REPORT OF TRADITIONAL   HEALTH PRACTICTIONERS  (THPS) CENSUS IN RWANDA.REALIZED IN COLLABORATION WITH MINISTRY            ...
Introduction•   This project was initiated to identify all    Traditional Health Practitioners (THPs)    working on Rwanda...
Introduction•   It was urgent to set up that database and create a    legal framework for traditional medicine to clean   ...
Introduction•   However, the direction board of AGA    RWANDA NETWORK has tried its best to    realize the projected censu...
Introduction   This document provides the overview of AGA    RWANDA NETWORK, Census Project of all    THPs in Rwanda and ...
1.2. About AGA RWANDANETW   ORK •   AGA RWANDA NETWORK is an abbreviation of    Kinyarwanda and English words which means ...
1.2. About AGA RWANDANETW   ORK•   Mission•   To sustain and improve Rwandan Traditional    medicine in line with modern d...
1.2. About AGA RWANDANETW   ORK•   Achievements•   From the moment it has been initiated, AGA RWANDA    NETWORK has realiz...
1.2. About AGA RWANDANETW   ORK   Production of AGA RWANDA NETWORK    documentary movie   Preparation and production of ...
1.3. The census project •   1.3.1. Objectives and expected results of the census    project•    Project goals    The objec...
•   Expected results•   This project would allow:    - AGA RWANDA NETWORK forum to make    actions plan to strengthen the ...
1.3. The census project•   1.3. 2. Beneficiaries  •   The direct beneficiaries•   The direct beneficiaries of this project...
1.3. The census project•   1.3.3. The implementation of the project•    1.3.3.1. Resources and ways to implement the    pr...
1.3. The census project   - Technical equipment to facilitate the creation    of the database: it was also necessary to a...
1.3. The census project•   Hum a n re s o urc e s :•   The mission team would consist of two    enumerators, two photograp...
1.3. The census project•   Fina nc ia l re s o urc e•   At the conception of the project, it was supposed that the    fina...
   Tim e re s o urc e s   The realization of this mission was divided into    three main steps:   - Data collection on ...
1.3. The census project•   B) Wa y s to im p le m e nt.•   Da ta Co lle c tio n a nd the ir e ntry o n the fie ld a nd d e...
•   The mission of census was done at different sites in each province as follows:•   Province/            City•   Site•  ...
1.3. The census project•   Da ta p ro c e s s ing•   Data processing was being done by an expert in    creating basic data...
1.3. The census project•   1.3.3.2 Uncounted problems •   The period all along the covered census for all    THPs working ...
1.3. The census project   However, this action of National Census of all    THPs in Rwanda has encountered different    c...
1.3. The census project   a) Lack of financial means   As it was proposed in submitted project to the    Minister of Hea...
•   Where do you think other amount of money    has been found for implementing submitted    budget for realizing the proj...
•   The Leaders of the Forum are also initiators of its    creation. They were rushing with time in terms of    improving ...
•   b) Lack of enough human resources:•   It was proposed that the team in census project    should be composed of 10 pers...
1.3. The census project•   c) Unfinished census at some sites:•   Because of insufficient human resource, census was not  ...
CHAPTER II: THE OVERVIEW OFTRADITIONAL MEDECINE ANDHEALTH IN RW ANDA.
2.1. Definitions   With reference to WHO documents, this    document takes into account the following    definitions:
2.1. Definitions   Tra d itio na l M d ic ine (TM) refers to the sum of                     e    knowledge and practices,...
   He a lth tra d ip ra c titio ne r (HT) is a person who is    known by the community within which he lives    to be com...
   Tra d itio na l Pha rm a c o p o e ia is the repertory of    a set of plant, animal or mineral substances    used with...
   Tra d itio na l m id wife (TMw) is a person who is    widely known within her neighborhood to be    able to help partu...
   I p ro ve d Tra d itio na l M d ic ine s (ITMs) are     m                           e    medicines made on the basis o...
   Tra d itio na l he rba lis t is a person who has    knowledge of medicinal plants and sells them    at a fixed place, ...
2.2. History and current status ofTraditional Medicine   2.2.1 History   Traditional Medicine was practiced in Africa   ...
2.2. History and current status ofTraditional Medicine   Being a huge pool of knowledge, philosophy    and cosmogony not ...
2.2. History and current status ofTraditional Medicine   Until now, the WHO estimates that 80% of    rural population liv...
2.2. History and current status ofTraditional Medicine   In Rwanda, it is sure that a large majority of    the people sti...
2.2. History and current status ofTraditional Medicine   The creation of Traditional Medicine Service in    the health ca...
2.2. History and current status ofTraditional Medicine   Moreover, the utility and timeliness of    integrating Tradition...
2.2. History and current status ofTraditional Medicine   In 1980, within the National University of    Rwanda, a ‘Ce ntre...
   It is nowadays known as the Ce ntre d e    Re c he rc he e n Phy to m é d ic a m e nts e t Sc ie nc e s    d e la vie ...
   Medicinal plants have always been the source    of new molecules used by pharmaceutical    industry. It is thus necess...
   According to the WHO, about 70% of the    world population uses Traditional (natural)    Medicine and indigenous knowl...
   . One of the reasons that account for this is    that sub-Saharan Africa is a region where    poverty levels are the h...
   Therefore, the majority largely depends on the    TM as far as health and health education are    concerned. Despite t...
   In China, plant-based traditional preparations    represent between 30 and 50 % of the total    sum of medicines consu...
   In Germany, 90% of people take a natural    medicine at a certain time in their life.   In Ghana, Mali, Nigeria and Z...
   In the USA, 258 million of adults use products    from complementary medicine.   The world market of medicinal plants...
