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  1. 1

    WHO traditional medicine strategy: 2014-2023.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 2013. [78] p.

    The WHO Traditional Medicine Strategy 2014–2023 was developed and launched in response to the World Health Assembly resolution on traditional medicine (WHA62.13). The strategy aims to support Member States in developing proactive policies and implementing action plans that will strengthen the role traditional medicine plays in keeping populations healthy. Addressing the challenges, responding to the needs identified by Member States and building on the work done under the WHO traditional medicine strategy: 2002–2005, the updated strategy for the period 2014–2023 devotes more attention than its predecessor to prioritizing health services and systems, including traditional and complementary medicine products, practices and practitioners.
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  2. 2
    Peer Reviewed

    AIDS and the irrational.

    Epstein H

    BMJ. British Medical Journal. 2008; 337:a2638.

    In a recent survey of HIV positive South Africans, almost half believed that tradi¬tional African medicine is more effective than antiretroviral drugs. This is upsetting news. The country has invested heavily in antiretroviral drugs, rapid HIV tests, CD4 cell counters, and condoms and is the site of many clinical trials into novel treatments and HIV prevention devices. In the midst of all this technology, why do irrational beliefs about AIDS persist? The reasons are complex. (excerpt)
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  3. 3

    Traditional health practitioner and the scientist: Bridging the gap in contemporary health research in Tanzania.

    Mbwambo ZH; Mahunnah RL; Kayombo EJ

    Tanzania Health Research Bulletin. 2007 May; 9(2):115-120.

    Traditional health practitioners (THPs) and their role in traditional medicine health care system are worldwide acknowledged. Trend in the use of Traditional medicine (TRM) and Alternative or Complementary medicine (CAM) is increasing due to epidemics like HIV/AIDS, malaria, tuberculosis and other diseases like cancer. Despite the wide use of TRM, genuine concern from the public and scientists/biomedical heath practitioners (BHP) on efficacy, safety and quality of TRM has been raised. While appreciating and promoting the use of TRM, the World Health Organization (WHO), and WHO/Afro, in response to the registered challenges has worked modalities to be adopted by Member States as a way to addressing these concerns. Gradually, through the WHO strategy, TRM policy and legal framework has been adopted in most of the Member States in order to accommodate sustainable collaboration between THPs and the scientist/BHP. Research protocols on how to evaluate traditional medicines for safety and efficacy for priority diseases in Africa have been formulated. Creation of close working relationship between practitioners of both health care systems is strongly recommended so as to revamp trust among each other and help to access information and knowledge from both sides through appropriate modalities. In Tanzania, gaps that exist between THPs and scientists/BHP in health research have been addressed through recognition of THPs among stakeholders in the country's health sector as stipulated in the National Health Policy, the Policy and Act of TRM and CAM. Parallel to that, several research institutions in TRM collaborating with THPs are operating. Various programmed research projects in TRM that has involved THPs and other stakeholders are ongoing, aiming at complementing the two health care systems. This paper discusses global, regional and national perspectives of TRM development and efforts that have so far been directed towards bridging the gap between THPs and scientist/BHP in contemporary health research in Tanzania. (author's)
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  4. 4
    Peer Reviewed

    Antiretroviral therapy abandoned for herbal remedies.

    Ahmad K

    Lancet Infectious Diseases. 2007 May; 7(5):313.

    In Zambia, widespread promotion of claims that herbal remedies can cure HIV/AIDS have been making individuals with HIV/AIDS abandon their antiretroviral therapy for ineffective drugs, the Network of Zambian People Living with HIV and AIDS has warned. Miriam Banda of the Network told journalists that both print and electronic media in the country have been persistently carrying advertisements and news stories that bring false hope to people living with HIV/AIDS. It is unclear how many people have been leaving antiretroviral programmes in the country as a result of these claims. At least 1.1 million people of Zambia's 11.6 million population have HIV/AIDS, which has devastated the economy and decreased life expectancy at birth to less than 40 years. (excerpt)
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  5. 5
    Peer Reviewed

    Traditional medicine development for medical and dental primary health care delivery system in Africa.

    Elujoba AA; Odeleye OM; Ogunyemi CM

    African Journal of Traditional, Complementary and Alternative Medicines. 2005; 2(1):46-61.

