WHO-EMIPHARM/107

August 1985

REPORT OF AN INTERCOUNTRY MEETING ON

THE USE OF MEDICINAL PLANTS AT

THE PRIMARY HEALTH CARE LEVEL

Kuwait, 20-25 April 1985

(Meeting Reference: EM/INC.SWG.MTG.UMP.PHC/7)

WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE EASTERN MEDITERRANEAN

1985

232

EDITORIAL JiOTE

The issue of this document does not constitute formal publication.

The manuscript has only been modified to the extent necessaey for proper comprehension. The views expressed, however, do not necessarily reflect the official policy of the World Health Organization.

The designations employed and the pt"esentation of the material in this document do not imply the expression of any opinion whatsoever on the part of the Secretariat of the Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers Ot" boundaries.

WHO-EM/PHAR."1/107

TABLE OF CONTENTS

page

I OP"EN"mG CE'RE'MO?ff ••••••••• , ••••• , , , • • • • • • • • • • • • • • • • • • • • • • • 1

II ELECTION OF OFFICIALS • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 2

III INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . .. . . . . . . 2

COUNTRY REPORTS

.AFGIImrsTm . • . • • • . • • • • • • • • • . • • • • • • . • • • . • . • • . • • • • • • • • • • • • . • • • . . 4

EGYPT •••••••••••••••••• , • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 4

KtNAIT •••.••.••••.••••• , ••..••••••••••••• , ••••••••• , , •••.•••• , 5

P AKIST.AN' •••••• , • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 5

SAtml ARA.BIA ••.•••••••••••••.•••• , •••. , • • • • . • • . • • • . • • • • • • . • • • . 6

SO'MALIA • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • . • • 7

sunm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a

IV WHO's PROGRAMME IN TRADITIONAL MEDICINE .................. 8

V ISLAMIC MEDICINE CENTRE, KUWAIT •••••••••••·•••••••••••••• 9

VI MEDICINAL PLANTS IN THERAPY ••••••••·••••••·••·••••••••··· 10

VII RESEARCH NEEDS IN THE USE OF MEDICINAL PLANTS -FOR THE

VIII

DELIVERY OF HEALTH CARE • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 10

SELECTION or MEDICINAL PLANTS FOR USE AT PHC LEVEL . ... . .. 11

IX BROAD PLAN FOR DEVELOPMENT OF A REGIONAL PROGRAMME ON

X

TilE USE OF MEDICINAL PLANTS AT PHC LEVEL •••·•••••·••••·•• 12

RECOMMENDATIONS .. . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

.ANNEX I CATEGORIES OF THE MOST COMMON DISEASES AND DISTURBANCES ENCOUNTERED AT PHC LEVEL FOR WHICH HERBAL REMEDIES COULD BE IDENTIFIED ••••••••••••••••• 15

ANNf.X II A CORE LIST OF MEDICINAL PLANTS FOR USE /J PHC LEVEL 16

.M"NEX III HERBAL REMEDIES FOR COMMON DISEASES AND SYMPTOMS SEEN 19

.M"NEX IV �ROAD PLAN FOR DEVELOPHENT OF A REGIONAL PROGRAMME O!-l THE USE OF MEDICINAL PLA.''ffS AT THE PRIMARY HEALTH PRIMARY HEALTH CARE LEVEL presented by Dr EL SAFI 24

.M'NE.� V LIST OF PARTICIPA.�TS •••••••••••••••••••••••••••••••• 29

�X VI AGE:NDA • .. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 33

�EX VII PROGR»ti:E .. • • . • . . • . . • • • • . • • • • • • • . • • • • • • • • • • • • • • . . • • . • 34

WO-EM/PHARM/107 page 1

An Intercountry Scientific 'Working Group Meeting on "Use of Medicinal Plants at the Primary Health Care Level0 was held at the Holiday Inn Hotel, Kuwait, in collaboration with the Government of Kuwait, from 20-25 April 1985

I OPENING CEREMONY

The meeting was conducted by H.E. Dr A.R. Al Awadi, Minister of Public Health and Minister of Planning, Government of Kuwait, who, in his inaugural address, referred to the rich heritage in the use of medicinal plants and herbal remedies described in Islamic Medicine by Arab and other Muslim physicians and scientists. He felt that this storehouse of knowledge should be used today for the treatment of the diseases seen in the countries in the Region. There was no need, he felt, to use synthetic drugs when simple herbal remedies were available and had been used for centuries to cure common conditions. He felt, hoYever, that use of such medicinal plants should be introduced carefully and in a scientific manner, avoiding, on the one hand, pressure for rapid introduction without study and, on the other, irrational bias against such remedies. He stated that the welcome initiative taken by the World Health Organization in holding this intercountry meeting should go a long way towards resolving several of the issues associated with the use of these herbal remedies.Dr Al Awadi welcomed the participants and observers to Kuwait, was happy that the meeting was being held in Kuwait and wished it all success.

The message from Dr Hussein A. Gezairy, Regional Director, Eastern Mediterranean Regional Office. -was read at the inauguration. - Dr Gezairy thanked the Government of Kuwait for hosting the meeting. He stated that several countries of the Region have been and are still using medicinal plants for delivery of health. It vas important and timely, he felt, to review this field at this juncture when the strategies for delivery of health at the primary health care level vere being formulated and implemented in the countries. It was important to see that this heritage should be employed to the full and utilized most effectively for the alleviation of sickness and suffering.

The Regional Director indicated that this meeting had limited specific objectives. These were: (a} to identify a core list of medicinal plants to be used at the primary health care level in countries in the Region, and (b) to prepare a broad, effective, imaginative and comprehensive plan for regional activity in this challenging and yet difficult field. Dr Gezairy

welcomed the participants and observers to the meeting and wished it all success.

WHO-EM/PHARM/ 107 page 2

The meeting was attended by representatives from Afghanistan, Egypt, Kuwait, Pakistan, Saudi Arabia, Somalia and Sudan. A list of participants, temporary advisers and observers who attended the meeting is attached (see Annex V) .

The provisional agenda (see Annex VI) was adopted. the meeting is given in Annex VII.

