Neglect of traditional medicine continues

Nigeria joined the rest of the continent on August 31 to mark the African Traditional Medicine Day (ATMD). The commemoration coincides with the date, August 31, 2000, on which the ministers of health adopted the relevant resolution at the 50th session of the World Health Organisation (WHO) Regional Committee for Africa in Ouagadougou, Burkina Faso.

The World Health Organization Africa Region (WHO AFRO) officially designated August 31st of each year as ATMD and calls upon the world to recognise, respect, conduct research and partner with the system of African traditional medicine and traditional knowledge.

This year’s theme entitled “Regulation of Traditional Health Practitioners in the WHO African Region” highlights the need to establish and strengthen regulatory systems in countries by identifying and supporting qualified practitioners and protecting the public against potentially harmful practices.

Traditional Medicine (TM) is the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness.

However, despite the huge potential of TM to make Nigeria financially independent, boost primary health care (PHC) services, and ensure Universal Health Coverage (UHC), governments at all levels have continued to neglect the practice.

Little attempt made by the Federal Government to advance the practice such as the development of the Traditional Medicine Policy for Nigeria 2007, the establishment of the Nigeria Natural Medicine Development Agency (NNMDA) Lagos, and the Nigerian Institute of Pharmaceutical Research and Development (NIPRD) Abuja have not been backed up by the political will and adequate funding.

The Minister of Science and Technology, Dr. Ogbonnaya Onu, in July, told journalists that plans were in the offing to develop Nigerian herbal medicines for export.

Onu said a situation where traditional medicine from Asian countries flooded Nigerian markets called for serious attention from government, saying there was need to look inward to develop local herbs for export.

He added: “We are tired of importing everything we need from outside; the time has come for us to look inward and see how we can export our traditional medicines.”

According to him, many diseases that appear incurable through orthodox medicine can be cured with herbal medicines. But there is no budget line for practice in the 2017 Appropriation Bill as provided by the TM Policy.

Article 12 of the Traditional Medicine Policy for Nigeria 2007 titled “Allocation of financial resources” notes: “Adequate funding from Federal, State and Local Government budgets shall be allocated to ensure proper integration of Traditional Medicine in National health care delivery system.

“Funding arising from private sector, technical cooperation, grants, gifts, donations, etc. shall be utilized as appropriate. “Financial resources shall be made available for public education and information, advocacy, and for training Traditional Medicine Practitioners through both the formal health system and associations of Traditional Medicine Practitioners.”

To address this anomaly, a Bill for an Act to provide for the establishment of complementary and alternative medicine commission recently passed third reading stage in the House of Representatives.

Also, a bill for an act to provide for the establishment of the Traditional Medicine Council of Nigeria has passed the third reading. The Guardian investigation revealed that there is indeed no funding for TM in Nigeria. The NNMDA got N791.1 million in the 2017 National Budget, according to the 2017 FGN Budget Proposal. A breakdown shows that bulk of the money is used for paying salaries and they do not have enough to meet their mandates.

The NNMDA was established in 1997 to enable the Federal Government of Nigeria through Federal Ministry of Science & Technology (FMST) actualize its critical and strategic mandate to research, develop, document. Preserve, conserve and promote Nigeria’s natural medicine (traditional/indigenous healthcare systems, medications and non-medications healing arts, science & technology) and assist facilitate their integration into the national healthcare delivery system. As well as contribute to the nation’s wealth and job creation, socio-economic growth and development effort.

The Guardian investigation revealed that due to poor funding, 20 years after its establishment, NNMDA has not being able to commercialized any of its discoveries in traditional medicine and is yet to export any product.

Also, the Appropriation Bill from the Budget Office of The Federation Ministry of Budget and National Planning shows that only N711.6 million is allocated to NIPRD, which had developed and has the patent to the world-acclaimed and verified potent herbal drug for sickle cell anemia, Nicosan (Niprissan).

NIPRD was established by Federal Government order No. 33 Vol. 74 of 11th June 1987 part B under the Science and Technology Act Cap 276. The overarching goal for the establishment of the Institute was to carry out research and development of drugs, biological products and pharmaceutical raw materials based on indigenous resources. NIPRD commenced operation in the year 1989. Today, NIPRD is a parastatal of the Federal Government of Nigeria under the Federal Ministry of Health (FMOH).

The Guardian investigation revealed that due to lack of funds and bureaucracy, NIPRD has stopped the commercial production of Nicosan and institutes budget over the years have barely been enough for paying salaries.

The situation is no different at NNMDA, which has made a lot of research into herbal cures that are begging for development but for lack of funds. It was reliably gathered that the budget for the agency is mainly used for paying salaries and not enough for any meaningful research work.

