Development of national policy on traditional medicine

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DEVELOPMENTOF NATIONAL

POLICY ONTRADITIONAL

MEDICINEA REPORT OF THE WORKSHOP ON DEVELOPMENT OF NATIONAL

POLICY ON TRADITIONAL MEDICINE, 11-15 OCTOBER 1999,BEIJING, CHINA

WORLD HEALTH ORGANIZATIONWestern Pacific Region

2000

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© World Health Organization 2000

This document is issued by the World Health Organization -Regional Office for the Western Pacific (WHO/WPRO) for general

distribution. All rights are reserved. Subject to due acknowledgement toWHO/WPRO, this document may, however, be freely reviewed,

abstracted, reproduced or translated, in part or in whole, provided thatsuch is not done for or in conjunction with commercial purposes and

provided that, if it is intended to translate or reproduce the entire work, orsubstantial portions thereof, prior application is made to the Publications

Unit, WHO/WPRO, Manila, Philippines.

The views expressed in this Report are those of the participants in theWorkshop on Development of National Policy on Traditional Medicine,11-15 October 1999, Beijing, China, and do not necessarily reflect the

policy of the World Health Organization.

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CONTENTSSummary 1

1. Introduction 4

1.1. The objectives of the workshop 6

1.2 Participants 6

1.3 Organization 6

1.4 Opening ceremony 6

2. Proceedings 8

2.1 Introduction: purpose of the 8meeting and method of work

2.2 Presentations: role of traditional 8medicine

2.3 Issues raised during discussion 10of country reports

2.4 Group discussion session one: 11concept, scope and role oftraditional medicine

2.5 Plenary session: concept, scope and 12role of traditional medicine

2.6 Field visit 13

2.7 Presentations on policy and 14programme development

2.8 Group discussion session two: 24development of national policyon traditional medicine

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2.9 Plenary session on conclusions and 25recommendations

2.10 Closing ceremony 27

3. Conclusions and Recommendations 29

3.1 Conclusions 29

3.2 Recommendations 38

ANNEXES:

Annex 1: List of Participants, Temporary 41Advisers, Consultant, Observersand Secretariat

Annex 2: Opening speech of Dr Shigeru Omi, 51WHO Regional Director for theWestern Pacific

Annex 3: Summary of Country Reports 53

CambodiaPeople’s Republic of ChinaCook IslandsFijiFrench PolynesiaHong Kong, ChinaKiribatiLao People’s Democratic RepublicMalaysiaMongoliaPapua New GuineaPhilippinesRepublic of KoreaSamoaSingaporeSolomon IslandsViet Nam

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DEVELOPMENT OF NATIONAL POLICY ON TRADITIONAL MEDICINE

SUMMARYThe workshop on development of national policy on traditional

medicine took place in Beijing, China, from 11 to 15 October 1999.The main objectives of the meeting were:

(1) to review the role of traditional medicine andgovernment policy;

(2) to share experiences with participants from othergovernments;

(3) to identify difficulties and constraints; and

(4) to discuss ways for setting up a policy.

The meeting was attended by 18 participants from 17 countriesof the Western Pacific Region, four temporary advisers, oneconsultant, the responsible officer from the WHO Regional Officefor the Western Pacific, a representative of WHO TRM/AFRO andfive observers. Mr Jiang Zaizeng was elected Chairman andDr Umadevi Ambihaipahar Vice-Chairperson. Dr Eliseo T.Banaynal Jr. and Dr Chris Cheah Hean-Aun were electedRapporteurs.

Dr Zhu Qing-shen, Vice Minister of Health, welcomed theparticipants to the workshop on behalf of the Ministry of Healthand State Administration of TCM of China. Mr A. Schnur, ActingWHO Representative for China delivered the opening remarks ofDr Shigeru Omi, WHO Regional Director for the Western PacificRegion.

Various presentations compared legislation and regulation oftraditional medicine in the Region, with particular emphasis on thedevelopment of national policies. Country reports on the role andimportance of traditional medicine in each country as well as on

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existing policies and those planned by the government were presentedand discussed by the participants. Further presentations addressedresearch and education on traditional medicine as well as regulationand quality control of herbal medicines in China.

The participants held a plenary discussion on:

(1) the situation of traditional medicine in the Region,particularly the concept, the scope and the role oftraditional medicine as well as its awareness, and

(2) ways to develop a national policy on traditional medicineand to identify a traditional medicine programme atnational level and below.

The main conclusions and recommendations of the workshopcan be summarized as follows:

(1) “Traditional medicine is the sum total of knowledge,skills and practices on holistic healthcare, which isrecognized and accepted by the community for its rolein the maintenance of health and the treatment ofdiseases. Traditional medicine is based on the theory,beliefs and experiences that are indigenous to thedifferent cultures, and that is developed and handeddown from generation to generation.” (Definition oftraditional medicine adopted at the workshop.)

(2) A national policy of the government on traditionalmedicine is needed in order to define the role oftraditional medicine in national health care deliverysystems and to promote its use as an affordable andcost-effective form of healthcare by ensuring its safety,efficacy and quality.

(3) The national policy on traditional medicine shouldinclude vision and mission of the government in thefield of traditional medicine. As a starting point,Member States should establish a national focal pointfor traditional medicine and develop an action plan.

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(4) Collaboration between Member States and WHO todevelop national policies, exchange information anddevelop various international standards is essential.

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1. INTRODUCTIONTraditional medicine is able to contribute significantly to the

common goal of health for all by its capacity to maintain health andtreat diseases. Various forms of traditional medicine are practisedin the Western Pacific Region. The use of medicinal plants andtheir preparations as well as the technique of acupuncture are themost important forms of traditional medicine used in the Regionand are part of the cultural and social heritage of many countries.

WHO has addressed the importance of traditional medicinewithin the healthcare system of Member States in various resolutions.Based on these resolutions, WHO’s policy can be summarized asfollows:

(1) WHO is fully aware of the importance of herbalmedicines for the health of a large number of the population. Herbalmedicines are recognized as valuable and readily available resources,and their appropriate use is encouraged.

(2) To promote the proper use of traditional medicine, acomprehensive programme of identification, evaluation, preparation,and cultivation of medicinal plants is encouraged;

(3) It is necessary to

• make a systematic inventory and assessment (pre-clinical and clinical) of medicinal plants;

• to introduce measures on the regulation of herbalmedicines to ensure quality control of herbalproducts by using modern techniques, as well asapplying suitable standards and goodmanufacturing practices;

• and to include herbal medicines in the nationalstandard or pharmacopoeia.

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In order to introduce measures for regulation and control oftraditional medicine, a government policy is needed which requires,as a first step, a clear statement on the role of traditional medicinein health care. For this reason, the extent of governments’involvement and the relationship between traditional medicine andformal health services requires a clear definition in order to developa programme that might result in establishing a system to guaranteethe safe and effective application of traditional medicine.

In December 1997, WHO Regional Office for the WesternPacific Region organized a Working Group meeting for thosecountries in the Region that had specific interest in these issues andthat required support in finding solution for relevant questions. Asa result of the Working Group meeting, the Guidelines for theappropriate use of herbal medicines have since been finalizedreflecting the main recommendations of the group. The guidelinescover a broad range of topics in relation to herbal medicines,including national policy development, regulation of practice andregistration of herbs and plants. This can be regarded as a milestonetowards the appropriate use of herbal medicines which could beadopted or adapted by Member States in the Region. The WorkingGroup, furthermore, recommended that each Member State shouldaddress the need and extent of regulatory mechanisms to promotesafe and effective use of herbal medicines, and that WHO shouldplay an active role to organize national programmes to promote theuse of herbal medicines.

More and more countries in the Region have expressed supportfor the development of a national policy, as well as regulation andregistration of traditional medicine to ensure its proper use andpossible integration into the healthcare system. For this reason,WHO Regional Office for the Western Pacific invited representativesfrom interested countries in the region to share experience in nationalpolicy development and to help those countries lagging behind toinitiate efforts for policy development.

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1.1. The objectives of the workshop

The main objectives of the meeting were to:

(1) review the role of traditional medicine and governmentpolicy;

(2) share experiences with participants from othergovernments;

(3) identify difficulties and constraints; and

(4) discuss ways for setting up a policy.

1.2 Participants

The meeting was attended by 18 participants from 17 countriesof the Western Pacific Region, 4 temporary advisers, 1 consultant,the responsible officer from the WHO Regional Office for theWestern Pacific, 1 representative of WHO TRM/AFRO and 6observers.

The list of participants is attached as Annex 1.

1.3 Organization

Mr Jiang Zaizeng, Deputy Director of the Department ofInternational Cooperation, State Administration of TraditionalChinese Medicine of China, was elected Chairman. Dr UmadeviAmbihaipahar, Principal Advisor of Social Change and MentalHealth, Department of Health of PNG, was elected Vice-Chairperson.Dr Eliseo T. Banaynal Jr., Deputy Director General of the PhilippineInstitute for Traditional and Alternative Health Care, and Dr ChrisCheah Hean-Aun, Assistant Director of the Traditional ChineseMedicine Department (Singapore), were elected Rapporteurs.

1.4 Opening ceremony

The opening session was attended by all participants, WHOtemporary advisers, observers, WHO short–term consultant andguests from the Chinese Government, including Dr Zhu Qing-shen,

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Vice Minister of Health and Director-General of State Administrationof Traditional Chinese Medicine (SATCM).

