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An Evidence-Based Conceptual Framework

for Policy Development for Strengthening


the Role of Indigenous Medicine
in Health Sector in Sri Lanka

by

Dr. Danister L. Perera


Introduction:

Sri Lankan heritage of Indigenous Systems of Medicine (ISM) is essentially nurtured within
an exclusive biophysical and cultural context more than thirty millennia of human civilization
proven with anthropological evidences. It was recognized as the national health care system
under ancient royal reign and catered country-wide people's health needs within a systematic
organizational structure. The examination of evolutionary process of ISM policies includes
articulating why it historically existed outside dominant institutions, biomedical models, and
Eurocentric paradigms throughout last five centuries. During the colonial period ISM faced a
very deteriorative fate and irreparable drawback which continue it's negative impact even after
sixty decades after independence. Most of the post-colonial governments could not reposition
ISM in national health system in full capacity and eventually national health became a
dependent of socio-economic determinants of globalization. International trends on
complementary and alternative medicine in contrast to biomedicine dictate internationally
accepted guidelines for extending quality, safety and efficacy of traditional medicine.
Currently ISM sector needs to be streamlined within an institutional framework which is
being revised, restructured and reformed in accordance with present national development
policies and the political vision of the government. Since ISM has delivered its optimum
service to achieve MDGs during last decades, the sector has to viably play a role in SDG
related to health and update the standards for moving forward with the WHO Traditional
Medicine Strategy 2014-2023.

The institutional framework of this legislation and organizational layout created through legal
provisions enforced by the Ayurveda act No. 31 of 1961 maintain the administrative structure
in ISM sector in a sustainable manner up to date. Section 89 provides a very broad and
extensive interpretation which crosses an international limits and regional boarders for the
term Ayurveda as "Ayurveda, Siddha, Unani and indigenous medicine, and any traditional
system of medicine or surgery indigenous to any Asian country and recognized by respective
governments as such." This definition expands legal scope of Ayurveda unto cross-border
transmission which builds up a regional cooperative identity like ASEAN, SAARC or IOR-
ARC. But this term denoted an Indian dominant articulation in ISM and established a
misnomer into national paradigm where the traditional identity of ISM is totally neglected. In
this context ISM needs to review and discuss the potential impacts and limitation factors of
agreements and conventions like CBD, GATT, TRIPS, CITES, SAFTA, FTA etc. The
international opportunities for ISM professionals, services and products should be critically
evaluated and demonstrated with a guidance based on factual evidences. The most timely
requirement as identified by the sector-wide brain storming is to introduce a functional policy
framework and legal reform that can accommodate the fast growing demand of traditional
medicine in global forum. It is therefore the minister has clearly dictated the timely need of
repealing the existing legislations and introducing new reforms to upgrade the institutional
and organizational structure of the sector.

Quality, Efficacy and Safety:

Existing Ayurveda Act has provided considerably acceptable and adequate legal provisions to
regulate ISM pharmaceuticals in order to assure consumer protection through quality, safety
and efficacy. But still it is an urgent need to develop a set of guidelines in accordance with
internationally agreeable framework and recommended by the WHO. 1 ISM pharmaceutical
industry is very much fast growing sector in line with domestic requirement and global
demands which has been increased in significant rate during the last decade of second
millennium. Therefore regulatory measures and quality standards pertaining to ISM medicinal

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Former Member, PTF for National Health Policy, Former Registrar of Ayurveda Medical Council
products were major issues taken up in national and international forums during past few
decades.2 Regulatory procedures directly have an impact on rational use, consumer protection
and minimal risk involvement. With regard to Traditional Medicine (TRM) WHO has
reported legal status of regulatory frameworks existed worldwide whereas only 25 out of 191
member states had a national policy (13%), 65 member states had laws and regulations on
herbal medicines (34%), and 19 member states had a national research institute (10%).3 In
WHO's conclusive review quality, safety and efficacy were major concerns and regulatory
data and information on ISM products shared with national authorities are inadequate and not
reflected in national policies whereas in Sri Lanka a post marketing surveillance system is not
in operation.4 Even though the quality assurance of ISM products is a very complicated and
problematical intervention in terms of scientific methodology WHO has emphasized the
necessity of developing a working model for evaluating and validating traditional medicine in
terms of research.5 At the same time WHO has issued guidelines for the assessment of herbal
medicines.6 Supporting documents were also published for elaborating quality control
methods plant materials.7 But it is evidently noted that these methods and guidelines made
available for herbal medicine are not sufficient and inadequate to meet standards for ISM
pharmaceuticals.8