   The African community will be celebrating the    African Traditional Medicine Day on 31 August    each year. The decis...
   The ministers, on that occasion, asked that    this day be instituted in Member States and    introduced in the calend...
   The image and role of Traditional Medicine    have been reinforced in Africa when the    Heads of State of the contine...
3. Current situation of TM   Nowadays, Rwanda’s policy on the    development and utilization of Traditional    Medicine r...
   The support given to health cooperatives of    tradipractitioners in order to promote the    conservation of tradition...
   The interests directed towards different    cultural aspects of Traditional Medicine by the    Rwandan and foreign edu...
   The existence of different levels of education    and research activities in the field of    Traditional Medicine in t...
   The availability of western medicine health    workers and health tradipractitioners so that    they can collaborate, ...
   The development of traditional pharmacopoeia    in order to make safe, effective and accessible    local medicinal pla...
   However, a more detailed analysis of different    aspects is necessary in order to better define    strengths to be co...
   Strengths and weaknesses in the field of TM   2.4.1. Law and regulation framework   Strengths       The Government ...
•   The Law no. 95/004 0f 18/01/95 sets up conditions    for the management of forest resources in Rwanda.    (Paragraph d...
   W  eaknesses:   The existing laws and current procedures do    not really regulate everyone’s activities in this    f...
   The blueprint law on health does not specify    the role of Traditional Medicine in the    improvement in the health s...
   The absence of a Code of practice and ethics    adapted to the reality of Traditional Medicine.   2.4.2 Institutional...
   Elaboration rules, norms, regulations of the    TM practices;   Promotion of the rational use of traditional    medic...
   the existence of Traditional Medicine    Department within the Institute of Scientific    and Technological Research;...
   W  eaknesses   The absence of national multidisciplinary and    intersectoral framework for consultation and    coord...
   The insufficiency of equipment and funds for    research does not allow full exploitation of the    Traditional Medici...
   Apart from IRST, there does not exist any    other institutions in charge of developing    Traditional Medicine and co...
   . Improved Traditional Medicines (ITMs)   Strengths   The level of achievements in the field of    research in Tradi...
   W  eaknesses   Despite the existence of a lot of reliable    information about medicinal plants used to    obtain loc...
   There are no funds for scientific evaluations of    the traditional remedies, the only way to get    evidences of thei...
   CHAPTER III: CENSUS FIELD MISSION    RESULTS PRESENTATION AND ANALYSIS.   3. 1. Introduction   Before we present res...
   AGA RWANDA NETWORK trained five of his    educated and dedicated members in order to    help as interviewers. A questi...
   After giving asked information according to the    questionnaire, there was a photographer to    take his picture whic...
   . Census field mission results.       Below are figures of people given the    complete service from the interview t...
   According to these figures in the table above,    in Muhanga districts is where we have many    registered traditional...
Sex of questioned andregistered TPs:SEX      NUMBER    %Female   514       52.72Male     461       47.28
Figure 1: Sex of questioned andregistered TPs          47%FemalesMales                        53%
   It is clear in this table that    we have many    females TPs than males. Normally Rwanda as    a country is inhabited...
   But there is another aspect of gender which    must be considered in traditional medicine in    Rwanda.
   In Rwandan culture, there is no segregation as    far as traditional medicine heritage is    concerned. If we admit th...
   Then we will conclude that even though    females were neglected in many aspects of    Rwanda traditional culture, the...
 Group of ages   Number of TPS   %Under 35          257             24.6536- 60            349             35.5060 and abo...
350                                            Not attended                                               school at any le...
   The graphic shows that a big number of    traditional practitioners never attended the    school even at a primary lev...
   . Most of encountered THPs working in    Rwanda have neither informal nor formal    education. Most of them do not eve...
   It has been found out however, that there are    some people among THPs who have    advanced levels of education, even...
Diseases curing ability                               Number of THs with ability   %Circulation system diseases healing ab...
   The table and the graphic above are showing    the diseases treatment ability of traditional    practitioners accordin...
Figure 3: Graphic of kinds oftherapy 700              639 600 500 400    336                                        Magica...
   According to testimonies of TPs we realized    that there are two kinds of therapy used in    traditional medicine. On...
   We found that a big number of TPs is using    natural therapy (65.54%) but we must not    neglect 34.46% that uses mag...
Table 10: Classification of THPs concerningwhere they have got knowledge in TMWhere the knowledge is from   Number of TPs ...
   Those who declared to have the knowledge    from ancestors (35.39%) are more than other    groups. When you consider i...
Figure 4: Concerningcollaboration with Healthcenters:
Figure 4: Concerningcollaboration with Healthcenters: 500 400 300                            There is a collaboration 200 ...
   In this mission it has also been found that    some of THPs do not work with Health    Centers. This is caused by two ...
Table 12: Concerning TPs affiliation incooperatives, the table below shows whathas been found:Cooperative affiliation     ...
   As shown in the table above 59.80% of    tradipractitioners is affiliated in cooperative    and 38% not yet. Even thou...
   Activities to support/ give advice to    cooperatives of tradipractitioners are not    widespread.   The Ministry was...
   CHAPTER IV: CONCLUSION AND    RECOMMENDATIONS.   4.1. Conclusion   The work which has been done according to    mean...
   It is important to see that what were done will    serve as a stepping stone to many some    activities action plan. I...
   Recommendations   All above encountered situation and    challenges have led us to following    recommendations to th...
   To provide budget for payment of taken loan in    realization of actions done in covered census    because it was very...
   To allow AGA RWANDA NETWORK    additional time for returning to sites where    census was not finished and provide bud...
