Development and valorisation of traditional medicine and traditional practitioners in Burkina Faso support project

Development and valorisation of traditional medicine
and traditional practitioners in Burkina Faso support
project

Marc OLIVIER
SAMA BIOCONSULT
27 Bis rue des 9 soleils
63 000 Clermont Ferrand
FRANCE


“PHAVA”

OLIVIER M., THUILLIER F., TRAORE A.


INTRODUCTION: PHAVA project presentation

PHAVA ( Pharmacopoeia and Valorisation) was initiated
and is piloted by GERES, a French NGO, with the help
of Sama Bioconsult, a consultant firm specialised in
biology and more particularly in medicinal plants.
This project, strongly supported by the Head of
Pharmaceutical Department of the Ministry of Health in
Burkina Faso, is financed by the French Ministry of
Co-operation and implemented locally by CAA, a
specific department of ABAC, an NGO based in
Ouagadougou.

This project consists in supporting the development
and valorisation of traditional medicine, through
support to traditional practitioners, mainly grouped
in associations, in order to improve traditional ways
and enable traditional medicine to integrate the
official health system and through this improve the
general sanitary condition of those populations which
revert to this type of medical care all over the
country.

This project, due to take place over a period of two
and a half years, can be divided into 2 main phases:

- during the first phase of the project (1999) a 9
month analysis was undertaken with various promoters
of traditional medicine and pharmacopoeia in Burkina
Faso, as part of a participative approach
(associations of traditional practitioners,
independent traditional practitioners, provincial
units of traditional pharmacopoeia (CPPT), shops
selling plant-based medicine).
This first phase gave the number and location of
traditional practitioners in the PHAVA project’s range
of action, along with their activity, their strong
points, but also their difficulties and weaknesses,
their goals and their projects through individual
(traditional practitioners and shops) or collective
(associations, CPPT) survey files.
- During the second phase (2000- 2001), in progress at
the moment, a certain number of supporting actions
described in the second part of this document, are
being implemented.

I – PHASE I: ANALYSIS AND PARTICIPATIVE DIAGNOSIS

I – 1 – Goals
Here were the to main goals of phase I.
1 – Identifying and recruiting volunteers,
prioritarily traditional practitioners (TP), acting on
a local level.
2 – Implementing a participative survey to gather data
on traditional practitioners’ activities and on
traditional medicine in general, in the areas covered
by the project, to get a better idea of their work
methods, and hoping to find out more about their
experience, their difficulties and their projects for
the future (analysis and diagnosis).
3 – Writing support action proposals, from the data
gathered in the previous step, for implementation in
phase II.

I – 2 – Method, study area, schedule, survey sheet,
consultation workshops

I – 2 – 1 – Starting phase: Nov. Dec. 1998
1 – Setting up the PHAVA team: recruiting agents in
the field, presenting the project to the team members
and distributing roles: the PHAVA team has the
following structure:
- project monitoring by GERES, from France
- local co-ordination by CAA – ABAC – GERES in
Ouagadougou, Burkina Faso
- a PHAVA project technical advisor, from Sama
Bioconsult, PhD in Science, in charge of the project
on national level with a team of two graduate
engineers and two field operators for the two main
regions covered by the project (Central-eastern,
South-eastern)

2 – Presenting the PHAVA project to the
administrations present in the different areas,
Ministry of Health and UNHCR particularly.

3 – Searching for contacts in the various areas and
identifying the different types of target actors for
the PHAVA project.

At the close of the preparation phase, 3 areas in
Burkina Faso were chosen:
- the eastern area: the Fada N Gourma area, recognised
for its experience in pharmacopoeia.
- the south-western area : the areas around Bobo
Dioulasso, Banfora, Orodara and Sindou, known for
their richness in medicinal plants and experience in
dealing with them.
- the central area : the area around Ouagadougou was
chosen because of it being an urban centre, with all
its characteristics : urbanisation, monetary
exchanges, disappearance of medicinal plants.

The project identified different types of actors in
traditional medicine and pharmacopoeia:
- independent traditional practitioners
- traditional practitioner associations
- traditional pharmacopoeia provincial units (TPPU)
- shops selling traditional medicine.

