FUND RAISING STARTEGY FOR THE PROMOTION OF TRADITIONAL MEDICINE IN TANZANIA

 

THE UNITED REPUBLIC OF TANZANIA

 

MINISTRY OF HEALTH AND SOCIAL WELFARE

FUND RAISING STARTEGY FOR THE PROMOTION OF TRADITIONAL MEDICINE IN TANZANIA

1.0: EXECUTIVE SUMMARY

In the Alma-Ata Declaration of 1978 recognition was given to the role of traditional medicine and its practitioners in achieving health for all. Tanzania and African states have been in the process of promoting and developing traditional medicine by preparing specific policy, legislation and managerial structures to govern the practice of traditional medicine as part of national health system and ensure an adequate budget allocation for effective development of traditional medicine.

Despite the effort to advocate, institutionalize, promote and utilize traditional medicine there some weaknesses in the area of research and development, documentation, cultivation, manufacturing and using it as a means to poverty reduction.

Besides weaknesses mentioned above, other weaknesses include inadequate understanding by Tanzanian elites with regard to traditional medicine and its medicinal resources; lack of enough financial resources to fund traditional medicine activities; lack of understanding on the importance of traditional medicine and medicinal resources in poverty reduction. Insufficient evidence on safety and efficacy of traditional medicines, lack of knowledge of attitudes, practices and behaviors in traditional medicine due to inadequate documentation and lack of protection of intellectual property rights and of endangered medicinal plant species (e.g. mass destruction, inadequate protection of endangered medicinal plant species and bad harvesting practices).

The proposed strategic mechanism aims at fund raising which in turn will assist the implementation of traditional medicine activities. The principles on which the strategy is based are advocacy, and partnerships. The implementation framework in achieving the strategic mechanism are upon the Government and Stakeholders.

2.0: INTRODUCTION

Traditional medicine is defined as "the total combination of knowledge and practices, whether explicable or not, used in diagnosing, preventing or eliminating physical, mental or social diseases and which may rely exclusively on past experience and observation handed down from generation to generation, verbally or in writing".

Traditional medicine plays an important role in meeting the primary health care needs of many people and thus has the potential to occupy a key place in contemporary community health care. Traditional medicine is increasingly becoming popular in health care services as well as in poverty reduction.

According to World Health Organization (WHO), it is estimated that 60% of Tanzanian population depends on traditional medicine for primary health care. It is an important part of Tanzanian cultures and thus due to diminishing revenues and cuts in international aid have forced the government to reconsider the advantages of indigenous health care practices. Moreover, there is growing evidence of the effectiveness of traditional remedies for the treatment of common ailments, including some priority diseases. Traditional health practitioners (THPs) enjoy considerable social status within their local communities and can play an important role in curative, preventive and rehabilitative measures of many diseases as well as in health education and promotion.

The Alma-Ata Declaration of 1978 recognized the role of traditional medicine and its practitioners as important allies in achieving health for all, in understanding this WHO African Region developed Traditional medicine Strategy to spearhead its institutionalization and promotion within Member States. In Tanzania traditional medicine and its practitioners are recognized through National Health Policy, Traditional and Alternative Medicines Act, Cap 244 and its Regulations as well as various National Document and Guidelines. These document shapes the way traditional medicine is advocated, institutionalized, promoted and its utilization through research and development.

Despite the fact that traditional medicine is advocated, institutionalized, promoted and utilized there some weaknesses in the area of research and development, documentation, cultivation, manufacturing and using it as a means to poverty reduction. Weak programme for the training of traditional medicine in undergraduate courses in the health and natural sciences and continuing education of traditional medicine practitioners including traditional birth attendants.

Besides weaknesses mentioned above, other weaknesses include inadequate understanding by Tanzanian elites with regard to traditional medicine and its medicinal resources; lack of financial resources to fund traditional medicine activities; lack of understanding on the importance of traditional medicine and medicinal resources in poverty reduction. Insufficient evidence on safety and efficacy of traditional medicines, lack of knowledge of attitudes, practices and behaviours in traditional medicine due to inadequate documentation and lack of protection of intellectual property rights and of endangered medicinal plant species (e.g. mass destruction, inadequate protection of endangered medicinal plant species and bad harvesting practices). To address these weaknesses there is need to strategize the integration of traditional medicine and its medicinal resources through health systems, agricultural development, industrial utilization of medicinal resources, and training on the importance of traditional medicine and to protect the genetic rights of the indigenous locale where the materials come from.