As stated by WHO difficulty of Evaluation of TRM products and inadequate development of


methodology in turn has slowed development of regulation and legislation for TRM.9 It is also
emphasized by WHO as in some countries animal, mineral, or other materials may also be
used in TRM regulations should be specifically tailored to address each countrys unique
situation.10 There is an urgent need for redrafting national legislations for accommodating
good review practices in terms of pharmaceuticals in any system.11 In 2000 the United
Kingdom government assessed complementary and alternative systems of medicine and
Select Committee on Science and Technology of the House of Lords produced a thought
provoking report on TRM.12 The main point of contention was on the use of scientific validity
(efficacy) to rank and categorize TRM, which went beyond the terms of reference. 13 In this
report European mindset has changed positively and flexibly to review scientific background
of natural medicine and looked consciously at the core of alternative systems of medicine
including Ayurveda.14

As the global strategy and plan of action referenced in the WHO Beijing Declaration notes, it
is important that research on TRM be encouraged, improved and extended. This will support
the professionals, academics and industry to further their quality-oriented and evidence-based
practices unto the consumer protection as well as the sector advancements. Unfortunately, the
widespread increase in TRM use has not been accompanied by a corresponding increase in the
quantity and quality of clinical inquiry. The most frequent reason given by young generation
of physicians for not accepting the use of traditional medicine is that they perceive such
therapies as lacking rigorous scientific support. The affirmative research findings that support
the efficacy of TRM definitely encourage the young graduates to practice TRM as cost-
effective system that contribute much to the national healthcare. As an advocacy document,
the Beijing Declaration will hopefully encourage governments to create or improve national
TRM policies, as well provide an incentive for more clinical inquiry, improved
communication between health care providers and the integration of traditional medicine into
mainstream care across the globe.

To confront with the international standards Sri Lankan should be proactive to learn from
Indian model which attempts to validate traditional knowledge in terms of modern science and
harmonization of the complex process of Ayurvedic therapeutics. Need of clinical and
scientific testing of traditional remedies is very much highlighted in WHO consultative

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Former Member, PTF for National Health Policy, Former Registrar of Ayurveda Medical Council
meetings.15 This scientific expertise demanded and required to implement the process of
clinical evaluation of TRM was greater than what may be available on national levels.16 The
WHO posed a question in 2002, whether a herbal medicine can be used clinically if no harm
has been found after the use of that herbal medicine for generations and there is no
documentation of such an effect.17 For an answer to the question, reference is made to an
earlier WHO document published in which states "absence of reported or documented side
effect is not an absolute assurance of safety of herbal medicine.18 In 2004 JAMA questioned
safety of Ayurvedic herbal preparations based on Harvard Medical School report and created
global problem on heavy metal content of Ayurvedic herbal preparations. 19 It was made clear
that testing for safety and efficacy was crucial, and incorporating TRM pharmacopoeia into
officially endorsed health programs was obviously emphasized. The WHO monographs
published on medicinal plants (four volumes) are authentic sources for developing national
standards for quality control profiles and guidelines for manufacturing high quality ISM
products. WHO guidelines on good agricultural and collection practices (GACP) for
medicinal plants (2003) is also an useful source for assuring quality standards of plant-based
raw materials which are currently being questioned in many aspects.20 It is mandatory to
implement a national program as dictated by WHO guidelines on safety monitoring of
herbal medicines in pharmacovigilance systems (2004) to update safety issues and consumer
awareness on the ISM products.21

Preparation of a list of essential drugs and national hospital formulary for ISM sector was
discussed in national forums and taken up as an important issue.22 The relationship between
TRM and essential drugs was not explicitly mentioned in the policy documents prepared by
the WHO throughout the decade, even though the use of TRM for essential drugs was an
original goal in the selection of essential drugs.23 The WHO has reported that only 16% of
member countries have included TRM medicines into national essential drug list which does
not entertain Sri Lanka.24 Just as the WHOs definition of essential drugs were tied to
financial and biomedical terms, this objective in TRM use overlooks that people have their
own rationalities for deciding on therapies. Irrationality, defined from a biomedical view, may
be totally rational from the consumers point of view. 25 It is described many beliefs and
behaviors rooted in TRM concepts, including diverging notions of efficacy and the
individualized nature of therapy. At first glance, the link between these areas may not be
obvious and TRM and essential drugs may even appear inherently contradictory. In contrast to
the TRM Program, some of the difficulties surrounding the essential drugs concept are
highlighted and these features are also common to the Primary Health Care (PHC) and TRM
programs.26

