Mainstreaming Traditional
Medicine in Pubic Health Discourse
T C James
RIS
New Delhi
Achievement of universal
health care is a major
concern
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Key Facts - 1
• 8.8 million children under 5 years of age died in 2008
– 60.99 deaths per 1000 in 2009
– 40 % deaths in the first month
• 104 million (i.e., 16 %) children under nourished
(2010)
• Less than 50 % child births assisted by skilled health
worker
• 33.3 million persons with AIDS, of which 2.4 m. in
India
– 2.7 million new cases in 2008
– 2 million HIV/AIDS related deaths in 2008
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Key Facts- 2
• 14 million TB cases
– 1.9 million TB related deaths in 2009]
• 247 million cases of malaria (2009)
– 1 million deaths malaria related deaths (2008)
– In Africa a child dies every 45 seconds of malaria
– Malaria accounts for 25 % all child deaths
• 1 billion people suffer from neglected tropical
diseases
– 190,130 cases of cholera reported in 2008
– 213, 036 cases of leprosy were reported in 2009
Miles to go and miles to go…
4
Millennium Development Goals:
Health (2000)
• The Millennium Development Goals to
achieve by the year 2015 include:
Reduction of child mortality rate;
Improvement of maternal health;
Combating successfully HIV/AIDS, malaria, and
other diseases.
5
Issues in Public health
• Availability of Human Resources
• Inequities in
– Availability
– Accessibility
– Affordability of Medicines
6
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Number of Physicians per 10,000
Population
Country
Number
Country
Number
Russia
43
Argentina
32
Norway
39
Mexico
29
Spain
38
Brazil
17
France
37
China
14
Germany
35
Iran
9
USA
27
India
6
UK
21
Sudan
3
Japan
21
Indonesia
1
Australia
10
Kenya
1
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Availability of Medicines
• The availability of medicines for both acute
and chronic conditions suboptimal across
countries, particularly in the public sector
• Generics for chronic diseases were
significantly less available than those for acute
conditions in both the public (36% vs. 53.5%)
and the private sector (54.7% vs. 66.2%).
– From a study by Alexandra Cameron of 30
commonly used drugs in 40 low and middle
income countries
9
Affordability of Medicines - 1
• In developing countries, most medicines are
paid for out-of-pocket by individual patients
rather than through social security systems.
• 86 % of population would be pushed into
poverty as a result of purchasing medicines
(WHO study in 16 countries)
10
Affordability of Medicines - 2
• Prices people pay for lowest priced generic
medicines vary from 2.5 times to 6.5 times
the international reference prices in case of
HIV, TB & Malaria drugs
• High prices are a barrier to use of medicines
and health products.
11
Access to Medicines
• Access: “Having medicines continuously available
at public or private health facilities or medicine
outlets that are within one hour’s walk from the
homes of the population.” (UNDP)
Countries
Access
level
53 countries (Developed world, Sri Lanka, Korea)
95%
37 countries (Indonesia, Iran, China)
80 %
47 countries (Philippines, Malaysia, Pakistan)
50 %
25 countries (India, Kenya, Ghana, Brazil, Cambodia)
0%
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Tackling the Problem
• Modern Medicine alone may find it difficult to
take care of public health in all countries
• Need a holistic approach involving traditional
medicines also.
