MID-TERM REVIEW OF THE AFRICAN UNION (AU) DECADE OF AFRICAN TRADITIONAL MEDICINE ( ) AUGUST 2008

Transcription

1 MID-TERM REVIEW OF THE AFRICAN UNION (AU) DECADE OF AFRICAN TRADITIONAL MEDICINE ( ) AUGUST 2008

2 Acknowledgement This report was prepared by the African Union Commission in collaboration with the World Health Organization

3 ACRONYMS AAMPS AIDS APCD ARIPO AUC AU/STRC CHP CNARP DAFMEP FIIRO GACP HIV IMRA IPR KEMRI MA MEDBASE MIAM NAPRECA NDP NDRA NEML NGO NISIR ORID PHC PLWA PROMETRA REC RECIPRENA REJOMETRA TDRC THETA THP TM TMK TRIPS WHO Association for African Medicinal Plants Standards Acquired Immuno Deficiency Syndrome African Plants Checklist & Database African Regional Intellectual Property Organization African Union Commission African Union Scientific and Technical Research Commission Conventional Health Practitioner Centre National pour la Recherché Pharmaceutique Database for African Medicinal Plants The Federal Institute of Industrial Research, Oshodi Good agricultural and Collection Practices Human Immune-Deficiency Virus Institut Malgache pour Recherché Appliqués Intellectual Property Rights Kenya Medical Research Institute, Marketing Authorisation National Medicinal Plants Database for South Africa) Malaria Institute at Macha Natural Products Research Network for East & Central Africa National drug Policy National Drug Regulatory Authorities National Essential Medicine List Non Governmental Organisation National Institute for Social and Industrial Research Other Related Infectious Diseases Primary Health Care People Living With HIV and AIDS Promotion of Traditional Medicine Regional Expert Committee Network for development of TV programmes for promotion of natural products Network of journalists for promotion of Traditional Medicine Tropical Diseases Research Centre Traditional & Modern Health Practitioners Together against AIDS Traditional Health Practitioners Traditional Medicine Traditional Medicine Knowledge Trade-Related Aspects of Intellectual Property Rights World Health Organisation

4 EXECUTIVE SUMMARY Since the Alma Ata Declaration on primary health care (PHC) 30 years ago (1978) which recognized the role of traditional medicine (TM) and its practitioners as important allies in achieving Health-for-All, important progress has been made in the area of TM. The Organisation of African Union (OAU) Decision on the decade of TM was made in 2001.The First AU Session of the Conference of African Ministers of Health, which was held in April 2003 in Tripoli, Libya, adopted the Plan of Action and implementation mechanism which was endorsed by the AU Summit Heads of State and Government in Maputo in The main objective of the Plan of Action is the recognition, acceptance, development and integration/institutionalization of TM by all Member States into the public health care system by The Maputo declaration on Malaria, HIV/AIDS, and TB and other related infectious diseases (ORID) of July 2003 resolved to continue supporting the implementation of the Plan of Action for the AU Decade of African TM ( ), especially research in the area of treatment for HIV/AIDS, TB, Malaria and ORID. Furthermore, in July 2003, the Lusaka Summit declared the period as the OAU Decade for African TM. This report on the Mid-Term review of the Decade is prepared in line with the request by African Ministers of Health during their 3rd Ordinary Session of AU Conference of Ministers of Health held in Johannesburg, South Africa, from 9 to 13 April 2007 after considering a status report on the implementation of the Plan of Action on the AU Decade of African TM ( ).The Ministers recommended that a Mid-Term review of the decade be undertaken by AU Commission in During the Special Session of the Conference of AU Ministers of Health held in Geneva, Switzerland on 17 May 2008, a progress report on the implementation of the AU Decade of ATM was considered and it was then that the Ministers recommended that the report be developed into the Midterm Review of the Decade which would be presented to the Ministers during the 6 th commemoration of the ATM Day (31 August 2008) in Yaoundé, Cameroon. In this connection, the AU Commission in collaboration with WHO conducted a mid-term review of the Decade of African TM. The midterm review describes the progress on the implementation of the plan of action of the AU Decade of TM in the five AU regions of the continent covering the eleven priority areas outlined in the plan of action of the AU Decade of TM. These areas include: Sensitization and popularization of TM; Policy and Legislation on TM, Institutional arrangements; Information, education and communication; Resource mobilization; Research and Training; Cultivation and conservation of medicinal plants; Local production of standardized ATM; Protection of Traditional Medicine Knowledge (TMK) and Control access to Biodiversity; Partnerships; Evaluation; Monitoring and evaluation. It also reflects progress on the implementation of the Regional strategy on promoting the role of TM in health systems adopted by RC50 in Ouagadougou, Burkina Faso in 2000 and provides an update of the progress of TM in AU Member States before and after the declaration of the Decade of African TM. Finally the report highlights the challenges and recommendations proposed by Member States to accelerate the implementation of the plan of action of the AU decade of ATM. These recommendations are to be tabled for discussion during the Conference on the Midterm review of the AU decade of ATM ( ) to be held during the 6 th Commemoration of the ATM Day in Yaoundé, Cameroon on 31 AUGUST The report on mid-term review indicates that Member States have made good progress in the area of sensitization and popularization of TM and development of tools for institutionalizing TM in health systems. Some R&D and small scale local production are being carried out by AU Member States.

5 However, the much needed phase III clinical trials to ascertain the safety, efficacy and quality of TMs and protection of traditional medical knowledge are hampered by limited financial resources. Additional financial resources for conducting clinical trials, local production of TMs and for protection of traditional medical knowledge need to be considered if TM is to be given its rightful place and mainstreamed in health systems and services.

