Traditional Medicine in Uganda: Historical Perspective, Challenges and Advances NotesKI "Traditional medicine" refers to the ways that existed of protecting and restoring health before the arrival of modern medicine (World Health Organization - WHO 1996). It has also been defined as the sum total of all knowledge and practices used in the prevention, diagnosis, and elimination of physical, mental or social imbal- ances and which relies exclusively on practical experience and observation handed down from generation to generation, whether orally or in writing (Akerel, 1984). It has bee debated whether the word "traditional" should be used at all, as it implies some degree of stagnancy or backwardness (Heggenhougen et al 1998). http://www.worldbank.org/afr/ik/default.htm T he traditional medical practi- reotypes are fast fading (Van der Geest tioner has been defined by a 1997). For example, with increased ur- regional committee of the Afri- banization, many practitioners do not can region of the WHO ( 1976 ) as know their patients as well as was the being "a person who is recognized by case earlier and often deal with patients the community in which he lives as of different cultural, social, and religious competent to provide health care by backgroundsthanthemselves. No. 67 using vegetable, animal, and mineral April 2004 substances and certain other meth- ods. These methods are based on so- IK Notes reports periodically on cial, cultural and religious back- Indigenous Knowledge (IK) initiatives in Sub-Saharan Africa and occasionally grounds as well as on the knowledge, on such initiatives outside the Region. attitudes, and beliefs that are preva- It is published by the Africa Region's lent in the community regarding Knowledge and Learning Center as part of an evolving IK partnership physical, mental, and social well be- between the World Bank, communi- ing and the causes of disease and dis- ties, NGOs, development institutions and multilateral organizations. The ability" (Sofowora 1982). This defini- views expressed in this article are World Bank tion has been long and widely used. those of the authors and should not be However, caution needs to be exer- attributed to the World Bank Group or its partners in this initiative. A cised when basing health policy upon webpage on IK is available at // these all-embracing and often mis- www.worldbank.org/afr/ik/ default.htm leading definitions as the older ste- 2 Categorization of traditional medicine needs on treatment from traditional medical practitioners (Koumare 1983). Since 1977, when it established its tradi- Traditional medicine covers a wide and heterogeneous field tional medicine program, the WHO, has "stressed the need of medical practice. Attempts have been made to categorize for governments of the countries interested in the use of tra- traditional healers on the basis of their method of healing or ditional medical practices to give adequate support to en- the ailments they treat. One categorization based on type of gaging traditional medical practitioners in primary health healing divides healers into pure herbalists--herbalist, ritu- care programs." It also encourages and supports countries in alist and spiritualists (IDRC 1980). It then subdivides these identifying and providing safe and effective remedies and categories into generalists and specialists according to their practices for use in the pubic and private health services degree of polarization in treating one or more illnesses. (WHO 1998). The degree of training and qualification of these healers In the pre-colonial era, as in other African countries, tradi- varies, with some having undergone quite a vigorous and tional medicine was the only health system in Uganda. Under lengthy period of training, others having been initiated or colonial control, traditional medicine practice was equated having had a calling, while others have little training and low with witchcraft and seen as contrary to the cause and ideals ethical standards, making it easy for critics to label them of the pre-eminent colonial religion and western medicine. unscientific and "charlatans". The use of traditional medi- Though actively suppressed, it was still practiced in a less cine in developing countries is universal, according to the explicit manner. After independence in 1962, trends towards WHO. It estimated that 80 percent of the populations of strengthening national and cultural identities began re- most underdeveloped countries rely for their health care emerging. The current government is very supportive of tra- ditional medicine and has encouraged its "integration into IK Notes the existing health services." The organizational relationship between traditional medicine and Western-type health sys- tems in Uganda has been a "tolerant" one (traditional practi- would be of interest to: tioners are free to practice as long as they do not claim to be registered medical practitioners because, although recog- Name nized, traditional healers cannot make such claims since the repeal in 1996 of the 1968 Medical and Dental Practitioners Institution Act ). However, the government has moved closer to integra- tion. The category referring to both systems is officially rec- Address ognized and serves patients through equal but separate sys- tems; and the other category referring to both systems being combined in medical education is jointly practiced within the health services of the country. The great majority of tra- ditional practitioners in Africa are herbalists with only 5 per- cent being pure spiritualists. The prevalence of the use and Letters, comments, and requests for publications should be addressed to: utilization of traditional medicine in Uganda is similar to other parts of Sub-Saharan Africa. In Uganda, the ratio of tra- Editor: IK Notes ditional practitioners to population was estimated by Hogel Knowledge and Learning Center Africa Region, World Bank et al. in 1991 to be 1:287 (Green 1994 :19) compared to the 1818 H Street, N.W., Mailstop J8-811 ratio of medical doctors to population, which is 1:10,000 in Washington, D.C. 20433 E-mail: pmohan@worldbank.org urban areas and 1:50,000 in the rural areas. 