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Medicinal Plants Public Disclosure Authorized An Expanding Role in Development
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(List continues on the inside back cover) WORLD BANKTECHNICAL PAPER NUMBER 320
Medicinal Plants
An Expanding Role in Development
Jitendra Srivastava, John Lambert, and Noel Vietmeyer
The World Bank Washington, D.C. Copyright © 1996 The International Bank for Reconstruction and Development/THE WORLD BANK 1818 H Street, N.W. Washington, D.C. 20433, U.S.A.
All rights reserved Manufactured in the United States of America First printing April 1996
Technical Papers are published to communicate the results of the Bank's work to the development com- munity with the least possible delay. The typescript of this paper therefore has not been prepared in accor- dance with the procedures appropriate to fornal printed texts, and the World Bank accepts no responsibili- ty for errors. Some sources cited in this paper may be informal documents that are not readily available. The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations, or to members of its Board of Executive Directors or the countries they represent. The World Bank does not guarantee the accuracy of the data included in this publication and accepts no responsibility whatso- ever for any consequence of their use. The boundaries, colors, denominations, and other information shown on any map in this volume do not imply on the part of the World Bank Group any judgment on the legal status of any territory or the endorsement or acceptance of such boundaries. The material in this publication is copyrighted. Requests for permission to reproduce portions of it should be sent to the Office of the Publisher at the address shown in the copyright notice above. The World Bank encourages dissemination of its work and will normally give permission promptly and, when the reproduction is for noncommercial purposes, without asking a fee. Permission to copy por- tions for ciassroom use is granted through the Copyright Clearance Center, Inc., Suite 910, 222 Rosewood Drive, Danvers, Massachusetts 01923,U.S.A. The complete backlist of publications from the World Bank is shown in the annual Index of Publications,which contains an alphabetical title list (with full ordering information) and indexes of sub- jects, authors, and countries and regions. The latest edition is available free of charge from the Distribution Unit, Office of the Publisher, The World Bank, 1818 H Street, N.W., Washington, D.C. 20433, U.S.A., or from Publications, The World Bank, 66, avenue d'Iena, 75116Paris, France.
ISSN: 0253-7494 ISBN:0-8213-36134
Jitendra P. Srivastava is Principal Agriculturalist in the Agricultural and Natural Resources Department of the World Bank. John Lambert is professor of Biology,Carleton University, Ottawa, Canada. Noel Vietmeyer is Senior Program Officer,Office of International Affairs, National Research Council, Washington, D.C..
Libraryof Congress Cataloging-in-PublicationData
Srivastava, Jitendra, 1940- Medicinal plants: an expanding role in development / Jitendra Srivastava, John Lambert, and Noel Vietmeyer. p. cm. - (World Bank technical paper; no. 320) ISBN 0-8213-3613-4 1. Materia medica, Vegetable. 2. Medicinal plants-Government policy. 3. Social medicine. I. Lambert, John, 1938- H. Vietmeyer, Noel, 1940- . III. Title. IV. Series. RS164.S73 1996 615'.32-dc2O 96-13421 CIP TABLE OF CONTENTS
FOREWORD...... v ABSSRACA ...... vi ACKNOWLEDGMENTS ...... vii EXECUTIVE SUMMARY ...... viii 1. INTRODUCTION ...... 1 Definition ...... 1 World Trade ...... 1 Usage in Developing Nations ...... 2...... 2 Usage in Industrialized Nations ...... 4 2. TBE RESOURCE BASE...... 5 Uncontrolled Exploitation ...... 5 National Conservation Activities ...... 6 International Conservation Activities ...... 8 3. MEDICINAL PLANTS IN WORLD BANK PROJECTS ...... 9 Global Enviromnental Facility Activities ...... 10 4. TOWARD A STRATEGY ...... 11 Policy and Regulations ...... 11 Markets and Prices ...... 12 Conservation ...... 12 Acceptance ...... 12 Cultivation ...... 13 Quality Control ...... 15 Environmental Issues ...... 16 Institutional Capacities ...... 7 International Actions ...... 17 The Ultimate Outcome ...... 17 APPENDIX 1...... 19 BI3LIOGRAPHY ...... 20
iii
FOREWORD
This short conceptpaper is intendedto serve as a preliminaryexploration of the subjectof medicinalplants in their role as biologicalresources. Various organizations-among them the World Health Organizationand the World Bank's own HumanDevelopment Department-are involvedwith issues surroundingthe efficacy,safety and generalhealth merits of healingplants. We concernourselves only with ways and meansof achievingand/or maintainingsustainable productionof plant speciesalready accepted for healthcarepurposes. It is a realityof many countriesthat millionsof people employplants they considerto have healing or preventativeproperties. Whatever the levelof provenefficacy, these plantsare economic resourcesof our times. Yet althoughmillions of dollarsare investedin supportingfood and other crops, little or nothingis spent on supportingthe world's medicinal-plantresource base. The present paper is a step toward determiningif this imbalancein prioritiesis justified.By concentratingon the agriculturalpotential, we hope to assistcountries and development agenciesin better dealingwith their naturalresource, human development, and generalhealthcare efforts. This reviewhas beenjointly fundedby the Agricultureand Natural ResourcesDepartment and the Research SupportBudget of the WorldBank.
AlexanderF. McCalla Director Agricultureand Natural ResourcesDepartment
v ABSTRACT
Medicinalplants are commonlyused in treatingand preventingspecific ailments and diseasesand are consideredto play a beneficialrole in health care. Despite their importance,medicinal plants are seldomhandled within an orgaized, regulatedsector; most are stillexploited with little or no regardto the future. The paper outlinesthe importanceand usage of medicinalplants in healthcare, national conservationactivities in selectedcountries, and in World Bank developmentprojects. The final sectionfocuses on developingcountry strategy needs for implementingpolicies covering medicinal plant conservation,cultivation, processing and marketing.Medicinal plants are viewed as a possible bridgebetween sustainableeconomic development, affordable health care and conservationof vital biodiversity.
vi ACKNOWLEDGMENTS
The authors wish to thank Alexander McCalla and Douglas Fomo for their support and encouragement,and RobinPorter, SectorLibrary, World Bank for her effortsin locatingand obtawing many of the documentsreviewed for the paper. They would also like to thank V. Mackrandilal, AF2AG, R. Goodland,ENVDR; C. Mackinnon,ENVGC; J. Parrotta, AGRAF; and K. Shawe, NRI, UK for theirhelpful comments on earlierdrafts.