6 1. INTRODUCTION 1. The use of TM is a global reality in that it has been used since the existence of mankind by all nations. Since the Alma Ata Declaration 30 years ago (1978) on PHC, important progress has been made in the area of TM. Many developed countries such as Canada, Germany, France, Australia, United Kingdom and USA have been using it as complementary and alternative medicine for over a decade. China, Vietnam and South Korea have officially fully integrated the two systems of medicine whereas India has promoted in parallel development of both conventional and traditional systems of medicine. 80% of the population in the AU Member States uses TM for their PHC; however, it is not sufficiently integrated into health systems. 2. The Assembly of OAU Heads of States and Government in April 2001 in Abuja declared that research in the area of TMs used for the treatment of Malaria, HIV/AIDS, Tuberculosis and other Related Infectious Diseases (ORID) should be made a priority. The Lusaka decision requested the OAU Secretary-General in collaboration with WHO and other interested stakeholders to assist OAU Member states to elaborate a Plan of Action, to provide a general framework to guide Member States in formulating respective national strategies. The Plan of Action as well as the Mechanism for Monitoring and Reporting were developed by the AUC in collaboration with WHO. 3. WHO s Governing Bodies and Members States have adopted various resolutions and declarations. For example, resolution on Promoting the Role of TM in Health Systems: A strategy for the African Region adopted by the fiftieth session of the WHO Regional Committee for Africa (RC50) held in Burkina Faso in 2000, and the Brazzaville Declaration on TM by RC57 in The aim of the regional strategy is to contribute to the achievement of health for all in the region, by optimizing the use of TM. 4. Since 2001, AU Member States have been implementing the plan of action of the AU Decade of African TM and the priority interventions of the WHO regional strategy namely, policy formulation; capacity building; research promotion; development of local production including cultivation of medicinal plants; and protection of traditional medical knowledge and intellectual property rights (IPRs). This mid-term review report builds on the document presented to the Conference of African Ministers of Health during the Special Session of the CAMH held in Geneva on 17 May It is based on country reports on the implementation of the plan of action on the AU Decade of ATM and on the analysis of reports and data from countries supported by WHO between 2001 and August The mid-term review report is hereby presented to the AU Ministers of Health held in Yaoundé, Cameroon, 31 August 2008 on the occasion of the African TM Day. The AU Commission anticipates preparing a comprehensive continental report in THE MID-TERM REVIEW OF THE IMPLEMENTATION OF THE PLAN OF ACTION ON THE AU DECADE OF AFRICAN TRADITIONAL MEDICINE 6. This mid-term report describes the progress on the implementation of the plan of action of the AU Decade of TM in the five AU regions of the continent during the period 2001 to August 2008.It is based on the eleven priority areas outlined in the plan of action of the AU Decade of TM. These are: a) Sensitization and popularization of TM b) Policy and Legislation on TM c) Institutional arrangements

7 d) Information, education and communication e) Resource mobilization f) Research and training g) Cultivation and conservation of medicinal plants h) Local production of standardized ATM i) Protection of traditional medical knowledge (TMK) and Control access to Biodiversity j) Partnerships k) Evaluation, monitoring and evaluation 7. The mid-term review was developed by building on the progress report on the implementation of the decade that had been compiled in May 2008 based on the analysis of reports on implementation of five of the eleven main priority areas of the PoA of the AU decade of ATM. Additional information from the analysis of WHO reports from Countries on the remaining six priority areas namely: Information, education and communication; training; partnerships and evaluation, monitoring and evaluation has been included. The report also reflects progress on the implementation of the Regional strategy on Promoting the role of TM in health systems adopted by RC50 in Ouagadougou, Burkina Faso in 2000 and provides an update of the progress of TM in AU Member States before and after the declaration of the Decade of African TM. Furthermore the report highlights the challenges and recommendations proposed by AU Member States for accelerating the implementation of the plan of action of the AU decade of ATM. 8. Table 1 shows a Regional breakdown of the 37 (80%)out of 46 AU Member States from WHO African Region responding to the questionnaire on Rapid Assessment Tool on the mid-term review of the Decade of ATM. Table 1: Regional AU Member States breakdown responding to the questionnaire on Rapid Assessment Tool on the mid-term review of the Decade of ATM Central Africa East Africa North Africa Southern Africa West Africa countries countries countries countries countries 1. Cameroon, 2. Central African Republic 3. Congo 4. Chad 5. DRC 6. Sao Tome Principe 1. Burundi 2. Ethiopia 3. Eritrea 4. Kenya 5. Madagascar 6. Mauritius 7. Rwanda 8. Seychelles 9. Tanzania 10. Uganda No information 1. Botswana 2. Lesotho 3. Namibia 4. South Africa 5. Swaziland 6. Zambia 7. Zimbabwe 1.Benin 2.Burkina Faso 3. Cote d Ivoire 4.Gambia 5. Ghana 6. Guinea Bissau 7. Liberia 8. Mali 9. Mauritania 10. Niger 11. Nigeria 12. Senegal 13. Sierra Leone 14. Togo 6 Countries 10 Countries 7 Countries 14 Countries 2.1 SENSITIZATION OF THE SOCIETY AND POPULARIZATION OF TRADITIONAL MEDICINE Commemoration of African Traditional Medicine Day 9. In July 2003 in Maputo the African TM Day was endorsed by Heads of State and Government as an advocacy initiative among AU Member States. The inaugural African TM Day was commemorated in South Africa on 31 August 2003 in conjunction with RC53 and the launching of the research centre on African TM with the Theme: African TM, Our Culture, Our future. Reports from the 37 AU Member States who responded to the Midterm Review questionnaire reveal that