4 – Meetings with people working in traditional
medicine: University professors (Pr. GUINKO, Botanist,
Pr. NACOULMA, Biochemist, Mrs MILLOGO, Botanist, Mr.
BOGNONOU, Ethno-botanist, etc.)

5 – Identification and information of potential
partners (NGOs, Consulates, etc.) on the project’s
starting phase.

6 – Writing and editing a PHAVA presentation brochure,
which was distributed to the various actors, partners,
authorities, and potential partners.

I – 2 – 2 - Analysis and diagnosis –Jan. – July 1999)

I – 2 – 2 - 1 – Participative surveys (Jan. – May
1999)

The potential actors having been identified and having
accepted to work with us on this project, survey
sheets (sheets for individuals, associations, TPPU)
were created and the various actors interviewed in the
different regions in order to gather the most
information possible on:

1- individuals: identity, experience of traditional
medicine, data on patients, data on medicinal plants
used and most common illnesses treated, medical
expertise, equipment and facilities available, needs
and projects.

2- associations: offices, number of members, ways of
functioning, achievements, equipment and facilities
available, needs and projects.

3- Traditional Pharmacopoeia Provincial Units:
description of teams, equipment and facilities, ways
of functioning and relationship with traditional
practitioners in the area, type of medicine made and
medicinal plants used, needs and projects.

4- Shops selling traditional medicine: information on
person in charge, shop and equipment description, sale
team, types of medication sold, needs and projects.

I – 2 – 2 – 2 – Regional consultation workshops (March
– May 1999)

The close of this analysis and diagnosis phase was
marked by the organisation in the three areas of
regional consultation workshops which gathered
together the various actors of the area and potential
partners (Water and Forestry Authorities, NGOs, Health
authorities). They took place on March 29th, 1999 for
the Bobo Dioulasso, Banfora, Orodara and Sindou area,
April 28th, 1999 for the Fada N Gourma area, and May
24th, 1999 for the Ouagadougou area. These workshops
was an opportunity to feed information back to the
various actors, and to engage a discussion on what
actions should be undertaken during phase II of the
project.

I – 3 – Results

I – 3 – 1 – general characteristics of the PHAVA
project implementation areas

The area around Ouagadougou represents a high
potential market for improved traditional medication,
which was one of the primary goals of the PHAVA
project. The level of consumption of traditional
medication is already high in Ouagadougou, because of
the high cost of so-called “modern” medication.

The surveys however showed that despite this, prices
are rising and that there is an important financial
hold over the traditional market, as well as heavy
competition between traditional practitioners. There
is also an increase in the number of false traditional
practitioners and crooks, which only highlights the
necessity for a better organisation of traditional
practitioners and more co-operation with the Health
Ministry departments (decree authorising traditional
medical practises).

The Ouagadougou area is also characterised by the
difficulty to obtain medicinal plants, because of the
deforestation around the capital, this having an
influence on the prices of these plants.

The Fada N Gourma area in the east of the country is
known in the entire country for the competence of its
traditional practitioners, but also suffers from
difficulties in obtaining medicinal plants, despite
good co-operation between the various actors
(traditional practitioners, TPPU).

The Bobo Dioulasso area in the South-west is
characterised by the presence of several different
ethnic groups which each has its own pharmacopoeia,
and by the abundance of plant resources due to its
more temperate climate, the nature of its soils and
its great bio-diversity. The association is very
active, organising regular meetings (elected
representatives and general assemblies), has land at
its disposal to plant medicinal plants and organises
regional and international tours (particularly in the
Ivory Coast) to promote its traditional products.

The Banfora area has a wide experience in the field of
traditional medicine and has several types of actors
in the field, including a traditional practitioners’
association. Historically it is in this area that the
development of TPPU has been the furthest and this
area remains in advance for its pharmacopoeia.
There are also a great many traditional practitioners
in this area working with a great many available plant
resources.

The Sindou area is on the other hand characterised by
the difficulties for the actors to set up a
development project because of the difficult access to
the area, its low level of income and general lack of
training. Despite this, the various actors are
particularly taken by the PHAVA project and
participated actively in the surveys. They co-operate
efficiently with the environment and health services
(exchanging patients), and have land at their disposal
for medicinal plants.