Dr Zhu Qing-shen gave his welcoming remarks at the openingsession. On behalf of the Ministry of Health and State Administrationof TCM of China, Dr Zhu warmly welcomed all the participants tojoin the Workshop on Development of National Policy on TraditionalMedicine. Dr Zhu said that since the People’s Republic of Chinawas founded, China’s Central Government had attached greatimportance to the development of traditional medicine. The Chineseconstitution stipulates that “both modern medicine and traditionalChinese medicine must be developed”. Dr Zhu pointed out that theworkshop held by Western Pacific Region was a good occasion forChina to learn from different countries about traditional medicine.

Mr A. Schnur, Acting WHO Representative for China deliveredthe opening remarks of Dr Shigeru Omi, WHO Regional Directorfor the Western Pacific Region. In his opening speech, Dr ShigeruOmi welcomed all the participants, WHO short–term consultant,temporary advisers, observers and guests from the Chinesegovernment and expressed his sincere appreciation to the Governmentof China for hosting this meeting. He emphasized that traditionalmedicine had been practised for hundreds of years making a greatcontribution to maintaining human health and to the struggle ofhuman beings against various diseases. The growing interest of thepopulation and the increasing use are also raising the interests ofgovernments, and several countries and areas in the Region areconsidering integration of traditional medicine into their health caresystems. For such government involvement, however, a governmentpolicy is needed which clearly states the level and the direction of itsdevelopment. The Working Group recommended in 1997 thatappropriate use of herbal medicines should be supported by variousmeans. Sharing experiences in the development of policies andprogrammes as well as identification of constraints and possiblesolutions should, therefore, be the aim of the current workshop.

The opening speech of Dr Shigeru Omi is attached as Annex 2.

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2. PROCEEDINGS

2.1 Introduction: purpose of the meeting and method ofwork

Dr Chen Ken gave a brief introduction to objectives, processand expected results of the workshop. The purpose of this meetingwas the following:

• reviewing the role of traditional medicine andgovernment policy;

• sharing experiences with participants from othergovernments;

• identifying difficulties and constraints; and

• discussing ways for setting up a policy.

2.2 Presentations: role of traditional medicine

2.2.1 Traditional medicine in the Western Pacific Region

Dr Chen Ken described traditional medicine (in particular herbalmedicines and acupuncture) as an important part of the medical andcultural tradition of each country in the Region, as well as in thehealth services, particularly in rural areas, where it might be theonly accessible, effective and affordable alternative. WHO supportsthe proper use of medicinal plants and the use of acupuncture, inparticular. Various WHO resolutions have indicated them to beeffective in various conditions.

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Medicinal plants are used by most traditional systems ofmedicine, as direct therapeutic agents or as raw material forpharmaceutical products; furthermore, chemical structures derivedfrom plants can be used as models for synthetic compounds.Acupuncture as a simple medical technique stimulating selectedpoints in the body has been practised in China for more than 2500years, with a systematic theory developed and nowadays proveneffective by modern scientific research.

Dr Chen Ken described the characteristics of traditional medicineas a holistic approach based on the needs of individuals and in manysystems on the belief that illness is a loss of balance between severalopposing aspects in the human body that can in case of illness berestored by therapies. Traditional medicine, developed before itsinception, is not easily understood by modern medicine, often due toa lack of scientific evaluation. Practices and forms of traditionalmedicine, however, vary greatly from country to country. The roleof traditional medicine is also different in countries and areas of theRegion.

Dr Chen put particular emphasis on education and training ontraditional medicine, indicating various universities offering degreeson traditional medicine. A further important issue was the evaluationof quality (e.g. testing for heavy metals) as well as of safety andefficacy of herbal medicine by scientifically–based research.

2.2.2 The use of traditional medicine in Europe and theU.S.A.

Dr Barbara Steinhoff, WHO short–term consultant, presenteddata on market importance of and consumers’ attitude towards herbalmedicinal products in Europe. A positive trend towards the use ofnatural medicines in Germany could be shown in a study conductedby the Institute for Demoscopic Research Allensbach in 1997.According to this study, the group of users of natural medicinescomprised two thirds of the German population (65%). In 1970,only 52% of the population was included in this group. The usersestimated the risk attached to natural medicines was lower than theones attached to chemical pharmaceutical products. 80% of thepopulation believed that the risk of natural medicines is low, whereas47% and 37%, respectively, of the population estimated the risk ofchemical medicines as middling and great, respectively.

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In the U.S.A., there was a growing interest in herbal medicines,although in most cases herbal products were not regarded as OTC(over–the–counter) medicines but dietary supplements. Variouspreparations, e.g. from Gingko biloba and Hypericum perforatumhad experienced a significant increase in demand. Particularly forcirculatory disorders, calming, cough/cold and immunologic system,prostatic complaints and slight to medium depressive disorders, theuse of herbal products had increased notably.

Furthermore, Dr Steinhoff elucidated the importance ofacupuncture in Europe and in the U.S.A. in the treatment of variouscomplaints. The practice of acupuncture in Europe was closelylinked to the medical profession as could be demonstrated by anumber of physicians’ training programmes that used acupunctureand which physicians from different national societies had developed.An increasing number of insurance companies already providedcoverage for acupuncture services.

2.3 Issues raised during discussion of country reports

The representatives of Member States of the Western PacificRegion reported on the legislation and regulation of traditionalmedicine in their country. The summary of reports which have beensubmitted by the participants prior to the workshop are enclosed asAnnex 3 in full length.

The promotion and integration of traditional medicine encountermany hurdles in Asian countries. Cambodia, for one, is burdenedby financial problems. In the Cook Islands, the lack of legislationfor changes in the national health agenda has stifled traditionalmedicine in spite of the fact that majority of the population patronizeit. It was, however, proposed that the Cook Islands situation couldbe solved through advocacy. The Fiji delegate recommended that amovement in traditional medicine should be initiated and dialogueswith government officials should be started.

The issue of intellectual property rights remained controversialand according to the delegate from Fiji, this issue should be lookedinto. The report of the delegate from French Polynesia drew questionsinquiring if criteria in selecting traditional healers existed. In Fijithere was none. The Malaysian delegate mentioned that the criteria

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were made by “God”, thus, making it difficult to question theirvalidity. The delegate from Hong Kong, China, added that criteriafor traditional healers were important for accreditation andcredibility. Malaysia faced a peculiar problem in that scientistsinvolved in the research and development of herbal medicines didnot want to share data and knowledge.

A question was raised about how strict legislation for traditionalmedicine should be in comparison to food legislation. The generalopinion was that food legislation did not require such high standardsas legislation on medicines did.

Following the presentation of all country reports, Dr Chen Kengave a summary stating that the main difficulties governments werefacing consisted in:

• a lack of mutual understanding between traditionalhealers and modern medicine;

• a lack of communication between governments andhealers;

• a lack of evidence based on scientific research; and

• a lack of funds and human resources as well as a lackof measures to protect intellectual properties andpatents.

Creation of a better understanding between traditional healersand modern medicine seems to be one of the important goals. Inmany countries, traditional medicine is not accepted by the medicalsociety (e.g. the Philippines). Solutions should be found by takinginto consideration the role of traditional medicine in today’s life.WHO gives support to Member States, particularly in the fields ofmedicinal plants and acupuncture.

2.4 Group discussion session one: concept, scope androle of traditional medicine

Two groups were formed for group discussion. Each groupselected a Chairperson and a rapporteur.

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The first session of group discussion was focused on the concept,the scope and the role of traditional medicine.

During the group discussion, definitions of traditional medicineused by WHO document and government documents in thePhilippines and Papua New Guinea were reviewed. Two groupsbrainstormed to bind items that should be included in the definitionand took into account further proposals for amending the definition.

It was agreed that practice of traditional medicine had expandedits original ethnic boundary. Although traditional medicine may notbe fully explicable by modern science at the moment, its furtherdevelopment and a possible rapprochement with modern medicinein the future should not be ruled out.

2.5 Plenary session: concept, scope and role oftraditional medicine

In the plenary session, the result of each group’s discussionswas presented and discussed.

A small working group, consisting of Dr Ping-yan Lam(chairman), Mr L. P. Maenu’u, Dr O. Kasilo and Dr E. T. Banaynal,was assigned to give a proposed definition of traditional medicinebased on definitions given by two groups.

After a brief discussion, the workshop accepted the text of thedefinition of traditional medicine. The definition is recorded in section3 of this report.

In terms of the role of the government, questions relating togood manufacturing practice and conservation of biodiversity alsoshould have been taken into account, but the group felt thatimplementation of too much regulation was not desirable at thisstage.

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2.6 Field visit

On Wednesday, 13 October 1999, a field visit took place. Thepurpose of the visit was to demonstrate the role of traditional medicineat three different levels of the health service network in China and toinform the participants of the recent research activities in traditionalmedicine.

2.6.1. Shun Yi County

Shun Yi county is located 30 KMS north–east of Beijing. It has12 townships, 427 villages, and a population of 548 000. About440 000 of the population are engaged in agriculture. The threelevel (county-townships-villages) health care delivery system is inplace.

Participants visited Shun Yi County Hospital of ChineseMedicine, a township health centre and a village health station toobserve the role of traditional medicine in three different healthservice facilities at different administrative levels.

Established in 1985, the county traditional medicine hospitalcurrently has 288 staff members and 235 beds, and further expansionis planned. Main areas of health care include internal medicine,surgery, gynaecology, paediatrics, laboratory and radiology. In thishospital, traditional medicine is used in integration with modernmedicine and includes methods such as computer tomography.

The visit to the district hospital was followed by a visit to atownship health centre and a village health centre in Shun Yi Districtthat use traditional medicine such as herbal medicine and acupuncturealongside modern medicine.