Definitive Role in Primary Healthcare:

In nineteen eighties significant progress taken place subsequent to the WHOs Alma Ata
declaration becomes remarkable advancement in traditional medical sector but not realistically
aligned with PHC interventions. 27 The international initiative to integrate ISM into health care
systems in the same decade therefore appears to have made nominal impact on national levels
in the following decades. Diverting the global attention to the ISM, which was engaged in a
frantic effort to retain its identity and establish its existence amidst all these threats, challenges
and uncertain stages, became a good omen.28 The developed and rich society in western
countries have lost hopes regarding health especially due to the hazards and ineffectiveness of
chemical pharmaceuticals of the Western Medical System, and at a time there is a tendency
for alternative treatment in natural medical systems, the need has arisen to provide services
and products of quality in the ISM.29 But the outcomes of studies done on existing
conventional health systems and their performances are not satisfactory in terms of health

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Former Member, PTF for National Health Policy, Former Registrar of Ayurveda Medical Council
achievements of developing countries and rural communities.30 WHO has positively attempt
to create a dialogue in research field to develop an effective methodology to harmonize ISM
with scientific interventions.31

Even though mandate for upliftment of ISM was dictated in portfolios of post-colonial
governments in order to restore it's social reputation it was a very difficult task yet to be
achieved in a coexistence of pluralistic health care systems.32 Mainstreamed health system
which is totally predominated and monopolized by allopathic medical profession did not
provide any room for accommodating ISM in healthcare since it was considered as a
unscientific, outdated and obsolete system in past moving modern world. It has become
exclusively an underprivileged and marginalized system which is yet to be legally accredited
and officially recognized in the national health system.33 In the social set up which was
manipulated by neo-colonialism and industrialization, the healthcare system based on western
medical system succeeded in influencing speedily and strongly the minds of the population.34
Then ISM faced the challenge of not being commensurate with post-colonial value system in
a serious manner as an adverse result of the globalization and its development goals.35
However, it is clear that ISM was subjected to a comparative drawback because it is socially
dethroned and culturally displaced within political reinforcement of open economy. Also it is
an everlasting universal problem prevailed in any culture where the modern medical system is
propagated and established through power, politics and wealth. Therefore it is not a problem
of medical pluralism or co-existence of multiple systems and explicitly has become problem
of medical hegemony. Although WHO has officially accepted Sri Lanka as a country has an
inclusive health system which entertains ISM as a parallel system, rights and privileges of
ISM practitioners have been very much neglected, ignored, disregarded and deserted for
longtime.36

It is a well-known fact that the biomedical model of national health during the latter part of
the last century adversely affected traditional knowledge and indigenous practices in
healthcare. The most of negative impacts, problems and limitations of ISM in existing health
care model are due to subsequent outcomes of ideological hegemony and hierarchical
technocracy of allopathic medicine. Since almost all of the internationally existing policies,
approaches, institutions, models in national health systems which are designed for
mainstreaming cosmopolitan medicine within the context of globalization such conventional
hierarchical set up of biomedicine is not democratic enough to accept medical pluralism and
multi-system health care delivery.37 Social determinants of health are increasingly subject to
the influences of globalization, which seek to extend and exploit the market which is rapidly
invaded by medicalization.38 Within this context formulation and implementation of policies
in heath sector reforms are explicitly influenced by social, economic, political trends of
globalization where the role of ISM is vaguely and inadequately defined. 39 The politics stream
without rational policy goals beset with constrains and obstacles created through massive and
continuing resourcing of biomedicine was despite the financial and moral support given by
the Governments to Ayurveda.40

In 1992 the Presidential Task Force (PTF) on National Health Policy has officially accepted
the role of the ISM sector within the National Health System and among the recommendations
made in that regard, emphasis has been made of the necessity of a national policy.41 Another
side view of an approach of this nature is the presence of features compatible with local,
social, cultural and economic environment of Sri Lanka. In 1997 the next PTF on National
Health Policy considered ISM in its agenda in a logical manner and sustainable context.
Ayurvedic medicine still enjoys a fair proportion of clients in treatment of conditions like
bone fractures or joint dislocations, chronic pain resistant to allopathic analgesic drugs,

