(1990; 48 pages) [French]
Annex 4. Inaugural address by Dr G.L. Monekosso, Director, WHO Regional Office for Africa, Brazzaville
It is a great pleasure for me to be here in Francistown for the opening of this Consultation on AIDS and Traditional Medicine. I should like to express my sincere thanks to everyone who worked to make this consultation possible. In particular, I should like to thank the Government of Botswana for their full cooperation and support, and for their generous and kind offer to host this meeting.
AIDS was first identified as a devastating syndrome in June 1981. Since then, HIV infection and AIDS have weighed heavily on all our consciences. We have watched with grief in our hearts the uncompromising human suffering that the disease has unleashed on the world, and which it has continued relentlessly to do, even today.
As of mid-1990, a global total of 266 098 cases of AIDS have been officially reported to the World Health Organization by 156 Member States. However, it is believed that this figure represents only a fraction of the actual number of AIDS cases worldwide. It has been estimated that at present there may be as many as 700 000 AIDS cases, and six to eight million HIV-infected persons throughout the world. WHO has projected more than one million cases of AIDS worldwide by the early part of the 1990s, and some five to six million cumulative cases by the year 2000.
No region of the world has been spared the misery brought about by AIDS and HIV infection; and Africa is no exception. Of the total number of AIDS cases that I have just mentioned, about 65 000 cases have been reported in sub-Saharan Africa alone, representing roughly 24% of the world's total cases.
Given the paucity of resources available to African governments and the extremely high number of AIDS cases that I have just quoted, there is an urgent need for designing new approaches to contain further the spread of this dread disease. This consultation, with its singular objective of exploring new and innovative ways of involving traditional health practitioners in global efforts to control and prevent AIDS comes, therefore, at a most appropriate and opportune time.
We expect traditional health practitioners to contribute positively to the control and prevention of AIDS for a number of important reasons:
- Traditional medicine has been playing a very significant and increasing role in meeting the primary health care needs of all our people.
- The achievements of WHO's Member States in expanding and improving health services within the last decade, to both urban and rural populations, have been remarkable. These achievements - in this brief span of time - are in part the results of collaborative efforts between WHO and its Member countries. Many of these efforts have explored ways to integrate the positive and effective elements of traditional medicine into primary health care activities.
- In most developing countries, between 60 and 80% of the population live and work in the hinterlands. To most people in rural environments and the deprived groups in the urban areas, access to any form of health care has been mostly through the traditional health care delivery systems. The men and women who practise traditional medicine are usually well-distributed throughout a country, and they can be found in every single village and hamlet. Since 60% of deliveries take place outside medical establishments, there is no doubt about the unique and important services provided by traditional birth attendants in most countries within the framework of their primary health care programmes.
- Traditional health practitioners enjoy respect and esteem in their communities. Traditional medicine has always been an inseparable part of the history and culture of all peoples. It is the culmination of the experiences of people in their struggle against disease and in maintaining healthful practices. By virtue of being at the front line of the struggle to prevent and cure diseases, traditional health practitioners have acquired considerable knowledge about the community and the people who live in it. They have a deep understanding of the culture in which they operate. They are well-placed to understand the dynamics of health in relation to man and his total environment. This has led to the profound respect that they enjoy from the members of the community in which they live and work.
- The sheer numerical strength of traditional health practitioners, coupled with the fact that they are already fully integrated into their communities, make them an important singular resource for delivering health care to every part of the country. They constitute a credible and powerful institutional network for reaching both urban and rural populations with well-formulated health messages. The success of the Chinese and other country experiences in integrating traditional medicine into primary health care programmes and activities as a viable option to achieve the fullest coverage of vast rural populations are well documented. The involvement of traditional health practitioners in efforts to control and prevent AIDS could, therefore, be a significant and critical issue.
There are, of course, other reasons why traditional health practitioners can contribute positively to the fight against AIDS. But the ones I have just touched upon here are what I consider the major reasons for supporting the efforts of WHO's Traditional Medicine Programme and its Global Programme on AIDS to bring all of you together to deliberate on the timely and important issue of how to involve traditional health practitioners in AIDS control and prevention.
Some important questions to be answered during these few days of consultation are the following:
1. What is the current situation of the traditional health practitioner in the national health care delivery system generally and, specifically, what is their role and involvement in HIV/AIDS control and prevention?
