(1990; 48 pages) [French]
Annex 5. Traditional medicine and AIDS: Prospects and perspectives by Dr Olayiwola Akerele, Programme Manager, Traditional Medicine, WHO Geneva
It is a pleasure to add my welcome to that of the distinguished personalities who have addressed you this afternoon, and, at the same time, to express to our Botswana hosts and colleagues our deep appreciation for the consideration, kindness, and generosity they have shown in hosting this consultation. I am sure that it is obvious to all of us how much care, thought, and hard work have gone into the preparations they have made to ensure that our visit to their beautiful country will be not only pleasant but highly rewarding and full of interest.
The purpose of our consultation is to:
(i) explore the best ways of involving traditional health practitioners in the prevention and control of AIDS in Africa;
(ii) draft guidelines on approaches that countries could use to secure the involvement and continued participation of traditional health practitioners;
(iii) examine the need for health services operational research in traditional medicine that is relevant to developing and implementing strategies for AIDS prevention and control and other public health problems.
I am delighted to have this opportunity to work with you in finding the best ways and means to maximize the utilization of traditional health practitioners in preventing and controlling AIDS. I do not need to make a case for the important role of traditional medicine in primary health care, since all of you are experts in this field. I know that you are as convinced as I am that it is only logical for us to take the next step and consider the most appropriate measures to involve traditional health practitioners in community health activities, and, in particular, to accentuate and accelerate the work that needs to be done in AIDS prevention and control.
What I should like to do now is give you a brief outline of the objectives and activities of the WHO Traditional Medicine Programme. In our work in traditional medicine, the World Health Organization encourages and supports countries to identify and provide safe and effective remedies and practices for use in the formal and informal health systems. WHO'S priorities in its Traditional Medicine Programme are reflected in a number of activities; these are grouped into five main areas of concern:
NATIONAL PROGRAMME DEVELOPMENT
HEALTH SYSTEMS AND OPERATIONAL RESEARCH
CLINICAL AND SCIENTIFIC INVESTIGATIONS
EDUCATION AND TRAINING
EXCHANGE OF INFORMATION
In the area of national programme development, WHO collaborates with its Member States in the review of national policies, legislation, and decisions on the nature and extent of the use of traditional medicine in their health systems. This includes assisting ministries of health in establishing policies and appropriate mechanisms for introducing traditional remedies and practices into primary health care programmes.
Research is a broad area of endeavour that includes health systems, clinical, and scientific research. Health systems and operational research involves: studies on the potential and limitations of the use of traditional health practitioners in primary health care in district health systems, surveys of traditional medical practices, and inventories of medicinal plants and other natural substances used. Comparative studies of modern and traditional medicine evaluate the relative advantages, such as clinical efficacy and cost-effectiveness, as well as the cultural acceptability of the two systems to the consumers.
Clinical and scientific investigations are also needed to ensure safety and efficacy, as they are done for modern medicaments, especially for manufactured products moving in international commerce. Within the context of an overall health research strategy, national research establishments are continuing to investigate the safety and efficacy of many of the remedies used by traditional health practitioners from the point of view of ethnobotany, medical anthropology, experimental pharmacology, and clinical practice, as well as to conduct epidemiological studies. These institutions are undertaking clinical evaluation of traditional methods of treatment and pharmacological and toxicological studies on commonly used medicinal plants. They also undertake to standardize and improve traditional formulations destined for pharmaceutical production.
In the area of education and training, WHO promotes the acquisition of new knowledge and skills of all health personnel, including traditional health practitioners. In advocating training for them, WHO emphasizes the further development of their competence and skills within the framework of primary health care so as to afford them an opportunity to share their experiences with others. Incorporation of elements of traditional medicine into training schemes for other health workers is also being pursued by countries. Providing communities with educational material about valid traditional health practices is also being actively implemented.
Finally, the exchange of information is a vital role that WHO plays, not only in traditional medicine, but in virtually every aspect of public health. In this, it is ably supported by some national reference centres and by WHO collaborating centres. The International Traditional Medicine Newsletter, published by the Chicago Collaborating Centre for Traditional Medicine, provides an opportunity for exchange of information on the subject, reporting both on the work of other collaborating centres and also on country experiences. This newsletter has been playing a valuable role by providing individuals and institutions with a means of keeping in touch with developments in other parts of the world.
