by individual persons or by home industries. These medicines need not be registered. They are made by traditional medicine practitioners for use by their own patients. They may not be labelled or marked except with the empirical name. The Minister of Health is responsible for helping the producers of these medicines ensure the quality of their products. To this end, the Ministry permits the use of only 54 species of plants in these medicines. The safety of all 54 species is known through traditional experience.

• The second group consists of traditional medicines produced and packed on a commercial scale, whether large or small. These medicines must be registered and licensed before they may be sold. In order to be registered, jamu (and traditional medicines not indigenous to Indonesia) must have undergone scientific study, including microbiological testing. These studies are to ensure the safety and efficacy, composition and rationality of the composition, dosage form, and claimed indications for the medicines. For use in formal health services, clinical trials must be carried out. The Ministry of Health of Indonesia has produced a publication, Guidance for Clinical Trial of Traditional Drug, to help manufacturers fulfil these requirements.

In accordance with the 1993 General Guidelines, health efforts, including those for traditional medicine, have been strengthened within the framework of the national health care legislation (192).

Traditional birth attendants are permitted to practise without registration or a licence (193), Allopathic physicians with appropriate training in acupuncture are able to practice acupuncture in public hospitals.

Education and training

The Centre for Traditional Medicine Research, under the Ministry of Health and Social Welfare, provides training in traditional medicine. The Directorate of Selected Community Health Development, also under the Ministry of Health and Social Welfare, offers training programmes in primary health care for traditional practitioners of acupressure.