8 the ATM Day has been commemorated every year since 2003 with support from governments, WHO, and other partners. Participants at these events included THPs, researchers, pharmacists, medical doctors and the public. In additional to the ATM day, some countries have institutionalized a National Traditional Medicine Week, e.g. Burkina Faso, Congo, Mali and Ghana. During these events, various activities such as exhibitions of TMs, conferences, seminars, round tables and cultural dances have been held. This year s (2008) theme for the African TM Day is The Role of Traditional Health Practitioners in Primary Health Care Sensitization Workshops 10. Some AU Member States (e.g. Benin, Burkina Faso, Mali and Ghana) and NGOs {e.g. Traditional and Modern Health Practitioners Together against AIDS (THETA) based in Uganda and Promotion of TM (PROMETRA) based in Senegal have taken the opportunity of the African TM Day to organize sensitization workshops. Most countries have organized sensitization workshops on specific themes. The countries shown in Table 2 have organized sensitization as well as consensus workshops for development and adoption of national tools for institutionalizing TM in health systems and with law or regulation on TM at different times before and mostly after the Decade of ATM. These workshops have not only popularized TM but also enhanced collaborations between practitioners of TM and those of conventional medicine in areas such as identification of medicinal plants, research and development, education and training and establishment of networks. For example, in 2006 a network of Malian parliamentarians for TM was created. The media has also been involved in the sensitization of the TM Day to the general public and exhibitions of African traditional medicinal products have been organized Any other activities aimed at promoting African Traditional Medicine 11. Benin, Burkina Faso, Congo, Ghana and Mali have instituted the TM Week for advocacy which is commemorated each year by traditional health practitioners (THPs), conventional health practitioner (CHPs), NGOs and other relevant stakeholders. During the period under review, a number of countries have developed various advocacy materials such as tools and guidelines, books, newsletters, bulletins, monographs which have contributed to promoting African TM. For example, in 2007 Cameroon produced monographs of medicinal plants used for the treatment of diarrhoea, malaria, diabetes, sickle-cell anaemia and hypertension and Mali published two books on Indigenous Veterinary Medicine and African Traditional Medical Treatment. Congo and Nigeria published their national policy and the situation of registration and local production, respectively whereas Ghana published the second strategic plan for development of TM ( ). Ethiopia and Zambia developed guidelines for safety monitoring of TMs in 2005 and for research in TMs and national health research policy in 2006 respectively. WHO has also published various tools and guidelines on TM and produced advocacy information materials based on the theme for ATM Day for use by countries at the Occasion of the African TM Day. 2.2 POLICY AND LEGISLATION ON TRADITIONAL MEDICINE Policy, rules, regulation and law 12. Twelve countries indicated having established a national policy on TM before the declaration of the Decade of African TM 1. Since January 2001-August 2008 twenty six countries have developed 1 Chad (2000), Equatorial Guinea (1999), Gabon (1995 as part of national health policy); Ethiopia (as part of the National Drug Policy (NDP) in 1993, Tanzania (1990), South Africa (1996) and Zambia (1997) both as part of NDPs, respectively; Benin (2001updated in 2007), Cote d Ivoire (1996 updated in 2007), Guinea (1994), Liberia (1989) and Togo (1996).

9 national TM policies after the declaration of the Decade of African TM 2 making a total of 38 (83%) out of 46 AU Member States in the African Region with such policies. Sixteen countries indicated having had laws or regulations on TM before the declaration of the AU decade of African TM 3 whereas seventeen Countries have developed laws on TM after the declaration of the Decade making a total of 33 (72%) out of 46 countries with such laws/ regulations. In 2002 Angola, South Africa and Zambia indicated that laws or regulation on TM were in progress. Table 2 shows countries of the five AU regions which developed national policies and had law or regulations before and after the declaration of the Decade of African TM during January 2001-August Table 2. Countries indicating to have established national policies and regulation before and after the declaration of the Decade of African Traditional Medicine To add some EMRO countries as discussed on AU Member States in the five regions Central Africa countries Africa countries East Africa countries North Africa countries Southern Africa countries West Africa countries Countries with draft or approved policies on TM before the decade (N=12) Chad 2000), Equatorial Guinea (1999), Gabon (1995 as part of national health policy) Ethiopia (1999) and Tanzania (1990); Countries with draft or approved policies after the declaration of the Decade of African TM (N=26) Cameroon (?), Central African Republic (CAR) (2007), Congo (2006), DRC (2006) Madagascar (2004), Mauritius (1989) Rwanda (2007), Uganda (2006) Countries indicating development/progre ss of law or regulation on TM after the decade (N=17) 2002:Cameroon, CAR, Chad, Gabon and Sao Tome Principe (in progress), DRC (2006) 2002:Kenya, Madagascar, Seychelles, Uganda, and Tanzania (in progress), Rwanda (2007)_, Countries with law or regulation on TM before declaration of Decade (N=16) Equatorial Guinea (1985) Ethiopia (1996), Mauritius (1989) and Uganda (1993) No information; No information; No information; No information South Africa (1996) and Zambia (1997) both as part of NDPs Benin (2001), Cote d Ivoire (1996 updated in 2007), Guinea (1994), Togo (1996) Angola (as part of national health policy, 2005), Malawi (2004), Mozambique (2004), South Africa (2007), Zambia (2008), Zimbabwe (2007) Benin (2007), Burkina Faso (2004), Cote d Ivoire (2007), Gambia (2005), Ghana (2002), Liberia (2008), Mali (2005), Nigeria (2007), Niger (2002), Senegal (2006), Sierra Leone (2006), 2002:Angola, South Africa and Zambia (in progress), Zimbabwe (2006) 2001: Benin and Togo (in progress) Namibia (1994), South Africa (1990), and Zimbabwe (1981) Burkina Faso (1994), Cote d Ivoire (1999), Ghana (1992), Guinea (1997), Liberia (1989), Mali (1973), Niger (1997), Nigeria (1993 and revised in 1999), Senegal (1998) 2 Angola (as part of national health policy), Benin (2007), Burkina Faso (2004), Cameroon (), Central African Republic (2007), Congo (2006), Cote d Ivoire (2007), DRC (2006), Gambia (2005); Ghana (2002), Liberia (2008), Madagascar (2004), Malawi (2004), Mali (2005), Mozambique (2004), Nigeria (2007), Niger (2002), Rwanda (2007), Senegal (2006); Sierra Leone (2006), South Africa (2007), Uganda (2006), Zimbabwe (2007) 3 Burkina Faso (1994), Cote d Ivoire (1999), Equatorial Guinea (1985); Ethiopia (1996), Ghana (1992), Guinea (1997), Liberia (1989), Mali (1973), Mauritius (1989), Namibia (1994), Niger (1997), Nigeria (1993 and revised in 1999), Senegal (1998), South Africa (1990), Uganda (1993), Zimbabwe (1981)