Partial financial support from the Research Support Budget of the World Bank is gratefilly acknowledged.Sole responsibility for the contentof the paperrests withthe authors.
vii EXECUTIVE SUMMARY
In virtually every developing nation, plants are used in medical practice. But now, as a result of rising numbers of people and of an aging populace, many medically important species are becoming scarce; some are facing the prospect of extinction. In India, for instance, providers to the indigenous health care systems have begun recognizing that supplies of raw plant materials cannot be guaranteed. As a precaution, they now require producers to deliver two year's supply in advance. As a further precaution, some are establishing farms specificallyto cultivate medicinals. Such experiences are by no means limited to India, and they serve to raise an alarm. As noted, most developing countries depend on plants for their traditional forms of medicine. Alternative sources of health care are unavailable for many of their peoples. What should be done to assure future supplies? Despite the potential for disaster, few of the vulnerable medicinal species are today protected by conservation legislation. The new Global Biodiversity Strategy should be a help in protecting such a resource. However, until recently it was focused primarily on protected natural reserves, ignoring agricultural, marginal, and degraded lands, all of which are important sites of threatened medicinal-plant biodiversity. Although the World Health Organization and other health-oriented institutions have supported medicinal-plant projects, the international development community at large has not addressed the issue of medicinal plants in the overallframework of natural resources. As of now, for instance, few developing countries or economic assistance organizations have any policy or strategy that addresses their roles, present or potential, in dealing with medicinal plants. This neglect could be serious. Many seemingly unrelated projects-those dealing with conventional agriculture, forestry, land reclamation, rainforest protection and infrastructure development, for instance-affect medicinally important wild species. In addition, such high-value botanic resources might have immense value in development projects. In fact, medicinal plants may contribute to the success of future programs dealing with such diverse subjects as agriculture, forestry, biodiversity conservation, health care, and social and economic sustainability. A successful strategy for medicinal species will involve economic, agricultural, social and environmental inputs. For this reason, the Agriculture and Natural Resources Department of the World Bank is undertaking an evaluation of the present situation and the likely future needs of the medicinal species. The present document is just a small first step. Its purpose is to elicit comment and suggestions for the main paper, yet to come. This second review will focus primarily on three countries, analyzing and drawing lessons from their separate approaches to the regulation and development of medicinally important plants. From that, it is hoped, will come important lessons for all nations.
viii 1. INTRODUCTION
Despite all the progress in synthetic chemistry and biotechnology, plants are still an indispensable source of medicinal preparations, both preventive and curative. Hundreds of species are recognized as having medicinal value, and many of those are commonly used to treat and prevent specific ailments and diseases. At least four out of every five of those plants are collected from the wild, most from the floras of developing countries. Medicinal properties may be present in one or all of their parts: root, stem, bark, leaf, flower, fruit or seed. While in industrialized countries health providers have reduced their dependence on the Plant Kingdom, the majority of developing countries still rely on herbal remedies. However, in a complete turn-around, modern science and Western medicine are getting interested in the healing herbs once more (Eisenberg, et.al., 1993; Grunwald, 1994). Indeed, "phytomedicines" are beginning to link traditional (homeopathic) medicine and modem (allopathic) medicine. As a result of the new openness from leading industrialized nations, a wealth of technical information is now coming available, notably from sophisticated laboratories who are analyzing herbal ingredients and their effects with the latest technologies.
Definition
In the past a number of definitionsfor the term medicinal plant have been offered. and Soejarto (1991) imply that it is only when medicinalproperties are proven by Western research should a species be labeled a "medicinalplant." Fellows (1991), on the other hand, suggests that the term indicates merely a species known to beneficially modulate the physiology of sick mammals,and that has been used by mankind. For present purposes,we are employingthe followingdefinition: Medicinal plants are those that are commonly used in treating and preventing specific ailments and diseases, and that are generally considered to play a beneficial role in health care.
World Trade
Medicinalplants are already importantto the global economy.In 1980, for instance, the World Health Organization(WHO) estimated the world trade at US$500 million.Moreover, as above noted, demandis steadilyincreasing not onlyin developingcountries but also in the industrialized nations. In both Europe and North America, for example,the demand is being fueled by an outburstof consumerinterest in productsthat are "all-natural"as wellas by aggressivemarketing of herbalremedies (Lewington, 1993). | | #jAl MediCineSales 1al1;;Ai inu Grot RatelsbyRel
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This risingglobal interestis now creatingburgeoning legitimate and "underground"trades in plant materials,many of which are alreadybeing routinelymoved around the world. Most samplesare collected in developingcountries in a completelyunregulated manner. In Nepal, for instance, numbers of medicinalplants are being uprooted and sold as raw products to India, where they are graded, packagedand exported (Edwards,1993).
UJsagein Developing Nations
W;HOestimates that approximately80% of the developingworld's populationmeet their primary health care needs through traditionalmedicine (Bannerman, 1982). Many differentsystems exist: the Ayurvedic,Unani, and Siddhiin India;the Kampoin Japan, the Janui in Indonesia;and more. In China, plant-based medicineis the backbone of the health care for perhaps a billion people; botanicalsare used for the primaryhealth care needs of 40% of China's urban patients and over 90% of its rural patients. In the traditional decoctions as well as in the officially decreed medicines, huge quantities of plant materials are used. Indeed, the annual demand has been reported to exceed700,000 tons (Xiao-Pei-gen,1991). The economicvalue is also huge. In 1987, for instance, China's traditional plant remedies were valued at US$571 million,and its country- wide sale of crude plant drugs was put at $1.4 billion(Li Chaojin,1987). In South Asia the situationis similar.There, some 800 millionpeople (out of a total populationof over one billion) rely on herbal medicines.In India, for instance, traditional health systemsrun
2 parallel to the modem health-care sector. Officiallyrecognized and fully sanctioned by the government,these traditionalsystems (such as Ayurveda,Unani, Siddhaand Tibetan)are
Box 2: The Mongoose Knows:
Before a mongooseattacks a snake,reported the botanist Rumphus in the .700s,it foifies itself by eating the leaves of .theserpent-root plant. And if a monose gets bitten; it seeksout the serpent root, eats the leaves, rolls around three or four times1 rests.a little as if'6drggd;hen,- regainingstrength, rushes back to the attack...... - .- - - .-. ------.. . - . -.-. ,...... Maybe there is nothingto this story.from the great aturalist who' ed his Mit in,what'. iw,' Indonesia,but since 1949 the serpent root's magicalpowers has Ocertainlyexcitedthe.world's medicalestablishment. That year the BritishHeart Journalreported'tha tb:thep t is."clinally effectivefor treating highblood pressure." Three.yearslater, Swss a e discovere.dthat'a chemicalin the root, is an antihypertensiveand sedative. Called reserpine,nit tbe-Cmthieworld's first tranquilizer,thereby opening up a vast new field of therapy,previously unsuspected.