2.6.2. Beijing University of Traditional Chinese Medicine(TCM)

Professor Zheng Shouzeng, the President of the University,welcomed the delegates to the University which, founded in 1956, isone of the earliest TCM universities in China and has 3347 students,including 329 post–graduate and 350 foreign students. It boasts of4 schools, 7 departments and 7 professional programmes. The threepost–doctoral research programmes are Chinese medicine, Chinese

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pharmacy and the integration of Chinese and Western medicine.Over the past 40 years, 9837 local students and 1883 foreign studentsfrom 83 countries and regions have graduated from the University.

The delegation visited class rooms where students were takinga course on the effectiveness of herbal medicine by experimentalstudy. The delegation observed laboratory studies of traditionalmedicine carried out by several post–graduate students. Thedelegation also visited the Museum of Herbal Medicines and Historyof Chinese Medicine. The dialogue session at the conclusion of thevisit saw a lively discussion between the staff and students of theUniversity and the delegation. Issues discussed included theintegration of Chinese and Western medicine and the promotion oftraditional medicine in the Asia Pacific Region.

2.7 Presentations on policy and programme development

Following the participants’ agreement on the concept, scopeand role of traditional medicine, several presentations were givenon WHO’s policy agenda in the field of traditional medicine as wellas on legislation and regulation of traditional medicine in differentparts of the world.

2.7.1 WHO’s policy and its intervention in traditionalmedicine

In his presentation, Dr Chen Ken gave an overview of resolutionsrelevant to traditional medicine adopted by World Health Assembly(WHA) and the Regional Committee. WHO’s policy can besummarized as follows:

• WHO is aware of the important role played bytraditional medicine in preventive, promotive andcurative aspects of health for a large percentage of thepopulation, especially in developing countries;

• WHO notes that traditional medical practitioners arean available resource which could be utilized in primaryhealth care, whenever possible and appropriate;

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• WHO encourages interested Member States to supporttheir traditional system of medicine through continuousevaluation, formulation of policies with appropriateregulations suited to national health systems, anddevelopment of a comprehensive programme ontraditional medicine; and

• WHO supports the integration of traditional medicinewith modern medicine, where appropriate, andencourages activities which lead to cooperation betweenhealth care through traditional medicine and modernhealth care, especially as regards the use ofscientifically-proven, safe and effective traditionalremedies, which ensure that the contribution ofscientifically-proven traditional medicine is fullyexplored.

Main activities of WHO in these fields consist of:

• cooperation with, and provision of technical supportto, interested Member States in the development ofnational policies;

• promotion of proper use of traditional medicine bygiving support to Member States in programmedevelopment, e.g. in encouraging villages to cultivatespecific plants as community–based activities, or ininitiating training courses for school teachers, healthworkers and mothers (the “decision–makers” at home);

• promotion of quality of traditional medicine in terms ofservices and products, e.g. by establishing trainingopportunities and performing training for medicaldoctors and traditional healers as well as by establishingrules for good manufacturing practice and control ofheavy metals and pesticide residues in herbal medicines;

• promotion of research by giving support to prepareguidelines on research methodology together withspecific workshops;

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• exchange of information as well as documentation ofknowledge by databases in close cooperation with WHOCollaborating Centres.

2.7.2 The legislation and regulation of traditional medicine inChina

Professor Shen Zhi-xiang reported on different reviews inlegislation during the past decades and described five different levelsof legislation on traditional Chinese medicine (TCM) from the stateconstitution (where the legal status of TCM is stipulated) to locallaws in provinces and municipalities. He focused on different typesof regulation on TCM such as medical administration, productionand trade, scientific technology and education, personnel and labour,international cooperation and drug control laws. Establishment oflaws and regulations is guided by the following principles:

• to establish the legal status and role of TCM in theState affairs;

• to strengthen the management of TCM and tostandardize the sequence of TCM work; and

• to safeguard the legal rights of patients and healthworkers and the people’s good health.

As an administrative institution, the State Administration ofTraditional Chinese Medicine was established in 1986 to performlegal supervision and to fight against illegal activities. At eachdifferent level of administration particular administrative institutionswere formed. Thus, an administrative system exists from top tobottom.

He stated that in China, attempts were continuing to improvethe status of TCM. Further development of TCM in the futurewould include creation of new laws and revision of the existingones, and enlargement of international exchange and cooperationprogrammes.

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2.7.3 The legislation and regulation of traditional medicine inHong Kong, China

Dr Ping-yan Lam stated that main health care providers in HongKong were practitioners of Western medicine. Trade with TCM,however, was very important; there were about 2000 types of herbsas well as about 3300 proprietary Chinese medicines in the market.Although TCM formed an integral part of the health care system,there were no control mechanisms and no official recognition untilrecently.

Article 138 of the Basic Law of Hong Kong provides properpolicies to develop Western and Chinese medicine and to improveservices in this field. A Working Party appointed in 1989 hadrecommended to establish a committee and a statutory frameworkfor the promotion, development and regulation of TCM. Thisrecommendation resulted in the appointment of the PreparatoryCommittee on Chinese Medicine (PCCM).

On 14 July 1999, the Chinese Medicine Ordinance was enactedproviding the establishment of the Chinese Medicine Council. Itsfunctions are to ensure adequate standards for practitioners as wellas for products, promote professional education, promote the properuse of products, and ensure their safety, quality and efficacy. TheChinese Medicine Council includes a Practitioners Board and aMedicines Board, and oversees the registration system of Chinesemedicine practitioners. They are entitled to use the title of a registeredChinese medicine practitioner in a specific field, e.g. acupunctureor bonesetting. Regulation of Chinese medicines comprises twolists depending on the potential harmfulness of the substance.Products already in the market on 1 March 1999 when a newlegislation was set into force are “grandfathered” and will be reviewedparticularly on quality aspects. New products require assessmentof safety, quality and efficacy by the Chinese Medicine Board.

Regulation and promotion of TCM is a complex subject, andamong many considerations, the main issues to be addressed include:

• strategic positioning of TCM in health care system;

• interface between practitioners of Western andtraditional medicine;

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• scope of practice of practitioners;

• implications of integration;

• methodology and criteria for evaluation of herbs andproducts; and

• long-term financial viability in terms of goodmanufacturing practice.

2.7.4 The legislation and regulation of traditional medicine inEurope and the USA

Dr Barbara Steinhoff gave an overview of legislation andregulation of traditional medicine in Europe stating that medicinalproducts in general require pre-marketing approval based on proofof quality, safety and efficacy. In order to fulfil the requirements setby various European directives, Member States of the EuropeanUnion have made different approaches to review herbal medicinalproducts in the market in order to fulfil the requirements of theseEuropean directives. She described the different situation in differentMember States of the European Union focusing particularly on theoption of a bibliographic application for products with a well-established medicinal use.

The so-called decentralized system to obtain marketingauthorization in more than one Member State provides, as a generalrule, that the assessment by one national authority should be sufficientfor subsequent registration in other Member States. As commoncriteria for the assessment of safety and efficacy of herbal medicinalproducts did not exist for a long time, harmonization of scientificassessment was regarded to be a precondition for adjustment ofdifferent marketing authorization decisions of authorities, particularlyin case of products having different national traditions and assessmentcriteria. Dr Steinhoff described the attempts for harmonization ofassessment criteria that had so far been achieved by the EuropeanScientific Cooperative on Phytotherapy (ESCOP), as well as by theWorking Group on Herbal Medicinal Products consisting of healthauthorities’ representatives.

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In the USA, the situation is quite different because herbalproducts are in most cases marketed as dietary supplements withrestricted claims on their label, only in few cases as OTC drugs.Attempts to clarify the situation with the Food and DrugAdministration (FDA), particularly in terms of acceptance of foreignmarketing experience have not yielded any concrete results.

In the morning session, an overview of regulation of acupuncturewas given with the conclusion that in many countries there were nospecific requirements set by law, but developed by the physicians’associations for postgraduate training. In the USA, the situationwas different in each state. There were specific practice acts availablein 33 states.

During the discussion, the issue was raised that govern-ments were faced with difficulties whether to regulate a productas medicine or as food.

2.7.5 Development of national policy on traditional medicine

Dr Chen Ken indicated that as the interest of public andacademics as well as involvement of government was increasing, agovernment policy and measures to control the proper use oftraditional medicine was needed.

Different categories of government policies in existencemay be summarized as follows:

• Integrated - Traditional medicine is an integral part ofthe official health service system.

• Supported - The government recognizes the role playedby traditional medicine, supports its proper use,particularly as a community and individual practice,initiates efforts to bring proven traditional medicine intothe formal health service system and takes measures tocontrol its safe practice, although it is not part of theformal health service system.

• Recognized - The government officially announces itis aware of the potential role of traditional medicine.

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However, there is no activity relevant to traditionalmedicine organized or supported by the government.

• Not recognized - The existing traditional medicinesystem is ignored and only the practice of modernmedicine by professionals and auxiliaries is recognizedand supported.

Dr Chen Ken mentioned the following main issues that shouldbe addressed in a policy:

• The governments’ attitude towards traditional medicine

– recognition of the role of traditional medicine inthe health care system, ethnological background;

– support for the appropriate use of traditionalmedicine and identification of its health, economicand social benefits;

– recognition of the role played by practitioners oftraditional medicine in maintaining health of peopleliving in the communities where the practitionerslive.

• Legislation and regulation

- establishment of suitable management andregulatory measures;

- regulation and licensing of traditional medicinepractices; and

- regulation of herbal products, their manufacturersand distribution.

