GOVERNMENT INTENDS REGULATING AFRICAN
TRADITIONAL HEALERS AND THEIR MEDICINES
By May 1st all African Traditional Practitioners were required to have been registered with the Traditional Health Practitioners Council, or face jail time for practicing illegally. However, almost a year after an Interim Council was set up and eight years since the passing of the Traditional Health Practitioners Act, it is still not functioning due to lack of government seed funding.
The TNHA has been monitoring efforts by the government to regulate Traditional Healing Practice and African Traditional Medicines, and I have personally been following this process with great interest since 1996 when I first registered as a member of the Traditional Healers Organization.
Firstly, the May 1st cut-off date for registration with this Council is impossible because the Traditional Health Practitioners Council (THPCSA) as a structure has not yet been established, as required by the Traditional Health Practitioners Act of 2007.
Seven years after this Act was passed, in April 2014, it’s provision for a statutory Interim Traditional Health Practitioners Council of South Africa was finally written into law. This established the Council and an Accreditation Committee, staff and registration procedures for Traditional Health Practitioners. The Council was given powers to gazette regulations in respect of disciplinary inquiries and investigations defined in the Act, and in terms of the transitional provisions, practitioners currently engaging in traditional health practice had until 1st of May 2015 to register with the Council.
However to date there has been no funding allocated to it for it to do carry out this task.
South African Traditional Healers have fought since 1994 to be formally recognized as primary contact practitioners in South Africa. The most prominent traditional healers association, the Traditional Healers Organisation, has around 69,000 members. It is estimated that there are some 220,000 African Traditional Healers practicing in South Africa.
A large proportion of these traditional healers are represented by about 100 national and regional associations, while many do not belong to any organisation at all. It is estimated that between 65% and 80% of South Africans consult traditional healers as their first port of call when ill. An estimated 30-million people, then, utilise their services on a regular basis.
Compared to an estimated 27,000 medical practitioners and specialists, and 1 ,080 prescribing Allied Health Practitioners (Homeopaths, Chinese Medicine Doctors, Naturopaths etc), soon-to-be registered Traditional Health Practitioners outnumber these existing professionals almost seven-fold.
Traditional healers have catered to the needs of millions of South Africans over the centuries. The marginalisation of traditional medicine is the legacy of apartheid and colonialism which divided medical practice into the “acceptable” and “unacceptable”.
Surely it’s time for the State to allocate its resources more equitably to fund the development, training and research of this previously marginalised sector of health professionals, not least to remedy the historical bias against its practitioners and the ongoing suppression and bio-piracy of their medicines.
In 1996 official dialogue began among various self-regulating traditional healer associations and Health Minister Nkosazana Dlamini-Zuma, but little came from those consultations. It wasn’t until Health Minister Manto Tshabalala Msimang became rose to power in 1999 that concrete steps were taken towards official recognition and regulation. Minister Tshabalala Msimang was supportive of non-conventional and traditional health, and on February 11, 2004 the first Traditional Health Practitioners Act (Act 132 of 2005) was passed into law, the first step toward formal registration and of traditional healers. For the first time they were legally considered to be “health practitioners”. This legislation gave traditional healers equal standing to other biomedical and allied health practitioners, which was confirmed by the Supreme Court of Appeal (SCA) judgement in the ‘sick note’ case in November 2013.
On the August 17, 2006 the Constitutional Court declared the 2004 Traditional Health Practitioners Act unconstitutional, since the National Council of Provinces had not complied with its duty to facilitate public involvement in the passing of the Bill into law.
The Court directed the DoH to fix the error and after doing this, in January 10 2008, the current Traditional Health Practitioners Act (Act 22 of 2007) was passed and signed by President Thabo Mbeki.
Six months later, on the July 25 2008, Minister Tsabalala Msimang gazetted an official document Draft Policy on African Traditional Medicine for South Africa. This publication laid out a solid framework for the institutionalisation of African Traditional Medicine in the national healthcare system. At this time there was much anticipation among healers and the newly appointed THPCSA as they believed that the process of their integration as practitioners and their traditional medicines into the healthcare system would follow, as had happened in other counties such as India, China and Cuba and some other African countries.
When Minister Tshablala Msimang passed away in 2009, the momentum towards setting up the Traditional Health Practitioners Council (THPCSA) was lost. Politics also no doubt played a role: The ANC held its elective conference in 2009, which was followed by national elections and the appointment of a new Minister of Health, Dr Aaron Motsoaledi.