II ELECT! ON OF OFFICIALS

The programme of

The following persons were selected as Chairman, Vice-Chairman and Rapporteurs for the meeting:

Chainnan: Vice-Chairman: Rapporteurs:

III INTRODUCTION

Dr Abdel Rahman Al Awadi Dr Mohamed Ikram Dr M. El Safi Dr S. Hilal

In his introductory remarks, Dr Ranjit Roy Chaudhury, Regional Adviser, Pharmaceutical, Diagnostic and Therapeutic Substances, provided the back­ground which had led to the convening of the meeting. He expressed the hope that this would be only the first of a series of such working group meetings. In the original suggestion received from the Government of Kuwait, among the topics mentioned were standardization of herbal prepara­tions, development of regulatory procedures for the use of herbal preparations, and economic exploitation of the availability of raw materials available in the Region for preparation of herbal remedies. These issues and others could be discussed at subsequent meetings.

Dr Chaudhury then stressed the importance of identifying a common limited list of herbal remedies which could be used for most of the illnesses and symptoms seen at the primary health care level. · The identification of such a limited list from the large number of plants reportedly being used for a similarly large number of conditions would be the first step in rationally developing a broad plan for the use of herbal preparations at the primary health care level. It should be clearly understood that the core list would only be a model and guide for the countries and that countries themselves would need to prepare their own national lists. Once a list for the country had been agreed upon, then only could efforts be made for procurement, cultiva­tion, collection, storage, preparation, standardization and use of these herbal preparations. He expressed the hope that the group would be able to produce such a core list of �erbal remedies.

WHO-EM/PHARM/107 page 3

Dr Chaudhury then discussed the other two expected outcomes of the meeting, viz: (i) delineation of what research needs to be carried out in the field of herbal remedies and (ii) the development of a broad plan for development of this field of work in the Region. He hoped that the plan drawn up and the recommendations made in both these areas would be realistic and feasible for implementation within the near future within the country resources available for such activities. In fact, such a plan should enable the programme in the Region to be initiated immediately.

Dr Al Awadi then addressed the group and asked them to approach their task with objectivity and caution and to put forward rational and scientific objectives for the further development of traditional medicine. This heritage has been with us, he said, for thousands of years and the information available today from the actual use of herbal remedies, and from the ancient texts of Islamic Medicine, as also the knowledge existing in other countries, should be utilized for the benefit of the people. It was, however, essential that utilization of the herbal remedies be placed within a scientific frame­work so that the countries and their populations would take seriously and with enthusiasm to the widespread use of herbal remedies. There were several obvious reasons for use of herbal remedies in the everyday context, including availability of the sources of the remedies in the countries themselves, low cost and accessibility to such remedies only by large segments of the population in some countries of the Region. It was important, however, to approach this whole issue with caution and objectivity. There should be no unnecessary pressure to push the use of traditional medicines nor should there be biased opposition to such use. Increasing use of traditional medicines should be supported by objective, rational and scientific informa� tion gathered in the countries regarding the efficacy as well as the side­effects of these remedies and the feasibility-of �btaining regular standardized preparations for widespread use. Dr Al Awadi hoped that this '©Uld be only the first of several meetings and consultation groups which would examine issues such as standardization of herbal remedies, registration and regula­tions regardin� sale of herbal remedies and economic exploitation of resources for herbal remedies available in countries of the Region.

\,.."HO-EM/PHARM/ 10 7

page 4

COUNTRY REPORTS

Representatives of the different countries presented short background papers describing the status of use of medicinal plants in their countries. These are summarized below.

Af'GHA.'USTAN

Afghanistan is a mountainous area and because of semi-tropical and dry climate and a vast difference in altitudes the temperature varies from area to area, reaching sub-zero in winter while in summer rising to 45°c. Medicinal plants abound in Afghanistan and grow naturally in the plains and mountains.

The use of medicinal plants by the people of different ailments has been in vogue since very ancient times. They used roots, flowers, leaves, seeds and other parts of the herbs and plants sometimes as decoctions, or po1wdered and taken with milk or water. Ointments are also made, for skin diseases, and the juice of medicinal plants is also extracted. These remedies are used by the people on the basis of experience handed down from generation to generation and also by practitioners of "Unaniu Medicine.

EGYPT

The discovery of the healing and curative properties of plants is as old as the human race. Egyptian papyri dating back as far as 2000 B.C.

record for example, the use of mustard, linseed and squill. In the twentieth century, with the advent of synthetic drugs, the use of medicinal plants underwent a set-back. The use of medicinal plants is mostly confined to the poor living in rural areas urban fringe, desert lands and oases. The use of herbs by these people is based upon experience inherited from both ancient Egyptian and Islamic civilization.

Durin� the last few years utilization of medicinal herbs has been extended from poor and rural areas to middle-class and rich people and to big cities. This shift has come about not only as a sequel to side­reactions of synthetic drugs but it is also an economic necessity in developing countries. Herbs are used either in the crude state or as mixtures. There are many forms: decoctions t herbal teas, powders, instant teas, tablets. drops, ointments and lotions. A variety of galenicals and pharmaceutical preparations are also made up from medicinal plants and are used extensively.

KUWAIT

WHO-EM/PHARM/107 page 5

Medicinal plants have continued to serve through the ages as a source of medicament for treatment of a number of diseases in the different systems of medicine in the world. Eminent Muslim scholars such as Al-Razi, Ibn Sina, lbn Al-Betar Al-Samarqandi and others have to their credit compilations describing many plants with morphological details, parts used, methods of preparation and dosage, etc. They classified plants according to the diseases and the diseases according to the humoural theory.

The Arabian peninsula, in addition to its importance due to its geographical situation, has the advantage of a wide range of climatic variations with the result that different types of medicinal plants abound there. These plants have fewer side effects than synthetic medicaments, and are cheaper and therefore more available to the needy.

With the growing cost of health care and manifestations of serious side-effects of synthetic drugs there is a growing tendency to "go back to nature". The developing countries are using medicinal plant5- as the main source of treatment for various diseases. However, one should dif­ferentiate between the aims of introducing herbal treatment in the developed and the developing countries. One faces difficulties in the use of medicinal plants in treatment, starting from identification of the plants and ending with the registration of the pharmaceutical preparations. The herbs used differ in many respects from those utilized in the synthetic variety of medicine.