A breakdown of NNMDA’s N791.1 million budget shows that N268,464,384 is for recurrent expenditure and N522,708,417 for capital projects while that of NIPRD shows that of the N711.6 million for 2017, N663,990,655 is for recurrent expenditure and just N47,659,000 for capital projects.

Besides the WHO and United States Centres for Disease Control and Prevention (CDC)-approved herbal drug for sickle cell anaemia, Nigeria has potential herbal medicine products for the prophylaxis and the treatment of cancers, Human Immunodeficiency Virus (HIV), management of stroke, hypertension, diabetes, malaria, anti-rabies and anti -snake vaccines, among others.

Meanwhile, the National Agency for Food, Drug Administration and Control (NAFDAC) made giant strides towards the development of TM under the leadership of Dr. Paul Orhii. Orhii had set up a national committee of experts in natural medicines including professors of medicine and TM practitioners. But all the hype could not be sustained due to lack of funds and the political will from the Federal Government.

Also, as part of efforts to improve TM practice in the country, the Federal Government of Nigeria, in 2006, formed the National Association of Natural and Traditional Medicine Practitioners (NANTMP) was formed.

The Federal Government under the Leadership of Chief Olusegun Obasonjo through Prof. Eyitayo Lambo the then Minister of Health established the NANTMP on December 19, 2006.

Meanwhile, a further breakdown of the 2017 national budget showed that only N19.55 billion is earmarked for 15 research institutes out of the N65.1 billion annual budgets for the FMST and N304.1 billion for the FMoH.

This means that only 0.26 per cent of the 2017 national budget of N7.44 trillion was allocated for research; and only 5.29 per cent of the N369.2 billion allocated to science, technology and health that is budgeted for research.

According to the World Bank data, Nigeria, in 2007, spent just 0.219 per cent of its Gross Domestic Product (GDP) on research and development.

However, FIIRO, which has made giant strides in the development of herbal drugs, got a budget of N3.47 billion. FIIRO has also developed a new herbal-based sickle cell product that has been shown to be effective in treating patients with the disorder.

Besides poor funding what are the other challenges?
A study on “The Contributions of African Traditional Medicine to Nigeria’s Health Care Delivery System” published in www.iosrjournals.org identified challenges towards TM development to include limited organisational arrangement for the institutionalisation of traditional medicine such as: poor allocation of financial resources for implementation of traditional medicine activities; delay in the establishment of mechanisms for the official recognition of traditional health practitioners; lack of national policies in the country; limited national strategic plans for policy implementation; lack of mechanisms of collaboration between practitioners of conventional and traditional medicine; and limited research data on the safety, efficacy and quality of traditional medicines and documentation of traditional medicine practices.

On the way forward, Prof. Anthony Elujoba and his team of researchers at the Village Chemist, Department of Pharmacognosy, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, in a report published in African Journal. Traditional, Complementary and Alternative Medicines said: “The WHO has since urged developing countries of the world to utilize the resources of Traditional Medicine for achieving the goals of Primary Health Care. This injunction stems round the various advantages of Traditional Medicine namely, low-cost, affordability, ready availability, accessibility and acceptability and perhaps low toxicity.

“The practitioners are ready sources of medical and dental manpower. It is also expected that in recognizing them and hence utilizing the advantages, the various disadvantages of the practice can also be resolved. These include lack of adequate scientific proof, imprecise diagnosis and dosage, unstandardized medicines and occultic practices.”

The study is titled “Traditional medicine development for medical and dental primary health care delivery system in Africa.” Director of Paxherbal Clinic and Laboratories Ewu, Edo State, Rev Fr. Anslem Adodo, said: “The traditional medicine curricula are a millstone for the practise of traditional medicine in Nigeria. One of the major challenges of Tradition medicine is that it has not moved from the realm of the subjective to the objective, from the implicit to the explicit knowledge.

“It is important that we preserve this vast body of indigenous knowledge in writing, thereby making it explicit, so that it can be passed on to others. It is crucial that traditional medicine evolved from implicit knowledge to explicit knowledge, from knowledge embodied in individual local healers to a ‘communiversity’ of knowledge that is available to all.”

To achieve this, Adodo said Paxherbals has partnered with the Institute of African studies at the University of Ibadan, to design a new MA and PhD curricula for Traditional African Medicine.

President, Nigerian Council of Physicians of Natural Medicine, Prof. Magnus Atilade, has urged the three tiers of governments to fund research and other activities in the traditional and alternative medicine.

Atilade made the plea at a news conference on the ATMD organised by the council in Lagos. The theme of the day is: “Repositioning Traditional, Complementary and Alternative Medicine in Nigeria.’’

Atilade also called on all health institutions, stakeholders and professionals to collaborate with the traditional medicine practitioners to boost healthcare delivery.

