African Traditional and Complementary Therapies

Abstract

Complementary therapies describe a wide range of healthcare practices that can be used alongside conventional treatments to deal with chronic health problems, treat symptoms, or simply to stay healthy. Examples include herbalism, bloodletting, purgation, prayers and incantations, hydrotherapy, diet, exercise, massage, etc. The basis for these practices stems from core beliefs: imbalance of body functions causes illness, the body can self-heal under the right conditions, and treatment should be of the whole body and not just symptoms; religion, spirituality, and culture are very strong underlying factors. The reasons for using complementary therapies are primarily to maintain good health, dissatisfaction with conventional medicines, taking charge of one’s own health, ready availability, and notions of safety. In rural Africa, complementary therapies have been used solely as alternative therapies due to inadequate healthcare. This chapter deals with the African traditional complementary therapies that coexist with conventional medical practices and their advantages and disadvantages.

1. Introduction

The term “complementary therapies or medicine” refers to a broad spectrum of therapeutic and diagnostic practices that exist largely outside conventional medicine and are not fully integrated into the dominant healthcare system [1]. It is often used interchangeable with both alternative medicine and traditional medicine in some countries [2] or collectively called traditional, complementary, and alternative medicine (TCAM). Stricter definitions describe “indigenous traditional medicine” also known as ethno-medicine as the sum total of knowledge and practices, whether explicable or not, used in diagnosing, preventing, or eliminating physical, mental, and social diseases, administered by a trained practitioner or as self-care [3]. This knowledge or practice may rely exclusively on past experience and observation handed down orally or in writing from generation to generation. These practices are native to the country in which they are practiced. The majority of indigenous traditional medicine has been practiced at the primary healthcare level [4]. Complementary medicine (CM), on the other hand, is defined as a broad set of healthcare practices that are neither part of a country’s own tradition nor part of conventional medicine and are not fully integrated into the dominant healthcare system. CM practices are used interchangeably with TCAM practices in some countries [5], while alternative medicine refers to practices used in place of conventional practice. Integrative medicine refers to conventional medicine combined with TCAM that are safe and show evidence of efficacy. TCAM is a focus on biological, psychological, social, and spiritual influences to pathology. It is characterized by a belief in the supernatural cause of illness, divination being a diagnostic tool, and the use of a wide variety of agents and techniques in its treatment [6, 7]. In the modern African setting, it may encompass local herbal medicines or products, indigenous healthcare practices [6, 8], and imported complementary and alternative medicine products and practices (e.g., acupuncture or chiropractic, etc.). Sub-Saharan Africa (SSA) is one region of the world in which TCAM has long been held to be widespread, with a considerable number of its population relying on it to maintain their health or prevent and treat communicable and noncommunicable diseases [9, 10]. However, some peculiar practices of TCAM, which include voodooism, incantations, chants and mysticism, etc., generate controversies and reduce the scientific credibility. The traditional healers’/attendants’ rituals/incantations and other peculiar practices appear to be more important than the pharmacological effects of herbs and other practices. The traditional medical practitioner is usually a well-known and trusted person in his community, with competence to provide healthcare by using plant, animal, and mineral substances and other methods based on and religious practices. He makes use of indigenous social, cultural, and knowledge, beliefs, and/or experiences to treat disease and promote health. Healing power is passed down through generations via oral transmission and apprenticeship or through knowledge imbued by the “gods.” Its powers and skills are generally reserved for the members of certain families by inheritance or the members of regional or cultural communities [8, 11].

TCAM is an important and often underestimated health resource with many applications, especially in the prevention and management of lifestyle-related chronic diseases and in meeting the health needs of indigenous populations, especially in Sub-Saharan Africa, where conventional healthcare systems are largely inadequate. Other terminologies that have been used include natural medicine, nonconventional medicine, or holistic medicine [2]. Common to most TCAM systems is a focus on individualizing treatment [1]. TCAM encompasses products, practices, and practitioners. TCAM has evolved over millennia by drawing on the religious beliefs and social structures of indigenous people and by exploiting natural products in their environment and more recently by developing and validating therapeutic and preventive approaches through scientific methods [12]. Despite the promise of contemporary medical practice, large segments of humanity either cannot access its benefits or cannot afford; rather, people opt for practices based on their culture, proof of efficacy, and accessibility. TCAM use is indeed very common in Africa but varies among different populations based on their beliefs and sociocultural practices [13, 14]. At least 4 out of 10 adults have used some form of TCAM.