PAKISTAN

Man has used plants for his sustenence and also for the relief of his ailments for thousands of years. Indeed, they were the main form of treat­ment till the turn of the century. They are still used by thousands of people in developing countries and are the first line of treatment in the rural areas of Pakistan, where 75% of the country's population lives. Medicinal plants are cheap and easily available. They are usually reported to have no or low toxicity. Every village in Pakistan has a "hakim"; there are about 40 000 registered hakims and perhaps double this number who are unregistered. These practitioners practise the art of healing both in rural and urban populations. Some of them are graduates from "Tibbi" Colleges. Others derive knowledge from folklore or secrets passed on to them by elders. The hakim is looked upon with respect and reverence as he forms a part of the local culture.

The diversity in climatic conditions, topography and other geographical variations have given Pakistan a rich medicinal flora. One medicinal plant may be given for several ailnents. A small fraction of the thousands of medicinal plants have been investigated for alkaloids etc. The phanna­cokinetics and the exact mode of action of most of these plants or their

WHO-EM/PHAR?-1/ 107 page 6

active ingredients have yet to be determined. Some efforts in this direc­tion are in progress. However, in Pakistan. many pharmaceutical £inns specialize in the manufacture of compound formulations made from several single drugs mentioned in the classical texts of Ibn Sina, Al-Razi etc.

SAUDI ARABIA

In the past the people of Saudi Arabia depended exclusively on medicinal plants to cure diseases and this practice continues alongside modern medicine. The use of medicinal plants has been passed down through family traditions, drug recipes an□ traditional herbalists. Saudi Arabia has diverse climatic conditions and is rich in plant resources; more than a thousand plants have been mentioned in its flora.

Realising these facts, the Government of Saudi Arabia - represented by the Ministry of Health, Saudi Arabian National Center f or Science and Technology (SA:.�CST) and King Saud University. have promoted applied scientific research into national resources. Two projects concerning medicinal plants and drugs used in folk medicine are now in progress in which phytochemical, pharmacological, pharmacognostical, haematological and antimicrobial studies have been undertaken,

The survey of different regions of Saudi Arabia for the prevalence of diseases and their treatment with local herbal drugs has shown that local resources are sufficient to meet the requirements of common ailments. There is a great potential in medicinal plants, yet their application nationwide for PRC should be carried out cautiously. A pilot study should be undertaken, choosing a few villages and selecting appropriate medicinal pl�nts \-:hich h:r1e proved to be effective and safe.

It is worth mentioning that, from the analysis of the list of essential drugs compiled by WHO, it has been ascertained that there are at least f ifteen such drugs �hich can be substituted by medicinal plants found in Saudi Arabia.

SOMALIA

WHO-EM/PHAP,M/ 107 page 7

Most of the Somali population live in rural areas where herbal medicine is the only source of medical care. The traditional healers tend to be secretive. They have been drafted to work in the PHC programme; however, this experiment has not been very satisfactory. Herbalists are also working at the Centre for Medicinal Plants. ln 1974, the Ministry of Health issued certificates to traditional healers who had been been successfully examined for their knowledge. These healers run small shops where they sell dif­ferent remedies of plant and animal origin.

The Somali �ational Vniversity has included traditional medicine as an official subject in the Nedical Faculty. In this teaching, about one-third of the hours (100 hours total) are earmarked for medicin.al plants. The students acquire knowledge about the local names of all known plants used in the country and the diseases they cure, including collection, processing and laboratory-testing them. The policy of both the Ministry of Health and the Somali National University is to promote scientific research on medicinal plants with a view to inte3rating useful plants into the health care of the country.

At present there are two centres for the study of medicinal plants, with the following activities:

1. Preparing pharmaceutically the most commonly used plants in traditional medicine for further testing.

2. Literature survey and botanical identification. 3. Experimental studies. 4. Clinical verification of efficacy. 5. Isolation and determination of structure of pharmacologically

active compounds.

lt is now proposed to combine the t�o centres so as to form the "Institute for Research on Natural Products". The University Programme for Medicinal Plants is expected to.accelerate the screening of plants regarding their antimicrobial, anti-inflammatory and analgestic activities. Toxicolo­gical investigation of plants showing significant pharmacological activity is proposed so that clinical studies may be carried out.

SlmAN

l.THO-EM/PHARM/107 page 8

Traditionally a very high percentage of people in Sudan depend on herbal remedies. This has been a result of various cultural influences over a period of time. Most medicinal plants grow wild and in abundance in many parts of Sudan. There is ample scope for systematic cultivation of plants in large areas which are lying waste.

The Medicinal and Aromatic Plants Research Institute under the National Council for Research was established in 1972 to study various aspects of plants indigenous to Sudan - their phytochemistry, agronomy, pharmacology and pharniacognosy. The Institute is compiling material for the publication of an atlas of medicinal plants used in Sudanese folk medicine. In this Institute plants on which there is already some ethnobotanical or anthro­pological information are studied in preference to plants for which these is as yet no such background information.

The current research projects in the Institute include:

- Molluscicidal activity of certain plants. - Anti-helmintic activity, - Anti-microbial agents of plant origin, - Anti-diabetic activity of plants used in Sudanese folk medicine. - Oxytocic, contraceptive and abortive activity. - Anti-cancer agents - Traditional management of gastro-intestinal disturbances and

diseases of early childhood.

This Institute enjoys active collaboration with the Traditional Medicine Research Institute, KhartoUI!I.

Sudan has a.rich spontaneous floral distribution and there is variation in the use of medicinal plants at the PRC level.

IV WHO's PROGRAMME IN TRADITIONAL MEDICINE

Dr R.R. Chaudhury presented, on behalf of WHO Headquarters, a paper on WHO's overall programme in the field of traditional medicine. WHO had allocated priority to three areas for collaboration with Member States. These were in the fields of Evaluation, Integration and Training. In the first area, WHO was attempting to have traditional medicine examined and evaluated carefully, with an open mind, so that it could be accepted and supported by all sections for use in the delivery of primary health care. The second area, that of integration, involved an effort to col­laborate with national governments to integrate the use and practice of traditional medicine into national health systems. With regard to the third area, training, all health staff - but particularly medical and nursing students - need to be made aware of the place of traditional medicine, while traditional practitioners need to be approached with understanding and recognition of their skills so as to encourage them to share their knowledge

WHO-EM/PHARM/107 page 9

and play their part in the national health services. The establishment of WHO Collaborating Centres in Traditional Medicine, the holding of consulta­tion group meetings and the organization of courses in specific subjects were some of the mechanisms being used by WHO in this field.