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Former Member, PTF for National Health Policy, Former Registrar of Ayurveda Medical Council
dermatological conditions for which topical applications are available eg. psoriasis, snake
bites and some psychiatric disorders.42 Recommendations of the PTF on National Health
Policy has officially accepted the role of the ISM sector within the National Health System
and among the recommendations made in that regard, emphasis has been made of the
necessity of a national policy. There is a timely need to update review mechanism of the
economic benefits gained through ISM and evaluate the real contribution of ISM to the
national healthcare system. Policy goals should be set to achieve the quality of life by
contributing to physical, mental, social, economic and spiritual well-being of the people of Sri
Lanka by adopting professional excellence in ISM.

Similarly the global interest in conserving the indigenous knowledge systems and utilizing
them successfully parallel to primary health practices is in the increase.43 For that very reason,
the sponsorship of the international funding agencies for developing the availability,
accessibility and affordability of ISM is favorably encouraged.44 The necessity for scientific
validation of TRM was linked specifically to its use in PHC programs, and the fact that TRM
remedies should be subject to the same regulation and control as biomedical ones.45 However,
it appears that growing commercial interests in ISM was also a factor prompting the safety
and efficacy agenda, in an effort to moderate enthusiasm and alleviate unrestricted
profiteering. The WHO made it clear that the primary resource base of TRM had not been
legitimized without qualification, only certain aspects that had to meet biomedical standards.
In effect, this restricted the officially recognized primary resource base of TRM, and therefore
the secondary resources that could flow from it. This may be partly related to the complexity
and contentious nature of the policy issue, but also because adoption of the policy as
envisaged had onerous requirements that acted as a deterrent.

MDG was one of the key factors in health policy formulation and WHO played a crucial role
in such process. Alma Ata declaration, being one of the historical events that marked the
international need of TRM practices into national health systems, the long gestational period
and delayed growth it could slowly penetrate bureaucratic and monopolized health systems in
developing countries.46 In 2002 WHO by its four-year strategy plan regarding TRM very
clearly demonstrated that when the extensions of ISM are carried forward progressively,
problems could arise with policy, safety, effectiveness, quality, approach and rational use. 47
These involvements are very vital to secure similarity in winning the challenges arising in
maintaining the ISM services effectively as a source within the mainstreamed national health
system. With attempts to maintain an apolitical, neutral stand in 2004 WHO working group
has emphasized necessity of policy reforms in ISM sector.48 In relation to TRM, the impacts
of international initiatives at country levels can vary widely and at national level it is argued
to be minimal in Sri Lanka. For example, with regard to the critical indicators that identified
in the TRM Strategy 2002-2005 demonstrated very little or no progress on national level since
policy planning was controlled by Western medicine. Sri Lanka is standing still on the issue
of national policy even after the 58th World Health Assembly which discussed issues and
strategies related to converting policy guidelines in traditional medicine into action program.49

During last decades it is evidently shown that western civilization oriented lifestyle has
pushed the society towards most of the heath burdens where the traditional lifestyle can
contribute cost-effective manner.50 Within this context no thorough study has been done to
evaluate the role of ISM in NHS within the range of socio-economic, demographic,
ethnographic factors. But WHO has made various attempts to discuss the role of TRM in
national health care to mitigate health burdens in a sustainable manner.51 In 2007 WHO
envisaged the public health in terms of "heath security" which is to be urgently taken into
account in both curative and preventive aspects with special reference to non-communicable

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Former Member, PTF for National Health Policy, Former Registrar of Ayurveda Medical Council
diseases.52 The most historical event was that in 2008 World Health Report came up with
theme "Primary Health Care; Now More Than Ever" which discussed negative impacts of
commercialized, fragmented and hospital-oriented health services with a nonverbal emphasize
on recommendations of Alma Ata in 1978.53 From 30 years after Alma Ata declaration of
WHO in 1978 which had called for mobilizing TRM resources in PHC strategies in member
countries ISM has not been recognized as catalyst of PHC due to the gap between policy and
politics in national health in Sri Lanka.