The Orodara area is similar to the Sindou area
inasmuch as the traditional practitioners and the
Health authorities co-operate and contribute equally
to the health service. This area is quite rich in
plants, but with a rather more humid climate than the
other areas which brings about difficulties in drying
during the wintertime.

I – 3 – 2 – Types of actors of Traditional Medicine
(TM) and Traditional Pharmacopoeia (TP) in Burkina
Faso

The following actors were retained in the course of
the PHAVA project:

A – traditional practitioners’ associations, the
Laafia Association (which means “Good health”) in Fada
N Gourma, the “Wuti were” traditional practitioners’
association in Banfora, others in Sindou and Oradara,
the Houet “Reel wende” association in Bobo Dioulasso.
We were able to collect data from a total of 121
traditional practitioners belonging to 5 associations.

- the “indicator” files (23) show that in Fada N
Gourma most members belong to the Gourmancé ethnic
group and come from an area close around Fada N
Gourma. The average age of these members is quite
high, along with the number of years experience, but
the new generation is also quite present. Knowledge in
the field comes mainly from their parents,
approximately 1/3 of these traditional practitioners
have pupils. However they consider their main activity
as being agriculture, it being their main source of
income. Most of them do not know how to read or write.

- the “indicator” files (18) for Bobo Dioulasso show
that the traditional practitioners come from very
backgrounds, from the area around Bobo Dioulasso, but
also from the Mossi and Samo regions. Their age
varies, there are young people and women among them,
they have acquired their knowledge mainly from their
parents. Half of them have pupils and traditional
medicine is their main activity.

- the “indicator” files (36) for Banfora show that the
traditional practirioners there come from various
areas, although a majority comes from close around (10
from sénoufo, 4 from Gouin): once again all age groups
are represented here and several of them are women ,
specialised in child care. Most of them acquired their
knowledge from their parents, and a large majority of
them have pupils (22 out of 36).

- The “indicator” files (23) in Sindou show that the
average age is quite high among traditional
practitioners, and that most of them come from the
area close around Sindou. Knowledge comes mostly from
their parents and their main activity is agriculture.

- The “indicator” files (21) in Orodara show that
traditional practitioners were recruited mainly in the
area (10 from the Siamou ethnic group): they are
generally highly experienced and were trained by their
parents. Very few of them have pupils, as is the case
in the other regions. Traditional medicine is the main
activity for a good half of them.


B – Shops selling traditional medication: the area
around Ouagadougou has seen the development of a great
many shops selling traditional medication based on
plants, which are either imported from countries which
make more efforts in the presentation, the packaging
(Ghana, Togo, India, China, Europe) or else produced
locally: sapienta, Flore santé, Phytosalus.

C – Traditional Provincial Pharmacopoeia Units in Bobo
Dioulasso, Fada N Gourma and Banfora, chosen for their
support of associations each in their own town.

D – independent traditional practitioners, in Bobo
Dioulasso, for instance.

