Medicine Programmes in Madagascar
Madagascar has inherited a wealth of ethnomedical knowl¬edge.
The first medical thesis written by a Malagasy con-cerned the study
of a plant traditionally used as a trial poison in Madagascar (Rasamimanana
1891), and the fol-lowing two theses were devoted to an inventory
of Malagasy medical beliefs and practices (Ramisiray 1901; Ranaivo
1902). Furthermore, a preliminary census of traditional health practitioners
in three provinces of Madagascar re¬vealed that there were more
than 2000, which can be extrap¬olated to over 5000 in the whole
is also endowed with a flora of unique global importance on account
of its biodiversity, endemicity, and ethnomedical uses. Of approximately
13 000 species present in Madagascar, over 80% are endemic to the
island, and about 3500 are reported to have medicinal properties.
of Madagascar has shown its political com¬mitment to traditional
medicine by supporting, through an inter-ministerial convention,
a commission to study regula¬tions on traditional medicine and
its pharmacopoeia in Madagascar, which was established in May 1996.
This com-mission was enlarged by decree N°2339/2002 dated 28th
August 2002 marking the creation of a National Advisory Committee
on Traditional Medicine. The Committee brings together the principal
public and private stakeholders in a spirit of partnership. It has
recently drafted the national pol¬icy on traditional medicine
in Madagascar which now will move forward to be validated at the
WHO level. The general objective of this traditional medicine policy
is to improve ac¬cess for the population, especially the most
vulnerable popu¬lations, to quality care and service.
Operational objectives are the following:
1. To elaborate
a legal, regulatory, organizational and prescriptive framework for
exercising the profession of traditional healer and for using the
2. To promote
and reinforce dialogue and partnership be¬tween local communities,
traditional healers, researchers, and clinicians for the promotion
of ethnomedical practices and their scientific investigation;
Philippe Rasoanaivo. Institut Malgache de Recherches Appliquées,
B.P. 3833, 101-Antananarivo, Madagascar. E-mail address: email@example.com
3. To develop
appropriate legislation and regulatory texts, in collaboration with
relevant organizations, for access to biological resources and in
particular medicinal plants, for the protection of traditional knowledge,
and for equitable sharing of benefits arising from the devel¬opment
of traditional practices and the sustainable exploitation of these
biological resources, in accordance with the Secure Local Management
scheme ("GELOSE") established by the National Department
of the Environment and with the Convention on Biological Diversity,
of which Madagascar is a signatory;
4. To evaluate
ethnomedical practices for their safety, effi¬cacy, and quality,
to optimize the use of research results, to follow up patients having
taken traditional medicine, to promote the cultivation of medicinal
plants and the local production of improved traditional medicines,
in order to make traditional medicine less empirical and more rational,
while preserving as far as possible the values which confer its
5. To reinforce
the systems for information, training, and education on traditional
medicine programmes in Madagascar can be di¬vided into two categories:
(1) programmes that are coordi¬nated by the Ministry of Health,
and (2) programmes that are carried out on an institutional basis.
Traditional Health Practitioner Association
The traditional healers created a national association of traditional
healers following decree N°221/02/MI/SPAT/ ANTAIAss of 3rd June
2002. Two meetings have been held between doctors and traditional
healers, attempting to bridge the divide between conventional and
Institutes involved in medicinal plant research/ production
Institut Malgache de Recherches Appliquées (MIRA)
Malgache de Recherches Appliquées (IMRA) was created in 1958
by Professor Albert Rakoto-Ratsimamanga, former Research Director
at the Centre National de Recherche Scientifique, and pioneer of
the scientific re-search in Madagascar. At its inception, IMRA was
a non-governmental organization, but since 1993 it has been granted
status as a Foundation following a government decree. IMRA is by
far the best equipped. centre in Madagascar for biodiversity conservation
and drug discovery from natu¬ral products, and has a strong
network of collaborations with western institutes.
IMRA is a
good example on how scientific research could be integrated with
health care, conservation, and production. At this point, it has
1. Department of Research with two areas of activities: (i) discovery
of biomolecules in the areas of malaria, cancer, diabetes, immunomodulation,
cardiovascular and respiratory diseases, and (ii) analytical analysis.