In recent years, we have witnessed the development of WHO collaborating centres for traditional medicine. The first such centre was designated in February 1979 in Italy. This was the Istituto Italo-Africo in Rome and, in the early 1980s, a number of other centres were designated. Today, we have 26 collaborating centres for traditional medicine throughout the world: five in the African Region, three in the American Region, one in the Eastern Mediterranean Region, two in the European Region, three in the South-East Asia Region and twelve in the Western Pacific Region.
In many countries, there are institutions supported by national and international bodies. These can be mobilized to participate in the activities that we will outline during the course of this week.
That traditional medicine and its practitioners have a useful role to play in AIDS prevention and control, particularly in the African Region, is no longer open to doubt. However, this role needs to be explored in more detail; but first there are three important areas that lend themselves to immediate consideration:
(1) putting traditional health practitioners fully into the picture about the AIDS situation, the threat it represents to the population and to themselves, and the strategies available for its prevention and control;
(2) involving traditional health practitioners in enlisting community participation in, and support for, various aspects of national AIDS programmes, e.g., condom distribution, health education, epidemiological studies, and contact tracing;
(3) securing the collaboration of traditional health practitioners to share their knowledge and experience in the use of traditional remedies that may have antiviral, particularly anti-HIV, activities, and those that are used for conditions related to AIDS, e.g., opportunistic infections and Kaposi's sarcoma.
In this context, I should like to briefly mention an activity in biomedical research. One of the key issues to be addressed by WHO and its Member States is how to formulate an up-to-date research and development policy in traditional medicine. Why? Because at present research policies in most countries do not reflect the role of traditional medicine in health services. New research and development policies could greatly assist institutions in addressing the critical problems now being faced. One recent development is the investigation of traditional medicinal plants considered to have antiviral properties or activity against opportunistic infections occurring in patients with AIDS. For viral diseases or syndromes for which no vaccines are available, such as AIDS, therapeutic agents that are capable of selectively blocking the replication cycle of HIV are clearly needed.
A number of natural products have demonstrated an anti-HIV or anti-reverse transcriptase activity in vitro; for example, castanospermine, derived from the Australian chestnut tree, and glycyrrhizin, derived from liquorice. Such natural products have also been tested in limited clinical trials. To this end, a meeting was organized in collaboration with the Biomedical Research Unit of the WHO Global Programme on AIDS (1989) to consider the systematic and scientific assessment of potential anti-HIV activity for further clinical evaluation. A memorandum on the meeting is available for those of you who are interested.
With respect to the first consideration, we have to continue to find innovative ways to make traditional health practitioners fully aware of the AIDS pandemic and its consequences because in many developing countries they are often the first to be contacted in sickness and the last recourse for the desperate and chronically ill.
With AIDS patients, this puts them at special risk, but at the same time it places them in an opportune position to participate in the struggle against AIDS and in programmes aimed at health promotion. Traditional practitioners have to be informed of the risks for them personally and of the methods to reduce exposure to HIV infection for the population in general.
Given the potential importance of traditional medicine in the fight against this dread disease, our consultation should consider developing general guidelines that national AIDS programmes may adapt and use to secure the full collaboration and involvement of traditional health practitioners in AIDS programmes.
The guidelines that we develop would prepare nationals to develop and implement, in their respective countries, programmes for training traditional health practitioners. It is expected that countries will initiate a series of activities at district level for both modern health staff and traditional health practitioners in an effort to engage their collaboration in AIDS prevention and control.
Our consultation should also consider the opportunities and possibilities for an expanded role for traditional health practitioners, emphasizing their close involvement in health services, as well as their active participation in operational health programmes, especially at the community and district levels.
We should also give some thought to what form cooperation between the formal and the traditional health sectors might take and to what kind of additional support may be required in the nature of training, equipment, information exchange, networking, and the like.
The WHO Traditional Medicine Programme is, by its very nature, a multi-disciplinary and multi-institutional arrangement, and this is closely reflected in the disciplines represented here today.
The fact that we are all here to discuss modalities of cooperation with traditional health practitioners means that they are still a very relevant factor in the health equation.
This is a rather paradoxical situation, but one that illustrates very well our conviction of the immense potential that traditional health practitioners have for improving the health of all our communities.
I thank you.