35916 Traditional Medicine Programmes in Madagascar M adagascar has inherited a organizational and prescriptive wealth of ethnomedical knowledge. framework for exercising the profes- The first medical thesis written by a sion of traditional healer and for using Malagasy concerned the study of a plant the traditional pharmacopoeia; traditionally used as a trial poison in 2. To promote and reinforce dialogue Madagascar (Rasamimanana 1891), and and partnership between local the following two theses were devoted to communities, traditional healers, Notes an inventory of Malagasy medical beliefs researchers, and clinicians for the and practices (Ramisiray 1901; Ranaivo promotion of ethnomedical practices 1902). Furthermore, a preliminary census and their scientific investigation; of traditional health practitioners in three 3. To develop appropriate legislation provinces of Madagascar revealed that and regulatory texts, in collaboration there were more than 2000, which can with relevant organizations, for be extrapolated to over 5000 in the whole access to biological resources and in KI island. particular medicinal plants, for the Madagascar is also endowed with a protection of traditional knowledge, flora of unique global importance on and for equitable sharing of benefits account of its biodiversity, endemicity, arising from the development of and ethnomedical uses. Of approximately traditional practices and the sustain- 13 000 species present in Madagascar, able exploitation of these biological http://www.worldbank.org/afr/ik/default.htm over 80% are endemic to the island, and resources, in accordance with the about 3500 are reported to have medici- Secure Local Management scheme nal properties. ("GELOSE") established by the The government of Madagascar has National Department of the Environ- shown its political commitment to tradi- ment and with the Convention on tional medicine by supporting, through an Biological Diversity, of which Mada- interministerial convention, a commission gascar is a signatory; to study regulations on traditional medi- 4. To evaluate ethnomedical practices cine and its pharmacopoeia in Madagas- for their safety, efficacy, and and car, which was established in May 1996. quality, to optimize the use of re- This commission was enlarged by decree No. 91 search results, to follow up patients N°2339/2002 dated 28thAugust 2002 April 2006 marking the creation of a National Advisory Committee on Traditional IK Notes reports periodically on Medicine. The Committee brings to- Indigenous Knowledge (IK) initiatives in Sub-Saharan Africa and gether the principal public and private occassionally on such initiatives stakeholders in a spirit of partnership. It outside the region. It is published by has recently drafted the national policy the Africa region's Results and on traditional medicine in Madagascar Learning Center as part of an which now will move forward to be evolving K partnership between the World Bank, communities, NGOs, validated at the WHO level. The general development institutions, and objective of this traditional medicine multilateral organizations. The views World Bank policy is to improve access for the expressed in this article are those of population, especially the most vulnerable the authors and should not be attributed to the World Bank Group or popu-lations, to quality care and service. its partners in this initiative. A Operational objectives are the following: webpage on IK is available at: 1. To elaborate a legal, regulatory, //www.worldbank.org/afr/ik 2 4. To evaluate ethnomedical practices for their safety, tics for local uses at affordable prices, and exports efficacy, and and quality, to optimize the use of research Centella asiatica, Drosera ramantacea, other medici- results, to follow up patients having taken traditional nal plants, and essential oils for commercial purpose. This medicine, to promote the cultivation of medicinal plants latter activity is an important source of income for the and the local production of improved traditional medi- Institute. cines, in order to make traditional medicine less empirical 3. Department of Clinics with nearly 30 medical consulta- and more rational, while preserving as far as possible the tions per day. Patients may be treated either with values which confer its originality; and phytomedicines or conventional drugs, or both. 5. To reinforce the systems for information, training, and One relevant achievement of IMRA has been the com- education on traditional medicine. puterized compilation of all ethnomedical uses of Madagas- Traditional medicine programmes in Madagascar can be car plants. More than 6000 plants have been recorded with divided into two categories: (1) programmes that are all detailed information. IMRA is also involved in training coordinated by the Ministry of Health, and (2) programmes activities at different levels. that are carried out on an institutional basis. Centre National d'Application de Recherches Pharmaceutiques (CNARP) Background Information The Centre National d'Application de Recherches Pharmaceutiques is a state institution which was created The Traditional Health Practitioner Association by the