10 2.2.2 Availability of structure at Ministry of Health as focal point on Traditional Medicine 13. Twenty five countries indicated having established a National TM Office in the Ministry of Health (MOH) before the declaration of the Decade of African TM 4 and twelve countries reported to have established these after the declaration 5 bringing this number to 37countries.. In order to accelerate implementation of TM activities, fifteen countries established a National Programme in the MOH before the declaration of the Decade of African TM 6 whereas fourteen countries indicated to have established such Programmes after the declaration of the Decade of African TM 7 making a total of 38. Table 3 shows countries which had established TM Office and TM Programme in the Ministry of Health before and after the declaration of the AU decade of African TM. Table 3: AU Member States which established TM Office and TM Programme in the Ministries of Health before and after the declaration of the decade of African TM AU Member States in the five regions Central Africa countries East Africa countries North Africa countries TM Office in the Ministry of Health before 2001 (N= 26) Cameroon (1995), Central African Republic (1997), Chad (1997), Congo (1982), Equatorial Guinea (1995), Gabon (2000) Eritrea (1997), Tanzania (1989), Uganda (1964), Madagascar (1997), Mauritius (1989) TM Office in the Ministry of Health after the Decade of TM (N= 12) Cameroon (2002), Chad (2004), DRC (2002), Sao Tome Principe (2002) Burundi (2003), Comoros (2002), TM Programme in the Ministry of Health before 2001 (N=15) Congo (1982); Ethiopia (1995 Madagascar (1997), Tanzania (1989) No information No information No information TM Programme in the Ministry of Health after the Decade of TM (N=14) Cameroon (2002), DRC (2002), Equatorial Guinea (2002), Chad 2004), Sao Tome Principe (2002) Madagascar (2007) Mauritius (2002) No information Formatted: Portuguese Portugal Southern Africa countries Angola (1998), Mozambique (1977), Namibia (1990), South Africa (2002), Zambia (1996) Office split between National Drug Policy and Analysis and TM desk) South Africa (2006) Zambia (2008), Zimbabwe (2006) Angola (1998) and Mozambique (1977). South Africa (2006) Zimbabwe (2006). West Benin (2000), Burkina Faso Cote d Ivoire Benin (1999), Cote d Ivoire 4 Angola (1998), Benin (2000), Burkina Faso (1987), Cameroon (1995), Central African Republic (1997), Chad (1997), Congo (1982), Eritrea (1997), Equatorial Guinea (1995), Gabon (2000), Gambia (2000), Ghana (1999), Guinea (1977/97?), Lesotho (1996), Liberia (1989), Madagascar (1997), Mali (1968), Mozambique (1977), Namibia (1990), Niger (1995), Nigeria (1997), Senegal (1996), Togo (1991), Tanzania (1989), Uganda (1964), Zambia (1996) Office split between National Drug Policy and Analysis and TM desk) 5 Burundi (2003), Cameroon (2002), Chad (2004), Comoros (2002), Cote d Ivoire (2002), DRC (2002), Gambia (2001), Sao Tome Principe (2002, Sierra Leone (2002), South Africa (2006) Zambia (2008), Zimbabwe (2006) 6 Angola (1998), Benin (1999), Congo (1982), Ethiopia (1995), Gambia (year not indicated), Ghana (2000), Mali (1973), Mozambique (1977), Senegal (1996), Tanzania (1989) and Togo (1996). 7 Cameroon (2002), Chad 2004), Cote d Ivoire (2006), DRC (2002), Equatorial Guinea (2002), Gambia (2005), Liberia (2001), Madagascar (2007), Mali (2005), Niger (2001), Sao Tome Principe (2002, Sierra Leone (2002), South Africa (2006), Zimbabwe (2006).

11 Africa countries (1987), Gambia (2000), Ghana (1999), Guinea (1977), Liberia (1989), Mali (1968), Niger (1995), Nigeria (1997, Senegal (1996), Togo (1996). (2002), Gambia (2001), Sierra Leone (2002) Ghana (2000), Senegal (1996) (2006), Gambia (2005), Liberia (2001), Mali (2005), Niger (2001) Sierra Leone (2002) Any efforts that facilitated development of policy and legislation on traditional medicine 14. Countries established various mechanisms to facilitate institutionalization of TM in health Systems. For example, Nigeria (2001) and South Africa (2002) established Presidential Task Teams to work on the broad policy framework on African TM, to facilitate the registration and regulation of African TMs in collaboration with their respective national drug regulatory authorities and to establish a school of ATM (Nigeria). More than sixteen countries had established a national expert committee on TM before the declaration of the Decade of African TM (e.g. Central African Republic (1985), Mozambique (2000), and after the decade (e.g. Benin (2007), Chad 2005), Ghana (2001), Gambia (2001), Nigeria (2007), Nigeria (2001), Sierra Leone (2003), South Africa (2001), Tanzania (2005), Togo (2006), Zambia (2008), Zimbabwe (2006). 15. In 2001 WHO established a 12-Member Regional Expert Committee on TM (REC) drawn from AU Member States in WHO African Region to serve for four years to support the implementation and monitoring of the Regional Strategy on Promoting the Role of TM in Health Systems. The REC which is serving its Second Term has adopted tools and guidelines developed by WHO and assisted the Organization to provide technical support to countries. 2.3 INSTITUTIONAL ARRANGEMENTS Human capacity development utilizing essentially regional and South-South Cooperation 16. Capacity building of researchers was carried out through a series of training workshops organized by WHO and countries during the period under review. For example, WHO organized a regional workshop on evaluation of TMs in Madagascar in 2000 which reviewed WHO research protocols for malaria and HIV/AIDS. The Organization also organized a Regional Workshop on Research and Development and Intellectual property rights in South Africa in 2003 and on Evaluation of WHO/CIDA supported research projects in TM and Malaria in Kenya in 2005 which reviewed progress in research. Similarly WHO organized training workshops on Pre-Clinical Safety Testing of TMs in collaboration with the Tropical Diseases Research Programme of WHO/HQ held in South Africa in 2004 and in Kenya in Capacity of National Drug Regulatory Authorities (NDRAs) in registration of traditional medicines in AU member States was built through a series of training workshops on regulation of African TMs organized by WHO, e.g. in South Africa in 2003 and in Spain in 2004 (in conjunction with the Conference of International Drug Regulatory Authorities organised by WHO every two years). The expected outcomes of these workshops were Guidelines on registration of TMs in WHO African Region. With WHO support in 2005 Ethiopia and in 2006 Uganda strengthened the capacities of officials of the respective NDRAs for the evaluation of safety, efficacy and quality of TMs for registration purposes. The training was carried out by the National Food and Drugs Board of Ghana in Accra. The WHO guidelines on registration of TMs facilitated Nigeria and Uganda to develop their national guidelines in 2004 and 2005 respectively; whereas Zimbabwe was supported to develop draft regulation for complementary and herbal medicines in The SADC

