Regional progress in traditional medicine 2011-2010 (June 2012)
Government support on traditional medicine
The level of recognition and support for traditional medicine from governments varies considerably in the 37 countries and areas of the Western Pacific Region. To date, there are 18 countries and areas that had developed official government documents (including national policies, regulations or laws) applicable to traditional medicine, compared to 12 countries and areas having official documents before 2000. Examples of recent progress include Nauru, who developed a national policy in 2009, and Cambodia, who issued a policy on traditional medicine in 2010. Meanwhile, Fiji, Kiribati, Niue, New Caledonia and the Federated States of Micronesia are all in the process of establishing national policies on traditional medicine.
Across the Region, therehas been an increase in government activities in traditional medicine, including the establishment of a national office and/or a national expert committee. Fiji, Nauru and Tuvalu are in the process of establishing government bodies for traditional medicine. In the Philippines, the regulation of acupuncture providers was issued in 2008, and regulations on chiropractic and homeopathic providers were enacted in 2009. Within the last few years, Fiji also enacted regulation for acupuncture providers. In 2007, the Lao People's Democratic Republic established the regulation of herbal medicine. Some countries and areas have specific regulations on herbal medicine (Cambodia, China, Hong Kong (China), Macao (China), the Republic of Korea, and the Philippines), and some have traditional medicine included in regulations applicable to conventional pharmaceuticals (French Polynesia, Japan, Mongolia, Malaysia and New Zealand) (Figure 1). While other countries and areas are in the process of establishing regulations for herbal medicine (Papua New Guinea) and regulations for traditional medicine providers (New Caledonia).
Quality, safety and efficacy of traditional medicine
In the Western Pacific Region, some aspects of quality, safety and efficacy of traditional medicine showed considerable improvement in the period 2001-2010. The implementation of standards for Good Manufacturing Practices (GMP) for herbal medicines showed a significant increase. No countries and areas in the Region reported applying GMP for traditional medicine products in 2001. There are now nine countries and areas with GMP implemented: Australia, China, Hong Kong (China), Japan, Malaysia, Philippines, Republic of Korea, Singapore and Viet Nam. In addition, Macao (China) and Mongolia are in the process of establishing GMP for herbal medicinal products. Solomon Islands and Vanuatu have the same GMP rules as for conventional pharmaceuticals. These data indicate a significant increase in concern for the quality and safety of traditional medicines.
The establishment of national pharmacopoeias or monographs has also increased in the last decade, from four countries and areas with national pharmacopoeias in 2001 to nine by 2010. Rather than develop their own systems, several countries and areas have officially adopted or recognize the standards established by other countries in the Region. This facilitates international harmonization and mutual recognition.
Regarding the development of research institutes for traditional medicine, 13 countries and areas in the Region currently have a national institute. However, in some countries research may be carried out by other facilities. For example, Papua New Guinea does not have a separate traditional medicine research institute; the work is done by the national Department of Health in collaboration with the University of Papua New Guinea.
Education and training programmes
The provision of university-level education and related training programmes in traditional medicine helps to ensure the safe and effective use of traditional medicine by health care providers. To date, 14 countries and areas in the Region have established a course on traditional medicine at the unviersity level, 12 of these provide education to at least bachelor's degree level. Seven of these countries and areas provide PhD level education for traditional medicine (China, Hong Kong (China), Japan, Macao (China), Mongolia, the Republic of Korea and Viet Nam). In Cambodia, although not at university level, there is a government-recognized training program for indigenous traditional medicine practitioners.
Economic value of traditional medicine services
Due to the inconsistency of terminology and regulatory status in each country, it is difficult to establish precise data on the economic value of traditional medicine. However, it is clear that the use of traditional medicine is growing in the Region, and the economic value associated with the provision of traditional medicine services has risen in the last 10 years.
Sales of traditional medicine have seen a significant increase in the last decade. The annual industrial output for China listed on the herbal database Chinese Materia Medica was US$ 47.84 billion in 2010, up 29.5% from the previous year. Total profit reached nearly US$ 4.52 billion in 2010, up 33% over the previous year.
Complementary/alternative medicine sales in Australia totalled US$ 1.12 billion in 2008. In Japan, herbal medicine (Kampo medicine) sales increased from US$ 1.42 billion in 2007 to US$ 1.47 billion in 2008. The same trend can be seen in the Republic of Korea where annual expenditures on traditional medicine were US$ 4.4 billion in 2004, rising to US$ 7.4 billion in 2009 through gradual market expansion.
Health insurance coverage is an indicator of the level of government and/or community support for improved and comprehensive access to traditional medicine. Ten countries currently have health insurance coverage for traditional medicine provided by the government and/or private sectors. However, in most cases, the health insurance is partial and only covers specific areas such as acupuncture, chiropractic and herbal medicine.
Continuity and change, and Regional challenges
It is apparent that since the publication of the Regional Strategy for Traditional Medicine in the Western Pacific (2001-2010), there has been significant, but variable, progress in implementing the Strategic Objectives by countries and areas across the Western Pacific Region.
The 2011-2020 strategy presents a balance between continuity and change, tradition and innovation. It provides for a continuation of the directions and actions that remain relevant to the needs of countries and areas and WHO. It also identifies and addresses new and emerging opportunities, challenges and directions that have appeared globally and regionally since the development of the first regional strategy.
The objectives, challenges, directions and actions of the first regional strategy will still be relevant to some of those countries and areas that have seen little advancement in the last decade. Equally, countries and areas that have made major advances may require some of the approaches taken at the time to be updated.
Challenges for the future development of traditional medicine in the Region are related to framing policy, the development and enforcement of regulatory standards for practice and products, guidance for the assessment of quality, sfaety and efficacy, education and training, access and equity to traditional medicine products and services and the safety monitoring of traditional medicine. An overarching challenge for all countries and areas is finding the required financial and human resources.
These challenges are addressed in the directions and actions proposed for each of the five key Strategy Objectives.