PEOPLE AND PLANTS WORKING1 PAPER - MARCH 1993 This series of working papers is intended to provide information and to generate fruitful discussion on key issues African in the sustainable and equitable use medicinal plants of plant resources. Please Setting priorities send comments at the interface between conservation on this paper and primary healthcare and suggestions A.B. Cunningham for future issues to People and Plants Initiative, Division of Ecological Sciences, UNESCO, 7 Place de Fontenoy, 75352 Paris CEDEX 07 SP, France. The designations employed and the presentation of material throughout this publication do not imply the expression of any opinion whatsoever on the part of UNESCO concerning the legal status of any country, territory, city, or area of its authorities, or concerning the delimitation of its frontiers or boundaries. The opinions expressed in this paper are entirely those of the author and do not commit any Organization. Author's address: A.B. Cunningham 84 Watkins Street - White Gum Valley, Fremantle 6162 Western Australia - Australia Published in 1993 by the United Nations Educational, Scientific and Cultural Organization, 7 Place de Fontenoy, 75352 Paris CEDEX 07 SP. Printed by UNESCO Presse on chlorine-free recycled paper. Series editor: Alison Semple Design and layout: Ivette Fabbri Suggested citation: Cunningham, A.B. (1993). African medicinal plants: setting priorities at the interface between conservation and primary health care. People and Plants working paper 1. Paris. UNESCO. African medicinal plants SETTING PRIORITIES AT THE INTERFACE BETWEEN CONSERVATION AND PRIMARY HEALTHCARE Abstract Sustainable management of traditional medici- use of bark, roots or whole plants used as herbal nal plant resources is important, not only medicines is possible, the high levels of money because of their value as a potential source of and manpower required for intensive manage- new drugs, but due to reliance on traditional ment of slow growing species in multiple- medicinal plants for health. The vast majority species systems are unlikely to be found in most (70-80%) of people in Africa consult traditional African countries. The cultivation of alterna- medical practitioners (TMPs) for healthcare. tive sources of supply of popular, high conser- With few exceptions, traditional medicinal vation priority species outside of core conser- plants are gathered from the wild. Although vation areas is therefore essential. However, reliance on TMPs may decline in the long term commercial cultivation of such species is not a as alternative healthcare facilities become simple solution and at present is unlikely to be available, increasing demand for popular herbal profitable due to the slow growth rates for medicines is expected in the foreseeable future. most tree species and low prices paid for tra- Over the same period, certain vegetation types ditional medicines. These slow growing species that were sources of supply of traditional med- are a priority for ex situ conservation and strict icines will drastically decline due to forest protection in core conservation areas. By con- clearance for agriculture, afforestation of mon- trast, the high price paid for some species does tane grasslands, uncontrolled burning and live- make them potential new crop plants for agro- stock grazing. Exclusion from core conserva- forestry systems (e.g. Warburgia salutaris, tion areas adversely affects TMPs who previ- Garcinia kola, G. afzelii, G. epunctata) or agri- ously gathered medicinal plants in those sites. cultural production (e.g. Siphonochilus In addition, supplies of herbal medicines to aethiopicus). Pilot studies on these species are TMPs are affected by competing resource uses needed. such as timber logging, commercial harvesting Priority areas for cooperative action for export and extraction of pharmaceuticals, between healthcare professionals and conser- and use for building materials and fuel. This vationists are rapidly urbanizing regions with creates a growing demand for fewer resources, a high level of endemic taxa, particularly west in some cases resulting in local disappearance Africa (Guineo-Congolian region), specifically of favoured and effective sources of tradition- Côte d’Ivoire, Ghana, and Nigeria; east Africa al medicine and reduced species diversity. (Ethiopia, Kenya, Tanzania); south-eastern The most vulnerable species are popular, Africa (South Africa, Swaziland). The most slow growing or slow to reproduce, or species threatened vegetation types are Afro-montane with specific habitat requirements and a limit- forest and coastal forests of the Zanzibar- ed distribution. Although in theory, sustainable Inhambane regional mosaic. PEOPLE AND PLANTS WORKING PAPER 1, MARCH 1993 1 African medicinal