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Traditional Medicine
• “Traditional medicine refers to health
practices, approaches, knowledge and beliefs
incorporating plant, animal and mineral based
medicines, spiritual therapies, manual
techniques and exercises, applied singularly or
in combination to treat, diagnose and prevent
illnesses or maintain well-being.” (WHO)
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Traditional Medicine: A Living
Tradition/Science
•
•
•
•
•
•
Traditional Medicine not static, but evolving
Traditional vs ‘Modern science’
Multiplicity of systems
Heterogeneity vs. Homogeneity
Macro -- Micro
Body, mind, soul
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Understanding Traditional Medicine
• Holistic system that treats the whole person
• Medicines based on basic elements which are
materialized in genetic resources and
environment
• Sustainability of traditional medicine depends
on protection of environment and biological
diversity conservation
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Importance of Traditional
Medicine
• TM plays an important role in meeting
primary health care needs in developing
countries
• 1/3rd of population have no regular access to
modern medicine
• Around 80 per cent in developing countries
rely on traditional medicine
• In India, 36.6 % child deliveries are managed
by traditional birth attendants
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Usage of Traditional Medicine
Country
Usage of TM
Country
Usage of TM
Ethiopia
90 %
Canada
70 %
Benin
80 %
France
49 %
India
70 %
Australia
48 %
Rwanda
70 %
USA
42 %
Tanzania
60 %
Belgium
31 %
Uganda
60 %
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Rationale for Using TM
• Cost Factor
• Accessibility Factor
• Cultural Factor
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Cost Factor
• In developing countries, generally traditional
medicine is cheaper compared to modern
medicine
• In developed countries high income
population access traditional medicine
• Also low income ethnic groups from
developing countries
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Cultural and Environmental
Factors
• Traditional Medicines are from locally
available plants, herbs and minerals and
knowledge
• People are more used to them
• No side effects generally
21
Accessibility Factor
• Ratio between traditional healer to
population in Africa varies from 1:200 to 1:400
• Ratio between allopathic practitioners and
population is 1:20,000
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Challenges
• Quality, standardisation, safety, issues
• Access to natural resources for raw materials
• Sustainable use of natural resources
23
Traditional Medicines in India
• Formal
 Ayurveda
 Body consists of 5 elements, viz. earth, water, fire, air and vacuum
and illness a disturbance in the 3 humours, viz., vata, pitta, &
kapha, constituted by the 5 elements
 Medicines mostly herbal.
 Siddha
 Use herbs, metals and minerals
 Unani
 A Greco-Arab system
 Yoga
 Breath control and regulated poses
• Informal
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Indian Approach to Traditional
Medicine
• Protection, Development and Use
• Certain states have taken steps to integrate
traditional medicine in their public health
programmes
– E.g. Use of Siddha medicines in Chikungunya
epidemic in Tamil Nadu
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Some Statistics: Ayurveda (2008)
•
•
•
•
•
•
Hospitals - 2416
Beds - 43,710
Dispensaries -- 13,989
Registered Practitioners -- 460,001
Colleges -- 305
Pharmacies -- 7910
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Some Statistics - Siddha (2008)
•
•
•
•
•
•
Hospitals - 276
Beds - 2586
Dispensaries -- 529
Registered Practitioners -- 6687
Colleges -- 10
Pharmacies -- 302
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Some Statistics - Unani (2008)
•
•
•
•
•
•
Hospitals - 268
Beds - 4686
Dispensaries -- 1028
Registered Practitioners -- 47,963
Colleges -- 46
Pharmacies -- 324
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Registered Medical Practitioners
in India (2006)
System
Registered Medical Practitioners
Allopathy
662,646
Ayurveda
453,661
Siddha
Unani
6381
46,558
• 43.32 % of registered practitioners belong to
3 TM streams
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Use of Traditional Medicine
• Alternative?
• Complementary?
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Need a Fresh Approach to Public
Health Issues
• Need to recognise and effectively use Traditional
Medicines too
• Integration with public health programmes
• Recognition of Traditional Medicine pharmacopoeia
• Put TM on the same footing as Allopathy
• Insurance coverage?
• Sensitization of health workers, policy makers and
general public
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Declaration of Alma-Ata 1978
• “Primary health care: (inter alia)
– relies, at local and referral levels, on health
workers, including physicians, nurses, midwives,
auxiliaries and community workers as applicable,
as well as traditional practitioners as needed,
suitably trained socially and technically to work as
a health team and to respond to the expressed
health needs of the community.”
Use of traditional medicine for public health
programmes is in accordance with WHO
Alma-Ata Declaration
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Thank You
E-mail: tcj@nic.in
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