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Malaysian Journal of Public Health Medicine 2011, Vol. 11(2): 1-5

ROLE OF TRADITIONAL AND COMPLEMENTARY MEDICINE IN UNIVERSALCOVERAGE

Maihebureti Abuduli1,3

, Sharifa Ezat WP2

, Syed Aljunid1

1United Nations University International Institute for Global Health (UNU-IIGH).2Faculty of Medicine, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur.3Xinjiang Uyghur Medical College, Xinjiang, China.

INTRODUCTION

Traditional and Complementary Medicine (T&CM)has been gaining acknowledgement andacceptance all over the world. It is the mostinvaluable treasure and has been developed over

the course of thousands of years in the quest forhuman wellbeing.

Definition and term of T&CM is still acontroversial issue in the world. T&CM is calledby different names such as traditional medicine,complementary and alternative medicine (CAM),complementary medicine, alternative medicineand unconventional medicine, or sometimes it iscalled by its specific name for example: in IndiaAyurveda, Unani and Siddha; in China it is alsocalled Chinese, Uyghur, Tibetan and Mongolianmedicine.

T&CM is also called by its specific name inMalaysia. T&CM is a term generally used todescribe the practice of medicine which is not ofthe conventional scientific medicine. T&CMmeans a form of health- related practicedesigned to prevent, treat, and/or manage illnessand/ or preserve the mental and physical well-being of individuals and include such practices astraditional Malay medicine, traditional Chinesemedicine, traditional Indian medicine,homeopathy and complementary therapies, andexcludes medical or dental practices by

registered medical or dental practitioners1

. T&CMis divided into the body-mind medicine, biologicalbased medicine, manipulative and body basedpractices, and whole medical system in Malaysia.

Traditional and complementary medicine inMalaysiaNowadays, there are high levels of public interestavailable in different kinds of traditional andcomplementary therapies in Malaysia. In view ofthe potential growth and demand of T&CM inMalaysia, the government of Malaysia had set upthe TCM Division in the Ministry of Health in

20041, which led to the decision to establishintegrated hospitals in 20061.

There are six programmes available in T&CMinstilled among the five universities and collegessuch as; College of Complementary MedicineMelaka, INTI international University CollegeNilai, Cyberjaya University College of MedicalScience (CUCMS) Cyberjaya, Management andScience University (MSU) Shah Alam and theInternational Medical University (IMU) Bukit Jalil.There are nine integrated public hospitals whichare practicing T&CM in Malaysia. They are KepalaBatas Hospital in Pulau Pinang, Putrajaya Hospitalin W.P. Putrajaya, Sultan Ismail Hospital in JohorBharu, Duchess of Kent in Sabah, Sultanah NurZahirah Hospital in Kuala Terengganu , SarawakGeneral Hospital , Port Dickson Hospital inSeremban, Sultanah Bahiyah Hospital in Alor SetarKedah and Hospital Cameron Highlands.

These hospitals practice traditional Malaymassage, acupuncture, herbal oncology andpostnatal massage1. Traditional Malay massageand acupuncture are used for chronic pain andstroke; herbal oncology is used for complementtreatment with allopathy therapy; postnatalmassage is used to relieve muscle cramps andfatigue after labour. Tung Shin Hospital in KualaLumpur is the first and only private hospital inMalaysia to offer T&CM. Malay massage,acupuncture, herbal medicine for cancer andMalay postnatal care are most commonlypracticed in Malaysia. Herbal preparation,acupuncture and traditional massage are the

three elements which would be introduced in thehospitals conducting the pilot projects2.

More than 7,000 traditional and complementarymedicine practitioners were registered with theirrespective bodies in 20062. Now, the number ofT&CM practitioners totalled to 11,691;whichinclude voluntary registration by localpractitioners and application for professional visaby foreign practitioners. The profession:population ration is currently at 1:24213.Traditional and Complementary Medicine division(T&CMD) received RM2,179,635.00 budget which

is much higher than in 2006 and 2007 foroperational and development expenditure and75.1% of the budget was spent on management

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services such as payment to T&CM practitionersand acquisition of supplies for T&CM integratedhospitals. In the 10th Malaysia Plan (10-MP),T&CMD targets to establish at least two T&CMbranch office each year 4. According to a survey in2004, around 69.4% Malaysian population used

T&CM in their whole life and 55.6% of them usedT&CM in each year 5. According to a survey donein primary care clinics in Kuching, Sarawak; fromJanuary to April 2004, approximately 51.4%patients used CAM and 47.8% of those patientsused more than one type of CAM 6.