12 Secretariat is in the process of finalizing guidelines for harmonizing registration of TMs in its Member States and Zimbabwe is coordinating this activity Establishment/Strengthening of Centres of Excellence dealing with Traditional Medicine 18. The following countries reported that their research institutions were dealing with TM before the declaration of the decade: Burkina Faso (Institute for research in health sciences, Department of Training and Research in health sciences, Centre Medical Saint Camille de Ouagadougou, Centre Muraz, University Hospital Centres and others. Chad (1993), DRC (1976), Equatorial Guinea (1989), Ethiopia (995), Comoros (1979), Kenya (Kenya Medical Research Institute (KEMRI), 1984), Ghana (Centre for Scientific Research into plant medicine,1975), Madagascar (1957 {Institute Malgache pour Recherché Appliqués (IMRA)} and 1971 {Centre National pour la Recherché Pharmaceutique (CNARP)}, Mali (Department of Traditional Medicine, 1968), Mauritius at the University of Mauritius (2001), Nigeria {(The Federal Institute of Industrial Research, Oshodi (FIIRO) in 1988 based in Lagos and the National Institute for Pharmaceutical Research and Development in 1992 based in Abuja, Rwanda (1982), Sierra Leone (960),Tanzania (Muhimbili National Research Institute for Traditional Medicine, 1974) and Uganda (The National Quality Control Laboratory, 1963).Since 2000, research on ATM in Zimbabwe was spearheaded by the National Research Institute (Blair), University of Zimbabwe (Departments of Pharmacy, Chemistry and Education). Some of these research institutes have been significantly strengthened during the implementation of the plan of action of the Decade and the regional strategy on promoting the role of TM in health systems. WHO is working with some of these institutions which have indicated willingness to be designated as WHO Collaborating Centres for TM. 19. The Gambia established a research institute in 2001 whereas South Africa launched a centre for research into African TM in Pretoria in Mozambique established in 2007 a research institute in the Ministry of Health in addition to Research institute in the Ministry of Science and Technology. Cote d Ivoire is in the process of establishing a reference laboratory on TM at the national Institute of Public Health whereas in 2007 it established a pilot TM treatment centre. In 2007 Zambia selected four centres of excellence for testing TMs (Tropical Diseases Research Centre (TDRC), University of Zambia, National Institute for Social and Industrial Research (NISIR) and the Malaria Institute at Macha (MIAM) Networking between institutions and researchers in Africa 20. Before the Decade of ATM, the Natural Products Research Network for East and Central Africa (NAPRECA) was established in 1984 from the realization that Africa was rich in biodiversity but poor in R&D in Natural Products. So far NAPRECA branches have been established in Botswana, Cameroon, Congo, DRC, Ethiopia, Kenya, Madagascar, Rwanda, Sudan, Tanzania, Uganda, and Zimbabwe. After the Decade of ATM and a series of workshops organized by WHO, the Western Africa Network of Natural Products Research Scientists (WANNPRES) was established in Burkina Faso in Namibia reported that the University of Namibia s Faculty of Science has been designated as the focal point for the Southern African Network for Biosciences flagship project on validation of the traditional medicines used for HIV/AIDS. Network of journalists for promotion of TM (REJOMETRA) and network for development of TV programmes for promotion of natural products (RECIPRENA) were established in Burkina Faso. These networks are contributing to strengthening R&D of TMs in AU Member States. A list of research institutions and researchers is being compiled by WHO into a full directory and will be ready for dissemination by the end of the Decade of ATM. 2.4 INFORMATION, EDUCATION AND COMMUNICATION Workshops for traditional health practitioners and conventional health practitioners