    Traditional African Medicine (TAM) is our socio-economic and socio-cultural heritage, servicing over 80% of the populations in Africa. Although, it has come a long way from the times of our ancestors, not much significant progress on its development and utilization had taken place due to colonial suppression on one hand, foreign religions in particular, absolute lack of patriotism and political will of our Governments, and then on the other hand, the carefree attitudes of most African medical scientists of all categories. It is incontrovertible that TAM exhibits far more merits than demerits and its values can be exploited provided the Africans themselves can approach it with an open mind and scientific mentality. The degree of sensitization and mobilization by the World Health Organization (WHO) has encouraged some African countries to commence serious development on TAM. The African Regional Director of the WHO has outlined a few guidelines on the responsibilities of all African nations for the realistic development of TAM, in order to sustain our health agenda and perpetuate our culture. The gradual extinction of the forests and the inevitable disappearance of the aged Traditional Medical Practitioner should pose an impending deadline for us to learn, acquire and document our medical cultural endowment for the benefit of all Africans and indeed the entire mankind. (author's)
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  6. 6

    Living well with HIV / AIDS: a manual on nutritional care and support for people living with HIV / AIDS.

    Food and Agriculture Organization of the United Nations [FAO]. Food and Nutrition Division. Nutrition Programmes Service; World Health Organization [WHO]. Department of Nutrition for Health and Development

    Rome, Italy, FAO, 2002. vi, 97 p.

    The links between nutrition and infection are well known. Good nutrition is essential for achieving and preserving health while helping the body to protect itself from infections. Consumption of a well-balanced diet is essential to make up for the loss of energy and nutrients caused by infections. Good nutrition also helps to promote a sense of well-being and to strengthen the resolve of the sick to get better. The nutritional advice in this manual can help sick people, including those living with HIV/AIDS, to feel better. Few crises have affected human health and threatened national, social and economic progress in quite the way that HIV/AIDS has. The pandemic has had a devastating impact on household food security and nutrition through its effects on the availability and stability of food, and access to food and its use for good nutrition. Agricultural production and employment are severely affected and health and social services put under great strain. Families lose their ability to work and to produce. With worsening poverty, families also lose their ability to acquire food and to meet other basic needs. Time and household resources are consumed in an effort to care for sick family members, partners may become infected, families may be discriminated against and become socially marginalized, children may be orphaned and the elderly left to cope as best they can. Meeting immediate food, nutrition and other basic needs is essential if HIV/AIDS-affected households are to live with dignity and security. Providing nutritional care and support for people living with HIV/AIDS is an important part of caring at all stages of the disease. This manual provides home care agents and local service providers with practical recommendations for a healthy and well-balanced diet for people living with HIV/AIDS. It deals with common complications that people living with HIV/AIDS experience at different stages of infection and helps provide local solutions that emphasize using local food resources and home-based care and support. (excerpt)
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  7. 7

    Our families, our friends: an action guide. Mobilize your community for HIV / AIDS prevention and care.

    Lowry C

    [Bangkok, Thailand], United Nations Development Programme [UNDP], South East Asia HIV and Development Project, 2000. vi, 30 p. (Best Practice Documentation on Community Mobilization for HIV / AIDS: Case of Thailand)

    Community actions on the prevention and control of AIDS are initiated based on the community’s needs. The community hospital may play an important role in promoting and supporting care for people with HIV/AIDS (PWHA) within their area. In turn, the sustainability of controlling HIV problems in the community is based on the strength of that community. Therefore, building resources within the community should be promoted, so that those concerned understand the problems, provide acceptance to PWHA, and work together to reduce the impact of HIV/AIDS. Religious leaders can play a major role in providing support and encouraging social change towards the acceptance of PWHA. Self-help groups are very important community units, they provide care, psychosocial support and generate income for PWHA. The work plan of activities needs to be flexible, based on the needs of PWHA and their community. This action guide can help people in your community to understand how to help one another and work together for their mutual benefit, now and in the future. (excerpt)
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  8. 8

    [People's perception of diseases: an exploratory study of popular beliefs, attitudes and practices regarding immunizable diseases]

    Worldview International Foundation, Bangladesh

    Dhaka, Bangladesh, Worldview International Foundation, 1987 Nov. [44] p.