V ISLAMIC MEDICINE CENTRE, KUWAIT

Dr Ahmed R. El-Gindy, then described the activities of the Islamic Medicine Centre, Kuwait. He indicated that there were three main ongoing activities at the Centre. Studies were being ccnducted on:

(a) Heritage of the Muslim scholars (b) Relation betveen Islam and Medicine (c) Herbal Medicine.

In the field of Herbal Medicine, the main theme of the activities were carried on in two departments as described below.

V-1. Clinical Department

Treatment of eight diseases has been introduced. The diseases selected are: (a) allergic rhinitis; (b) bronchial asthma; (c) chronic sinusitis; (d) diabetes; (e) migraine; (f) rheumatism; (g) urinary tract infection and (h) vitiligo.

Dr El-Gindy also described relations between the Centre and other hospitals in Kuwait and hov they check on thiir patients.

V-2. Department of Research on Herbal Treatment

The Department comprises the following units:

(a) Pharmacological unit (b) Phyto- and pharmacognostical unit (c) Pharmaceutical and Development Unit (d) Quality Control Unit (e) Bacteriology (£) Instrumental analysis.

Dr El-Gindy also identified the aims, objectives and duties of each unit and gave examples of how the herbal combination is suggested and how the Centre proceeds to develop it into a pharmaceutical formulation.

During the course of the meeting, the participants visited the Islamic Medicine Centre, the Cancer Centre and Adam Hospital and saY the activities at these centres. The group also visited the KuYait Oil Company at Ahmadi.

WHO-EM/PHARM/107 page 10

VI MEDICINAL PLANTS IN THERAPY

Dr Farnsworth then presented a background paper on Medicinal Plants in Therapy. He stated that plants are useful sources of drugs, either in the fonn of extracts or as pure substances derived from them. There are approximately 119 substances of known structure that are used globally as drugs and which are extracted from plants. About 75% of these drugs are used for the same purpose(s) as the plants from which they are derived. This meant that. in most cases. the progenitor plants could still be useful as drugs in traditional medicine. These 119 drugs were obtained from about 90 species of plants. many of which can be cultivated in developing countries. These 119 plant-derived drugs of known structure and/or the 90 species of plants from which they were discovered, are useful for the treatment of 62 different disease conditions (therapeutic categories) .

Because of a short supply of qualified pharmacologists in developing countries and since chemists/biochemists are usually not in short supply, it is suggested that in the early stages of drug development programmes, intact animal studies be substituted by so-called "pre-screens" (in vitro bioassays) to identify useful drug effects of plant extracts. These assays can be carried out by chemists/biochemists.

VII RESEARCH NEEDS IN THE USE OF MEDICINAL PLANTS FOR THE DELIVERY OF HEALTH CARE

Dr Mohammed Ikram then presented a background paper on research needs in the use of medicinal plants for the delivery of health care. After discussion of the paper it was felt that the following activities shall be undertaken:

(a) Selection of herbal preparations for the most common diseases in each country.

(b) Pharinacological screening of the above preparations should be undertaken in order to select effective medicinal plants. It will be better and more effective if centres of excellence in special fields are developed in each country, these could collaborate in pharmacological screening.

(c) Pharmacological testing criteria have to be modified for those herbal preparations which have been in use for a long time in each country. The experience of China and Japan in particular could be helpful in this respect.

(d) Standards have to be prescribed for quality control of herbs. Possible parameters could be: microscopic examination, loss on drying, ash content, acid insolubre ash, water-soluble and alcohol-soluble solids. qualitative tests, TLC and HPLC. Experience of China, Japan and India could be helpful.

WHO-EM/PHARM/107 page 11

The different approaches to assessing the effectiveness of medicinal plants were discussed by the participants. The advantages and disadvantages of both the traditional approach, whereby the plant substance is tested for toxicity and for its pharmacological properties before being clinically evaluated for efficacy, and the alternative approach �hereby plants in common use could be directly assessed for efficacy in patients after limited ani�al toxicology studies, were discussed at length. It was agreed that each country would need to identify which approach suited the country and follow that approach.

VIII SELECTION OF MEDICINAL PLANTS FOR USE AT PRC LEVEL

Dr Hilal then presented a paper on the selection of medicinal plants for use at PHC level. This was discussed at length in relation to the list of plants suggested for use by the countries at the PHC level. A core list of plants for use in the Region was then prepared. Dr Hillal indicated that promotion and support of the incorporation of useful elements of traditional medicine into national health systems, viz. at PHC level, has been a basic approach in WHO's Global Medium-Term Programme of Traditional Medicine.

In this Region, the information which has been systematically collected from Member Countries showed that there is a vi.de range of traditional medicine with a variety of backgrounds of beliefs, patterns of practice and potential resources. An increasing interest in the promotion of traditional medicine, particularly in the field of medicinal plants and herbal remedies, has been expressed by several countries of the Region.

Regional progrm:ime activities have been primarily directed.towards promoting and supporting national efforts to incorporate useful:.·1:raditional practices of proven efficacy with a view to strengthening and eitending the delivery of health care along with the global strategy of HFA/2000.

The first Intercountry Meeting on Traditional Medicine was organized in Khartoum in March 1983. During the meeting, the Regional Medium-Term Progrmmne for the period 1984-1989 was presented and discussed. Encouraging the development of lists of essential medicinal and herbal remedies which could be usefully utilized in PHC was urged in the recommendations.

_Each country has, therefore, the direct responsiblity for preparing the appropriate list according to its own resources, disease patterns, acceptability to the people, health policy and various other environmental and socio-cultural factors.

WHO-EM/PHARM/107 page 12

IX BROAD PLAN FOR DEVELOPMENT OF A REGIONAL PROGRAMME ON THE USE OF MEDIClliAL PLANTS AT PHC LEVEL

Dr El Safi presented a paper entitled "A Broad Plan for development of a regional programne on the use of medicinal plants at PHC level" (for complete text, see Annex IV) .

This was discussed at length and eventually a plan of action was agreed upon for activities in the areas of (a) policies; (b) research; {c) manpower development and {d) development of formulations.

Agreement was also reached concerning the inputs required from WHO for further development of this programme.

X RECOMMENDATIONS

X-1. A National Task Force or Advisory Group should be set up in every country to initiate, coordinate, monitor and implement programmes of traditional medicine.

