Seventy-five per cent of the population of Mali uses traditional medicine. There is approximately one traditional medicine practitioner for every 500 inhabitants. Around 180 Herbalist Cards, 200 Therapist Cards, and 1000 Collaboration with the Traditional Medicine Department Certificates have been issued. There are 32 associations for practitioners of traditional medicine in the country.
The Department of Traditional Medicine and the National Research Institute of Medicine and Traditional Medicine were created in 1973. They were designated to demonstrate the value of traditional medicine resources through scientific research and to differentiate the roles of herbalists from those of other traditional medicine practitioners, which included defining their respective status, regulations, and code of ethics.
The Department of Traditional Medicine is mandated to inventory medicinal plants and their indications, verify the therapeutic and toxic effects of the recorded plants, undertake studies to improve and standardize the forms of presentation of traditional medicines, train researchers in the fields of traditional medicine and traditional pharmacopoeia, involve traditional medicine practitioners in the politics of primary health care, write technical notices related to traditional medicine, and set up expert advisory missions for national and international institutions interested in traditional medicine in Mali.
In order to fulfil this mandate, the Department has planned the following: a census of traditional medical practitioners; an umbrella association to bring together the 32 traditional medicine practitioner associations; the production of improved traditional medicines, some of which have status as essential medicine in Mali and are indexed in the National Therapeutic List; the set up of phytochemical analyses as well as pharmacological and clinical tests of medicinal plants; the training of national and foreign researchers; and participation in symposiums, seminars, and workshops.
An order issued by the Minister of Public Health and Social Affairs on 16 May 1980 (38, 39) established a Scientific and Technical Committee to work in conjunction with the National Research Institute of Medicine and Traditional Medicine. The Committee, whose functions are defined in relation to the overall health care needs of the country, has drawn up draft regulations on the practice of traditional medicine.
By Decree 94/282/P-RM of 15 August 1994, the Government of Mali regulated the opening of private consultation clinics for traditional medicine, medicinal herbs stores, and improved production units for traditional medicine. According to the Decree, private consultation clinics for traditional medicine are establishments that provide traditional medical care to patients. Medicinal herbs stores are airy and clean premises, which possess shelves and a counter and are run by a chartered person. The only purpose of the stores is to sell medicinal plants or medicines made from plants. However, conventional pharmacists are also allowed to sell herbs. Improved production units for traditional medicine are semi-industrial or industrial units that transform raw materials into herbal preparations and herbal products.
Decree 95/1319/MSS-PA/SG of 22 June 1995 establishes organizational and functional rules for the private consultation clinics, medicinal herbs stores, and improved production units. Under this decree, membership in a registered and recognized traditional health practitioner association facilitates one's ability to obtain a certificate of notoriety and morality. Chartered traditional medical practitioners, medical staff, and retired traditional medicine paramedical staff may open private traditional medicine consultation clinics. Chartered medicinal plant sellers, graduates from the Katibougou Rural Polytechnic Institute (which specializes in water and forests) or its equivalent, and graduates from the Superior Normal School (which specializes in biology) or its equivalent are allowed to open medicinal herbs stores. Industrial exploitation of medicinal plants is authorized only when it involves herbs, leaves, sterns, barks, and/or fruits and is permitted only when the plants are cultivated. Collection of wild plants for industrial exploitation is not permitted. Improved traditional medicine production units must be supervised by a pharmacist, and a pharmacist, chemical engineer, or biologist must monitor the control procedures.
Article 8 of Decree 95/009/P-RM of January 1995, establishing permits for pharmaceutical products, outlines special rules for requests involving traditional medicines made from plants. These requests should include the name and address of the person in charge of putting the product on the market, and if the latter is not the manufacturer, the name and address of the manufacturer: a summary of the product's characteristics (name, form, pharmacological properties, therapeutic indications, posologies, and administration); chemical and pharmaceutical files; toxicological and pharmacological files; a clinical file; 10 samples of the product; and a receipt for the registration fee.
Local officials are allowed to authorize the practice of traditional medicine in their administrative and/or health subdivisions. Some traditional medicine practitioners are involved in Mali's primary health care programme (6).
Education and training
Created in 1996, the Faculty of Medicine, Pharmacy, and Odonto-Stomatology of the University of Mali is responsible for training allopathic physicians and pharmacists. Among the requirements for students and researchers are courses directly related to traditional medicine and traditional pharmacopoeia, such as Botany, Pharmacognosy, Vegetal Substances, Chemistry, Pharmaceutical Legislation, and Public Health. Other schools, faculties, and institutes that collaborate with the Department of Traditional Medicine on training and research in traditional medicine include the Rural Polytechnic Institute, the Superior School of Health, the Central School of Commerce and Industry, the Rural Economy School, the Faculty of Science and Technology, and the Faculty of Arts, Languages, and Human Sciences.
Universities, organizations, and international and foreign research centres - such as universities in Burkina Faso, Cote d'Ivoire, France, Italy, Norway, and Senegal; the Centers for Disease Control and the National Institutes of Health, both in the United States; and ACCT, GAMES, and the World Health Organization - collaborate together on postgraduate training, research, thesis supervision, and examination boards.
Periodic meetings, seminars, and workshops have been organized with traditional medicine practitioners, sometimes through their associations. The main points of national health programmes on AIDS, mental health, and family health have been presented with the intention that traditional medicine practitioners act as intermediaries, informing the public, and in recognition of the fact that traditional medicine practitioners are involved in patient care. The Department of Traditional Medicine organizes and supervises exploratory meetings and missions between associations of traditional medicine practitioners and their foreign partners.
Each year the Department of Traditional Medicine organizes open houses on health information, education, and communication in traditional medicine. Radio and television programmes on traditional medicine with independent traditional medicine practitioners, representatives of associations, or persons in charge of technical services are regularly transmitted on public and private stations.
National health insurance covers allopathic medical care for only 500 000 to 1 000 000 of Mali's 11 000 000 inhabitants. It does not cover traditional or complementary/alternative medical care.