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Integrating conventional and traditional systems of health care

The main vision of the Ministry of Health (MoH) is to develop a healthcare system that gives people easy access to quality health services at affordable cost.

In Asmara, the MoH made public the national policy regarding traditional medicines, which was ratified and at a meeting conducted on the 6th of December in Orotta Refferal Hospital Hall. The national policy was first drafted in 2015.

Although, modern medicine was introduced to Eritrea during the Italian rule (1882-1941) traditional medicine (TM) has to this day been widely accepted and practised. This is because it is easily accessible and affordable, and, people have trust in the TM system. It plays an important preventive, curative and rehabilitative role in the health of the Eritrean society. However, TM has been operating without policy and legal framework to regulate the TM practitioners, their practice and products. This may inevitably exposes the Eritrean people to hazards due to unqualified practitioners and unsafe practices. The MoH recognizes and advocates the use of TM and supports the idea of incorporating it into the national health system, with the objective of ensuring that TM treatment is done scientifically, rationally and with proper safety protocols. Moreover, there has been some public awareness raising campaigns on the potential opportunities that could be tapped from the use of TM in Eritrea and its benefits to the health sector.

Mr. Eyasu Bahta, director of the National Medicine and Food Administration in the MoH, said that the issuing of this particular policy is expected to narrow the gap between modern and traditional medical practitioners and is envisioned to encourage the introduction of integrated health service provision.

In 2012, the MoH established a Traditional Medicine Unit under the National Medicines and Food Administration (NMFA) with the responsibilities of formulating policy guidelines on the practice of TM, registering TM practitioners, monitoring safety of the practice as well as heightening public education and research.

Mr. Eyasu said that the Traditional Medicine Unit (TMU) functions under the NMFA-MoH, for sustainable regulation and safety of TM Practice throughout the nation. According to Mr. Eyasu, there is also a National Advisory Committee which gives advice on activities of the TMU.

The development of the Eritrean traditional medicine policy conforms with the global, continental, regional and national policies and commitments for development and promotion of TM through resolutions, declarations and strategies. According to the Eritrean National Traditional Medicine Policy, the declarations include: “Alma-Ata Declaration of 1978 which recognized the role of TM and its practitioners in achieving health for all; the Declaration of the Heads of States and Government on the first Decade of African TM (2001-2010) in Lusaka and of the Second decade of African TM (2011-2020) in Namibia which call for the Member States to integrate TM in their national health systems. Similarly, the Ouagadougou Declaration on PHC and Health Systems in Africa and the Algiers Declaration on Research for Health both of 2008 recognizes the role of TM in health systems […] The strategies include the Africa Health Strategy: 2015-2025 of the African Union; the WHO Traditional Medicine Strategy (2014-2023) adopted by the World Health Assembly by its Resolution WHA 67.18 on TM and Resolution on Enhancing the role of TM in Health Systems; A Strategy for the African Region (AFR/ RC63/ R3) adopted by the WHO Regional Committee for Africa in 2013 in Brazzaville. These Resolutions urge Member States to: formulate national policies, regulations and standards as part of comprehensive national health systems; promote appropriate, safe and effective use of TM; accelerate the implementation of national policies, strategies and plans among others” (MoH, 2017:14-15).

The penal code in Eritrea, Article 518, also states that “Nothing in this Article shall prevent the practice of a system of therapeutics according to indigenous methods by persons recognized by the local community to which they belong, to be duly trained in such practice, provided that no such person shall be authorized to practice except amongst the local community to which he belongs and in such a manner as is neither dangerous nor injurious to the person, health or life.”

It is envisaged that the Eritrean TM policy will optimize the benefits of TM practice, its cultivation, harvest, production and marketing to the people of Eritrea. The integration of TM into national health care system has the potential to supplement, strengthen and promote better health care for all, in line with the World Health Organization and the national vision. The implementation of this policy will require mutual cooperation between different stakeholders within and outside the country. Since TM uses various natural resources for the preparation of medicinal products, environmental control should be emphasized in order to sustain indigenous plants and other sources of TM products including indigenous knowledge for the future.

Eritrea is endowed with rich flora, fauna, marine and terrestrial biodiversity conventionally used by the people for medicinal purposes. The Convention on Biological Diversity (CBD) of March 21, 1996 is an evidence to Eritrea’s desire to incorporate traditional medical practices while preserving and nurturing its biodiversity. Steps have in fact been initiated to create comprehensive database of medicinal plants in the Faculty of Health Sciences and at the Institute of Technology. In addition, 165 medicinal plants used in some districts in Eritrean highlands have been compiled. There is also a collection of 142 Eritrean medicinal plants by the Asmara College of Health Sciences and some medicinal plant species are cultivated and preserved at the Department of Biology at the Eritrean Institute of Technology.

Currently, the majority of the Eritrean population relies on TM for treatment of various diseases. Different TM methods, which have been widely practised in the country, include bone setting, cupping herbal therapy, hydrotherapy, male circumcision, massage, skin scarification, and treatment of snake bite (including other animal bites) spiritual healing, uvelectomy, thermal therapy, traditional midwifery, tooth extraction and others. The tradition of TM is a common practice in the African Region. However, systematic research to produce scientific evidence on the safety, efficacy and quality of most TM products and practices has not been done. Therefore, the advocacy for the integration of TM into national health care system has become mandatory. The development policy should serve as a catalyst to fully engage all stakeholders, traditional medicine practitioners (TMPs) and the people at large in the nation’s health system. It is actually what Eritrea has just started to do.

The Medicinal Plants and Drug Discovery Research Centre (MPDDRC) conducted a reliable, initial survey on the number of TMPs. The survey revealed that there were more than 3,900 TMPs in Eritrea. Some of the therapies provided are claimed to be effective. For example, research indicates that facial palsy is believed to be effectively treated by TM. Nevertheless, further research is needed to confirm or dispute the effectiveness of TM in facial palsy.

There are neither shops nor open street peddlers of traditional herbs or other materials. However, in recent years some people have started to promote and/or sell complementary or alternative medicine (CAM) such as herbs, plant parts and other materials claiming treatment for some diseases. This trend may continue to expand in the future. Therefore, regulation of CAMs needs to be done.

Pharmacist Filmon Tesfai and Pharmacist Dawit Yemane, who are actively working in the TMU, said that, the National Policy was drafted and consensus reached in the year 2015.The document was revised thoroughly by the TMU alongside key stakeholders, who obtained approval by the Office of the Minister in the year 2016. The document was sent for printing early in 2017. The printed document is now at hand. They added that the main objective of this unit is to accomplish the visions and goals of the TM policy, which is to promote the appropriate use of TM and create a health care system where both the conventional and traditional systems are joined together to provide access to healthcare.

Understanding and assessing people’s traditions while scientifically integrating conventional and traditional systems of health care is the vision of the ministry for integrated development in the country’s health care.

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