IMRA has a fully equipped section to carry on the biological screening.
of Production and Export which produces nearly 40 plant-based
drugs, nutraceuticals, and cosme¬tics for local uses at affordable
prices, and exports Centella asiatica, Drosera ramantacea, other
medicinal plants, and essential oils for commercial purpose. This
latter activity is an important source of income for the Institute.
of Clinics with nearly 30 medical consulta¬tions per day.
Patients may be treated either with phytomedicines or conventional
drugs, or both.
achievement of IMRA has been the computer¬ized compilation of
all ethnomedical uses of Madagascar plants. More than 6000 plants
have been recorded with all detailed information. IMRA
is also involved in training activities at different levels.
d'Application de Recherches Pharmaceutiques (CNARP)
The Centre National d'Application de Recherches Pharma¬ceutiques
is a state institution which was created by the First .-Republic.
The inaugural opening ceremony was held in May 1972, but the Centre
started functioning in 1977.
The Centre has five
departments, reflecting the multidisciplinarity and complementarities
of the work in medici¬nal plant research and development:
of Galenical Pharmacy
HOMEOPHARMA is a private company which was created in 1992 by Dr.
Jean Claude Ratsimivony. The areas of activi¬ties are homeopathy,
phytotherapy, and aromatherapy.
has a range of products for local uses, namely:
- Creams for
Fanamboarana Fanafody (OFAFA)
OFAFA is a semi-public institution devoted to the produc¬tion
of bulk imported drugs. It was created in 1981 follow¬ing an
official agreement between the Chinese and the Malaygasv Governments.
Although it is not involved in inv production of phytomedicines,
the current infrastructure may be adequately used to produce useful
Programmes under the coordination of the ministry of health
In order to achieve the objectives of the national policy on traditional
medicine, the strategy has seven parts:
1. To create
a technico-legal commission charged with finalizing the texts which
have previously been drawn up, and to elaborate new texts following
the instructions of the National Policy on Health.
2. To facilitate
the creation of traditional healers' associa¬tions in order
i. To serve
as an internal reference system
ii. To provide a professional code of ethics with a
view to rapidly discrediting charlatans, and
iii. To enable dialogue with modem medical practitio-
3. To solicit
the participation of all stakeholders in the elaboration and/or
finalization of texts on biological re-sources, protection of traditional
knowledge, and equita¬ble sharing of benefits arising from the
development of ethnomedical practices, in accordance with the Conven¬tion
on Biological Diversity and the model law of the African Union.
4. To create
a multidisciplinary scientific committee in charge of all that pertains
i. Research, training, and information on traditional medicine;
ii. Inventory and database building on ethnomedical practices
and medicinal and food plants;
iii. Design, development, and production of phytomedicines and
iv. Conservation and cultivation of medicinal plants.
5. To promote and facilitate the production of phyto¬medicines
and nutraceuticals in appropriate state institu¬tions and private
6. Actively to involve local communities in programs to develop
traditional medicine, using participative ap¬proaches, so that
they are both participants and benefi¬ciaries.
7. To create appropriate mechanisms for local communities to benefit
from research results on the potential of their respective regions.
From this strategy, the National Advisory Committee identi¬fied
three areas of intervention: (1) Malagasy Pharmaco¬poeia, (2)
phytomedicine production, and (3) laws and regulations regarding
the practice of traditional medicine.
The objective of the programme is to select the 100 top pri¬ority
species and to gather all available information. A multi-disciplinary
committee composed of medical doctors, pharmacists, scientists,
and traditional health practitioners has been put in place to handle
selected on the basis of the following criteria:
- Plants of
potential or effective economic value;
- Plants for
which the current phytochemical/biological
Investigations may lead to useful applications
- Plants with
relevant ethnomedical data.