First Republic. The inaugural opening ceremony was The traditional healers created a national association of held in May 1972, but the Centre started functioning in traditional healers following decree N°221/02/MI/SPAT/ 1977. ANTA/ as of 3rd June 2002. Two meetings have been held The Centre has five departments, reflecting the between doctors and traditional healers, attempting to multidisciplinarity and complementarities of the work in bridge the divide between conventional and traditional medicinal plant research and development: medicine. · Department of Botany/Ethnobotany · Department of Chemistry Institutes involved in medicinal plant research and · Department of Pharmacology production in Madagascar · Department of Galenical Pharmacy · Department of Clinics. Institut Malgache de Recherches Appliquées (MIRA) The Institut Malgache de Recherches Appliquées (IMRA) HOMEOPHARMA was created in 1958 by Professor Albert Rakoto- HOMEOPHARMA is a private company which was Ratsimamanga, former Research Director at the Centre created in 1992 by Dr. Jean Claude Ratsimivony. The National de Recherche Scientifique, and pioneer of the areas of activi-ties are homeopathy, phytotherapy, and scientific re-search in Madagascar. At its inception, IMRA aromatherapy. was a non-governmental organization, but since 1993 it HOMEOPHARMA has a range of products for local has been granted status as a Foundation following a uses, namely: government decree. IMRA is by far the best equipped . · Homeopathic products centre in Madagascar for biodiversity conservation and · Essential oils drug discovery from natural products, and has a strong · Phytomedicines network of collaborations with western institutes. · Nutraceuticals IMRA is a good example on how scientific research could · Plant-based soaps be integrated with health care, conservation, and produc- · Anti-insect candle jar tion. At this point, it has three departments: · Creams for massage 1. Department of Research with two areas of activities: (i) discovery of biomolecules in the areas of malaria, Orinasa Fanamboarana Fanafody (OFAFA) cancer, diabetes, immunomodulation, cardiovascular and OFAFAis a semi-public institution devoted to the produc- respiratory diseases, and (ii) analytical analysis. IMRA tion of bulk imported drugs. It was created in 1981 follow- has a fully equipped section to carry on the biological ing an official agreement between the Chinese and the screening. Malaygasv Governments.Although it is not involved in 2. Department of Production and Export which produces production of phytomedicines, the current infrastructure nearly 40 plant-based drugs, nutraceuticals, and cosme- may be adequately used to produce useful phytodrugs. 3 Programmes under the coordination of the Ministry has been put in place to handle the work. of Health Plants were selected on the basis of the following criteria: In order to achieve the objectives of the national policy on · Plants of potential or effective economic value; traditional medicine, the strategy has seven parts: · Plants for which the current phytochemical/biological 1.To create a technico-legal commission charged with investigations may lead to useful applications finalizing the texts which have previously been drawn up, · Plants with relevant ethnomedical data and to elaborate new texts following the instructions of the National Policy on Health. The content of each monograph of the Malagasy Pharma- 2.To facilitate the creation of traditional healers' associa- copoeia comprises: tions in order · Validated botanical name i. To serve as an internal reference system · Synonyms ii. To provide a professional code of ethics with a · Vernacular names view to rapidly discrediting charlatans, and · Botanical description at macroscopic and microscopic iii. To enable dialogue with modem medical practitio- levels ners. · Geographical distribution and ecological status 3.To solicit the participation of all stakeholders in the · Data on phytochemistry, pharmacology and toxicology elaboration and/or finalization of texts on biological re- · Identity tests sources, protection of traditional knowledge, and equi- · Assays for constituents table sharing of benefits arising from the development of · References. The expected outcomes are: ethnomedical practices, in accordance with the Conven- · Knowledge of 100 priority species which serves as a tion on Biological Diversity and the model law of the basis for the formulation of conservation and valorization African Union. programme within the frame of the sustainable uses of 4.To create a multidisciplinary scientific committee in the biodiversity for the benefit of health and economy; charge of all that pertains to: · Production of medicinal plants with a "pharmacopoeia i. Research, training, and information on traditional label"; and medicine; · Extraction of biomolecules with the perspectives of drug ii. Inventory and database building on ethnomedical development. practices and medicinal and food plants; The Malagasy Pharmacopoeia, in both hard copy and iii. Design, development, and production of digital version, is expected to be completed within two phytomedicines and nutraceuticals; and years. iv. Conservation and cultivation of medicinal plants. 