Many believe that Minister Motsoaledi was appointed to mitigate the negative image associated with Tshabalala Msimang’s Minister’s stance on HIV/Aids and support of natural healing modalities.
TRADITIONAL HEALTH PRACTITIONERS COUNCIL STYMIED FINANCIALLY BY DEPARTMENT OF HEALTH
Over the past few years, vocal and organised traditional healer groupings have become impatient with what they perceive to be empty promises from the Ministry and Department of Health. There is no Council in place, and there has been little interaction with government. They are genuinely aggrieved.
It would seem the hiatus on action on the THPCSA is the result of a lack of political will, originating from Minister Motsoaledi’s office to provide funds to set up and enable the Council and its members to fulfil their statutory mandate to protect the public from charlatans and their harmful practices, and to integrate traditional medicine into the formal health care system.
Meeting after meeting between Ministry officials, DoH officials and the THPCSA have taken place, and in each instance the THPCSA requested seed funding to launch the Council, and to begin its work (register practitioners and create regulations), as outlined in section 47 the Act. After much haggling government conceded that the THPCSA needed seed money to fulfil its statutory function, prescribed by law.
In January this year a crisis meeting between various THPCSA members and Minister Motsoaledi took place where he requested that they draw up a business plan for the envisaged Council, so that requested funds (alleged to be between R20-30million) could be released from the National Treasury. The Council they still await the release of the promised funds.
With the May deadline come and gone, it is difficult to understand how the THPCSA was expected to screen an expected 200,000 applications from practitioners with no financial means. While other statutory health professions councils are self-funded through cost recovery means (application and annual registration fees), they were initially set up with state funding.
It is also curious that payment of members of THPCSA is given as a partial reason why spending in Pharmaceutical Trade and Product Regulation (MCC and the formation of SAHPRA) was hampered in the ‘Department of Health Strategic Plan 2014/15 – 2018/19′ report (Page 38).
AFRICAN TRADITIONAL MEDICINES TO BE REGULATED UNDER THE PHARMACEUTICAL DRUG REGULATOR
The THPCSA has been kept in the dark about the DoH’s plans for African Traditional Medicines (ATMs), and only recently learned through the Traditional and Natural Health Alliance that ATMs would be regulated by the South African Health Products Regulatory Authority (SAHPRA), which is intended to replace the current Medicines Control Council and expand the scope of the products controlled by it.
Although ATMs are not mentioned in the Medicines and Related Substances Bill (Bill 6 of 2014, which sets up SAHPRA), or described anywhere in the definitions, the Director-General of Health, Ms. Malebona Precious Mtsotso clearly outlined to Parliament’s Portfolio Committee on Health that ATMs s would be regulated by SAHPRA. This was in September last year, before public hearings on the Bill.
When the Traditional & Natural Health Alliance (TNHA) asked why the THPCSA was not invited to provide input into the Bill, the DoH first denied that ATMs would be regulated under SAHPRA, perhaps hoping to sweep this politically inconvenient matter under the carpet.
A letter from an attorney was then sent to the Department of Health, requesting clarity on whether ATMs would be regulated by SAHPRA.
A reply from Lufuno Makhoshi, the Acting Director of Legal Services on the December 27th 2014, stated that ATMs were not “currently” dealt with in the Bill.
In late February 2015 questions on this subject were directed to the MCC and DoH by both ANC and EFF members of the Parliamentary Health Committee to the Department of Health. It was then conceded that they did indeed intend to control and regulate African Traditional Medicines under SAHPRA (around 2019). This coincides with the end of the five-year phased call-up process (roadmap) for Complementary Medicines, which begun in November 2013. First we regulate Complementary Medicines, then Traditional African medicines?
DEPARTMENT OF HEALTH PLANS FOR AFRICAN TRADITIONAL MEDICINES
On November 19, 2014, at a follow-up Portfolio Committee meeting in Parliament, the Director-General, Ms. Mtsotso alluded to a “booklet” which had been prepared by her Department, which outlined the framework for the regulation of Traditional Health Practitioners and the regulation of African Traditional Medicines, in terms of their safety, quality and efficacy. She could not produce this booklet at the meeting, and said she would present it to the technical sub-committee of the Portfolio Committee on Health.
After exhaustive inquiries, and being given the run-around, the TNHA eventually obtained a copy of this booklet and distributed it to various key members of the THPCSA. It came as a surprise to them, as they had not seen it or been briefed on its contents.