X-2. It is reconmiended that information and knowledge about the use of herbal remedies be provided on a regular basis to medical, paramedical and phannacy graduates and students.

X-3. Systematic research in various aspects of herbal medicine should be initiated, organized and further strengthened. Centres of clinical phannacology should be set· up to help in clinical evaluation of herbal remedies for efficacy and safety.

X-4. A consultation should be held to develop specific regulations for registration of herbal preparations in countries of the Region.

X-5. A consultation should be held in the Region for standardization of herbal preparations for.therapeutic purposes.

X-6. A meeting should be held in the Region for developing a plan for economic exploitation of raw material available in the countries of the Region and for setting up regulations for its import and export.

X-7. It is recommended that periodic meetings be held to monitor progress in the implementation of the programme for the use of medicinal plants at PHC level.

X-8. It is further recorm:nended that WHO initiate activities in the following areas:

(a) Drug information sheets which should be prepared for all medicinal plants identified in the Core List for the most appropriate use of these at PHC level.

WHO-EM/PRARM/107 page 13

(b) Training to be provided in quality control, standardization, experimental pharmacology and clinical pharmacology, all related to herbal medicine.

(c) Data on medicinal plants identified in the core list can be supplied through the WO Collaborating Centre for Traditional Medicine in Chicago, USA, and the NAPRALERT data base.

X-9. A Regional Advisory Panel for traditional medicine should be set up to accelerate development of this programme�

X-10. It is recommended that WHO should identify centres for eventual designation as WO collaborative centres in this field,

WO-EM/PHARM/107 page 15

ANNEX I

CATEGORIES OF THE MOST COMMON DISEASES AND DISTURBANCES ENCOUNTERED AT

PHC LEVEL FOR WHICH HERBALREMEDIESCOULD BE IDENTIFIED

1. Gastrointestinal tract diseases

2. Respiratory diseases

3. Skin diseases

4. Helminthic infestation

5. Fever

6. Pain and inflammation

7. Allergy

8. Urinary tract diseases

9. Arthritic conditions

10. Eye diseases

11. Burns, scalds, wounds,·abscesses and swellings

12. Snake bites, sco�ion stings and insect stings

WHO-EM/PHAR.�/107 page 16

ANNEX II

A CORE LIST OF MEDICINAL PLANTS FOR USE AT PHC LEVEL

Criteria for selection of a core list

The core list of herbal remedies was selec ted , keeping in view the

following cri teria :

a) actual use of the medicinal plants in the countries in the Region ;

b) scientific li tera ture indicating efficacy of the plants in certain diseases and common applications ;

c ) mention in early texts of Is lamic scholars as having therepeutic effect, and

d) use of the medicinal plants for therapeutic purposes in countries outside the Region .

Acacia arabica (nilo tica) L .

Adha toda vasica Nees

Albizia anthelmintica Brongn.

Allium cepa L.

Aloe spp . (vera L. ; ,ferox Miller , barbadense)

Althea offic inalis L .

Ammi majus L .

Ammi visnaga L .

Apium graveolens L.

Artemesia spp . L. (cina) (Berg) Willkomm

Azadiracta indica A. (Juss)

Balani tis aegyp tiaca L.

Berberis ari s tata L. ·

WHO-EM/PHARM/107 page 17

Capsicum minimum Roxb. (annum) L .

Cassia spp. (acutifolia Delile, angustifolia Vahl, fistula L . )

Chichorium intybus L.

Cinnamomum Zeylanicum Nees (C. cassia Blume )

Commiphora makul Engl. (C. molmol Engier)

Cydonia oblonga Mill

Cympopogon proximus (Hochst) Stapf

Datura spp. L .

Elettaria cardamomum Maten

Fagonia arabica L.

Ficus carica L.

Glycyrrhiza glabra L.

Hibiscus sabdarrifa L.

Hyoscyamus spp. L.

Lactuca sativa L.

Lawsonia alba La Mark

Linum usitatissimum L .

Lupinus termis (albus) L.

Matricaria chamomile L.

Mentha spp. L .

Morus alba L.

Nymphaea alba L.

Ocimum sanctum L .

Origanum spp . L.

Peganum harmala L .

WHO-EM/PHARM/107 page 18

Plantago spp . (ovata Forsk t psyllium L . )

Prunus domes tica L.

Portulacca oleracia L.

Psidium guajava L.

Punica granatum

Raphanus sativum L.

Rheum officinalisa Baillon

Ricinus communis L .

Rosa domestica L .

Santalum album L .

Solenestemma argel Del . t Hayne

Thymus vulgaris L.

llmbelliferous fru its : (anise L . t fennel L . t caraway L . ; cumin L. • coriander L . t

dill L • • • • • • • • • )

Urginea maritima (Squill ) L .

�ithania somnifera L .

Zingiber officinale Roscoe

Zizyphus vulgaris Lam .

WHO-EM/PHARM/107 page 19

ANNEX III

HERBAL REMEDIES FOR COMMON DISEASES AND SYMPTOMS SEEN

Guidelines for Development of Herbal Remedies

Each plant should be authenticated botanically and the method of its cultivation, collection, storage, processing and manufacture should be established. The part (s) of the plant used and the traditional methods of preparation, dosage, mode of administration and usage should always be sought. This may necessitate collaboration be�een the countries of the Region . The compiled text should be regularly revie�ed and updated in the light of more information, to meet the needs of heal th care.

The follo\tlng is a list of remedies used for common diseases and disturbances enountered at PHC level. This list is only a model of some herbal medicinal plants which are in use in most countries of the Region, and should be modified by each country to meet its o.m requirements. The part of the plant used, method of pre­paration of the remedy , dose to be administered, mode of administration of the plant substance and other such detail s will be described in a separate subsequent publication. This v ill incorporate Information Sheets for each of the plants included in this list.

1. Gastrointestinal Tract Remedies

a. Anti-diarrhoeals

b. Laxatives

c. Carminatives

d. Spasmolytics

e. Stomachics

£ . Anti-Emetics

a. Anti-diarrhoeals

Acacia arabica

Acacia catechu

Berberis aristata

Commifora molmol , C. mukul

Punica granatum

b. Laxatives

WH0-EM/PHAR.l.1/107 page 20

Aloe ferox, A. barbadense , A. vera

Cassia acatifolia , C. angus tifolia

Chicorium intybus

Glycyrrh iza glabra

Plantago ova ta, P . psyllium

Rhamnus frangula

Ricinus communis (fixe d oil)

c . Carminatives

d .