13 21. AU Member states, traditional health practitioners (THPs), conventional health practitioners and researchers have participated in meetings organized by AU Member States, WHO and Regional Economic Communities. For example, Burkina Faso and REJOUMETRA have trained over 200 THPs on good manufacturing practice and over 200 health professionals on ethnomedical evidence. Ghana reported that in 2002 a training manual for THP s was developed and reviewed in The manual will further be reviewed in 2010 in line with WHO training tool. Training needs assessment and pre-testing of manual has been carried out whereas sensitization and continuing education programmes have initiated in a number of districts. At least three Training of Trainers (TOT) programme are carried out per year. The theme depends on the sponsoring agency but in accordance with the overall Strategic Plan and Modules in the Training Manual. The Ministry of Health of Ghana organized in collaboration with Africa First (NGO) two Global Summit on HIV/AIDS, TM and Traditional Medical Knowledge in Accra in 2006 and In 2002 Cameroon sponsored two health officials to Metz for training in ethno pharmacology with support from the French Society on Ethno pharmacology. In 2007 other two health officials went to China to participate in the Second Seminar on the Management and Development of Chinese TM. Mali organized workshops on IPRs for THPs and conventional health practitioners and researchers in Bamako in 2006 and 2007 as well as on reflections for local production of TMs in Other workshops organized by countries which involved THPs and conventional health practitioners are outlined in and Table 2 above. 23. In the framework of validation of tools for the development and integration of traditional medicine in health systems, Cameroon and other OAPI Member States participated in various training sessions and meetings of experts organized by OAPI, ARIPO, WHO and AU which dealt with various aspects related to institutionalizing TM in health systems and the Decade of ATM held in Benin (2004), Botswana (2005), Cameroon (2007), Cote d Ivoire (2003), Ethiopia (2005), Niger (2007) and Zimbabwe (2001, 2006). WAHO organized a Consultative Meeting to develop a harmonized policies and regulatory Framework for the WAHO Sub-Region and Discussion Forum for THPs and Conventional Health Practitioners and researchers in Ghana in 2007 and 2008 respectively. NGOs such as THETA, PROMETRA, and PROMETRA etc. have also been involved in training THPs Development of Innovative Public Awareness programmes for all sectors of the Society 24. Most countries in Africa have taken the opportunity of the ATM Day to develop innovative public awareness of the role of TM in health systems. These have included role plays, debate, workshops, seminars and TMs exhibitions and objects used for TM practice. Thee activities have involved traditional and conventional health practitioners and the public. On its part, WHO has developed Traditional Medicine Information materials some of which have been posted on WHO website for use by countries during the commemoration of ATM Day. WHO has also developed and published number of tools and guidelines on TMs. However, there is need for AU Member States to develop more Innovative Public Awareness programmes with support from AU, WHO and relevant partners Dissemination and popularization of OAU Decade of African Traditional Medicine 25. In order to disseminate and popularise OAU Decade of ATM the plan of action for implementation of the Decade was endorsed by the Summit of Heads of State and Government in Maputo in July Questionnaires for surveys of the mid-term review of the decade of ATM were also developed and sent to AU Member States. More copies of the Plan of Action of the AU Decade

14 as well as the Mechanism for Monitoring and reporting will be disseminated to Member States through the Ministers of Health during the Conference on Midterm Review in Yaoundé Cameroon on 31 st August 2008 on the occasion of the Commemoration of ATM Day Commemoration of one day African Traditional Medicine Day 26. This day already dealt with contributes to providing information to all sectors of the public on traditional medicine 2.5 RESOURCE MOBILIZATION Formulation of project proposals for grants through bilateral and multilateral and collaboration arrangements completed. 27. Some countries indicated to have formulated project proposals or have used their national strategic plans on TM for grants and collaboration agreement. However, financial resources were not mobilized due to lack of interest from the already limited donors. Other AU member states succeeded in mobilizing financial resources from NGOs, bilateral and multilateral organizations: Benin ( ), Burkina Faso (2001 and 2006), Chad, Congo (2006), DRC ( ), Ethiopia (1998), Gambia (2006), Ghana (2001), Guinea Bissau, Mali (2002, 2003, ), Niger ( ), Nigeria ( ), Rwanda, South Africa (since 1990), Tanzania (2002, ) and Zimbabwe (2006). 28. Major donors for projects and strategic plans mentioned by countries include the Global Fund for Malaria, HIV/AIDS and TB; development of health system projects; the Canadian International Development Agency (CIDA), the World Bank (WB), the African Development Bank (ADB), International Development Research Centre (IDRC), WHO, WAHO, University of Oslo and NGOs (Italian NGOs, PROMETRA and Antenna Technology (Swiss), OAPI, French and Taiwanese cooperation Mobilization of Member States to commit adequate resources for the implementation of plan through annual budgetary allocations 29. Most of countries indicated that funds were not allocated for ATM; in others provisions were made but funds were not allocated whereas in other countries funds were allocated but only for specific activities such as celebration of ATM Day, sensitization and training of THPs and distribution of training materials. The following Member States indicated that provision for ATM in national budget were made although insufficient for adequate implementation of the priority interventions of the Decade of ATM and sometimes there was a delay in release of budgeted funds: Benin ( ), Burkina Faso (every year before the Decade), Burundi (2007), Cameroon, Chad, Congo, DRC (2002), Ethiopia (1995), Ghana (since 1991), Lesotho ( ), Liberia, Mali (since 1968 as part of the budget for the National Institute for Research in Public Health), Niger (2002), Nigeria (2007), Rwanda, South Africa, Tanzania (1989), Zambia (2008) and Zimbabwe (2006) Efforts by WHO that have facilitated implementation of the plan of action of the AU Decade of African Traditional Medicine by AU Member States 30. In 2001 WHO mobilized financial resources from CIDA to support countries implement the Regional strategy on Promoting the Role of TM in Health Systems through a Project on Strengthening Traditional Health Systems for Malaria Prevention and Control which will come to an end in June The implementation of this project by AU Member States has had a significant