This Strategy will facilitate the promotion of the integration into health systems, agricultural development, industrial utilization of medicinal resources, and training of traditional medicine practices and medicines for which evidence on safety, efficacy and quality is available and the generation of such evidence when it is lacking. In this context integration means increase of health care coverage through collaboration, communication, harmonization, partnership building between conventional and traditional systems of medicine, while ensuring intellectual property rights and protection of indigenous knowledge. Similarly, it is the utilization of traditional medicine in growing and cultivation of medicinal resources, industrial utilization of medicinal resources, training health and natural science students in traditional medicine practices and medicines aiming at increased health care coverage and poverty reduction.

This document addresses the importance of traditional medicine and medicinal resources in health care systems and in growing and cultivation of medicinal resources, industrial utilization of medicinal resources, training health and natural science students in traditional medicine practices and medicines aiming at increased health care coverage and poverty reduction.

3.0: SITUATION ANALYSIS AND JUSTIFICATION

Trends in the use of traditional and complementary medicine Worldwide are on the increase in many developed and developing countries. The alternative and complementary medicine industry in Australia is growing at a rapid rate. It is currently estimated that the market is worth over one billion dollars, with more than 20% of that market being herbal medicine and related products. In Australia, as well as overseas, this market appears to be growing at about 30% per year. In Malaysia, it is estimated that about US$ 500 million is spent every year on traditional medicine, compared to only about US$ 300 million on modern medicine. In Sri Lanka, 50-60% of the populations rely on traditional medicine and Traditional Birth Attendants.

In 1997 Americans made 627 million visits to practitioners of alternative medicine and spent $27 billion of their own money to pay for alternative therapies that is a growth of 47.3 per cent since 1990. In contrast, Americans made only 386 million visits to their family doctor. The trend to alternative medicine is repeated throughout Western society. In Australia 57 percent of the population now use some form of alternative medicine, in Germany 46 percent do, and in France 49 percent do. The growth of some types of alternative medicine is indeed astounding. Between 1991 and 1997 the use of herbal medicines in the United States grew by 380 per cent and the use of vitamin therapy by 130 per cent. These are impressive numbers by anyone's standard.

The rapid growth is largely due to a growing demand from the public, one reason for this growth is a strong desire from people to take greater control of their own health and well being. Another reason is the perceived or real need to avoid the unwanted side effects of conventional medical drugs.

Herbal treatments are the most popular form of traditional medicine, and are highly lucrative in the international marketplace. Annual revenues in Western Europe reached US$ 5 billion in 2003-2004. In China sales of products totaled US$ 14 billion in 2005. Herbal medicine revenue in Brazil was US$ 160 million in 2007.

Total global herbal market is of size 62.0 billion dollars, in this European Union is the biggest market with the share 45% of total herbal market. North America accounts for 11%, Japan 16%, ASEAN countries 19% and rest of European Union 4.1%. Countries like Japan and China have successfully marketed their traditional medicines abroad. In China, traditional medicines account for 30- 50% of total medicinal consumption.

The forecast is that the global market for herbal products is expected to be $5 Trillion by 2050. Herbal remedies would become increasingly important especially in developing countries. Tanzania, with its biodiversity has a tremendous potential and advantage in this emerging area.

Some countries in the African Region are producing locally, various plant based preparations for chronic diarrhoea, liver disorders, amoebic dysentery, constipation, cough, eczema, ulcers, hypertension, diabetes, malaria, mental health and HIV/AIDS. In Mali and Burkina Faso for example have registered and included some of these medicines in their national essential drug lists.

The World Health Organization estimates that 80% of the populations in developing countries depend on traditional medicine for their health care needs. The African Region is facing difficulties in ensuring equitable access to health care and only about half of the populations in the Region have access to formal health services. Traditional medicine however, maintains its popularity for historic and cultural reasons. In Benin and Sudan, for example, 70% of the population rely on traditional medicine while, in Uganda, users of traditional medicine make up 70% of the population. In Ghana, Mali, Nigeria and Zambia, 60% of children with fever were treated with herbal medicines at home in 1998. In Tanzania, it is estimated that 60% of the populations rely on traditional medicine for health care needs.

