PART 2: Green Gold: Looking back for a healthier and sustainable future: An overview of South Africa’s medicinal plant resources
– Dr Gary I Stafford
Part two of Dr Stafford’s article on medicinal plant resources in south Africa asks, ‘What is African Traditional Medicine?’
The Draft National Policy on African Traditional Medicine in South Africa (DRAFT NATIONAL POLICY on ATMSA, 2008) defines African traditional medicine as follows:
‘African Traditional Medicine is a body of knowledge that has been developed and accumulated by Africans over tens of thousands of years, which is associated with the examination, diagnosis, therapy, treatment, prevention of, or promotion and rehabilitation of the physical, mental, spiritual or social wellbeing of humans and animals.
‘South Africa is one of the few nations that have made significant progress to integrate
traditional and complementary medicine into the legislative framework for health
practitioners. Traditional medicine, represented by approximately 190 000 traditional
health practitioners, has sustained the health of millions of South Africans over centuries.
There are currently about 3 600 registered Allied Health Care Professionals in South
Africa.’ (Gqaleni et al. South African health review, 2007 – ‘Traditional and Complementary Medicine’ – http://www.hst.org.za/uploads/files/chap12_07.pdf).
In South Africa, a large population of traders, collectors and traditional healers use medicinal plant biodiversity, not only for health purposes, but also to derive a livelihood.
In 2007 the trade in traditional medicines in South Africa was estimated to be worth R2.9 billion per year, representing 5.6% of the National Health budget. With 27 million consumers, the trade is vibrant and widespread. There are at least 133 000 people employed in the trade, with a large percentage of rural women (Mander et al. South African health review, 2007 – ‘Economics of the Traditional Medicine Trade in South Africa’ – http://www.hst.org.za/uploads/files/chap13_07.pdf).
The plant trade is a key to developing rural industries and businesses. However, supply of plant material (some 771 species) and medicines is not sustainable. Currently almost all plants are harvested from the wild, with popular species, such as Natal ginger (https://www.plantzafrica.com/plantqrs/siphonaeth.htm) and kalmoes (https://www.plantzafrica.com/plantab/alepidamat.htm), becoming locally extinct and being traded at very high prices. Much of the current research and development effort focuses on novel drugs research, with little effort being directed at improving the current harvesting, production, processing, storage and treatment technology. The future of the traditional medicines trade and its benefits are uncertain.
In the Western Cape, medicinal plants are largely being traded by a collective of males of mixed ethnic origin who have adopted Rastafarianism as part of their culture (Petersen et al. 2012; Petersen et al. 2014). They are known as bush doctors or ‘bossiedokters’ in Afrikaans and they gather medicinal plants from the wild, trade these plant products amongst themselves and ultimately sell them to the public who use medicinal plants for health in both rural and urban settings. Together with Prof Nox Makunga at Stellenbosch University, Dr Stafford works closely with the Cape Bush Doctors Organization (Kaapse Bossie Doktors – http://www.cbd.org.za/), an NPO that focuses on the formalisation and protection of KhoiSan medicinal practitioners, their knowledge of indigenous medicinal plants and traditional health and spiritual practices. Through a unique relationship established in 2012 with several researchers from Stellenbosch University, this community of ‘bossiedokters’, as an authentic and active group of traditional healers, have been collaborating on finding solutions towards the commercialisation of their indigenous knowledge. One success story is the investigation and development of an herbal adjunct breast cancer therapy, which is partly funded by the South African National Research Foundation (NRF- www.nrf.ac.za). This study is one of the few that is driven and involves close collaboration between the researchers and the knowledge holders, in this case, the Cape Bush Doctors. Stellenbosch University and the Cape Bush Doctors Organisation have co-signed a Memorandum of Understanding and a Collaboration Agreement, and are in the process of securing a benefit sharing agreement, in line with the Nagoya Protocol (https://www.cbd.int/abs/). They are also joint applicants on a patent protecting the knowledge generated from this research.
