BHM 151: Introduction to Herbal Medicine in Ghana PDF

BHM 151 Introduction to herbal medicine: Herbal medicine practice in Ghana, historical development, prospect, challenges and way forward Dr. Bernard K. Turkson Department of Herbal Medicine, 1 Faculty of Pharmacy and Pharmace...

BHM 151 Introduction to herbal medicine: Herbal medicine practice in Ghana, historical development, prospect, challenges and way forward Dr. Bernard K. Turkson Department of Herbal Medicine, 1 Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences.  Outline Herbal medicine practice in Ghana Historical development Prospects Challenges Way forward 2  History of traditional medicine in Ghana-Pre-Colonial Period No organized system of healthcare. Healthcare was mainly delivered by men and women recognized by society as competent to provide health, usually these were the custodians of the societies cultural norms and artefacts-priest healers. 3  Herbal medicine practice in Ghana Herbal medicine plays a significant role in the healthcare system of Ghana, with a substantial portion of the population relying on traditional remedies for their health needs. The integration of herbal medicine into the formal healthcare system has been recognized and supported by government initiatives and international health organizations. 4  Current Status and Integration Approximately 60% to 70% of Ghanaians depend on traditional medicine, primarily herbal remedies, for their healthcare needs, particularly for managing both communicable and non-communicable diseases. The government has made strides by establishing herbal medicine units in 55 government hospitals across the country. This integration is part of a broader strategy to enhance access to healthcare and improve the quality of services provided. 5  Historical development of herbal medicine Healthcare in Ghana is pluralistic, and includes the use of biomedical and traditional healing systems for the treatment of illnesses. Biomedicine was introduced in Ghana during the colonial era and brought with it western notions of illness and healing. The colonial era also brought Christianity in Ghana through whose missions many traditional and cultural practices were prohibited as they were considered primitive and/or demonic. In fact, traditional healing practices were banned outright under the Native Customs Regulation Ordinance of 1878 (was a law in the Gold Coast Colony that regulated the judicial authority of native kings) 6  Historical development of herbal medicine With the attainment of political independence from colonial rule in 1957 efforts have been made to recognize and promote the work of traditional healers in Ghana. Over the years, the Government of Ghana has, supported the development of traditional medicine via the establishment of institutions and the enactment of relevant policies. The Ghana Psychic and Traditional Healers Association was formed in 1961. In 1975, the Centre for Plant Medicine Research (CPMR; formally, the Centre for Scientific Research into Plant Medicine) was established to conduct scientific research into plant medicines. 7  Historical development of herbal medicine The Traditional and Alternative Medicine Directorate (TAMD) was established in 1999 by upgrading the existing Traditional Medicine Unit (formed in 1991) under the Ministry of Health to oversee policy-related issues. In 2000, the government enacted an act (Act 575) for the establishment of a Traditional Medicine Practice Council (TMPC) with the responsibility for the registration and regulation of all Traditional Medical Practitioners in the country. The Food and Drugs Authority was established by the Food and Drugs Law 1992 (PNDC 3058) to control the manufacture, exportation, importation, distribution and licensing of all food and drugs to be marketed have a herbal unit for handling herbal medicines. 8  Historical development of herbal medicine In 2011, the government approved the integration of traditional medicine into the healthcare system of Ghana. Substantial progress has also been achieved in other areas, including the publication of the Recommended Herbal Medicinal List (two editions). Publication on basic procedures for assessing safety and efficacy of herbal medicine products. A monograph on medicinal plants of Ghana published by Traditional and Alternative Medicine Directorate (TAMD)-MoH, Ghana. 9  Historical development of herbal medicine Training critical manpower for the herbal medicine industry in Ghana. In 2001, the Department of Herbal Medicine at Kwame Nkrumah University of Science and Technology (KNUST) was established to offer a 4-year BSc Programme in Herbal Medicine. The aim of the Department is to train herbal medicine practitioners in application of basic principles, tools, and guidelines. Institute of Traditional and Alternative Medicine (ITAM) was established in 2019, with the mandate to develop and promote all traditional complementary and alternative medicine practices through research, education, and advocacy. 10  Historical development of herbal medicine The first Traditional Medicine Practitioners Association, the Ghana Psychic and Traditional Healing Association, now known as the Ghana Psychic and Traditional Healers Association was established in 1960 under the auspices of Osagyefo Dr. Kwame Nkrumah and reconstituted in 1975 bringing all Practitioners under one umbrella Association. In 1991, the government of the Provisional National Defence Council (PNDC) under the auspices of the Council for Indigenous Business Association (CIBA) set up the National Council of Herbal Medicine, now known as the Ghana National Association of Traditional Healers (GNATH). 11  Historical development of herbal medicine As a result, in September 1999, the new constitution which brought into being the Ghana Federation of Traditional Medicine Practitioners Associations, GHAFTRAM, an umbrella body for all Traditional Medicine Practitioners Associations and Societies or Groups was born. GHAFTRAM or the Federation after working effectively in conjunction with the Ministry of Health, Ghana had its formal recognition on July 7, 2008 and has been participating in almost all activities under the Ministry. 