3 Traditional medicine, law and policy The Drugs Regulatory Authority Act of August 1993, stat- ute 13, stated that "there should be research into and pro- Until independence, traditional medicine was legislated un- motion of traditional and herbal medicine". Though the pro- der the still-functioning Witchcraft Act (1957), which made curement and distribution of all drugs comes under the Na- the practice of witchcraft or the representation of oneself as tional Drug Authority (NDA), the NDA Policy and Authority a person possessing supernatural powers an offense per se, statute of 1993 has no provision for handling herbal medi- whatever the purpose for which the act may be committed. cines. Also, there is no provision for the production, distribu- The Medical and Dental Surgeons Act of Uganda, 1968, pro- tion and use of herbal medicines. The NDA has been given hibited unlicensed persons from practicing medicine, den- the task of formulating policy on herbal medicines and has tistry or surgery. However, in Section 36, it allowed for the set up a special technical advisory committee on herbal practice of any system of therapeutic medicine by a duly- medicines to do so. This committee drafted its first report in trained person recognized by the community to which he September 1997, and further drafts are pending. belongs, provided that the person/practice is limited to that Despite all these trends towards establishing and regulat- community only. ing herbal medicine use, the present legal status of tradi- In 1987, the Health and Policy Review Commission made a tional medicine remains unclear. The Medical and Dental number of recommendations about traditional practitioners, Surgeons Act, 1968, has been repealed, and replaced by the which include the following: Medical and Dental Practitioners statute of 1996. There is no ˇ Their inclusion in local health teams and use in Primary provision for traditional practitioners in this most recent leg- Health Care delivery islation, leaving the traditional practitioners in a legal ˇ The formation of National Associations for traditional prac- limbo. The government has ordered the formulation of a Tra- titioners ditional Medicine Bill, and the Ministry of Health has set up ˇ The Ministry of Health (MoH) to arrange appropriate train- a program--Public-Private Partnerships--that has been com- ing programs for traditional healers, practitioners such as missioned to draft it. The ministry has, under this program, Traditional Birth Attendants, and bone setters appointed a National Task Force chosen from among the gov- ˇ The referral of patients between medical practitioners and ernment institutions and ministries, such as the Ministry of traditional practitioners to be an open and acceptable Gender and Social Development, Ministry of Justice, Minis- practice. try of Planning and Economic Development, as well as repre- sentatives from the Traditional Healers Associations, non- In the area of further research into traditional medicine, it governmental organizations and other stakeholders who to- recommends that: gether are intended to enrich the terms of references of this ˇ The Natural Chemotherapeutics Research Laboratory program. This program is mandated to come up with a draft should be strengthened to carry out applied research on Traditional Medicine Bill that will be presented to Parlia- such aspects as packaging and bottling of traditional medi- ment for debate and possible enactment into law. Hopefully, cines this process will formalize the legal recognition of tradi- ˇ Land should be made available to grow medicinal plants tional medicine practice in Uganda. identified by the traditional healers, and funds should be made available to preserve these identified species. 4 References 7. Foster G.M. (1983), "An Introduction to Ethno medicine." In Bannerman, R.H. (ed.) (1983) Traditional Medicine and 1.Akerele. O (1984), "WHO's Traditional Medicine Program: Health Care Coverage, Geneva WHO. Progress and Perspectives," WHO Chronicle, 38 (2), 76-81. 8. IDRC (1980), Traditional Medicine in Zaire: present and 2.Heggen Hougen, K and Sesial-Lewis, P. (1998), Traditional potential contribution to the health services. Ottawa-Ont. Medicine and Primary Health Care. An introduction and IDRC. selected annotated bibliography. EPC Publications N0. 18, 9. WHO (1998), "Policy and activities on Traditional Medi- Autumn 1988, LSHTH. cine. " Accessed January 1999. 3.Sofowora, A. (1982), Medicinal Plants and Traditional 10. Green, A.C.(1997), "The participation of African Tradi- Medicine in Africa. Chichester, John Wiley and Sons LTD. tional Healers in AIDS/STD prevention programs." Tropi- 4.Kaumare M. (1983), "Traditional Medicine and Psychiatry cal Doctor 27 suppl. 1) 56-59. in Africa". In Bennerman, R-H (ed.) 1983 , Traditional 11. National Drug Authority, Uganda (1997), Technical Advi- Medicine and Health Coverage. Geneva WHO. sory Committee on Herbal Medicines : First Report. 5.Sindiga I, et al. (eds.) (1995), Traditional Medicine in Af- rica, Nairobi, East Africa Educational Publishers. 6. Van der Geest (1997), "Is there a role for Traditional Medicine in basic health services in Africa? A plea for a community perspective," Tropical Medicine and Int. Health, 2,9: 903-911. This article was written by Dr. Sekaya Yahaya, Mr. Warren Aryeija, and Ms. Unice Bitwari. It was first published by PROMETRA in its magazine, Médécine Verte, No. 01, July­September 2001. This version is a translation of the origi- nal. For more information, please contact Dr. Eric Gbodossou : Erick@refer.sn