Poor funding, weak regulation cripple efforts to develop traditional medicine
Today, August 31, is the African Traditional Medicine Day (ATMD). The commemoration of the ATMD coincides with the date, August 31, 2000, on which the ministers of health adopted the relevant resolution at the 50th session of the World Health Organisation (WHO) Regional Committee for Africa in Ouagadougou, Burkina Faso.
The theme of this year’s Day is: “Local Manufacturing of African Traditional Medicine Products in the African Region.”
Traditional Medicine (TM) is the sum total of the 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 the prevention, diagnosis, improvement or treatment of physical and mental illness.
A recent study of TM published in the British Medical Journal Global Health found high use in Sub-Saharan Africa despite modern medicine.
Researchers who have undertaken the first systematic review into the use of traditional, complementary and alternative medicines (TCAM) in Sub-Saharan Africa found its use is significant and not just because of a lack of resources or access to conventional medicine.
The paper “Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review,” in the journal BMJ Global Health, looked at 180 studies on TCAM use in the region between 2006 and 2017.
Their review found relatively high use of TCAM alone, or in combination with conventional medicine, in the general population and for specific health conditions such as pregnancy, cancer and malaria.
TCAM use especially TCAM products was “significant,” the researchers found, with up to 94 per cent of the population in Nigeria and Ethiopia and an average of just under 60 per cent across the studies. The researchers acknowledged the available articles came from just four countries and were not always of the highest quality, highlighting the need for further public health research in this area.
Biological-based therapies such as herbal therapy were the most common TCAM used in Sub-Saharan Africa, followed by faith-based healing methods (prayer/spirituality) and mind-body therapies (massage, traditional bone setting, relaxation, meditation and yoga).
University of Sierra Leone lecturer and UTS doctoral candidate Peter Bai James, who led the study, said: “Health departments and governments across the region must acknowledge that TCAM is here to stay and seek to understand the challenges and opportunities this presents for health care.”
The paper said: “TCAM product safety regulation across Africa is still a challenge as many countries … lack adequate regulatory framework to ensure the safety and quality of TCAM. The systematic collection and analysis of TCAM safety data is crucial in order to protect patients and the public at large.”
However, despite the huge potential of TM to make Nigeria financially independent, boost primary health care (PHC) services, and ensure Universal Health Coverage (UHC), governments at all levels have continued to neglect the practice.
Little attempt made by the Federal Government to advance the practice such as the development of the Traditional Medicine Policy for Nigeria 2007, the establishment of the Nigeria Natural Medicine Development Agency (NNMDA) Lagos, and the Nigerian Institute of Pharmaceutical Research and Development (NIPRD) Abuja have not been backed up by the political will and adequate funding.
To address this anomaly, a Bill for an Act to provide for the establishment of complementary and alternative medicine commission passed third reading stage in the last House of Representatives.
Also, a bill for an act to provide for the establishment of the Traditional Medicine Council of Nigeria passed the third reading in the last National Assembly.
The Guardian investigation revealed that due to lack of funds and bureaucracy, NIPRD has stopped the commercial production of Nicosan and institutes budget over the years have barely been enough for paying salaries.
The situation is no different at NNMDA, which has made a lot of research into herbal cures that are begging for development but for lack of funds. It was reliably gathered that the budget for the agency is mainly used for paying salaries and not enough for any meaningful research work.
Besides the WHO and United States Food and Drug Administration (FDA)-approved herbal drug for sickle cell anaemia, Niprisan/Nicosan, Nigeria has potential herbal medicine products for the prophylaxis and the treatment of cancers, Human Immunodeficiency Virus (HIV), management of stroke, hypertension, diabetes, malaria, anti-rabies and anti -snake vaccines, among others.
Meanwhile, the National Agency for Food, Drug Administration and Control (NAFDAC) made giant strides towards the development of TM under the leadership of Dr. Paul Orhii. Orhii had set up a national committee of experts in natural medicines including professors of medicine and TM practitioners. But all the hype could not be sustained due to lack of funds and the political will from the Federal Government.
Also, as part of efforts to improve TM practice in the country, the Federal Government of Nigeria, in 2006, formed the National Association of Natural and Traditional Medicine Practitioners (NANTMP) was formed.
The Federal Government under the Leadership of Chief Olusegun Obasonjo through Prof. Eyitayo Lambo the then Minister of Health established the NANTMP on December 19, 2006.
However, stakeholders have made recommendations on how to ensure the development of TM in the country even as they decried how zero budgetary allocation, poor funding, weak regulations are under developing the industry.