5.To promote and facilitate the production of phyto- Phytomedicine production medicines and nutraceuticals in appropriate state institu- The objective of this programme is the formulation of tions and private companies. phytomedicines for local uses and export where appropri- 6.Actively to involve local communities in programs to ate. Basically, this programme is a follow-up of the Mala- develop traditional medicine, using participative ap- gasy Pharmacopoeia. proaches, so that they are both participants and benefi- Six diseases are targeted in the programme, namely: ciaries. diarrhoea, malaria, asthma, diabetes, cardiovascular 7.To create appropriate mechanisms for local communities diseases, and AIDS. to benefit from research results on the potential of their A scientific committee was created to coordinate the respective regions. overall programme. Interested stakeholders are kindly From this strategy, the NationalAdvisory Committee identi- requested to submit a project that will be evaluated by an fied three areas of intervention: (1) Malagasy Pharmaco- expert committee. The draft WHO/AFRO guidelines on poeia, (2) phytomedicine production, and (3) laws and research and meth-odology for evaluating the quality, regulations regarding the practice of traditional medicine. safety, and efficacy of traditional medicines will be recom- mended for all partici-pants. OFAFA, IMRA, and OFAFA Malagasy Pharmacopoeia will be in charge of the production of selected The objective of the programme is to select the 100 top phytomedicines, priority species and to gather all available information.A multi-disciplinary committee composed of medical doctors, pharmacists, scientists, and traditional health practitioners 4 Laws and regulations of the practice of traditional Conclusions medicine A technico-legal committee was created to finalize all texts Madagascar actively took part with Uganda and Ghana in related to laws and regulations on the practice of traditional the adoption of the Decade of Traditional Medicine in medicine. These include: Africa during the OAU Summit held in Lusaka in July · Law relative to the production, control, and commercial- 2001, and participated in the 15th Meeting of the Inter- ization of improved traditional remedies in Madagascar; African Expert Committee onAfrican Traditional Medicine · Law relative to the recognition of the practice of tradi- and Medicinal plants in Arusha in January 2002 for the tional medicine in Madagascar; drafting of a decade plan of action. · Decree relative to the organization of the practice of The overall goal of the programs on traditional medicine traditional medicine in Madagascar; and in Madagascar is an improved conservation, management, · Law relative to the access to the resources of the biologi- and sustainable uses of Madagascan medicinal plants cal diversity in Madagascar. through a multi-sector partnership at national and regional levels, with the aim of integrating traditional and modern Bioprospecting and drug discovery medicine in health care, drug discovery, and poverty Three Institutes are involved in bioprospecting in Madagas- alleviation. It is hoped that within the Decade of African car: Traditional Medicine, relevant achievements will be made · CNARP under the International Cooperative Biodiversity by Madagascar through the strong commitment of the Group (ICBG) program, including Missouri Botanical Ministry of Health and Family Planning. Garden, Centre National de Recherche pour l'Environe- ment, Conservation International, NGO MATEZA, Virginia Polytechnic Institute, Bristol Myers Squibb, and References: Dow Agroscience as partners; · IMRA collaborating with a pharmaceutical company; and Ramisiray, G. 1901. Croyances et pratiques médicales des · Chemistry Laboratory of the Faculty of Sciences under a Malgaches, Thèse de Médecine, Paris; Revue de new ICBG program. Madagascar 8: 549-464. Ranaivo, C. 1902. Pratiques et croyances médicales des The African Traditional Medicine Day: newly Malgaches relatives aux accouchements et à la identified programs médecine infantile, Thèse de Madagascar celebrated the African Day of Traditional Médecine, Paris, 1902; Revue de Madagascar, 5èmeannée, Medicine. It was attended by various stakeholders. Partici- n°1. pp. 42-48. pants agreed on the following programmes: Rasamimanana, J. 1891.Contribution à l'étude de l'action · Evaluation of the efficacy and safety of relevant herbal physio-logique de la tanghinine cristallisée extraite de preparations originating from traditional health practitio- Tanghinia venenifera, Thèse de Médecine, Lyon. ners; and · Evaluation of the efficacy of bone setting. Relevant results will be presented at the next celebration of theAfrican Traditional Medicine Day. This IK Note was written by Philippe Rasoanaivo, and orignally published at the Traditional Medicine Programmes in Madagascar, Biodiversity & Health: Focusing Research to Policy at the proceedings of the International Sympo- sium, held in Ottawa, Canada, October 25-28, 2003. For more information or if you have questions, please contact Philippe Rasoanaivo,email: rafita@wanadoo.mg.