By Dr. George O. Essegbey, Director, and Mr. Stephen Awuni, Research Scientist, Science and Technology Research Institute, Council of Scientific and Industrial Research (CSIR), Accra, Ghana
Over the past 30 years Ghana has made significant progress in enhancing the standing of traditional medicine as a viable healthcare option. By developing a favorable policy framework, the government has fostered innovation and improved traditional medical practice. The informal nature of the sector, however, poses particular challenges when it comes to securing the sector’s long-term sustainability and when ensuring that policy and practice are fully aligned.
Ghana’s experience in the area of traditional medicine offers interesting insights into the dynamics of innovation in a sector that, while pivotal in supporting equitable healthcare delivery goals, is largely made-up of micro-entrepreneurs operating in the informal economy (see box). The country’s achievements in strengthening traditional herbal medical practice have recently been the focus of a WIPO Development Agenda study which explores how innovation – the introduction and development of new and improved products and processes – takes place within the informal economy; the mechanisms by which traditional medical practitioners secure a competitive advantage; and, in particular, how informal operators protect their know-how.
Ghana’s innovation landscape for traditional medicine
The study identifies traditional herbal medical practitioners, policy makers, researchers, regulators, entrepreneurs and consumers as critical actors in Ghana’s traditional medicine innovation landscape. Each, in some way, is driving innovative traditional medicine practice, making it possible to provide affordable access to quality goods and services on the one hand and creating sustainable livelihood opportunities, on the other hand. External influences, such as trade and economic agreements, and scientific and technological advances are also shaping the sector’s innovation landscape.
National innovation policies typically focus on scientific and technological research and development. The future advancement and viability of Ghana’s traditional medicine sector, however, hinges on creating an operating environment that takes advantage of the informal nature of traditional medicine practice while continuing to encourage innovation and strengthen entrepreneurship for improved quality and efficacy of traditional medicine products and practice.
For many, especially in developing countries, traditional medicine is their first choice. This is particularly true for those living in remote or marginalized areas where distance and cost are barriers to orthodox treatment. In Ghana, around 70 percent of the population sees traditional medicine as a desirable and necessary means of treating problems that Western medicine cannot adequately remedy.
Ghana’s drive to transform traditional medicine into a potent vehicle for health-care delivery has been on track since the 1990s. With just one medically trained doctor per 1,200 patients and one traditional medicine practitioner per 400 patients, traditional medicine has an important role to play in meeting equitable healthcare delivery goals.
A pro-innovation policy framework is vital
Ghana’s experience underlines the importance of developing and implementing a pro-innovation policy framework underpinned by legislation and regulations. In this respect, Ghana’s Ministry of Health, which is responsible for overseeing the nation’s healthcare delivery system, has been indispensable in fostering innovation in traditional medicine and in enhancing its acceptability as a healthcare option (see box). Unlike modern medicine, traditional medicine practice generally lacks a strong scientific base, using knowledge acquired through many years of experience. The Ministry has been pivotal in addressing challenges of quality control, efficacy of products and in putting traditional medicine practice on a more rigorous scientific footing.
In 1994, the Traditional and Alternative Medicines Directorate was established under the Ministry of Health. This was an important first step in integrating traditional herbal practice into Ghana’s health-care delivery system. Its mission is to make available, a well-defined, recognizable, complementary system of health based on “excellence in traditional and alternative medicine knowledge”.
The Traditional Medicine Practice Act (Act 575) of 2000 further bolstered government policy, requiring practitioners to register with the Traditional Medical Practice Council; an important move in raising standards and formalizing traditional medical practice. The Act defines traditional medicine as “a practice based on beliefs and ideas recognized by the community to provide health care by using herbs and other naturally occurring substances.” Importantly, it specifically recognizes that traditional medicine practice goes beyond the physical to encompass social and psychological dimensions of healthcare.
The Ministry’s policy initiatives have led to the establishment of traditional medicine clinics in public hospitals and the inclusion of selected herbal medicines in its Essential Drug List.
The role of Traditional Medical Practitioners
Traditional medicine practitioners have also been working to enhance their practice. Traditional medicine thrives on locally available resources, and knowledge of the health-care value of plants and their derivatives. Practitioners play a key role sharing knowledge and in adding value to and improving the quality and delivery of their products and practice, in particular through the formation of a strong network of associations.
Product and process innovation
Innovation within the sector is evident from the improved efficacy and range of products available and in the use of new production processes.
Traditional medicine is used to treat a wide variety of ailments including diabetes, fever, hypertension and infertility. Product innovations encompass a wide range of herbal preparations – capsules, pills, creams, tinctures – sold in a variety of outlets ranging from the handbags of itinerant traditional herbalists, and traditional markets, such as Makola in Accra, to purpose-built corner kiosks and the growing number of modern pharmacies popping up in urban centers.
Traditional modes of production have given way to modern technologies to produce, package and market traditional medicines. Many practitioners, especially larger operations, now use grinding and mixing machines, blenders, apparatus for bottling and filling tubes and capsules and stainless steel boilers. The production environment, designed to ensure a stable supply of utilities and continuous output, is equipped with water storage containers, pumping machines and generators. Packaging involves the use of seals and good labelling information relating to dosages, expiry dates and batch numbers. More sophisticated producers also assure quality using pH meters and analyzers. Some traditional herbal clinics also use modern diagnostics.
