There has been a continuing demand for, and popular use of, traditional and complementary medicine (T&CM) worldwide. In some developing countries, native healers remain the sole or main health providers for millions of people living in rural areas. For instance, the ratio of traditional health practitioners to citizens in Africa is 1:500, whereas the ratio of medical doctors to citizens is 1:40,000 1. In the Lao People’s Democratic Republic, 80% of the population live in rural areas, with each village being serviced by one or two traditional health practitioners 2. Over 100 million Europeans are currently users of T&CM, with one- fth being regular users; a similar proportion choose health care that includes T&CM 3. According to a national survey in China, practitioners of traditional Chinese medicine received 907 million visits from patients in 2009, which accounts for 18% of all medical visits to surveyed institutions. Further, the number of traditional Chinese medicine inpatients was 13.6 million, or 16% of the total in all hospitals surveyed 4.
In a few countries, certain types of traditional medicine (TM) have been completely integrated into the health care system, including China, the Democratic People’s Republic of Korea (North Korea), the Republic of Korea (South Korea), India, and Vietnam. In China, for instance, traditional Chinese medicine and conventional medicine are practiced alongside each other at every level of the health care service, and public and private insurance cover both forms of treatment.
In many other countries, T&CM is partially integrated into the national health system, while in some countries there is no integration at all.
Much has changed since the last World Health Organization (WHO) global strategy document was released in 2002. More and more countries are coming to accept the contribution that T&CM can make to the health and well-being of individuals and the comprehensiveness of their health care systems. In the period 1999 to 2012, the number of member states of WHO with national policies covering TM has increased signi cantly. This includes countries better regulating herbal medicines or creating national research institutes to study T&CM 5.
Governments and consumers are becoming more open to broader aspects of T&CM practices and to considering them as an integrated part of health service delivery. In Africa, the number of national regulatory frameworks increased from one in 1999/2000 to 28 in 2010 6. Across the Atlantic, the Ministry of Health in Brazil has developed a national policy on inte- grative and complementary practices 7, while in the eastern Mediterranean region, ve member states report having reg- ulations speci cally for T&CM practitioners 5. Member states in the southeast Asia region are now pursuing a harmonized approach to education, practice, research, documentation, and regulation of TM 5; in Japan, 84% of Japanese physicians use Kampō (Japanese traditional medicine) in daily practice 8.
In Switzerland, certain complementary therapies have been reinstated into the basic health insurance scheme available to all Swiss citizens 9.
Despite signi cant advances, the regulation of T&CM products, practices, and practitioners is not occurring at an equal pace 5. Member states report that faster progress is being made in the regulation of herbal medicines, while that for T&CM practices and practitioners is lagging. Of concern is that the safety, quality, and ef cacy of T&CM services cannot be assured if there is not appropriate regulation of practices and practitioners. This situation presents a serious challenge for many member states, where a lack of knowledge and experience exists regarding the formulation of national policy, leading to weak or absent regulation and a lack of proper integration of T&CM services into the health service delivery system. It also re ects the need of all member states to push WHO to update its global strategy on TM.
Responding to the needs and challenges identi ed by member states and building on the work done under the WHO Traditional Medicine Strategy 2002–2005 (10), the updated strategy for the period 2014–2023 devotes more attention than its predecessor to health services and systems, including T&CM products, practices, and practitioners. The key objec- tives of the updated strategy are summarized below.
Objective 1: To build the knowledge base for active manage- ment of T&CM through appropriate national policies. There is a great diversity of products, practices, and practitioners in T&CM. The rst strategic step towards achieving this objective is to understand and recognize the role and potential of T&CM. The strategy recommends that member states acknowl- edge and appraise, in detail, which types of T&CM are used by their populations and devise their own country pro le for T&CM practices. As the marketplace for T&CM becomes more global, harmonization and cooperation will become more important.
The second strategic step under this objective recommends that member states strengthen knowledge generation, collaboration, and sustainable use of T&CM resources, including intellectual and natural resources.
Objective 2: To strengthen quality assurance, safety, proper use, and effectiveness of T&CM by regulating T&CM products, practices, and practitioners. The rst strategic element under this objective is to recognize the role and importance of product regulation. The emphasis should be on the monitoring and implementation of established regulations of TM products. Since herbal medicines are now used internationally, products often used in parts of the world other than that in which they were originally grown, developed, or manufactured. This highlights the importance of considering different legislative frameworks in different countries, and ensures that information on quality and safety is shared so that products are used appropriately.
