Towards Actualising African Medicinal Potential

The theme of the workshop: "The role of African Herbal Medicine in Primary Healthcare and Wealth Creation in Nigeria", was organised in partnership with the National Association of PAX Healthcare Providers, Enugu State....

Pax Herbal Clinic and Research Laboratories, a Catholic centre for scientific cultivation, utilisation, development and promotion of African Herbal Medicine, established in 1996, with over 600 certified PAX Healthcare Providers, nation-wide, held a one-day workshop in Enugu, on Thursday, November 26, 2009.

The theme of the workshop: "The role of African Herbal Medicine in Primary Healthcare and Wealth Creation in Nigeria", was organised in partnership with the National Association of PAX Healthcare Providers, Enugu State.

In his welcome address, the director of PAX Herbal Clinic and Research Laboratories, Rev. Fr. Anselm Adodo, OSB, stated that the aim of the workshop was to bring policy makers, government agencies and the private enterprises together to discuss the potentials of herbal medicine in primary healthcare, disease prevention and wealth creation.

He listed the objective of the workshop as follows:

• Improved healthcare delivery from the development of Traditional Medicine Knowledge and Practice, (TMKP), in view of the vast number of Nigerians that depend on it for healthcare maintenance.
• Reducing drastically the level of secrecy of TMKP among Traditional Medicine Practitioners, 9TMP's).
• Saving TMKP from extinction through conservation, preservation and documentation of medicinal plants
• Job and wealth creation through increased production, distribution and marketing of TM products locally and internationally.

He regretted that the deliberate misinformation, the apathy and lack of support for the sector vis-à-vis policy decisions and framework is affecting the growth of the sector in Nigeria, whereas other nations of the world are reaping billions of dollars from the exportation and the use of herbs.

He wondered why government was reluctant to work with established and reputable herbal institutions in furtherance of an effective healthcare system for the country. For instance, Pax Herbal Clinic and Research Laboratories is one of the biggest, best equipped, best-organised and most modern herbal research centres in Africa.

He added: "With quality control, microbiology, diagnostic and drug formulation laboratories that are comparable to any standard laboratories in any part of the world, and with 20 of her herbal supplements already listed by NAFDAC, PaxHerbals has justifiably been described as the frontrunner of an emerging medical revolution in Africa".

Adodo asked: "Africa is often described as a vast entity with huge positive potentials. But how long shall we continue to exist as mere potentiality? When is Africa going to wake up from her slumber and actualise her potentials".

"While countries like China and India have invaded the global herbal market like a colossus, Nigeria is still busy discussing whether herbal medicine is a good source of healthcare or not. While the annual global market for herbal medicine is estimated to be over 100 billion dollars, African professionals are busy attending seminars to convince them of the efficacy of herbal medicine. And Nigerian medical doctors and pharmacists are engaged in a fierce battle of supremacy about who is important than the others", he lamented.

He continued: "While Chinese medical doctors, botanists, pharmacists and other scientists are all united in the development of their traditional medicine into global transformative venture. Nigeria scientists are standing by the ring side complaining about the attitude of charlatans and quacks. A better approach is to join hands to correct the perceived weakness and mistakes of our traditional medicine, and help transform it into a globally acceptable enterprise.

Adodo then proceeded to situate the deep-seated problem confronting herbal medicine in Nigeria: "Although the discovery of useful therapeutics from plants has changed the face of medicine and the course of civilization, many people, especially some in the Government and the orthodox medical community, evaluate herbal medicine as though they were worthless or dangerous".

"Most of the potent drugs ever developed by human beings came from plant sources. And the best is yet to come. Now that the efficacy and potency of herbal medicine are being scientifically investigated, acknowledged and documented, the challenge for the Nigerian government is to work out policies that will regulate the herbal medicine sector".

He noted: "In doing this, the overriding interest must be how to integrate medicine into the mainstream of national healthcare system, intellectual property rights protection for traditional property rights protection for traditional medicine practitioners, speedy passage of the Traditional Medicine Bill, and government support for documentation, standardization and protection of herbal plants from extinction due to human activities".