With these innovations, the acceptability of traditional medicine products is not simply a question of faith or culture but the result of greater confidence in their quality and efficacy.
Despite the huge progress made, the sector’s ability to develop further is hamstrung by the small-scale and fragmented nature of operations. Traditional medicine practice in Ghana covers a continuum: the bulk of micro-practitioners operate at different points of the informal economy, while a smaller number of larger businesses operate within the formal economy; in some instances entrepreneurs operate in both. To innovate and evolve, informal sector micro-enterprises need access to investment, an expanding market and new skills.
These findings highlight the need for policies that support learning and knowledge transfer within the sector, to drive traditional medicine innovation. An emphasis on training and research and development helps introduce practitioners to new production and processing techniques, quality assurance and good manufacturing practices, among other things. In this respect, traditional medicine associations, such as GHAFTRAM, have an important role to play in encouraging innovation and sharing best practices among their members.
Some progress has been made in using state procurement as a vehicle for expanding the market for local herbal drugs. The expansion of the list of traditional medicine treatments qualifying for reimbursement under the National Health Insurance Scheme (NHIS) would further boost the market for these products.
At present, the study shows, unsurprisingly, that those with the greatest capacity to scale-up operations are the bigger outfits. To support equitable healthcare delivery goals, however, the overriding challenge is to support the advancement of the sector as a whole. But up-scaling creates a dilemma. If practitioners scale-up their businesses and add additional value through innovation, the price of their products may rise making them less affordable to their customers. Such a scenario underlines the need for coherent policies that facilitate scalability without threatening affordability.
Harnessing the value of innovation
While Ghana has an effective formal intellectual property (IP) system in place, few traditional medicine practitioners actually use it to protect their innovations or their business interests, and those that do typically operate in the formal economy. The bulk of practitioners rely on trade secrecy.
Embedded in cultural practice, secrecy comes at little or no financial cost to the individual (although it can cost the collectivity dearly insofar as knowledge that is not codified or passed on to others dies with the inventor).
Many practitioners, especially those operating in the informal economy, are not aware of the potential advantages of acquiring IP rights, such as trademarks, designs or patents. And for those aware of the IP system, the stringent requirements associated with obtaining IP protection are often beyond their reach. Much still remains to be done to raise awareness and understanding among practitioners about how to use IP rights to support their longer-term business interests. How to encourage innovation and strengthen entrepreneurship among traditional medicine practitioners in the informal economy is a crucial policy challenge in Ghana.
Policy initiatives to support the development of traditional medicine practice in Ghana
- The Traditional Medicine Practice Act, Act 575 of 2000
- The Strategic Plan for the Development of Traditional Medicine (2002 – 2004)
- Policy on Traditional Medicine Development (2003)
- Training Manual for Traditional Medicine Practitioners (2003 and 2005)
- Strategic Plan for the Development of Traditional Medicine (2005 – 2009)
- Code of Ethics and Standards of Practice (translated into three local languages – 2006)
- List of Recommended Herbal Medicines Essential for Primary Healthcare Services (2008)
- Policy and Administrative Guidelines for Complementary Alternative Medicine (2008)
- Guidelines for Intellectual Property Rights Protection Framework for Indigenous Knowledge Related to Health and Medicinal Plant Resources (2008)
Defining the informal economy
For over 40 years the role played by the informal economy in economic development, poverty reduction and employment in low-income countries has caught the attention of academics and policymakers. Coined in the 1970s there is still no universally accepted definition of “informal economy” or its scope. Not to be confused with the underground or illegal economy, the informal economy typically comprises small household (or unincorporated) enterprises that provide goods and services in exchange for remuneration or barter but which are not regulated.
Amid efforts to upgrade traditional medicine practice (and to safeguard against quackery) there are concerns among seasoned practitioners that traditional medicine is simply being merged with orthodox medical practice. They maintain the aim should be to reinforce traditional medicine as a distinct and parallel practice.
While the credibility of traditional medicine practice hinges on stronger regulation, the challenge for policy-makers is to develop innovative approaches that leverage the innovation potential of informal actors.
National innovation policies typically overlook innovation in the informal economy. Ghana, however, has gone some way in building bridges between modern systems of science and technology and traditional medicine. Examples include the prescription of traditional herbal preparations in public hospitals and the introduction of the first herbal medicine degree program at the Kwame Nkrumah University of Science and Technology (KNUST).
Healthcare in Ghana is generally near the top of Sub-Saharan African rankings, but bottlenecks in delivery remain, along with certain gaps in policy and practice. Overcoming these challenges will involve policy-makers thinking out-of-the-box to create a space for the numerous micro-entrepreneurs who are the backbone of Ghana’s traditional medicine practice to thrive. This is an opportunity to support national equitable healthcare delivery goals as well as national economic development goals. The continued advancement of traditional medicine practice promises significant opportunities for job creation across the traditional medicine value chain. Moreover, beyond their use at home, there are also significant opportunities to commercialize traditional medicine products in global markets. Perhaps it is time to put traditional medicine on a more industrial footing.