    Researchers interviewed 57 mothers and 27 heads of family in predominantly rural areas about 135km from the capital city of Dhaka, Bangladesh to learn about their perception of diseases. They also talked with 3 traditional healers and 8 influential people in the different locales, e.g., teachers and imams. They learned that each vaccine preventable disease has at least 1 local name rooted in popular beliefs, e.g., all local names for poliomyelitis are associated with an ominous wind. Generally, the local people believe that witches or evil spirits cause all the vaccine preventable diseases. These entities prefer attacking babies, but also are known to afflict women. A preventive measure practiced includes pregnant women never leaving the house in the evening, at noon, or at midnight since these are the times when they are most exposed to evil spirits. There exist 2 traditional healers--fakirs and kabiraj. Fakirs use mystic words with religious chants and perform various healing rituals. The kabiraj sometimes use healing rituals, but also prescribe indigenous medicines. This research provides some useful insights into WHO's Expanded Programme on Immunization in developing communication strategies which build on what people already know. For example, since the local people believe that evil spirits or witches attack the newborn immediately after birth may provide an incentive for early immunization. Since preventing illness and death in newborns is a goal of both modern and traditional medicine, it is likely that the local people are not so concerned with the real cause of illness and will accept any practice that keeps their infant healthy and that fits into their beliefs and perceptions.
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  9. 9

    Report of the Third Meeting of Directors of WHO Collaborating Centres for Traditional Medicine, Beijing, People's Republic of China, 23-26 October 1995. Sponsored by the World Health Organization in association with the State Administration of Traditional Chinese Medicine of the People's Republic of China.

    World Health Organization [WHO]

    [Unpublished] 1995. [3], 61 p. (WHO/TRM/96.1)

    The Third Meeting of Directors of World Health Organization (WHO) Collaborating Centers for Traditional Medicine was held in Beijing, China, during October 23-26, 1995, to review and discuss activities, progress, problems, needs, developments, and plans for future work. 19 of the 25 collaborating centers for traditional medicine were represented. The Vice-Minister of Public Health and Director-General of the State Administration of Traditional Chinese Medicine welcomed attendees, with the inaugural address given by the Assistant Director-General of the WHO. An account of recent research and developments in traditional Chinese medicine in China was then given by the Director of the Department of Foreign Affairs, State Administration of Traditional Chinese Medicine. The meeting was comprised of a series of presentations on activities in traditional medicine in three WHO regions and at the collaborating centers represented. The presentations were followed on the second day by discussions of the role of collaborating centers and their work plans for the following 4 years, on strengthening cooperation between the centers and WHO, and upon collaboration between the centers themselves. The third day was devoted to a consideration of participants' conclusions and recommendations. On the fourth and final day of the conference, visits were made to the Hospital of the Beijing College of Acupuncture and Traumatology, the Beijing University of Traditional Chinese Medicine, the Institute of Acupuncture, and the Institute of Information on Traditional Chinese Medicine of the China Academy of Traditional Chinese Medicine.
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  10. 10

    Overview of use of traditional medicine in the WHO Western Pacific Region.

    Ken C

    In: Report of the Third Meeting of Directors of WHO Collaborating Centres for Traditional Medicine, Beijing, People's Republic of China, 23-26 October 1995, sponsored by the World Health Organization [WHO] and China. State Administration of Traditional Chinese Medicine. Geneva, Switzerland, WHO, 1996. 25-30. (WHO/TRM/96.1)

    Within the World Health Organization's (WHO's) Western Pacific Region, traditional medicine takes the form of simple family remedies and a system of traditional medicine that has been developed and documented over thousands of years. Traditional medicine is an integral part of the community, and its practitioners are well-patronized and valued. Traditional medicine is accessible and affordable in developing countries. Even in developed countries in the region, traditional medicine is available as an alternative to modern medicine, and medicinal plants are studied as potential sources for pharmaceuticals. While the field of traditional medicine is vast, the WHO has chosen to concentrate on herbal medicine and acupuncture because these aspects have the most to contribute to national health services. In this region, traditional medicine is an integral part of the national health care systems in China, Japan, the Republic of Korea, and Viet Nam, and the WHO regional office will promote the formulation of relevant national policies in these and the other countries it serves. Efforts to promote the safe and effective use of traditional medicine for primary health care include the development of training materials and courses in Viet Nam, selection of medicinal plants in Laos and the Philippines, and promotion of health among the elderly using traditional means in Viet Nam. Efforts in the areas of research, information exchange, and quality control have contributed to improved delivery of traditional health care services. Despite these achievements, the potential impact of the services of traditional practitioners is far from being met. Training of both traditional and modern practitioners requires strengthening, increased information exchange, assured government involvement, and financial support.
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  11. 11

    WHO activities in traditional medicine in the Eastern Mediterranean Region (summary of presentation).