   To allow AGA RWANDA NETWORK    additional time for returning to sites where    census was not finished and provide bud...
   To help in partnership extension between AGA    RWANDA NETWORK and other Forums of    THPs all over the world as a goo...
   To find scholarship for some skilled THPs in    order to help them specialize in TM   To help in the creation of Nati...
   To reinforce the program of working in    cooperatives because Tradipractitioners’    cooperatives are not established...
   Establish the code of practices and ethics for    TMs in Rwanda: There does not exist a code    of practice and ethics...
   Enhance training programs for TPs:    Tradipractitioners’ needs for training/education    are not fully taken into acc...
   Establish a laboratory of traditional medicine:    Existing laboratories in which lab work can be    done are not well...
   Promotion of research and education in the    field of traditional medicine: The frameworks    for joint national, sub...
   To establish a library and data bank on    traditional medicine: There are difficulties in    accessing updated librar...
   To strengthen national institutional and    organizational capacities related to the    development of TM resources. ...
   To strengthen national capacities in charge of    training/education and researches on different    aspects of Traditi...
   To increase the quantity of Traditional    Medicines available, within the framework of    National Pharmaceutical Pol...
CONTACTS   Tel: +250 (0) 784 18 65 85   E-mail: rekerahoe@yahoo.in   AGA RW   ANDA NETW    ORK E-mail adress: agarwan ...
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The report on the sensus done by AGA Rwanda Network in partnership with the Ministry of Health of Rwanda. Uploaded by NTAMPAKA Jean for www.agarwanda.com

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Transcript of "AGA RWANDA NETWORK CENSUS "

  1. 1. REPORT OF TRADITIONAL HEALTH PRACTICTIONERS (THPS) CENSUS IN RWANDA.REALIZED IN COLLABORATION WITH MINISTRY OF HEALTH COORDINATED AND PRSENTED BY AGA RWANDA NETWORK
  2. 2. Introduction• This project was initiated to identify all Traditional Health Practitioners (THPs) working on Rwandan ground and set up a database of all those Practitioners wishing to pursue the treatment and healing profession in order to have a membership card issued by an official National Forum called AGA RWANDA NETWORK in collaboration with the MOH.
  3. 3. Introduction• It was urgent to set up that database and create a legal framework for traditional medicine to clean up this sector, which increasingly becomes a victim of charlatans who sully it by their business practices harmful to public health.• The project has been accomplished and submitted to the Ministry of Health in order to be sponsored yet, in the requested amount which was over 28 million of Rwandan Francs, the Ministry of Health has provided about 297 thousands for the national radio announcement. This has been caused by the fact that the requested sponsorship was not prepared in the budget of MoH.
  4. 4. Introduction• However, the direction board of AGA RWANDA NETWORK has tried its best to realize the projected census despite of lack of that requested sponsorship. Leaders of the Forum have been working in the place of temporal employees that would be hired once sponsored. They were only encouraged by the fact that the projected census was to help in the creation of professional and legal framework through which TM would be practiced in Rwanda.
  5. 5. Introduction This document provides the overview of AGA RWANDA NETWORK, Census Project of all THPs in Rwanda and the way it has been conducted, results from collected data analysis and it will end by recommendations based on found results.
  6. 6. 1.2. About AGA RWANDANETW ORK • AGA RWANDA NETWORK is an abbreviation of Kinyarwanda and English words which means ABAVUZI GAKONDO RWANDA NETWOK. It is a National Forum of Rwandan Traditional Health Practitioners which aims at both sustaining and improving Rwandan Traditional Medicine in line with modern development. It has been created in March 27th 2011 at Kigali by volunteer people, who already had discovered the richness hidden in Traditional Medicine and how it can enhance health services in Rwanda hence the development of the country.
  7. 7. 1.2. About AGA RWANDANETW ORK• Mission• To sustain and improve Rwandan Traditional medicine in line with modern development therefore fully exploit the related wisdom in Rwandan culture.• Vision• To enhance the traditional medicine in Rwandan culture improving knowledge and skills of traditional medicine practitioners.• Location• The National office is now located in Kigali City, Nyarugenge District, in Gitega Sector near the Gitega Sector’s offices.
  8. 8. 1.2. About AGA RWANDANETW ORK• Achievements• From the moment it has been initiated, AGA RWANDA NETWORK has realized different achievements such as:• Establishing the National Office, located at Gitega near of the Sector.• Making a garden of different medicinal plants• Establishing provincial and District committees all over the country.• Conducting trainings for Traditional Health Practitioners in all Provinces and Kigali City. The trainees have acquired enriched knowledge and skills in different courses such as human anatomy, physiology, pathology, how to prepare natural medicine, nutrition, introduction to psychology, Asian medicine, Rwandan traditional medicine, etc.
  9. 9. 1.2. About AGA RWANDANETW ORK Production of AGA RWANDA NETWORK documentary movie Preparation and production of a book of TM that will continue to be produced in Volumes. The first volume is called: “INDONGOZI Y’UBUVUZI GAKONDO BWA KINYARWANDA” Census of all THPs all over the country Preparation and celebration of the 09th African Day of TM celebrated on 02nd Sept 2011.
  10. 10. 1.3. The census project • 1.3.1. Objectives and expected results of the census project• Project goals The objectives of this census were: - To identify and record all activities on traditional healers in the entire country; - To produce a database of traditional healers at the national level that will allow to know t heir location, specialty, etc. - To produce a membership card to be issued to confirm the recognition of each Traditional Heath Practitioner (THP) in the domain.
  11. 11. • Expected results• This project would allow: - AGA RWANDA NETWORK forum to make actions plan to strengthen the capacity of traditional healers in order to help the government to professionalize traditional medicine in Rwanda; - To fight against quackery and enhance the profession of traditional medicine.