The stakeholders include: Director General of the Nigerian Institute for Pharmaceutical Research and Development (NIPRD) Abuja, Dr. Obi Adigwe; Director, Pax Herbals Ewu, Edo State, Rev Fr. Anselm Gbenga Adodo; and a professor of Botany and Vice Chancellor, University of Lagos, Akoka, Toyin Ogundipe.
The Guardian made efforts to interview the Director General of NAFDAC, Prof. Christianah Mojisola Adeyeye, and the Director General of NNMDA, Dr. Sam Etatuvie, but they declined to comment.
However, the aforementioned responsive stakeholders in separate but exclusive interviews with The Guardian provided answers to begging questions on ATM.
Despite the huge potential in traditional medicine, the country is still paying lip service to its development? Why?
Adigwe told The Guardian that Traditional Medicine (TM) consists of a wide scope of indigenous healthcare service delivery which include from traditional birth attendants, herbal medicines, bone setters, barber surgeons, diviners and so many other practitioners.
He said Nigeria has a huge potential readily available to be harnessed in TM and in recent years, significant efforts have been made by the Federal Ministry of Health (FMoH) to actualize its full development. From the publication of the National Traditional Medicine Policy in 2007 up to the creation of a full department named: Traditional, Complementary and Alternative Medicine (TCAM) Department at the FMoH in 2018. All these and lots more, Adigwe said show how consistently the Federal Government of Nigeria (FGN) had been strategically laying a solid foundation to strengthen the TM practice in the country.
Adodo said for the past eleven years, Nigerians have been blaming the government for the neglect of TM but that is an easy way out. Perhaps, he said Nigerians should do something more innovative? “What if the practitioners of herbal medicine in Nigeria to form a formidable pressure group to ensure that government gives the required support and attention to the development of herbal medicine?” he asked.
To do this, Adodo said, great leadership, selflessness and interest in the common good would be required on the part of the practitioners. “But are they up for that?” he asked.
Adodo is a Nigerian scholar who is a pioneer of Alternative medicine in Africa. He is also Benedictine monk and priest of the Roman Catholic Church in Edo state Nigeria.
Adodo said this is where he expects government agencies like the Nigeria Natural Medicine Development Agency (NNMDA) Lagos and NIPRD to play a leadership role. The Director of Pax Herbals said he mentioned NIPRD because it needs to expand its understanding of research to embrace tapping into the human resources in traditional healers and helping to organise them and same applies to the National Agency for Food and Drug Administration and Control (NAFDAC).
Ogundipe, who is also an advocate of natural medicine, said the situation is due to ineffective campaign and so, improved and explosive sensitisation is needed. He said TM education should be injected into early education in the country.
There have been talks about integrating traditional medicine into mainstream healthcare. How far with the plans? Is it a good idea?
Adigwe said the expectation to integrate TM into mainstream healthcare delivery in Nigeria is real but as clearly enumerated in the National Traditional Medicine Policy (NTMP) there are specific steps and processes which have to be followed to ensure a sustainable integration.
He said the idea is very good and progressive but it cannot be rushed just for the sake of playing to the gallery. So far there are joint plans by the NIPRD and TCAM Department of the FMoH to train and up-skill the Traditional Medicine Practitioners (TMPs), with particular emphasis on the herbalists amongst them to improve their good manufacturing practices, as well as undertake other relevant practices that will lead to better engagement with relevant products, for instance listing with the regulatory agencies. He said these are strategies that NIPRD believes will improve the quality and acceptability of the herbal products in the long run. Adigwe said the identified promising products that passed the compliance to safety and potency could ultimately integrated into the mainstream healthcare systems.
Adodo said: “My position has always been that government should recognise and support herbal medicine as a complementary health care system which can exist side-by-side with the orthodox allopathic healthcare system. One will learn from the other and complement each other. I am for collaboration rather than integration.”
Ogundipe said integrating TM into mainstream healthcare is absolutely an excellent and laudable idea. This, he said, is done elsewhere, especially Asia and the end products traverse the region to the rest of the world, even the so-called developed nations. Ogundipe said it is important in Nigeria because the greater parts of the population are in the rural areas where there is huge abundance of biodiversity and this is being used for healing.
It seems there is no budget for traditional medicine from the 2018 budget document. Why? Are you okay with that?
Adigwe said there would be very vague to out-rightly generalize that there is no budget for TM from the 2018 budget document. He said the rather more factual situation is that there is a statutory department of TCAM in the FMoH, with the full complement of experts manning the implementation of the NTMP in the country.
The NIPRD DG, however, said that being said, what Nigeria as a country needs to be focusing on should be the prioritisations that will eventually enable the country as a people harness the fullest potential of TM, both in terms of access to healthcare and in relation to socioeconomic benefits.