plants: setting priorities at the interface between conservation and primary healthcare - A.B. CUNNINGHAM Contents Abstract Contents Introduction 4 Medicinal plant use in Africa The role of traditional medical practitioners Customary controls on medicinal plant gathering Dynamics of the commercial trade Domestic trade International trade The impact of the trade in medicinal plants Sustainable supplies of traditional medicines Sustainability of chewing stick harvesting Supplying international trade The real price of trade The reasons for concern Focus of management effort Conditions for cultivation as an alternative source of supply 29 Policy priorities for conservation and primary healthcare Key issues Conservation strategy Policy recommendations International and national policy Sharing the costs Conservation methods In-situ conservation Buffer zones and ex-situ conservation Buffer zones Traditional medical practitioners Conservation through commercial cultivation Botanical gardens and field gene banks Other recommendations Education and training Research and monitoring 35 Conclusions Acknowledgements Personal communications References Appendix 1: African medicinal plants observed in trade Appendix 2: Plant species mentioned in text 2 PEOPLE AND PLANTS WORKING PAPER 1, MARCH 1993 African medicinal plants: setting priorities at the interface between conservation and primary healthcare - A.B. CUNNINGHAM Introduction “If there is to be any real improvement in the maceutical production using traditional health of the under-served populations of the medicinal plants with known efficacy world, then there will have to be full utiliza- (Sofawara, 1981). tion of all available resources, human and mate- Little attention however, has been paid to rial. This is fundamental to the primary health- the socio-economic and conservation aspects of care approach. Traditional medical practition- medicinal plant resources, probably due to the ers constitute the most abundant and in many relatively small volumes involved and the spe- cases, valuable health resources present in the cialist nature of the informal trade in them. community. They are important and influential However, the management of traditional med- members of their communities who should be icinal plant resources is probably the most com- associated with any move to develop health ser- plex African resource management issue fac- vices at a local level.” ing conservation agencies, healthcare profes- Akerele (1987) sionals and resource users. As pressure is increasing on diminishing medicinal plant sup- “First the unukane (Ocotea bullata) trees were plies, constructive resource management and killed by ring-barking for sale in the cities. Now conservation actions must be identified, based the same is happening to igejalibomvu (Curtisia upon a clear understanding of the surrounding dentata) and umkhondweni (Cryptocarya myr- medicinal plant use. tifolia) trees. Soon they will be gone as well This study seeks to respond to three cen- and we will have to buy the barks from the tral questions: herb traders.” (1) What are the causes behind the depletion Herbalist, Nkandla forest, Natal, of wild populations of medicinal plant South Africa, 1987 species in Africa? (2) Which species are of particular concern The populations of developing countries and should be given priority for positive worldwide continue to rely heavily on the use action? of traditional medicines as their primary source (3) What can be done to ensure the effective of healthcare. Ethnobotanical studies carried conservation of all medicinal plant out throughout Africa confirm that native plants species? are the main constituent of traditional African medicines (Adjanohoun et al., 1980; An explanation of the present situation in the Adjanohoun et al., 1984; Adjanohoun et al., first section (“Medicinal plant use in Africa”) 1985; Adjanohoun et al., 1986; Adjanohoun et illustrates the urgent need for action. The al., 1988; Ake Assi, 1988; Ake Assi et al., actions required to alleviate problems and an 1981; Hedberg, et al., 1982; Hedberg et al., assessment of priorities for medicinal plant con- 1983a; Hedberg et al., 1985b; Kokwaro, 1976; servation and resource management are dis- Oliver Bever, 1987). With 70-80% of Africa’s cussed in the second section (“Policy priorities population relying on traditional medicines, the in conservation and primary healthcare”). importance of the role of medicinal plants in The study is based on research and literature the healthcare system is enormous. Medicinal surveys, correspondence with other researchers, plants are now being given serious attention, field visits to establish contact with traditional as is evidenced by the recommendation given medical practitioners (TMPs) and