Reserpineextracted from the roots of variousspecies of vo,fia itsnwknown.to. not onycIr the.central nervous system.but to lower blood-pressureand control heart-beat athmia. Most of it comes from India, where the powdered root has been in use foratiea'st 2000 yearsnotably for treatingmental illness. Not until1952, when reserpine was isolaited'fromthe iaw plant e-x'trat, did its use in Westemmedicine begin to take off. Nowadays,the drug is mainlyused: to' ontrol,I high blood pressure but it is still-one of the most effectivetranquilizers,. and akes-the livs of millionsof schizophrenicsfar more bearable..-
In the 35 yearssince the ser ro-otgave the worldits fst tranqi, thiild Asia pl- d its botanicalrelatives in Afrca haverisen to becomeof majoreconomic and dn im,poa ,nce Alreadyby 1961,the consumermarketfor, prescription drugs'fom serpent-roospecies exceeded US$100nmillion in the UnitedStates alone.These days,,mor'e than 22 miiiont presriptionsfor reserpineand. 5 millionfor serpent-rootextacts ate dispensedanually in the U.S. In addion 2 millionprescriptions for combinationsof se'rpentroot and other dr gsear fille.deac yea
All this -goesto show tht the mongoose:probably- knew 'what- i,t :was -doling. Rumpius- :tr offereda provocative'leadtoabreakthroughinmedicine, b,u't'it took-us.2'00yer.. s...... to.rel Andhundreds of other-- provoca-tive-, - - - -leads- --- :an - ~~~~~..a lto of healingpower :..-. remain ... inpats ti to... be 'e,xp,lored.-Hopefully, pe'ople w...... ill get to, nvestigate themsoon, or-it may.'be,too la,'te;. the...... plnt 'us m,aynot be aroundanymore. '- ' ', -. . -.------:, - -: ...--...'..'. .- :--..'-'-''-'.'.... :.-
comparableto the modenMone in their degree of organizationand research.Indian records estimatethat the traditionalhealth sector encompasses55,000 licensedpharmacies, 13,770 3 dispensaries,7,000 licensed manufacturingunits, 16,990 hospitals, 98 Ayurvediccolleges, and 400,000 registeredpractitioners (versus 332,000 registeredphysicians). India's traditionalhealth sector actually accounts for an estimated 35 million persondays of employmentannually and therefore is an importantincome generator.
Usage in Industrialized Nations
Differentlevels of medicinal-plantusage are found in differentindustrialized countries, but all the levels are surprisinglyhigh. For example, the German herbal-product market in 1989 was estimatedat US$1.7 billion.And of the 500 millionprescriptions written each year in the United States one in four is reported to involvea pharmaceuticalderived from a leafy plant, an amount estimated in 1990 to be worth US$11 billion a year. Furthermore, almost all countries have a second outlet for plant-derivedpharmaceuticals: non-prescription drugs. Many laxatives,cough and cold preparations,and over-the-countersleep remediescome from plants. The natural productsin these prescriptionsand over-the-counterpreparations include: 1 quinidine,suppresser of out-of-sequenceheartbeats from the bark of Cinchonasp.; 2 quinine,antimalarial from Cinchonasp.; 3 pilocarpine,glaucoma treatment from Brazilian Pilocarpus sp.; 4 picrotoxin,used worldwideas a nervous systemstimulant from Anamirta sp.; 5 L-Dopa,treating Parkinson's diseaseform Mucuna sp.; 6 bromelain,anti-inflammatory from pineappleAnanas sp.; 7 scopolamine,sedative from Datura sp.; 8 digitalinand digoxin,heart drugs from foxgloveDigitalis sp.; 9 atropine, powerfulpupil-dilator from belladonnaAtropa sp.; 10 curare, musclerelaxant (notablyused in surgery)from Chondrodendronsp.; 11 ephedrine,decongestant from ChineseEphera sp.; 12 ipecac, emeticand dysenterycure from CentralAmerican Cephaelis spp.; and 13 sennosides,laxative from Senna spp.
Some of these therapeutic compounds are now easier or cheaper to synthesizein industrial facilities.However, in the above list, numbers 1-7 are extracted from plant sources while those listed in numbers8-13 can be producedsynthetically but in developingcountries at least still come mainlyfrom the plant sources (Farnsworthand Soejarto, 1991). When the overall benefits to society are taken into account, the value of plant-derived pharmaceuticalsis even more surprising.Principe (1991) estimatesthe total economicvalue to the United States to be at the very least $68 billionannually. In other words, when the improvements in people's health and capacitiesare factored in, the country reaps a financialdividend about six timesthe alreadylarge marketvalue of the plant productsthemselves.
4 2. THE RESOURCE BASE
The number of plants that are used medicinallyis very large. The Natural Products Alert (NAPRALERT)database at the Universityof Illinoishas documentedthe ethnomedicinaluses for more than 9,000 species, includingmonocotyledons, dicotyledons, gymnosperms, pteridophytes, bryophytesand lichens(Farnsworth and Soejarto, 1991). The number officiallysanctioned due to provenefficacy is less, but still impressive.India, for example,formally recognizes just over 2,500 speciesas havingtrue medicinalvalue (Jain and DeFilipps,1991). In the Third World as a whole, it is estimatedthat over 6,000 plantsare authorizedin traditionalmedicine (Huxley, 1984).This is perhaps an underestimatebecause Chinesetraditional medicine alone employsan estimated5,000 officiallysanctioned plants (Farnsworth and Soejarto 1991). The number of plant-derivedcompounds known to be pharmacologicallyactive is also large. Worldwide, at least 121 chemicalsubstances of known structure are extracted and purified for medicinalpurposes (Anon, 1982).A much larger numberof "raw" extracts are used in traditional medicalpractices. Although these are not purifiedinto separatecompounds, many are believedto exert therapeuticeffects good enoughto be proven effectiveby modem analysis.
Uncontrolled Exploitation
Despite all their importance,medicinal plants are, for the moment at least, seldomhandled within an organized, regulated sector; most are still exploitedwith little or no regard to the future. As noted, escalating consumer demand is already resulting in the indiscriminateharvest of wild plants.This is damagingboth ecosystemsand their preciousbiodiversity. The damageis especially serious when bark, roots, seedsand flowers-all essentialfor the species' survival-are removed. Concern is growing that many medicinalplants (not to mention the knowledgeabout their use) are on the verge of extinction.The need to protect rare medicinalplants seems to be urgent. Samplescollected today may in the future be found to combat dreaded diseases,but there is no guaranteethat the plant willthen still exist. This could be unfortunatenot only for the patientsbut for the countriesthat could developlucrative industries out of the buddingresource. China's situation gives some sense of the scope of this problem. There, more than 80% of the 700,000 tons of plant materialharvested each year comes from wild sources. The destructionof forests, overgrazingof meadows,expansion of industry, and increasingurbanization, as well as the excessivecollection of wild plants all meanthat the natural sources of medicinalsfor a billion people are being rapidlyreduced. In country after country, reducing exploitation rates is clearly necessary if vulnerable wild populationsare to survive,let alone to recover. A look at the legislationregarding harvesting and trading indicatesthat it is ineffectiveas it now stands. New policiesand rigid enforcementare needed. Althoughit is obviousthat the economicvalue of medicinalplants is enormous,the true size of the sector is undetermined.Data are scarce or non-existent;detailed informationon medicinal 5 plants is seldom collected(and in some cases deliberatelyso). As a result of the uncertainty,no conservationaction has been taken for most of the threatenedspecies.
National Conservation Activities
Despitethe fact that not much is being done to conservemedicinal plants, a few governmentsare tryingto protect some local species.Their efforts includeimproving the methods of collectionas well as the deliberate cultivationof the plants. The goal is normally to ensure proper quality control and to regulate commercefor the protection of both producer and consumer.These few governmentsare also involvedin educatingtheir populationsand in creating greater awarenessof the importanceof medicinalplants as a whole.Examples follow.