Up until a decade ago, traditional healing in virtually all its forms had been illegal for more than a century in South Africa. Under the provisions of the Suppression of Witchcraft Act (1957) (first introduced in 1895, last amended in 1970 http://www.justice.gov.za/legislation/acts/1957-003.pdf), all forms of divination were outlawed. Divination is the heart of healing in Africa; therefore, all healing was outlawed. One of the main hindrances for the improvement of traditional medicine, especially the medicinal plant aspect, in South Africa has been Clause 36 of the Medical, Dental and Supplementary Health Services Profession Act (1974 see http://www.hpcsa.co.za/Uploads/editor/UserFiles/downloads/legislations/acts/health_professions_ct_56_1974.pdf). This clause forbade any registered practitioner to practise in collaboration with a non-registered person, and for non-registered persons to perform acts pertaining to the medical or dental professions. The outcome of this legislation was to drive traditional healers ‘underground’ and divide them into several secretive sub-groups. Fortunately these laws have been replaced by following recommendations of the WHO (1978), and like its neighbours Ghana, Tanzania, Zambia and Zimbabwe, South Africa has attempted the ‘professionalisation’ route to traditional healers (Last and Chavunduka, 1986; Pillsbury, 1982). The Traditional Health Practitioners Act (THPA, http://www.gov.za/sites/www.gov.za/files/a22-07.pdf) was gazetted in parliament in May 2005, and is designed to formalise the structure and organisation of traditional health practice through the Traditional Health Practitioners Council of South Africa (the THP Council) (THPA, 2004). This was closely followed by a Draft National Policy on African Traditional Medicine in South Africa. The Policy was recently gazetted (National Policy on ATMSA, 2008) for public comment. The Policy ‘is designed to provide a framework for the institutionalisation of African Traditional Medicine in the South African healthcare system’. This document is the result of the Presidential Task Team on African Traditional Medicine which was appointed in 2006 to make recommendations with regard to a national policy and an appropriate regulatory and legal framework for the institutionalisation of African traditional medicine in South Africa.
To achieve the institutionalisation African traditional medicine the Policy recommended that legislation on African traditional medicine be enacted to provide ‘an enabling environment for African Traditional Medicine in its entirety and scope, covering but not limited to:
- the regulation of African traditional medicine in South Africa;
- registration and regulation of African traditional medicines and medicinal products in South Africa;
- protection of African traditional medicine knowledge and intellectual property rights; and
- the protection of the rights of persons involved in the discipline of African traditional medicine in South Africa’.
The informal trade of medicinal plants in the Cape has also recently received academic attention by researchers Aston Philander (Lisa Aston Philander Curator, CBS Conservatory, University of Minnesota) together with Nokwanda Makunga (http://www0.sun.ac.za/scicom/?news=3500 and http://academic.sun.ac.za/botzoo/makunga/index.htm 2008, 2011, 2012, 2014) and Cape Town based researcher Lief Petersen of the Sustainable Livelihoods Foundation (http://livelihoods.org.za/ 2012, 2014). These studies have shown that in Cape Town alone there are over 5100 traditional healers trading 130 plant species that are wild harvested.
The informal nature of African traditional medicine, together with the oppressive historical laws in South Africa, makes it a difficult sector to work with. As such it does not respond well to regulation and consequently regulation alone is unlikely to improve the traditional medicines industry and the associated healthcare for the millions of consumers in South Africa.
What many suggest is needed, in addition to regulation, is incentives that promote appropriate technologies in wild plant harvesting, preferable moves towards farming, better storage and packaging. Research into dosage and treatment are required. It is hoped that these incentives would encourage the current market players to participate in the development of their own industry.
The origin and voice of these initiatives is also important for buy-in from key role players and thus these incentives should be established by the various tiers of government and can include bursaries and research funds to conduct the basic research around improving the supply and quality of herbal products. Since 2000 the NRF has distributed R330 million in research funds and this has had little direct benefit on the ground. Perhaps we also need to assess how funds are directed.
A safe and hygienic market infrastructure needs to be developed, with processing facilities and easy access to clean packing and adequate storage to reduce waste. Lastly, local and foreign pharmaceutical manufacturers, natural product processors and distributors need to be encouraged to invest in the South African traditional medicines sector by ensuring that investors can secure the ownership rights of the technologies developed.
The use of plants for health and wellbeing is strongly ingrained in many cultures and this is unlikely to change. It is time that a more inclusive vision for the traditional medicine industry be developed in South Africa. Working with the Cape Bush Doctors and conservation bodies to develop their products, making safer and sustainable options available is a small step in that direction.