Cinnamomum zeylanicum

Ele t taria cardamomum

Matricaria chamomile

Mentha spp .

Ocimum sanctum

Origanuni spp.

Thymus vulgare

Umbelliferons Fruits , Anise, Carawav, Coriander, Cumin, Dill, Fennel

Zingiber off icinale

Spasmolvtics

Atropa belladonna

Da tura spp .

Hyoscyamus spp.

Solenes temma argel

e . S tomachics

Rheum officinalis

f . An ti-Eme tics

Atropa be lladonna

Hyoscyamus spp .

Men tha spp.

Zingiber of ficinalis

2 .

WHO-EM/PIIAR.�/107 page 2 1

Remedies for Upper Respiratory Diseases

Adhatoda vasica

Allium cepa

Althea officinalis

Ammi visnaga

Cassia fistula

Cinnamomum zeylanicum

Ficus carica

Glycyrrhiza glabra

Hi.biscus subdarrifa

Linum usi tatiss imum

Mentha spp .

Nigella sativum

Ocimum sanc tum

Prunus domestica

Psidium guajara

!ilia tomentosa , T. ulmifolia

Urginea maritima

�ingiber_ officinalis

3 . Remedies for Skin Diseases

Aloe vera , A. barbadense , A. ferox

Ammi majus

Azadiracta indica

Ficus carica

Fumaria officinalis , F. parviflora

Lawsonia alba

Lupinus termis , L . albus

Natricaria chamomillae

Nymphaea alba

Santalum albam

WH O-EM/PHAPJ1/ 107 page 22

4 . Anthelminthics

s .

6.

7 .

Albizia anthelmintica

Artemisia cina

An ti pyre tics

Allium cepa , A. sativum

Fagonia arabica

Analges ics and Anti-Inflammatory Agents

Lactuca sa tiva

Ma tricaria chamomile

Peganum harmala

Anti-allergies

Cydonia oblonga

Zuzyphus vulgaris

8 . Remedies for Urinarv Infections

Ammi visnaga

Balanites aegyptiaca

Cucumis sativum , C . melo

Cympopogon proximus

Nymphaea alba

Raphanus sa tivum

9 . Remedies for Arthritic Cond itions

Caps icum minimum, C. annuum

Commifora mukul

Withania somnifera

10 . Remedies for Eve Diseases

Berberis aris tata

Rosa domascena

WHO-EM/PHAF.M/107 page 23

11 . Trea tment for burns , s cal ds , wounds , absces ses and swelling_s

Aloe vera , A . barbadense , A . ferox

Lawsonia alba

Linum us ita tissimum

Punica granatum

12 . Trea tment for snake bites , scorpion stings and insect stings

Aloe spp .

Azadirac ta indica

Heliotropeum s tringosum

N . B. Medicinal plants can also be used at Primary Health Care level for preventive measures , e . g . insect repellents : Citronell ; Mulluscicides ; Balanites aegyp tiacae.

WRO-EM/PHAR.�/107 page 24

ANNEX IV

BROAD PLAN FOR DEVELOPMENT OF A REGIONAL PROGRAMME ON nm USE OF MEDICINAL PLANTS AT THE PRIMARY HEALTH CARE LEVEL

presented by

nr EL SAFI

Plants and herbal remedies are used in several countries in the Eastern Mediterranean Region of WHO for therapeutic purposes. Particularly in the rural areas, people have belief and faith in herbal medicine and look on the herbalist and the traditional healer, to a large extent, as the first level of health care to which they have ready access.

It is important to use this heritage of ·knowledge and information for treatment of patients at the primary health care (PRC) level where, in fact, it is already being used on a wide scale.

There are , however, several difficulties , problems and constraints which are inherent in the use of medicinal plants for therapeutic purposes . There are a large number of plants reputed to be effective for the treatment of a variety of symptoms and specific diseases and selection needs to be made as to which plants could be used for each disease. Practitioners of the allopathic system of medicine may not readily accept the claims regarding the efficacy of these herbal remedies and need to be convinced that they are effective and safe. Other issues, such as the availability of the plant material in adequate quantities, cultivation of such plants or importation thereof if necessary , standardization of the different preparations, storage and distribution may also pose problems.

Primary Health Care (PHC) i s defined as essential care based on practical , scientifically sound, socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and a cost the community and country can afford. Two of the main elements of PHC are the provision of appropriate treatment of common diseases and injuries and provision of essential drugs .

A rich materia medica . employing chiefly cheap and indigenously available non-toxic drur,s, deep knowledge of dietetics in health and disease and a wide range of therapeutic measures are the characteristics of traditional medicine. In vie� of the foregoing it is necessary that a well-conceived policy be adopted for the development and utilization of medicinal plants for use in medical care.

WHO-EM/PHARM/107 page 25

Medicinal plants form the main resources for therapeutic recipes used in traditional medicine. or locaility has its own peculiar flora resulting and climatic conditions.

the preparation of Each country, sub-region

from its own geophysical

These medicinal plants are either cultivated systematically or grow wildly . They may be indigenous to the country or imported in a variety of forms. Each country, through usage, has identified the most commonly used plants.

The group agreed on the following broad plan of action.

1. POLICIES

1. 1. At country level there is a need for formulation and declaration of national policies for the development and use of traditional medicine systems including the use of medicinal plants This should be coupled with administrative, organizational and budgetary commitments to meet this goal.

1 . 2. Supportive legislation at all levels should be promulgated when necessary and restrictive laws and clauses identified and repealed if possible.

1. 3. In many countries research on medicinal plants is in progress • . Some countries have compiled and published inventories, formularies and pharmacopoeias of medicinal plants. The centres involved in medicinal plants research should be identified and a focal centre designated in each country to enhance intra- and inter-country liaison and be responsible for follow-up of the implementation of the national programme of use of medicinal plants at PHC level.

1. 4. A national task force or working advisory group should be established. The composition of this group should be multidisciplinary and widely representative inclu�ing all concerned parties.

The task force should have the following terms of reference:

1. 4. 1. To sensitize policy-makers and planners to current issues relating to medicinal plants used at PHC level and to ensure the collaboration and help of policy-makers and planners in charge of the PHC programme in each country.