In Africa, TCAM is interwoven with religious practices involving body and soul, hence the name holistic. This spiritual aspect of healing encompasses belief and worship to God and reverence and acknowledgement of ancestors. Ancestors are compassionate spirits of departed blood relatives of an individual and may involve a whole lineage spanning generations. They are revered but not worshipped as one would pray to God but serve to mediate between the living and God to bring healing and luck to them. They are regarded as custodians of the lives of future generations and, therefore, occupy a position of dignity and respect among their descendants [15]. According to [9], a considerable number of people in Sub-Saharan Africa (SSA) rely on traditional, complementary, and alternative medicine (TCAM) to meet their primary healthcare needs; yet, there remains a dearth of research evidence on the overall picture of TCAM utilization in the region. There have been reports of varied prevalence of the use of TCAM in Africa. In comparison, the use of TCAM products was found to be higher than that of practitioner services, especially for self-care and over-the-counter use among the general population. TCAM may be used alone or in combination with orthodox medicine, in both general population and specific health conditions.

2. Types of complementary therapies

The National Institutes of Health has grouped TCAM into five overlapping domains, namely, biologically based therapies, manipulative and body-based approaches, mind-body medicine, alternative medical systems, and energy medicine [1, 12]. Some complimentary therapies are discussed as follows:

• Biologically based practices: Nutritional excess and deficiency have been problems in today’s society, both leading to certain chronic diseases. Thus, many dietary and herbal approaches are used to balance the body’s nutritional well-being, e.g., vitamins and mineral supplements, unconventional diets (such as low-carbohydrate and keto diets), and natural products [16]. A dietary supplement could be intended to supplement the diet and will contain, for instance, a vitamin, a mineral, an herb, a botanical, or an amino acid. A dietary supplement might also be intended to supplement the diet by increasing the total daily intake of a concentrate, a metabolite, a constituent, an extract, or a combination of these ingredients. Health foods, including functional foods, are any natural food popularly believed to promote or sustain good health by containing vital nutrients. Functional foods also include any foodstuff enhanced by additives and marketed as beneficial to health or longevity. Examples include cereals, breads, or beverages, which are fortified with vitamins and herbs. Health foods and/or functional foods may be advertised or marketed with specific health claims and may, therefore, be regulated differently than other foods [4]. Eating nutritious foods help patients get important nutrients, such as protein, vitamins, and minerals. Depending on the ailment, patients may experience appetite loss, weight loss, or weight gain. Eating well helps to maintain a healthy body weight during and after treatment. Natural products are substances produced by living organisms and built by cells from biomolecule, e.g., botanicals, minerals, herbs and herbal preparations, and probiotics. Animal fats, cartilage, bones, and other parts are also part of natural products. Herbal medicines include herbs, herbal materials, herbal preparations, and finished herbal products that contain phytochemicals (alkaloids, tannins, glycosides, flavonoids, etc.) as active ingredients, parts of plants (leaves, seeds, roots, flowers, and bark) are used for medicinal purposes, other plant materials, or combinations thereof. In some countries, herbal medicines may contain, by tradition, natural organic or inorganic active ingredients that are not of plant origin (e.g., animal and mineral material) [4].

• Manipulative and body-based approaches: These focus primarily on the structures and systems of the body. They include massage, chiropractic (spinal manipulation), osteopathy, and traditional bone setting. Womb manipulation and alignment is also an important aspect of preconception therapy. Spinal manipulation is used to treat an array of conditions that arise as a result of abnormal alignment or stress on the vertebrae, often due to musculoskeletal complaints. Traditional bone setting is the traditional form of osteopathy. Though appearing crude because of the lack of the use of X-ray, it has recorded tremendous success. The bonesetter may often make used of herbs to relieve pain and promote healing and may use primitive forms of straps and wooden splints to hold the bone in place.

• Mind-body medicine: This is based on the fact that the mind exerts powerful influences on bodily functions and vice versa. They include an array of approaches that incorporate spiritual, meditative, and relaxation techniques, including hypnosis, yoga, acupuncture, Tai chi, Qi gong, and breathing exercises. Appropriate psychotherapy was found to reduce depression and anxiety and improved coping skills.

• Alternative medical systems: Health is based on the balance and flow of vital energies through the body. For example, in acupuncture, vital energy flow is restored by placing needles at critical body points.

• Energy medicine: This involves the use of energy either biofield- or bioelectromagnetic-based interventions, e.g., reiki, purging, bleeding/bloodletting, and treatment with heavy metals.