He said as such, there is the urgent need to increase funding to Ministries Departments and Agencies (MDAs) particularly NIPRD that is charged with Research and Development (R&D) in phytomedicine, to undertake the relevant activities that will enable the expeditious actualisation of the significant potentials of the traditional medicine industry in Nigeria.
Adodo said this is part of the administrative problem that comes with integration. He explained: “Most often, integration means a bigger partner (orthodox medicine) swallows up the smaller partner (herbal medicine). Collaboration means that we give equal respect to the two partners and create a level playing ground for them to flourish. For me, this is a better approach to the development of our TM.”
Ogundipe said: “This I believe is an oversight due to high reliance on and priority to orthodox medicine in Nigerian health care system. However, it would be good for the budget for the ministry of health to be revised or a supplementary budget prepared to capture the needs of traditional or herbal medicine.”
NIPRD has a drug, Niprisan, which is endorsed globally even by FDA and the WHO. How far with the drug?
Adigwe said the TMs sector is worth several trillion dollars per annum, and commercialization of the relevant research is always the rate limiting step to achieving socioeconomic success, as has been done in India, China and other such settings.
He said with Niprisan, NIPRD has now taken the right step towards adopting and implementing this model and Niprisan has now been successfully commercialized for mass production through a licensing agreement between NIPRD and May & Baker PLC.
Adigwe said the product should be in the market shortly and there are about seven other fully developed phytomedicines by the institute all awaiting uptake for commercialization such as the Niprimal (anti-malarial), Niprimune (Immune booster) and other products.
Our investigation revealed that most relevant agencies saddled with research and development into natural medicine like the NNMDA, NIPRD, NAFDAC etc. do not have enough fund for R&D. What is your take on that and what is the way forward?
Adigwe said: “As I have stated previously, there is the need for more funding and prioritization of R&D if we are to effectively address the high disease burden in the land. Also, it is pertinent to state that funding of R&D is not only supposed to be by the government alone, there should be more engagement, in terms of endowments and grants by the private sector and development partners. Also, the long awaited R&D fund should be implemented just as it was done to tertiary education.”
Ogundipe said: “Well, the effort of the management of those parastatals should be appreciated but so much is desired from them. I think there should be room for such branches of the ministry to absorb University staff for sabbatical leave because experience has shown that they need huge assistance from the University in terms of research and development. Also, the structure of work there should deviate from the current pure civil service protocols. There should healthy collaboration with the University, after all, we are all working for a better nation.”
Have you made any major breakthrough in research into natural medicine?
Adigwe said the herbal medicine space is one which NIPRD has always understood its potential and in Nigeria, the evidence suggests that around 8,000 indigenous plants have ethno-pharmaceutical and ethno-medicinal properties. Therefore, he said, in line with its statutory mandate, NIPRD has over the last two decades successfully developed phytomedicinal products and process technologies.
Adigwe said seven products have been fully developed as mentioned earlier, with another set of over twenty at different stages of development. On process technologies, he said the institute has developed a number of contextual processing protocols for extracting aromatic and essential oils and other active principle of interest from indigenous plants and other natural resources.
He said all these were achieved with very little funding; the true potential of NIPRD has not been tapped essentially due to gross under funding.
Ogundipe said: “I have contributed a significant quota and I can boldly say that there is paltry quantum of research articles across the nation’s University that are crying for execution and product development.”
What have been the challenges towards development of TM?
Adigwe said: “As I have categorically stated earlier, funding had been the greatest challenge. With improved funding and government’s prioritisation of the sector in order to actualise Nigeria’s emergence as Africa’s pharma hub, NIPRD would naturally become the nucleus to drive the industry’s revitalisation.
Ogundipe said the major challenge is the inability to collaborate effectively between universities and research institutes on funding and effective monitoring.
What are your recommendations on how best to develop TM?
Adigwe said the review of the existing NTMP to reflect the current reality in the sector is a step in the right direction. At NIPRD, he said they have for decades now been the frontline advocates for developing the right partnerships to stimulate development in this sector. Adigwe said NIPRD has now leveraged on this administration’s new momentum to develop new synergies with the National Agency for Food and Drug Administration and Control) and the TCAM Department, as well as with the practitioners and general public. This, he said, is the foundation for future of TM practice in Nigeria, and with the right support from all stakeholders, Nigeria can finally begin to reap the health and socioeconomic benefits of the sector’s underutilised potential.
The UNILAG VC said research Institutes should be given targets and there should be firm and committed supervision in the activities of these institutes.
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