The content of each monograph of the Malagasy Pharmaco¬poeia
description at macroscopic and microscopic levels
distribution and ecological status
- Data on
phytochemistry, pharmacology and toxicology
- Assays for
The expected outcomes are:
of 100 priority species which serves as a basis for the formulation
of conservation and valorization programme within the frame of
the sustainable uses of the biodiversity for the benefit of health
of medicinal plants with a "pharmacopoeia label"; and
of biomolecules with the perspectives of drug development.
Pharmacopoeia, in both hard copy and digital version, is expected
to be completed within two years.
of this programme is the formulation of phytomedicines for local
uses and export where appropriate. Basically, this programme is
a follow-up of the Malagasy Pharmacopoeia.
are targeted in the programme, namely: diarrhoea, malaria, asthma,
diabetes, cardiovascular diseases, and AIDS.
committee was created to coordinate the overall programme. Interested
stakeholders are kindly requested to submit a project that will
be evaluated by an expert commit-tee. The draft WHO/AFRO guidelines
on research and meth¬odology for evaluating the quality, safety,
and efficacy of traditional medicines will be recommended for all
partici¬pants. OFAFA, IMRA, and OFAFA will be in charge of the
production of selected phytomedicines.
and regulations of the practice of traditional medicine
A technico-legal committee was created to finalize all texts related
to laws and regulations on the practice of traditional medicine.
- Law relative
to the production, control, and commerciali
zation of improved traditional remedies in Madagascar;
- Law relative
to the recognition of the practice of tradi
tional medicine in Madagascar;
- Decree relative
to the organization of the practice of tradi¬tional medicine
in Madagascar; and
- Law relative
to the access to the resources of the biologi¬cal diversity
and drug discovery
Three Institutes are involved in bioprospecting in Madagas¬car:
- CNARP under
the International Cooperative Biodiversity Group (ICBG) program,
including Missouri Botanical Garden, Centre National de Recherche
pour l'Environe¬ment, Conservation International, NGO MATEZA,
Vir¬ginia Polytechnic Institute, Bristol Myers Squibb, and
Dow Agroscience as partners;
- IMRA collaborating
with a pharmaceutical company; and
Laboratory of the Faculty of Sciences under a new ICBG program.
African Traditional Medicine Day: newly identified programs
Madagascar celebrated the African Day of Traditional Medi-cine.
It was attended by various stakeholders. Participants agreed on
the following programmes:
of the efficacy and safety of relevant herbal preparations originating
from traditional health practitio¬ners; and
of the efficacy of bone setting.
will be presented at the next celebration of the African Traditional
Madagascar actively took part with Uganda and Ghana in the adoption
of the Decade of Traditional Medicine in Africa during the OAU Summit
held in Lusaka in July 2001, and participated in the 15th Meeting
of the Inter-African Expert Committee on African Traditional Medicine
and Medicinal plants in Arusha in January 2002 for the drafting
of a decade plan of action.
The overall goal of the programs on traditional medicine in Madagascar
is an improved conservation, management, and sustainable uses of
Madagascan medicinal plants through a multi-sector partnership at
national and regional levels, with the aim of integrating traditional
and modern medicine in health care, drug discovery, and poverty
alleviation. It is hoped that within the Decade of African Traditional
Medicine, relevant achievements will be made by Madagascar through
the strong commitment of the Ministry of Health and Family Planning.
Ramisiray, G. 1901. Croyances et pratiques médicales des
Malgaches, Thèse de Médecine, Paris; Revue de Madagascar
1902. Pratiques et croyances médicales des Malgaches
relatives aux accouchements et à la médecine infantile,
Médecine, Paris, 1902; Revue de Madagascar, Sème année,
J. 1891.Contribution à l'étude de l'action physio¬logique
de la tanghinine cristallisée extraite de Tanghinia venenifera,
Thèse de Médecine, Lyon.
This IK Note was written by Philippe Rasoanaivo,
and orignally published at the Traditional Medicine Programmes inMadagascar,
Biodiversity & Health: Focusing Research to Policy at the proceedings
of the International Sympo-sium, held in Ottawa, Canada, October
25-28, 2003. For more information or if you have questions, please
contactPhilippe Rasoanaivo,email: firstname.lastname@example.org.