Herbal medicine, the use of herbs or herbal remedies to treat diseases, is a common practice globally, with approximately 80 percent of the world’s population using herbal medicine. In recognition of the popularity of herbal medicine, Ghana’s national government piloted a project in 2011 to integrate herbal medicine with biomedical medicine in 17 public hospitals in the country. Other nations, such as China, have integrated herbal medicine into their health care systems, but there has been little research on how effective the integration in Ghana has been.
To gain a better understanding of this effort, a research team led by Dr. Bernard Appiah, assistant professor and director of the Program on Public and International Engagement for Health at the Texas A&M School of Public Health, analyzed the integration using the World Health Organization’s Health Systems Framework. The study, published in the journal BMC Complementary and Alternative Medicine, relied on interviews of experts in various aspects of herbal medicine to examine six key areas: leadership and governance, health care financing, health workforce, medical products and technology, information and research, and service delivery.
Dr. Appiah and colleagues interviewed 25 herbal medicine experts in Ghana, including medical herbalists, public health researchers, a biochemist, a social scientist, a traditional herbalist, and herbal medicine researchers. One of the overall strengths of this integration identified in the interviews is the existing widespread use of herbal medicines in Ghana and the wealth of traditional knowledge in the country. The interview responses also indicated several strengths and challenges related to the herbal medicine integration among the framework’s six key areas.
One of the main stumbling blocks for implementing the integration program has been a lack of clear explanation of policy and administrative procedures by the government. Interviewees cited how insufficient explanations of protocols made it difficult to implement the program. Another challenge noted was the lack of National Health Insurance Scheme (NHIS) coverage of herbal medicines, which could hamper use by patients who must pay out of pocket. Also noted were a shortage of research on safety and efficacy of herbal medicines and a lack of trust in herbal medicines by conventional health care providers. Lastly, the interviewees identified a shortcoming in efforts by the government and other parties to inform the public about the herbal medicine integration.
The experts interviewed also identified several integration strengths. First, a controlled integration of herbal medicines into the conventional health care system can reduce the risk of people receiving counterfeit herbal medicines from unregulated providers. They also identified the potential for new job opportunities and how hospitals in the integration provided new avenues for research on herbal medicine safety and efficacy, attitudes and beliefs, and complementary use of herbal and conventional medicine.
Several avenues for improving the integration of herbal medicine in Ghana include were identified including the need for clearly defined goals and procedures to guide health care professionals and other stakeholders. Another is the need to include at least those herbal medicines that have been proven safe and effective in NHIS coverage. Informing the public is another area for improvement, which could make use of mass media and would require efforts to engage and train members of the media. Introducing herbal medicine into health care education would also likely benefit the integration by potentially increasing trust in herbal medicine. Lastly, the interviewees noted a need to engage farmers and agricultural researchers to protect and conserve sources of herbal medicine, some of which are threatened.
“Our study offers opportunities for the government of Ghana and others to work together to conserve medicinal plants that are becoming extinct and to engage media professionals and members of the public to help promote the integration of herbal medicine into traditional healthcare,” says Dr. Appiah.
A limitation identified was the lack of more in-depth methods such as focus groups. Dr. Appiah and colleagues note that future research should involve policymakers and patients as well as herbal medicine researchers and use both qualitative and quantitative research methods.
This study serves as a first step in gaining a better understanding of Ghana’s integration of herbal medicine into its health care system. The findings Dr. Appiah and his colleagues reached show that the integration has been positive to a small extent, though there are several challenges and areas for improvement such as clearer government guidance and improved public awareness campaigns. Improving this integration could make the already widespread use of herbal medicine in Ghana even more effective.