    Habib AA

    In: Report of the Third Meeting of Directors of WHO Collaborating Centres for Traditional Medicine, Beijing, People's Republic of China, 23-26 October 1995, sponsored by the World Health Organization [WHO] and China. State Administration of Traditional Chinese Medicine. Geneva, Switzerland, WHO, 1996. 23-4. (WHO/TRM/96.1)

    Goals of the World Health Organization (WHO) Eastern Mediterranean Region's Traditional Medicine Program include recommending ways to promote traditional herbal medicine, preparing a list of and information sheet about essential medicinal herbs, and, most urgently, developing guidelines for the formulation of national policies. Extending health care coverage through the authenticated, safe, and efficacious use of traditional medicines will require recognition of traditional medicine in the national health care system, preparation and dissemination of information, compiling a list of essential medicinal herbs, securing a regular supply of these herbs, research into development of new remedies, development of quality assurance programs, and establishment of regulatory measures. Many of these tasks can be performed by national advisory committees.
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  12. 12

    WHO activities in traditional medicine in the African region.

    Koumare M

    In: Report of the Third Meeting of Directors of WHO Collaborating Centres for Traditional Medicine, Beijing, People's Republic of China, 23-26 October 1995, sponsored by the World Health Organization [WHO] and China. State Administration of Traditional Chinese Medicine. Geneva, Switzerland, WHO, 1996. 17-22. (WHO/TRM/96.1)

    Within the World Health Organization's (WHO) African Region, there is a great deal of interest in incorporating traditional health practitioners in national health systems. This interest is in line with the objective of the WHO Regional Office (to promote rational utilization of traditional medicine within national health care systems). Specific objectives are to help develop policy clarifying the role of traditional medicine in this context, to identify through research and to license appropriate traditional techniques, and to provide complementary training to practitioners of traditional and modern health care systems. The Region's goals are to have such training programs implemented in 25 of the 46 member states by December 1995. By this date, inventories and licensing studies should be instigated in an additional 5 states, and formal structures should be established in yet another 5. Education, information, and advocacy will be forwarded through a series of workshops. The current status of the practice of traditional medicine in the region has been assessed through a survey questionnaire. The Regional Office has contributed to international efforts in this field and is in the process of creating a regional data bank. Constraints include the absence of a focal point for traditional medicine in the various countries, the skepticism of certain decision makers, the lack of objectives and materials for retraining of practitioners in the two systems, and inadequate funding. A biennial regional workshop would foster important South-South cooperation in achieving programmatic goals. In addition to meetings of Directors of the WHO Collaborating Centres, WHO traditional medicine advisors should meet annually to evaluate the program and share experiences.
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  13. 13

    Introductory remarks.

    Zhang X

    In: Report of the Third Meeting of Directors of WHO Collaborating Centres for Traditional Medicine, Beijing, People's Republic of China, 23-26 October 1995, sponsored by the World Health Organization [WHO] and China. State Administration of Traditional Chinese Medicine. Geneva, Switzerland, WHO, 1996. 11-6. (WHO/TRM/96.1)

    During his introductory remarks to the Third Meeting of Directors of the World Health Organization (WHO) Collaborating Centres for Traditional Medicine, Dr. Xiaorui Zhang, Medical Officer of the WHO Traditional Medicine Programme, noted that the number of Collaborating Centres has grown from 10 in 1981 to 21 in 1987 and 25 today (in 1996). The WHO Traditional Medicine Programme and the Collaborating Centres promote and develop traditional medicine, provide technical support, promote the proper use of traditional medicine, and disseminate information on traditional medicine. Zhang sketched the purposes of the meeting as reviewing the work of the Centres as well as their research accomplishments, developing a publication on the latest developments and research in traditional medicine, discussing work plans for the next 4-8 years, and promoting the exchange of information and knowledge among the Centres.
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  14. 14

    Inaugural address.

    Antezana FS

    In: Report of the Third Meeting of Directors of WHO Collaborating Centres for Traditional Medicine, Beijing, People's Republic of China, 23-26 October 1995, sponsored by the World Health Organization [WHO] and China. State Administration of Traditional Chinese Medicine. Geneva, Switzerland, WHO, 1996. 4-6. (WHO/TRM/96.1)

    Dr. Fernando Antezana, Assistant Director-General of the World Health Organization (WHO) delivered the inaugural address at the Third Meeting of Directors of WHO Collaborating Centres for Traditional Medicine. He noted that revived interest in the use of traditional medicines throughout the world led countries to seek cooperation from the WHO in identifying positive elements of traditional medicine for inclusion in national health systems. The WHO seeks to ensure that traditional medicine is examined critically but with an open mind using a realistic and pragmatic approach. Thus, useful traditional practices may be linked with modern medicine to great advantage. WHO recognizes that much of the world's population depends upon traditional medicine, that practitioners are a potentially important resource for the delivery of health care, and that medicinal plants are very important. The objectives of this meeting are for participants to exchange views and share experiences as well as to decide how the role of traditional medicine can be more clearly established within national health systems. Such a move also furthers the cost containment goals of health systems.
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  15. 15

    Address of welcome.