China
Some 35,000 items of ethno-pharmacologicaldata have been enteredinto data bases. D The Institute of Medicinal Plant Development, a WHO Collaborating Centre of TraditionalMedicine, in Beijingspecializes in the researchof medicinalplants. - The Center of TraditionalMedicine-which includesa genebank and a botanical garden in Beijing, with branchesin Yunnan and Hainan Island-undertakes R&D in medicinalplants. (Theseprograms all operate under the auspicesof the Chinese Academyof MedicalSciences.) Thailand
- Thailand's Primary Health Care Program recognizes and even promotes herbal and traditionalmedicine. - A National Committee on Medicinal Plants has been established and charged with developing a nationwide policy. This policy will include support for ethnomedicaland botanical surveys, an informationsystem and data base, the manufacture and export of traditionalmedicines based on plants, and the conservationand cultivationof medicinal plants on a nationalbasis.
Indonesia
* A medicinal-plantgarden (Hortus Medicus Tawangmanguensis)has been establishedat the Center for Research and Developmentof IndustrialPlants. * The Departmentof Health operates a country-wideprogram called "the livingpharmacy" to take the benefits of medicinalplants to the various and widely scattered rural areas throughoutthe archipelago.
6 India
* The Central Council for Research in Ayurvedic, Unani and Siddhi medicine and homeopathyundertakes R&D into botanicals. * The IndianPharmacopoeial Laboratory analyzes traditional healing-plant materials. * The IndianForestry Service and the Forestry Research Institute both have programs on the plantingand encouragementof medicinalherbs in the forest understory. * The Botanical Surveyof India includesmedicinals in its assessmentsof the Subcontinent's plant resources. * The State Department of Tribal Welfare promotes herbal medicinesbecause the tribal peoplestend to rely on these even more than most Indians. * The Arya Vaidya Sala, an importantcenter of Ayurvedamedicine at Kattakkolin the state of Kerala, operates a college, hospital, factory, and research laboratory for medicinal plants.It also operated a herbalgarden and two farmsthat cultivatemedicinals. Thel Tropical Forest Research Institute at Jabalpur in the state of Madhya Pradesh emphasesmedicinal plants that can be grown amongthe trees. It cultivatesand distributes plant materialsto pharmaceuticalenterprises.
Bangladesh
The newly establishedResearch Institute on HerbalMedicines has recentlybeen preparing a "formulae" of traditional medicines. This formal document-being constructed with inputs from government,universities and private organizations-will establish protocols for evaluatingtraditional remedies, as well as the processing, production, licensingand marketingof medicinalplants.
Sri Lanka
* The Ministry of IndigenousMedicine has established(with WHO assistance)medicinal- plant nurseries. It has also declared a number of natural areas to be "MedicinalPlant Reservations." * The Bandaranaika Memorial Ayurvedic Research Institute undertakes research into medicinalplants as well as into the formulationof products from them. * The Royal Botanical Gardens in Peradeniyaand several private gardens maintainliving medicinalplant collections.
* Botanical surveys that include therapeutic plants are being carried out by the Wildlife Conservationand Forest Departments.
7 Ethiopia
* The BiodiversityInstitute (formerlyPlant Genetic ResourcesCenter) plays a leading role in getting medicinalplants into cultivation.It has a well establishedprogram of conserving plant genetic resources and is complementingits gene banks by establishingon-farm conservation. It recently established a collaborative program with regional traditional health practitioners,providing among other things land for growingmedicinal plants.
International Conservation Activities
Althoughthe situationis hardlyclear, one can say with confidencethat globallyspeaking little has been done to conserve medicinalplants in any organized fashion. In spite of the rising trade in medicinals,few policiesat the nationaland internationallevel encouragecultivation programs or protectthe resourcebase. Moreover,since the 1988 ChiangMai DeclarationSaving Lives by Saving Plants (WHO/IUCN/WWF,1993), few genetic conservationefforts now incorporate speciesused in traditional medicine.Many countries have "gene banks" of course, but these repositories are mainlydedicated to food-cropgermplasm, not manycontain any medicinalplants. The ConsultativeGroup on InternationalAgricultural Research (CGIAR)-with its network of 17 international agricultural research centers and programs in natural resource management, germplasmconservation, institution building, and networking-would seem to be well placed to play a role in medicinalplant conservationand cultivation.However, its primary focus is food crops, and a reviewof past CGIARAnnual Reports fails to reveal attentionto any medicinal-plant activities. Privately funded internationalagencies seem to be the current leaders in conservingmedicinal- plant biodiversity,or at least in highlightingthe need. These organizationsinclude the World ConservationMonitoring Center (WCMC), the World WildlifeFund for Nature (WWF), the Nature Conservancy,the InternationalUnion for the Conservationof Nature (IUCN), and several botanic gardens (notably, Kew, Edinburgh,New York, and Missouri Botanical Gardens). One notable endeavor is the joint collaborationbetween IUCN, WWF and the InternationalPlant GeneticsResources Institute (IPGRI), which has drawn up guidelinesfor establishinga network of wild-speciesseedbanks in botanicgardens. Many non-governmentorganizations (NGO's) are collaboratingwith local interest groups to strengthenthe traditionalhealthcare systems. A few are also assistingin programsto conserveand cultivatemedicinals.
8 3. MEDICINAL PLANTS IN WORLD BANK PROJECTS
At present medicinal plants are hardly a priority in the World Bank's financial, analytical and/or advisory services. A prelirminaryreview of abstracts listed in the Lending Operations Database and the Report Bibliography Service turned up only six references to the words "medicinal plant" and "traditional medicine" in the period covering FY 79 to the present. These six were the following: * Projects in both Pakistan and Indonesia seeking to overcome constraints to incorporating traditional-health practices into government healthcare efforts. * A general review of traditional medicine in Sub-Saharan Africa, which had found that traditional medicine was an important source of healthcare for educated, as well as less privileged, people. (It also concluded that traditional healers were important human resources.) * Projects in Turkey, India and Madagascar that were establishing programs to conserve and cultivate a range of genetic resources, including some medicinal plants. Each project was oriented particularly toward strengthening institutional capabilities, and dealt with the plants only secondarily.
A search of Operational Directives, Operation Policies, Bank Procedures, and Good Practices, revealed only one reference to medicinal plants. This (found under Good Practices) covered a sectorwide strategy for forestry development. In one section the strategy emphasized the economic importance, particularly to the poor, of non-timber forest products (notably, nuts, fruits and medicinal plants). It noted that information on these products is rarely available or analyzed. Three recent World Bank publications, two: Investing in Health, 1993; and Better Health in Africa, 1994, clearly recognized the role traditional healers can play in helping the informal health sector and modern healthcare systems, but neither provided any detail. The third publication, Traditional Knowledge and Sustainable Development (Davis and Ebbe, 1995) discussed the contribution and importance of plants in traditional medicine to the health and well-being of the world's population. Country reports dealing with China, India, Indonesia, Philippines, and Pakistan identify medicines, crude drugs, and/or pharmaceuticals in production and export trade tables (see, for example, China: Foreign Trade Reform, 1994, pp262, 263, 303). The country reports from China also identify medicinal-plant components in three projects: * Jiangya Dam sub-project. An important component of this activity in Hunan Province is the resettlement of 14,000 people. These are mainly farm families skilled at growing rice, wheat, maize and soybean, with some rapeseed and tobacco as cash crops. Most are to be resettled at higher elevations in the river valley where they will have to develop new farm lands and new crops. They are expected to switch to predominantly cash-crop production that will include medicinal plants, tea, and fruit trees.