Based on literature, biological therapies, such as the use of herbal and animal products, are the most common forms of TCAM used in Sub-Saharan Africa, followed by faith-based healing methods, such as prayer/spirituality [17, 18], and mind and body therapies (traditional bone setting, meditation and yoga, massage, relaxation, and music and art therapy). Others include acupuncture, Tai chi and Qi gong, massage, hydrotherapy, physical activity, and diet and nutrition [19]. Some of these health practices, though not originally African, have been adopted overtime and are included in complementary therapies practiced today in modern Africa, especially Chinese medicine due to the recently increased influx of the Chinese into Africa.

Acupuncture is a form of complementary medicine and a component of traditional Chinese medicine and is one of the imported complementary therapies in Africa [20, 21]. It involves the use of very thin needles or pressure to stimulate specific points on the body. Acupuncture causes changes in the fascia, which is the connective tissue that covers the muscles and bones. This can lead to changes in the brain, such as the release of chemicals like serotonin or changes in electrical activity. These changes are thought to explain, in part, how acupuncture works to treat different symptoms. Acupuncture has been used for the alleviation of pain [22], nausea, vomiting [23], fertility, childbirth chronic asthma, epilepsy, and addiction, among others. The efficacy of acupuncture is considered to be due to the release of endorphins and the stimulation of the peripheral nervous system when the skin is punctured [24]. The safety of acupuncture is assured when administered by well-trained practitioners using sterile needles. However, being an invasive procedure, adverse effects have been reported, such as hemorrhage, hematoma and bacterial infection, nerve injuries, hepatitis, kidney damage, etc. [25].

Homeopathy: According to the principles of homoeopathy, certain remedies, when given in high concentrations, tend to mimic the symptoms presented by the patient, and that upon dilution and vigorous shaking releases the curative “essence.” Dilution continues until no more of the original substance remains, but the water molecules are believed to retain a “memory” of the original substance [26]. While no scientific evidence has been found to support the theories of homeopathy, some successes have been reported. Randomized clinical trials have suggested that it might be effective for treating influenza, allergies, and postoperative ileum [12]. Some schools of thought consider it to be a little more effective than placebo [27].

Yoga is another important aspect of complementary therapies. Yoga promotes slow breathing techniques used to relax mind and body, as well as to increase oxygenation [28]. It reduces stress and anxiety by using breathing exercises, meditation, relaxation techniques, and poses to stretch and flex different muscle groups. Yoga also calms the mind and connects mind and body. Studies have shown that yoga increases the activities of the parasympathetic nervous system by releasing γ-amino butyric acid, GABA [29].

The benefits of yoga include improved overall quality of life, increased physical functioning, and increased ability to conduct the activities of daily living. Yoga also improves mood and physical well-being, improves nausea, reduces pain and fatigue, improves sleep problems, and helps regulate stress hormones. It also decreases inflammation and increases immune function.

Tai chi and Qi gong are part of traditional Chinese medicine that combine a series of fluid movements, which are slow and deliberate, meditation, regulated breathing, and calming of the mind, thus enhancing physical health and emotional well-being. Derived from martial art, Tai chi and Qi gong can improve the quality of life, reduce sleep problems, and decrease inflammation. Tai chi is based on spiritual and philosophical ideas that advocate for a need for balance in the body, mind, and spirit, with the notion that life energy or “chi” needs to flow freely for good health to occur. Qi gong, also derived from martial art, on the other hand, trains both body and soul and focuses on the relationship between the individual and the cosmic environment [30, 31].

Meditation is the practice of focusing your attention to calm the mind and relax the body. Sometimes, a calming word or chant is silently repeated. Other times, there is only focus on breathing or just being aware of thoughts and feelings with no judgment, attachment, or interpretation. Meditation can be self-taught or guided by others. There are many different types, including focused meditation, open awareness and mindfulness, and compassion or loving-kindness meditation, with or without religious undertone. Studies show that meditation can decrease chronic pain, improve mood and many other aspects of quality of life, lower stress hormones, and improve immune function [32].

Music therapy involves the use of musical and rhythm-based interventions to support and develop physical, mental, social, and spiritual well-being. It is a noninvasive, nonpharmaceutical, relatively inexpensive but effective therapy, which targets improvements in cognitive function and physical rehabilitation. Music has been shown to have psychosocial, behavioral, and motor benefits as treatment for neurological dysfunctions. Music induces changes by linking brain regions within multisensory and motor networks, thereby having effects on emotion and reward systems. Evidence suggests that music-based therapy improves balance and functional mobility in patients with Parkinson’s disease and positive benefits in dementia as well as mitigating pain, improving blood flow and joint flexion required for a more rapid healing process during the rehabilitation phase after stroke [33, 34].