    Zhang W

    In: Report of the Third Meeting of Directors of WHO Collaborating Centres for Traditional Medicine, Beijing, People's Republic of China, 23-26 October 1995, sponsored by the World Health Organization [WHO] and China. State Administration of Traditional Chinese Medicine. Geneva, Switzerland, WHO, 1996. 2-3. (WHO/TRM/96.1)

    The Vice-Minister of Public Health and Director-General of the State Administration of Traditional Chinese Medicine (SATCM), Dr. Zhang Wenkang, presented a welcoming address at the Third Meeting of Directors of the World Health Organization's (WHO) Collaborating Centres for Traditional Medicine. Zhang noted that traditional medicine has played a significant role in human prosperity throughout history in many nations. In recognition of this, the WHO has designed 25 Institutions as Collaborating Centres in Traditional Medicine. China has a constitutional mandate to develop both modern and traditional medicine and has established the SATCM to oversee the development of traditional medicine. Traditional medicine and pharmacology are being integrated with modern science through research, development of traditional preparations, and the dissemination and application of nonmedical therapies. China will continue to support the work of the WHO in this regard.
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  16. 16

    Traditional medicine and WHO.

    Zhang X

    WORLD HEALTH. 1996 Mar-Apr; 49(2):4-5.

    In 1977, the year in which the World Health Organization (WHO) Traditional Medicine Program was established, the World Health Assembly urged governments to give their traditional systems of medicine the greater attention which they need and merit. Appropriate regulations should be developed and applied as suited to national health system needs. Traditional medicine plays a major role in primary health care in many developing countries, and its use has increased in recent years. WHO understands that while many elements of traditional medicine are beneficial, others are not. The organization therefore does not blindly endorse all forms of traditional medicine, but works to ensure that traditional medicine is examined critically and objectively, and that safe and effective forms of traditional medicine are developed and made available to the public. WHO supports research and training in traditional medicine in member states. National policy, herbal medicine, acupuncture, and training and research are discussed.
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  17. 17
    Peer Reviewed

    Health for all by 2000 AD: the role of Ayurveda.

    Ghai S; Ghai CM

    NURSING JOURNAL OF INDIA. 1994 Jun; 85(6):122-4.

    It is difficult to provide comprehensive primary health care to entire populations in developing countries like India where 80% of the population lives in rural areas. People continue, however, to contract diseases and die despite advances in science, medicine, and technology. Many people who live in villages could enjoy better health status if they were informed about the unsanitary nature of their living conditions and taught how to practice preventive and promotive health care. One of the most certain and feasible ways to reach the entire world population with education about the importance of basic, preventive, and promotive health care and how to secure it is to enlist the support and help of traditional medicine and its practitioners in cultures worldwide. In so doing, primary health care will become a mass grassroots movement. The World Health Organization has acknowledged the need to involve traditional medicine in its drive to secure Health for All by 2000. Health for all demands focus upon health at the local level, rooted in the natural and cultural environments of populations concerned. The authors describe Ayurveda, the traditional system of medicine in India, and how it emphasizes the prevention of disease.
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  18. 18

    Traditional knowledge and sustainable development. Proceedings of a conference sponsored by the World Bank Environment Department and the World Bank Task Force on the International Year of the World's Indigenous People, held at the World Bank, Washington, D.C., September 27-28, 1993.

