TRADITIONAL MEDICINE PROGRAMME IN MOZAMBIQUE: PERSPECTIVES TO COME TOGETHER WITH THE MODERN MEDICINE

TRADITIONAL MEDICINE PROGRAMME IN MOZAMBIQUE: PERSPECTIVES TO COME TOGETHER WITH THE MODERN MEDICINE

A.B. Agostinho, D. Manjate, J. Massingarela, R. Gaspar, N. Chilemba, M. Rico and Iraida Perera

PREAMBLE

Mozambique, as a developing country is no exception to the rule of its people seeking the use of Traditional Medicine (TM) for the treatment and prevention of diseases affecting them. Mozambique is provided with large experience in this field especially in former war-hit areas both for the liberation struggle and the civil war waged over 25 years.

In 1977, based on the experience acquired during the colonial war and following the guidelines from Alma Ata Conference prepared by the World Health Organization (WHO) in which recommendations were made for the use of locally available resources for the provision of primary health care to all communities and cultures, Mozambique decided to consider the positive side of Traditional Medicine, by setting up the Traditional Medicine Office charged at this initial stage with the duties of carrying out ethno medical studies of Mozambican medicinal herbs.

From the efforts made on listing, classifying and conservation of medicinal herbs a four volume collection was produced and the fifth volume is forthcoming on "Medicinal Plants and its Traditional Use in Mozambique" by Jensen and Mendes 1,2,3,4 in addition to the creation of a herbarium of Mozambican medicinal herbs.

At this point in time, the cultural, psychological and symbolic issues were not taken into consideration, as well as phytochemical ethno botanical clinical or biological, toxicological and pharmacological studies, which were not regarded as a priority matter for research.

In the span between 1992 and June 1996 through the Swiss Cooperation, two socio-anthropologists were hired with the aim of drawing up a liaison policy between the Ministry of Health and traditional medicine practitioners. It was then, that the socio-anthropological component was identified as being a priority area. In this view, a specific program was prepared aimed to:

a.) Charge the Traditional Medicine Research office with establishing liaison between the National Health System and Traditional Medicine practitioners., creating a confidence instilling environment between these two sectors; and

b.) Design a Traditional Medicine Programme intended to produce recommendations for a policy formulation that the government would adopt with regard to Traditional Medicine Practitioners.

The government of Mozambique is currently considering targeting its activities towards Traditional Medicine in order to put it on par with Classical Medicine.

This endeavor calls for the review of current legislation as it dates back to the Portuguese colonial era. The above referred legislation considers the practice of Traditional Medicine a crime and its practitioners as liable to legal penalties.

In both types of policies, however, (colonial and post-independence) the practice of traditional medicine has always been exercised in the underground and has been met with some tolerance by the governments of the day, due to a number of factors such as culture, poverty, insufficient communication and health network, etc.

According to Green et al., by 1991 the ratio between a doctor and inhabitant in Mozambique was 1/200.000 whereas for the traditional healer and inhabitant the ratio was 1/50.000. This data, despite being outdated, may not differ significantly from the present state of affairs and with the recent general population census carried out last, updated data is forthcoming.

The Traditional Medicine law is under study and may be passed shortly.

We are aware that Mozambique must take long strides towards the application and use of health related traditional resources.

Program objective

It is this framework that the traditional medicine program in the next four years 1998-2001 expects to broaden its activities, including not only the socio-anthropological and ethno-medical field but also ethno-botanical, phytochemical studies, simple biological and clinical experiments and toxicological screening.

This program seeks to highlight all existing key sectors in the Department of Traditional medicine. The Traditional Medicine Research office is a division attached to the National health institute, the sole institution in the Ministry of Health specialized in health research.

Bearing in mind the experience gained with the introduction, over the last 3 years, of the soci-anthropological component, which gives priority to the study of cultural, psychological and symbolic aspects of Traditional Medicine, the objective of the present is to:

* Create an inter-ministerial group with the mission of making recommendations and implementation of the new legislation that provides a legal framework to traditional medicine practitioners, by revoking all old laws that consider the practice of traditional medicine a crime.

* Create an inter-institutional group, involving research, universities and ministries, in a way to save some aspects as Biodiversity, conservation and culture of medicinal plants.

* Carry on the survey and identification of medicinal herbs available in Mozambique, promoting in this way clinical studies based on information provided by traditional medicine practitioners and to create a Database.

* Create capacity for quality control of medicinal herbs manufactured and sold throughout the country and for export.

* Strengthen the research capacity of GEMT in socio-anthropological field, clinical experiment, ethnobotanical, phytochemical area, toxicology/pharmacology and biological experiment.

* Encourage the use of medicinal herbs, counseling on the creation of improved herbariums within the norms of Good Manufacturing and Practice (GMP).

* Participate in the training of health technical staff, especially in health anthropology.

* Establish co-operation ties with other countries in the region and worldwide.

This program requires from our government serious commitment not only in human and material resources but also financially.

OUTLOOK

We are confident that the present policy of making use of neutral resources will impact on the national economy. Imported medicines are ever increasing and absorb the badly needed hard currency.

We believe that in encouraging the use of medicinal herbs with efficiency and proven quality, we will not only promote economic trust in the country but also encourage our researchers to investigate other medicines and traditional treatment yet to be studied.

In collaboration with the inter institutional group, GEMT shall:

a.)Investigate on natural resources related to medicinal herbs countrywide

b.)Promote the culture, use and exploitation of medicinal herbs

c.)Prepare norms that regulate the collection, manufacturing and sale of medicinal herbs as well as.

d.)Promote the creation of a Mozambican Pharmacopoeia that includes traditional medicines.

e.)Contribute to the development of pharmaceutical, chemical, food and cosmetic industry.

The costs of this program are available at around US$840,000.00 for four years (1998-2001) and the government of Mozambique are looking for a potential financier to support it.

Limitations to the Programme

Susceptible factors that can block the succession of the programme are:

* Lack of human, material and financial resources

* Lack of bioetic norms adapted for specific conditions in Mozambique, namely in the research area in human beings.

* Lack of a right communication methodology between MOH - DTM and Traditional practitioners.

* Difficulties in articulation with other institutions and / or ministries