• Rational use of traditional medicine

• Development of traditional medicine

- development of appropriate human resources

- planning for research and development

• Subscribing to the conservation of medicinal plants

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• Cooperation among traditional and modern medicine

• Technical collaboration with other countries

• Monitoring and evaluation of national traditionalmedicine policy

The procedure to develop a policy should include the followingitems:

• A systematic review of the current status of traditionalmedicine in individual countries and its role inmaintaining health will be necessary for policydevelopment.

• The national health authority is the most appropriatebody to take the lead in developing the national policy.

• A national advisory committee could be set up to assistthe health authority in developing a policy. The advisorycommittee could be supported by subcommittees toadvise on specific aspects, if required.

• A strategic plan should be developed as part of overallplanning. Following identification of problems andbenefits, priorities can be set and objectives betterdefined. The adoption of a strategy is very importantas it may involve a choice between several approachesto address the issues.

• Consultation with the communities and interested partiesconcerned is essential. Where necessary, expert opinioncan be obtained from international agencies and othercountries. The public can be consulted when the policyis prepared.

• The contents of the draft policy document should bediscussed with institutions within and outside ofgovernment and with the private sector before it isfinalized and submitted for formal endorsement.

• Guidelines for the appropriate use of herbal medicinesprepared by the Working Group on Herbal Medicinesin 1997 provides detailed information on how to develop

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a national policy on herbal medicine. The principlesreflected in the guidelines can also be applied todeveloping a policy covering traditional medicine as awhole.

In the discussion it was observed that difficulties could consistin an appropriate budget, and, therefore, as a first step recognitionby government would be necessary.

2.7.6 Research and education on traditional medicine inChina

Ms Situ Wen held the presentation prepared by Professor LiZhen-jie and gave an overview of the basic situation of science andtechnology in traditional Chinese medicine as well as of thesupporting system for research and development.

In China, a tremendous amount of work has been done in thefield of “evidence–based” basic theory of TCM, the hypothesis ofacupuncture anaesthesia and channels and on mechanisms ofcompound TCM herbs as main fields. Further achievement willcomprise prevention and treatment of major diseases, protection ofTCM resources, substitution of drugs extracted from endangeredspecies, and quality control standards. Significant success has alsobeen made in the treatment of various conditions such as acuteabdominal diseases and bone diseases, in the development of newtechnologies of preparation and dosage forms, in artificial cultivationof plants with medical value, and in the research on development ofnew drugs from plants materials.

Visions and expectations for the next 10 years could encompassthe following issues:

• upgrading the standard of TCM, training and capacitybuilding;

• rational allocation of resources;

• establishing a system to modernize TCM; and

• insisting on the policy of serving clinical practice,production and society’s needs, encouraging integrationof science into economy to serve social developmentand economic construction.

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Important tasks, therefore, are:

• pursuing intensified basic theory research;

• regulating and upgrading clinical research;

• strengthening research on sustainable application ofTCM;

• developing good varieties and poll-free “green”medicines;

• increasing quantity and quality of Chinese medicines;

• carrying out research on artificially–cultivatedsubstitutes to replace endangered species in cooperationwith WWF;

• implementing the “Plan of Action for the ModernIndustrialization of Chinese Medicine”; and

• enhancing capacity building and speeding up thecreation of an information network.

If these issues are addressed, TCM will make a contribution tothe modern life science development and to the health of people.

The following discussion made it clear that traditional medicineneeds development, although some of its effects cannot be fullyexplained by modern science. Research might verify the validity oftraditional practice or even improve what has been traditional. It isvery important to gain further information by research, whytraditional medicine is effective. In this respect, consumer protectionis an important issue. Therefore, it should be ensured that traditionalmedicines are safe through appropriate research.

2.7.7 Regulation and quality control of herbal medicines inChina

Dr Lin Ruichao presented the organizational structure of theState Drug Administration (SDA) and organizations attached toSDA. He focused on quality standards such as the ChinesePharmacopoeia, Ministerial Drug Standards and PharmaceuticalStandards of SDA, and explained the content of the guidelines forthe standardization of Chinese Materia Medica. They include

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requirements for name, source, identification, description, extract,processing, assay, characteristics and channel tropism, action andindication, usage and dosage, precautions for use and conditionsfor storage. Reference substances are available for identificationand assay in the form of chemical substances as well as referencecrude drugs.

Examples for quality control were given using modern analyticalmethods such as thin layer chromatography as a crude drug andliquid chromatography used for single crude drugs as well as forpatent medicines consisting of several compounds. This wasdemonstrated by the examination of Salvia miltiorrhiza as singledrug and a mixture from Radix Ginseng rubra, Radix Ophiogonisand Fructus Schizandrae by using different methods for identificationand assay of each compound.

Various guidelines are available in China for registration ofherbal drugs and products. If powder is used traditionally and anew dosage form is developed (e.g. a capsule), documents forassessment have to be submitted. There seems, however, to be alack with regard to the control of raw material.

Regarding isolated substances, it was confirmed that singlesubstances isolated from plants did not fall under the definition oftraditional medicines.

2.8 Group discussion session two: development ofnational policy on traditional medicine

The discussion continued after two groups had been formatted.The composition of the groups was the same as it had been earlier.The groups discussed the development of a national policy ontraditional medicine and the issues to be addressed, including thedevelopment of a traditional medicine programme and action plans.Each group listed difficulties in preparing a national policy and apossible solution to those difficulties.

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2.9 Plenary session: on conclusions andrecommendations

Dr Umadevi Ambihaipahar, Vice–Chairperson, summarized theresults of the workshop up to this point. She stated that the situationof traditional medicine showed large differences in Member Statesof the Western Pacific Region as well as when compared with Europeor the United States of America. Group discussions, however,resulted in a common definition of the scope and concept of traditionalmedicine, and in the field–trip “real life” was experienced.Furthermore, details on research and education in the field oftraditional medicine in China were presented, spurring intensivegroup discussions on development of national policies.

The rapporteurs of both groups, Dr Chris Cheah Hean-Aunand Dr Eliseo T. Banaynal Jr., reported on the outcome of the groupdiscussions and presented the results. Both groups had agreedoverwhelmingly that a national policy was needed. Both groupsthoroughly explained their ideas about ways to develop a nationalpolicy, about the contents of a national policy and about the role ofgovernment. Likewise, both groups had some of the same results;however, the order of the discussed items were slightly different.

In the plenary discussion, both proposals were discussed togetherin order to find a common statement. The group reiterated that anational policy was needed, and that a consensus was required forgovernment action, e.g. funds, consumer protection and promotionof traditional medicine.

As proposed by Dr Chen Ken, the group agreed thatpreparation and organization of a strategic plan should, therefore,cover

- identification of common status, systematic review;

- identification of national focus point;

- establishment of an advisory committee;

- consulting experts; and

- public consultation and government adoption.

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The group discussed potential difficulties in the development ofnational policies and options for solving these problems. The groupunanimously agreed that the role of the government in policydevelopment should consist in its function leading management body(government or ministry of health) and in its task assessing the scopeof the problem.

Promotion of proper use and integration of traditional medicineinto national health care systems should be the guiding principles.For these reasons, it was suggested that a list of items to be includedin a policy should be developed, accompanied by a preambledescribing what the national policy should be in general. Thesegeneral aspects should cover a definition of the government’s role inthe development of traditional medicine in the healthcare deliverysystem. Another guiding principle should be safety and efficacy.Last, but not least, the policy should include vision and mission aswell as goals and objectives which should be expressed throughgeneral policy statements.

Within the content of the policy, a clear statement on thedefinition of traditional medicines was regarded to be of highimportance. Within this definition the government in each countryshould clearly indicate the role, the scope and concept of traditionalmedicine.

As a solution to the problem of lack of understanding oftraditional medicine and non-cooperation between practitioners ofWestern and traditional medicine, it was discussed whetherintegrating the knowledge of traditional healers into the westernsystem and vice versa was feasible. Introduction of traditionalmedicine curricula in the western system has, however, only beenpossible in some countries, e.g. in China, but not in the Republic ofKorea. For this reason the group proposed as a solution either toencourage practitioners to practise both systems of medicine tocomplement each other, where applicable, or to introduce traditionalmedicine curricula in the western system, where applicable.Furthermore, introduction of education and training to traditionalhealth practitioners as well as an attempt to convince other healthcare providers that traditional medicine does not intend to competebut to safeguard public health could be potential options.

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Dr Banaynal suggested that a paragraph on the issue raised inthe meeting concerning the protection of intellectual property rightsshould be included in the recommendations.

After a detailed discussion, a conclusion was drawn up. Thegroup also agreed on the development of a national policy in thefield of traditional medicine and gave subsequent recommendationsto WHO and its Member States, which are recorded under section3: Conclusions and Recommendations.

2.10 Closing ceremony

Mr Jiang Zaizeng, in his closing remarks, said that it had beena great honour for him to chair this fruitful workshop in whichgovernment officials and health administrators from 17 countries inthe Western Pacific Region participated. He regarded this workshopas a contribution to the official promotion of traditional medicinenot only in the Western Pacific Region but all over the world. Hereferred to the opening ceremony and the welcoming remarks of DrZhu Qing-shen who had pointed out that the workshop offered Chinaan opportunity to learn about traditional medicine from differentcountries, and that China hoped, with cooperation from WesternPacific Region countries, to build WPRO into a traditional medicinecentre for the world. He announced a conference on traditionalmedicine to be held in Beijing in April 2000 and invited everyone toparticipate. He expressed his thanks to Dr Chen Ken for havingprepared and organized the workshop, to Umadevi Ambihaipaharfor acting as Vice–Chairperson and all participants for theircooperation.