9 * Southwest Poverty Reduction Project. Livelihoods in the project area in Guizhou, Guangxi, and Yunan provinces are mostly based on subsistence farming; the families have very limited resources and access to only small amounts of cash. The objective of the Bank-supported component is to increase agricultural incomes. In this regard, approximately 10,000 ha will be planted to medicinal plants (Eucommia ulmoides, Illicium verum, Lonicera confusa, and Ficus spp.). Farmers have been assured they will receive use rights for a term not less than 50 years for the lands they plant to these perennial crops. . Sonliao Plain Agricultural Development Project. This integrated agricultural development project in Liaoning Province has the primary objective of increasing agricultural production, farm income, and rural employment. A small component of the project is the cultivation of eight species of medicinal plants (names not provided) on 1,333 ha in Kuzuo County.
Global Environmental Facility Activities
Under the GEF only one listed project includes medicinal-plant protection and conservation: the Sri Lanka National Planning and Conservation of Biodiversity Project. This specificallynotes that medicinal plants are an important component in the country's rich biodiversity, that they contribute to the healthcare delivery system, and that they are of economic importance in the daily lives of local people. Under the project there are three sub-components relating specifically to medicinal plants:
Programs for the in-situ conservation of selected medicinally important species, Expansion of the ex-situ conservation programs; and . Research and demonstration on the feasibility of medicinal plant propagation and subsequent promotion of conmmunity-basedefforts aimed at cultivation and marketing promising species.
10 4. TOWARD A STRATEGY
It seemsunlikely that medicinalplants will decrease in importanceanytime soon. For one thing, the numberof peopledemanding greater accessto herbalremedies in the industrializedcountries seems likelyto go on increasing.For another, the healingplants will continueas the primarymeans of preventiveand curativehealthcare in the developingcountries. Indeed, rising population growth and fallingeconomic levels will probably make these plants more important than today. Even now suppliesof certain speciescannot be guaranteed,and the future will see the situation worsen.Many seemingly unrelated natural and man-madeactivities-among them, the constructionof roads and dams, the expansionof cities, deforestation,desertification, and land degradation-will profoundlyaffect the medicinal-plantsupply and costs. The presenttime therefore offers a unique opportunityto work with developingcountries in implementingpolicies to regulatemedicinal plant conservation,cultivation, processing, and marketing. At this pioneeringstage, in which norms and standardsfor the healthcareof billionsof people in the developingnations are going to be rapidly set, a strategyfor the fiutureshould be developed. This will be far from easy, the medicinal-plantbusiness is fluid, undocumented, and largely unregulated.Much about it is unclear, and will remainthat way for some time. But, regardlessof the difficulties,a beginningmust be made to address this importantbut neglected area. Elements for sucha strategycould includethe following.
Policy and Regulations
Any nation's strategyfor medicinalplant developmentneeds to considerboth current and potential policiesand regulations.Among points each nation needs address are:
* Is the use of medicinalplants encouraged in healthcareprograms? * Are there policies for conserving medicinalplants and incentives to encourage local communityparticipation? * Is there a policyfor restoringplants harvested in the wild? * Are there incentivesfor collectorsand farmersto keep the productionof medicinalplants sustainable? * Does the governmentsupport researchinto these plants? * What are the policiesregarding the export of medicinalplants? * Are onlyraw materialsexported? * Is "in-country" processing(which may further help the trade in medicinalplants) being promoted.
11 Markets and Prices
Any future strategy should be based on good knowledge of the economics and commercial operations surroundingmedicinal plants. A preliminaryreview of availabledata on markets and prices indicatesthat at present no completedata for even a singlemedicinal species is available. Despite the fact that herbal products are being exportedin large quantities,few plant of medicinal importanceare subjectto internationalregulations, and little is known about the volume of such trade. There is not even a clearcut understandingabout the factors affecting the trade. For instance, almost no data on actual production,employment, pricing, and financialflows between countries is available.The market prices for medicinalplants and materials derived from them provideonly limited insight into the workingsof the marketsand their profits. All of these uncertaintiesneed to be taken into account in developingstrategies and policiesfor futuredecision-making purposes.
Conservation
As a matter of priority, any strategy must address the plight of the increasingnumber of wild medicinalplants threatened with extinction. Some Western countries have adopted protective legislationto control collectionand limit the demand of their own species by imposing export restrictions.(This has occurred with ginseng in the forests of United States, for example.)In the developingcountries, similar legislation is desperatelyneeded, at least for certain species. It seemslikely that somenature reserves and protectedareas canprovide a sustainablesupply of plant materialsfor sustaininghealth. Local peoplewill cooperatein conservinga habitatif their own self- interestis enhanced.Allowing them to gatherherbs in the forests,as theyhave donetraditionally, could be an incentiveto protectingthe wholeecosystem, such as a rainforest.These plants are not like field crops; many can be profitablyharvested on small scale and with little disruptionto the natural environment.American families, for instance, have for centuries scavengedforests from North Carolina.to Wisconsinin searchof ginseng.Protected areas containingreservoirs of medicinalplants might similarlybe exploitedon a sustainablebasis. Not onlymay this reducethe damagefrom illegal harvesting,it mightperhaps even provide financial resources to buildup the nativeresource.
Acceptance
There is a need to create a greater awarenessof the medicinaland economicvalue of medicinal plants. This is especiallyimportant among government officials, farmers, and scientists.Only with their support can the heritagebe wiselyused, and exploitedand conservedat the sametime.
12 Tradition is especiallyimportant in the case of medicinalplants. Any strategy to preserve such specieswill have to take people's needs and perceptionsinto account. Local users often have a good understandingof how sustainableharvesting should be practiced(Cunningham, 1991). At present there is little support for strengtheningconservation of medicinalplants. How to bring this about shouldbe part of the strategyevolved. Approachesmight include participation of: * The Public. It seems obviousthat to promote conservationand the sustainableeconomic use of medicinalplants demands a better dialogue with the recipients of traditional healthcare. * Industry. People who collect medicinalplants in the field are generallyunaware that they are destroying the resources that sustain them. Local industriesand exporters who pay them, however,are awarethat suppliesare decliningand threateningtheir livelihood.They shouldtherefore be coopted. It is in their self-interestto participatesupportively. * Women.Women play a vitalrole in collectingand cultivatingmedicinal plants as well as in dispensingmedicines to the family.Their knowledgeand input into the decision-making process should be sought from the beginning.Various NGOs and local groups involving womenmight well spearheadthe conservationand use of medicinalplants. - Farmers. The idea of cultivatingmedicinal plants is not entirely new. Many traditional health practitioners even now maintain their own sources of healing plants. Families commonlyplant medicinalspecies in their home gardensand some encouragethe plantsto grow in nearby common lands. Local pharmaceuticalenterprises also maintain herbal supplierswho sometimesoperate farms.
