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National Council of Traditional Healers and Herbalists Associations of Uganda (NACOTHA)

The term "traditional medicine" refers to ways of protecting and restoring health that existed before the arrival of modern medicine with medicinal plants being the world's oldest known health-care products. As the term implies, these approaches to health belong to the traditions of each country and have been handed down from generation to generation. Traditional systems in general had to meet the needs of the local communities for many centuries, so it should be prioritized when situations of conflict come into play.  

Traditional medicine is based on "a wholistic/holistic approach to life", equilibrium between the mind, body and the environment with an emphasis on health rather than on disease. Such a unique vision is not common in the Western "scientific" approach to health. For its wholistic approach, traditional medicine highlights the importance of prevention,  maintaining a healthy lifestyle and avoiding certain risk factors. From this point of view, traditional medicine contributes to improving the quality of life of those who suffer from minor illnesses or from certain incurable diseases. Designed by  the constitutional definition of health, this pathway goes beyond the mere absence of disease and introduces a state of complete physical, mental and social well-being.

The National Council of Traditional Healers and Herbalists Associations of Uganda (NACOTHA) is a non-government organization of traditional healers and herbalists associations in the country. NACOTHA was formed in 1990 with the mission of uniting all traditional health practitioners in their associations; contributing to improved community health and health promotion through the strengthened collaboration of traditional healers and herbalists, orthodox medical practitioners and the community; and by strengthening the role of traditional medicine as a primary health care practice.  From this perspective, Ugandan health authorities should promote, encourage and support organizations like NACOTHA, which is fighting for the cause of African traditional medicine throughout Uganda. NACOTHA's  primary goal to develop and promote African traditional healing practices in Uganda has gained success as it seeks to accomplish these major objectives:

  1. To unite all traditional healers and associations in Uganda into a legal functional sector

  2. To lobby, seek government support and NGO partnerships to promote the development and utilization of traditional healing practices.

  3. To build organizational capacity and knowledge of traditional healers. 

  4. To conserve, protect and propagate medicinal plants, animals and cultural sites in all parts of the country.

  5. To conduct functional research on all aspects concerning traditional healing practices in Uganda.

  6. To increase public awareness and understanding about the value of traditional medicine and other healing practices through improving health, prevention and management of diseases.

A large proportion of the population in a number of developing countries, still rely on traditional practitioners including traditional midwives, herbalists and bone-setters, and on local medicinal plants to satisfy their primary health care needs. In Uganda, there is at least one traditional health practitioner for every 200-400 people compared to one orthodox medical practitioner for every 10,000 people. The World Health Organization estimates that traditional midwives assist in up to 95% of all rural births and 70% of urban births in developing countries. The reason for such reliance on traditional medicine is its accessibility and affordability in comparison with allopathic medicine.  Eighty percent of the population in Uganda will resort to traditional medical practitioners for their health problems because of its cost effectiveness, local availability, and synergistic activities. Moreover, not only can traditional medicine be properly used in cases of communicable diseases such as malaria, HIV/AIDS, and in maternal health through traditional midwifery, it also plays a role in this country where people are becoming affected by non-communicable, chronic illnesses and diseases, such as type II diabetes and high blood pressure as the result of adopting a western lifestyle. Therefore, a correct use of such therapies and practices could very well lead to the self-socioeconomic and cultural development of African people worldwide. Traditional healers, encouraged and sensitized by NACOTHA, are now documenting and recording their findings on medicinal plants, disease prevention, management and research. 

 In response to these trends, the government of Uganda has in recent years stepped up its efforts to ensure the promotion of traditional medicine and has shown good will to traditional medicine and related practices. Even so, the monopoly and low level of tolerance on the side of orthodox medical practitioners towards traditional medicine is still significantly evident. Parallel tendencies between traditional and orthodox health practitioners seen at various levels in health provisions is still an obstacle that needs to be seriously addressed to enable a more integrated understanding and application of both systems in medical training and practices.  However, a genuine interest in various traditional practices now exists among practitioners of modern medicine; and a growing number of practitioners of traditional, indigenous or alternative systems are beginning to accept and use some of the modern technology. This serves to foster teamwork among all categories of health workers within the framework of primary health care. 

The reasons for the inclusion of traditional healers in primary health care are manifold. These include: 1) traditional healers know the socio-cultural background of the people; 2) they are highly respected and experienced in their work; 3) economic considerations; 4) the distances covered in some countries; 5) the strength of traditional beliefs; and 6) the shortage of health professionals, particularly in rural areas, to name just a few.  