On behalf of all participants, Dr Eliseo T. Banaynal Jr.acknowledged the effort and support of the WHO Regional Officefor the Western Pacific in holding the workshop and thanked thechairpersons, temporary advisers and consultant as well as theChinese government for being exceptional partners.

Professor Li Zhen-jie, Vice Director General of the StateAdministration of Traditional Chinese Medicine, congratulated WHOon the success of the conference which from his point of view hadbeen both active and fruitful for the development of traditional

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medicine in the Western Pacific Region. Regarding recent positivedevelopments, he mentioned that the Chinese government wasinvesting heavily into basic research on traditional medicine.A common goal of all countries as well as guidance by WHO wouldfacilitate exchange of information and cooperation between thecountries. He invited all participants to visit Beijing again in April2000.

Dr Chen Ken thanked all participants for their contribution tothe successful, fruitful and productive meeting, and thanked WHO,particularly the Western Pacific Regional Office, for its support ofthe Traditional Medicines Programme. He expressed his thanks tothe Chinese Government, the Ministry of Health and the StateAdministration of Traditional Chinese Medicine for their support.He thanked the Chairman and Vice–Chairperson for their efforts tomake the meeting succeed, the chairmen of the group discussionsand the rapporteurs, the consultant and the colleagues from WHOas well as from the Institute of Chinese Materia Medica for theirsupport.

As a result of the meeting, Dr Chen Ken concluded, theparticipants have shared experiences, knowledge and concerns abouttraditional medicine and prepared detailed findings on developmentof a national policy on traditional medicine, particularly in terms ofthe role of the government, existing difficulties and possible solutions.He maintained that if they do something in the future, it should bedone together. He mentioned a meeting of the Southern Pacificislands to be held in Fiji in October 1999 where an exchange ofinformation would take place with the aim to develop harmonizedapproaches in traditional and modern medicine. Working togetherwith Member States and other international organizations, researchinstitutes and nongovernmental organizations in the promotion oftraditional medicine would be a big step forward in reaching thecommon goal of ”Health for All”.

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3. CONCLUSIONS ANDRECOMMENDATIONS

3.1 Conclusions

Definition of traditional medicine

“Traditional medicine is the sum total ofknowledge, skills and practices on holistichealthcare, which is recognized and acceptedby the community for its role in the maintenanceof health and the treatment of diseases.Traditional medicine is based on the theory,beliefs and experiences that are indigenous tothe different cultures, and that is developed andhanded down from generation to generation.”

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Scope of traditional medicine

Traditional practice of medicine includes a widescope such as:

• herbal medicine;

• acupuncture;

• massage/manipulation;

• heat/steam/sauna;

• diet;

• exercise (e.g. Yoga, Qigong); and

• spiritual/mental therapy and others.

Role of traditional medicine

Traditional medicine has an established promotive,preventive, curative and rehabilitative role withvarying emphasis in different countries. It can bethe main form of health care, or an integratedcomponent of the mainstream health care, or analternative or complementary to the main form ofhealth care in the countries in the Region.

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Reasons for acceptance of traditional medicine by thepublic, including:

• cost effectiveness and affordability;

• accessibility;

• cultural acceptability;

• natural material and holistic approach;

• safe and fewer side effects or other negative effects;and

• effectiveness.

Role of government in the field of traditional medicine

Since traditional medicine is still popular in manycountries and has been reappearing in others, thegovernments should give traditional medicineappropriate recognition to improve the image andstandard of the practitioners. This can be done throughpolicy changes, regulations and registration andimproving training and research of traditionalmedicine.

The roles of the government are considered to be thefollowing:

• policy maker;

• legislator;

• regulator;

• developer of referral systems, structures andfacilities for traditional medicine;

• developer of repository of data bases;

• maintainer of registry/directory of practitioners;

• enabler, in areas of:

• insurance,

• training and education,

• product research and development, and

• regulation of practice.

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Need for a national policy on traditional medicine

A national policy on traditional medicine is neededfor the following reasons:

• The use of traditional medicine is widespreadin some countries and is the only available formof health care system in others.

• It will define the role of traditional medicine inhealth care delivery systems.

• Government commitment is needed to ensurethe direction, action and provision of financialand other resources.

• Traditional medicine needs to be regulated inorder to ensure its safety, efficacy and quality.

• It could assist in the control of the growth ofmedical expenditures.

• Traditional medicine could be an affordable andcost-effective form of health care.

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Steps for development of a national policy

The government is the leading body for developmentof a national policy on traditional medicine.Development of a national policy should consist in thefollowing steps:

(a) information campaign to enable the governmentto understand and appreciate the role of traditionalmedicine in the community;

(b) identifying a national focal point or managementbody devoted to traditional medicine (e.g., theministry of health);

(c) organizing an advisory committee or task forcecomprising:

• champions of traditional medicine;

• stake holders;

• lay people; and

• local and foreign experts (including traditionalmedicine practitioners, pharmacists, botanists,academics, medical doctors, lawyers,environmental and conservation departments,etc.);

(d) conducting a systematic review and a situationalanalysis to provide information to the governmentin order for it to make an informed policy decision;

(e) providing a draft policy statement;

(f) organizing nation–wide workshops and nationalconsultations involving stake holders including thegovernment, the public, practitioners (e.g. doctors,pharmacists, pharmacologists, traditional healthpractitioners), and other relevant organizations;

(g) getting approval/endorsement from relevantgovernment authority, and, if applicable,legislation to support the national policy;

(h) developing a strategic plan;

(i) allocating funds;

(j) implementing national policy; and

(k) evaluation and monitoring.

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Contents of a national policy

In general, the national policy should include adefinition of the government’s role in thedevelopment of traditional medicine in the healthcare delivery system. Safety and efficacy shouldbe stated as the guiding principles. The policyshould also include vision and mission as well asgoals and objectives of the traditional medicinepolicy.

Detailed policy statements should be given in the following areas:

Vision

The vision (foresight) of the government on traditionalmedicine could include the following points:

• Definition of traditional medicine

An individual country may wish to give its owndefinition of traditional medicine as related toits cultural, social and economic values.

• Contribution of traditional medicine inhealthcare system

The government should address the likelycontribution of traditional medicine to thehealth care delivery system of the country.

• Benefits of traditional medicine

The government should explain the benefits oftraditional medicine for the society and theeconomy of the country.

• Positioning and interface between traditionalmedicine and Western medicine in healthcaresystem.

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Mission

The mission is a general statement to define tasks and function,to be performed by the government and its designated agency.

The government of the country should define its missionaccording to the particular needs of the country. The mission couldinclude the following points:

• promotion of the proper use of traditional medicineparticularly in PHC delivery system;

• the government’s responsibility for the traditional medicineprogramme;

• need for new legislation or expansion of laws alreadyexisting in the country, taking into account the existinginternational conventions;

• regulation of traditional medicine practitioners, provisionof infrastructure as far as applicable, development of codeof ethics and practice for practitioners;

• education and training of practitioners;

• regulation of raw materials , semi-finalized and finishedproducts;

• acceptable standards of safety and quality;

• consideration on potential coverage by state healthinsurancies;

• capacity building of traditional medicine human resourcesin order to strengthen expertise of government in traditionalmedicine;

• conservation of plants and animals (conventions ofbiodiversity and endangered species);

• promotion and advocacy (dissemination of informationinside and outside governments);

• research and development;

• international technical co-operation and exchange; and

• monitoring and evaluation of implementation of thenational policy on traditional medicine.

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Difficulties in developing a national policy andprogramme in traditional medicine

The following difficulties could exist:

• lack of political will;

• lack of understanding of traditional medicine;

• role and positioning of traditional medicine inthe country;

• resistance to change by all;

• reluctance/non-cooperation by practitioners,manufacturers to government intervention intraditional medicine;

• financial constraints;

• difficulty in reaching a consensus inaccreditation of practitioners;

• shortage of qualified manpower in and out ofgovernment; and

• shortage of personnel in government to ensuresustainability of traditional medicine.

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Proposed solutions

Solutions for existing difficulties mentioned above canconsist in:

• advocacy by education and informationdissemination to raise public awareness ontraditional medicine;

• open discussions and consultations;

• convincing the government of long term financialbenefits of traditional medicine;

• allowing practice of both systems of medicine tocomplement each other (where applicable);

• introducing traditional medicine curricula to theWestern system (where applicable);

• introducing education and training to traditionalhealth practitioners;

• convincing other health care providers thattraditional medicine policy is not to compete withthem but to safeguard public health;

• mobilizing financial resources (plan of action,lobby in budget proposals);

• a transition period/grace period given topractitioners and manufacturers (phase by phasethrough consultations; government incentives),before regulation is introduced;

• working out a credible system of accreditation;

• developing social organizations (associations oftraditional medicine practitioners);

• capacity/capability building (intercountryexchange programmes/technical cooperation);

• liaison with WHO, other internationalorganization and other countries; and

• use of NGOs as long as government takes a leadingrole to ensure capacity building and sustainabledevelopment.

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3.2 Recommendations

The workshop reached its consensus and agreement ondevelopment of a national policy on traditional medicine as reflectedin 3.1 Conclusions. In addition, the participants of the workshopprovided the following general recommendations to WHO and itsMember States.

(1) WHO should provide technical support interestedMember States to develop a national policy.

(2) WHO should help to formulate national action plans.

(3) WHO should organize workshops to share experiencesto develop a national policy.

