Can Investment in African Traditional Medicine Systems

Yield Better Public Health Returns Than Allopathic Healthcare Systems?

Eluemuno R. Blyden, Ph.D.AfriVax, Inc.

OptAIDS/WHAM WorkshopToronto, July 29, 2008 / Second Life® now through 2011

Summary

•Define the scope of Traditional Medicine (TM) and Allopathic Medicine (AM) in Sierra Leone

•Outline an approach to measuring the relative contribution of TM and AM to the Health status quo in Sierra Leone as indicated by various surveys

•Review approaches to quantifying the efficiency with which TM/AM might convert investment into public health good

•What impact can AM and TM systems have on HIV/AIDS in the Salone context?

Why Sierra Leone?

•Plenty of Data (not all good)

•Good microcosm of the typical African situation in a small geographical area o16 ethnic groupso5 major ecosystem typeso3-4 independent TM Systems?

•Low HIV seroprevalence, extensive HIV education

•Investement in healthcare needed

•Personal experience

Link to Google Maptotal: 71,740 sq km

Kenema, Kono Kailahun - east province; Bo, Moyamba and Bonthe south province; Port Loko, Koinadugu, Kambia, Tonkolili, Kabala and Bombali - north province

Sierra Leone's Health Challenges

National Health Priorities, Sierra Leone

The current national priority health problems are:•Malaria•Sexually Transmitted Infections including HIV/AIDS•TB•Reproductive health including maternal•and neo-natal mortality•Acute Respiratory Infections•Childhood immunisable diseases•Nutrition-related disease•Water, food and sanitation-borne diseases•Disability•Mental illness National Health Policy 2002 Govt. of Sierra Leone

Approx 5000 AM Workers Extrapolate as many as 20,000

Where do Sierra Leoneans turn to for medical help?•About 6% of people consult Traditional Medicine Practitioners

(TMP) for primary care compared to ~70% who consult Doctors, Nurses and PHOs

•Only about 30% of people have ready access to Allopathic Medicine (AM) infrastructure.

•70% of Births within 3 miles of a Public Health Unit (clinic) were at -home supervised by a Traditional Birth Attendant

Suggest that we should ask:•What do Sierra Leoneans consider medical help?

Assumptions for Analytical Approach

•National health status as indicated by statistics is the OUTCOME of combined TM and AM services

•Relative contribution of each cannot be completely quantified or disentangled

•Full scope of TM not fully defined•Bias as against TM by those evaluating National health status•Some general statements can be made about the potential

impact of TM/AM on national health by extrapolation from limited data

Advantages of AM System

•Based on a broader foundation of experimental and experiential knowledge

•Well-established Diagnosis/ Intervention/ Outcomes model

•Well-established regulatory models/systems articulated with global health

•Well-established human capacity formation

•Has a strong material infrastructure

•Pharmaceutical resource available

Advantages of TM

•Available and accessible at places of need

•Well established indigenous infrastructure

•Economically independent of global economic fluctuations

•Socio-culturally coherent (not imply acceptance)

•Holistic approach of African TM could be more effective at palliative and curative care (relevant to HIV/AIDS)

Technical efficiency of peripheral health units in Pujehun district of Sierra Leone: a DEA applicationAde Renner1, Joses M Kirigia*2, Eyob A Zere3, Saidou P Barry2,

Doris G Kirigia4, Clifford Kamara5 and Lenity HK Muthuri6

Healthcare provision as a process

AM: The need for a new approach...

"Twenty-two (59%) of the 37 health units analysed were found to be technically inefficient, with an average score of 63% (standard deviation = 18%). On the other hand, 24 (65%) health units were found to be scale inefficient, with an average scale efficiency score of 72% (standard deviation = 17%). Conclusion It is concluded that with the existing high levels of pure technical and scale inefficiency, scaling up of interventions to achieve both global and regional targets such as the MDG and Abuja health targets becomes far-fetched."