2. What is the present level of their knowledge about HIV infection and AIDS?
3. How can the educational infrastructure be adapted to accommodate the preparation of traditional health practitioners to effectively participate in national activities for the prevention and control of HIV infection and AIDS?
4. What kind of educational programmes will need to be developed, in terms of course content, methods, teaching/learning materials, etc.?
5. How do we assess the traditional health practitioners' understanding of their role and functions in national AIDS control and prevention activities?
6. How do we supervise traditional health practitioners when they carry out these prevention and control activities in their communities?
At this time, we have only partial answers to some of these questions. We know that the short- and medium-term national plans that we developed in collaboration with Member States have given the highest priority to AIDS education of health personnel, including physicians, technicians, and, where appropriate, a broad range of other health workers such as traditional birth attendants and traditional health practitioners. We are aware that countries are according the highest priority to using all elements of the health system in HIV/AIDS prevention and control. However, we still do not have a clear understanding of the form and content of educational programmes for traditional health practitioners. We have as yet no definite idea about how to monitor and evaluate their training. The answers to these questions will be necessary in order to enable us to develop educational activities that will ensure the full and continued involvement of traditional health practitioners in the AIDS control and prevention efforts.
I am sure that in the course of your deliberations more questions will be raised, to which you will have to find appropriate answers.
Unfortunately, today, there is no cure for AIDS nor is there a vaccine against the disease. As we continue to make progress towards finding a biomedical solution to the problem, our only hope at this time is to intensify our efforts to control this scourge by capitalizing on the only known weapon we have against the disease: EDUCATION for behavioural change. We emphasize education, information, and communication as our most effective weapons. Why? Because we know that individual behaviour and practices are mainly responsible for most HIV transmission.
Therefore, by involving traditional health practitioners in the educational process, we are providing them with the necessary information to guide them in making decisions to modify or abandon those practices that expose them and their clients to the risks of HIV infection and other public health hazards. When they have become better informed, traditional health practitioners can, in turn, inform and educate their communities about AIDS and HIV infection and other diseases; this would be especially effective when the messages are translated and adapted to local languages and cultures. As informed partners in the provision of health care (whether or not they are part of the formal health system), traditional health practitioners could be instrumental in promoting social and cultural support for those practices that spell good health.
The African Regional Office has always welcomed with open arms any practical and constructive suggestions for improving and extending health services to all of our people. Our office, along with the other regional offices, welcomes this consultation for the important contribution it could make to the ultimate goal of strengthening the primary health care approach through the meaningful involvement of traditional health practitioners.
We all know that traditional medicine has from time immemorial been a key resource to meeting the health needs of peoples in developing countries. This recognition is evident in the efforts that we have made from time to time to explore ways to further strengthen our health care delivery systems.
For example, national AIDS control plans in many African countries, including Botswana, Kenya, Tanzania, Uganda, and Zimbabwe, have already defined programme areas such as community-based care, counselling, and certain symptomatic treatments as suitable for involving traditional health practitioners.
However, action-oriented and decision-linked research on knowledge, attitudes, beliefs, and practices involving traditional health practitioners in the prevention and control of AIDS is needed and should be given high priority during your deliberations.
The experience gained from such research will enable all national AIDS programmes in the African Region to formulate country-specific, innovative, and effective strategies to prevent and control this disease.
These research results may also serve to illustrate to what extent traditional health practitioners, including traditional birth attendants, can contribute to community health development.
Another example of our attempts to strengthen the use of traditional medicine in the health services is the recent meeting of experts from developing countries on traditional medicinal plants. They met in Arusha with the objective of exploring all practical ways of strengthening overall South-South cooperation on the rational utilization of medicinal plants in the health services. Among other things, the meeting helped to reinforce the recognition of traditional medicinal-plant remedies as an important component of primary health care programmes in the countries of the South.
We are gathered here today, in this beautiful city of Francistown, for a few days of deliberation on the subject of AIDS and traditional medicine. I am sure that the recommendations and conclusions of this consultation will point us in the right direction towards ensuring the involvement and continued participation of traditional health practitioners in the global efforts to control and prevent the spread of HIV infection and AIDS. The challenge facing us is enormous, but we have the calibre of experts who are equal to the task at hand.
Once again let me express my deep appreciation and thanks to all of you here, and, in particular, to the Government of Botswana for all the preparations that have been made to ensure that our stay is not only productive, but also enjoyable.
I now have the pleasure of declaring open the First Consultation on AIDS and Traditional Medicine: Prospects for Involving Traditional Health Practitioners.