The experience of Burkina Faso in the area of traditional pharmacopoeia

JEAN-MARIE THIAMBIANO

Ministry of Health and Social Welfare
Directorate of Pharmaceutical Services
Burkina Faso

Introduction

Geographical Information

Situated in the heart of West Africa, Burkina Faso is a country which is completely landlocked . It borders on the Republic of Niger to the East, on Ivory Coast to the West, on Ghana, Togo and Benin to the South, and on Mali to the North-West. The country covers an area of 274,000 square kilometers with an estimated population of 8,600,000 inhabitants in 1988.

Demographic characteristics

The population density is 31 persons per square kilometre. The urban population is low, only 12%. Thus 88% of the Burkinabe live in the rural zone. The population is mainly that of young people. 42.2% of the population is made up of young people of less than 15 years. The birth rate is at 49.9% and the infant mortality rate is high: 134% while the gross mortality rate is 24%. The annual population growth rate is 2.68%.

Administrative structure

The country is divided in 30 provinces, 300 districts and 7,285 villages. This administrative structure is under the Ministry of Territorial Administration.

Overview of the sanitary situation

The sanitary situation is affected by the following:

· problems of drainage and the provision of drinking water;
· the quantitative and qualitative insufficiency of the sanitary services;
· the persistence of epidemo-endemic diseases due to a low socio-economic level of the population. These diseases remain the main cause of the high mortality rate, especially among children (134%).

In order to rectify the situation, the Burkinabe State has carried out a number of vaccination campaigns, some of which are:

· the operation "Commando vaccination" of 1984;
· the operation "Doors Open on Vaccination" of 1988;
· the operation "Daily Vaccination" of 1989.

These operations enabled the vaccination, during a very short time, of an important number of children. The state also carried out other more permanent actions such as the establishment of fixed vaccination stations and the creation of primary Health Stations (PSP) in the villages. All this has helped to improve the sanitary situation.

The National sanitary policy

Objectives

The sanitary policy is based on the primary health care. Its objective is to ensure "Health for All by the year 2000". As such, a sanitary scheme for the decade 1980 - 1990 has been worked out, and this scheme is meant to deal with the major community health problems. In order to achieve this, it is essential that the state should establish actions of curative care promotion and re- adaptation, in the functional infrastructure, with the necessary equipment and personnel.

Given certain realities, namely the fact that this project was not in line with the financial realities of the country, it became necessary to revise it so as to put into account the sanitary priorities at the national level. The main components of the project centered on the following points:

· the implementation and the working out of programmes for the control of endemo-epidemically transmissible diseases;

· the creation of basic sanitary services, especially maternal and infant health care;

· the training and in-service training of the paramedical personnel in the domain of public health and the control of endemo- epidemics. (epidemiology?)

Institutional Device

In order to meet the objectives of the national sanitary policy, a pyramidal system of Health was recommended. Its structure is as follows:

Starting from the base to the top, we have the following structure:

· ESSA: Institute of Health Science;
· MS-AS: Ministry Of Health and Social Welfare;
· H.N: National Hospital;
· CHR: Regional Hospital Centre;
· C.M: Medical Centre;
· CSPs: health and Social Promotion centre; and
· PSP:Primary Health Station.

The national pharmaceutical policy

The inability to cover the whole national territory with medicines is one of the major handicaps in making an effective implementation of primary health care in Burkina Faso. Thus, the national pharmaceutical policy has instituted the following objectives:

General objectives

· To provide the population with essential medicines at a reasonable price and as permanently as possible.

· To improve the management of medicines in all the sanitary structures in order to make a rational use of the resources which are supplied for sanitary use.

· To institute and develop the natural product by integrating into it the medical returns and the traditional pharmacopoeia.

Specific objectives

· To assess and strive to satisfy the needs for public sanitary education in essential medicines and technical materials.

· To select the medicines which are considered essential in Burkina Faso.

· To monitor the effects of medicines on the market with the help of national and international experts.

· To contribute to the fight against the abuse and illegal traffic of drugs.

· To exploit and to avail to the users all information or documentation relative to pharmaceutical products.

· To promote traditional pharmacopoeia and medicine.

Methods

In order to attain these objectives, a number of measures were considered, namely:

· The establishment of a Directorate for Pharmaceutical Services (DSPH) consisting of a department for pharmacopoeia and traditional medicine. This Directorate is expected to monitor the application of the national pharmaceutical policy.

· The establishment of a national corporation responsible for pharmaceutical supplies (SONAPHARM) in 1985, which played the role of a state whosaler and which enabled customers to buy their medicines at a reasonable price.

· The creation of a medical laboratory for the country (MEDIFA) in 1989 whose role was to study soluble materials (salty and sweet serum). A similar institution had been created in 1978.

This is called IRSN (Research Institute of Natural Substances). It is under the Ministry of Higher Education and it contributes, to some extent, to the local production and to the promotion of medicine and traditional pharmacopoeia.

Burkina Faso's policy in the sphere of traditional pharmacopoeia

Justifications

In spite of the establishment of the SONAPHARM in 1985, which helped to lower the prices of certain medicines, the national budget has problems in meeting the demand for primary medicines in sanitary education. Also, the new medicine supply policy is only confined to emergency medicines.

The cost of the other medicines has to be entirely met by the people. And, in spite of the efforts made by the State, the price of medicines remains always high especially given the very low gross national product. Also the majority of the Burkinabe people have a very low income and therefore turn to the traditional medicineman.

Historical account

In Burkina Faso, both medicine and traditional pharmacopoeia have gone through four major historical periods:

· The precolonial period
· The colonial period
· The revolutionary period

The precolonial period

During this period, traditional medicine was totally under the jurisdiction of traditional practitioners who were scattered in all villages. These were both general practitioners as well as specialists (bone setters, gyneoco-obstricians e.t.c.). Their activities were practically secret and entirely private. Their services were based on humanism and were offered free of charge.

The colonial period

During this period, there was a brutal interruption of the medicinal evolution due to the coming of the colonial power which forbade this practice on the ground that the "civilised" medicine from the metropole was much more superior. But this act was futile since, rather than disappear, this traditional medicine started being practiced secretly.

The neo-colonial period

Since the time of independence in 1960, this period has been marked by an attempt of codification. A number of very general and limited texts were worked out with the intention of legally permitting the traditional healers to practice their art. However, at this period, the traditional healers had not been accorded real freedom by the local authorities.

Revolutionary period

After the advent of the revolution in August 1983, Burkinabe traditional medicine came out from its lethargy. The authorities were openly in favour of having the traditional practitioners participate in the resolution of health problems experienced by the people in order to attain the objective "Health for All by Year 2000". But in order to participate effectively in this challenge, traditional medicine has to adapt itself with time and knowledge. Thus, the minister for Health and Social Welfare, at the opening of the 1st National Seminar on Medicine and Traditional Pharmacopoeia on 16th November 1987, declared:

The fight which we have started in order to restore the confidence of our people in matters of public health, should not only be confined to things to do with our past experiences, but also we should work hard in order to render to this medical wealth a confirmed scientific value.