National Policy on Traditional / Complementary Medicine, Malaysia Ministry of Health Malaysia August 2002 Contents Page 1 Introduction 2 2. Policy Statement 3 3. Definitions 3 4. Vision for T/CM 5 5. Mission of T/CM 5 6. Objectives of T/CM 6 6.1. Practice 6 6.2. Education and Training 6 6.3. Raw materials and Products 7 6.4. Research 7 7. Strategies 8 7.1. Practice 8 7.2. Education and Training 9 7.3. Raw materials and Products 10 7.4. Research 11 7.5. Networking and International Collaboration 12 8. Conclusion 12
NATIONAL POLICY ON TRADITIONAL / COMPLEMENTARY MEDICINE 1. INTRODUCTION For the past decades, traditional medicine has made significant contributions to the health care of our people. Traditional medicine continues to be patronised by the community to treat diseases and maintain health. It is widely acknowledged that the use of Traditional and or Complementary Medicine (T/CM) is widespread and increasing. Malaysia's rich tropical biodiversity is a reliable source for natural health products and the Government is now addressing its full potential. Since independence, Malaysia has established and developed a modern healthcare system, which all Malaysians can be proud of. Meanwhile Complementary medicine has also taken root in Malaysia. The growing global interest and demand for natural healthcare and the widespread use of traditional /complementary medicine in this country, necessitates a new approach to the development of Traditional and Complementary Medicine. This is consistent with the paradigm shift in healthcare that is taking place throughout the world. The World Health Organisation (WHO) is aware of the important role played by T/CM in preventive, promotive and curative aspects of health for a large proportion of the population, especially in developing countries, and thus advocates tapping its usefulness. WHO therefore encourage member states to support T/CM and plan for the continuous evaluation, formulation of policies with appropriate regulations suited to their specific national health systems. The National Health and Morbidity Survey 11 that was carried out in 1996 showed that an estimated 2.3 % of Malaysians, reported visits to traditional / complementary practitioners and 3.8 % used both modern and traditional /complementary medicine. This could well be gross under-reporting, as studies around the world have shown that more than 40% of the population in many countries are using T/CM for their healthcare needs. The Ministry of Health has taken a positive and proactive approach towards traditional/ complementary medicine to ensure its quality and safety for the consumers. It supports efforts to integrate T/CM with modern medicine and will introduce it, incrementally where appropriate, into the mainstream of our national health system.
2. POLICY STATEMENT ON TRADITIONAL / COMPLEMENTARY MEDICINE Traditional / complementary medicine (T/CM) system shall be an important component of the healthcare system. It will co-exist with modern medicine and contributes towards enhancing the health and quality of life of all Malaysians. The government will facilitate the development of T/CM in the country and ensures the quality, safe practices and products of T/CM. It will support the identification of its health, economic and social benefits. 3. DEFINITIONS There is as yet, no universally agreed definition for "Traditional Medicine" and or "Complementary Medicine". The definitions below shall be the basis of the Government's approach to the development of T/CM. 3.1. Traditional Medicine "Traditional medicine is the sum total of knowledge, skills and practices on holistic healthcare, which is recognised and accepted by the community for its role in the maintenance of health and the treatment of diseases. Traditional medicine is based on the theory, beliefs and experince that are indigenous to the different cultures, and that is developed and handed down from generation to generation" WHO (WPRO) Report Workshop on development of National policy on Traditional Medicine, Beijing China 1 1-1 5 Oct. 1999 3.2. Complementary Medicine "Complementary medicine, in practice, refers to a wide range of health interventions originating from different cultures across thousands of years of history." Scottish Office Department of Health, Complementary Medicine and the National Health Services (The Stationery Office, London November 1996) 3.3. Traditional and Complementary Medicine (T/CM) "Traditional and Complementary Medicine practice together, is other than practice of medicine or surgery by registered medical practitioners, as defined in Medical Act 1971
3.4. Traditional/Complementary Medicine practitioners Malaysian Medical Council, Ministry of Health, Malaysia (2001) "T/CM Practitioners are practitioners as defined under Sub-paragraph 3.1 above and are registered with T/CM Umbrella Bodies. 3.5. T/CM Umbrella Bodies (T/CM Bodies) The T/CM Umbrella Bodies are national bodies that are registered with the Registrar of Societies, and appointed by the Ministry of Health (MOH) to accredit the curriculum and training institutions, register and self-regulate T/CM practitioners through the compliance of standard codes of practice and conduct of identified modalities. There are five umbrella bodies at present, namely, the Malay, Chinese, Indian, Complementary and Homeopathy T/CM groups. 3.6. T/CM Standing Committee The T/CM Standing Committee which is chaired by the Deputy Director General of Health (Research and Technical Support) comprises of relevant senior officers from the Ministry of Health, representatives from local Universities, professional bodies, WHO and the umbrella bodies. It is responsible for the development of T/CM in line with this Policy Document. The secretariat of this committee is the Primary Health Care Section, Family Health Development Division of the MOH. 3.7. T/CM Council The T/CM Council is a higher Body which is chaired by the Director General of Health, with nominated members from the various stakeholders of health. It advises the T/CM Standing Committee on the direction and position to be taken by Malaysia on the development of T/CM. 4. VISION FOR TRADITIONAL 1 COMPLEMENTARY MEDICINE Traditional / complementary medicine shall optimally be integrated into the Malaysian healthcare system to achieve a holistic approach towards enhancing health and the quality of life.