1. 4.2. To identify, in collaboration with the concerned health authorities. the most cormnonly encountered diseases at PHC level.

mIO-EM/PH.ARM/107 page 26

1. 4. 3. To identify and compile a list of the medicinal herbs most commonly used for the treatment of these diseases and d isorders.

1. 4.4. To formulate and implement a national plan of action for the safe and effective introduction of these medicinal plants for medical care at PRC level .

1. 4. 5. To ensure mechanisms for regular procurement and distribution of medicinal plants to health delivery teams at PRC level. Such mechanisms should provide for safe storage and, if necessary , cultivation and/or importation of medicinal plants.

1. 4. 6. To sponsor necessary research conducive to the efficacious and safe use of medicinal plants and ensure that it is carried out. This should be consonant with the standards and regulations of the country in question.

1. 4. 7. To devise mechani sms for on-going evaluation and periodic review of progress of the introduction of medicinal herbs for use at PHC level.

2. RESEARCH

Research should address questions of efficacy and safety and should sat isfy national regulations and standards. The national task force may address the following:

2. 1. Formulate plans for muldisciplinary/multicentre applied research programmes in each country. Intercountry' programmes among Member countries of the Region in the spirit of technical cooperation among developing countries (TCDC) is encouraged.

2.2. The objectives of research must be very clear and directed toward practical needs.

2. 3 . All facil i ties for research and expert manpower, within each country and in the Region, should be utilized maximally .

2. 4. Literature flow and experience exchange should be encouraged between countries of the Region. International data bases on medicinal plants, their delays and/or other local literature services should be effectively utilized.

WHO-EM/PHARM/ 107 page 27

3. MANPOWER DEVELOPMENT

Active steps should be taken into consideration with WHO to promote manpover development in the different disciplines and areas related to the development and introduction of medicinal herbs for use at PHC level. The foll0t.1ing areas should be considered:

3 . 1. Devise appropriate training programmes for training of trainers of Community Health Workers (CHWs) , Traditional Medical Practitioners (niPs) etc. Training of trainers should be a central activity for which instructors must be carefully chosen and coached.

3.2. Compilation of simple training manuals on medicinal plants in use at PHC level is essential as training material for Communit y Health Workers as well as for other health personnel.

3 .3. Research findings and relevant information on medicinal plants should be circulated widely to all personnel and t o the lay public t hrough all available and relevant media and t hrough teaching, training and orientation programmes.

3. 4. Revise manuals for Community Health Workers and Traditional Birth Attendants Yith a view to including in them the relevant infotmation on the selected medicinal plants to be used at PHC level.

3. 5. It would be desirable for the therapy regimen to be given to PHC workers to enable them t o treat their patients appropriately. The regimen should explain the signs and symptoms of the disease, its course, the drug of choice , the points to be observed during the course of treatment, and an indication as t o when and wh�re t o refer the patient at the right time.

4. DEVELOPMENT OF FORMULATIONS OF MEDICINAL PLANTS FOR USE AT PHC LEVEL

4. 1. There is need to make available to medical and paramedical personnel, traditional medical practitioners and community health workers, etc. standardized medicinal plant preparations in appropriate formulation. Member States will need to consider carefully the appropriate methods of manufacturing formulations presented for use at PHC level, according to each country's particular needs and available resources.

4 . 2. Countries locally. studies to facility.

are encouraged to produce at least some herbal pharmaceuticals In order to do this, funds should be available for feasibility establish qualit y control and a small-scale production

WHO-EM/PHARM/107 page 28

4. 3 . There is need to improve and promote methods of cultivation, collection and storage of selected medici nal plants. The cultivation, collection and production of medicinal plants within a country should be carefully studied.

4. 4 . Where necessary and appropriate, simple multipurpose kits containing a selected assortment of medicinal plants (among other accessorie s) for Community Health Workers (CHWs) should be devised.

5 . WHO INPUTS

A Regional Advisory Panel for Traditional Medicine should be set up to give impetus to the whole programme of traditional medicine in the Region.

5.1. Through its netYork of Collaborating Centres for Traditional Medicine and other related disciplines, both within and outside the Region, WHO should maximally utilize areas of competence of each centre, i n the interests of healthy collaboration and exchange of experience, expertise and knowledge.

5 .2 . A series of workshops at national level should be sponsored by WHO to address problems related to the use of medicinal plants at PRC level.

5.3. In-country training courses and sponsored by WHO in the

and scholarships should be facilitated field of medicinal plant research,

5. 4. Funds to f inance national programmes of use of medicinal plants at PRC level should be :illocatcd by WHO.

AFGHANISTAN

EGYPT

KUWAIT

PAKISTAN

* Did not attend.

WHO-EM/PHARM/107 page 29

ANNEX V

LIST OF PARTICIPANTS

Mr A. Rahman Pazhoohesh Pharmacist Ministry of Public Health Kabul

Dr Mohamed Galal Ghorab Head Department of Research and Drug Control Memphasis Pharmaceutical Company, Zeiton Cairo

* Dr Shehab Ahmed Shehab Medical Officer Centre of Islamic Medicine Kuwait

· * Dr (Mrs} Kadriah Al Awadi Ministry of Health Kuwait

Dr Adel Al Sharad Ministry of Health Kuwait

Dr Abdullah Al-Khars Department of Pharmacology/Toxicology Faculty of Medicine Kuwait University Km.rait

* Dr Sameeha Al-Flaij Ministry of Health Kuwait

Dr Mazharul Haque Associate Physician and Assistant Professor Department of Medicine Jinnah Postgraduate Medical Centre Karachi

SAUDI AAA.BIA

SOMALIA

SUDAN

OBSERVERS

WHO-E?-t/PHAR.'1/ l 07 page 30

Pharm. Saud Al-Eshaiwy Riyadh Central Hospital Riyadh

Dr Abdullahi Mohamed Ahmed Lecturer of Traditional Medicine Faculty of Medicine . S.N.U. }to�adishu

Dr Ahmed Khider Bashir Senior Researcher Medical Research Institute and Acting Director. Medical Research Council National Council for Research Khartoum

Dr Mohamed Zohour Al Hassan Ministry of Health Km.:rait

Dr Ahmed Abul Fadl Minis try of Health Kuwait

Pharmacist Mokhtar Al Bishr Ministry of Health Kuwait

Dr Ryad Al Alami Ministry of Health Kuwait

OBSERVERS (cont'd)

