Prior to the introduction of the professional practice of herbal medicine, made possible by way of formal education/training in Ghana through the Kwame Nkrumah University of Science and Technology (KNUST), the indigenous/informal practice of herbal medicine existed and still exists. The informal herbal medicine practice forms part of the Traditional medicine practices in Ghana. Traditional medicine has undergone lots of developments in effort to meet modern trends of healthcare delivery. The developments were made possible through successive government policies and the establishment of a Traditional and Alternative Medicine Directorate (TAMD) within the Ministry of Health to help with the implementation of the set policies.
The contribution of a highly recognized body, the Ghana Federation of Traditional Medicine Practitioners Associations (GHAFTRAM) in the Traditional medicine developmental journey cannot be overlooked. GHAFTRAM, formed in 1999 as proposed in previous government policies on a common representation for all Traditional medicine practices brings together associations of the different practices within the Ghanaian Traditional medicine thus providing a common representation in the interest of the different practices to government through agencies of the ministry of health like the Traditional medicine practice council(TMPC), Traditional and Alternative Medicine Directorate ( TAMD), and other stakeholders. With all the good efforts, GHAFTRAM, has not been successful in migrating the services of Traditional Medicine Practitioners unto the main health delivery system in Ghana despite government policies on integration of TMP’s into the healthcare system. The reason for this shortcoming is the fact that practitioners of Traditional Medicine are not professionally trained and the healthcare system in Ghana employs professionally trained people in different fields of practices with a common foundation that enables them work together as a unit in the interest of patients and the general public as a whole. The training of professionals usually involve formal education through tertiary institutions like universities etc. While the activities of health practitioners are regulated by legally recognized practice councils, their various professional associations ensure the continuous development of their practices in general as they have the controlling power which is believed to always serve public interest. 16 years after the introduction of BSC Herbal medicine at KNUST, trained professionals and their professional association, the Ghana Associations of Medical Herbalists (GAMH), have nothing close to having the controlling power of herbal medicine practice in Ghana.
The Ghana Associations of Medical Herbalists (GAMH), the only professional association of herbal medicine professionals trained at KNUST was established in Accra in 2005 and has since been involved in lots of activities/work to achieve the objectives to which it was formed for the betterment of the herbal medicine industry in general. GAMH with the help of the Business Sector Advocacy Challenge (BUSAC) fund, and the Ministry of health pushed for the commencement of a pilot project in September 2012 as a requirement for future integration of the services of Medical Herbalists into the mainstream healthcare delivery system. This resulted in the creation of herbal medicine units in selected government hospitals nationwide as pilot centres of the services of Medical Herbalists. Other success stories of GAMH as a professional body include; advocacy for National Health Insurance Scheme’s (NHIS) coverage of diagnostic services at the various herbal medicine pilot centres, organization of the maiden scientific conference in Kumasi in 2013. Two Continous Professional Development trainings (CPD) for members of GAMH was also organized with the support of the Traditional Medicine Practice Council (TMPC) and other stakeholders in 2014 and 2015 respectively. Despite the efforts and success stories enjoyed by the Ghana Association of Medical Herbalists ( GAMH) in recent times, it is still faced with lots of shortcomings and as such it is not strongly recognized and does not have the controlling power over the herbal medicine practice as expected of a professional association of a practice in the health sector. The shortcomings are described in this article in accordance with the structure of an ideal professional association/body. These include; Policy and Public affairs, Legal and governance, Education, Training and Continuous Professional Development (CPD), Membership and employer engagement, Research and Knowledge, International membership and affiliation, and Other factors.
POLICY AND PUBLIC AFFAIRS
There is currently no known government policy or policies on the professional practice of herbal medicine for Medical Herbalists. No policy exist that gives GAMH authority as the controlling body/association over herbal medicine practice in Ghana. The available policies from the past till date have focused on Traditional Medical Practitioners (TMP’s).
The available policy on herbal medicine practice, “Policy on Traditional Medicine Practice in Ghana” only makes provision for local herbalists and other indigenous practices that employ the use of herbs under the Traditional medicine umbrella. The policy which was developed by the Ministry of Health in 2005 at the time where the professional practice of herbal medicine was at its earliest stage with very few professionals in the system, the same year GAMH came into being, outlines the directives for the development of Traditional medicine practices and as such the Ghana Federation of Traditional Medicine Practitioners Associations (GHAFTRAM) in addition to other stakeholders like Ministry of Health, Ghana Health Service, Food and Drugs Authority(FDA), Ghana National Drugs Programme, Centre for Scientific Research Into Plant Medicine, Centre for Scientific and Industrial Research, , Ghana Medical Association, Nurses and Midwives Council, Pharmacy Council, World Health Organization and DANIDA were the bodies that contributed towards the development of the policy for TMP’s. Others included were Sociology and Biochemistry Departments of the University of Ghana and the Faculty of Pharmacy of the Kwame Nkrumah University of Science and Technology. Some of the laid down directives contained in the said TMP policy was the need for a Traditional Medicine Practice Council( TMPC) to regulate practices of TMP’s, among others. The TMPC was later established in 2010 under the act 575 parliamentary act 2000 in accordance with the provisions made in the 2005 policy on Traditional Medicine.