Traditional medicine has many benefits, such as health care services and marketing of medicines. In order to get quality, safe and efficacious traditional medicines there is a need to systematically grow raw materials and process according to Good Agriculture and Collection Practice (GACP) and Good Manufacturing Practice (GMP) standards. Through growing medicinal resources many people will be employed, who in return gets money hence reduces their poverty. In Tanzania medicinal resources such as cinnamon, avocado, baobab, turmeric, Artemisia annua, quinine, African potatoes, punica granatum, saw palmetto, kigelia Africana etc. These medicinal resources some are food or spices, once processed properly will allow them to earn enough money for their daily leaving and hence reduce poverty.

Besides the justifications mentioned above there are other reasons such as impact of globalization; continue health epidemics of HIV/AIDS, malaria, tuberculosis, diabetes, childhood illness, etc; challenges of meeting MDGs without incorporating traditional medicine; ongoing challenges of increasing bio-piracy and continued loss of traditional medicine material and intellectual property from Tanzania; need to increase the commercialization of traditional medicine products and global climate change and its impact upon Tanzania’s biodiversity.

The criteria for having the strategy to solicit funds are:

a)    The country recognizes traditional medicine through Policy and Legal framework;

b)    There is a lot of diversity in the traditional medical practices and bio-resources;

c)    Traditional medical knowledge is by and large un-codified and not systematically organized;  

d)    Medicinal and aromatic plants as well as other medicinal resources are not adequately documented, managed and protected;  

e)    Institutional mechanisms for traditional medicine education and training and health care delivery are inadequate;

f)       Research and development of traditional medicine, medicinal and aromatic plants as well as other medicinal resources need to be scientifically and market driven to produce evidence on the safety, efficacy and quality as well as to deliver benefits for commercial exploitation and socio-economic empowerment;

g)    The huge potential of traditional medicine in Tanzania need to be harnessed to strengthen the health care systems to meet the health needs of the people and use the potential for poverty reduction;  

h)    Enforceable policies, planning and regulatory framework are the important prerequisites for ensuring sustainable and focused development of traditional medicine in Tanzania, which aim at improving health and poverty alleviation.

4.0: LIMITATIONS AND BOTTLENECKS OF THE SYSTEM

The medicinal plants have been traditionally obtained from forests and no systematic efforts have been made in past for developing the package of practices for cultivation of these plants. The best way for propagating plants and most appropriate season for raising new plants is not known for most of the plants.

The Tanzania diversity has many types of medicinal and aromatic plants which need to develop the packages of practices for cultivation and standardization to be worked out. Currently, Tanzania has no specified standards on quality of medicinal plants. Extinction of some species will cause shortage of medicinal plants especially those that are collected from the forests. Shortage of medicinal and aromatic plants has led to a growing interest of farmer for commercial plantation of such plants. The ever increasing demand for herbal products and shift in people’s interest in nature has led to indiscriminate exploitation of plants and species from the forest and other places which have led to near about extinction of some species. The investment in large-scale plantation is needed but it would be fruitful only if scientific methods of cultivation are developed.

Currently some medicinal plants are being procured in thousands of tones (baobab, African potatoes, Kigelia africana, saw palmetto, etc) but there is no organised marketing, and there is also no reliable information on their demand & availability and export potential. Procurement of this information is very difficult since the trade of medicinal plants is just un-organised. Under present condition there is absence of co-ordination and linkage between different Departments/Organisation and their field units leading to haphazard development and absence of suitable policy.

Although there are many traditional health practitioners countrywide claiming to treat and cure many communicable and non communicable diseases but lack of data through clinical trials and laboratory, work it is difficult to prove the extent of efficacy of individual prescriptions and cures. As a result, the practitioners leading to varying results prescribe a large variety of cures and practices. It will be beneficial if the cures claimed are systematically taken up and subjected to laboratory investigation and clinical trials so that their efficacy is established or disproved. This will allow the most effective cures out of the many claimed for a particular condition to be identified, which then can be propagated for extensive use for the benefit of patients.

There is one more problem that is faced by the industry, with increase in use of machines in preparing the medicines and other formulations the residue of these machines in form of iron powder is left behind which leads to problem as the desired result could not be achieved. There are no certifying agencies for these products. This creates problem in the export of these products and there is need for the certifying agency at central level.