The council president said that funding traditional and alternative medicine would encourage more people to adopt the system. He further stated: “The WHO has supported, promoted and assisted the development of traditional and alternative medicine in a bid to drive African health agenda.

“Speedy passage of the Traditional Medicine Bill now before the National Assembly is also very important. “Integrating indigenous medicine into the country’s healthcare delivery is very important to our society as the practitioners are closer to the people.

“It is high time that government does the needful to legitimatise, control and integrate traditional medicine into the nation’s healthcare delivery. “This system will put stop to quackery and bring reduction to maternal mortality rate in Nigeria.

“It will be banded with law, and training of the practitioners will be enforced to boost effective healthcare delivery.” A biochemist, Dr. Olugbenga Aina, said that encouraging natural products and drugs would boost the nation’s economy and development.

Aina, who works with the Nigerian Institute of Medical Research (NIMR), Yaba, urged the three tiers of government and the private sector to support traditional medicine with adequate funding.

He said: “Integration of traditional and alternative medicine into the healthcare delivery system will popularise it as being done in other countries such as India, China and Europe.

“NIMR decided to collaborate with natural medicine practitioners by testing their herbal products in our laboratories to know the effectiveness and its side effects on herbal drugs before consumption.

“Most people are confused because they do not know the efficacy of most herbal drugs.”

Adodo added: “Having been at the forefront of championing the official integration of Traditional herbal medicine into national healthcare system for over 10 years now, I have come to realize that the future of healthcare in General, and African Herbal medicine in particular, does not lie in the hands of those heavily dressed salaried professionals who sit down all day in air-conditioned offices in Abuja rolling out foreign-made, unrealistic policies and proposals to government, or the crowd of lazy professors in our universities who are yet to upgrade their knowledge bases and cannot go outside their master’s and doctoral thesis, written perhaps 30 or 40 years ago, to embrace new ideas.”

Unlike Nigeria, Ghana has made significant progress in enhancing the standing of traditional medicine as a viable healthcare option. By developing a favorable policy framework, the government has fostered innovation and improved traditional medical practice.

But like in Nigeria, the informal nature of the sector, however, poses particular challenges when it comes to securing the sector’s long-term sustainability and when ensuring that policy and practice are fully aligned.

Director and research scientist at Science and Technology Research Institute, Council of Scientific and Industrial Research (CSIR), Accra, Ghana, Dr. George O. Essegbey, and Mr. Stephen Awuni, noted that Ghana’s experience in the area of traditional medicine offers interesting insights into the dynamics of innovation in a sector that, while pivotal in supporting equitable healthcare delivery goals, is largely made-up of micro-entrepreneurs operating in the informal economy.

The country’s achievements in strengthening traditional herbal medical practice have recently been the focus of a World Intellectual Property Organisation (WIPO) Development Agenda study which explores how innovation – the introduction and development of new and improved products and processes – takes place within the informal economy; the mechanisms by which traditional medical practitioners secure a competitive advantage; and, in particular, how informal operators protect their know-how.

The researchers said the continued advancement of traditional medicine practice promises significant opportunities for job creation across the traditional medicine value chain. “Moreover, beyond their use at home, there are also significant opportunities to commercialize traditional medicine products in global markets. Perhaps it is time to put traditional medicine on a more industrial footing.”

Director of Traditional and Alternative Medicine Directorate of the Ministry of Health and Member of the Pharmaceutical Society of Ghana (PSGh) and the International Pharmaceutical Federation (FIP), Dr. Anastasia Yirenkyi, has called for special fund for traditional medicine development is needed.

She said: “As I sat in the meeting, I asked myself: How do we achieve UHC for the citizens without traditional and alternative medicine (TAM)? How do we develop orthodox medicine while the needed attention to TAM is almost at ground zero?”

The pharmacist said research institutes have the potential herbal medicine products for the prophylaxis and the treatment of Cancers, Human Immunodeficiency Virus (HIV), management of stroke, hypertension, diabetes, malaria, anti-rabies and anti -snake vaccines. “If funds are released for research and development of these products, we are likely to cut down the health budget drastically.”

“I appeal to you to set aside funds for the development of traditional and alternative medicine in Ghana. We must provide safe and quality traditional medicine products and services to the citizens of Ghana,” she said.

Prof Honolu Konotey, the renowned Ghanaian sickle-cell physician who said: “Unless Africans can find alternative sources of therapeutic measures in traditional medicine, the future is bleak indeed, because even with improvement in public health measures, people will still require drug treatment. We therefore need to collect and record all anecdotes, including the embarrassing and most primitive ones. By sifting through them carefully we can use our scientific knowledge not only to discard harmful practices, but also discover hidden treasures.”