15 impact on the plan of action of the Decade of ATM because of the similarities of the priority interventions, 2.6 RESEARCH AND TRAINING Clinical trials on malaria and HIV/AIDS in few institutions supported by WHO using protocols for evaluation of traditional medicines developed by WHO 31. Several research institutions are at different stages of conducting R&D for validating the safety, efficacy and quality of TMs used for malaria, HIV/AIDS, diabetes, sickle cell-anaemia and hypertension using WHO guidelines with technical and financial support from WHO, government and other partners. Encouraging results are being documented in some countries, for example, TMs used for malaria compared favourably with the recommended national standard treatment in clinical trials in Burkina Faso, Cameroon, DRC, Ghana, Kenya, Madagascar, Mali, Mozambique, Nigeria, South Africa, Tanzania, Uganda, and Zimbabwe. Burkina Faso, Cote d ivoire, Ghana, Nigeria, South Africa, Tanzania, Uganda, and Zimbabwe have reported to have observed an increase in CD4/CD8, decrease of viral loads, substantial increase in weight gain in some cases, improvements in the quality of life and clinical conditions of people living with HIV/AIDS (PLWA). However, further research is needed for better interpretation of these results. 32. Most of sickle-cell disorder patients treated exclusively with TMs was protected from crises, while the frequency and severity of crises in some volunteers were reduced significantly and hospital visits and absenteeism from school and work were also significantly reduced Burkina Faso, Nigeria and Togo. Other countries are conducting research on other medicinal plants in addition to the five priority diseases such those used for hepatitis, boosting the immune system, ulcers, hypertrophy of the prostate and reproductive health. Table 4 lists examples of AU Member States conducting TMs research on malaria, HIV/AIDS, Sickle-cell anaemia, diabetes and hypertension. Table 4. African Countries conducting traditional medicines research on Malaria, HIV/AIDS, Sickle-cell anaemia, Diabetes and Hypertension Country Malaria HIV/AIDS Sickle-cell anaemia Diabetes Hypertension Central African countries Cameroon X X X X X DRC X X East African countries Burundi X Ethiopia X X X Kenya X X X Madagascar X X X Rwanda X X X X Tanzania X X X Uganda X X Southern Africa countries Mozambique X South Africa X X X X Zambia X X Zimbabwe X X West Africa countries Benin X X X Burkina Faso X X X Cote d Ivoire X X Ghana X X X X Mali X X X X

16 Nigeria X X X X X Senegal X Togo X X Curricula in Traditional Medicine and training programmes developed in collaboration with relevant government and professional authorities 33. Congo, Ghana, Kenya, Mali, Nigeria and Zimbabwe reported before the Declaration of the Decade of ATM to have introduced some modules on TM in the curricula of Pharmacy students before the decade of ATM. Similarly, Ghana and Uganda reported to have included modules on TM in the curricula of medical students. The University of Nkwame Nkrumah Science and Technology in Kumasi, Ghana started offering a Degree in Herbal Medicine after the Decade of ATM In some countries training sessions for THPs have been organized by ministries of health, associations of THPs and non-governmental organizations (NGOs) such as Traditional and Modern Health Practitioners Together Against AIDS (THETA) based in Uganda and Promotion of TM (PROMETRA) based in Senegal respectively, on some aspects of PHC. Training materials for THPs have been developed by many countries including Burkina Faso, Ghana, Mali, Senegal, South Africa, Zimbabwe, Namibia (Traditional Birth Attendants) etc. 34. Ghana reported that in 2002 a training manual for THP s was developed and reviewed in The manual will further be reviewed in 2010 in line with WHO training tool. Training needs assessment and pre-testing of manual has been carried out whereas sensitization and continuing education programmes have initiated in a number of districts. At least three Training of Trainers (TOT) programme are carried out per year. The theme depends on the sponsoring agency but in accordance with the overall Strategic Plan and Modules in the Training Manual/Tool The Ministry of Health, WANNPRES, Food and Drugs Board, National Board for Tertiary Education, Commonwealth Science Council, have sponsored training programmes. Since 2003 Training in Good harvesting Practices; Silvicultural Practices; Good Agricultural Practices has been undertaken and ANAMED an NGO has biennial training in cultivation. 35. Some countries requested WHO for training materials for University medical and pharmacy students (Cameroon, Congo, DRC, Ghana, Mali, South Africa and Tanzania) and for THPs (Congo, Ghana, Kenya, Mali, Senegal, Uganda and Tanzania).Therefore WHO requested those countries to field-test draft WHO Guidelines for Traditional Health Science Students an Continuing Education of Conventional Health Practitioners in TM and draft WHO Guide for THPs in PHC during Thereafter, WHO organized a Working Group Meeting to share country experiences in these areas. Effective implementation of these tools will facilitate upgrading the knowledge and skills of THPs in PHC, collaboration between the practitioners of the two systems of medicine facilitate introduction of TM in the curricula of health science students. 2.7 CULTIVATION AND CONSERVATION OF MEDICINAL PLANTS National Policy on conservation adopted and Presence of Commercial/Community/ individual cultivation of medicinal plants Table 5: A summary of national policy on conservation and related documents developed by some AU Member States Country Policy document developed Botswana Natural Policy on Natural Conservation and Development which encourages research -The Agricultural Conservation Act Burkina Faso -Signatory to the Convention on Biodiversity which promotes conservation plants. It also has national strategy on conservation of genetic resources Ghana National Biodiversity Conservation Policy -National Policy on Wild Life