I – 3 – 3 – Traditional medicine

- the “traditional medicine” data sheet on Fada N
Gourma shows that most consultations take place at the
traditional practitioners’ home. The number of
patients varies greatly, and can be quite high, mostly
coming from the area. Consultations are free, the
medicine can be paid in different ways, more often
than not by a symbolic gesture, according to the
patient’s wealth: this trait is characteristic of this
particular area in which the financial aspect is not
what determines the choice of exercising this
function. This is to be taken into account when
suggesting forms of support: the traditional
practitioners in this area do not all follow a
commercial and financial goal, but are led by their
conviction that they can do something to help the
population because of the gift of knowledge acquired
or handed down to them by their parents. In this sense
not all the traditional practitioners in the area are
interested in promoting their products in Ouagadougou,
preferring to be in direct contact with their patients
(medical ethics). A few traditional practitioners,
mostly women are specialised in child care.
- the “traditional medicine” data sheet on Bobo
Dioulasso indicates that consultations take place
either at the patient’s home or at the
practitioner’s. Their patients often come from across
the border, quite close, of Ivory Coast or from Mali.
Activity is quite important, some traditional
practitioners have over 50 patients a month. The urban
characteristic is that medication has to be paid for
mostly in money, and that the price can be quite high,
without however reaching such levels as are seen in
Ouagadougou.
- the “traditional medicine” data sheet on Banfora
shows that traditional practitioners in the area
prefer consulting at their home, and often receive
foreign patients (from Mali and Ivory Coast) which is
easily explained by the proximity of the border.
Activity is generally very high, some practitioners
claim to see up to 100 and even 300(!) patients per
month. There is no charge for consultation and no
urban aspect concerning prices and payment means for
the medication, the amount is often symbolic and
almost always adapted to the patient’s wealth. Many
traditional practitioners (19 of them) have close
relationships with the health services staff,
particularly the TPPU.
- the “traditional medicine” data sheet on Sindou
indicates that most patients come from the area and
are seen at the practitioner’s home. As stated above
concerning their main activity, they only see few
patients compared to those in the Banfora area for
instance (5 to 40 per month). Consultations are free,
as is often the medication, unless it is paid
symbolically or by presents in accordance with the
patient’s wealth.
- the “traditional medicine” data sheet on Orodara
shows that it is quite similar to the Sindou area: a
lot of the medication is free or paid symbolically.
Certain practitioners however receive many more
patients, which can be explained by the presence of a
tarmac road, and certain patients come from close-by
Mali.

I – 3 – 3 the actors’ needs

The difficulties and therefore the expectations of
people selling medicinal plant-based medication in
Ouagadougou concern supply (transport, import duties),
lack of data and of local plant-based products,
packing and storage (problems with packaging and
labels), selling (return price of improved traditional
medication, promotion), technical (knowledge on plants
and illnesses) and commercial (management) training,
difficult relationship with official health services.

The needs of the associations and independent
traditional practitioners are quite similar:
- issue of medicinal plant supply, especially in the
Fada N Gourma and Ouagadougou areas.
- Problem of drying the medicinal plants after
cropping, especially during the rainy season and in
the Sindou and Orodara areas, which are the most
humid.
- Crushing the plants (especially barks and roots)
- Packing and storing the medicine (packing and
weighing equipment).
- The wish to have a place that could be used as
meeting place, a place to receive and talk with the
patients, to store and sell traditional medicine, is
often brought up in the conversation.
- Support in installing medicinal plant groves.

I – 4 – Conclusion of the analysis and participative
diagnosis phase: support proposals

cf. following chapter: implementing support actions.

II – PHASE II : IMPLEMENTING SUPPORT ACTIONS

From the results of the survey analyses, by region,
different actions have been decided which include
material support, training, technical support either
on a national level (and concerning all the
associations) or on a specific level (one or sometimes
two associations).

II – 1 – National scale (or transversal) actions

II – 1 – 1 – Actions already implemented
A – Training on association organisation and
management

A week-long training seminar was organised in January
2000 for 25 traditional practitioners from various
areas covered by the PHAVA project. The training was
done by a specialised organisation and dealt with
basic knowledge of simplified accounting and
organisation and management of associations, with
special emphasis on the definition of the roles and
duties of each association board member and the life
of an association.

B - Training and awareness awakening on national
policies and legislation in the field of Traditional
Medicine and Pharmacopoeia

A one-day seminar was organised by the PHAVA project
in March 2000 in Ouagadougou with 21 traditional
practitioners and plant-based medication vendors from
various areas covered by the project. Co-operation
with the Direction of the Pharmaceutical Department
(Manager of Traditional Medicine and Medication
Registration Department) led to the presentation of
various conferences on national policy in terms of
traditional medicine and on the issue of registering
improved traditional medication (“simplified”
authorisation to sell), followed by numerous debates.

C – Training on wrappings, packing and labelling
Improved Traditional Medicine

Two days of awareness awakening and training on
wrappings, packing and labelling were organised with
the same 21 traditional practitioners in March 2000.
They aimed at awakening awareness on the interest and
the necessity to improve wrapping and packing of
traditional medicine (quality criteria, preservation,
patient information).