  12. 12. 1.3. The census project• 1.3. 2. Beneficiaries  • The direct beneficiaries• The direct beneficiaries of this project are in particular, THPs forum members.• Indirect beneficiaries• The indirect beneficiaries are the entire Rwandan population in general who may be in one way or another, a victim of the unlawful practices of charlatans who claim the true healers.  
  13. 13. 1.3. The census project• 1.3.3. The implementation of the project• 1.3.3.1. Resources and ways to implement the project. a ) Re s o urc e s re q uire d• M te ria l re s o urc e s : a• - It was supposed to use means of transport of the mission team and beneficiaries: Since the action of recording was to be on two or three sites, as appropriate, in each province, the mission team would need a vehicle for their travel and ticket costs for THPs to motivate them.
  14. 14. 1.3. The census project - Technical equipment to facilitate the creation of the database: it was also necessary to avail two laptops computers, one desktop computers, a printer, a machine for printing plastic cards, a photocopy machine, and two digital cameras.
  15. 15. 1.3. The census project• Hum a n re s o urc e s :• The mission team would consist of two enumerators, two photographers and an expert in the creation of databases. The enumerators should be persons experienced in the field of traditional medicine in order to reap all the technical information necessary for the data of traditional practitioners. It would also be a census project coordinator.
  16. 16. 1.3. The census project• Fina nc ia l re s o urc e• At the conception of the project, it was supposed that the financial resources that would be used were to come entirely from the grant that would be mainly allocated as follows:• - Cost of technical equipment• - Transportation costs of the mission team and tickets for the movement of beneficiaries. - Fees paid to consultants for this mission• - Operating expenses for the coordination of this activity.• It is very important to consider that when the project was implemented all resources used were only from the arrangement of AGA RWANDA NETWORK. That is why all predetermined actions in this projected were not done properly and/or entirely.
  17. 17.  Tim e re s o urc e s The realization of this mission was divided into three main steps: - Data collection on field; - Data processing; - Publication of results and validation
  18. 18. 1.3. The census project• B) Wa y s to im p le m e nt.• Da ta Co lle c tio n a nd the ir e ntry o n the fie ld a nd d e live ring c a rd s .• Here is explained the process of the data collection and entry, photographs identification, and cards delivering:• The registration of all information relating to the identity of traditional healers was done by using the method of interview. AGA RWANDA NETWORK trained five persons of his educated and dedicated members were used in order to help as skilled interviewers. A questionnaire was prepared as an interview tool. Interviewers were helping interviewees to answer this questionnaire and answers were recorded immediately with software which would serve in data analysis. After giving asked information according to the questionnaire, there was a photographer to take the picture of THP, which was used for his identification card. The cards were printed and delivered hence registered in the book of AGA RWANDA NETWOK immediately.
  19. 19. • The mission of census was done at different sites in each province as follows:• Province/ City• Site• Dates•  • KIGALI CITY• Nyarugenge• 07/08/11• 08/08/11•  •  • WEST• Nyagatare• 09/08/11• Rwamagana• 10/08/11• Bugesera• 11/08/11•  • NORTH• Gicumbi• 12/08/11• Musanze• 14/08/11•  •  • EAST• Nyabihu• 15/08/11• Karongi• 16/08/11
  20. 20. 1.3. The census project• Da ta p ro c e s s ing• Data processing was being done by an expert in creating basic data to arrive at a computerized database that would be used each time for consultation when necessary. Public a tio n o f re s ults a nd va lid a tio n• The results of the mission was supposed to be published as a report and validated during a validation session of all stakeholders: MoH, IRST, WHO, UNESCO etc.
  21. 21. 1.3. The census project• 1.3.3.2 Uncounted problems • The period all along the covered census for all THPs working in Rwanda has been very important for it had helped to contact many of THPs, their names, their ages, where they are located, their way of treating and/or healing and diseases and/or illnesses that they find solution to. All these collected information will help to make a strategic plan for improving health care delivered from Traditional Medicine (TM).
  22. 22. 1.3. The census project However, this action of National Census of all THPs in Rwanda has encountered different challenges as it was also done unexpectedly without any other prior preparation. Therefore, encountered challenges can be grouped in following lines:
  23. 23. 1.3. The census project a) Lack of financial means As it was proposed in submitted project to the Minister of Health for the covered census, the project contained a budget of 28,990,000Rwf in which the Ministry of Health has only provided 297,000Rwf for radio announcement.
  24. 24. • Where do you think other amount of money has been found for implementing submitted budget for realizing the projected action of census? Could Leaders of AGA RWANDA NETWORK let the action not done because of that lack of financial sponsorship…..? If the National Forum of THPs in Rwanda was directed by leaders who did not get the idea to initiate it, they would suspend the action, but it has not been the case.
  25. 25. • The Leaders of the Forum are also initiators of its creation. They were rushing with time in terms of improving TM in Rwanda. That is the reason why they could not let the opportunity pass without any exploitation. The forum has taken loan for different basic needed materials such as computers, printers, machine for cards plastification, and other amount, though it was still insufficient for activities that were to be performed. This means that though the action of census has been realized all over the country, the executer, AGA RWANDA NETWORK, is still facing the problem of the used loan.