17 Lesotho Madagascar Senegal Cameroon Mali Mauritius South Africa Zimbabwe National Policy on Wild Bush Fires -National policy on conservation of medicinal plants -Signatory to the Convention on International Trade of Endangered Species -Established a national policy on cultivation of medicinal plants -Guidelines for the Collection, Drying, Conservation and Storage of Raw Materials for Traditional Medicines - Code on forests of and legislation for the collection and conservation of medicinal plants -National policy on conservation of medicinal plants -National policy on conservation of medicinal plants included in the national policy -National policy on conservation of medicinal plants 36. DRC reported that medicinal plants are commercialized whereas Sierra Leone reported that has been involved in ex-situ conservation of the biodiversity. The following countries in 2002 reported having been involved in either commercial/community/ individual cultivation of medicinal plants: Burundi, Congo, Chad, Liberia, Mali, Mauritius (local medicinal plants), Burkina Faso reported botanical gardens will be established in all regions in 2008, but is already cultivating Artemisia annua. Ghana reported that associations for the planting and collection of commercially Important Medicinal plants e.g. Moringa, Voacanga, Artemisia Annua have been formed and are being strengthened. Few large scale pharmaceutical and chemical industries have interest in product development. Export of raw medicinal plants rather increasing. Mali has established botanical gardens for THPs in Siby, Kolokani, Badiangara and Bamako in 2002 and Cameroon, Ghana Kenya, Malawi, Mozambique, Nigeria (2007), Senegal Tanzania and Uganda (large scale cultivation), Zambia, Zimbabwe are cultivating Artemisia annua. Nigeria is also cultivating basil (2006), shear butter (2001) and Moringa (2000) and Tanzania has been cultivating chamomile and peppermint since 1989, Rwanda indicated to have commercial and individual cultivation of commonly used medicinal plants for local production of TMs. South Africa has had cultivation of various medicinal plants since In Zimbabwe cultivation of medicinal plants is carried out in five districts since 2005 by the Ministry of Environment and Tourism, project funded by UNDP Adoption of WHO guidelines on Quality Control of Medicinal plants (QCMP) and Good agricultural and Collection Practices (GACP) of Medicinal Plants 38. Some countries are working on the national policy on conservation of medicinal plants and felt that most of the initiatives would be difficult to implement before the bill is in place. An increasing number of countries are adopting WHO guidelines on Quality Control of Medicinal plants and Good agricultural and Collection Practices (GACP) of Medicinal Plants. Ghana developed a Manual on Cultivation and Harvesting of Medicinal Plants in 2003 by adapting WHO guidelines and Ethiopia adopted the WHO Guidelines in Chad, Liberia and Mauritius indicated to have adopted WHO QCMP and GACP. 39. In order to promote and develop quality control standards for African medicinal plants and to strengthen the capacity and skills of staff in relevant institutions, Ghana developed and published in 1992 published the Ghana Herbal Pharmacopoeia containing 50 most commonly used medicinal plants and revised it in Madagascar has developed 100 monographs since 2004, South Africa completed 60 monographs on African medicinal plants in 2005 and Nigeria developed a national herbal pharmacopoeia ( ) which is being printed. The Association for African Medicinal Plants Standards (AAMPS) based in South Africa was established in 2005 and will continue to finalize the 50 monographs targeted for It is important that more countries continue to develop these monographs in order to document African TM for posterity to supersede oral literature of formularies, which are sometimes distorted or are rapidly disappearing due to the death of people who possess the information.

18 2.8 LOCAL PRODUCTION OF STANDARDISED AFRICAN TRADITIONAL MEDICINE Presence of African Traditional medicines Manufacturing Facilities Table 6. Examples of countries with manufacturing facilities for traditional medicines Country Manufacturing facility Additional information/products Benin -Institut des Sciences Biomédicales Appliqués (ISBA), -Institut d Hygiène et de Médecine Biotique (IHMB), -Institut de Recherché en Narcothérapie; Centre Seyon (Archidiocèse). Burkina Faso Ghana Madagascar -4 production Units : an NGO Phytosalus in Ouagadougou, Phytofla Laboratory in Banfora, Gamet Laboratory in Ouagadougou and Kunawolo Laboratory in Bobo -Public sector, L Institut de Recherché Médicales et d Etudes des Plantes Médicinales with its Centre de Recherché en Plantes Médicinales et en Médecine Traditionnelle -Private sector, three laboratories for manufacture -150 small-scale facilities that are registered for herbal medicine production, -8 have capacity for large-scale production (e.g. Centre for Scientific Research into plant medicine {CSRPM}) - 2 public (CNARP) and private (IMRA) laboratories for local production of improved TMs since 1989 whose capacity was increased in 2004 Mali -A structure for local production of TMs since 1989 whose capacity was increased in Nigeria -4 Production facilities at the National Institute for Pharmaceutical Research and Development in Abuja; Neimeth, Jobellin and Esosa Rwanda -Two production Units at Centre de Recherché en Phytomedicaments et Sciences de la Vie (CPR&SV) {Plants Medicine and Life Science Research Centre} et l Institut des Recherché Scientifiques et Technologiques (IRST {Technological Scientific Research Institute } -In the process of establishing a national centre for local production of TMs. -4 of the 11 TMs which have been issued marketing authorizations have been included on the national essential medicines list, e.g. Saye and N dribale for malaria -Syrup Hépasor used for hepatitis (Labothéra Laboratory); Syrup Pola Gastral AT200 used for gastrointestinal system Syrup (KAMSU-KOM Laboratory) Gama used as antihaemorrhoid (Laboratoire AFRICAPHARM) -CSRPM has also a clinic used for clinical trials and observational studies. Over 1,000 TMs have been registered A marketing authorization has been issued for an antidiabetic (Medeglucil) -7 TMs including for malaria have been included on the national list of essential medicines. -Products are Niprisan at NIPRID for sickle-cell disease (1989), Ciclavit by Neimeth for SCD (2000), solamine by Esosa for SCD (2000), The research centres have a treatment Clinic for traditional health practitioners. The centres have produced medicines for cough, stomach pain (Gifurina), and anti- parasites and antibacterial (Umuravumboide) etc. Senegal -One of the hospitals and other structures which Since 1980 manufactures traditional medicines South Africa -Various manufacturing plants since Audit of ATMs manufacturing facilities are in the process of being initiated. Zimbabwe Has manufacturing facilities which are mainly privately owned -Production is disjointed and there is no link within the production chain 40. Botswana stated that there are small businesses harvesting and packaging some of the local medicinal plants. In April 2007 the Conference of African Ministers of Health adopted the Pharmaceutical Manufacturing Plan for Africa (PMPA) whose main objective is to ensure a sustainable supply of affordable medicines as well as local production of quality generic medicines (including). Efforts are being made by AUC to secure funds to facilitate the implementation of the PMPA through our partners. Between 2004 and 2005 WHO in collaboration with the AU/STRC supported eight pilot countries to undertake needs assessment for local manufacture of TMs. Between 2001 and 2005 WHO, the African Initiative and the Centre for Development of Enterprise and Industry of the European Union provided support to Benin, Burkina Faso and Mali for feasibility studies in terms of availability of raw materials, equipment for large-scale production and distribution of TMs, IPRs issues and partnerships with the private sector. Tanzania carried out the feasibility study for domestic production of dihydroartemisinin for treatment of uncomplicated falciparum malaria ( ). These activities revealed that manufacturing facilities for local production of