    Davis SH; Ebbe K

    Washington, D.C., World Bank, 1995. vii, 58 p. (Environmentally Sustainable Development Proceedings Series No. 4)

    On September 27 and 28, 1993, the World Bank indicated its support to the UN International Year for the World's Indigenous People by hosting a conference on traditional knowledge and sustainable development. The proceedings of this conference are presented in two sections. The first section contains a summary of the conference in which several themes were highlighted, including the importance of traditional knowledge to the cultural survival of indigenous peoples, the relationship of this knowledge to the land and environment, the contributions that traditional knowledge can make to agricultural sustainability and health, the relevance of traditional institutions for development planning, and recent government and international initiatives concerning traditional knowledge and the rights of indigenous peoples. This section concludes with remarks by the World Bank's Vice President for Environmentally Sustainable Development. The second section provides a transcript of a roundtable discussion involving conference participants who emphasized that 1) traditional knowledge must be understood in its cultural context, 2) development and the preservation of traditional knowledge are not contradictory, 3) local participation is crucial to the success of development interventions, 4) the integrity and survival of indigenous people depend upon preservation of their land rights, and 5) a new partnership must be forged among indigenous peoples, national governments, and international development agencies. Appended to this document are the conference program, a list of participants, a directory of indigenous knowledge resource centers, the World Bank's Operational Directive on Indigenous Peoples, and a selected bibliography.
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  19. 19

    Nature's medicinal bounty: don't throw it away.

    Akerele O

    WORLD HEALTH FORUM. 1993; 14(4):390-5.

    About 80% of the world's people depend largely on traditional plant-derived drugs for their primary health care (PHC). Medicinal plants serve as sources of direct therapeutic agents and raw materials for the manufacture of more complex compounds, as models for new synthetic products, and as taxonomic markers. Some essential plant-derived drugs are atropine, codeine, morphine, digitoxin/digoxin, and quinine/artemisinin. Use of indigenous medicinal plants reduces developing countries' reliance on drug imports. Costa Rica has set aside 25% of its land to preserve the forests, in part to provide plants and other materials for possible pharmaceutical and agricultural applications. The Napralert database at the University of Illinois establishes ethnomedical uses for about 9200 of 33,000 species of monocotyledons, dicotyledons, gymnosperms, lichens, pteridophytes, and bryophytes. Sales of crude plant drugs during 1985 in China equaled US$1400 million. Even though many people use medicinal plants, pharmaceutical firms in industrialized nations do not want to explore plants as sources of new drugs. Scientists in China, Germany, and Japan are doing so, however. Screening, chemical analysis, clinical trials, and regulatory measures are needed to ensure safety of herbal medicines. WHO has hosted interregional workshops to address methodologies for the selection and use of traditional medicines in national PHC programs. WHO, the International Union for the Conservation of Nature and Natural Resources, and the World Wide Fund for Nature developed guidelines for conservation of medicinal plants. Their 2-pronged strategy includes prevention of the disappearance of forests and associated species and the establishment of botanical gardens. WHO's Traditional Medicine Programme hopes that people will apply known and effective agroindustrial technologies to the cultivation and processing of medicinal plants and the production of herbal medicines and the creation of large-scale networks for the distribution of seeds and plants.
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  20. 20

    Policy aspects of community participation in maternal and child health and family planning programmes.

    Askew I; Carballo M; Rifkin S; Saunders D

    Geneva, Switzerland, World Health Organization, 1989. [2], 56 p. (WHO/MCH/89.14)

    The International Conference on Primary Health Care (PHC) organized by WHO and UNICEF in Alma Ata in 1978 pointed to involving the public in health care services including planning, implementation, and evaluation. These projects, experience in other areas of community participation (CP) as well as a meeting that was organized by WHO and the UN Fund for Population Activities (UNFPA) in Zimbabwe in October 1986 are detailed. The rationale for CP is to improve health service delivery and to enable health service users to have more control. Emphasis is placed on women in communities as the key participants in maternal and child health/family planning (MCH/FP) programs to increase their status. Women are the beneficiaries of MCH/FP services with traditional responsibility for the health of their families. They make up the majority of nurses, modern and traditional midwives, and paramedical workers within the formal system. In traditional communities women become community health workers (CHWs) and village development workers. WHO has supported research to assess the health impact of community participation in health services. UNICEF has focused on a more integrated approach where community participation is promoted through community development activities. UNFPA has supported projects in which traditional birth attendants or village health workers are trained to improve their skills in MCH/FP. Some policy issues for CP implementation in MCH/FP programs include: decentralization of the health care systems; health care information and education; training; resources for CP in MCH/FP activities; implementing MCH/FP activities in the community (antenatal care, delivery care, child care, and FP care); promoting multi sectoral collaboration; and evaluating and monitoring community participation. Some international research projects initiated are the PRICOR operations research project on the implementation of the PHC (supported by USAID), and ESCAP's cross-cultural research project about constraints on community participation in national FP programs (supported by UNFPA). Governments are urged to hold workshops for policymakers, train district and local officials in managerial skills, develop guidelines for medical preventive health training curricula, and develop management information systems.
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  21. 21
    Peer Reviewed

    Jidda: the traditional midwife of Yemen?