  26. 26. • b) Lack of enough human resources:• It was proposed that the team in census project should be composed of 10 persons: two enumerators, two photographers, two persons for cards making, one person for cards registration and delivery, two officers of AGA RWANDA NETWORK for coordinating activities, and one consultant for data collection and analysis. The used team lacked 3 persons: 1 photographer, 1 card maker, and 1 person for cards registration and delivery. Some of census activities have been done by AGA Leaders themselves. This lack of enough human resources has been the cause of following challenge:
  27. 27. 1.3. The census project• c) Unfinished census at some sites:• Because of insufficient human resource, census was not done for all THPs at some sites due to the big number of them at these sites, which are: Bugesera, Musanze, Nyabihu, and Muhanga. The team has returned at the Site of Bugesera on 21st August 2011 where it has also been found out that there still is a need to go at what was called Ngenda Commune because there has been claimed to be many THPs who are not yet registered because of misinformation. The site of Musanze was composed by 3 Districts: Musanze, Burera, Rulindo, and Gakenke. The census was done for only one District, Musanze. The census team will be obliged to go at each District of the remained for avoiding cost of journey to people. Other people at Nyabihu and Muhanga Sites were registered but not given membership cards because of electrical problem.
  28. 28. CHAPTER II: THE OVERVIEW OFTRADITIONAL MEDECINE ANDHEALTH IN RW ANDA.
  29. 29. 2.1. Definitions With reference to WHO documents, this document takes into account the following definitions:
  30. 30. 2.1. Definitions Tra d itio na l M d ic ine (TM) refers to the sum of e knowledge and practices, explicable or not, transmitted from generation to generation, orally or in writing, used within a human community to diagnose, prevent or eliminate disequilibrium of physical, mental, social or spiritual wellbeing.
  31. 31.  He a lth tra d ip ra c titio ne r (HT) is a person who is known by the community within which he lives to be competent to provide health care, by means of plant, animal or mineral substances, and other methods, based on socio-cultural and religious beliefs, as well as on knowledge, behaviour and beliefs related to physical, mental, social and spiritual wellbeing and causes of illnesses and disabilities prevailing within the community.
  32. 32.  Tra d itio na l Pha rm a c o p o e ia is the repertory of a set of plant, animal or mineral substances used within a human community in order to diagnose, prevent or eliminate disequilibrium of physical, mental, social or spiritual wellbeing.  
  33. 33.  Tra d itio na l m id wife (TMw) is a person who is widely known within her neighborhood to be able to help parturient women and whose competence comes from a familial legacy or from training with other traditional midwives. They are at present known as Maternal Health Assistants (MHA).
  34. 34.  I p ro ve d Tra d itio na l M d ic ine s (ITMs) are m e medicines made on the basis of local traditional pharmacopoeia, with known toxicity limits, with pharmacological effect confirmed through scientific research, with quantifiable dosage of which quality can be controlled when put on the market.   
  35. 35.  Tra d itio na l he rba lis t is a person who has knowledge of medicinal plants and sells them at a fixed place, preferably in a marketplace. M d ic ina l p la nts (MP) are plants used in e Traditional Medicine of which at least one part has therapeutic properties.
  36. 36. 2.2. History and current status ofTraditional Medicine 2.2.1 History Traditional Medicine was practiced in Africa long before the adoption of western medicine. Its practice stood the test of colonialism, despite measures taken at that time to marginalize Traditional Medicine
  37. 37. 2.2. History and current status ofTraditional Medicine Being a huge pool of knowledge, philosophy and cosmogony not yet exploited, Traditional Medicine not only offers possibilities of effective and accessible treatments for pathologies prevailing in communities, but also constitutes a cultural legacy and a means to establish the relationship between populations and their own history and culture.
  38. 38. 2.2. History and current status ofTraditional Medicine Until now, the WHO estimates that 80% of rural population living in developing countries relies on Traditional Medicine for their health care (WHO, 2001). The Alma-Ata Declaration of 1978 and many relevant declarations by the WHO and other international organizations have emphasized the importance of Traditional Medicine.
  39. 39. 2.2. History and current status ofTraditional Medicine In Rwanda, it is sure that a large majority of the people still uses resources of Traditional Medicine to solve health problems. Referring to research works done in other countries of our sub-region, we estimate that there is about 1 tradipractitioner per 500 inhabitants.
  40. 40. 2.2. History and current status ofTraditional Medicine The creation of Traditional Medicine Service in the health care Division of the Ministry of Health goes back to 1980. It was in charge of establishing a National Policy on Traditional Medicine, coordinating its implementation, establishing Rwandese Traditional Pharmacopoeia and preparing basic documents aimed at integrating Traditional Medicine and health tradipractitioners, including traditional midwives, into the framework of primary health care.
  41. 41. 2.2. History and current status ofTraditional Medicine Moreover, the utility and timeliness of integrating Traditional Medicines which have been proved innocuous, effective and of good quality into the collection of therapeutic products available to deal with pathologies predominating in the community need not to be demonstrated.
  42. 42. 2.2. History and current status ofTraditional Medicine In 1980, within the National University of Rwanda, a ‘Ce ntre Unive rs ita ire d e Re c he rc he e n Pha rm a c o p é e e t M d ic ine Tra d itio nne lle ’ – é CURPHAMETRA- (University Centre for Research in Pharmacopoeia and Traditional Medicine) was created. This was later on transferred to the I titut d e Re c he rc he ns Sc ie ntifiq ue e t Te c hno lo g iq ue – IRST- (Institute of Scientific and Technological Research).
  43. 43.  It is nowadays known as the Ce ntre d e Re c he rc he e n Phy to m é d ic a m e nts e t Sc ie nc e s d e la vie (Centre for Research in Phytomedicines and Life Sciences). This centre has the mission, among others, to carry out the study of medicinal plants and any other products or methods used in Traditional Medicine.