Over the years, the World Health Assembly has adopted a number of resolutions drawing attention to the fact that most of the populations in various developing countries around the world depends on traditional medicine for primary health care. The work force represented by practitioners of traditional medicine is a potentially important resource for the delivery of health care. The World Health Organization (WHO) through its Traditional Medicine Program, supports Member States in their efforts to formulate national policies on traditional medicine and to study the potential usefulness of traditional medicine. This focus includes evaluating practices and examining the safety and efficacy of traditional remedies, upgrading the knowledge of traditional and modern health practitioners, as well as educating and informing the general public about proven traditional health practices. 

In operation in Uganda is the government's Health Policy 1999 and a draft traditional medicine bill presented to the Parliament. According to the government's health policy, the private sector in Uganda consists of NGOs, private practitioners, the traditional health care system of traditional healers and midwives and an expanding private pharmaceutical sector. It is collectively responsible for a significant proportion of the health sector in the country. Each one of these constitutes sub-sectors with specific comparative advantages, which must be recognized if they are to be fully harnessed. Moreover, the use of traditional medicine as a response to primary health care needs above all, particularly in the poorest populations, makes it one of the most useful means to reach the " Health for All objectives". The achievement of such objectives requires the employment of all the resources available in the government at any kind of level. Within this category, traditional medicine is absolutely a resource, which should not be wasted but properly utilised.  

NACOTHA's Achievements

1. Uniting traditional healers and associations in Uganda.

NACOTHA has been able to carry out concrete research on traditional health practitioners and their initiators in their respective categories. This research, which took a duration of one year, revealed the following inefficiencies and dubious acts claimed to be associated with traditional health practitioners. These included:

Working in close collaboration with relevant authorities, NACOTHA found it necessary to streamline the duties of traditional health practitioners. This was in line with their constitutional mandate to register, censor, control, organize, administer and oversee all traditional healers in the country.  The Offices of Culture and Politics and Underprivileged Youth in the President's Office also backed the recommendation of registering and censuring by giving NACOTHA the sole responsibility to carry out the registration and censoring exercise of all traditional health practitioners in Uganda. The government of Uganda has also recognized the noble job being done by NACOTHA.

  

The Censuring and registration exercise is complete for the Kampala District and a report on the registration exercise has been submitted to the relevant authorities. Seminars, workshops and sensitization of traditional health practitioners about the negative health practices and promotion of current health practices has been done in 16 other districts of Uganda. Seminars, workshops and sensitization of traditional health practitioners is a ongoing process to cover the whole country.

2.  Lobbying for government support.

NACOTHA has liased and coordinated with government officials and NGOs in Uganda so as to harmonize and integrate traditional healers' participation in different national programs. More than that, NACOTHA through seminars and workshops has trained traditional health practitioners and masses on issues like hygiene, disease prevention, crime prevention, AIDS counseling etc. 

NACOTHA has also worked in collaboration with district directors of medical services in .prevention and management of hygiene program. It is working hand in hand with ministry of Gender and Community development in AIDS prevention and management programs. Further more, NACOTHA represents traditional health practitioners in the Inter-agency Coordinating Committee (ICC)-Ministry of Health, Private Partnership-Ministry of Health, World Intellectual Property Organization (WIPO) and the ad hoc committee on the National Drug Authority for herbal medicine.

3. Building organizational capacity and knowledge of traditional health practitioners.

The managerial skills and leadership skills of NACOTHA have been strengthened to substantial levels through trainings of its leaders. Some traditional healers have gained scientific knowledge and equipment through symposiums and workshops. Illiterate traditional health practitioners have been encouraged to go for adult literacy programs. The gap, therefore, remains at organizing traditional health practitioners into one joint body, a gap the National Council Of Traditional Healers and Herbalists Associations (NACOTHA) identified and is trying to bridge.

NACOTHA formed a National Cultural Health Research Center in traditional healing practices and culture at Kijjansi Park. The center accommodates traditional health practitioners who attended to out-patients daily. The traditional health practitioners at the center have learned a lot on how to exchange knowledge, cross-referrals amongst themselves and the follow up of patients with different diseases. 

NACOTHA started an apprenticeship school for the younger generation to learn about their culture.

4. Increase public awareness and understanding about values of traditional medicine and other healing practices in improving health, prevention and management of diseases.