Out of pocket T&CM expenditure is rapidlygrowing. It is estimated that in 2007, Malaysiaspends an estimated RM$500 million7. From 2000to 2005, annual sales for traditional medicinesincreased from US$ 385 million (RM 1 billion) toUS$ 1.29 billion (RM 4.5 billion) in Malaysia8

indicating

that approximately 3.4 times increasewithin five years.

Use of traditional and complementary medicineIn many developing countries the majority of thepopulation is dependent upon traditionalmedicine to meet its primary health care needs.For example in Africa it reached 80%, India 67 %,China 40%, Chile 71%, and Colombia 40% 7 . Incontrast to this, almost half of the population inmany developed countries regularly use someform of T&CM such as United States, Australia,France and Canada; 42%, 48%, 49% and 70%

respectively9

.

In Germany, 80% of physicians prescribedphytomedicines, which accounts for 27% of allover the counter medicines and as high as 52% ofadults first turn to natural remedies fortreatment of illness 10. The reasons of using T&CMare different. For example, higher income andhigher education are guiding factors of patientpreference for traditional medicine in developedcountries. Around 65% of population traditionalmedicine is the only available source ofhealthcare in some countries such as India 11.

Although, usage of traditional andcomplementary medicine is higher, westernmedical doctors do not seem to be aware aboutits significance and importance. These results inmany interactions between western medicine andT&CM. A nationwide survey done in the USAshowed that 72% of the respondents who usedunconventional therapy did not inform theirmedical doctor that they had doneso 12 resultingin many unintended side effects and interactions.

Around 70% of the population in India relies ontraditional medicine for primary health care

usage. The proportion of plants usage in thedifferent Indian systems of medicine are; among

the Ayurveda 2000, Siddha 1300, Unani 1000,Homeopathy 800, Tibetan 500, Modern 200 andfolk 4500 types13.

T&CM was the suggested therapy in 75% of allchronic illness and for 99% of all psychiatric

illness by doctors in Shenyang, China14

. InSingapore, paediatric oncology patientscommonly rely on their traditional indigenousmedicines15. Studies showed that 964% ofpatients with cancer used T&CM in Taiwan16.From 1990 to 1997 usage of herbal medicine itselfincreased to 380% in United States in 7 years 17.Another factor that exacerbated the use is thecheaper cost of T&CM. For example, inacupuncture for musculoskeletal conditions, itcosts around 60%, chiropractic medicine costs 24percent less than Western medicine. Expendituresfor Ayurveda are 50 % lower per person than

conventional medicine18

. These cheaper coststructures exacerbated the wide use amongpopulation who believe in its disease curative andpreventive properties.

T&CM has been used among both communicableand non communicable diseases. Especially, it isused extensively among the chronic and ongoingdiseases sufferers such as for treatment ofrheumatoid arthritis, osteoarthritis, depression,diabetes, stroke, chronic kidney disease,gastrointestinal, liver disease, cancer asthma,eczema, premenstrual syndrome, migraine,

menopausal symptoms, chronic fatigue, andirritable bowel syndrome etc. There are manycases on how T&CM therapies have been found tosuccessfully relieve the symptoms.

Evidence of effectiveness of T&CM

Although, great numbers of people use T&CMrecently, many people are not aware of the sideeffects of T&CM. Some people hesitate in usingT&CM concurrently with conventional medicine oras alternatives therapies. More research has beendone in effectiveness of T&CM but still it needsmore research in this area.

T&CM has been proved to be successful intreating numerous diseases and conditions withless side effects. For example HIV/AIDS, certainkind of cancer, malaria, SARS, hepatitis B,insomnia, anxiety, depression and some chronicdiseases and conditions.