  44. 44.  Medicinal plants have always been the source of new molecules used by pharmaceutical industry. It is thus necessary to protect natural sites of natural medicinal plants and take specific measures designed to domesticating and reintroducing endangered or extinct medicinal plant species, as well as to grow medicinal plants that are most widely used.
  45. 45.  According to the WHO, about 70% of the world population uses Traditional (natural) Medicine and indigenous knowledge to satisfy health care needs. It is believed that this number is higher in sub-Saharan Africa because many people use TM instead of conventional treatments
  46. 46.  . One of the reasons that account for this is that sub-Saharan Africa is a region where poverty levels are the highest and very few people have financial means that allow them to have access to expensive health services. In addition, doctors are not always available and there are also customs and practices which make them prefer TM
  47. 47.  Therefore, the majority largely depends on the TM as far as health and health education are concerned. Despite that the role of TM is recognized, it is not yet, in sub-Saharan Africa, a component of the formal health system as is elsewhere in other regions. In Africa, Asia and Latin America, many countries use TM to meet some primary health needs. Here are some examples:
  48. 48.  In China, plant-based traditional preparations represent between 30 and 50 % of the total sum of medicines consumed. In the United Kingdom, annual total sum of money spent on alternative medicine represent US $ 230 millions. In industrialised countries, “complementary” or “alternative” medicine is an equivalent to TM.
  49. 49.  In Germany, 90% of people take a natural medicine at a certain time in their life. In Ghana, Mali, Nigeria and Zambia, the first- line treatment for 60% of children infected with strong fever due to malaria resorts to medicinal plants administered at home. 70 % of Canadians use at least once complementary medicine.
  50. 50.  In the USA, 258 million of adults use products from complementary medicine. The world market of medicinal plants, which is rapidly growing, represents at present more than US$60 billion per year. According to the Commission for Alternative and Complementary Medicine, a sum of US$17 billion was allocated for Traditional Medicines in 2000 in the USA.
  51. 51.  The African community will be celebrating the African Traditional Medicine Day on 31 August each year. The decision to institute this day is a result of the adoption, in 2000, of a resolution on the “Promotion of the role of Traditional Medicine in health systems: Strategy of African Region” by the health ministers of the Region.
  52. 52.  The ministers, on that occasion, asked that this day be instituted in Member States and introduced in the calendar of days celebrated by the WHO. The celebration of that day aims to highlight the importance of that resource which helps to improve health.
  53. 53.  The image and role of Traditional Medicine have been reinforced in Africa when the Heads of State of the continent declared in Abuja in august 2001 that research in Traditional Medicine must be a priority. This declaration was followed by another, made in Lusaka in July 2001, which made the 2001- 2010 period a “Decade of African Traditional Medicine”.
  54. 54. 3. Current situation of TM Nowadays, Rwanda’s policy on the development and utilization of Traditional Medicine resources is based on many strong points: The existence of technical structure within the Ministry of Health in charge of implementing this policy;
  55. 55.  The support given to health cooperatives of tradipractitioners in order to promote the conservation of traditional knowledge and protect health tradipractitioners’ profession against money-mindedness and quackery that are spreading because of urbanization and traditional value crisis.
  56. 56.  The interests directed towards different cultural aspects of Traditional Medicine by the Rwandan and foreign education and research institutions and the existence of “living treasures” of Traditional Medicine’
  57. 57.  The existence of different levels of education and research activities in the field of Traditional Medicine in the framework of national, sub-regional and international joint collaboration.
  58. 58.  The availability of western medicine health workers and health tradipractitioners so that they can collaborate, in the framework of doing operational research on the complementarily between both health systems, in order to really improve the health status of the populations;
  59. 59.  The development of traditional pharmacopoeia in order to make safe, effective and accessible local medicinal plant-based medicines available; Measures taken to protect biodiversity; 
  60. 60.  However, a more detailed analysis of different aspects is necessary in order to better define strengths to be consolidated and weaknesses to eliminate in the framework of implementing the National Policy of Traditional Medicine. 
  61. 61.  Strengths and weaknesses in the field of TM 2.4.1. Law and regulation framework Strengths  The Government of the Republic of Rwanda has set up conditions to be fulfilled in order to practice Traditional Medicine in Ministerial Instructions N° 20/18 of the 16th June/2006.
  62. 62. • The Law no. 95/004 0f 18/01/95 sets up conditions for the management of forest resources in Rwanda. (Paragraph discussing TM to be included). See Official Gazette.
  63. 63.  W eaknesses: The existing laws and current procedures do not really regulate everyone’s activities in this field and do not defend true health tradipractitioners: a review of laws involving concerned people is therefore necessary.
  64. 64.  The blueprint law on health does not specify the role of Traditional Medicine in the improvement in the health status of the populations and social and health development programmes, even if it provides for Traditional Medicines in the framework of National Pharmaceutical Policy.
  65. 65.  The absence of a Code of practice and ethics adapted to the reality of Traditional Medicine. 2.4.2 Institutional framework Strengths  The existence of the service in charge of TM within the Ministry of Health. This service has many missions, of which the most important are: Elaboration the policy on TM and following up its implementation;
  66. 66.  Elaboration rules, norms, regulations of the TM practices; Promotion of the rational use of traditional medicines; Coordinating interventions in the field of TM
  67. 67.  the existence of Traditional Medicine Department within the Institute of Scientific and Technological Research; Some partners of the Government intervening in the field of health collaborate or support IRST in the development of Traditional Medicine. We can mention, among many others, the WHO, UNESCO, and others.
  68. 68.  W eaknesses The absence of national multidisciplinary and intersectoral framework for consultation and coordination between different institutions concerned with the development of different aspects of Traditional Medicine. Insufficient administrative and technical staff (in the field of Traditional Medicine) in terms of quantity and quality.
