Prescriptions and policy implications

This section discusses some of the policies concerning the use of medicinal plants which could not only bring benefits to local people in the form of facilitating sustainable livelihoods, and provide benefits in strengthening primary health care, but could also support the conservation of biodiversity.

The role of medicinal plants in sustaining livelihoods

From the information available it is difficult to assess the possibilities for income generation on the basis of collection of medicinal plants in rural areas. Instead, it is necessary to examine the experience of other products, the most applicable being other collected non-timber forest products (NTFPs). Falconer (1990) concludes that the markets for NTFPs are growing throughout West Africa, especially in urban and peri-urban areas. There is strong or growing demand for products such as bushmeat, palm oil, chewsticks, cola nuts and medicines, as well as manufactured goods such as furniture. In some regions the use of plant medicines is thought to be increasing because of the rising cost of Western drugs and the negative experience of disillusion with modern drugs and the modern health system. Previous sections have shown that Ghana's economic crisis and subsequent structural adjustment policies have resulted in modern medical treatment and facilities becoming less accessible to many people, especially the poor and those in many rural areas (Wondergem et ah, 1989). Falconer's research demonstrates that there are many small businesses which trade in NTFPs such as medicinal plants, live animals and animal products, but there is little information available on these, especially on market and demand fluctuations.

A number of problems in the marketing of such products can be identified; for example, poor transportation, irregularity of product supply and insufficient market information. Plant medicines can be difficult to market as they often need to be fresh (one of the advantages of Western drugs is that they can be stored). Amanor (1992) notes that one of the greatest requirements of traders in herbal medicines are containers and labels which allow them to store products for sale. This may be one way in which the trade in medicinal plants can be given more added value and made more profitable for small traders. Responses to a survey of traditional healers in west Ghana (Fink, 1990) revealed that there is a need for training in methods of conserving plant medicines. In the past attempts have been made to standardise products as one way of sustaining demand.

Falconer's study of the marketing of chewsticks highlights a number of factors which may be extremely important in the marketing of other NTFPs, such as medicinal plants (Falconer, 1990). The preferred tree species is Garcinia epunctata (local name, Nsokodua), and harvesting is concentrated in the southwestern region of Ghana where the tree is most plentiful. Although the trees may be prevalent in more remote regions, the main chewstick production centres are in urban areas, especially in Kumasi and Accra. Logs are collected from the forest by groups of gatherers who come out from the city specifically for that purpose. The harvest is transported by truck, either by the collectors themselves or by wholesale traders, to the urban markets. Sometimes local villagers collect, but rarely on a large scale; they are disadvantaged as they are unable to operate in the complex trade networks, and lack the capital resources to develop their business. Logs need to be processed and sold soon after harvest before they lose their chewstick properties. There are hundreds of women who work in Kumasi processing logs into chewsticks; each may work on one or two logs and sell about 300 bundles of chewsticks a day. They sell to both local and foreign traders, and direct to the public. Kumasi is the major source of chewsticks for all the market in the Ashanti Region and an estimated 4-20 million bundles are produced each month. Thus the trade makes a significant contribution to the regional economy. Falconer (1990) has estimated that it generates a final retail value of 280000 million cedis (£500000) a month, a value incorporating the added value at each level of the trade network. A more accurate estimate is the standing value of the resource may be the village price paid for a log in the forest, which amounts to 9.5 million cedis (£17200).

The salient features of this trade are that local rural people are disadvantaged and it is difficult for them to become established in business for a number of reasons; lack of access to trade networks, lack of capital and transport opportunities militate against them. Other difficulties concern the non-storable quality of the products; seasonal fluctuations in supply and demand; and physical accessibility (especially during the rainy season).

Although a number of studies have shown the value of sustainable harvesting of non-timber forest products to be considerable (Peters et al, 1989; Ruitenbeek, 1990), the little evidence available suggests that there is limited opportunity for income generation from gathering and collection of medicinal plants for local consumption through the indigenous health care system. The income raised, although seasonally important to poorer households (and often those headed by women), remains supplementary and unreliable; however, if herbal medicine were to be incorporated more formally into the primary health care system, and its trade better organised and regulated, then there are perhaps increased possibilities.

Incorporating medicinal plants into primary health care Policy guidelines set out by WHO have recommended the integration of traditional healers into primary health care, as community health workers for example, and the Alma Ata Conference on Primary Health Care in 1976 recommended that governments should give high priority to the utilisation of traditional medicine, including the incorporation of proven traditional remedies into national drugs policy. In Ghana, as Warren et al. (1982) point out, the separation of Western and indigenous health systems in public policy does not correspond to attitudes within society: the majority of Ghanaians regard the two systems as acceptable and viable alternatives, and patronise both freely. This implies that there may well be room for integration of the two approaches.

