The document discusses investment in traditional medicine systems in Sierra Leone versus allopathic/Western medicine systems. It outlines that traditional medicine is more accessible but understudied. While allopathic medicine has advantages, studies show the current system is inefficient. Integrating traditional medicine could improve health outcomes and combat issues like HIV/AIDS more effectively given traditional medicine's holistic approach and existing infrastructure. More research is needed to quantify traditional medicine's contributions and potential returns on investment.

1. Can Investment in African
Traditional Medicine Systems
Yield Better Public Health
Returns Than Allopathic
Healthcare Systems?
Eluemuno R. Blyden, Ph.D.
AfriVax, Inc.
OptAIDS/WHAM Workshop
Toronto, July 29, 2008 / Second Life® now through 2011

2. Summary
•Define the scope of Traditional Medicine (TM) and Allopathic
Medicine (AM) in Sierra Leone
•Outline an approach to measuring the relative contribution of
TM and AM to the Health status quo in Sierra Leone as
indicated by various surveys
•Review approaches to quantifying the efficiency with which
TM/AM might convert investment into public health good
•What impact can AM and TM systems have on HIV/AIDS in
the Salone context?

3. Why Sierra Leone?
•Plenty of Data (not all good)
•Good microcosm of the typical African situation in
a small geographical area
o16 ethnic groups
o5 major ecosystem types
o3-4 independent TM Systems?
•Low HIV seroprevalence, extensive HIV
education
•Investement in healthcare needed
•Personal experience

4. Link to Google Maptotal: 71,740 sq km
Kenema, Kono
Kailahun - east
province;
Bo, Moyamba
and Bonthe
south province;
Port Loko,
Koinadugu,
Kambia,
Tonkolili, Kabala
and Bombali -
north province

5. Sierra Leone's Health Challenges

6. National Health Priorities, Sierra Leone
The current national priority health problems are:
•Malaria
•Sexually Transmitted Infections including HIV/AIDS
•TB
•Reproductive health including maternal
•and neo-natal mortality
•Acute Respiratory Infections
•Childhood immunisable diseases
•Nutrition-related disease
•Water, food and sanitation-borne diseases
•Disability
•Mental illness
National Health Policy 2002 Govt. of Sierra Leone

7. Approx 5000 AM Workers Extrapolate as many as 20,000

8. Where do Sierra Leoneans turn to for
medical help?
•About 6% of people consult Traditional Medicine Practitioners
(TMP) for primary care compared to ~70% who consult
Doctors, Nurses and PHOs
•Only about 30% of people have ready access to Allopathic
Medicine (AM) infrastructure.
•70% of Births within 3 miles of a Public Health Unit (clinic)
were at -home supervised by a Traditional Birth Attendant
Suggest that we should ask:
•What do Sierra Leoneans consider medical help?

9. Assumptions for Analytical Approach
•National health status as indicated by statistics is the
OUTCOME of combined TM and AM services
•Relative contribution of each cannot be completely quantified
or disentangled
•Full scope of TM not fully defined
•Bias as against TM by those evaluating National health status
•Some general statements can be made about the potential
impact of TM/AM on national health by extrapolation from
limited data

10. Advantages of AM System
•Based on a broader foundation of experimental
and experiential knowledge
•Well-established Diagnosis/ Intervention/
Outcomes model
•Well-established regulatory models/systems
articulated with global health
•Well-established human capacity formation
•Has a strong material infrastructure
•Pharmaceutical resource available

11. Advantages of TM
•Available and accessible at places of need
•Well established indigenous infrastructure
•Economically independent of global economic
fluctuations
•Socio-culturally coherent (not imply acceptance)
•Holistic approach of African TM could be more
effective at palliative and curative care (relevant
to HIV/AIDS)

12. Technical efficiency of peripheral health units in Pujehun district of
Sierra Leone: a DEA applicationAde Renner1, Joses M Kirigia*2, Eyob A Zere3, Saidou P Barry2,
Doris G Kirigia4, Clifford Kamara5 and Lenity HK Muthuri6
Healthcare provision as a process

13. AM: The need for a new approach...
"Twenty-two (59%) of the 37 health units analysed were found
to be technically inefficient, with an average score of 63%
(standard deviation = 18%). On the other hand, 24 (65%)
health units were found to be scale inefficient, with an average
scale efficiency score of 72% (standard deviation = 17%).
Conclusion
It is concluded that with the existing high levels of pure
technical and scale inefficiency, scaling up of interventions to
achieve both global and regional targets such as the MDG and
Abuja health targets becomes far-fetched."
Technical efficiency of peripheral health units in Pujehun district of
Sierra Leone: a DEA applicationAde Renner1, Joses M Kirigia*2, Eyob A Zere3, Saidou P Barry2,
Doris G Kirigia4, Clifford Kamara5 and Lenity HK Muthuri6