Art therapy is a form of complementary psychotherapy that uses artistic materials (visual art, painting, and drawing) as palliative care focused on relieving suffering patient with serious illness to ameliorate symptom burden and adapt to the stressful life experiences associated with life-limiting diagnosis. It utilizes the expressive qualities of art to improve physical, mental, and emotional well-being. It also improves cognitive and semimotor functions, fosters self-esteem and self-awareness, cultivates emotional resilience, promotes insight, enhances social skills, reduces and resolves conflict and distress, and advances societal and ecological changes. Art therapy is used mainly for cancer, depression, anxiety, autism, dementia, and cognitive impairment, especially in situations when verbal interaction becomes difficult and provides a safe and indirect way to connect oneself to others [35, 36].

Massage can help promote relaxation, ease tension, increase comfort, and reduce pain, especially in musculoskeletal conditions. People with cancer may especially benefit from massage and its subspecialty called oncology massage. In addition to receiving massage from a massage therapist, a caregiver can do simple massage to help relax. It is also possible to do a self-massage [32].

Research shows that massage can reduce pain, decrease tension and stress, help with recover after surgery, ease anxiety and depression, and help with sleep problems and fatigue [32].

Regular exercise: A growing amount of research shows that exercise can greatly improve different aspects of patients’ physical and mental health during every phase of treatment. An exercise program can rejuvenate a patient, if used appropriately [37].

3. Factors affecting and reasons for TCAM use

A number of factors were identified as being promoters of TCAM use. Generally, the use of TCAM could simply be for health promotion and maintenance, but could equally be dependent on the type of illness and severity. Favorites among diseases include mental illness, impotence, infertility in females, and chronic disorders. Key factors that affect its use include relatively low cost and flexibility of payment of products and services, accessibility, availability affordability, compatibility, and suitability for the treatment of various diseases particularly certain chronic ones that orthodox medicine has not been able to cure, and the perception that because these products are natural, they must be safe with fewer side effects [38]. It was observed that patients that use TCAM also access conventional medicine, which more common in developing countries [39]. The fact that TCAM is in alignment with sociocultural, religious, and spiritual values is also a strong factor. Trust and confidence in traditional medicine practitioners and the perceived privacy as well as recommendation by elders, relatives, and friends also contributed to the choice to patronize TCAM products and facilities. Furthermore, recent increase in scientific research and validation of traditional medicines and aggressive advertisement of products and services are enhancing factors.

Dissatisfaction with conventional medicine, inadequate health facilities, unavailability of drugs, difficulty in accessing healthcare, negative attitudes of health workers, lengthy procedures, and long waiting time are other push factors to patronizing TCAM. Furthermore, TCAM is sought for: i) health conditions that had failed to respond to initial treatment, ii) health conditions stigmatized at communities of origin, and iii) health conditions thought to have resulted from supernatural causes [40]. Some of the benefits of complementary therapies are the holistic approach, which is more or less according to the philosophies and beliefs of a people, and the individualized approach to patients’ care, involving them as active participants in their own health, portraying a high degree of physical, psychological, and spiritual contribution to treatment with a sense of self-satisfaction. There is also a strong emphasis on use as preventive medicine [41, 42] (Figure 1).

Figure 1.

Factors related to reasons for TCAM use and nonuse [41].

4. Barriers to the use of TCAM

Limiting factors to the use of TCAM in Africa include absence of scientific evidence supporting TCAM practices, lack of belief in safety and efficacy, lack of appropriate dose, unhygienic preparations [43], unregulated TCAM practitioner practice, and lack of education and proper training of practitioners. There are also no standard regulations as in orthodox medicine such that fake, ineffective substances and practices may be commonplace. The World Health Organization (WHO) further advocates that for future existence and integration of TCAM into conventional healthcare, attention ought to be paid to overcome the following hurdles: lack of research data, lack of mechanisms to monitor the safety of products, lack of expertise within national health authorities and control against appropriate mechanisms to monitor and regulate practitioners and products, lack of cooperative channels between national health authorities to share information about TCAM mechanisms to monitor the safety of products, and lack of mechanisms to control and regulate TCAM advertising and claims [4]. In addition, the lack of control of overharvesting and the conservation of endangered species and dwindling biodiversity due to climate change, thereby resulting possibly in extinction, are of great concern [44]. All these present major challenges to any effort to optimize TCAM.