12  Prospects Reduce the national health burden The ratio of traditional health practitioners to the Ghanaian population was about 1:200, whereas the ratio of medical doctors to population is 1:20,000. The high dependence of Ghanaians on herbal medicine is due to factors such as high accessibility, affordability, and trust. Herbal medicine has huge prospects of providing solutions in the management and treatment of diseases such as cancer, diabetes among others, where conventional medicine has so far not provided effective treatment. During the recent COVID-19 pandemic, herbal medicines were an important source of hope for most people in Ghana, and elsewhere in the world such as China 13  Prospects Economic opportunities The herbal medicine industry is a major source of employment in the country, as a large number of people such as traditional medicine practitioners, herbal manufacturers, local vendors, raw plant materials aggregators and suppliers, and farmers are involved in the value chain of the herbal medicine industry. The Ghana Federation of Traditional and Alternative Medicine Practitioners (GHAFTRAM) is currently made up of about 40,000 traditional medicine practitioners, including all practice groups. Huge prospects for youth employment and poverty reduction in the country. 14  Prospects Economic opportunities Herbal medicine is part of Ghana’s national heritage; as such, it could be promoted for purposes of medical tourism, to generate income for the country. 15  Challenges Despite the promising prospects for herbal medicine in Ghana, several challenges hinder its growth: Registration of herbal medicines For the registration of herbal medicines, the Food and Drugs Authority (FDA) requires pharmacological data (efficacy), toxicity data (safety), and clinical data on the herbal medicine. While a large number of herbal products satisfy this requirement for registration, a substantial number of products still fail to be registered, mostly due to microbial contaminants. 16  Challenges About 50% of herbal products out of 615 products analyzed in 2021 at the CPMR was below quality control standards. Registration of herbal medicines Microbial contamination is common in herbal medicines, and it is always difficult for manufactures to prevent or control this contamination. lack of data on shelf life of herbal products. Since almost all herbal medicines for FDA registration do not have data on stability studies, the current practice is to license liquid formulations for only 1 year. However, this interim measure is a huge burden to both the regulator and manufacturers, because of the annual renewal of registration of products. 17  Challenges Registration of herbal medicine products is also hampered by unclear guidelines regarding nomenclature of products. Regulatory Issues The certification process for practitioners is often complicated and costly, leading to potential exploitation by unscrupulous individuals. Quality Control There is a lack of standardized procedures for assessing the safety and efficacy of herbal products. 18  Challenges Research Gaps Insufficient scientific research undermines traditional claims regarding the pharmacological effects of medicinal plants. Resource Shortages There is a shortage of raw materials necessary for producing herbal medicines due to environmental factors and overharvesting. 19  Way forward Application of modern technology in manufacturing It is important to increase the efficiency and production of high-quality herbal medicines that meet international standards. Most herbal medicines in Ghana are produced on a small scale, and as liquids that are often associated with several undesirable characteristics, such as bitter taste, short shelf-life, dosing and control of microbial contamination during manufacturing as well as challenges with patient compliance. Moreover, the bulky nature of such liquid dosage forms makes the product inconvenient for export outside the Ghanaian market. 20  Way forward Regulation of herbal medicines industry Regulation of herbal medicines must be given serious attention and support in the country. Pharmacovigilance of herbal medicines is critically important for developing reliable information on the safety of herbal medicines. Improve packaging and branding Ghana imports herbal medicines from countries such as India, China, United Kingdom and Germany. The importation of pharmaceutical drugs and medical devices (including herbal medicine) is governed by the Food and Drug Law, 1992 (PNDC Law 305) 21  Way forward These imported products are well packaged with patient leaflets which are essential for prescription by doctors and other healthcare practitioners. In contrast, most Ghanaian herbal medicines are not well packaged, such that, imported herbal medicines are commonly prescribed. 22  Way forward Large-scale cultivation of medicinal plants The sustainability of the herbal industry in Ghana depends on continuous availability and supply of good quality raw plant materials. Indeed, conservation of rare, endangered and threatened medicinal plants is a global concern. There is also an urgent need for the application of biotechnological interventions to conservation and multiplication of threatened medicinal plants. Research and development a national research and development policy on herbal medicine for Ghana is urgently required. 23  Way forward Such a national agenda would have the benefit of bringing together all the relevant stakeholders such as researchers, regulators, practitioners, and policymakers to consider capacity needs, policy gaps, funding, and other critical needs. Such steps will ultimately lead to a medium-to long-term strategy for development of the herbal industry in Ghana. It will lead to establishment and strengthening of research networks, partnerships and databases which are needed in the herbal medicine industry. 24  Way forward Increase government support 25