The second strategic direction is to recognize and develop T&CM practice and practitioner regulations for education and training, skills development, services, and therapies. As more countries develop policies and regulatory frameworks, there is a need to evaluate their effectiveness and identify ways in which challenges regarding practice and practitioner regulations can be addressed by benchmarking against appropriate reference standards.
Objective 3: To promote universal health coverage by integrating T&CM services into health care service delivery and self-health care. One of the most signi cant questions raised about T&CM in recent years is how it might contribute to universal health coverage by improving service delivery in the health system, particularly primary health care. A rst step is to capitalize on the potential contribution of T&CM to improve health services and health outcomes. Mindful of the traditions and customs of peoples and communities, member states should consider how T&CM might support disease prevention or treatment as well as health maintenance and health promo- tion. This process should be consistent with safety, quality, and effectiveness standards and in line with patient choice and expectations. Based on each country’s realities, it is recommended that models for integrating T&CM into national health systems should be explored.
Next, it is important to ensure that consumers of T&CM can make informed choices about self-health care. In many member states, self-selection of T&CM products accounts for a large part of the T&CM market. Education of consumers, together with ethical and legal considerations, should sup- port and shape the key aspects of informed choice for T&CM intervention.
The WHO resolution WHA67.18 urges member states to adapt, adopt, and implement the WHO Traditional Medicine Strategy 2014–2023 as a basis for national T&CM programs or work plans and to report to WHO on progress in implementing the strategy. The resolution also encourages WHO to support member states in the implementation of the strategy in the coming decade 11.
Around the world, T&CM continues to grow in popularity. Progress in the regulation of T&CM is gaining momentum, even as that of T&CM practices and practitioners advances at a somewhat slower pace. Safety, quality, and effectiveness of T&CM services is paramount, but cannot be ensured if appropriate regulation of practices and practi- tioners is not in place. The goals of WHO Traditional Medicine Strategy 2014–2023 are to support member states in harnessing the potential contributions of T&CM to health, wellness, people-centred health care, and universal health cover- age, while also promoting safe and effec- tive use of T&CM through the regulation, research, and integration of T&CM products, practices, and practitioners into the health system, as appropriate.
It should be emphasized that given the great diversity of products, practices, and practitioners in T&CM among the member states, it is important to enhance international communication and collaboration in sharing knowledge and practices, in developing and exchanging scientific knowledge and pembinaan programs, and in sharing experiences in developing and implementing policies and regulations. Also, as the marketplace for T&CM becomes more globalized, the quality, safety, proper use, and ef cacy of T&CM in different nations need to be harmonized and standardized utilizing evidence based science.
- A. A. Abdullahi, African J. Trad., Comp. and Altern. Med. 8, 115 (2011).
- Lao Ministry of Health and World Health Organization. Health Service Delivery Pro le, Lao PDR, 2012 (Compiled in collaboration between WHO and Ministry of Health, Lao PDR, 2012), http://www.wpro.who.int/health_services/service_delivery_pro le_laop dr.pdf.
- European Information Centre for Complementary & Alternative Medicine (http://www.eiccam.eu/home.php?il=1&l=eng).
- State Administration of Traditional Chinese Medicine, Report of a survey on T&CM basic situation in 2009 (2011).
- WHO Traditional Medicine Strategy 2014-2023 (World Health Organization, Geneva, 2013), pp. 15-56.
- World Health Organization, Progress report on decade of traditional medicine in the Africa region (WHO African Region (AFRO), Brazzaville, 2011).
- Retrieved from http://bvsms.saude.gov.br/bvs/publicacoes/pn pic_access_expansion_initiative.pdf.
- E.C. Moschik et al., Usage and Attitudes of Physicians in Japan Concerning Traditional Japanese Medicine (Kampo Medicine): A Descriptive Evaluation of a Representative Questionnaire- Based Survey. Evidence-Based Complementary and Alternative Medicine. 2012, (Article ID 139818, 13 pgs, 2012).
- Swiss Confederation, Five CAM methods eligible for reimbursement under speci c conditions for a provisional period of six years. (2011; www.bag.admin.ch/aktuell /00718/01220/index html?lang=de&msg-id=37173).
- WHO Traditional Medicine Strategy 2002–2005 (World Health Organization, Geneva, 2002).
- World Health Organization, WHO Governing Body Documentation Of cial Records, http://apps.who.int/gb/or/.
- Government of China, National Bureau of Statistics of China. China Statistical Yearbook 2011: Chinese Medicine (1987–2010) (The State Administration of Traditional Chinese Medicine, China, 2011).
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