(4) WHO should provide criteria for the assessment oftraditional medicines (e.g. monographs).

(5) WHO should co-ordinate the development of variousinternational standards in traditional medicines.

(6) WHO should co-ordinate the development of acollaborating framework to support exchange ofinformation, development of national policies, trainingof personnel and the establishment of standards, etc.

(7) Member States should develop national policies andaction plans on traditional medicine as part of thenational health care system.

(8) Member States should establish a national focal point/coordinating/leading body for traditional medicine.

(9) Member States should make extensive reference to thefindings of this working group.

(10) Member States should make use of WHO guidelineson traditional medicine as references.

(11) Member States should disseminate information ontraditional medicine within individual Member States.

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(12) Member States should collaborate with WHO and otherMember States in the exchange of information,development of national policies, training of personneland the establishment of standards, other internationalorganizations, etc.

(13) Member States should give particular attention to thedevelopment, issues and concern related to the protectionof intellectual property rights and patents of medicinalplant products and traditional practices as well as tothe protection of biodiversity.

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ANNEX 1

LIST OF PARTICIPANTS, TEMPORARY ADVISERS,CONSULTANT, OBSERVERS AND SECRETARIAT

1. PARTICIPANTS

CAMBODIA

Ms Chengli BotaChiefTechnical BureauNational Centre for Traditional MedicineMinistry of Health#151-153 Kampuchea Krom StreetPhnom Penh, CambodiaTel. no. 855 23 880374FAX: 855 23 426841

CHINA, PEOPLE’S REPUBLIC OF

Mr Jiang ZaizengDeputy Director-GeneralDepartment of International CooperationState Administration of Traditional Chinese MedicineNo. 13 Baijiazhuang DongliChaoyang DistrictBeijing 100026People’s Republic of ChinaTel. no. 86 10 6591126; 65063322FAX: 86 10 65911268

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Ms Situ WenDeputy DirectorDivision of Multilateral RelationsDepartment of International CooperationState Administration of Traditional Chinese MedicineNo. 13 Baijiazhuang DongliChaoyang DistrictBeijing 100026People’s Republic of ChinaTel. no. 86 10 6591126; 65063322FAX: 86 10 65911268

COOK ISLANDS

Dr Auemetua TaurariiDirectorClinical ServicesMinistry of HealthP.O. Box 109RarotongaCook IslandsTel. no. 682 29664FAX: 682 23109E-mail: [email protected]

FIJI

Dr Nacanieli GoneyaliDirectorHospital ServicesMinistry of HealthP.O. Box 2223Government BuildingsSuvaFijiTel. no. 679 306177; 221514FAX: 679 306163

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FRENCH POLYNESIA

Dr François LaudonDirector of HealthMinistry of HealthPapeeteFrench PolynesiaTel. no. 689 46 00 08FAX: 689 43 00 74E-mail: [email protected].

HONG KONG, CHINA

Dr Leung Ting-hungAssistant Director of HealthTraditional Chinese MedicineDepartment of Health21/F, Wu Chung House213 Queen’s Road EastWanchaiHong KongTel. no. 852 2126 5100FAX: 852 2123 9566E-mail: [email protected]

KIRIBATI

Mrs Bernadette EkeietaChairpersonMaurin Kiribati CommitteeHigher Executive OfficerMinistry of Works and EnergyP.O. Box 489BekoTarawaKiribatiTel. no. 686 21493; 26336FAX: 686 21348

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LAO PEOPLE’S DEMOCRATIC REPUBLIC

Dr Kaysone KeolaVice DirectorTraditional Medicine HospitalVientianeLao People’s Democratic RepublicTel. no. 856 21 41 6967

MALAYSIA

Dato’ Dr Mohd. Ismail MericanDeputy Director-General of Health(Research and Technical Support)Ministry of Health Malaysiac/o Institute for Medical ResearchJalan Pahang50588 Kuala LumpurMalaysiaTel. no. 603 2989820FAX: 603 2920675E-mail: [email protected]

MONGOLIA

Dr Sharav BoldOfficer-in-ChargeTraditional MedicineMinistry of Health and Social WelfareOlympic Street-2Ulaanbaatar-48MongoliaTel. no. 976 1 322 878FAX: 976 1 320916

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PAPUA NEW GUINEA

Dr Umadevi AmbihaipaharPrincipal AdvisorSocial Change and Mental HealthDepartment of HealthP.O. Box 807Waigani N.C.D.Papua New GuineaTel. no. 675 3259017FAX: 675 3231640

PHILIPPINES

Dr Eliseo T. Banaynal, Jr.Deputy Director-GeneralPhilippine Institute for Traditional and Alternative Health CareGround Floor, Bldg. 15San Lazaro CompoundRizal Avenue, Sta. CruzManilaPhilippinesTel. no. 63 2 781 88 38FAX: 63 2 711 52 66

REPUBLIC OF KOREA

Mr Hyun Woo HanDeputy DirectorOriental Medicine DivisionMinistry of Health and Welfare1 Chung-ang-dongKwachun CityKyunggi ProvinceSeoulRepublic of KoreaTel. no. 82 2 503-7535FAX: 82 2 503-7584

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SAMOA

Dr Leota Sio Paulo AinuDirectorClinical Health ServicesDepartment of HealthMalifaApiaSamoaTel. no. 685 22905FAX: 685 22905

SINGAPORE

Dr Chris Cheah Hean-AunAssistant DirectorTraditional Chinese Medicine DepartmentMinistry of HealthCollege of Medicine Building16 College RoadSingapore 169864Tel. no. 65 3259210FAX: 65 3259078E-mail: [email protected]

SOLOMON ISLANDS

Mr Leonard Palmer Maenu’uChairmanLeadership Code CommissionMinistry of Health and Medical ServicesP.O. Box 611HoniaraSolomon IslandsTel. no. 677 21275FAX: 677 21812; 677 22606

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VIET NAM

Dr Chu Quoc TruongDeputy-DirectorDepartment of Traditional MedicineMinistry of Health138 A Giang Vo RoadHa NoiViet NamTel. no. 844 8462 384FAX: 844 8464 051

2. TEMPORARY ADVISERS

Professor Li Zhen-jieDeputy Director-GeneralState Administration of Traditional Chinese MedicineNo. 13 Baijiazhuang DongliChaoyang DistrictBeijing 100026People’s Republic of ChinaTel. no.: 86 010 65911264; 11269; 23571FAX: 86 010 65911268

Professor Shen Zhi-xiangDirectorDepartment of International CooperationState Administration of Traditional Chinese MedicineNo. 13 Baijiazhuang DongliChaoyang DistrictBeijing 100026People’s Republic of ChinaTel. no.: 86 010 65911264; 11269; 23571FAX: 86 010 65911268

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Dr Lin RuichaoDirectorDivision of Chinese Materia Medica and Natural ProductsNational Institute for the Control of Pharmaceutical & Biological ProductsState Drug Administration2 Tiantan XiliBeijing 100050People’s Republic of ChinaTel. no.: 86 010 67017755-307FAX: 86 010 67023650

Dr Ping-yan LamDeputy Director of HealthDepartment of HealthWu Chung House21st Floor213 Queen’s Road EastWanchaiHong KongTel. no.: 852 2961 8551FAX: 852 2836 0071E-mail: [email protected]

3. CONSULTANT

Dr Barbara SteinhoffScientist in the field of Regulatory Affairs and Drug Safety of Herbal MedicinesBundesfachverband der Arzneimittel- Hersteller e.V. (BAH)Ubierstr. 71-73D-53173 BonnGermanyTel. no.: 49 228 9574516FAX: 49 228 9574590E-mail: [email protected]

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4. OBSERVERS

Professor Huang YipingVice-HeadWHO Collaborating Centre for Traditional MedicineInstitute of Chinese Materia MedicaBeijingPeople’s Republic of ChinaTel. no. 86 10 64032658FAX: 86 10 64013996

Ms Song LiDirectorForeign Affairs OfficeAcupuncture Institute of China Academy of Traditional Chinese MedicineNo. 18 BeixincangDongzhimenneiBeijing 100700People’s Republic of ChinaTel. no. 86 10 64035765FAX: 86 10 64013968

Professor Yang Gong FuAssociate ProfessorNanjing University of Traditional Chinese MedicineAssociate DirectorWHO Collaborating Centre for Traditional Medicine282 Hanzhong RoadNanjing 210029People’s Republic of ChinaTel. no. 86 25 6798243FAX: 86 25 6798078

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Ms Fan LinglingDirectorForeign Liaison OfficeSecretariatThe World Federation ofAcupuncture-Moxibustion Societies18 BeixincangBeijing 100700People’s Republic of ChinaTel. no.: (010) 64063648FAX: (010) 64013968; 64063648

Mr Gregory Wing Lup LeungDeputy Secretary for Health and WelfareHealth and Welfare Bureau19/F Murray BuildingGarden RoadCentralHong KongTel. no. 852 2973 8101FAX: 852 2810 7851

4. SECRETARIAT

Dr Chen Ken (Responsible Officer)Medical OfficerTraditional MedicineWHO Western Pacific Regional OfficeU.N. Avenue, ErmitaManilaPhilippinesTel. no.: (63 2) 528-9948FAX: (63 2) 521-1036E-mail: [email protected]

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ANNEX 2

OPENING SPEECH OF DR SHIGERU OMI,REGIONAL DIRECTOR, WHO REGIONAL OFFICE FOR THE

WESTERN PACIFIC DURING THE WORKSHOP ONDEVELOPMENT OF NATIONAL POLICY

ON TRADITIONAL MEDICINE,11-15 OCTOBER 1999, BEIJING, CHINA

Distinguished participants, ladies and gentlemen,

I am very pleased to welcome you all to this workshop ontraditional medicine. On behalf of the World Health Organization,I would like to express my sincere appreciation to the Governmentof China for hosting this very important meeting.

