4 October 2018

Nigeria: Is There a Role for Trado-Medicine in the Nigerian Health Sector?

Photo: IRIN
(File photo).
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"Immediately they fall sick they consult the oracle to tell them what is causing that illness and proffer a traditional remedy." - Healthcare Worker, Benue state.

Mallam Salisu Mohammed is a traditional medicine practitioner plying his trade in Minna, the capital city of Niger State. Popularly known as 'Dr. Salisu', his traditional medicine centre is somewhat modernized, made of two rooms. One has a seat and a table just like a doctor's consulting room where Salisu sees his patients. The other room serves as a sort of medicine storage room where his 7 apprentices observe his practice and produce whatever 'medicine' Salisu requests. Patients wait in a long veranda and Salisu says he sees more than 150 of them every day. "People come for different reasons; malaria, diabetes, hypertension, erectile dysfunction and others", he says. At 10am on the day the Nigeria Health Watch team visits, six women are already waiting to see Salisu. At his centre, located in the densely populated Unguwan Daji Area of Minna, more women visit than men, coming in for mostly menstrual problems, their children's' illnesses and sometimes, inability to conceive, he said.

The practice of traditional medicine is deeply rooted in the culture of many Nigerians and still remains the first port of call for many when they fall sick. With the scientific advancements in healthcare that have made treatment safer and more effective, it is perhaps surprising that people still prefer to seek cures from herbs and roots whose safety and efficacy have not been sufficiently established. Most traditional medicines are often raw plant leaves and roots sometimes ground and blended into powders or boiled to liquid before being given to the patients. There is little solid evidence to understand their level of efficacy or the damage they may cause, thus the concern remains that without proper scientific research, traditional medicines could do more harm than good.

It is true that a majority of orthodox drugs are developed from plants, which means that traditional medicines themselves are not the problem. However orthodox drugs usually go through years of research and testing to determine their potency, suitable doses and possible side effects. They are not released for patients' use until certified safe for consumption and effective for the necessary ailment.

So why, despite the availability of modern medicine, do traditional medicines still enjoy so much popularity and patronage? Is it culture, affordability or convenience? The Nigeria Health Watch team hit the streets of Abuja to ask people why they still use traditional medicines. From the vox pop below, public perception seems to show that the main reasons why Nigerians patronise tradition medicines are quality, affordability and accessibility, the three cardinal points of Universal Health Coverage. Belief also plays a key role in the public's decision to choose traditional medicine over orthodox medicine.

According to Mallam Salisu, it costs about N500 to treat malaria or typhoid with his traditional medicine. This is relatively cheaper than what a patient will pay to treat the same ailment at a hospital. It is also usually less complicated to seek care from traditional medicine sellers. At a hospital, a patient will first need to open a file or buy a card if he doesn't have one, and the cost for this varies from hospital to hospital but it is usually between N100 to N500. Then a consultation fee may be charged as well. If the physician goes for the standard practice and orders for tests to be conducted, the patient has to pay for that as well. Traditional medicine practitioners don't conduct tests of course, they guess according to symptoms and treat. If it turns out that a patient needs medications, at a hospital these will have to be paid for as well. That is a lot of money in a country where more than 44% of the population live in extreme poverty, and where not more than 1% of the population has health insurance. Another issue is the inaccessibility of standard, well-equipped health centres, especially in rural areas. This could prompt people to seek healthcare from a traditional healer nearby. Then there is the long period of time one has to spend in a hospital before being attended to. All these are potential factors that dissuade people from going to the hospital.

Culture and religion play significant roles in the lives of Nigerians, who are made up of more than two hundred ethnic groups. Belief usually influences the people's way of life and their health-seeking behaviours, though it is not clear to what extent they do. Culture may encourage people to choose a certain way of seeking healthcare, but this means that culture may also discourage people from seeking healthcare and this may end up harming them. Increasing education and awareness of the importance of proper diagnosis and treatment is necessary if we are to win the war against harmful health-seeking behaviours.

The Federal Ministry of Health in 2007 produced a Policy Document to integrate and regulate the traditional medicine practice in the country. However, not much can be said about the implementation of that policy by various government agencies, and arguably a majority of the practitioners are not aware of the existence of the policy and thus do not base their practice according to the requirements of the policy. The question is, whose mandate is it to regulate the practice of the Traditional Medicine Practitioners? Is it the Medical and Dental Council of Nigeria? The Pharmacist Council of Nigeria or NAFDAC? What is the status of the bill to establish the Traditional Medicine Council that was proposed in 2010 and passed third reading at the House of Representatives in 2017?

The Lagos State Government in 1980 established the Traditional Medicine Board for the state, and other states like Bauchi followed suit, but has the Board set the pace for more states to follow? Nigeria has two health research institutes, namely the Nigerian Institute of Medical Research and The National Institute of Pharmaceutical Research and Development, and both institutes have departments for Traditional Medicine Research, but not much is known about their activities and what impact they have had on the practice of traditional medicine in Nigeria. Apart from conducting research, these are departments that ideally should serve as centres where traditional medicine practitioners are required to bring their products for testing on efficacy and safety.

With the gaps existing in the regulation of these practitioners and little knowledge of the existence or function of the agencies tasked with traditional medicine research, what motivation exists for the traditional medicine practitioners to actually submit their products for proper testing? These institutes' websites do not make access easy, in comparison to the Centre for Traditional Medicine and Drug Research of the Kenyan Medical Research Institute. The Traditional Medicine Practitioners Association of Nigeria has a functional website with contact details of the executives, however the Association must make more efforts to incorporate less educated practitioners like Salisu into their activities to encourage capacity building.

As efforts continue towards achieving UHC so that standard healthcare can be affordable and accessible to all Nigerians, a system must be made to regulate traditional medicine practitioners. Our research institutes must rise to the challenge of conducting research on traditional medicines, at the same time increasing their accessibility to practitioners.

Traditional medicine practitioners like Malam Salisu are everywhere in Nigeria, and their livelihoods depend entirely on that business. Therefore, an outright ban of their trade could be socially and economically catastrophic for them. However, allowing them to continue operating freely without a system that controls and regulates their practice is also a serious danger to the health of many Nigerians, as the potentially harmful side effects of these medicines are not known. At the very least, systems should be put in place that subject their medicines to safety tests before they can be administered to their patients.

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