Technical efficiency of peripheral health units in Pujehun district of Sierra Leone: a DEA applicationAde Renner1, Joses M Kirigia*2, Eyob A Zere3, Saidou P Barry2,

Doris G Kirigia4, Clifford Kamara5 and Lenity HK Muthuri6

Traditional Medicine Services

INPUTS:

•TMPs, TBAs, Apprentices•Support staff (family,

community members)•Transportation (Public)•Materials and Supplies

( Local/ imported roots, bark, leaves, animal parts)

•Capital (Paramount Chiefs, Formative Societies, Self-employed)

OUTPUTS: •Preventative Healthcare•Curative Healthcare•Palliative healthcare •Individual Health Education•Community Health

Education•Emergency Medicine

TM: The need for a new approach..

•Need more scientific approach •Need better regulation of formation and practice•Many quacks and charlatans...•Better pharmaceutical practices (ie toxicity evaluations etc)•Better resource management and conservation•Update indigenous laws and make new constitutional ones

Preventive Medicine

Malaria preventives include "broomstone", Fignut leaves (Jatropha curcas), and the barks of several indigenous tree species.

Curative Medicine

Palliative Medicine

Emergency Medicine

Jan 29.2006Cholera kills 18 children in BontheEighteen children are reported to have died of diarrhea in fishing villages around Delken it’s surrounding in the Bonthe district, southern Sierra Leone over the past week.This epidemic is reported to have affected over one thousand people of whom thirty are children in that area. An emergency medical response team from the Ministry of Health and Sanitation and World Vision-Sierra Leone has been dispatched to the area to carry out curative and preventive treatment.Elizabeth Domboi, nurse in charge of health and sanitation confirmed that the epidemic killed 18 children before native herbalists put it under control. She complained that local residents in the district have negative response towards conventional treatment.....Awoko Newspaper

Perinatal Choices and OutcomesPercent distribution of women aged 15-49 with a birth in two years preceding the survey by type of personnel assisting at delivery. Sierra Leone. 2005

TM Potential for Reducing HIV Transmission?

Male Circumcision – No Data for Sierra Leone Presented!!

Female Genital Cutting (Circumcision) is widespread and popular in Sierra Leone– More on FGC

In a review of 19 cross-sectional studies, 5 case-control studies, 3 cohort studies, and 1 partner study. A substantial protective effect of male circumcision on risk for HIV infection was noted,...After adjustment for confounding factors in the population-based studies, the relative risk for HIV infection was 44% lower in circumcised men. The strongest association was seen in men at high risk, such as patients at sexually transmitted disease (STD) clinics, for whom the adjusted relative risk was 71%

lower for circumcised men. CDC Fact SheetEvidence exists for a similar effect in circumcised females

Enabling factors for TM

•Sierra Leone Traditional Healers Association (SLENTHA)

•Several new Acts of Parliament supporting TM and its practice including National Policy on Traditional Medicine

•Good environmental conservation movement protecting forest resources

•Civil conflict HELPED increase the awareness of the value of indigenous knowledge assets

•Tradition of collaboration between AM and TM has existed in the past.

Obstacles to an Integrated AM/TM System in Sierra Leone•Biggest obstacle is prejudice against AFRICAN Traditional

Medicine-- Chinese and other TMS receive SL govt support!!•This prejudice is probably greater IN Sierra Leone than

outside due to stigmatization!•Paucity of evidence based assessments of TM impacts•Need better funding of research and development of TM

Practice and systemization•Better human and natural resource management in relation to

TM needs•Better integration of indigenous knowledge in Primary,

Secondary and Tertiary education curriculi

Conclusion•Previous studies indicate AM system would not yield good

return on investment due to systemic inefficiency•TM is a valuable resource that could be used to improve the

impact of all public health care interventions and help stop the spread of HIV/AIDS & other global health threats

•The TM resource is more evenly distributed geographically and is more robust due to its predominantly local dependencies

•Enabling environment created by grassroots efforts and advocacy need more support and greater evidence based data to define the value of potential investment-- this can be determined even from the tangential information about TM practice already existing today

•Tiwai Traditional Medicine Health and Fitness Village Project http://www.tiwaihealthvillage.com

Summary

•Define the scope of Traditional Medicine (TM) and Allopathic Medicine (AM) in Sierra Leone

•Outline an approach to measuring the relative contribution of TM and AM to the Health status quo in Sierra Leone as indicated by various surveys

•Review approaches to quantifying the efficiency with which TM/AM might convert investment into public health good

•What impact can AM and TM systems have on HIV/AIDS in the Salone context?