Statistics demonstrate overwhelmingly that it is the world's poorest countries who are most in need of inexpensive, effective treatments for communicable diseases. Of the 10.5 million children who died in 1999, 99% came from developing countries. Over 50% of children's deaths in developing countries are due to just five infectious diseases. Similarly, 99% of the two million tuberculosis deaths each year occur in developing countries, and 80% of the current 30 million people living with HIV/AIDS live in sub-Saharan Africa.53
At the same time, access to modern essential chemical drugs is lowest where people are suffering most from communicable diseases. The reasons are well known and include inadequate financing and poor health care delivery. In developing countries, however, TM can be comparatively inexpensive. Additionally, TM practitioners may be widely trusted and respected providers of health care, albeit not necessarily officially recognized.
If access to TM is to be increased to help improve health status in developing countries, however, several problems must be tackled (Table 10). Firstly, reliable standard indicators to accurately measure levels of access - both financial and geographic - to TM must be developed. Qualitative research to help identify constraints to extending access should also be undertaken.
Table 10. Key needs in increasing availability and affordability of TM/CAM
At national and global levels:
• Identification of safest and most effective TM/CAM therapies and products (including: evidence that the therapy is effective; evidence that the therapy is safe; evidence that the therapy is cost-effective).
• Research into safe and effective TM/CAM treatment for diseases that represent the greatest burden, particularly for poorer populations.
• Recognition of role of TM practitioners in providing health care in developing countries.
• Optimized and upgraded skills of TM practitioners in developing countries.
• Indigenous TM knowledge protected and preserved.
• Sustainable cultivation of medicinal plants.
Secondly, the safest and most effective TM therapies must be identified, to provide a sound basis for efforts to promote TM. The focus should be on treatments for diseases that represent the greatest burden for poor populations. This means focusing on the development of antimalarials, and HIV/AIDS treatment and prevention.
Evidently, increasing access to safe and effective TM should not mean displacing programmes to increase access to allopathic medicine. Rather opportunities to improve cooperation between TM practitioners and allopathic medicine practitioners, should be created, to enable patients to draw upon both TM and allopathic therapies to best meet their needs. This is of course the case everywhere (and applies also to CAM). But it is particularly relevant in areas with poor access to allopathic medicine. Fortunately, in these areas, TM practitioners tend to be well established and well respected. Working with these practitioners can facilitate effective dissemination of important health messages to communities, as well as promotion of safe TM practices.
If access to TM is to be increased sustain-ably, the natural resource base upon which it often depends must be sustained. Raw materials for herbal medicines, for instance, are often collected from wild plant populations. Over-harvesting due to intensified local use or to meet export demand is a growing problem. In Eastern and Southern Africa, the sustainability of wild stocks of the African potato (Hypoxis hemerocallidea - formerly H. rooperi) is threatened because widespread publicity about the use of the plant in treatment of HIV/AIDS has boosted demand for it.31 Since the vast majority of plant genetic resources and other forms of biodiversity are found in or originate from developing countries with least capacity to protect them, such problems are in urgent need of resolution.
Unresolved intellectual property issues are another access problem. While research into TM is essential to ensuring access to safe and effective treatments, the knowledge of indigenous TM practices and products gained by researchers can be a source of substantial benefits to companies and research institutes. Increasingly, it appears that knowledge of TM is being appropriated, adapted and patented by scientists and industry, with little or no compensation to its original custodians, and without their informed consent.17