For this support action, PHAVA has planned the
distribution in each area of packaging equipment
(scales, bag sealer, bags, bottles) and the setting up
of a stock management committee for each association.


D – Supporting actors – establishing contacts

During the workshops in Ouagadougou, round table
discussions were organised between associations and
plant-based medication salesmen to encourage exchanges
and better co-operation.
Besides, all along the PHAVA project, this type of
action (contacts, data exchange,…) takes place daily.

II – 1 – 2 : Actions being implemented (actually,
done!)

A – National TM and ITM Promotion Fair
At the close of the PHAVA project (end 2000 or
beginning 2001) we have planned to organise a
promotion Fair for traditional medicine and
traditional pharmacopoeia in order to present the
results of the PHAVA project and particularly insist
on Improved Traditional Medication (wrappings,
labelling).

B – Editing an educational booklet
This booklet which sums up all the activities
mentioned during the course of the project will be
highly illustrated with drawings and translated into
the national languages. It was edited at the close of
the project in order to take into account all the
results and experience acquired during the course of
the project. This booklet was presented in Ouagadougou
in May 2002 and get two prices from Ministery of
Health and CAMES at the Forum de la Recherche
Scientifique et de l'Innovation Technologique (FRSIT).

II – 2 – Local scale (specific) actions

II – 2 – 1 – Actions, already implemented

A – Training on medicinal plants
A training session on medicinal plants was organised
in co-operation with the Forestry and Environment
Departments in March 2000 in Fada N Gourma (where the
necessity to manage natural resources is essential)
and another one is planned in the Bobo Dioulasso area.

The different themes of this training session were:
- botanical identification of medicinal plants and
making a pressed herb book
- proper ways to pick plants
- drying medicinal plants
- plant management and protection on site
- general ideas of medicinal plant cultivation
- first approach of medicinal properties and toxicity
of certain medicinal plants

The theoretical training was then followed by field
visits to put into practise what had been learnt on
plant picking and botanical identification.


B – Design and development of medicinal plant grove
support

This action started in January 2000 in Bobo Dioulasso
and includes several themes, some of which have alredy
been implemented:
- site definition and picketing (11 hectares)
- building fire protections, growing hedges and
drawing pathways
- botanical study of existing plants
- choice of plants to improve the site and order of
seedlings from the Environment Department, while
waiting for a nursery to be built.

II – 2 – 2 – Actions being implemented

A – Design and construction of a medicinal plant
dryer

This action is planned for the more humid areas of the
country, and aims at developing a dryer which is
technically and financially adapted to the needs of
traditional practitioners in these areas.

B – Building and setting up a place for traditional
practitioners

This action is planned in 2 areas which don’t have a
building for that purpose at the moment, which makes
it a bit difficult to work.


III – CONCLUSION

During the course of the PHAVA project, through
implementation of participative actions, a
satisfactory co-operation has developed between the
main actors in the field of traditional medicine and
pharmacopoeia in Burkina Faso, particularly within the
traditional practitioners’ associations.

During the surveys in the analysis and diagnosis
phase, the willingness and motivation of the
traditional practitioners allowed us to gather a lot
of useful data in the areas concerned by the project
on different aspects of traditional medicine and
pharmacopoeia (area specificity, knowledge of various
actors and their ways, difficulties and needs).

Analysis and consultation in the various regional
workshops led to the definition of priorities to reach
the goals set by the PHAVA project, that is to say
improvements that might lead to better integration of
traditional medicine in the health system.

The support actions, which are each defined at a
certain level (national or regional) ,started in
January 2000, show an important commitment from
traditional practitioners and have led to very
positive results, which is certainly a good sigh for
what is to come.

In our opinion, the PHAVA project, pilot project in
Burkina Faso, can be an example for other wide range
actions, knowing that concerning health issues, it is
always possible and most of all necessary to continue
to do one’s best.


Contact:

Marc OLIVIER
SAMA BIOCONSULT
27 bis rue des 9 soleils
63 000 Clermont Ferrand - FRANCE

T/F: (33) 4 73 90 60 55
E.mail: oliviersama@yahoo.fr

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