A paper: "Integrating Herbal Medicines into National Healthcare: Problems and Prospects", by the Director-General of NAFDAC, Dr. Paul Orhii, was delivered by Festus Anumba, a Deputy Director in the Agency. He underscored the relevance of herbal medicine: "over 50 per cent our population particularly in the rural areas depends on herbal medicines for their primary healthcare needs", adding, "herbal medicine is a main source of livelihood for a significant number of the population who depend on it as their main source of income".

"High population growth rate, poverty and dwindling economic resources", he explained, "make our people resort to the use of herbal medicines for their immediate needs. The wide acceptability of herbal medicine is based on its accessibility and affordability".

Dr. Orhii maintained that "the primary concern regarding the use of herbal medicines is on their quality, safety and efficacy", and as such, the regulation and control of herbal medicine falls within the ambit of "NAFDAC's regulation and control".

He explained that it was in its effort to ensure quality and safety of herbal medicines that NAFDAC established standards and appropriate guidelines for the listing and registration of herbal medicines as well as setting up a National Advisory Committee on herbal medicines products.

In this wise, NAFDAC, he continued, evolved a categorised protocol for listing and registration of herbal medicines for Large Scale Manufactured Herbal Products; Imported Herbal Medicinal Products and Homeopathic Medicinal Products.

The Director-General of NAFDAC further explained that because the criteria guiding the protocols vary as a result of the different characteristics of the categories, evidence of proven efficacy by documentation of oral report from long usage; laboratory evaluation; certificate of manufacture and free sale from country of origin, for imported products, and expert opinion on the product are basic criteria for consideration. He added, however, that herbal medicines produced in commercial quantities for extensive marketing require pharmacological, toxicological and clinical evaluation.

Orhii pointed out that NAFDAC, having taken cognisance of "the long usage of herbal medicines by our people and the recommendation of the World Health Organisation, (WHO), that government regulatory agencies should accept herbal products based on long history of safe use in a locality, decided to use Acute Toxicity Tests as safety parameter for simple herbal preparations, while reserving efficacy tests, detailed analysis and clinical trials for more complex products intended for the management of terminal illnesses such as HIV/AIDS".

He emphasised that manufacturers of herbal medicines who desire listing for their products are expected to include information on their production process, extraction procedure, indication of the medicinal plant, method of use and standardisation.

Importantly though, pharmaceutical enterprises involved in large scale production of herbal products are required to include evidence of herbarium authentication and entho-medical history of the plant as well as the identity and documentation of the types of plants and the current processes of cultivation, collection, processing and medicinal values.

On the heels of an upsurge in counterfeit drugs, including fakes increasingly being imported from Asia, especially China and India; the snowballing reality that more Nigerians were resorting to herbal medicines in search of cure for their illnesses; the undeniable fact that herbal medicines were far cheaper and more readily available than ethical orthodox pharmaceuticals, NAFDAC decided to streamline and simplify its regulatory requirements for the listing of herbal products to encourage producers to come forward to the agency with their products for screening.

The streamline guideline states that:

• Any product whose name, package or label bears close resemblance, and or sound alike to an already registered or listed product or is likely to be mistaken for such registered or listed product shall not be considered for registration.
  
  
• Issues bordering on trademark and patent are referred to and handled by the Trademarks, Patent and Design Registry.
  
  
• Registration of herbal medicines is based on quality and safety testing and we do not insist on clinical trials before listing. Listing is renewable every two years. However, NAFDAC insist that the manufacturer add the disclaimer to their labels stating "the claims made on this product have not been clinically evaluated by NAFDAC, and that a product manufacturer who wants to drop the disclaimer must undergo clinical trials".

Dr. Orhii also assured participants that "the regulations on labeling of herbal medicines were developed with the active participation of stakeholders". He itemized the required labeling information to include:

• The brand name, botanical or common name shall be qualified as herbal or homeopathic medicinal product.
• The name shall not be suggestive of therapeutic claim.
• Indications should be phrased in simplified manner without any ambiguity or unsubstantiated claims.
• The use of phrases such as 'treatment for', cure for', prevention for, and 'mitigation of' are not permitted until there is satisfactory clinical trial reports to support such claims.
• Each product shall have its distinct design and presentation to avoid counterfeiting.
• Adequate quantitative listing of all ingredients by their botanical or common names.
• Adequate directions for safe use of the product, including amount for use in specific age groups.