Rational Approach for Better Healthcare:

In government policy documents, the integration of ISM and biomedicine is still referred to as
a vague concept, a future activity, and beneficial step to be realized cautiously without
contradictions in the basic concepts of both systems of medicine.54 This supported more solely
due to the density of the universal provision of biomedical care, and the education system
which enabled effective utilization of health services which almost caused to crushing ISM
out of existence.55 In summary, history of integration offers tools to conceptualize the
interaction of medical systems but not for better harmonization or mutual agreement or
meaningful synergetic modal in coexisting culture. Different medical systems (primary
resource aggregates) are in competition and conflict with each other to obtain secondary
resources (wealth, power, status). 56 There are critical areas thoroughly to be explored in order
to formulate a conceptual framework of a rational synergetic model to expand, upgrade,
update, extend, re-structure, strengthen and rationalize the present health care service network
by incorporating the knowledge, attitudes, practices and approaches of ISM in a realistic
manner.

The diversity of healthcare practices available in Sri Lanka can be evidently demonstrated as a
live model of pluralistic health care systems which accommodates versatility in the sphere of
knowledge regarding ISM to be wisely utilized for national health needs. 57 The relationships
between the traditional healers and their patients and the medicine prescribed not only
preserve a medical knowledge, they preserve knowledge and wisdom, which is of a
cosmological order.58 The medical system coexists with other subsystems of the society,
creates an professional syncretism in which each inherits its own values, mandate, legitimacy,
body of knowledge, techniques and functional contribution to maintain the general level of
societal functioning.59 This idealistic context developed in the era when anthropologists were
assessing the operation of pluralistic medical systems, and may have led to a premature
assumption of an amicable relationship.60 The development, forms and use of ISM in Sri
Lanka have been studied by several anthropologists and Sri Lanka is considered an
interesting laboratory to examine pluralistic medical systems, as ISM and biomedicine
formally coexist.61 This created an avenue for anthropologists to incorporate their expertise
into mainstream health policy making and to work with multidisciplinary teams and pluralistic
health care delivery systems.62

Formal recognition of ISM has not yet translated into power or status in the formal health
services sphere, or an equitable distribution of resources or representation in health policy.
The policy domain of ISM in Sri Lanka should demonstrate in more detail to maximize the
operation of the analytical framework on a national level. Most policy and planning
documents regarding health refer only to biomedicine and health development in Sri Lanka
and generally restricted to the narrow ambit of those areas that fall within the purview of the
ministry of health and limited to biomedicine.63 Due to national level political activities and
the absence of definite clarity regarding ISM among those responsible in the state sector and
non-acceptance of the contribution and identity of the ISM within the national health

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Former Member, PTF for National Health Policy, Former Registrar of Ayurveda Medical Council
programs gradually got isolated and displaced. Applied studies of this type of health systems
argued for a greater degree of cultural sensitivity in the formulation and implementation of
health education and disease prevention programs imported from Western settings.64 There
are good reasons for traditional medicine to be promoted and integrated into mainstream
health care since those therapies are tend to be lower in cost and less invasive than western
therapies. Treatments are typically low-tech, high-touch in nature and rely on inexpensive
manual therapies and natural products in the public domain. They help avoid the human and
economic costs of adverse effects from medical treatment, as well as the legal and
administrative costs that can be associated with western therapies.

Explicitly there are many communication disagreements and fundamental dissimilarities


which drive to lack of mutual understanding and professional hostility between ISM and
western medical professionals.65 Sometimes it was not merely the hegemonic approach which
had been established by post-colonial regime but intrinsic weaknesses driven by imprudent
political agenda in ISM. Medical anthropology suggests that TRM therapies constitute the
knowledge and practices on health that originated long before the development and spread of
conventional / western medicine and knowledge.66 They reflect the history, culture, values and
beliefs of a country and obviously have undergone changes with the passage of human
experiences for being time-tested. This knowledge is usually embedded within cultural
context, decoded in traditional modalities and transmitted pedagogically from generation to
generation. In most countries where western medicine assumes full responsibility for health
care in the national arena, the majority of traditional medicines and other therapies are
considered complementary or alternative to conventional institutional health systems. 67 The
role of Allopathic system was strongly and aggressively established during the reign of
imperial which laid the foundation of dominant structure of biomedicine and neglected
function of ISM in national health.68 As a harmonically win-win solution for this mismatch
integration has been further suggested where it has been questioned whether this arranged
marriage is necessarily a happy marriage in between biomedicine and TRM.69

