A proposal to restructure primary health care in South Africa provides the perfect opportunity for complementary and alternative medicine to be formally integrated into the country’s health system.
Complementary and alternative medicine is any practice of medicine that is outside mainstream conventional allopathic medicine. Some of these medicines may be sourced from natural herbs and are referred to as herbal medicines. They are used, among others, as remedies for a variety of ailments like coughs and insomnia and as dietary supplements and weight loss.
In South Africa, as in many other countries, these alternative treatments are used alongside conventional medicines rather than exclusively. They are also chosen by patients rather than prescribed to them, which creates a complementary rather than an alternative practice.
In 2014 the government amended the Medicines and Related Substances Act. Practitioners of complementary and alternative medicine are now officially recognised and are obliged to register with the Allied Health Professions Council.
The amendment has been seen as the government acknowledging complementary and alternative medicines, but it has not translated into their inclusion into health policy. There is still much to be done before there’s symbiosis between these two systems.
Filling a critical gap
South Africa’s private health care system is rated among the best in Africa, with facilities said to be comparable to those in developed economies.
Against this backdrop it may seem counter-productive to focus on the integration of conventional with complementary health approaches. But the reality is that the population’s health care demands are not being met. This is particularly true in the country’s rural areas, where access to basic conventional health care is extremely limited.
In these rural settings, complementary and alternative medicine practices are common. The rich diversity of South Africa means there are a variety of alternative medicine approaches. However, current literature provides little information on its use.
Fully including these treatments into the health care programmes would ensure that safety, quality and efficacy studies are available and regulated. This is particularly important given the potential of side effects that the existing health care system may be unaware of or is ill-prepared to manage.
A global picture
Across the globe, only a few countries have achieved full integration. These include China, Korea and Vietnam.
But there is more to integrating complementary medicine than using one treatment with another. In an integrated system, complementary health care approaches are officially recognised and incorporated into all aspects of health as well as the national drug policy. Training and treatment measures are registered and properly regulated. Patients can access both conventional and complementary products and services.
In Equatorial Guinea, Nigeria, Mali, Canada and India, complementary medicine practices are inclusive rather than integrated. This is because the practice is not fully incorporated into all aspects of health. In these countries, complementary medicines are extensively used but are not fully accepted for health care provision. They are also not fully included in the national drug policy.
Many other countries have a “tolerant” system of complementary medicine, which means that allopathy is the major system of care and some complementary approaches are allowed under law. South Africa falls in this subcategory.
The popularity of complementary and alternative medicine in South Africa has resulted in calls for it to be integrated into the country’s health care and medical education systems.
But there are two problems. Firstly, integrative measures into medical and health schools in South Africa are almost non-existent. Linked to this is a scarcity of studies on the integration of these medicines with conventional ones and their effect on patients.
Secondly, there are challenges in deciding what student trainees should be taught. Adding the “selected content” to the intense schedule of medical, pharmacy, nursing and the allied health professions students will pose considerable challenges.
Valuable lessons could be learnt from countries like Cuba where complementary medicine is integrated into training and practice. Medical students are extensively trained in the theoretical and practical aspects of complementary and alternative medicine. Only duly qualified and certified health professionals are allowed to practice with complementary and alternative medicine. This ensures that patients are not exposed to unsafe practices.
Moving towards a single system
South Africa’s diversity means there are a variety of complementary health approaches that may differ among different racial, ethnic and cultural groups. This may pose a challenge to inclusion.
As a start, South Africa can create inclusion strategies which will see integration happen over time. These would include quality and efficacy studies and scientific evidence supporting the use of complementary and alternative medicines.
Inclusion strategies may need to be initiated in a specific province, with the full support of government and advisory bodies sanctioned by regulatory authorities. This would focus attention on a smaller area and may limit associated errors.
The strategy would also need to incorporate alternative medicine practices into the training curriculum of medical and health care workers. This would raise awareness of complementary practices among students and expose conventional health practitioners to the benefits and disadvantages.
This strategy would have several benefits, such as successfully incorporating complementary practises into the health system. It would also mean that practitioners could advise patients about medicines and treatments accordingly. Most importantly, it would advance the agenda of health care for all in South Africa.