IKNotes91 Traditional Medicine P

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					IK Notes
                                                                Traditional Medicine Programmes in Madagascar

                                                                M      adagascar has inherited a
                                                                wealth of ethnomedical knowledge.
                                                                                                                 organizational and prescriptive
                                                                                                                 framework for exercising the profes-
                                                                The first medical thesis written by a            sion of traditional healer and for using
                                                                Malagasy concerned the study of a plant          the traditional pharmacopoeia;
                                                                traditionally used as a trial poison in        2. To promote and reinforce dialogue
                                                                Madagascar (Rasamimanana 1891), and              and partnership between local
                                                                the following two theses were devoted to         communities, traditional healers,
                                                                an inventory of Malagasy medical beliefs         researchers, and clinicians for the

                                                                and practices (Ramisiray 1901; Ranaivo           promotion of ethnomedical practices
                                                                1902). Furthermore, a preliminary census         and their scientific investigation;
                                                                of traditional health practitioners in three   3. To develop appropriate legislation
                                                                provinces of Madagascar revealed that            and regulatory texts, in collaboration
                                                                there were more than 2000, which can             with relevant organizations, for
                                                                be extrapolated to over 5000 in the whole        access to biological resources and in
                                                                island.                                          particular medicinal plants, for the
                                                                   Madagascar is also endowed with a             protection of traditional knowledge,
                                                                flora of unique global importance on             and for equitable sharing of benefits
                                                                account of its biodiversity, endemicity,         arising from the development of
                                                                and ethnomedical uses. Of approximately          traditional practices and the sustain-
                                                                13 000 species present in Madagascar,            able exploitation of these biological
                                                                over 80% are endemic to the island, and          resources, in accordance with the
                                                                about 3500 are reported to have medici-          Secure Local Management scheme
                                                                nal properties.                                  (“GELOSE”) established by the
                                                                   The government of Madagascar has              National Department of the Environ-
                                                                shown its political commitment to tradi-         ment and with the Convention on
                                                                tional medicine by supporting, through an        Biological Diversity, of which Mada-
                                                                interministerial convention, a commission        gascar is a signatory;
                                                                to study regulations on traditional medi-      4. To evaluate ethnomedical practices
                                                                cine and its pharmacopoeia in Madagas-           for their safety, efficacy, and and
                                                                car, which was established in May 1996.          quality, to optimize the use of re-
                                                                This commission was enlarged by decree           search results, to follow up patients
   No. 91                                                       N°2339/2002 dated 28th August 2002
  April 2006                                                    marking the creation of a National
                                                                Advisory Committee on Traditional               IK Notes reports periodically on
                                                                Medicine. The Committee brings to-              Indigenous Knowledge (IK) initiatives
                                                                                                                in Sub-Saharan Africa and
                                                                gether the principal public and private         occassionally on such initiatives
                                                                stakeholders in a spirit of partnership. It     outside the region. It is published by
                                                                has recently drafted the national policy        the Africa region’s Results and
                                                                on traditional medicine in Madagascar           Learning Center as part of an
                                                                which now will move forward to be               evolving K partnership between the
                                                                                                                World Bank, communities, NGOs,
                                                                validated at the WHO level. The general         development institutions, and
                                                                objective of this traditional medicine          multilateral organizations. The views
   World   Bank                                                 policy is to improve access for the             expressed in this article are those of
                                                                population, especially the most vulnerable      the authors and should not be
                                                                                                                attributed to the World Bank Group or
                                                                popu-lations, to quality care and service.      its partners in this initiative. A
                                                                Operational objectives are the following:       webpage on IK is available at:
                                                                1. To elaborate a legal, regulatory,            //www.worldbank.org/afr/ik
4. To evaluate ethnomedical practices for their safety,           tics for local uses at affordable prices, and exports
  efficacy, and and quality, to optimize the use of research      Centella asiatica, Drosera ramantacea, other medici-
  results, to follow up patients having taken traditional         nal plants, and essential oils for commercial purpose. This
  medicine, to promote the cultivation of medicinal plants        latter activity is an important source of income for the
  and the local production of improved traditional medi-          Institute.
  cines, in order to make traditional medicine less empirical   3. Department of Clinics with nearly 30 medical consulta-
  and more rational, while preserving as far as possible the      tions per day. Patients may be treated either with
  values which confer its originality; and                        phytomedicines or conventional drugs, or both.
5. To reinforce the systems for information, training, and      One relevant achievement of IMRA has been the com-
  education on traditional medicine.                            puterized compilation of all ethnomedical uses of Madagas-
Traditional medicine programmes in Madagascar can be            car plants. More than 6000 plants have been recorded with
divided into two categories: (1) programmes that are            all detailed information. IMRA is also involved in training
coordinated by the Ministry of Health, and (2) programmes       activities at different levels.
that are carried out on an institutional basis.
