The ”cash and carry system” of health delivery where patients were required to pay at every point of service delivery before being attended to even with emergencies at available health facilities was replaced with a health insurance scheme by the government of Ghana with a goal to provide equitable access and financial coverage for basic health care services to its citizens.
The scheme known as the National Health Insurance Scheme (NHIS) was passed into law in 2003 with an establishment of the National Health Insurance Authority (NHIA) to oversee its operations in Ghana. There exist three main categories of health insurance under the scheme with the district mutual health insurance scheme which is operational in every district in Ghana being the most popular. The insurance scheme covers a list of diseases, services and medicines in accredited health facilities and pharmacies nationwide. The medicines covered by the scheme are of pharmaceutical origin with no room for herbal medicines.
The herbal medicine practice has over the years undergone changes to meet the health needs of people in Ghana. The practice for instance is now regulated by a council within the Ministry of Health (M.O.H) known as Traditional Medicine Practice Council (TMPC) and the medicines used now subjected to scientific verification before FDA certification. There is also the Traditional and Alternative Medicine Directorate (TAMDI) within the Ministry that oversees the various traditional and alternative medicine practices with special interest in herbal medicine.
According to the TAMDI some years ago, clinical practice of herbal medicine would be integrated into the main healthcare delivery if the scientific basis for herbal medicines are provided and also health professionals with knowledge in the practice of herbal medicines trained. The Kwame Nkrumah University of Science and Technology (KNUST) responded to the call with the introduction of the Bsc Herbal medicine at the Faculty of Pharmacy in 2001 to train physicians with special knowledge in herbal medicine referred to as Medical Herbalists (M.H).
The Centre For Scientific Research Into Plant Medicine (CSRPM), a government and W.H.O agency develops several herbal medicines with scientific basis used for provision of primary healthcare at the Centre’s clinic at Akuapem-mampong in the eastern region of Ghana. The CSRPM together with the herbal medicine department, Knust also supports the Food and Drugs Authority (FDA) in the provision of scientific basis for herbal products from different herbal companies before approval for sale.
One would expect a full integration as promised by TAMDI as the conditions are now met but unfortunately that was not the case until the leadership of the Ghana Association of Medical Herbalists (GAMH) with the help of the Business sector advocacy challenge fund (BUSAC) advocated for the integration in 2011. With a successful advocacy by GAMH, the M.OH and Ghana Health Service commenced a pilot project of the services of the medical herbalist in about 18 government facilities nationwide in September 2012.
The herbal unit at the pilot centres have an essential list of herbal medicines it uses for primary healthcare provision. Majority of the medicines used are from the CSRPM with others from herbal centres like Adom Herbal etc. According to the president of the Ghana Association of Medical Herbalist (GAMH), Dr Kofi Turkson in an interview PA systems were initially used to inform patients at hospitals of herbal medicine services within the facilities and that attracted people to the Herbal unit until patronage decreased drastically and a survey conducted pointed to the fact that it is because their services was not covered by NHIS.
The National Health Insurance Authority (NHIA) maintains that the products used by medical herbalists at the herbal units have to be classified or be in their generic form which cannot be achieved with herbal products. The generic classification only favors orthodox medicines because that is their nature. Generic medicines are pharmaceuticals whose active compounds are known together with their strengths. Examples include Nifedipine 20mg, diazepam 5mg, etc.
They are discovered through research mostly by pharmaceutical companies or laboratories and patented after which they are reproduced under different brand or trade names. Medical doctors prescribe generic medicines after diagnosis, for instance Amlodipine 10mg daily for 30 days, and it’s on the pharmacist to get brands of 10mg Amlodipine available dispensed to patients. Herbal products however are made from herbs that cannot be patented as they are naturally available and the nature of herbal medicines makes it difficult to identify the active compounds within a particular herb and their strength as herbs contain a lot of compounds in their inactive state that work together.
Herbal products mostly are the result of combination of different plant parts meaning that there will be thousands to millions of compounds whose strength are unknown in the formulation making it difficult for the products to fit into the generic system of classification adopted by the NHIA. Aside the products used, the services provided at the herbal units were also not covered by NHIS according to the GAMH president so meetings were held with duty bearers; Traditional Medicine Practice Council (TMPC), Traditional and Alternative Medicine Directorate (TAMDI), and the Chief Pharmacist that as a matter of urgency certain steps needed to be taken to ensure that services like card, labs and patient consultation fee were at least covered. Unfortunately that wasn’t done until GAMH again embarked on another advocacy and now the earlier mentioned services are covered by NHIS except the medicines.
The ministry of health and the Ghana health service (G.H.S) have failed to create awareness of the availability of herbal medicine units and services of the medical herbalist especially through the media since the commencement of the pilot project in selected government hospitals. No efforts has been made to scale up the pilot centres to cover other hospitals and increase patronage .
There is a poor referral system at these centres as some health professionals like nurses, doctors etc are even not aware of the establishment of herbal medicine unit. Those who are aware refuse to refer patients as a result of the failure of G.H.S to put in place measures to enlighten these health professionals about herbal medicine practice in general.
What then is the way forward?. The NHIS policies regarding coverage of medicines should be reviewed to make provision for an essential list of herbal medicines that will be used not only in the pilot centres but also in selected private herbal clinics and hospitals.
The Traditional Medicine Practice Council (TMPC) and TAMDI should by law make sure every herbal clinic and hospital have at least a professional ( Medical Herbalist) to ensure smooth coverage of NHIS at the facilities when provisions are made by NHIA. There should be awareness creation of the services of medical herbalists at the pilot centres through the media by the Ghana Health Service and the Ministry of Health to increase patronage.
The inclusion of herbal medicines in the National Health Insurance Scheme will go a long way to develop the herbal industry in Ghana as cultivation of medicinal plants large scales will be encouraged. Production of safe, and effective herbal medicines will also be encouraged as herbal industries will want their products to be included in the essential list of medicines covered by NHIS. Licensed herbal shops and pharmacies will also benefit as the coverage will be extended to the facilities for the benefit of the general public just like with orthodox medicines covered with NHIS.
Finally the negative perceptions and misconceptions people have about herbal medicine practice in general will be changed if the practice is fully integrated into the main health delivery system in Ghana and covered with NHIS.
Bentil Emmanuel Asare
President, Ghana Herbal Medical Students’ Association (Ghemsa)
Faculty of Pharmacy and Pharmaceutical Sciences, Knust.
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