(1990; 48 pages) [French]
2.1 Guidelines for formulating policies on training, research, and ethical issues in traditional medicine and AIDS
Countries should themselves decide which types of traditional practitioners they would want to involve in their national AIDS prevention, control, and care activities. While it is important to distinguish between different types of practitioners, it is understood that all types of traditional health practitioners recognized by their communities may well have important roles to play in AIDS prevention, counselling, and care and in community leadership.
2.1.1 The purposes of a policy on traditional medicine are:
(a) to protect the patient from substandard care;
(b) to recognize the role of traditional health practitioners and define their rights, privileges, and responsibilities as health care providers;
(c) to educate and guide the practitioners and the community;
(d) to correct the serious neglect in the education and training (including continuing education) of traditional practitioners and in research on the effectiveness of their practices;
(e) to protect the traditional health practitioner from malpractice suits and prosecution under existing and proposed penal laws;
(f) to protect individuals and the community from charlatans.
2.1.2 The goals of policy formulation include:
(a) the improvement of the health and welfare of the population;
(b) elaboration of a framework enabling the formulation of appropriate legislation and regulations for operational traditional medicine programmes;
(c) the provision of a basis for the consideration of key ethical issues:
- respect for the person as an individual and respect for the community as a whole;
- promotion of the beneficial effects of traditional medical care and elimination of the harmful ones;
- promotion of social justice through ensuring safe, culturally acceptable, and cost-effective traditional medical care to individuals and communities.
2.1.3 A policy on traditional medicine should provide guidelines for the following major areas: legislation and regulation; education and training; research and development; ethical issues; and allocation of financial and other resources.
(a) Legislation in traditional medicine should: enable the recognition of traditional health practitioners; define and standardize basic concepts of traditional medicine; define areas of practice; state the rights, privileges, and responsibilities of traditional health practitioners; provide a basis for their recruitment and registration, as well as the modalities for their utilization in health systems. Legislation drawn up by peers should provide the basis for ordinances and standards of reference to determine malpractice. Provision should be made for enactment of laws to protect the practice of the profession, as well as to stipulate the appropriate materia medica upon which traditional medicine should depend for its growth and survival.
(b) Education and training in traditional medicine should promote its acceptance and recognition as an integral part of the cultural heritage of the people, and it should facilitate collaboration between the modern and traditional systems. Information about traditional health care and its practitioners should be introduced into medical, nursing, and other health sciences curricula, as well as in social and behavioural sciences. Students of both systems should be involved in multidisciplinary action research in traditional and modern medicine. Appropriate information about the philosophy, principles, history, and cultural value of traditional medicine (merits and limitations) and the role of its practitioners should be included in secondary school curricula and introduced in the training courses for teachers. Prominent traditional health practitioners should be invited to explain and discuss their work. The complementary aspects of the modern and traditional health systems within a community must be emphasized to the practitioners of both systems in order to promote mutual professional respect. The following are educational activities that might promote the involvement of traditional practitioners in community health care:
- joint seminars and workshops should be organized for practitioners of modern and traditional medicine as well as for scientists of relevant disciplines;
- special courses of various grades and duration should be organized for traditional health practitioners, and, eventually, schools of traditional medicine should be developed, as was done in China and India.
Special training of traditional health practitioners for their participation in certain primary health care programmes must be emphasized. Appropriate entry points for their involvement in primary health care activities could be:
- oral rehydration therapy;
- traditional midwives for primary health care centres;
- family planning programmes;
- control of sexually transmitted diseases and AIDS;
- integrated AIDS and family planning programmes;
- endemic disease control such as of leprosy and tuberculosis;
- expanded programme on immunization;
- nutritional education;
- elaboration of national traditional medicine pharmacopoeia;
- needs assessment through KABP surveys on AIDS (knowledge, attitudes, beliefs and practices);
- collection and dissemination of information and simple statistics on health care.
(c) The importance of research as the source of new information for establishing community diagnosis, determining needs, and resolving community health problems must be emphasized in the development of a policy for the promotion of traditional medicine. Multidisciplinary action research should be recommended as the best means to promote traditional health care and the utilization of traditional health practitioners in primary health care at the district level. Traditional health practitioners should be represented in all formal national research bodies for traditional medicine. They should also be involved in the planning and implementation of research and in the discussion and evaluation of results for feedback. In all of this they should be treated with respect, adequately compensated for their participation, and duly acknowledged. University faculties and research institutions should be encouraged and funded to take an initiative in these efforts. Various kinds of research are necessary for a full and balanced development of traditional medicine. The following are some examples:
(i) operational or applied research that seeks to discover the strengths and weaknesses of traditional medicine practices in order to propose and offer solutions for improvement;
(ii) research to explore new remedies for health problems and diseases such as AIDS;
(iii) research on how to improve traditional medicine resources, such as the cultivation of medicinal plants, the breeding of animals, and the preservation and improvement of well-tested remedies;
(iv) research on traditional remedies to evaluate their physiological activity, pharmacological properties, toxicity, and, whenever possible, to determine their chemical structure;
(v) research on traditional health practitioners' concept of health, disease, treatment, and care;
(vi) research on the sociodemographic, epidemiological, and professional profiles of traditional health practitioners;
(vii) research on the modalities of cooperation between modern and traditional health systems.
Research priorities would need to be defined on the basis of affordability, cost-effectiveness, and feasibility. Research results should be carefully reported and disseminated to policy- and decision-makers at local and national levels. They should also be disseminated to the public for their information and educational purposes. All research must respect established ethical principles.
(d) It is important that all existing traditional or customary beliefs, norms, taboos, rules, and attitudes be considered in elaborating a code of ethics for the practice of traditional medicine, whether at district, regional, or national level. To ensure that the practice of traditional medicine be respectable, fundamental human rights must be codified and adhered to. These should include:
- protection of the individual;
- confidentiality in practice;
- informed consent in studies and drug trials;
- avoidance of prejudice against patients (e.g., those with AIDS, other sexually transmitted diseases, leprosy);
- respect for the dead;
- respect for proprietary rights and intellectual property;
- adequate compensation (for practitioners' services, malpractice suits);
- promotion of national resource regeneration and conservation.
The national body responsible for the regulation of traditional medicine, the various associations of traditional health practitioners, and the national body responsible for the protection of human subjects in research should be in charge of ensuring ethical conduct in the practice of, and research in, traditional medicine.
(e) Financial resources should be made available for public education and information and for the training of traditional health practitioners through both the formal health system and associations of traditional health practitioners. Budgetary allocation should be provided for traditional medicine in national health budgets, as well as in national AIDS programmes.
Adequate financial support is a key factor in the effective implementation of policies, programmes, and projects aimed at promoting the utilization of traditional health practitioners in the prevention and control of AIDS.