    Scheepers LM

    Social Science and Medicine. 1991; 33(8):959-62.

    An investigation on the "jidda," the traditional birth attendant (TBAs) of Yemen, was undertaken in 1989 because WHO training of TBAs in Yemen was regarded to have had mixed results. Information was collected through semistructured interviews between July and November 1989 in villages in the Anis region of the central highlands of Yemen: Taalibi, Hamaan Ali, Dhi Hud, Al Mashahidhah, and Al Masna'ah. Taalibi and Hamaan Ali were two of the original training sites, at which all 16 TBAs were trained. Of these, 14 TBAs plus approximately 28 untrained TBAs and village women were selected at random and interviewed. Quantitative data on the number of deliveries made before and after the training by 7 of the TBAs were made available. The term "jidda" was designated as the appropriate Yemini Arabic name for TBA and was generally accepted within the Primarily Health Care (PHC) terminology within Yemen. The term literally means grandmother. WHO policy assumes that the training of one or two TBAs in each village will provide all women with basic mother and child health care. Initially a confusing mixture of terms was used in the villages to refer to women who assist at deliveries. These terms included references to the woman who cut the cord. A final understanding was reached that the term "jidda" will mean WHO project-trained women. Nontrained women are called "those who cut the cord." The term "jidda" as a person with specialized knowledge and experience with deliveries is not connected to traditional terms for women, who of old, assisted at deliveries. Assistance at delivery is provided by variety of kin, neighbors, and related women living proximate to the women delivering. Remuneration is the promise of rewards in the afterlife. The job is not a fulltime occupation. The delivery process is describe, and it is clear that the assistant provides emotional support and literally cuts the cord. Providing an image of professionally and specialization and the bag of instruments to a few "jidda" has lead to inequality and confusion. "Jidda" still cut the cord, and the 7 trained "jidda" have not expanded their area outside if their neighborhoods. It is suggested that training be given to midwives and that research into the local situation occur prior to training activities in order for objectives to be achieved. In this situation less sophisticated training should be given to all women assisting in deliveries.
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  22. 22

    Community based health care and the interface with the basic health services.

    Streefland P; Chabot J

    In: Implementing primary health care: experiences since Alma-Ata, edited by Pieter Streefland and Jarl Chabot. Amsterdam, Netherlands, Royal Tropical Institute, 1990. 33-40.

    Community health care in developing countries consists of 1) self-medication, traditional medicine, and modern drugs; 2) the activities of village health workers (VHW) and village health committees (VHC); and 3) the outreach activities of basic health services (BHS). The village population, with it social stratification, sustains community-based health care (CBHC). In Africa, the VHWs are young literate males trained in curative and preventive work, or older, illiterate female traditional birth attendants (TBAs). TBAs are part of traditional medicine. Training of both paramedical in a district health center provides the TBA with a delivery kit and the VHW with 10-15 essential drugs for treating common illnesses. BHS is often entangled in the skirmishes of governments eager to promote primary health care and non-governmental organizations testing CBHC initiatives. VHWs are pain in different ways: 1) regularly by the government as is the case in Liberia, Zimbabwe, and India; 2) through remuneration by the community; or 3) not at all (they volunteer their services). The preconditions of the viability of CBHC that it be tailored to a specific sociocultural situation (thus avoiding an ineffectual blueprint approach) and that outside donor support be used prudently beyond an initial training. The question of financial reward for the VHWs by the village, the household, or the individual is also linked to CBHC viability. The selection of VHWs and the composition of VHCs require careful deliberation. Successful CBHC mandates clear rules, accountability, and a clearly-defined operation.
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  23. 23
    Peer Reviewed

    Side effects: cultural constructions and reinterpretations of western pharmaceuticals.

    Etkin NL

    MEDICAL ANTHROPOLOGY QUARTERLY. 1992 Jun; 6(2):99-113.