Cultivation
At present, the fanning of medicinalplants is small, scattered, and largely informal.Given the increasingglobal population and consequent rise in demand for medicinalplants, one strategy option is to regard medicinallyimportant species as underutilizedcrops. Farmingthese speciesis not only an alternativeto collectingplants from nature, it could help conservethe wild types by relievingsome of the pressure on them. Cultivationalso permits productionof uniform material from whichstandardized products can be consistentlyobtained. Cultivationshould be a major part of any strategy. An increasingnumber of developingcountries are already showing an interest in farming medicinalplants-trees, shrubs, lianas and herbs, annuals as well as perennials. In principle at least it seems possible that the cultivation of medicinalplants could be appropriatelyincluded in many agricultural and rural development projects. It will demandsocial acceptance, the incorporationof indigenousknowledge, and farmer and communityparticipation, but it can be done.
13 Box3: MarketForcesThreaten Haing nrdients
R¢apidurbanization in South ica issbringingthousandsofcountry people to CapeTown eamu ont. The new arrivalsbringhwi,th temh..etradition ofvisiting "sag swho prescribeherbal medicines.
Gatheoing.herbsro the :wild:has:become :a: boom: industry, and there are fears thattsomelts, especiallythose dgupfortheirroots or bulbs,may become extinct. Attemptsby the ce to stop people6colecingpl4antsthve Onnhile. one occasion six sangomaswere arrestedwhile collecig bark ina forest(onTable Mountain....Fioa Archer, ethobotanistMi at the Universityof Cape Town, initerded&on&their h piti'g out toWthemagistrate that if thesecollectors were lockedupe others would'simply t teir place.Arcrexplained, it was an opportunityto cooperatewith the healersin findingmore sustainablesources for healngplants
VThesangoas wererJeleased,nd- the WesternCape TraditionalPla Use Conmtt ee was set up. This committeehasnowdisussedwiththesngoas plansfor cultvatingtraditional herbs. The healersare entiusiastict:abot the idea becauseiR.twill savethema lot of tr , and ensurethem a steamysupply. of plants. he. committee,chairediby Cape Town City Council'sdirector of kparsand forests Peter Rist, hasappliedfto.the SouthAfican Nature Foundation for finding for a fll-tiie workerand cashto stail: a nursety.fD f7 .. -..... - -- SSE- :iS:....- :. .S . i.f ...... j . . .: .. . . .
'WouterV O van S7fS-jig..i-fS2f Velo,an spokesmanC 2IEiEIEI for SS.7fSi theSc e cittee,omm2iSSiau-" ee agedag e thatS 2the authorities97 wouldwo 2 E needn : too .bee carefuliS. .. abut...... -which:speciesD - iR E . .7E.fi.. . were7 7- cultivated,-. f 7 . . 7 and they :were E still7 discussinghow much control there wouldbe oer the nses. :Thebvps willbe valuablenot onlyto sanmas, who can sellthem in the same waythet now.sellwld iplants. They will also form a reservoirof potentialpharmaceuicals. :Research ;is needed:,to.: find: the bafsisof most of the traditionalremedies: before the sangomas' boe e d ....;:. ;::; : :.: .: :7:: ::0.: :f ; : 0; t ...... know"ledgdi;sappears.: ::0Tt ) ; :: 0i0 ;;0 :iS t :
Kate:deSnout, Nw Scientist4 Jan , 1992t
The cultivationof medicinalplants provides opportunities for geneticimprovement. For one thing, selectionand vegetativepropagation could produce cultivarsthat are rich in activeingredients and also have desirable agronomic traits such as good yields, pest and disease resistance, and environmentaltolerance. A well managedcultivation program presentsan opportunityfor local and national authoritiesas well as communitiesto exercisea beneficialinfluence over commercein medicinalplants and their derivatives-a process that could guaranteeboth safetyand efficacyand also ensure fair prices to collectors and cultivators. Both in-situ and ex-situ cultivation programs could be promoted especially to protect those rare, endangered and vulnerable species most threatened in their naturalhabitats.
14 Box 4: HelpingRestore Healing Hlerbs
India possesses a longunbroken medical heritage. The Foundationfor the Revitalizationof Local. Health Traditions(tRLIITI) seeks to rejuvenatethat legacy for use by the people of India.
The FRLHTis a non-governmentalfoundation which has linkswith the traditional'nedicine community,modem physicians,community health organizations,scientists, industry and government.Current projectsinclude:
*o In-situ and ex-situ.conservationof the plantsused in traditionalmedicine. .Eco-developmentprojects to benefitlocal communitiesliving around medicinal pIant conservationareas. . Field nurseriesto provideplanting m-aterial for rural householdsfor their primaryhealth needs Trainingin conservationbiology. *. Creatingpublic awareness of conservationefforts along.witha sense of public accountability. -Computerizedmulti-disciplinary. databases on medicinalplants. . Intemnationalcooperation in traditionalmedicine.
FRLHT, Bangalore,India. 1994
QualityControl
There is increasingconcern regarding the quality of medicinalplant material being deliveredto local pharmaceuticalindustries and the length of storage prior to processing.The storage time is of particular concern because of loss of efficacy.Any future strategy should encouragebetter handlingand prompt deliveries. Therapeutic products from plants differ crucially in one particular aspect from those from a laboratory:they are subjectto the vagariesof nature. A compoundfrom a chemicalreactor inside a factory is identicalbatch after batch, but the amount of product in livingplants can changewith such factors as the weather,the time of harvest, and the way the crop is harvestedand handled. Any strategymust address this variability.Investigations should be made into the stabilityof each herbal product, taking into account such practices as the effects of sunlight, temperature, humidity,plant husbandry,and packaging.
15 BoxS5:7The.200yearTreatment
:Oneof the great complaintsin the late 1700s, was }dropy. Peoplein laterlife came:down withsodien,: fesh, fluid-filledchests and grosslyswollen bellies. Physicians fthat era spent much of theirefforts attemptingto nid patients:of.theburden of excessfluid. Ail seemed in vain until in-1775 William Witheringvisited anold Shropsie womansuffering fromdropsy. She was seeminy rgone but a few weeks:later,; the :good doctor, who spent,muchof his time treatingthe poor, found her much improved.He discoveredshe had takentalocal folk-remedy that includedmore: than 20 differenthers. Upon consideration,Witering; decidedthat the activeherb was the Europeanwild flower knonas:: foxglove.
He thenused foxgloveextracts on his ownpatients with dramaticeffect, achieving a h propogtionof f cures.One man, for instance,shed 40 pints (about 10 liters)of fluid in two weeks. Withering;quited logically,thought the drug workedthrough the kidneys.He spent 10 yearslooking ito that potential but onlyafler his death was the real story recognized:ffoxglove acts not on the kidneys.but on the heart.Its componentsimprove the circulationof the blood, whichin turnW fushes out the:accumulation of excess flwuds.
Today,the commonfoxglove provides the world'smajor heart medicines,digitoxn anid digoxin. These:... haveso far resistedattempts at commercialsynthesis; it is stillnecessary to use plantmaterial for every dose adininistered.Each. yearAmericanAdoctors write more than16 nmillion ns for these; compounds as wellas 2.5 million prescriptionsfor the undifferentiatedextract of foxglove leaves All are still.derived from the dried leaves,sometimes from the Britishfoxglove Digitalis pupureu but mostly from the European Digitals lanwta.