Traditional medicine has been formally recognised by the state in Ghana since Independence. As part of the effort to boost African and indigenous arts and culture, the Psychic and Traditional Healing Association was formed in 1963, and in 1974 official recognition led to the establishment of the Centre for Scientific Research into Plant Medicine at Mampong. The centre was set up by the government to carry out systematic research on the efficacy of herbs used by indigenous healers, and the centre also has a clinic where these treatments are used. In response to the WHO guidelines, the Ministry of Health set up experimental programmes in primary health training for indigenous healers in Techniman District, and this project has since been replicated in other districts with the support of various nongovernmental organisations (see Warren (1987) for a review).

Despite government and institutional support, however, a number of impediments to the successful integration of the two medical systems have been observed in Ghana and elsewhere. Experience from the Centre for Scientific Research into Plant Medicines suggests that herbalists are suspicious of attempts to investigate their remedies, and some herbalists were found to be unwilling to divulge their treatments and preparations (Twumasi and Warren, 1986). There are reports of biomedical staff refusing to collaborate with some traditional healers (Warren et al., 1982; Barbee, 1986). Other problems may be even more fundamental; for example van der Geest (1985) criticises WHO's support of indigenous health care and its integration into primary health care systems as rhetorical, and believes that although such integration is going on in many countries on an informal basis, an effective integration of modern and traditional would probably lead to a speedy eclipse of indigenous medical traditions. Van der Geest describes the process which is happening in many countries as 'cooptation', so that the paradigms of scientific Western medicine still dominate, but allow a little of the indigenous practices, those that can be scientifically proved, to be accommodated within its service.

Despite these problems, the many advantages and benefits offered by a more integrated approach to health makes it a compelling proposition, and there appears to be a degree of commitment to such a policy by many government, health and academic personnel in Ghana. The opportunities which it presents, to provide cost-effective medical care to inaccessible rural areas, make further investments and efforts a priority. Further research is necessary to assess the potential role for plant medicines, and particularly the likely effects on demand and trade, and therefore income-generating capacity of plant medicines within such a system.

Conservation of biodiversity and property regimes Throughout this study, the issue of property rights has been shown to be of great importance to the conservation of natural resources, including wild plant species. Some communal property regimes may provide incentives for conservation. For example, in a case study of Nigeria, Osemeobo (1992) observes that under the traditional communal land tenure systems plants of economic or social or medicinal value, such as Garcinia cola (used for chewsticks) and Piper guineese (Ashanti pepper), are protected for the common benefit of the community. In Nigeria, however the majority of land is now under individual ownership, and Osemeobo argues that this system of tenure has resulted in major abuses and misuses of land.

This review has shown that communities develop complex systems of resource management that are often little understood by outsiders. Outsiders in this case means not only people from other countries, but those from other regions, and especially those from urban areas, or the middle class and educated elites. Increasingly, there are calls to support the investigation and understanding of traditional management regimes and social institutions as a means of combatting environmental degradation (see for example, collection in Cooper et al. (1992), Swift (1992) for examples of range management in East Africa and Richards (1985) in Sierra Leone). Redclift (1992) maintains that when excluded from the management of their local environment, people cease to be 'stewards' and become 'poachers'. The objective of designing workable incentive schemes is that they should become stewards again, and gamekeepers in the case of particularly valuable environments. Among the most appropriate measures for effecting this change is the assignment of management responsibilities to local institutions, strengthening community-based resource management systems, and introducing a variety of property rights and land tenure arrangements which can reinforce the positive effects of more sustainable and fiscal policies. These measures can serve to re-kindle traditional resource management practices, and focus the attention of the local community on the value of indigenous knowledge and experience. Redclift points out that the case is strengthened where natural environments are particularly rich in biodiversity.

How can indigenous values and management regimes be incorporated into policy, especially given the wide variation in belief and practice? Chandrakanth and Romm (1991) discuss the potential policy implications of religious forest classifications with reference to India and the USA. The state may apply classification according to economic, environmental and political criteria but people classify forests by different criteria, and their classifications embody values, motives and capacities (manifest institutions) that govern their own behaviour. In reviewing the current Indian government's classification of forests, the authors observe that when the enforceability of government forest policy is slight, a common state of affairs, the policy effectiveness depends on the degree of complementarity between the classes the state creates and seeks to implement, and the differentiations and purposes the people actually apply in their uses of land. In other words, the disparity between defacto and de jure classifications of forests affect the outcome of public policy. The State may further undermine traditional institutions such as a sacred grove by weakening the position and power of local leaders, such as village elders (Shepherd, 1991). In Ghana, a law currently under discussion recognises the environmental, cultural and scientific role of groves and other sacred sites and, if approved, will authorise traditional authorities to proclaim areas sacred and set the conditions for their protection (Dorm-Adzobu, 1991).

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