In conclusion we can surmise that in general the two major threats to medicinal plants are: first, the loss of habitat (through land use conversion, agricultural expansion and so on) which results in the loss of both known and unknown species; and second, the overexploitation of known species as a result in increased demand. Related to these two is the associated loss of indigenous knowledge and expertise. To what extent are these processes underway in Ghana?
The review of Ghanaian case studies has revealed various degrees of adherence to this generally accepted paradigm of species loss. First, there is a continuing loss of natural habitat, and especially moist tropical forest, ongoing in Ghana (IUCN, 1988, summarises the likely impact on species diversity and catalogues endangered species). Second, the review has exposed conflicting reports of overexploitation of medicinal plant species. Scarcity at present is likely to be localised, but conditions exist which make overexploitation of certain species a possibility in the near future. Third, and in this respect Ghana is better off than many countries, there is only sporadic evidence that indigenous technical knowledge is being lost, but again there are indications that this could happen unless state support for traditional healing continues.
There may well be a danger of over-romanticising the role of indigenous technical knowledge systems and traditional resource management regimes (see Brandon and Wells, 1992). In many tropical countries massive improvements in infant mortality and life expectancy have resulted from the introduction of scientific medical practices such as child immunisation. Indigenous property regimes are not necessarily more egalitarian or equitable, some are feudal in nature. Experience has proved that many compounds found in herbal medicines have powerful pharmaceutical properties (Schultes, 1991). Indeed, traditional knowledge has been sought by prospectors from multinational drug companies as a first lead to promising plant compounds, to the extent that herbalists are becoming suspicious of inquiries from outsiders about their remedies. Traditional medicine undoubtedly brings health benefits to many rural people, a large proportion of whom do not have access to biomedical services.
Can the production and consumption of plant medicines be compatible with a development strategy based on sustainable livelihoods? Plotkin (1991) describes the ideal situation as one where the establishment of local pharmaceutical firms would create jobs, reduce unemployment, reduce import expenditures, generate foreign exchange, encourage documentation of traditional ethnomedical lore and be on the basis of conservation and sustainable use of medicinal plants and their habitats. One attempt to implement such a policy may be the initiative by the Costa Rican government in setting up INBio, a national institution to catalogue all genetic material indigenous to the country and effectively hold patents on any developments resulting from that material (see Aylward, this volume). Juma (1989) maintains that a National Gene Bank, if effectively linked into a network of community-based activities, could serve as custodians of material for local users. For such an initiative to be successful, a national inventory of genetic resources is necessary. Lin Compton et al. (cited in Brokensha, 1989:183) propose a National Indigenous Knowledge Centre for Ghana, which would 'recognise, record and preserve important and usually overlooked national resources'. There are no details of how such an institution would be established, but it certainly merits serious consideration.
This study has highlighted the importance of medicinal plants to populations of developing countries, and their prospective role in primary health care. In addition, under favourable circumstances, medicinal plants could be useful components of a development strategy which enhances sustainable rural livelihoods. Economists argue that people will be motivated to conserve resources only when they are able to profit from their sustainable use, and thus benefit from their conservation. This is only possible if property rights are well-defined and are secure. The people who benefit from the conservation, those who profit from the exploitation, and those who hold guaranteed rights must be the same.
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