Conservation of Traditional Knowledgebase:

In 1991, the Executive Board recommended that the World Health Assembly adopt a
resolution on traditional medicine and modern health care (EB87.R24). This resolution was
adopted (WHA 44.34), although with slight modifications from the resolution of the
Executive Board. It also noted that increased funding was required to enable TRM to take its
rightful place in health care and requested member states to introduce measures for the
regulation and control of TRM. Member states were urged to increase funding and accelerate
activities to strengthen co-operation between TRM and biomedical health care providers,
particularly in relation to the use of scientifically proven, safe and effective traditional
remedies to reduce national drug costs. The Director-General was requested to continue to
recognize the importance of the TRM program and to ensure that the contribution of
scientifically proven traditional medicine is fully exploited within all of the WHO programs
where plant derived and other natural products may lead to the discovery of new therapeutic
substances.70 The reports of the WHO collaborating centers and regional offices are notable
for their heavy use of biomedical and scientific discourse to describe their activities and
outcomes. Therefore western scientific methodology has become a mandatory parameter for
validating TRM and biomedical effectiveness of TRM was considered necessary to ensure its
role in health care systems.71

After 30 years from the Alma-Ata Declaration on Primary Health the Beijing declaration
called upon WHO member states to include TM in their primary health care systems and to

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Former Member, PTF for National Health Policy, Former Registrar of Ayurveda Medical Council
recognize TM practitioners as health care providers. From this perspective, the Beijing
congress represented a significant milestone for the WHO and traditional medicine and the
declaration states that the "knowledge of traditional medicine, treatments and practices should
be respected, preserved, promoted and communicated widely and appropriately based on the
circumstances in each country." It further states that governments have "a responsibility for
the health of their people and should formulate national policies, regulations and standards,
as part of comprehensive national health systems to ensure appropriate, safe and effective use
of traditional medicine." As the economic value of traditional medicine has increased
significantly, the issue of intellectual property rights related to TRM has become a topic of
debate and concerns are discussed widely in global conclaves. Some countries are concerned
about misappropriation of natural resources, preservation of biodiversity and protection of
medicinal plant resources for the sustainable development of traditional medicine. In 2005,
the World Health Assembly concluded that member states should "take measures to protect,
preserve and to improve if necessary traditional medical knowledge and resources for
sustainable development of traditional medicine, depending on the circumstances in each
country; such measures might include, where appropriate, the intellectual property rights of
traditional practitioners over traditional medicine formulas and texts, as provided for under
national legislation consistent with international obligations, and the engagement of WIPO in
the development of national sui generis protection systems."

The final text states that "traditional medicine should be further developed based on research
and innovation in line with the Global Strategy and Plan of Action on Public Health,
Innovation and Intellectual Property adopted at the 61st World Health Assembly in 2008.
Governments, international organizations and other stakeholders should collaborate in
implementing the global strategy and plan of action." The referenced resolution contains a
number of provisions related to the protection of TRM and intellectual property rights, and
promotion and improvement of research on traditional medicine. Earlier versions of the
declaration had proposed different language: "The knowledge of traditional medicine,
treatments and practices must be preserved and protected, along with the natural resources
essential for their sustainable use." Countries with a strong history of practicing traditional
medicine, or with significant biodiversity resources, like Sri Lanka have an interest in
protecting against misappropriation and securing intellectual property rights that would allow
their communities to derive economic benefits from their TRM-related resources. The global
market reports have estimated that developing nations encounter negative economic impacts
annually through unpaid royalties by foreign pharmaceutical corporations that commercially
exploit TRM knowledge and practices.

Among the most of the nations who have struggled with determining how best to achieve
intellectual property protection for TRM, India, has established a Traditional Knowledge
Digital Library (TKDL) to prevent misappropriation through documenting formulations used
in traditional medicine. China also has recently enacted new laws that require disclosure of the
source of genetic resources in domestic patent applications with regard to the protection of its
TRM and related natural resources from commercial exploitation. The country not only seeks
to shield its large domestic market for pharmaceutical and traditional medicine products based
on native biological materials against uncompensated exploitation by foreign companies, it
also has an interest in promoting exports of biological resource-based inventions to foreign
markets. In some of these countries the majority of TRM may not be publically available, and
attempts to obtain patent protection may prove problematic because of disclosure
requirements.
Conclusions:

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Former Member, PTF for National Health Policy, Former Registrar of Ayurveda Medical Council
The main objective of this paper is to streamline the sector efforts in terms of functional
policy reforms that can meet the strategies of universal health coverage and sustainable
development goals. The WHO Traditional Medicine Strategy 20142023 was developed and
launched in response to the World Health Assembly resolution on traditional medicine
(WHA62.13) and aims to support Member States in developing proactive policies and
implementing action plans that will strengthen the role traditional medicine plays in keeping
populations healthy.72 The goals of this strategic plan stated as harnessing the potential
contribution of TM to health, wellness and people-centered health care and promoting the safe
and effective use of TM by regulating, researching and integrating TM products, practitioners
and practice into health systems, where appropriate. As the three strategic objectives indicate
Sri Lankan ISM sector envisage to be a part of this plan accordingly.

1. To build the knowledge base for active management of T&CM through appropriate
national policies by recognizing the role and potential of T&CM and strengthening the
knowledge base, build evidence and sustain resources.
2. To strengthen the quality assurance, safety, proper use and effectiveness by regulating
products, practices and practitioners to recognize and develop practice and practitioner
regulations for education and training, skills development, services and therapies in
traditional and complementary medicine.
3. To promote universal health coverage by integrating T&CM services into health care
service delivery and self-health care by capitalizing on the potential contribution of
T&CM to improve health outcomes and to ensure better choices about self-health care

Addressing the challenges, responding to the needs identified by Member States and building
on the work done under the WHO traditional medicine strategy: 20022005, the updated
strategy for the period 20142023 devotes more attention than its predecessor to prioritizing
health services and systems, including traditional and complementary medicine products,
practices and practitioners.73

Strengthening the legal framework and enacting new laws in order to utilize for increasing the
Institutional responsibility is a must for ensuring the policies in operation. Entire system
should be functionalized by maintaining the care services network according to excellent time
practices and standards and reasonably to suit the time in keeping with public requirements.
Community participation and responsibility will be maximized through enhanced social and
personal accountability by empowering the community to obtain active contribution for
maintaining good health through ISM. All the sector-wide efforts should be integrated for
promoting the stewardship of the ministry and other establishments of the state sector and
stakeholder institutions of all levels in the field of ISM. Encouraging and facilitating multi-
centered research activities also a timely need in order to materialize ISM practices and
underlying concepts in a sustainable manner. Increasing availability of quality ISM products
at an affordable cost and contributing sustainable outcomes to the national economy is an
innovative way to up keep public private partnership in industry. Institutional development
and capacity building is a basic need to optimize efficiency and productivity of the services by
mobilizing the strengths and opportunities on a rational basis. The ultimate action for
conservation of traditional resources and heritage is another critical area to be focused in order
to conserve the untapped knowledgebase of ISM. Incorporating the technologies and excellent
practices of the time relating ISM into the mainstream development process, by encouraging
innovative efforts will be an envisaged policy action for substantial effect.

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Former Member, PTF for National Health Policy, Former Registrar of Ayurveda Medical Council
1
WHO, 2004. Guidelines for the Regulation of Herbal Medicines in the South-East Asia Region, Regional
Office for South-East Asia, New Delhi, SEA-Trad. Med.-82, eveloped at the Regional Workshop on, the
Regulation of Herbal Medicines Bangkok, 24-26 June, 2003, Geneva: World Health Organization.
2
WHO, 1998. Regulatory situation of herbal medicines: a worldwide review (document WHO/TRM/98.1).
Geneva: World Health Organization.
3
WHO, 2001. Legal status of traditional medicine and complementary/alternative medicine: a worldwide review
(document WHO/EDM/TRM/2001.2). Geneva: World Health Organization.
4
WHO, 2005. National Policy on Traditional Medicine and Regulation of Herbal Medicines - Report of a WHO
Global Survey. Geneva: World Health Organization.
5
WHO, 2000. General guidelines for methodologies on research and evaluation of traditional medicine. Geneva:
World Health Organization.
6
WHO, 1997. Guidelines for the assessment of herbal medicines. In: WHO Expert Committee on Specifications
for Pharmaceutical Preparations. Thirty-fourth report. Geneva, World Health Organization, 1996 (WHO
Technical Report Series, No. 863), Annex 11. These guidelines were reproduced in Quality assurance of
pharmaceuticals. A compendium of guidelines and related materials. Volume 1. Geneva: World Health
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