5. Safety of TCAM

TCAM is still very much in use in modern-day Africa after hundreds of years of its existence without much reported cases of adverse effects [40]. Limited correlation between research and scientific evidence on safety and efficacy of most TCAM treatments has made them potential risks. Although practices such as acupuncture, homeopathy, and medication are low risks, adverse effects due to TCAM alone or in combination with conventional medicines have been reported [45]. These may be due to the side effects of TCAM products or drug interaction with conventional medicine. Herbs have been found to be toxic and produce herb-drug interactions due to their content of substances that have powerful pharmacological effects. Commonly observed effects include allergies, nausea, vomiting, diarrhea, abdominal pains, as well as dizziness, headache, and general malaise, and even death may ensue [46]. Liver and kidney problems have been observed among the chronic users of TCAM products [47]. However, the results of many evidence-based clinical trials have equally promoted credibility in TCAM.

6. Economic factors affecting the use of TCAM

Although social, medical, and cultural reasons account for why people in any given country prefer TCAM to conventional medicines, economic factors play a vital role in influencing TCAM use. The cost of TCAM, which is much cheaper than the cost of accessing conventional medical services, is the primary factor. Others include choosing a trusted traditional healer in whom much confidence is reposed, ease of access, and convenience. The poor are more likely to use TCAM, although people with high income are also likely to use TCAM for different reasons [48]. The method of payment is flexible, often on credit, in exchange for labor or contingent on outcome.

7. Prevalence of TCAM in Sub-Saharan Africa

Africa African traditional medicine is said to be one of the oldest and most diverse of all medicine systems, even though the medicines are poorly recorded. In developing countries, TCAM use is driven mostly by tradition and lack of resources. Over the years, the use of TCAM in both rural and urban areas across Africa has increased, but there is a great concern for its safety [45], efficacy, and control, and this poses a great challenge for health authorities and the general public [14]. There have been reports that there is varied prevalence but substantial use of TCAM, more of products (either for self-care and over-the-counter) than practitioner services, among the general population and specific clinical populations [19]. At least 80% of populations in Africa use TCAM [4].

The prevalence of TCAM during pregnancy, childbirth, and pregnancy termination is between 12% and 90.3% [49], but fewer patronage of TCM services during pregnancy but high use in the case of infertility, enhancing libido, general gynaecological conditions, and sexually transmitted diseases [50, 51].

TCAM products are highly used by patients with diabetes: Tanzania (77.1%), Nigeria (43%), Guinea (33%), and Kenya (12.4%) [52]. A higher rate was reported for cancer: Nigeria (65%), Ethiopia (79%), and Ghana (73.5%) [53]. Psychosis in some African countries (Nigeria, Ethiopia, Ghana, and Malawi) was also high (73%) [54]. The elusive COVID-19 was not left out in TCAM use. Massage and steam inhalation with various African herbs and spices were highly used and were believed to be effective for prevention and treatment.

Other reports revealed the following prevalence for noncommunicable diseases (61%), asthma (50%), epilepsy (65.5%), and schizophrenia (76%) [19, 38]. Musculosketetal problems, osteoarthritis, and bone fracture showed high patronage for bonesetters. All other health conditions, such as diarrhea, infantile colic, oral health, etc., were reported with varying prevalence.

In terms of different categories of people, a higher TCAM utilization rate was observed among outpatients than inpatients (72% versus 18.5%) [55]. Among student population, a higher utilization rate of products was found with high school than undergraduates, and much less for medical and paramedical students in both Ghana and Nigeria [56, 57]. Among healthcare professionals, TCAM use was much lower in Nigeria (20.777%) and South Africa (23.5%) [58, 59].

Sociodemographic studies indicated that TCAM users compared with non-TCAM users are more likely to be of low socioeconomic and educational status, unemployed and unskilled, while there were inconsistencies in age, sex, spatial location, and religious affiliation between TCAM users and non-TCAM users. Some reports, however, indicated that urban and semiurban dwellers were found to be younger (20–50 years) than rural dwellers (>58 years). Users were also found to be higher among married than not married [60] and women more likely than men [13].

The mean prevalence of concurrent use of TCAM products and conventional medicine within the general population and for specific health conditions in SSA was reported to be high but lower among patients with HIV/AIDS, and least with noncommunicable diseases such as diabetes [19].

