Can biomedicine and herbal medicine ever exchange vows?
“Oh, do you mean they have herbal medicine here? I have never heard of that, if I had known I would have patronised it.” This is a statement by a patient who visited one of the hospitals which has been selected by the Ghana Health Service to provide herbal medical services.
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According to the World Health Organisation (WHO), herbal medicine is a plant-derived material or prepared with therapeutic or other human health benefits, which contains either raw or processed ingredients from one or more plants. In some traditions, material of inorganic or animal origin may also be present.
On the other hand, traditional medicine is the sum total of knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in prevention, diagnosis, improvement or treatment of physical and mental illnesses. Herbal medicine is classified as the most commonly used type of traditional medicine.
What is biomedicine?
Biomedicine, also sometimes referred to as allopathic medicine, orthodox medicine or modern medicine, is the mainstream medical use of pharmacologically active agents or physical interventions to treat or suppress symptoms or pathophysiologic processes of diseases or conditions. This system is mostly referred to as ‘hospital’ by some Ghanaians.
In 1950, China started integrating its traditional medicine into the health system with the aim of providing comprehensive healthcare services for its people.
Integration in China ranges from policy level through registration of traditional products and regulations to cover traditional medicine practice. It also includes building of traditional medicine hospitals, as well as their operation under national insurance schemes. Currently, it has fully integrated traditional medicine into their biomedical health system with traditional medicine departments in 95 per cent of its hospitals.
Through the Indian Central Council Medicine Act of 1970, India also runs another model of integration. This model involves traditional medicine in the health system but not as full as that of China. This model is very often parallel; thus, both treatment alternatives operate separately in the health system.
One could say that an integrated system of health care is effectively running in China while an effective parallel system is operating in India. How possible could either case be in Ghana? What is Ghana’s current state of integration on the health delivery front?
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Pilot integration system
Since 2011, there has been an initiative by Ghana’s health sector to integrate biomedicine and herbal medicine and this is still in its pilot phase.
Some selected government hospitals all across the country now have herbal medicine units. One objective, as provided by the Ministry of Health, is to provide a one-stop point of all medicines for patients so that they are assured of the safety, efficacy and quality of the drugs that are prescribed.
The question is: Can biomedicine and herbal medicine ever exchange vows? A study was conducted in Kumasi South Hospital to explore the integration of biomedicine and herbal medicine, which is currently being run by the hospital. The study showed that while most patients did not know about the herbal clinic in the hospital, the health workers and management both had different views of the kind of integration that the hospital was running.
This study aimed to inform policy makers on their decisions concerning the pilot integration system currently running in the country. Based on the study, this article highlights the absence of a policy guideline and the perceptions about the integration.
The fact of the matter is that herbal medicine use is quite natural to our race. Eighty per cent of Africans are known to use traditional medicine, and with this knowledge, WHO supports integration of traditional medicine in the African health system. The first objective of the WHO traditional policy is that countries should develop a policy to guide their health systems to integrate traditional medicine in their health care.
The basic finding of this study showed that although the country had rolled out a pilot integration in some hospitals, there was no policy guideline for this new health service delivery. The only policy guideline available is that on traditional medicine development, which does not describe how the integration system should work in the hospitals. There is practically no standard operating procedure for how the biomedical unit and the herbal clinic should collaborate.
Is integration working?
Secondly, different views were identified as to how patients, health workers and management defined and viewed the integration.
From the nurses’ perspective, the collaboration was in relation to the fact that herbal medicine services could be assessed within the hospital premises but they did not recognise both systems to be fully integrated; they considered the health system to be a parallel one.
“We don’t know what goes on there, they (herbal clinic) are doing their own thing and we are also doing our own thing but there is no integration. There has not been any patient in the ward who is being treated by both herbal and biomedical practitioners,” a biomedical nurse said.
During interviews with doctors from the biomedical unit, they also supported the idea that the system was not integrated: “There is no information flow between the two systems, it is not really integration,” said a doctor at an Out patients Department. From the communication with doctors, their responses showed that there was not much interest in integration.
Data from patients showed that they had no knowledge about the herbal clinic as quoted by one patient: “Oh, do you mean they have herbal medicine here? I have never heard of that, if I had known I would have patronised it.” The irony of this quote is that the patient was sitting within the herbal clinic, ready to receive her biomedicine, because the hospital had moved their pharmacy to the herbal clinic premises.
From the views of management, the hospital administrator shared that the integration was working at the management level, as he quoted: “It is not a separate unit, it is under the leadership of the hospital and the records are unified.”
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The medical herbalists in the hospital perceived of the health system to be integrated especially because there were issues of referrals from the biomedical unit to the herbal unit and vice versa.
Discussions with other medical herbalists showed that the health systems in all the selected hospitals for the pilot differed, so it could be possible that the pilot system was more effective in some hospitals than others.
The interview with the pharmaceutical directorate in the Ministry of Health (MoH) showed that the ministry had set up directorates which include the Traditional and Alternative Medicine Directorate (TAMD) to manage the traditional medicines in the country and according to the key informant in the ministry, the ministry had plans to sustain the integration system as had been done in countries such as China. The key informant also explained that one key focus of this process of integration in Ghana was to maintain good documentation, good use of medicines and research into the herbal medicines used. Throughout the discussions, the only policy mentioned was the Traditional Medicine policy and this mentions nothing on integration in the hospitals.
This case study shows that there is first of all, no policy guideline for this new health service delivery system and secondly, there are different perceptions about how the integration is working in the hospital. This calls for the need for the Ministr of Health (MoH) to develop a policy guideline for biomedicine and herbal medicine integration (full integration or parallel) as recommended by the WHO and also an evaluation of how this pilot is working in the Ghanaian health system and the way forward.
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The writer is a young researcher with background in International Health. Her research area is health systems. Writer’s email: milliboat1@gmail.com