Millionsof-heart sufferers owe their livesto this.Digoxin and digitoxin,strengthen and regulate lheir heartbeat.This success and the consequentrelief of human miseryis thanks to the inquisitive:and: insightfiulcountry doctor, who establishedbeyond doubt the great valueof variousfoxove samples the poor folk of Shropshirewere employingtwo centuriesago. We have now benefitedfrom William Withering wisdomfor two centures.;
Environmental Issues
Any forthcoming strategy should address the ecological soundness of the conservation, management, and cultivation initiatives. Farming medicinal plants can in principle be an environmentalbenefit. For example,in marginal,remote, and/or degraded areas it may increase income and land values, which in turn may promote better soil conservation and more environmentallyfriendly land-management practices.
16 But cultivation may also exacerbate environmental problems. Pesticides and fertilizers, for instance, represent a risk if indiscriminately used. In the United Kingdom there is even now a proposal to produce 20,000 tons of daffodil bulbs annually, for galanthamine, a product thought to slow the progress of Alzheimer's disease (The Independent, May 23, 1995). Such large scale production implies monocropping, perhaps with accompanying pest problems and a possible need for pesticides.
Institutional Capacities
At present few developing countries have the resources or institutionalcapability to advise on policy and regulatory mechanismsand to provide the level of research required to guarantee a production of medicinal plants to sustain local pharmaceutical industries and provide for healthcare needs. The subject tends to fall into two government ministriesthat normallydon't deal directly with each other: agriculture and health. They would have to coordinate programs if medicinal plants are to be cultivated.
International Actions
Countries facing the problems of decliningmedicinal-plant resources probably have a lot to learn from each other. Collaboration between countries such as China, India, Ethiopia, Indonesia where cultivation programs are being developed is one approach. Another is to get those countries to cooperate with the others who have not yet begun to take stock of their medicinal-plantsor whose resources are just too limitedfor the task. The intemational research institutions can possibly play a major role in providing expertise in developinglocal capacitiesand assistinggovernments in framing appropriate laws to ensure protection of medicinalplants and to control their exploitation.As already noted, international agencies such as WHO, WWF, IUCN, and IPGRI also have experience to offer. They are presently playing a limited, but increasing role in medicinal plant conservation and cultivation. The recently established Botanic Gardens Conservation International (BGCI), linking more than 450 botanic gardens, is potentially a major resource for the conservation and development of medicinal species.
The Ultimate Outcome
Any strategy should maintain the long-term view. In principle at least, medicinal plants could contribute substantially to the overall management of natural resources. Indeed, if given research and policy support, they could potentially become high-value components of many agriculture and rural development programs, perhaps providing upscale alternatives to low-value food crops. 17 They have an especialpromise for the fragile habitats,where conventionalfarming is fraught with hazard. All in all, it seems clear that a greater awarenessand appreciationfor this subject of the healing herbs could be importantto developmentefforts in general.For many countries medicinalplants are a possible"bridge" between sustainableeconomic development, affordable healthcare and the conservationof vital biodiversity. Themore detailedassessment that is to followwill examine many of the issuesraised above. It willalso documentthe use, abuseand developmentpotential of medicinalplants. In particular,it willfocus on China,India, and Ethiopia.From all this, it is hoped to derive lessons and, where appropriate,to proposenew best practices.Further in-depth studies are neededto shedlight on the issuesraised in this paper.More specificinformation is requiredin areas indicatedin Appendix1. This willnecessitate a seriesof desk reviewsand in-countryresearch.
18 APPENDIX 1
Topics that require in-depth studies
1. CURRENTSTATUS OF MEDICINALPLANTS Trade and Economics Status of medicinalplants Links to modem medicine Links to biodiversity Links to agriculture (good, bad, and misrepresented) Links to forestry Medicallyuseful wild plants Chemical Synthesisand its relation to medicinalplants 2. FUTURENEEDS FOR MEDICINAL PLANTS Genes to maintain productivity Potential for dramatic advances Changingopportunities (new markets, new nutritionalor health findings,etc.) 3. THREATSTO MEDICINAL-PLANTBIODIVERSrrY Current losses of genetic diversityin medicinalplants Threatened wild varieties 4. PROTECTINGMEDICINAL-PLANT BIODIVERSrrY Preserving wild genes In-situ conservation Preserving by utilizing Ex-situ cultivation,conservation 5. OPERATIONALISSUES Economic issues Policy issues Regulatory issues 6. SOCIALISSUES Medicinal plants in traditionalsystems Developing medicinalcrops without losingtheir biodiversityand traditions Encouraging use (and preservation)of traditional medicines,practices, and knowledge Women's and children's issues Enhancing social capital Trust embodied in the traditionalhealers their herbal cures Income generation Values and constraintsnot well understood What are required policies,incentives, regulators framework research support, market support, market information 7. LESSONSLEARNED AND IMPLICATIONSFOR THE FUTURE
19 BIBLIOGRAPHY
Abebe, D and Ayehu, A. 1993. Medicinal Plants and Enigmatic Health Practices of Northern Ethiopia. Addis Ababa, Ethiopia.
Akerele, O., Heywood, V and Synge, H. 1991 Conservation of Medicinalplants. Proceedings of an International Consultation March 1988, Chiang Mai, Thailand. Cambridge University Press, Cambridge. Anonymous 1982. Markets for selected medicinal plants and their derivatives. Geneva: International Trade Center. 206pp. Bannermnan,R.H. 1982. Traditionalmedicine in modem health care. World Health Forum. Vol.3 (1): 8-13.
Cunningham,A. 1991. Developmentof a ConservationPolicy on CommerciallyExploited Medicinal plants: A Case Study from Southern Africa.In: Akerele O., Heywood V. and Synge H. (Eds) ConservationofMedicinalPlants. CambridgeUniversity Press, Cambridge.
Davis, S. and K.Ebbe. 1995. TraditionalKnowledge and SustainableDevelopment. Environmentally SustainableDevelopment Proceedings Series No.4. The World Bank Washington, D.C.
DeJong, J. 1991. TraditionalMedicine in Sub-SaharanAfrica. World Bank, Population and Human ResourcesDepartment. WPS 735. Washington,D.C.
Dobson, R. 1995. Try a little flower power. The Independent, May 23. Eisenberg,D.M., R.C.Kessler,C.Foster, F.E.Norlock, D.R.Calkins,and T.L.Delbanco. 1993. Unconventionalmedicine in the United States. New England Journal of Medicine. 328(4): 246-252.
Farnsworth,N.R. & D.D.Soejarto. 1985. Potential Consequencesof Plant Extinctionin the United States on the Current and Future Availabilityof Prescription Drugs. Economic Botany 39: 231-240.
Farnsworth,N.R. & D.D.Soejarto. 1991. Global Importance of MedicinalPlants. In: Akerele O., Heywood V. and Synge H. (Eds) ConservationofMedicinal Plants. CambridgeUniversity Press, Cambridge.