Traditional medicine has been practised for hundreds of years.It was the only available method of health care in this part of theworld before Western medicine was introduced to Asia. The servicesprovided by practitioners of traditional medicine formed a type ofhealth care coverage and dealt more or less satisfactorily with manyof the health problems at that time. Traditional medicine made agreat contribution to maintaining human health and to the struggleof human beings against various diseases. Even now, in spite of thewidespread introduction of modern medicine in the Region,traditional medicine still plays a role in many countries. Studiesconducted in Australia and other countries are showing that peopleare increasingly using traditional medicine and attach considerableimportance to it.

This increasing use of traditional medicine is also raising theinterest of governments. Several countries and areas in the Regionare seriously considering integrating traditional medicine into theirformal health care system. However, such government involvementneeds government policy on traditional medicine, which clearly statesthe level and the direction of its involvement. During the last five

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years, WHO has provided support in developing national policyand programmes on traditional medicine to the governments ofCambodia; Hong Kong, China; Malaysia; Mongolia; the LaoPeople’s Democratic Republic; Papua New Guinea; the Philippines;Singapore and Viet Nam.

In order to support more countries in the Region to developtheir own national policies and programmes on traditional medicine,the WHO Regional Office for the Western Pacific Region organizeda meeting of the Working Group on Herbal Medicines in December1997. During the meeting, the Guidelines for the appropriate useof herbal medicines were prepared. The Guidelines cover a broadrange of topics in relation to herbal medicines, with particularemphasis on national policy development, development of nationalprogrammes, regulations on practice and registration of herbalmedicines. Although focusing on herbal medicines, the principlesand approaches mentioned in the Guidelines can be expanded tocover the work of traditional medicine as a whole.

The participants of the Working Group recommended that WHOshould promote the use of the Guidelines for appropriate use ofherbal medicines among Member States and should organize trainingcourses, seminars and workshops on the appropriate use of herbalmedicines.

In response, WHO has organized this workshop to review therole of traditional medicine, share experiences in the developmentof policies and programmes on traditional medicine, identifyconstraints faced in promoting the proper use of traditional medicineand identify possible solutions to these difficulties.

I hope that as a result of the workshop, and with your activeinvolvement, more countries and areas in the Region will have asupportive policy and well-planned programme on traditionalmedicine.

With these few words, I wish you all a successful meeting andan enjoyable stay in Beijing! Thank you.

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ANNEX 3

SUMMARY OF COUNTRY REPORTS

(1) Cambodia

Ms Cheng Li Bota explained the country status oftraditional medicine. Having established a network ontraditional medicine in 1982, the government is nowfacing problems mainly caused by lack of collaborationbetween traditional healers and medical doctors, lackof proof of benefit as well as of budget and humanresources. She put particular emphasis on the activitiesof the National Centre for Traditional Medicine as partof the network which has performed, e.g. a survey ofmedicinal plants (514 with therapeutic value) in 6provinces, published booklets on medicinal plants,developed a list of 16 diseases that can be treated bymedicinal plants, stimulated clinical trials and organizeda National Workshop on Traditional Medicine andNatural Products supported by WHO in October 1997.Furthermore this centre provides training to studentsof pharmacy, provides information on medicinal plants,selects medicinal plants for primary health care,promotes the appropriate use and co-ordinates thenational network.

Government policy include organization of research ontraditional medicines and diseases that can be treatedwith it, establishing methodologies and technologies forthe development of traditional medicine, improvementof quality, training of professional health workers andpromoting the use of traditional medicine in primaryhealth care.

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Recent development include a decision of theHealth Ministry on traditional medicines stores, asubdecree on production and trading and aprocedure for regulations and traditionalmedicine. For the future, increase of importanceof Cambodian traditional medicine is one of thegovernment’s plans, furthermore an initiative toestablish quality, safety and efficacy criteria,development of traditional medicines andpromoting its rational use in collaboration withWHO and traditional healers.

(2) China

Mr Jiang Zaizeng talked about the important roleof Traditional Chinese Medicine (TCM) in Chinesetradition and culture. Complementing withwestern medicine, TCM has a specific task withinhealth services in the country. Infrastructure forserve of traditional medicine has beenestablished. Each county is equipped with acounty TCM hospital (altogether 1800 TCMhospitals), and also a majority of township healthcentres recruit TCM doctors and pharmacists.Health workers at the village clinics are able tous both western medicine and TCM.

Some of the main measures to enhance TCM inthese areas are:

• to provide guidance to the government inorder to bring the awareness into the ruralhealth service and thus to strengthen theleadership of TCM

• to intensify planning and to formulate policies

• to develop laws and regulations

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• to strengthen capacity building of TCMhospitals

• to enhance training of health workers

• to allocate funds.

According to the positive experiences that havebeen gained in the past years, a fundamentalpolicy should be the leading principle for thefuture, integrating the work with the developmentof economy and society.

After Mr Jiang’s presentation, a video programmeintroducing the role of traditional medicine in ruralareas of Anhui province, China was showed toparticipants.

(3) Cook Islands

Dr Auemetua Taurarii gave a statement about theimportance of and the growing interest intraditional medicine by the community and thegovernment. Traditional medicine however whichhad been frequently used before, was restrictedin its use by providers of western medicine in the1950’s , due to complications or side effects. Forthis reason, the use of traditional medicine inhospitals is not accepted.

Although the interest is growing, there is currentlyhowever no government policy on traditionalmedicine existing, because there is no priorityseen by health professions for the managementof health problems, and its use is restricted dueto yet unknown effects and potential side effects.A future strategy of the government taking intoaccount the question of efficacy of locally usedtraditional medicine seems to be of utmostimportance.

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(4) Fiji

Dr Nacanieli Goneyali reported on the wide useof medicinal plants in Fiji and a growing interestin traditional medicine, mainly due to betteraccessibility, particularly in local or ruralhealthcare. Currently, there are however no clearpolicy guidelines available, and development ofproper legislation is lacking. Wainimate, anassociation representing natural therapies, iscurrently working towards drafting properlegislation to protect intellectual property rights ofhealers, licensing of healers and regulation on safetyand efficacy of herbal products.

As the government recognizes the benefits of traditionalmedicine and how it can complement modern healthcare systems, its integration within national healthsystems is planned focusing e.g., on a policy framework,training of practitioners, development of standards ofpractice, regulations, safety and research to promotemutual understanding and the management ofintegrating both systems

(5) French Polynesia

Dr François Laudon described the legal requirementsto exercise medicine and other health care professions.These persons must have a French diploma andadditionally be registered.. The practice of Chinesemedicine, however, is not regulated although it is widelyused. There are regulations on the import of Chinesematerials and on the herbalists who market them, thestatus of a Chinese Medicine practitioner however isnot officially recognized, and western doctors do notcommunicate with Chinese herbalists.

During preparation of the health plan 1995-1999,the situation of traditional medicine and potentialactions to bring them closer to western medicine

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have been considered. Today the health authorityis likely to revise their policy on authorizationsfor Chinese herbalists in the near futureparticularly in terms of education of herbalists,control of practice, regulations for new medicines,validation of the annual list of medicinal plantsregulation on storage conditions for products aswell to establish compulsory training for herbalists.Continuing the dialogue with traditional practitionersand setting up a ministries’ steering committee forcodification are the most important goals for thefuture.

(6) Hong Kong, China

Dr Leung Ting-hung reported that while WesternMedicine has been the mainstream of the health caresystem in Hong Kong, Traditional Chinese Medicine(TCM) is widely used. Until recently there werehowever no specific legal controls and recognition ofTCM only incidental controls.

In 1989, the Working Party on Chinese Medicine wasset up to review the use and practice of TCM. Followingthe Working Party’s recommendation, the PreparatoryCommittee on Chinese Medicine (PCCM) wasappointed in 1995. They conducted a census amongTCM practitioners and collected data on the trade withChinese medicines available in the Hong Kong market.Based on the submission of PCCM’s first report in 1997which recommended the creation of a regulatoryframework and a statutory body for regulation andcontrol, and based on second report in 1999recommending further regulation and development, theChinese Medicine Ordinance was passed by theLegislative Council in July 1999. The governmentpolicy included the following main topics: developmentof a statutory framework, development of education,and scientific research in TCM.

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The Ordinance provides for the Chinese MedicineCouncil to implement the regulatory measuresadopting a system of self-regulation, and theDepartment of Health will provide theadministrative support and carry out enforcementwork. A licensing system and a registrationsystem to regulate manufacture and trade isscheduled for the year 2000. Universities haveintroduced particular courses in TCM practice,and research is being developed.

(7) Lao People’s Democratic Republic

Dr Kaysone Keola said that Lao traditionalmedicine (LTM) is a very ancient and has becomea very important part of the country’s heritageand culture. The government is encouraging andpromoting the use of both traditional and westernmedicine. The Research Institute of MedicinalPlants (RIMP) was established in 1976 and atraditional medicine hospital was established in1991.