To underscore the theme of the workshop, the Director-General reiterated that the development and launching of the Traditional Medicine Policy in 2007 was a further demonstration of the federal government's "sense of direction, commitment and involvement in the integration of traditional/herbal medicines in our national healthcare delivery system".

The policy, Dr. Orhii further stressed, which is aimed at fostering partnerships between traditional and conventional medicine practitioners "was launched to expedite the needed integration of traditional medicine into the formal national health system".

He maintained that "NAFDAC will sustain and strengthen its collaboration with relevant stakeholders to ensure the listing and registration of quality, safe and efficacious herbal medicines to facilitate its integration" into the nation's healthcare system, because it's "successful integration will reduce the cost of healthcare in Nigeria".

He, however, remarked that "in as much as the usage of traditional or herbal medicines is widespread in Nigeria, its integration into our national healthcare system remains problematic due to some reasons".

Some of the reasons he adduced are:

• Secrecy by practitioners regarding the actual content of their products.
• Inadequate coordination of activities of traditional practitioners.
• Inadequate Intellectual Property Rights,(IPR), laws and legislations.
• Difficulty in determining the active substance(s) and the toxic components of herbal preparations.
• Long period of usage of traditional or herbal medicines without proper documentation and control.
• Inadequate production and evaluation facilities for indigenous manufacturers of herbal medicines.

The Deputy Director, Department of Herbal medicine, in the Federal Ministry of health, Pharm. Mary Okpeseyi, who represented the Minister of Health, Prof. Babatunde Osotimehin, delivered a paper titled: "The Role of Herbal Medicine in Wealth Creation in Nigeria. She stated that "the workshop is not only important but timely, considering the recent global upsurge in the use of herbal medicine in various forms", as well as "the limitless opportunities of wealth creation that exist in various areas of herbal medicine".

She noted that due to "the dramatic increase in the use of herbal medicine in the past 30 years, the World Health Organisation, (WHO), estimated that 80 per cent of the people, Worldwide, rely on herbal medicines for some aspects of their primary health care".

She attributed the increasing use of herbal medicines to the increasing dissatisfaction with the high cost of orthodox medications; the inability of modern pharmaceuticals to treat every disease condition effectively; the search for natural products with less side effects and the resistance of some common ailments to orthodox drugs.

To illustrate the increasing use of herbal medicine, Okpeseyi noted that the global market for herbal medicines in 2004 was estimated at US$65billion. In 2003, the volume of herbal medicine in South Africa was 13million dollars; Ethiopia, 74million dollars and Burkina Fasso, 5million dollars. In 2005, the volume of import and export of medicinal plant material in Egypt stood at 13.7million dollars, while Morroco's export stood at 13.2million dollars.

She stated: "The global market for herbal medicines in 2007 was 85billion dollars, of which 24 per cent of the market was for China. Other countries worldwide shared the remaining 76 per cent. As at 2008 the global market of herbal medicines has risen to 100billion dollars, which translate to 15trillion Naira at the present exchange rate".

She lamented that despite the economic potential that currently exists in herbal medicine globally, Nigeria is not mentioned, and as such "do not benefit from the global economic benefits that accrue from herbal medicines and medicinal products".

Pharm. Okpeseyi further noted that "the current upsurge in the production and use of herbal medicine worldwide is not only as a means of health care but also as a means of economic empowerment; Nigeria cannot be left out". She listed wealth generating opportunities in the practice of herbal medicine to include:

• Abundance of human resources: Nigeria has highly qualified human personnel possessing required skills necessary in any human venture.
• Geographical location advantage and availability of large markets. The location of Nigeria presents an access to external market for both exports and imports.
• Advantage of arable land and good climate suitable for cultivation of diverse medicinal plants.

On available areas of investment in herbal medicine, Okpeseyi enunciated that financial empowerment and wealth creation can be generated in the cultivation of medicinal plants; the production of herbal medicines and the fabrication of machines.

"It is imperative to give kudos to Pax Herbal Clinic which is in the forefront in the production of herbal medicinal products for treating various ailments in the country and a lot of Nigerians have been financially empowered through the sales and distribution of these products country wide", she noted.

She concluded: "A healthy nation is a wealthy nation. There is need for the national economy to be diversified especially within the concept of the global economic melt down. Herbal medicines offer such diversification as well as job creation for the country both locally and internationally".