                                                                Centre National d’Application de Recherches
                                                                Pharmaceutiques (CNARP)
Background Information                                          The Centre National d’Application de Recherches
                                                                Pharmaceutiques is a state institution which was created
The Traditional Health Practitioner Association                 by the First Republic. The inaugural opening ceremony was
The traditional healers created a national association of       held in May 1972, but the Centre started functioning in
traditional healers following decree N°221/02/MI/SPAT/          1977.
ANTA/ as of 3rd June 2002. Two meetings have been held            The Centre has five departments, reflecting the
between doctors and traditional healers, attempting to          multidisciplinarity and complementarities of the work in
bridge the divide between conventional and traditional          medicinal plant research and development:
medicine.                                                       · Department of Botany/Ethnobotany
                                                                · Department of Chemistry
Institutes involved in medicinal plant research and             · Department of Pharmacology
production in Madagascar                                        · Department of Galenical Pharmacy
                                                                · Department of Clinics.
Institut Malgache de Recherches Appliquées (MIRA)
The Institut Malgache de Recherches Appliquées (IMRA)           HOMEOPHARMA
was created in 1958 by Professor Albert Rakoto-                 HOMEOPHARMA is a private company which was
Ratsimamanga, former Research Director at the Centre            created in 1992 by Dr. Jean Claude Ratsimivony. The
National de Recherche Scientifique, and pioneer of the          areas of activi-ties are homeopathy, phytotherapy, and
scientific re-search in Madagascar. At its inception, IMRA      aromatherapy.
was a non-governmental organization, but since 1993 it            HOMEOPHARMA has a range of products for local
has been granted status as a Foundation following a             uses, namely:
government decree. IMRA is by far the best equipped.            · Homeopathic products
centre in Madagascar for biodiversity conservation and          · Essential oils
drug discovery from natural products, and has a strong          · Phytomedicines
network of collaborations with western institutes.              · Nutraceuticals
IMRA is a good example on how scientific research could         · Plant-based soaps
be integrated with health care, conservation, and produc-       · Anti-insect candle jar
tion. At this point, it has three departments:                  · Creams for massage
1. Department of Research with two areas of activities: (i)
   discovery of biomolecules in the areas of malaria,           Orinasa Fanamboarana Fanafody (OFAFA)
   cancer, diabetes, immunomodulation, cardiovascular and       OFAFA is a semi-public institution devoted to the produc-
   respiratory diseases, and (ii) analytical analysis. IMRA     tion of bulk imported drugs. It was created in 1981 follow-
   has a fully equipped section to carry on the biological      ing an official agreement between the Chinese and the
   screening.                                                   Malaygasv Governments. Although it is not involved in
2. Department of Production and Export which produces           production of phytomedicines, the current infrastructure
   nearly 40 plant-based drugs, nutraceuticals, and cosme-      may be adequately used to produce useful phytodrugs.
Programmes under the coordination of the Ministry               has been put in place to handle the work.
of Health                                                       Plants were selected on the basis of the following criteria:
In order to achieve the objectives of the national policy on    · Plants of potential or effective economic value;
traditional medicine, the strategy has seven parts:             · Plants for which the current phytochemical/biological
1.To create a technico-legal commission charged with               investigations may lead to useful applications
  finalizing the texts which have previously been drawn up,     · Plants with relevant ethnomedical data
  and to elaborate new texts following the instructions of
  the National Policy on Health.                                The content of each monograph of the Malagasy Pharma-
2.To facilitate the creation of traditional healers’ associa-   copoeia comprises:
  tions in order                                                · Validated botanical name
       i. To serve as an internal reference system              · Synonyms
      ii. To provide a professional code of ethics with a       · Vernacular names
   view to rapidly discrediting charlatans, and                 · Botanical description at macroscopic and microscopic
     iii. To enable dialogue with modem medical practitio-         levels
   ners.                                                        · Geographical distribution and ecological status
3.To solicit the participation of all stakeholders in the       · Data on phytochemistry, pharmacology and toxicology
  elaboration and/or finalization of texts on biological re-    · Identity tests
  sources, protection of traditional knowledge, and equi-       · Assays for constituents
  table sharing of benefits arising from the development of     · References. The expected outcomes are:
  ethnomedical practices, in accordance with the Conven-        · Knowledge of 100 priority species which serves as a
  tion on Biological Diversity and the model law of the            basis for the formulation of conservation and valorization
  African Union.                                                   programme within the frame of the sustainable uses of
4.To create a multidisciplinary scientific committee in            the biodiversity for the benefit of health and economy;
  charge of all that pertains to:                               · Production of medicinal plants with a “pharmacopoeia
     i. Research, training, and information on traditional         label”; and
   medicine;                                                    · Extraction of biomolecules with the perspectives of drug
     ii. Inventory and database building on ethnomedical           development.
   practices and medicinal and food plants;                     The Malagasy Pharmacopoeia, in both hard copy and
     iii. Design, development, and production of                digital version, is expected to be completed within two
   phytomedicines and nutraceuticals; and                       years.
     iv. Conservation and cultivation of medicinal plants.