In this booklet, titled “South African Parliament Meeting, Cape Town, 4 March 2015 – Definitions, Policy and Regulation of Traditional Medicine: Practitioners, Practices, and Products/Herbal Medicines“, the Department of Health has unilaterally drafted a detailed regulatory framework for ATMs, which pre-empts the regulations required to be adopted and gazetted in terms of Section 47(a) of the Traditional Health Practitioners Act (Act 22 of 2007).
THPCSA members were incensed when they realised that the DoH had taken it upon itself, without consultation, to create such a framework to advance its agenda for African Traditional Medicines through the passage of the SAHPRA Bill. Members of the THPCSA, including its legal representative, then approached the Deputy Director-General of Health Dr Anban Pillay during a Health Portfolio Committee meeting in Parliament in March, demanding an answer as to why the THPCSA had not been invited to participate in processes leading to their medicines (ATMs) being regulated under SAHPRA. Caught off-guard, the Deputy Director-General of the DoH, Dr Anban Pillay initially dismissed their questions; as tempers rose and evidence was presented to him, he became visibly anxious. Thirty minutes later, THPCSA members received emails from the Director-General summonsing them to a meeting in Boksburg on March 23, where their grievances and concerns would be heard.
We have been told that at the Boksburg meeting there was general unhappiness among the THPCSA members after the Director-General handed out a similar booklet to the one the TNHA had uncovered. Many Council members left the meeting halfway through the Director-General’s speech. Our source tells us that government officials at this meeting wanted Council members to rubberstamp their proposals, despite there being no time to study or debate the contents of the documents provided.
Section 47 of the Traditional Health Practitioners Act clearly states that all regulations affecting the functioning of the THPCSA, the scopes of practice for its different classes of practitioners, and even the safety, administration and application of African Traditional Medicines are for the Council to deliberate upon and adopt, in consultation with the Minister. THPCSA members say it is not for the Department of Health to present ready-made regulations to them to rubber stamp at crisis meetings.
Three weeks ago the THPCSA Council members were again summonsed to a meeting in Pretoria, where they were allegidly handed new documents drafted by the Department of Health, and were asked to comment on them. One of the documents, which we obtsined from a source in the DoH appears to be a draft regulation that needs to be workshopped by Council members. It deals with the criteria the Council will set in order to accredit traditional healing training institutions, and assess the eligibility of practitioners to register with the Council. In this document it is clear that the Department of Health has no clue how to proceed with opening the professional registers for traditional health practitioners. In it, assumptions tare made that traditional healers have received formal institutionalised training in their professions and that they possess formal diplomas in traditional medicine. They do not seem to appreciate that the vast majority of traditional healers first enter the world of traditional medicine though apprenticeships, often in rural areas, and that the balance of their training is directed through dreams, visions and divination.
Just as traditional and natural health products are being subsumed into the western biomedical paradigm, traditional healers seem set to be forced to abandon their traditions for western education and a biomedical model of health.
The words of T/Dr Sindephi Spogter come to mind: “How exactly do you intend defining and restricting the spirits of our ancestors or our Creator in a few pieces of paper? (law).” (said at a meeting with the MCC in Pretoria in 1998).
WHAT IS NEEDED
Traditional healers have been excluded from the formal healthcare system for decades, a legacy of apartheid and colonial times. Being excluded from deliberations which affect their practices and medicines is unacceptable, perpetuating their ill-treatment.
At the same time biomedical researchers from various pharmacy departments at local universities and state research institutions continue to exploit our indigenous knowledge, screening the African Traditional Medicines treasure trove for novel drugs, and possible lucrative patents.
We believe all decisions on ATMs and practitioners should be the prerogative of THPCSA members and expert sub-committees. Traditional healers have a right to self-determination for their profession and their medicines.
Instead of looking at the example of BRICS countries, which have successfully integrated traditional and natural health products into their healthcare systems, our Health Ministry is leading us into a bio-medical system, driven by pharmaceutical interests under the guise of “harmonization” with Western medicine, a model where the distinction between regulators and the pharmaceutical industry is blurred.
It is unacceptable that the THPCSA continues to be side-lined as medical orphans, having to hold out a begging bowl for funds to legitimise and empower themselves. Traditional healers comprise the majority of healthcare practitioners in South Africa, and have served people’s health needs for thousands of years.