Fellows,L.E. 1991. Pharmaceuticalsfrom TraditionalMedicinal Plants and Others: Future Prospects. A paper presented at the symposium"New Drugs from Natural Sources" sponsored by I.B.C.TechnicalServices Ltd., London, June 13-14/1991.Royal Botanic Gardens, Kew.
20 Grunwald, J. 1994. The European Phytomedicines Market Figures, Trends, Analyses. HerbalGram. 34:60-65.
Huxley, A. 1984. Green Inheritance: The World Wildlife Fund Book of Plants. London: Collins/Harvill.
Jain, S.K. & R.A.DeFilipps. 1991. Medicinal Plants of India. Vol. 1 & 2. Reference Publ.Inc. Michigan Lewington, A. 1993. A Review of the Importation of Medicinal Plants and Plant Extracts into Europe. TRAFFIC International, Cambridge, UK. Li Chaojin. 1987. Management of Chinese TraditionalDrugs. In Akerele, O., Stott, G. and Lu Welbo. (Eds) The Role of TraditionalMedicine in Primary Health Care in China. AmericanJoumal of ChineseMedicine, Suppl.No. 1, 3941.
Principe, P.P. 1991. Valuingthe Biodiversityof MedicinalPlants. In: Akerele O., Heywood V. and Synge H. (Eds) Conservationof Medicinal Plants. CambridgeUniversity Press, Cambridge.
Srivastava,J.P., N.J.H. Smith and D.A.Forno. 1995. Biodiversityand Agricultureat a Crossroads. Draft Concept Paper, AGRAF, The World Bank, Washington,D.C.
WHO/IUCN/WWF. 1993. Guidelineson the Conservationof MedicinalPlants. IUCN, Gland, Switzerland.
World Bank. 1993. Investing in Health. The World Bank, Washington, D.C. ------1994. Better Health in Africa. The World Bank, Washington, D.C. ------1994. China: SongliaoPlain AgriculturalDevelopment Project. Report 12374-CHA. Washington, D.C.
------1995. China: SouthwestPoverty Reduction Project. Report 13968-CHA.Washington, D.C.
WRI, IUCN and UNEP. 1992. Global Biodiversity Strategy: Guidelinesfor Action to Save, Study, and Use Earth 's Biotic Wealth Sustainablyand Equitably.
Xiao Pen-gen. 1991. The Chinese Approach to Medicinal Plants-Their Utilization and Conservation. In: Akerele O., Heywood V. and Synge H. (Eds) Conservationof Medicinal Plants. CambridgeUniversity Press, Cambridge.
21
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No. 284 Valdes and Schaeffer in collaboration with Roldos and Chiara, Surveillanceof AgriculturalPrice and TradePolicies: A HandbookforUruguay No. 285 Brehm and Castro, The Marketfor Water Rights in Chile:Major Issues No. 286 Tavoulareas and Charpentier, Clean CoalTechnologiesfor Developing Countries No. 287 Gillham, Bell,Arin, Matthews, Rumeur, and Heam, CottonProduction Prospects for the Next Decade No. 288 Biggs, Shaw, and Srivastiva, TechnologicalCapabilities and Learningin African Enterprises No. 289 Dinar, Seidl, Olem, Jorden, Duda, and Johnson, Restoringand Protectingthe World'sLakes and Reservoirs No. 290 Weijenberg, Dagg, Kampen Kalunda, Mailu, Ketema, Navarro, and Abdi Noor, StrengtheningNational Agricultual ResearchSystems in Easternand CentralAfrica: A FrameworkforAction No. 291 Vald6s and Schaeffer in collaboration with Errazuriz and Francisco, Surveillanceof AgriculturalPrice and Trade Policies:A HandbookforChile No. 292 Gorriz, Subramanian, and Simas, IrrigationManagement Transfer in Mexico:Process and Progress No. 293 Preker and Feachem, Market Mechanismsand the HealthSector in Centraland EasternEurope No. 294 Valdes and Schaeffer in collaboration with Sturzenegger and Bebczuk, Surveillanceof Agricultural Priceand TradePolicies: A HandbookforArgentina No. 295 Pohl, Jedrzejczak, and Anderson, CreatingCapital Markets in Centraland EasternEurope No. 296 Stassen, Small-ScaleBiomass Gasifiersfor Heat and Power:A GlobalReview No. 297 Bulatao, Key IndicatorsforFamily Planning Projects No. 298 Odaga and Heneveld, Girls and Schoolsin Sub-SaharanAfrica: From Analysis to Action No. 299 Tamale, Jones, and Pswarayi-Riddihough, TechnologiesRelated to ParticipatoryForestry in Tropical and SubtropicalCountries No. 300 Oram and de Haan, Technologiesfor RainfedAgriculture in MediterraneanClimates: A Review of WorldBank Experiences No. 301 Edited by Mohan, Bibliographyof Publications:Technical Department, Africa Region,July 1987 to April 1995 No. 302 Baldry, Calamari, and Yameogo, EnvironmentalImpact Assessment of Settlement and Developmentin the UpperLeraba Basin No. 303 Heneveld and Craig, SchoolsCount: World Bank ProjectDesigns and the Quality of PrimaryEducation in Sub-SaharanAfrica No. 304 Foley,Photovoltaic Applications in Rural Areasof the DevelopingWorld No. 305 Johnson, Educationand Trainingof Accountantsin Sub-SaharanAnglophone Africa No. 306 Muir and Saba, ImprovingState EnterprisePerformance: The Roleof Internaland ExternalIncentives No. 307 Narayan, TowardParticipatory Research No. 308 Adamson and others, Energy Use,Air Pollution,and EnvironmentalPolicy in Krakow:Can EconomicIncentives Really Help? No. 309 The World Bank/FOA/UNIDO/lndustry Fertilizer Working Group, Worldand RegionalSupply and Demand Balances for Nitrogen,Phosphate, and Potash,1993/94-1999/2000 No. 310 Edited by Elder and Cooley, SustainableSettlement and Developmentof the OnchocerciasisControl ProgrammeArea: Proceedingsof a MinisterialMeeting No. 311 Webster, Riopelle and Chidzero, World Bank Lendingfor Small Enterprises1989-1993 No. 312 Benoit, ProjectFinance at the World Bank:An Overviewof Policiesand Instruments No. 313 Kapur, Airport Infrastructure:The EmergingRole of the PrivateSector No. 314 Valdes, Schaefferin collaboration with Ramos, Surveillanceof AgriculturalPrice and TradePolicies: A Handbookfor Ecuador No. 316 Schware and Kimberley,Information Technology and NationalTrade Facilitation: Making the Most of GlobalTrade No. 317 Schware and Kimberley,Information Technology and NationalTrade Facilitation: Guide to Best Practice No. 318 Taylor, Boukambou, Dahniya, Ouayogode, Ayling, Abdi Noor, and Toure, StrengtheningNational Agricultural ResearchSystems in the Humid and Sub-humidZones of West and CentralAfrica: A FrameworkforAction No. 319 Dakolias, The JudicialSector in Latin Americaand the Caribbean:Elements of Reform THE WORLD BANK u1 A partner in strengthening economies a and expanding markets m to improve the quality of life for people everywhere, especially the poorest
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780821 336137 Cover design by Walton Rosenquist ISBN 0-8213-3613-4 r