14. Traditional Medicine Services
INPUTS:
•TMPs, TBAs, Apprentices
•Support staff (family,
community members)
•Transportation (Public)
•Materials and Supplies
( Local/ imported roots,
bark, leaves, animal parts)
•Capital (Paramount Chiefs,
Formative Societies, Self-
employed)
OUTPUTS:
•Preventative Healthcare
•Curative Healthcare
•Palliative healthcare
•Individual Health Education
•Community Health
Education
•Emergency Medicine

15. TM: The need for a new approach..
•Need more scientific approach
•Need better regulation of formation and practice
•Many quacks and charlatans...
•Better pharmaceutical practices (ie toxicity evaluations etc)
•Better resource management and conservation
•Update indigenous laws and make new constitutional ones

16. Preventive Medicine
Malaria preventives include "broomstone", Fignut
leaves (Jatropha curcas), and the barks of
several indigenous tree species.

17. Curative Medicine

18. Palliative Medicine

19. Emergency Medicine
Jan 29.2006
Cholera kills 18 children in Bonthe
Eighteen children are reported to have died of diarrhea in fishing
villages around Delken it’s surrounding in the Bonthe district, southern
Sierra Leone over the past week.
This epidemic is reported to have affected over one thousand people
of whom thirty are children in that area. An emergency medical
response team from the Ministry of Health and Sanitation and World
Vision-Sierra Leone has been dispatched to the area to carry out
curative and preventive treatment.
Elizabeth Domboi, nurse in charge of health and sanitation confirmed
that the epidemic killed 18 children before native herbalists put it under
control. She complained that local residents in the district have
negative response towards conventional treatment.....
Awoko Newspaper

20. Perinatal Choices and Outcomes
Percent distribution of women aged 15-49 with a birth in two years preceding the
survey by type of personnel assisting at delivery. Sierra Leone. 2005

21. TM Potential for Reducing HIV
Transmission?
Male Circumcision – No Data for Sierra Leone Presented!!
Female Genital Cutting (Circumcision) is widespread and popular in Sierra Leone–
More on FGC
In a review of 19 cross-sectional studies, 5 case-control studies, 3 cohort studies, and 1 partner study.
A substantial protective effect of male circumcision on risk for HIV infection was noted,...After
adjustment for confounding factors in the population-based studies, the relative risk for HIV infection
was 44% lower in circumcised men. The strongest association was seen in men at high risk, such as
patients at sexually transmitted disease (STD) clinics, for whom the adjusted relative risk was 71%
lower for circumcised men. CDC Fact Sheet
Evidence exists for a similar effect in circumcised females

22. Enabling factors for TM
•Sierra Leone Traditional Healers
Association (SLENTHA)
•Several new Acts of Parliament
supporting TM and its practice including
National Policy on Traditional Medicine
•Good environmental conservation
movement protecting forest resources
•Civil conflict HELPED increase the
awareness of the value of indigenous
knowledge assets
•Tradition of collaboration between AM
and TM has existed in the past.

23. Obstacles to an Integrated AM/TM
System in Sierra Leone
•Biggest obstacle is prejudice against AFRICAN Traditional
Medicine-- Chinese and other TMS receive SL govt support!!
•This prejudice is probably greater IN Sierra Leone than
outside due to stigmatization!
•Paucity of evidence based assessments of TM impacts
•Need better funding of research and development of TM
Practice and systemization
•Better human and natural resource management in relation to
TM needs
•Better integration of indigenous knowledge in Primary,
Secondary and Tertiary education curriculi

24. Conclusion
•Previous studies indicate AM system would not yield good
return on investment due to systemic inefficiency
•TM is a valuable resource that could be used to improve the
impact of all public health care interventions and help stop the
spread of HIV/AIDS & other global health threats
•The TM resource is more evenly distributed geographically
and is more robust due to its predominantly local
dependencies
•Enabling environment created by grassroots efforts and
advocacy need more support and greater evidence based
data to define the value of potential investment-- this can be
determined even from the tangential information about TM
practice already existing today
•Tiwai Traditional Medicine Health and Fitness Village Project
http://www.tiwaihealthvillage.com

25. Summary
•Define the scope of Traditional Medicine (TM) and Allopathic
Medicine (AM) in Sierra Leone
•Outline an approach to measuring the relative contribution of
TM and AM to the Health status quo in Sierra Leone as
indicated by various surveys
•Review approaches to quantifying the efficiency with which
TM/AM might convert investment into public health good
•What impact can AM and TM systems have on HIV/AIDS in
the Salone context?