In view of the point one and point two in the bottlenecks, the Ministry of Agriculture and Food Security shall develop the scheme for development of agro based techniques and cultivation of medicinal and aromatic plants used in traditional medicine. Under this scheme central assistance is provided to specialized scientific institution on project basis for development of agro techniques of identified medicinal plants.

The Ministry of Industry, Trade and Market as well as Ministry of Finance and Economic Affairs (TRA) shall also undertake a study on the manufacturing units and marketing outlets for traditional medicines and its products.

5.0: THE STRATEGY

5.1: Aim and objectives:

Aim

The aim of this strategy is to solicit funds from various stakeholders for popularization of traditional medicine in the Country.

Objectives

The objectives are:

a)    to mobilize traditional medicine stakeholders in fund raising activities

b)    to sensitize Tanzanians to contribute funds for traditional medicine activities

c)    to popularize traditional medicine through media

d)    to create countrywide traditional medicine awareness through mass media

5.2: Principles

Advocacy

To advocate the idea to traditional medicine stakeholders popularization of traditional medicine through mass media, involvement in fund raising and contribution for the traditional medicine activities.

Partnerships

The Ministry of Health and Social Welfare, Traditional Health Practitioners and Stakeholders should collaborate to achieve in popularizing traditional medicine, raise fund and contribute funds for traditional medicine activities.

5.3: Implementation framework

The role of the government

The government recognizes the importance of traditional medicine to health systems and poverty reduction. The government is an instrumental in creating an enabling environment for promoting traditional medicine through silviculture, agronomical and health research. The Government does among others, allocate resources to traditional medicine. However, resource allocate is not enough, hence traditional medicine stakeholders to assist such efforts in mobilizing additional resources to support the institutionalization of traditional medicine, facilitate the popularization and create awareness.

The role of stakeholders

With regard to institutionalization of traditional medicine, facilitation of popularization and awareness creation, stakeholders are requested to assist in:

a)    mobilizing financial resources

b)    sensitize Tanzanians through media regarding traditional medicine

c)    to popularize traditional medicine through media

Monitoring and evaluation

Monitoring and evaluating the implementation of the strategy should be participatory in nature.

5.4: Key priority areas

In implementing this strategy the following are the key priority areas/activities:

1)     Formulate a special taskforce or committee;

2)     The committee to discuss with relevant stakeholders on the issue

3)     Community mobilization;

4)     Resource mobilization;

5)     Realization of the resources mobilized

6)     Implementation of traditional medicine activities

(a) Commemoration of African Traditional Medicine Day

Theme: “The Decade of African Traditional Medicine Day: What Impact?”

·         Traditional Medicine Week; both WHO Representative and Country Relevant Officials will be interviewed on the identified theme by Country and / International media in collaboration with WHO-AFRO

·         An exhibition of Traditional Medicine

(b) Districts and /or Councils to undertake relevant activity: Educate THPs and provide registration form for them to register

(c) Develop and print training materials for THPs

(d) Equip Research Institutions [NIMR and ITM-MUHAS] with relevant equipment to undertake research and produce traditional medicines of public health importance

(e) Ministries responsible for health, agriculture, forest, industry and finance to develop and print Joint Traditional Medicine Development Plan which accommodates WHO-African Regional Strategy and African Union Plan of Action.

7)     Evaluation, Monitoring and reporting mechanisms.

6.0: DETERMINANTS OF SUCCESS

Critical determinants of success of the implementation of this strategy are commitment of each stakeholder.

7.0: CONCLUSION

The development of the present strategy reflects the importance of traditional medicine in health and poverty reduction. Integration of traditional medicine in health systems will result in increased coverage of, and access to, health care as well as poverty reduction. The promotion of positive traditional medicine practices and the use of traditional medicines of proven efficacy and safety will supplement other efforts to achieve health for all and MKUKUTA initiative of reducing poverty in the country.

The implementation of this strategy requires concerted collaboration among all the partners and effective and rational mobilization of all resources available. In this context, the promotion of the role of traditional medicine is critical to, if not decisive in, assisting to integrate traditional medicine into the national health systems and used as a tool in reducing poverty to our people.