The Chairman, Lagos State Traditional Medicine Board, Dr. Bunmi Omoesyindemi, presented an interactive paper: "Integrating Traditional Medicine into Health Care System: The Lagos State Experience" He told the audience, who were thrilled by his lively speech, "the overall objective of a national health policy is to improve accessibility of the population to primary health care as well as to secondary and tertiary care".

He explained that the Lagos State government strategy in achieving its Millennium Development Goals include free community based primary care services; improved community awareness and community involvement; reduced disease burden and improved access to health services as well as improved health resolution and their management among others.

He observed: "In many developed countries, 70 per cent to 80 per cent of the population has used some form of alternative or complementary medicine (e.g acupuncture).

Countries like China, India and Germany who had developed their Traditional Health System have established and supported agencies and universities for research and development, documentation and promotion of traditional medicine. These have facilitated active public-private-partnership mechanism.

The results of these are abounding in Nigeria as Tianshi, GNLD, Forever Living products and other imported herbal products

Pax Herbal Health Care Provider, (PHCP), and Deport Manager, Owerri Zone, Mr. Tony Ogulewe, spoke on the duties and responsibilities of pax health providers to their clients and the communities in which they operate. He began with the procedure for the enlistment of prospective Pax Health Care Providers, whom, he maintained, are expected to enroll with the depot managers in the zone in which they intend to operate for a fee of N4,000, (four thousand), and undergo a four months intensive training.

At the completion of their training, the depot manager enrolls them for a written test at the headquarters of Pax Clinic and Research Laboratories, at St. Benedict Monastery, Ewu-Esan, Edo State.

As a rule, writing the test is not a guarantee that the prospective health care provider will be accepted. Applicants must pass the test and also convince the panel in an oral interview that he or she is truly committed to the altruistic and humanistic ideals of Pax in "bringing health nearer to the people', and propelled by the base instincts of making profit at all cost.

Ogulewe explained: "We usually advise our health care providers not to apply other herbal products or orthodox medicines when treating clients with Pax products, so that their reactions, positive or negative, can be properly monitored and documented to facilitate a detailed progress report to be sent to Ewu should the need arise where an intensive scientific analysis can be done'.

The chairman of the programme, Hon. David Atigwe, Chairman, House Committee on Health, Enugu State House of Assembly, commended Pax for its resilience, doggedness, innovation and entrepreneurial drive. He lamented that financially endowed Nigerians, essentially the elites, preferred to patronise herbal drugs from India and China rather than support authentic and viable indigenous pharmaceutical companies.

"With about 600 Pax Health Care Providers nationwide, Pax has demonstrated that it is really bringing health closer to the people. The federal government should not hesitate in enlisting Pax in its effort to evolve a broad based national primary health care system", Atigwe counseled.

Dr. (Mrs). Christiana Ugwueze. Pax Depot Manager, Enugu

Workshop Has Created More Awareness On Herbal Medicine

How would you describe the outcome of this workshop?
It was successful. The attendance would have been than what we witnessed today if not for the sallah festivities and the local government election that has kept many people rather busy. But I am happy that the workshop has created awareness on the efficacy of herbal medicine.

What are the challenges you face marketing herbal medicine?
There are so many marketers of herbal medicines here in Enugu. Their products are not as qualitative as Pax products in terms of packaging and efficacy and also do not have the huge reputation that Pax parades, so they sell their products far cheaper than we market Pax products.

Good enough, most of those who patronise them still come back to us after they had discovered that the cheaper medicines are not as efficacious as they had been made to believe. We are confident we will get there!

Do you have problems with government regulatory agencies?
No, we don't. We have not encountered any form of harassment from government officials and regulatory agencies in Enugu since we started. We are certified and our herbal products are duly listed by NAFDAC.

Having been in the herbal medicine circuit for some years, how can awareness of the sector be further promoted?Simple, we have to continue to do what we are doing here today. We need to organise more seminars and workshops. You can see the list of attendance: medical doctors; pharmacists; nurses; professors; university lecturers; researchers; professionals; traders; students and politicians. Each of them will go back and spread the message.

I am really surprised at the volume of herbal products that we sold here today. Other exhibitors who came with NAFDAC listed products also made good sales.

Most participants wanted the contact address of Pax herbal health care provider that was nearest to their homes or places of work. We had a list of all Pax herbal providers in Enugu, so we simply gave each of them a copy.