The government is encouraging and promotingthe use of both traditional and western medicine.New laws on traditional medicine will bepromulgated. Although there was someachievement during the past years, thedevelopment however has slowed down. Themost important problems are:

• limited budget

• combination of traditional and westernmedicine

• mutual understanding of both therapies

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• different names for medicine

• availability of formula

• training for healers

An executive plan should be set up taking intoaccount the needs and duties of both westernand traditional doctors, feasibility of the project,budget for financial support, criteria for traditionalhealers, promotion of the use of traditionalmedicine and organizing an association. Existingopportunities are the positive attitude of thegovernment and its policy, an existing traditionalmedicine network, a positive tendency towardsthe use of traditional medicine and the supportfrom countries all over the world.

(8) Malaysia

Dato’ Dr Mohd. Ismail Merican stated that whilemodern and scientifically based medical and healthfacilities are used extensively by all levels of thecommunity, alternative forms of therapy are alsopopular. They include Chinese, Malay, Indian andComplementary medicines. The government being pro-active in these issues, a Standing Committee onTraditional/Complementary Medicine was formed in1998 to advise and assist MOH in formulating policiesand strategies for the monitoring of traditional/complementary medicine in Malaysia. Manufacturersof traditional medicine must have GMP requirements.In particular, the government looks at issues related tothe product and the practice including training andresearch in traditional medicine. The Drug ControlAuthority is responsible for registration of traditional/complementary medicine products, and approx. 8,000products have been listed. Licensing of traditionalmedicine importers has been implemented since 1999.Malaysia is member in ”Commonwealth Working

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Group in Traditional/Complementary MedicineHealth System”.

Future plans of the government include furtherpromotion of cultivation, research as well as co-operation with organizations inside and outsidethe country. It is hoped that the availability ofexisting regulations and resources will helpstrengthening the acceptance of traditionalmedicine in future.

(9) Mongolia

Dr Sharav Bold reported that traditional medicinehas become an inescapable part of health caresystem in Mongolia since 1900’s. A TraditionalMedicine Department was set up in the NationalMedical University in 1990, and a lot of theoreticalwork is carried out by the national Institute ofTraditional Medicine.

An order to develop traditional medicines wasissued by the Health Minister in 1991 resulting inmany efforts on further enrichment of traditionalmedicine and cultural heritage. A policy wasdeveloped in 1996 followed by a work on basicdirections for the coming years. In 1998, aworking group was set up according to a statepolicy which was subsequently approved by aconference of medicinal doctors. It was furtherapproved by Resolution of the State Great KhuralParliament in July 1999. The document includesstrategies to develop traditional medicinehospitals, for training of traditional medicinemanpower and for production safe medicinaldrugs to meet GMP requirements.

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(10) Papua New Guinea

Dr Umadevi Ambihaipahar said that traditionalmedicine remains a form of practice outside theformal health system. It is widely accepted andpractised in rural areas. Papua New Guinea hasnumerous species of plants and majority oftraditional medicaments are of plant origin.Revision for introduction of proven traditionalmedicines has already been made in the NationalDrug Policy. The healthcare system is currentlypassing through a structural adjustment, the issueof traditional medicine however has not yetadequately been addressed. It is expected thata policy in support of the proper use of traditionalmedicine will be developed soon and will beembodied in the new National Health Plan (2001-2010).

Provision for introduction of proven traditionalmedicines in this document has already beenmade, and a draft is available setting prioritiessuch as promotion of proper use of medicinalplants, inventories of modalities and plants as wellas training of traditional healers. Programmepolicies are existing giving particular attention tothe of traditional medicine as complementarytherapy to the official allopathic system.

(11) Philippines

Dr Eliseo T. Banaynal Jr. reported on recentdevelopments in his country where Westernmedicine does no longer seem to be the onlyalternative although the health care system ispredominantly influenced by western medicine.Taking both traditional and western principles intoconsideration, development and promotion ofholistic medicine is an important aspect. Safe,effective and affordable medicines are needed.

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The Traditional Medicines Programme whichstarted in 1992 was signed into law8 December 1997. A guiding principle of thislegislation is the development of traditional andalternative health care and its integration into thenational health delivery system. Particularemphasis has been put on scientific research anddevelopment, promotion of the use of safe,effective and cost-effective modalities, trainingand formulation of standards, guidelines andethical codes. Based on this law, the PhilippineInstitute of Traditional and Alternative Healthcarewas founded take the measures necessary forimplementation of these objectives.

Further strategies for the future include increasedproduction of scientifically tested herbalmedicines produced in the country, furtherresearch and development activities,development and accreditation of schools,colleges and universities in co-operation withforeign institutions. There is reason to beoptimistic.

(12) Republic of Korea

Mr Hyun Woo Han described recent trends in thefield of Oriental Medicine resulting from anobligation of the state to sustain and developcultural heritage. In June 1993, the OrientalMedicine Division was founded and expandedto the Oriental Medicine Bureau in 1996,furthermore the Korean Institute of OrientalMedicine was established in 1994. OrientalMedicine at present has the same status aswestern medicine has. Oriental doctors howeverpractise only oriental medicine; there are approx.9000 doctors for Oriental medicines and approx.62 000 for Western medicine.

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The existing legal system covers herbal medicinepharmacists, oriental medical doctors, and herbalmedicine dispensers and shops by different laws.Research and development of traditionalmedicine is of great importance, as can bedemonstrated e.g., by the establishment of aClinical Research Centre for Oriental Medicinein 1996.

New fields made up comprise e.g. internalmedicine, paediatrics, etc. Promotion ofinternational cooperation is one of the goals aswell as standardization of the products anddemonstration of their health insurance benefits.Future plans of the government includeimprovement and development of traditionalmedicine as well as its control and improvementof quality and distribution.

(13) Samoa

Dr Leota Siu Paolo Ainuu reported that traditionalmedicine had been practised for a long time bytraditional healers. Documented knowledgeabout the use of traditional medicinal plants existsas can be shown by several examples. Besidesthe use of plants, traditional medicine also coverstraditional birth attendants, bone-setting,massage and acupuncture. There is growinginterest in traditional medicine and a tendencytowards consulting a traditional healer afterhaving been treated by government healthworkers, because the service provided by thegovernment is cheaper or even free.

The Health Sector Reform strategy has includedtraditional medicine. There is at present howeverno particular legislation on traditional medicinesexisting. The Medical Practitioner’s Act does notpermit practising medicine as a traditional healer.

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The government’s future plans are to

• recommend further studies on medicinalplants

• establish a botanical garden

• continue communication and dialogue withtraditional healers (formal training is notconsidered appropriate)

(14) Singapore

Dr Chris Cheah Hean-Aun pointed out thatbesides several laws regulating ChineseMedicine Materials (CMM) (which are undergeneral legislation for medicinal products), self-regulation mechanisms are available such aslisting of TCM practitioners (at present approx.1800), standardized TCM training courses andethical codes. The policy of the governmentincludes self-regulation mechanisms followed bystatutory regulation, measures to upgrade thestandard of practitioners’ training and control ofCMM.

In order to achieve a tighter control on products,new regulations were developed in 1998 requiringe.g., documentation, labelling and quality controlof Chinese Proprietary Medicines (CPM) whichwill be implemented step by step during the nextyears. Statutory registration of practitioners andacupuncturists as well as training courses andexamination are planned for the near future.Licensing of importers, wholesalers,manufacturers and assemblers of CPM productsis intended to be completed in 2001. Long-termgoal is to upgrade the manufacturing processesin order to achieve the WHO GMP standard.

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(15) Solomon Islands

According to the statement ofMr Leonard Palmer Maenu’u traditional medicineis practised as is common throughout the countryusing medicines derived from plants and trees.The procedures of preparation and applicationare very important because they influence theresults.

The government has agreed upon a policy whichrecognizes and accepts the use of traditionalmedicine in rural communities which mightsupplement modern medicines. This howeverwas not intended to be institutionalized. Thegovernment’s policy corresponds to WHOResolution (WHA 30.43) on primary health care.Prior to establishing more detailed policy howeverit is considered important to investigate questionsrelated to traditional medicine more intensively.

Regulatory measures on traditional medicine donot exist. Mr Maenu’u stated that care should betaken when implementing legislation, because anover-legislation could result which might containitems that should not necessarily be regulatedby law.

Based upon the government’s decision torecognize the use of traditional medicine,recommendations were made in order to collectdetailed information, e.g., by utilizing the existinghealth care network, close contact topractitioners, later on recruitment of experts.There are however obstacles with regard tofurther developments, such as narrow manpowerand lack of funding.

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(16) Viet Nam

Dr Chu Quoc Truong emphasized the long historyof traditional medicines and recent yearsachievements in his country but also the fact thattraditional medicine has still many difficulties.During the past decades traditional medicine aswell as integration of traditional and modernmedicines have experienced a positivedevelopment in terms of research anddocumentation, education and training. Greatattempts have been undertaken to combinetraditional and modern medicine and to bringtraditional medicine into the provision of anationwide public healthcare. The mainachievements are:

• Official position of traditional medicines in themedical system

• Training of staff in combination of traditionaland modern medicine

• Inheriting and applying precious medicinalrecipe

• Bringing the potential of traditional medicineinto full play

For the coming years development of research,modernization and further integration is planned.The objectives of national policy are thereforefurther development of integration, renewing andperfecting the network, mobilizing financialresources, and upgrade and develop the level oftechnique. The main policies are:

• inheriting traditional medicine with intellectualownership

• training of medical workers

• performing scientific research

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• developing effective control

• allocating further state budget

• broadening international cooperation.

Solutions could comprise administrativedevelopments, building up specific departments,and intensifying coordination among differentassociations carrying out policies on traditionalmedicines.

The country report of Kiribati was submitted. Therewas however no oral presentation of the report ofKiribati.

Documents

Development of national policy on traditional medicine