8.0: Budget

	Commemoration of African Traditional Medicine Day  on 31st August,  2012	210303	Extra-Duty	days	200,000	50	10,000,000
		220101	Office consumable	assorted	100,000	40	4,000,000
		220109	Printing Costs	assorted	50,000	300	15,000,000
		220201	Electricity	days	600,000	7	4,200,000
			Security	days	600,000	7	4,200,000
		220202	Water and sanitation Charges	days	1,500,000	7	10,500,000
		220302	Diesel	litres	3,000	2000	6,000,000
			Chairs	assorted	2,000	1500	3,000,000
			Tables	assorted	20,000	500	10,000,000
			Decorations	assorted	150,000	100	15,000,000
			Carpet	days	5,000,000	2	10,000,000
			Exhibition area	days	1,500,000	7	10,500,000
			Stage	days	3,000,000	2	6,000,000
			Posters/adv	assorted	20,000	50	1,000,000
		220503	Tents and  Camp Equipment	assorted	4,000,000	6	24,000,000
		221001	Air Travel Tickets	trip	400,000	6	2,400,000
		221002	Ground travel	tickets	100,000	200	20,000,000
			Workshop	person	200,000	25	5,000,000
			Travel within DSM	trip	200,000	25	5,000,000
			Communication	assorted	200,000	5	1,000,000
			Mineral water	person	2,000	1000	2,000,000
			Allowance	person	1,200,000	5	6,000,000
			ID Cards	person	10,000	5	50,000
			Insurrance	person	4,000,000	5	20,000,000
			Speech	days	50,000	2	100,000
			Emergency	assorted	10,000,000	1	10,000,000
			Report writing	days	500,000	1	500,000
			Seminar/training	person	100,000	30	3,000,000
		221005	Per Diem - Domestic	days	1,200,000	40	48,000,000
		221204	Programs Transmission Fees	assorted	6,000,000	3	18,000,000
		221405	Entertainment	assorted	3,000,000	7	21,000,000
		230401	Motor Vehicles and Water Craft	trip	2,600,000	1	2,600,000
	Sub Total						298,050,000
	To develop and print THPs training materials	220803	Workshop facilities	Day	200,000	14	2,800,000
		210503	Food and Refreshment		25,000	350	8,750,000
		221005	Per Diem - Domestic	Day	1,200,000	25	30,000,000
		220101	Office consumable	assorted	24,000	35	840,000
		230401	Motor Vehicles and Water Craft		2,400,000	2	4,800,000
		220109	Printing and Photocopying Costs	assorted	1,500	400	600,000
		221002	Ground travel	tickets	36,000	22	792,000
		220109	Production and Printing 3000 copies of Training Materials	copies	10,000	3000	30,000,000
		220302	Diesel	litres	800	3,000	2,400,000
	Sub-Total						80,982,000
	Provide subside to all Districts and/or Councils		Training of THPs and registration	assorted	3,000,000	180	540,000,000
	Provide subside to purchase equipment research Institutions dealing with TM		Purchase laboratory and manufacturing equipment	assorted	500,000,000	2	1,000,000,000
	To develop and print MDAs Joint Traditional Medicine Development Plan	220803	Workshop facilities	Day	200,000	14	2,800,000
		210503	Food and Refreshment		25,000	350	8,750,000
		221005	Per Diem - Domestic	Day	1,200,000	25	30,000,000
		220101	Office consumable	assorted	24,000	35	840,000
		230401	Motor Vehicles and Water Craft		2,400,000	2	4,800,000
		220109	Printing and Photocopying Costs	assorted	1,500	400	600,000
		221002	Ground travel	tickets	36,000	22	792,000
		220109	Production and Printing 2000 copies of Training Materials	copies	10,000	2000	20,000,000
		220302	Diesel	litres	800	3,000	2,400,000
	Sub-Total						70,982,000
	Evaluation, Monitoring and reporting		Report development	assorted	50,000,000	1	50,000,000
	OVERALL TOTAL						2,040,014,000

 9.0: REFERENCES

1. AU Plan of Action for 2011-2020
2. http://intstudy.com/articles/twealtmd.htm 29-05-2012
3. http://www.yourhealthbase.com/alternative_medicine.htm 29-05-2012
4. http://www.who.int/mediacentre/factsheets/fs134/en/ 29-05-2012
5. http://www.dsir.gov.in/reports/ittp_tedo/ism/ISM_AS_Market.pdf 29-05-2012
6. WHO – African Region: Regional Strategy 2001-2010
7. WHO – African Region: Draft Review Regional Strategy 2012-2022