5. MISSION FOR TRADITIONAL/ COMPLEMENTARY MEDICINE To ensure quality and safe use of traditional /complementary medicine practices and products in order to attain the optimum potential in healthcare delivery through: Promotion of the rational and proper use of traditional complementary medicine particularly in the Primary Health Care delivery system Appropriate education and systematic training of T/CM practitioners Adherence to acceptable standards of safety and quality for products and practic Establishment of strong research and development activities in T/CM Promotion and advocacy of T/CM Conservation of plants and animals for progress of T/CM development Enhancing international technical co-operation and exchanges relevant to T/CM 6. OBJECTIVES OF THE NATIONAL POLICIES ON T/CM 6.1. GENERAL OBJECTIVES To ensure that safe, quality T/CM practices and products are made available to the public at large. To facilitate the integration of T/CM into the national healthcare.system. 6.2. SPECIFIC OBJECTIVES The specific objectives are divided into four main component namely practice, training, product and research. For each of these components, the following strategies have been drawn: 6.2.1. PRACTICE To regulate the practice of T/CM by T/CM umbrella bodies using a phased approach, from seif-regulation followed by adherence to statutory regulations. To establish a registry of all T/CM practitioners. To promote the rational use of T/CM in order to minimise adverse effects. To promote acceptable practices of T/CM To ensure T/CM is practised in registered T/CM facilities. To facilitate the development of T/CM practice and its integration into the national healthcare system of the country.
6.2.2. EDUCATION AND TRAINING To ensure all T/CM practitioners undergo a formalised system of education and training. To put in place a process for accreditation. To ensure modern medicine providers have adequate awareness and knowledge of T/CM to allow for healthy coexistence and mutual understanding with T/CM practitioners. To ensure the general public has appropriate and adequate knowledge of T/CM in order for them to make informed decisions and choices of T/CM modalities. 6.2.3. RAW MATERIALS & PRODUCTS To facilitate the development of a comprehensive plan for sustainability and standardisation of raw materials. To ensure the effective conservation of medicinal plants with participation of all relevant agencies. To encourage industrial participation in the development of traditional / complementary medicine, without compromising quality. To ensure that dissemination of information and promotion of traditional / complementary medicine are made in a responsible manner and in accordance with existing legislations. To strengthen control on the production, distribution, import and export of traditional medicine products. To facilitate the development and protection of intellectual property rights related to T/CM knowledge, culture and biological resources. To strengthen the evaluation and monitoring of traditional/complementary medicine products that have been proven safe, effective and of high quality. 6.2.4. RESEARCH To prioritise, encourage, facilitate and conduct scientific research on traditional /complementary medicine practices and products. To establish methods and technologies for quality control, safety and efficacy of herbal medicines and traditional remedies. To set up an information database of traditional/complementary medicine for healthcare providers consumers, manufacturers and other agencies which are directly or indirectly involved in traditional/complementary medicine.
7. STRATEGIES The following strategies are proposed to achieve the above objectives. 7.1. PRACTICE The professionalism and systematic development of traditional/complementary medicine practitioners need to be enhanced. -The practitioners offer their services either through registered premises or from their homes. There is a need to register them, recognise and regulate their practice to ensure safe practices are adhered to. T/CM practices will be made safe for the public through acceptable standards and criteria, as endorsed by the T/CM Council. - All established T/CM umbrella bodies are required to set their standards and criteria that will ensure quality and safe practices. - All established T/CM umbrella bodies are required to enforce code of ethics and practices that have been endorsed by the Ministry of Health, through a process of self-regulation. - All established T/CM practitioners are required to comply to these set standards and criteria of practices, through peer evaluation. The T/CM Bodies shall maintain a register of their members or member organisations. T/CM Bodies shall develop criteria for membership or credentialing of practitioners. They will determine the code of conduct, ethical practice, and disciplinary processes and procedures. T/CM bodies shall have in place, a mechanism for complaints by members of the public. T/CM Bodies shall have in place a disciplinary procedure that is accessible to the public and shall take disciplinary action against errant members who are found to breach the code of conduct and ethics. The T/CM Council and T/CM Standing Committee shall recognise the T/CM Bodies' rules and regulation and endorse their efforts to disseminate information, on good T/CM practices. T/CM Bodies shall encourage their members to have adequate professional indemnity insurance.
