PAHO/HSP/HSO/018-00 Original: English Pan American Health Organization (PAHO) World Health Organization (WHO) Report Working Group PAHO/WHO Traditional, Complementary and Alternative Medicines and Therapies Washington, D.C. November 15-16, 1999 Division of Health Systems and Services Development, PAHO Traditional Medicine Team Department of Essential Drugs and Medicine Policies, WHO 5 TABLE OF CONTENTS 1. INTRODUCTION ..................................................................................................................... 1 2. DEFINITIONS ............................................................................................................................. 1 3. UTILIZATION AND SITUATION IN DIFFERENT COUNTRIES ................................................2 3.1 COMPLEMENTARY AND ALTERNATIVE THERAPIES ..................................................................... 2 3.2 UTILIZATION AND SITUATION IN DIFFERENT COUNTRIES............................................................ 3 4. CHALLENGES AND ISSUES ......................................................................................................3 5. RECOMENDATIONS ................................................................................................................ 4 6. PROPOSED ACTIVITIES ........................................................................................................... 5 6.1 HERBAL MEDICINE ................................................................................................................ 5 6.2 INTEGRATION OF COMPLEMENTARY AND ALTERNATIVE MEDICINES AND THERAPIES INTO THE NATIONAL HEALTH SYSTEMS AND PROMOTION OF INDIGENOUS HEALTH SYSTEMS ............... 5 6.3 EXCHANGE OF GENERAL AND EVIDENCED BASED INFORMATION................................................. 5 ANNEXES .......................................................................................................................................... I. AGENDA .......................................................................................................................... 1 II. PARTICIPANT LIST.............................................................................................................. 2 III. WORKSHOP ON MEDICINAL PLANTS ................................................................................... 3 IV. PROJECT 2000: "FRAMEWORKS FOR THE INTEGRATION OF INDIGENOUS MEDICINE AND THERAPIES INTO PRIMARY HEALTH CARE"............................................................................. 4 TABLES: UTILIZATION AND SITUATION IN DIFFERENT COUNTRIES......................................................... V. COMPLEMENTARY AND ALTERNATIVE THERAPIES .................................................................. 5 VI. INDIGENOUS MEDICINE ..................................................................................................... 7 5 Working Group on Traditional, Complementary and Alternative Medicines and Therapies 1. Introduction In the last two decades complementary and alternative medicines and their therapies became a very important aspect of health delivery in many developing countries. During the 90's the utilization of such therapies by of European, North and Latin American population has been growing rapidly. Traditional/indigenous medicine in the Region of the Americas has been practiced for centuries. The knowledge and practices of indigenous health systems cover the needs of the communities to some extent. However, the search for complementary services and the development and strengthening of strategies designed to establish national health systems that respond to the characteristics of the beneficiary population are valid approaches to improve the health of both indigenous and non-indigenous populations. With this in mind, the PAHO Division of Health Systems and Services Development decided to create a working group in collaboration with WHO-HQ to develop the following objectives: ! Formulate recommendations to PAHO in the development of the technical cooperation in complementary and alternative therapies (CAMT). ! Identify sources of technical and financial support for Latin America and the Caribbean. ! Develop mechanisms of coordination in the areas of complementary and alternative medicine and traditional/indigenous medicines and therapies within PAHO different Programs 2. Definitions Traditional Medicine and Therapies It is a medical knowledge that came long before the development and spread of Western medicine and it reflects a country's culture, history and beliefs. It is often passed on orally from generation to generation. Major Systems in Traditional/Indigenous Medicine ! Traditional Chinese traditional medicine Ayurvedic medicine Unani medicine Indigenous medicine ! Non Traditional Homeopathy Chiropractic Therapies ! Medication therapies Medical plants & herbal medicine Mineral materials 1 Pan American Health Organization/World Health Organization Animal materials Diet & nutrition ! Non medication therapies Acupuncture Manual therapy Traditional exercises (Qigong, Taiji, and Yoga) Physical, mental, spiritual and mind-body therapies Complementary/Alternative Medicine It refers to the medicine that does not play a major role within the national health care systems. In most counties where Western medicine assumes full responsibility for national health care, most forms of traditional medicine and other therapies are considered to be complementary or alternative systems of medicine. 3. Utilization and situation in different countries The demand for alternative and complementary therapies is growing in many countries, but the trends are different. While in developed countries the trend of using alternative therapies is because of the search for better health care, in developing countries this demand has to do with economic issues or because, as in the case of the indigenous medicine, it is the only available source of health care. 3.1 Traditional/Complementary and Alternative Medicine and Therapies The utilization of TRM/CAMT by the population in the developed counties is currently estimated as follows: Country % population Country % population utilizing utilizing Australia 60 United Kingdom 90 Belgium 40 U.S.A 40 France 49 Singapore 45 For Latin America, in Chile, 71% of the population accepts CAMT. In Colombia 40% of the population used CAMT. No data are available for other countries in Latin America. Situation analysis in Latin America To make an assessment of the situation a questionnaire was submitted to the Member Countries, 15 countries responded (see table in annex # 5). The results can be summarized as follows: 2 Working Group on Traditional, Complementary and Alternative Medicines and Therapies ! 11 out of 15 do have norms, policies and regulations in relation to at least one of the CAMT disciplines. ! 8 out of 15 countries do have a national program based at the Ministry of Health. ! 9 out of 15 countries do have an academic program in CAMT. ! The most common disciplines are herbal medicine, homeopathy, acupuncture, Ayurvedic medicine & chiropractic. 3.2 Indigenous medicine In the World Health Organization estimate, and in many developing countries, approximately 80% of the rural population, indigenous as well as non- rely on traditional medicine for their basic health care. This situation results from the limited access to Western medicine as well personal preferences. In Bolivia where 50,5% of the population is indigenous, the proportion of the population with access to Western medicine ranges from 11 to 70%. There is strong preference for traditional medicine. For example in southern Cochabamba, over 55% of the population opt for traditional medicine. Situation analysis in Latin America To make an assessment of the situation, available data on international resolutions i.e. ILO Convention 1691, PAHO Resolution CD37.R52, and information from 17 countries were reviewed (see table in annex # 5) The results can be summarized as follows: ! 9 out of 17 countries have ratified ILO Convention 169. ! All 17 countries as PAHO Member Countries have ratified Resolution CD37.R5 ! 9 out of 17 countries have laws and resolutions related to indigenous medicine ! 11 out of 17 countries do have a governmental technical unit in charge of indigenous issues including indigenous medicine. ! 4 out of 17 have a training program in indigenous medicine ! 7 out of 17 have a research program in indigenous medicine 4. Challenges and Issues ! Various forms of traditional medicine have developed in the context of different cultures and history in geographic regions without a parallel development of international standards and effective methods for evaluating traditional medicine. 1 ILO Convention, 1989, Article 25, 2. Health services shall, to the extent possible, be community-based. These services shall be planned and administered in co-operation with the peoples concerned and take into account their economic, geographic, social and cultural conditions as well as their traditional preventive care, healing practices and medicines 2 Resolution PAHO-CD37R5, 19932. 2.d. To promote the transformation of health systems and support the development of alternative models of care, including traditional medicine and research into quality and safety, for indigenous populations. 3 Pan American Health Organization/World Health Organization ! The quantity and quality of research data on safety and efficacy are insufficient to evaluate the potential of traditional medicine, to contribute to the health care of countries.