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Mainstreaming Traditional Medicine in Pubic Health Discourse

Mainstreaming Traditional Medicine in Pubic Health Discourse. T C James RIS New Delhi. Achievement of universal health care is a major concern. 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

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Mainstreaming Traditional Medicine in Pubic Health Discourse

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  1. Mainstreaming Traditional Medicine in Pubic Health Discourse T C James RIS New Delhi

  2. Achievement of universal health care is a major concern

  3. 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

  4. 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…

  5. 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.

  6. Issues in Public health • Availability of Human Resources • Inequities in • Availability • Accessibility • Affordability of Medicines

  7. Number of Physicians per 10,000 Population

  8. 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)

  12. 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.

  13. 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)

  14. 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

  15. 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

  16. 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

  17. Usage of Traditional Medicine

  18. Rationale for Using TM • Cost Factor • Accessibility Factor • Cultural Factor

  19. 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

  20. 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

  22. 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

  24. 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 Chikungunyaepidemic in Tamil Nadu

  25. Some Statistics: Ayurveda (2008) • Hospitals - 2416 • Beds - 43,710 • Dispensaries -- 13,989 • Registered Practitioners -- 460,001 • Colleges -- 305 • Pharmacies -- 7910

  26. Some Statistics - Siddha (2008) • Hospitals - 276 • Beds - 2586 • Dispensaries -- 529 • Registered Practitioners -- 6687 • Colleges -- 10 • Pharmacies -- 302

  27. Some Statistics - Unani (2008) • Hospitals - 268 • Beds - 4686 • Dispensaries -- 1028 • Registered Practitioners -- 47,963 • Colleges -- 46 • Pharmacies -- 324

  28. Registered Medical Practitioners in India (2006)

  29. Use of Traditional Medicine • Alternative? • Complementary?

  30. 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

  31. 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

  32. Thank You E-mail: tcj@nic.in

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