A study done in Africa; experience after usingfour to eight months of herbal therapy amongHIV patients, they found significant healthimprovement was achieved and significantincrease in CD4+ T cell counts (226%, p < 0.00001)19. Another research conducted in Taiwan amongcancer patients showed that T&CM preparations


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usage improved liver function duringchemotherapy among the patients with cancerreceiving chemotherapy by decreasing liverdamage, activating the antioxidant, treatinghepatitis, alleviating metabolic load anddecreasing ALT and AST 16.

In Ghana, Mali, Nigeria and Zambia, herbalmedicines were administered at home as first-linetreatment for 60% of children with high fevercaused by malaria20. WHO showed that 78% ofpatients living with HIV/AIDS in the USA use CAMmedicines 21. Traditional herbal medicine, AfricaFlower, has been used for decades to treatwasting symptoms associated with HIV 9. In China,traditional herbal medicine played a prominentrole in the strategy to contain and treat severeacute respiratory syndrome (SARS) 22.

Use of herbal medicine for liver disease has along tradition and history23. For example, Uyghurherbal medicine had played very important rulein treatment of hepatitis B in Xinjiang, China in1987. Herbal drugs contain chemically definedcomponent that can protect the liver fromoxidative injury, promote virus elimination, andinhibit tumor growth 23. Research shows thatsome herbs are beneficial for mental illness.Such an example would be the use of Valerianroot and kawa-kawa (a herb) are useful forinsomnia and anxiety. St. Johns wort has beenreported effective to treat mild and moderate

depression24

.

T&CM as a strategy in universal coverageUniversal coverage (UC) is defined as the accessto key promotive, preventive, curative andrehabilitative health interventions for all at anaffordable cost, thereby achieving equity inhealthcare access 25. According to WHO BeijingDeclaration in 2008, governments have aresponsibility for the health of their people andshould formulate national policies, regulationsand standards, as part of comprehensive nationalhealth systems to ensure appropriate, safe and

effective use of traditional medicine. This actprompted many governments to date to recogniseand integrate traditional medicine into theirnational health systems and become part of theuniversal coverage provisions and services26.

Malaysia has two-tiered health care system; agovernment led and tax funded public sector,and a thriving private sector creating adichotomous yet synergistic public-private model.There is no unifying system of universal access tohealthcare for every citizen27. Universalcoverage does cover limited T&CM practices insome countries such as China and Malaysia in afew of its pilot hospitals with good health

outcome so far, although no extensive clinicaltrials or interventions studies are done to proveotherwise.

As Malaysia is fast approaching its own nationalhealth insurance system with its own benefit

packages, T&CM usage and implementation has arole to be incorporated into the UC coveragemooted by the government. This is line with themassive expansion and popularity of T&CM albeitits safety and lack of clinical trials.

The draft Regional Strategy for TraditionalMedicine in the Western Pacific (20112020)provides guidance for its member states, WHO,development partners and other stakeholders onapproaches to maximize the health potential oftraditional medicine and its contribution touniversal access to health services for people of

the region28

. This strategy gave increasedemphasis to the values of primary health care andthe contribution of traditional medicine touniversal health access; the importance ofcooperation and the sharing of information tosupport the quality, safety and efficacy oftraditional medicine; and the need to protect andconserve indigenous health resources, includingtraditional knowledge28 Thus some form of T&CMshould be incorporated into the new nationalhealth care financing system in this country. Thiscan be made possible through its benefitpackages and sustainable deliveries among the

public/private hospitals or clinics, although theremight be some form of copayment in place in thefuture.

CONCLUSION

Practice of T&CM has increased worldwide. T&CMhas inherent value and efficacy for healthpromotion, prevention and treatment. It has anenormous presence in the Malaysian health caresystem..Patients have the right to seek T&CMaccess as part of their cultural heritage andbelief system. They should have a choice ofwhether to seek modern medicine or T&CM.Universal coverage should be taken place inMalaysian health care system with some provisionof T&CM. Also the costs of modern conventionalmedicine are becoming expensive for even thedeveloped countries to bear. It is recommendedthat the future national health insurance shouldcover T&CM practices and its future would bebrighter if Malaysian government pays moreattention to its development andimplementation.


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