  69. 69.  The insufficiency of equipment and funds for research does not allow full exploitation of the Traditional Medicine services and the achievement of objectives. The place and role of Traditional Medicine in comparison with other decentralised structures of the Ministry of Health are not clearly defined.
  70. 70.  Apart from IRST, there does not exist any other institutions in charge of developing Traditional Medicine and coordinating operational research and education activities in this field.
  71. 71.  . Improved Traditional Medicines (ITMs) Strengths The level of achievements in the field of research in Traditional Medicine in Rwanda is indeed undisputable but not sufficient:  The existence of sufficient raw materials  A good collaboration between tradipractitioners and IRST
  72. 72.  W eaknesses Despite the existence of a lot of reliable information about medicinal plants used to obtain local Traditional Medicine, new ITMs are not quickly made.
  73. 73.  There are no funds for scientific evaluations of the traditional remedies, the only way to get evidences of their efficacy, safety and quality; and to fully integrate TM in the national health system. ITMs, since they are not recorded, are not officially put on the market.
  74. 74.  CHAPTER III: CENSUS FIELD MISSION RESULTS PRESENTATION AND ANALYSIS. 3. 1. Introduction Before we present results from the census, it is very crucial to remind the processes of this mission on the field. Registration of all information relating to the identity of traditional healers. This was done by using the method of interview.
  75. 75.  AGA RWANDA NETWORK trained five of his educated and dedicated members in order to help as interviewers. A questionnaire was prepared as an interview tool. Interviewers were helping interviewees to answer this questionnaire and answers were recorded immediately with software which would serve in data analysis.
  76. 76.  After giving asked information according to the questionnaire, there was a photographer to take his picture which was used for his identification cards. The cards were printed immediately.
  77. 77.  . Census field mission results.   Below are figures of people given the complete service from the interview to the stage of turning home with the cards. Those figures are according to district and they are showing how district participated in this action.
  78. 78.  According to these figures in the table above, in Muhanga districts is where we have many registered traditional healers registered; in Nyaruguru is where we have the lowest number. It can be thought that in Muhanga we have many TPs registered because it has been the last site during the time of this census mission; so it was reached when a big number was already informed.
  79. 79. Sex of questioned andregistered TPs:SEX NUMBER %Female 514 52.72Male 461 47.28
  80. 80. Figure 1: Sex of questioned andregistered TPs 47%FemalesMales 53%
  81. 81.  It is clear in this table that we have many females TPs than males. Normally Rwanda as a country is inhabited by a big number of females than males; this is due mainly to the war and Genocide. So, it is not surprising to see that even in the field of traditional medicine the number of females is above the number of males.
  82. 82.  But there is another aspect of gender which must be considered in traditional medicine in Rwanda.
  83. 83.  In Rwandan culture, there is no segregation as far as traditional medicine heritage is concerned. If we admit that culture is “the wa y p e o p le live . Culture a ffe c ts e ve ry thing we think a nd d o , fro m ho w we tre a t o ur e ld e rs , to who we a llo w to be a he a le r, to wha t we d o whe n o ur c hild re n d o no t fe e l we ll” ;
  84. 84.  Then we will conclude that even though females were neglected in many aspects of Rwanda traditional culture, they were considered and very involved in this aspect of culture which is traditional medicine.
  85. 85.  Group of ages Number of TPS %Under 35  257  24.6536- 60  349  35.5060 and above  369  39.85
  86. 86. 350 Not attended school at any level300 304 274 264 Not finished250 primary level200 Finished primary150 level100 Vocational 59 training50 3021 31,18 28,1 27,07 13 10 6,05 2,15 1,05 0 3,07 1,33 A level NUMBER OF TPS % O level College University
  87. 87.  The graphic shows that a big number of traditional practitioners never attended the school even at a primary level; they number 31.18%. Another big number never finished the primary level 28.10%. Only 1.05 attended university level of education. There is also illiteracy problem.
  88. 88.  . Most of encountered THPs working in Rwanda have neither informal nor formal education. Most of them do not even have skills of writing and reading. This is one of handicaps for their collaboration with conventional health practitioners.
  89. 89.  It has been found out however, that there are some people among THPs who have advanced levels of education, even Universities’ that they should be promoted for specializing in TM as one way of improving TM related services Answers received from TPs concerning different system diseases/illnesses treatment/healing ability are clear in the table below:  
  90. 90. Diseases curing ability Number of THs with ability %Circulation system diseases healing ability 462 47.38Nervous system diseases healing ability 291 29.84Muscle system diseases healing ability 217 22.25Immune system diseases 104 10.66spiritual and psychological illness healing ability 479 48.82Digestive system diseases healing ability 535 54.87Respiratory system diseases 169 17.33Reproductive system diseases healing ability 467 47.89Integumentary system diseases healing ability 584 59.89
  91. 91.  The table and the graphic above are showing the diseases treatment ability of traditional practitioners according to their testimonies. All diseases were put in groups according to the human body systems. A big number of TPs are those who deal with integumentary system diseases (59.89%) and the lowest percentage is for those with immune system diseases (10.66). 
  92. 92. Figure 3: Graphic of kinds oftherapy 700 639 600 500 400 336 Magical therapy 300 Natural therapy 200 34,46 65,54 100 0 Number of TPs %
  93. 93.  According to testimonies of TPs we realized that there are two kinds of therapy used in traditional medicine. One is magical therapy another natural. What we have called magical is that one that uses spiritual power in treatment and the natural one is that uses only, natural medicine from natural resources.