    In drug development and marketing, multinational companies tend to patronize developing countries and even raise health risks by distributing products of questionable utility. The World Health Organization has pushed for standardization and quality assurance of drugs to compel companies to fully disclose adverse reactions. Clinical trials use small and unrepresentative samples, thus longterm side effects are not taken into consideration such as steroid-induced hypertension in asthma patients. Unintended side effects are true side effects in the view of some (hair loss and lacrimation in anticoagulant therapy). Reactions that encompass primary and secondary effects include allergic reactions, hypersensitivity, and the corollaries of differential drug metabolism (serum albumin polymorphisms, G6PD deficiency, hemoglobinopathies, and hepatic enzyme irregularities). Primary action and side effects are subject to interpretations, as the antihistamine Benadryl causes drowsiness when used for allergies, but as a sedative its ability to induce drowsiness is the primary action. Minoxidil promotes hair growth, but it was originally developed as an oral hypotensive, and it also could treat impotence. RU-486 or mifepristone, the abortion pill, has been used for glaucoma and brain tumor treatment. The Hausa of Nigeria use both indigenous plant medicines and drugs, but their cultural interpretation of drug effects can lead to confusion: bitter plants have been used as abortifacients and the bitter drugs chloroquine, penicillin, and chloramphenicol have also been endowed with such qualities. Stomach aliments are treated with chile pepper, coffee senna, and balsam apple along with erythromycin and salicylates to induce purging. The tooth discoloration caused by tetracycline therapy is imputed to witchcraft. A more relativistic approach concerning the side effects of drugs is needed as their perception in many cultures is conceptually different.
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  24. 24
    Peer Reviewed

    Medicalization and its discontents.

    Goodman MJ; Goodman LE

    Social Science and Medicine. 1987; 25(6):733-40.

    In 1978 leaders from 134 governments and 67 UN bodies proclaimed their union of purpose to bring Health For All by 2000. They described health in terms of access to primary health care, not the freedom of disease. The plan they developed was designed to bring all health care providers together, be they medical doctors (MDs) from Western medical schools herbalists, shamans or barefoot doctors. The plan was to create a system of referrals where people would initially turn to their traditional healers for help and then be moved along the system as the complexity of the condition exceeded the ability of attending healer. However, the system failed because of 3 major factors: political resistance, professional and economic inertia, and chauvinism and emulousness called the Jazz Factor. Instead of acting like a funnel to move people along the system from the less advanced to the more advanced healers, it acted like a filter. The political resistance is clearly seen when a careful examination of the AIDS virus is made. Many African nations refused to acknowledge that AIDS was even in their countries. Thailand was so fearful of losing tourism dollars that it covered up the fact that many of their prostitutes are infected. US servicemen are tested and discharged if they are found to be infected. In many US states people's rights to privacy hamper the control of the spread of AIDS. The sexual revolution is founded on liberal principles of freedom. The result is the right of individuals to spread the disease if they so choose. Economics plays its role when we see the linking of profit motive and the public interest in the health care area. The Jazz Factor refers to the practice of considering prestige over practicality. Oral rehydration therapy is an excellent example of this. Today dehydration caused by diarrhea is the single biggest cause of death among children. Yet the cure is so simple, so easy, and so inexpensive that it is within the reach of almost every family on earth. 1 reason given for this fact that there is no profit to be made from ORT. Today health care professionals still prescribe US$400 million worth of antidiarrheal drugs.
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  25. 25

    Trip report: Uganda.

    Casazza LJ; Newman J; Graeff J; Prins A

    Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1991. [41] p. (USAID Contract No. DPE-5969-Z-00-7064-00)

    Representatives from several nongovernmental organizations visited Uganda in February-March 1991 to help the Control of Diarrheal Disease (CCD) program bolster its ability to advance case management, training, and supervision of health care professionals. Specifically, the team focussed its activities on determining a strategy to create a national level diarrhea training unit (DTU) centered around case management for medical officers, interns and residents, medical students, and nurses. Similarly, it participated in developing a strategy for training traditional healers in diarrhea case management and for inservice training for health inspectors (preventive health workers). The team presented a generic model for a training/support system to the DTU faculty and CDD program manager. The model centered on what needs to be done to ensure that the local clinic health worker manages diarrhea cases properly and instructs mothers effectively to manage diarrhea. Further, in addition to comprehensive case management, content included interpersonal communication at all levels supplemented by supervision and training skills. It encouraged a participatory approach for training. In addition, it strongly encouraged the DTU faculty and CDD program staff to follow up on training activities such as supporting trainees and reinforcing skills learned in the training course. The team met with relevant government, university, and donor representatives to learn more about existing or proposed CDD activities. Further, the CDD program asked team members to assist informally in the surveyor training session for the WHO/CDD Health Facilities Survey. The team also spoke to WHO/CDD staff about its plans and future activities. WHO/CDD was concerned that training in interpersonal skills not weaken the quality of training in diarrhea case management.
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