Most TCAM users (55.8–100%) in SSA fail to disclose TCAM use to their healthcare providers, with the main reasons for nondisclosure being fear of receiving improper care, healthcare providers’ negative attitude and a lack of enquiry about TCAM use from healthcare providers.

Evidence suggests that Africans in diaspora still maintain their use of TCAM overseas, and it is commonplace to find them transporting medicines from Africa to their country of abode [61].

The increasing uptake of TCAM services across the continent in recent decades has attracted the attention of policy makers, researchers, and healthcare professionals. In the past 20 years, the WHO regional office for Africa spearheaded the implementation of a regional strategy endorsed by African Heads of State in Lusaka, Zambia to promote the role of TCAM in health systems in the African region [62]. The gains experienced since the adoption of the regional plan include policy formation in 36 countries and research promotion, including the establishment of TCAM research centers in some countries such as Nigeria, Ghana, and South Africa. The regional plan has also promoted the inclusion of TCAM courses into the curricula of healthcare training institutions in countries across the continent. For instance, such plan has seen the inclusion of TCAM courses in some South African and Nigerian universities at both undergraduate and postgraduate levels. In Ghana, universities offer a BSc in herbal medicine. In Guinea, Sierra Leone, and Tanzania, Master’s degree in herbal medicine has been made compulsory for pharmacists [62]. It has also promoted the training of TCAM practitioners and the local production and cultivation of medicinal plants, as well as the establishment of intellectual property rights for traditional medicine knowledge in few nations [55]. Despite such progress, most African countries continue to grapple with an absence of TCAM policy or its implementation, inadequate TCAM research infrastructure, and insufficient regulation of TCAM products and practices [15, 62]. For instance, by 2005, only 32% and 27% of the African countries who responded to the WHO global survey had a national policy and law or regulation on TCAM [63].

8. Conclusion

The pattern of disease is changing in developing countries of Africa as a result of globalization, mostly due to contributing factors such as lifestyle, diet, obesity, lack of exercise, stress, etc. A steady rise in the prevalence of chronic noncommunicable diseases is significantly contributing to Africa’s disease burden and is adding to healthcare systems already strained due to the high incidence of infectious diseases. It is, therefore, postulated that TCAM will continue to play an integral role in the health and well-being of people suffering from chronic diseases in Africa as it is part and parcel of African heritage.

Although the use of TCAM is increasing in both developed and developing countries, while this may be substantial, it continues to exist only at the periphery of conventional medicine. It is noteworthy that Western religion, education, modernization, and globalization in Africa have not affected the continuous existence of TCAM, as practiced both in urban and rural areas. This is because it is affordable, dependable, and culture oriented, taking care of healthcare needs of the people. The continued use and future of TCAM is to a great extent hinged on its coexistence with conventional medicine. The extent to which this integration will occur in future as well as the nature of this integration will be greatly influenced by the attitude of physicians, which is mostly negative. For futuristic purposes, the medical students’ attitude toward TCAM is, therefore, important in assessing the possibility that this may change. Students’ attitudes and beliefs may have a strong impact on the way they will ultimately practice this type of integrative medicine in future. A proper policy and practice response to increasing TCAM use requires an in-depth insight into the nature of TCAM use, including the profile of TCAM users as well as the drivers and barriers that facilitate and limit the use of TCAM. It is, therefore, important for health departments and governments across Africa to put forward policy designs and implementations regarding TCAM, its current role and future possibilities in healthcare systems in general and promoting TCAM training, research and development, as well as integration into mainstream healthcare systems and educational systems as a means of advancing TCAM use.

The WHO, in spite of the challenges of uplifting the role of TCAM in Africa, has noted quite a number of achievements, namely, formation of national policies and regulatory framework in some African member countries, promotion of research by the production of scientific evidence on the safety, efficacy, and quality of TCAM products and services, the development of inventories and monographs on medicinal plants and herbal pharmacopoeia, and capacity building by the inclusion of TCAM in training curricula of health professionals, educating, training, and integration of traditional health practitioners for primary healthcare. However, some challenges yet to be addressed in many African countries exist. There are limited data on safety, efficacy, and quality, limited resources for clinical trials, integrating TCAM to tertiary institutions healthcare systems, and inadequate protection of indigenous knowledge and intellectual proprietary rights. The way forward would, therefore, be to tackle these challenges. No doubt, there are differences between the degrees of organization and integration of TCAM into the mainstream health systems. While some countries may have no structure in place, others have considerable structures in place.

Overall, there is definitely hope for growth and future of TCAM in Africa.