(1990; 48 pages) [French]
1.1 Background of the consultation
The acquired immunodeficiency syndrome (AIDS) was first identified in June 1981. By December 1990, a global total of approximately 307 000 cases of AIDS had been officially reported to the World Health Organization (WHO) by 156 Member States. Of these reported cases, about 80 000 have been in sub-Saharan Africa.
However, it is believed that these reported figures represent only a fraction of the actual number of AIDS cases. Worldwide, WHO estimates that there may have been a cumulative total of as many as 1 000 000 cases, with 700 000 of these having occurred in sub-Saharan Africa. Some 8-10 million adults throughout the world have been infected with the human immunodeficiency virus (HIV). WHO projects a total of 8-10 million cumulative AIDS cases by the year 2000.
The AIDS pandemic has had a significant impact on individuals and communities everywhere in the world, particularly in the African Region. Modern medicine has so far been unable to contain the spread of HIV infection; therefore, renewed attention has been drawn not only to the potential of traditional medicine but principally to the major role that traditional health practitioners can play in the implementation of national strategies for the prevention and the control of HIV infection and amelioration of symptoms caused by opportunistic infections and AIDS.
In 1976, the World Health Assembly acknowledged the potential value of traditional medicine in expanding health services by calling attention to the manpower reserve constituted by traditional health practitioners (resolution WHA29.72). In the following year, a Health Assembly resolution (WHA30.49) urged countries to utilize their traditional systems of medicine. Another resolution was passed in 1978, in which the Organization was called upon to develop a comprehensive approach to the subject of medicinal plants (WHA31.33). Nine years later, in 1987, the Fortieth World Health Assembly reaffirmed the main points of the earlier resolutions, as well as related recommendations made at the International Conference on Primary Health Care, held in Alma-Ata, USSR, in 1978 (WHA40.33).
The Forty-first World Health Assembly drew attention to the Chiang Mai Declaration (1988): “Save Plants that Save Lives” and endorsed the call for international cooperation and coordination to establish a basis for the conservation of medicinal plants, in order to ensure that adequate quantities be available for the use of future generations (resolution WHA41.19).
In 1989, a resolution was passed (WHA42.43) that recalled earlier resolutions on traditional medicine, traditional health practitioners, and traditional remedies and affirmed that together they constitute a comprehensive approach to the utilization of medicinal plants in the health services.
This resolution provided a fresh mandate for future action in promoting effective collaboration between the traditional and modern health care sectors in WHO's Member States. The adoption of safe and useful traditional medicine practices in the design and implementation of national health systems makes good sense in terms of economics and cultural acceptability.
Given the paucity of human and material resources available to African governments and the extremely high number of AIDS cases in the region, there is an urgent need to devise new approaches that would contain the further spread of this dread disease. These new approaches should not only be developed within the framework of national strategies for delivering primary health care, but should also take into consideration the fact that in many countries, especially those in the African Region, traditional medicine is part of the health practices of individuals and communities; a form of private practice, outside the formal health system. Governments, therefore, have a responsibility to ensure that traditional medical practices are not harmful and to foster what is effective and beneficial, in keeping with the beliefs of the people. These positive practices can be crucial in meeting the challenge of the present crisis.
In responding to the gravity of the situation caused by AIDS, many African countries have developed national AIDS control plans. For example, Botswana, Kenya, United Republic of Tanzania, Uganda, and Zimbabwe have identified programme areas that are appropriate for involving traditional health practitioners in community health activities; these include community-based care, health education, counselling, and the relief of certain symptomatic conditions. In addition to these areas, there is also a potential for involving traditional health practitioners in providing the community with culture-specific information on sexual behaviour and in formulating and channelling specific health promotional messages. So far, these efforts have not been coordinated, and therefore there is no basis for a comparison of their effectiveness. However, there is no doubt that, properly motivated and involved, the traditional health practitioner can act as a valuable link to the majority of the population, who may be difficult if not impossible for modern health workers to reach.