KUWAIT

SAID)I ARABIA

'WHO-EM/PHARM/107 page 31

Dr Saleh Garbawi Ministry of Health Kuwait

Dr (Mrs) Mariem Al Jassim Ministry of Health Kuwait

Dr Fahim Amer Ministry of Health Kuwait

Dr Ahmed Shawky Ibrahim Ministry of Health Ku-wait

Dr Mohamed Saber Ministry of Health Kuwait

Dr Hamel Al Shabouri Ministry of Health Kuwait

Dr Unaizy Al-Unaizy Ministry of Health Kuwait

Mr Talal Fouad Hamdi Director, Hiraa Hospital Mecca

Mr Saleh Al-Senouna Director, Medical Supply Stores Eastern Province Ministry of Health Dammam

Mr Ibrahim Motawea King Fahd Hospital Pharmacy Department Medina

Dr Mohammed Abdul Aziz Al-Yahya College of Pharmacy King Saud University Riyadh

RESOURCE EXPERTS

Prof. N. Farnsworth

Dr Ekram Sezik

Dr R. R. Chaudhury

Dr Ahmed El Saf i

Dr Mohamed Ikram

Dr A .R . El Gindy

Dr Sayed Hilal

Hakim H. A. Razzack

Mi ss Aysha Hetata

Mrs M.T. Panayotti

WHO-EM/PHARM/107 page 32

Professor of Pharmacognosy University of Illinois, Chicago USA

Hacettepe University Faculty of Pharmacy Head, Pharmacognosy Department and Consultant of Ministry of Health

on Herbal Medicine Ankara TURKEY

WHO SECRETARIAT

Regional Adviser, World Health Organization Pharmaceutical, Diagnostic

and Therapeutic Substances (Secretary)

Temporary Adviser

Temporary Adviser

Temporary Adviser

Temporary Adviser

Temporary Adviser

Conference Officer

Secretary

Director , Traditional Medicine Research Institute

and WHO Collaborating Centre

for Traditional Medicine Khartou�, Sl."DA.�

Director , Pakistan Council of S cientific and Industrial Research, Peshawar, PAKISTAN

Islamic Medical Centre, Kuwait

Dean, Faculty of Medicine , Cairo University Cai�, EGYPT

Director, Central Council for Research in Unani Medicine. New Delhi, INDIA

World Health Organization

World Health Organization

1 . Opening of mee ting .

WHO-EM/PHAR�/ 107 page 33

ANNEX VI

AGENDA

2 . Presentation and discussion o f experience in the use o f medicinal plants for primary health care in countries in the Region.

3 . Presentation and discussion of the experience in the use o f medicinal plants for primary health care in o ther countries outside the Region.

4 . Identification of a core lis t o f medicinal plants to be used for delivery of p rimary health care in countries in the Region.

5 . Discussion of the research needs for further use of medicinal plants at the primary health care level .

6 . Discussion and development of a broad Regional programme to support the use of medicinal plants for primary health care in countries in the Region .

7 . Closing session.

Saturday, 20 April 1985

09 . 30 - 10 . 00

10 . 00 - 10. 30

10. 30 - 11. 00

11 . 00 - 14 . 00

Sundav , 21 April 1985

08 . 30 - 10. 00

10 . 30 - 11 . 00

11 . 00 - 11 . 30

11 . 30 - 12 . 00

12 . 00 - 1 2 . 4 5

12 . 45 - 14 . 00

WHO-EM/PHAR.�/107 page 34

ANNEX VII

PROGRAMME

- Regis tration

- Opening Session , Plenary Inaugural Address by H .E . Dr Abdul Rahman Al Awadi , �linister of Public Health and Minis ter of Planning

- Message from Dr Hussein A . Gezairy , Director, WHO Eas tern Mediterranean Region

- Recess

- Elec tion of Officers (Chairman , Vice Chairman , Rapporteur)

- Adoption of the Agenda

- Introductory Remarks - Regional Adviser on Pharmaceuticals, Dr R . R. Chaudhury

- Presentation of background papers on plants being used at the primary health care level in the countries of the Region

- Presentation of background papers by participants

- Recess

- Presentation by Dr El Cindy on " Islamic Nedical Cen tre in Kuwait11

- 11An overview of the use of medicinal plants for delivery of primary heal th care" p repared by Dr 0 , Akerele, Programme Manager TRM, Geneva, presented by Dr R .R . Chaudhury

- Presentation of background paper uSelec tion of medicinal plants for use at the p rimary health care level"

- General Discussion

Monday, 22 April 1985

08 . 3 0 - 15. 00

17. 00 - 18.45

18. 45 - 20. 00

Tuesday, 23 April 1985

08.30 - 09.30

09.30 - 11. 00

11. 00 - 11. 30

11. 30 - 14. 00

Wednesday, 24 April 1985

08 . 30 - 09 . 30

09 .30 - 11 . 00

11. 00 - 11 . 30

11.30 - 12. 00

12.00 - 14.00

WHO-EM/PHARM/107 page 35

- Visit to Islamic Medicine Centre

- Visit to Cancer Centre

- Visit to Al-Eidan Hospital

- Visit to KOC at Ahmadi

- Workshop discussions on preparation of a core l i st of medicinal plants for use in countries in the Region

Discussion on preparation of a core list (continued)

- "Herbal Medicine today" . Lecture presented by Professor N. Farnsworth, Professor of Pharma­cognos y , University of Illinois, Chicago, USA.

- Presentation of a core list of medicinal plants to be used at the primary health care level

- Recess

- Discussion and finalization of core list

"Quality Control of Herbal Preparations".

- Presentation of background paper on "A broad plan for development of use of medicinal plants for primary health care in the countries in the Region"

- Recess

- Research needs in the use of medicinal _ plants for delivery of health care

- Discussion on development of a broad plan for use of medicinal plants for primary health care in the countries in the Region

Thursday, 25 April 1985

08. 30 - 09. 10

09. 10 - 10. 30

10. 30 - 11. 00

11. 00 - 14. 00

WHO-EM/PHA.ro1/107 page 36

- Problems and controversies in clinical evaluation of medicinal plants

- Recommendations regarding further use of medicinal plants for delivery of ?rimary health care

- Recess

- Adoption of Report

- Closing Session .