It is therefore sad and appalling that TMPC, a council established for and controlled by TMP’s (indigenous practitioners) per the policy earlier discussed, still regulates the activities of the professional association of formally trained herbal doctors designated Medical Herbalists, 16 years after their introduction with successive batches of people inducted into the practice. TMPC (with no board membership for GAMH representives) has since offered licenses to qualified Medical herbalists, handle the educational curricula and other aspects of the training of these professionals (including internships to professional examination). This has greatly undermined the development of the clinical practice of herbal medicine in general. Only few Medical Herbalists of the several batches inducted are employed by the Ghana Health Service (GHS) at the various herbal clinic pilot centers in selected government hospitals nationwide. All herbal clinics/hospitals in Ghana by law should be supervised by Medical Herbalists and not just the temporal provisions at the piloting level since September 2012. Due to lack of policy reform and proper recognition, GAMH now works through GHAFTRAM, an indigenous body.
GAMH has failed to push for the reform of available policy on herbal medicine (Policy on Traditional Medicine Practice) to give recognition to Medical herbalists with well laid down directives to promote their practice and offer them the controlling power especially at a regulatory council level with issues regarding herbal medicine practice. This would change everything completely and the herbal industry will now enjoy protection from professionals who will serve it wholeheartedly as there will now be a balance in the interests of all stakeholders of the industry, and that of the public. The government should be well enlightened on the important role Medical Herbalists play and the need for a vibrant professional body in the herbal industry. Work done so far at the various herbal medicine pilot centers may be used in addition to research/studies conducted to influence policy makers.
LEGAL AND GOVERNANCE
This is another important structure that should be in place for any profession/practice and for its professional association or representation to be properly functioning. A law should exist to back a practice. For a law to exist, a bill (drafted act of parliament) has to be passed by parliament. The preparation of bills is done by Government and occasionally initiated by representations outside the circle of government as a legislative proposal or amendment legislative proposal (if the party involved seeks for amendment of existing laws). In the case where a bill expected to be prepared by government as a result of the submission of a legislative proposal or amendment legislative proposal from representations of a practice or profession (for instance by GAMH ), the Ministry in charge passes the proposal through some processes to become a draft bill to be introduced to parliament after the approval from cabinet. The bill if passed successfully by parliament becomes a law after approval from the attorney general and president. In a nutshell a law is an approved bill (act of parliament) that binds or backs any practice and its subsequent association (be it professional or not) or governmental provisions. The established act of parliament (passed bill) gives the structural and functional framework to a practice or government provisions. In the case of passage of a bill to recognize a new professional health practice, the typical structures to be established usually include; regulatory council with well-defined members of which the representative or association of the practice ( e.g GAMH) is recognized as a key body in the council aside other stakeholders on the council’s board.
There is no act of parliament established to back the professional herbal medicine practice currently in Ghana, just as there isn’t a policy. It is therefore expected of the representation, the Ghana Association of Medical Herbalists (GAMH) to make an initiative with the processes explained above. The available Traditional Medicine Practice act 2000 for Traditional medical practitioners(TMP’s) for instance outlines an act( act 575) that established the Traditional Medicine Practice Council(TMPC) to regulate the practice of traditional medicine, register practitioners, license practices, regulate the preparation and sale of herbal medicines etc. The board membership of TMPC includes five members nominated by the federation of all associations of TMPs (GHAFTRAM) , and recognized by the government as representing all TMPs in the country. It is the duty of these five members to elect the Chairman of the Council from among them. Other members of Council are representatives from the universities and research institutions, the Director of the Centre for Plant Medicine Research , the Chief Executive of the Food and Drugs Authority(FDA) and a Registrar, who shall be the Secretary to the Board. An established act of parliament by way of amendment of the TMP act 2000 is required to keep the activities of registered Medical Herbalists and other practitioners of herbal medicine in check professionally.
Other provision under this structure is the availability of a working constitution to guide the activities of the professional association. GAMH has a constitution but it is still faced with governance issues; the electoral process for executives of the association in the past was not properly observe and as such some executives overstayed their tenure of office.
MEMBERSHIP AND EMPLOYER ENGAGEMENT
There is no professional association or association of any kind without active membership. The welfare of members should be the topmost priority of any professional association. Provision should be made to ensure that all members in a professional association are practicing actively with good conditions of service offered by employers. A professional association is expected to engage with employers both in the government and private sectors to negotiate good conditions of service for members. Discrepancies with payment of dues by members for instance can be avoided by making arrangements with employers to make deduction of association dues from monthly salaries before members receive their salaries. The controllers and Accountant generals department does payment to people employed by government. It is directed by most professional association to deduct dues of members and transfer them into the association’s account. GAMH since its initiation has been faced with members’ participation and involvement. An attempt made by GAMH through BUSAC to create employment for Medical Herbalists by the Ghana Health Service (GHS) in 2012 only led to the piloting of herbal medicine services in selected government health institutions and as such only few are employed by government at the expense of several successive batches of Medical Herbalists inducted into the practice who are unemployed. Most members expect that the pilot project should have led to a full Integration that will require every hospital in Ghana to have herbal medicine units/Clinics by law. The efforts made by GAMH to ensure this has since not been fruitful. There is no engagement between GAMH and employers in the private herbal medicine practice sector to negotiate conditions of service to protect members from harsh/unprofessional treatment from employers. GAMH’s inability to do the above and more despite their efforts (known and unknown) have led to challenges with member participation, dues payment, etc. In addition, there isn’t a concrete member register available to the public and for GAMH to monitor members. There isn’t a set date for annual general assembly (AGM) although meetings are sometimes organized.
By Bentil Emmanuel Asare Adusei
The writer holds a BSc in Herbal Medicine from the Kwame Nkrumah University of Science and Technology