NACOTHA has identified real traditional healing practitioners, exposing and stamping out impersonators who commit crimes and atrocities in the name of traditional health practitioners.

NACOTHA has also conducted sensitization programs through seminars, workshops and radio talk shows to enlighten the public on the value of traditional medicine and how the public can help report any impostor in the sector.

NACOTHA is in the process of documenting and publicizing achievements made in traditional healing practices in the prevention, control and management of diseases especially in caring for people with HIV/AIDS.

 

NACOTHA's Challenges

1. Policy

A policy is "a commitment to a goal and a guide to action". Even if only 25 of WHO's 192 member states (as of 2000) have developed national policies on traditional medicine, these are still necessary tools in order to define the role of traditional medicine in the health care system and its use. In general, such a policy should cover a range of issues, such as: the definition of the government's role in developing traditional medicine in the health-care delivery system; provisions for safety and quality assurance; provisions for education and training; provisions for research and development; and also consideration of intellectual property issues. Though a traditional medicine bill has been drafted in Uganda, no policy has yet been developed for traditional medicine.  

2. Safety, efficacy, quality

Different from allopathic medicine that developed mainly from Western culture, traditional medicine has been influenced by different cultures, historical conditions and the environment. Furthermore, from its common basis as being a holistic approach to life, traditional medicine takes into account multiple and various factors. Its nature, therefore, renders it difficult to be evaluated since there are no common standards and methods to do so. There is research here that is done in traditional medicine but the Afrikan way of research is not similar to scientific research. NACOTHA is not opposed to western scientific methods of research but invites scientists to join them and learn how they carry out the research. This is because traditional medicine has managed to help the population from generation to generation. Afrikan traditional medicine is a different sector not yet known to westerners, so there is need of getting workshops, symposiums and seminars to let us know each other and evaluate each other accordingly.

3. Access

To guarantee access to traditional medicine means to ensure its equitable availability and affordability, with a particular attention to the poorest population. In low-income countries, the need of inexpensive and effective treatments for common diseases is very high. Yet one-third and sometimes up to one-half of the population of these countries lack regular access to essential drugs. Traditional medicine is, in comparison, much more available and affordable than allopathic medicine.

With the purpose of increasing the access to traditional medicine, reliable indicators must be developed to accurately measure financial and geographic levels of access. In addition, the safest and most effective therapies must be identified to provide a sound basis for efforts to promote it.  It should also be considered that traditional practitioners live at the community level, making traditional medicine extremely available. For this reason, "the role" of traditional practitioners should be recognized and cooperation between them and community health-workers should be strengthened.

Other issues are the protection of traditional knowledge, which has been increasingly appropriated, adapted and patented by scientists and industry, and sustainable use of natural resources that are sometimes being wasted and exploited. A method that can be adopted to protect traditional medicine is to create a national inventory of medicinal plants to ensure that indigenous knowledge is correctly and continuously used over generations. An example is the survey among traditional practitioners conducted by the Cote d'Ivoire's Ministry of Health that has recorded more than 2000 traditionally used plants.

4. Rational use

To guarantee rational use of medicines means generally to ensure sound and cost-effective use of drugs by health professionals and consumers. In regard to traditional medicine in particular, rational use has many aspects: proper use of good-quality products; good  communication between traditional medicine providers; provision of scientific information; and guidance for the public. There are various challenges in this regard. With respect to education and training, the knowledge, qualifications and training of traditional medicine providers should be appropriate. In addition, traditional medicine and allopathic practitioners should understand and appreciate the complementarities of the two different approaches. There is, however, no mutual trust between the two health practitioners (Modern and Traditional), making it difficult for the two to genuinely collaborate.

In conclusion, the real challenge facing the advance of traditional medicine is lack of recognition from the government and certain religious groups. This is a critical issue if traditional healing practices have to play a larger role to fill the vacuum left by the crumbling allopathic medicine in many villages of Uganda. Church groups condemn the use of some traditional healing practices because it is rooted in the so-called 'traditional or animistic religion.' It would need more than good will to change the perception of policymakers including politicians, priests, physicians, etc. Due to lack of legalization, there is minimal or no government budget assigned to traditional health practitioners to run their activities like training, research, sensitizations, etc. Traditional medicine can be employed on a variety of different fronts. It is actually used in developing and developed countries for treating both communicable and non-communicable diseases. In this respect, formalization of traditional medicine needs to be done, as a matter of urgency, not only in close consultation with the traditional health sector, but taking direction from them as to appropriate models of formalization and training.