7.2. EDUCATION AND TRAINING Presently there is no system for formal education and training locally and no standardisation and accreditation of overseas training programmes resulting in a lack of confidence on T/CM by the general public, especially by modern medicine providers. To ensure quality of education and training in T/CM, the following strategies are suggested: Establishment of formalised government and private T/CM training institutions locally by the Ministry of Education, Corporate Bodies, NGOs or T/CM Associations. Recognition, accreditation and credentialing of T/CM Institutions and practitioners, trained locally and overseas by the National Accreditation Board. Encouragement of T/CM twinning training programmes between local and overseas institutions. Introduction of Continuing Professional Development as a requirement for practitioners. There is currently a lack of confidence by medical doctors on T/CM due to the paucity of information on T/CM and inadequate access to scientific evidence in T/CM practices. In order to instil confidence and enhance cooperation and smart partnerships, modern medicine providers should have adequate knowledge of T/CM through: Incorporation of relevant T/CM modules into the undergraduate and post-graduate modern medicine medical curriculum and allied health science training programmes in the local training institutions. Introduction of T/CM in the Continuous Medical Education programmes of modern medicine practitioners Exchange of visits of model premises of both practices. Provision of sponsorships of T/CM training programs with participation from NG0s, T/CM Associations and corporate bodies. Creation of incentives for training for sub-specialities with scholarships or special financial education packages. The increasing utilisation of T/CM products and practices by the public are due to the extensive promotion of T/CM products, the holistic nature of many T/CM modalities and the increasing demands for alternatives in healthcare. To enable the public to make informed decisions the following are suggested: Greater efforts be made to improve awareness through dissemination of accurate information to the general public on the appropriate use of T/CM. Incorporation of information on T/CM as an essential component of the Mass Customised and Personalised Health Information and Education of Telehealth (MCPHIE).
7.3 RAW MATERIALS AND PRODUCTS Malaysia, with its rich tropical biodiversity is well positioned to be a major producer of Traditional and Complementary healthcare products. However there is little standardisation of the raw materials used in the manufacture of the products. Although local manufacturers are required to comply with the current Good Manufacturing Practice (GMP), there are no requirements at present for the mandatory use of standardised raw materials. Hence to capitalise and improve Malaysia's position in the T/CM industries, modern technologies, cutting. edge research and methods of processing must be introduced. The following strategies are recommended: A sustainable supply of quality traditional/complementary medicine raw materials be made available through the development of a cultivation plan, protection of indigenous and natural health resources and technology from unwarranted exploitation, with co-operation from other agencies. The development of a comprehensive programme for the standardisation of traditional/complementary medicine raw materials. Constant production of Traditional/complementary medicinal products in accordance to acceptable standards using contemporary methods of processing. Availability of scientific evidence to support efficacy of traditional/complementary medicinal products. Regular updating and expansion.of the current monograph on Malaysian plants towards the production of a pharmacopoeia for traditional/complementary medicine products. Development of awareness programmes among manufacturers, distributors and agents of T/CM products on the importance of disseminating accurate information on T/CM. 7.4. RESEARCH Traditional / complementary medicine, although beneficial, is often not supported by scientific evidence. Hence scientific research is required in order to provide evidence of safety and efficacy of traditional / complementary medicine products and practices. A systematic research and development programme, with emphasis on quality, safety and efficacy to facilitate acceptance and integration of traditional/complementary medicine, will be introduced into the existing healthcare system. A planned and systematic approach to traditional/complementary medicine research shall be adopted. The approach shall include the utilisation of standard protocols and guidelines approved by recognised international organizations such as the World
Health Organisation, United Nations and the International Committee for Harmonisation pertaining to T/CM. Such researches will include experimental and applied research as well as clinical research. Adequate funding for traditional/complementary medicine research shall be provided to keep abreast with current advances and development in traditional complementary medicine research. Trained personnel in traditional/complementary medicine research & development shall be made available through structured capacity building activities. Research and Development Centres for traditional/complementary medicine shall be identified and developed under the National Institutes of Health (NIH). Awareness of issues related to Intellectual Property Rights (IPR) for the protection of research discoveries on traditional/complementary medicine shall be developed and implemented. Repositories and databases on traditional/complementary medicine with national and international linkages shall be established. 7.5. NETWORKING AND INTERNATIONAL COLLOBORATION The increasing development of T/CM in many parts of the world and hence the greater reliance on sharing of evidence-based medicine and the knowledge on T/CM / shall be benefited through. Regional and international co-operation with other T/CM centres via seminars, workshops and other activities. Establishment of Referral centre(s) with networking facilities for the practice, training, education, product and research development of traditional/complementary medicine by the umbrella bodies. 8. CONCLUSION The development of this national policy on T/CM in Malaysia will help strengthen the role of T/CM in our national healthcare system and complement our efforts towards an integrated healthcare network for the benefit of both the healthcare providers as well as the public.