5.To promote and facilitate the production of phyto-
                                                                Phytomedicine production
  medicines and nutraceuticals in appropriate state institu-
                                                                The objective of this programme is the formulation of
  tions and private companies.
                                                                phytomedicines for local uses and export where appropri-
6.Actively to involve local communities in programs to
                                                                ate. Basically, this programme is a follow-up of the Mala-
  develop traditional medicine, using participative ap-
                                                                gasy Pharmacopoeia.
  proaches, so that they are both participants and benefi-
                                                                  Six diseases are targeted in the programme, namely:
                                                                diarrhoea, malaria, asthma, diabetes, cardiovascular
7.To create appropriate mechanisms for local communities
                                                                diseases, and AIDS.
  to benefit from research results on the potential of their
                                                                  A scientific committee was created to coordinate the
  respective regions.
                                                                overall programme. Interested stakeholders are kindly
From this strategy, the National Advisory Committee identi-
                                                                requested to submit a project that will be evaluated by an
fied three areas of intervention: (1) Malagasy Pharmaco-
                                                                expert committee. The draft WHO/AFRO guidelines on
poeia, (2) phytomedicine production, and (3) laws and
                                                                research and meth-odology for evaluating the quality,
regulations regarding the practice of traditional medicine.
                                                                safety, and efficacy of traditional medicines will be recom-
                                                                mended for all partici-pants. OFAFA, IMRA, and OFAFA
Malagasy Pharmacopoeia
                                                                will be in charge of the production of selected
The objective of the programme is to select the 100 top
priority species and to gather all available information. A
multi-disciplinary committee composed of medical doctors,
pharmacists, scientists, and traditional health practitioners
Laws and regulations of the practice of traditional              Conclusions
A technico-legal committee was created to finalize all texts     Madagascar actively took part with Uganda and Ghana in
related to laws and regulations on the practice of traditional   the adoption of the Decade of Traditional Medicine in
medicine. These include:                                         Africa during the OAU Summit held in Lusaka in July
· Law relative to the production, control, and commercial-       2001, and participated in the 15th Meeting of the Inter-
   ization of improved traditional remedies in Madagascar;       African Expert Committee on African Traditional Medicine
· Law relative to the recognition of the practice of tradi-      and Medicinal plants in Arusha in January 2002 for the
   tional medicine in Madagascar;                                drafting of a decade plan of action.
· Decree relative to the organization of the practice of           The overall goal of the programs on traditional medicine
   traditional medicine in Madagascar; and                       in Madagascar is an improved conservation, management,
· Law relative to the access to the resources of the biologi-    and sustainable uses of Madagascan medicinal plants
   cal diversity in Madagascar.                                  through a multi-sector partnership at national and regional
                                                                 levels, with the aim of integrating traditional and modern
Bioprospecting and drug discovery                                medicine in health care, drug discovery, and poverty
Three Institutes are involved in bioprospecting in Madagas-      alleviation. It is hoped that within the Decade of African
car:                                                             Traditional Medicine, relevant achievements will be made
· CNARP under the International Cooperative Biodiversity         by Madagascar through the strong commitment of the
  Group (ICBG) program, including Missouri Botanical             Ministry of Health and Family Planning.
  Garden, Centre National de Recherche pour l’Environe-
  ment, Conservation International, NGO MATEZA,
  Virginia Polytechnic Institute, Bristol Myers Squibb, and
  Dow Agroscience as partners;
· IMRA collaborating with a pharmaceutical company; and          Ramisiray, G. 1901. Croyances et pratiques médicales des
· Chemistry Laboratory of the Faculty of Sciences under a         Malgaches, Thèse de Médecine, Paris; Revue de
  new ICBG program.                                               Madagascar 8: 549-464.
                                                                 Ranaivo, C. 1902. Pratiques et croyances médicales des
The African Traditional Medicine Day: newly                       Malgaches relatives aux accouchements et à la
identified programs                                               médecine infantile, Thèse de
Madagascar celebrated the African Day of Traditional             Médecine, Paris, 1902; Revue de Madagascar, 5ème année,
Medicine. It was attended by various stakeholders. Partici-       n°1. pp. 42-48.
pants agreed on the following programmes:                        Rasamimanana, J. 1891.Contribution à l’étude de l’action
· Evaluation of the efficacy and safety of relevant herbal        physio-logique de la tanghinine cristallisée extraite de
   preparations originating from traditional health practitio-    Tanghinia venenifera, Thèse de Médecine, Lyon.
   ners; and
· Evaluation of the efficacy of bone setting.
Relevant results will be presented at the next celebration of
the African Traditional Medicine Day.

    This IK Note was written by Philippe Rasoanaivo, and orignally published at the Traditional Medicine Programmes in
    Madagascar, Biodiversity & Health: Focusing Research to Policy at the proceedings of the International Sympo-
    sium, held in Ottawa, Canada, October 25-28, 2003. For more information or if you have questions, please contact
    Philippe Rasoanaivo,email: rafita@wanadoo.mg.