  94. 94.  We found that a big number of TPs is using natural therapy (65.54%) but we must not neglect 34.46% that uses magical therapy. Concerning where the TPs have got the knowledge in traditional medicine, answers are grouped in four following groups:
  95. 95. Table 10: Classification of THPs concerningwhere they have got knowledge in TMWhere the knowledge is from Number of TPs %From ancestors 320 35.39From parents 280 28.71From schools 80 8.20From elsewhere 270 27.70
  96. 96.  Those who declared to have the knowledge from ancestors (35.39%) are more than other groups. When you consider in deep, you will find that almost all magical traditional practitioners are in this group. A small group (8.20%) is that one of those who got the knowledge from schools. All of those last ones are natural therapists.
  97. 97. Figure 4: Concerningcollaboration with Healthcenters:
  98. 98. Figure 4: Concerningcollaboration with Healthcenters: 500 400 300 There is a collaboration 200 There is no collaboration 100 0 Number of TPs %
  99. 99.  In this mission it has also been found that some of THPs do not work with Health Centers. This is caused by two main facts. The one is that some THPs were not informed that they were to work with Conventional Medicine Health Practitioners (CMHPs). The second is that some of Health Centres still ignore the role of THPs in health services, the reason why they do not recognize them yet, they are much needed.
  100. 100. Table 12: Concerning TPs affiliation incooperatives, the table below shows whathas been found:Cooperative affiliation Number of TPs affiliated %Affiliated in cooperatives 583 59.80Not affiliated in cooperative 372 38.20
  101. 101.  As shown in the table above 59.80% of tradipractitioners is affiliated in cooperative and 38% not yet. Even though is big number is affiliated in cooperatives; others are still working in disorder because these cooperatives are not established all over the county.
  102. 102.  Activities to support/ give advice to cooperatives of tradipractitioners are not widespread. The Ministry was still having some weaknesses with regard to organization, services and logistics of TM. The coordination of traditional therapists’ cooperatives is not done. Through AGA RWANDA NETWORK all those shortcomings can be resolved.  
  103. 103.  CHAPTER IV: CONCLUSION AND RECOMMENDATIONS. 4.1. Conclusion The work which has been done according to means which was available is worth of praise. This project required both human and financial resources beyond AGA RWANDA NETWORK capacity.
  104. 104.  It is important to see that what were done will serve as a stepping stone to many some activities action plan. It is in this context that the mobilization of resources and sensitization must be planned for the future.
  105. 105.  Recommendations All above encountered situation and challenges have led us to following recommendations to the ministry of health:
  106. 106.  To provide budget for payment of taken loan in realization of actions done in covered census because it was very needed to be done though there was no prepared budget for it. The Ministry of Health should even look for whoever can be sponsor so as to find financial means to AGA RWANDA NETWORK as the Forum is too new born to face financial problems that it has to find solutions to.
  107. 107.  To allow AGA RWANDA NETWORK additional time for returning to sites where census was not finished and provide budget for that action. To contribute in trainings of all THPs working in Rwanda for increasing the efficiency of their services to the people.
  108. 108.  To allow AGA RWANDA NETWORK additional time for returning to sites where census was not finished and provide budget for that action. To contribute in trainings of all THPs working in Rwanda for increasing the efficiency of their services to the people.
  109. 109.  To help in partnership extension between AGA RWANDA NETWORK and other Forums of THPs all over the world as a good way of improving experiences for THPs working under umbrella of Rwandan Forum. To establish a special program to affiliate all recommend facilitation all THPs to Health Centers near of them for collaborations
  110. 110.  To find scholarship for some skilled THPs in order to help them specialize in TM To help in the creation of National College of TM as a very efficient way of training skilled THPs
  111. 111.  To reinforce the program of working in cooperatives because Tradipractitioners’ cooperatives are not established all over the county. To strengthen AGA RWANDA Network is other to assume properly the function of coordination of traditional therapists’ cooperatives.
  112. 112.  Establish the code of practices and ethics for TMs in Rwanda: There does not exist a code of practice and ethics adapted to the organization of the health tradipractitioner’s profession and fight against quackery.
  113. 113.  Enhance training programs for TPs: Tradipractitioners’ needs for training/education are not fully taken into account at different levels of health system. Elaborate specialized module in traditional medicine and insert them in curricula: There do not exist in different curricula, modules of specialized education, especially with regard to the study of TM.
  114. 114.  Establish a laboratory of traditional medicine: Existing laboratories in which lab work can be done are not well equipped. Health tradipractitioners do not formally take part in passing on knowledge at different levels.
  115. 115.  Promotion of research and education in the field of traditional medicine: The frameworks for joint national, sub-regional and international collaboration between different structures involved in research and education in different aspects of Traditional Medicine are always formalized.
  116. 116.  To establish a library and data bank on traditional medicine: There are difficulties in accessing updated libraries and data banks in the field of research on Traditional Medicine. There do not exist any reference book on Rwandese Traditional Pharmacopoeia and a complete and accessible data base of medicinal plants of the flora of Rwanda.
  117. 117.  To strengthen national institutional and organizational capacities related to the development of TM resources. To reinforce health tradipractitioners’ capacities in order to help them provide the population with quality services.
  118. 118.  To strengthen national capacities in charge of training/education and researches on different aspects of Traditional Medicine. To reinforce the collaboration between tradipractitioners and conventional medicine practitioners in order to address priority health problems.
  119. 119.  To increase the quantity of Traditional Medicines available, within the framework of National Pharmaceutical Policy
  120. 120. CONTACTS Tel: +250 (0) 784 18 65 85 E-mail: rekerahoe@yahoo.in AGA RW ANDA NETW ORK E-mail adress: agarwan WEB: www.agarwanda.com
  121. 121. END
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