The cost of the modern medical system is beyond most countries: its services only reach the few who can afford them. Most people cannot pay the high costs of medicines and treatments. Non-affordability leads to non-accessibility and thus non-availability. Any system which provides a service that is not affordable and therefore not accessible and not available can never claim to be effective and efficient.

Poor but rich
About four fifths of the world’s population now live in developing countries, which though economically poor are often rich in biodiversity. Most of their governments spend around $10 per person per year on health care. At least 1.3 billion people in developing countries try to make ends meet on less than a dollar a day. The World Health Organization estimates that about 80 per cent of the world’s people rely on herbal medicines (and thus biodiversity) at least to some extent.

Despite all this, governments, policy makers, health authorities and administrators, modern medical personnel, scientists and conservationists all misunderstand the importance of biodiversity to the health of people, especially the poor.

The relationships between humans and the biodiversity around them are manifest in local traditional knowledge and in the uses to which different people of diverse cultures put it in such areas as health, nutrition, energy, shelter, tools, transport, entertainment, religion and cultural identity.

The use of biodiversity is a fundamental link between people and the environment. It does not denote primitiveness, as some would want us to believe. Everyone uses it in one form or another; it just happens that people of the biodiversity-rich but economically poor countries often have easier access to biodiversity in its real (basic or original) state. They use it to meet their health care needs because it is accessible and often effective, and because they cannot afford the services provided by the official medical system.

Rather than seeking to understand why these people employ this strategy, we (the ‘educated’ lot) tend to belittle, ignore and neglect it and suggest procedures and activities that are alien to them. But only when we understand an issue can we come up with the appropriate solution.

It is in listening that we hear, in hearing that we know, and in knowing that we understand. Listening is thus a vital key to understanding – not the passive listening that we do with only the ears and do not follow up, but listening with all the senses, the whole being. Such active listening enables us to understand and act accordingly. It always manifests itself in action.

Reflecting reality
If health policies and strategies are not achieving their goal, then new and appropriate ways must be sought. There must be a re-think – and re-act – to enable people’s health care needs to be met more effectively and efficiently. Rather than adopting the modern medical system wholesale, it must be adapted to complement existing local systems. It is necessary to reflect the realities of countries rich in biodiversity but poor economically by first meeting their health care needs with their biodiversity before resorting to external resources such as pharmaceutical products.

Integrated health care
A pilot programme in the village of Ambodisakoana, northwest Madagascar, from late 1993 to the end of 1997 showed that this approach is both feasible and viable. The Clinique de Manongarivo was based on the integrated health care system approach to providing health care and conserving biological and cultural (biocultural) diversity. This consciously targets and harnesses people’s links with biodiversity, in order simultaneously to meet their health, economic and biocultural diversity conservation needs, and those of their areas. It manages the similarities and differences within the diversity of the material and human resources of the medical systems available in a complementary and sustainable manner.

It is in listening that we hear, in hearing that we know, and in knowing that we understand

The pilot programme resulted in the sustainable use of local biodiversity. Three treatment protocols were established and applied in the clinic: treating diseases using biodiversity (medicinal plants) only; using pharmaceutical products only; and using the two in combination. Twenty-eight of the 36 different diseases or medical cases encountered in the area were treated effectively by local medicinal plants alone (for examples see list at end), two by pharmaceutical products, and the other six by the combination.

Appropriate plants and plant parts were selected to treat diseases effectively. Laboratory investigations resulted in, for example, using the leaves of a Burasaia sp. for the treatment of fever, instead of its roots, which had been used by the traditional medical practitioner and the community. Similarly, the oil extracted from the fruit of a Mauloutchia sp. was used to treat toothache, instead of the bark. Thirty different species of medicinal plants were selected and cultivated in the clinic’s garden, thus helping to take undue pressure off some of those growing wild in the area.

The use of local biodiversity – which is often free and, at worst, five to ten times cheaper than the pharmaceutical products – enabled patients at the clinic to save money. To give a few examples: they saved around $5 by using ginger to take care of their motion (travel) sickness; $7 by using a Croton sp. to treat diarrhoea; up to $20 by using an Erythroxylum sp. for asthma; and around $35 by using a Mauloutchia sp. for herpes. (Pharmaceutical products are usually three to four times more expensive in rural areas than in urban centres and are often more difficult to find.)

The savings made it possible for them to afford the pharmaceutical products needed for the diseases that had no effective local biodiversity remedy. The money saved was also used to help meet other family needs, such as paying for the cost of a child’s education or improving the diet.

Mutual benefits
Reinforcing the life-saving value of biodiversity through using local plants for local health needs made it easier to evoke people’s willingness to help it. They felt obliged to save it because they depended on it for survival. Continually and sustainably using medicinal plants prevented both biodiversity and culture disappearing.

The target of ‘Health for All by the Year 2000’ never became a reality. But adapting the modern medical system to complement existing local ones – while reinforcing the relationship between humans and nature – through using biodiversity, could provide a way forward.

If adapted and applied, it would be a better way to meet health care needs cost-effectively. It would also provide a basis for solving some of the poor countries’economic and biocultural diversity conservation needs. It minimizes waste while maximizing benefits. And it clearly manifests the pillars of health care service provision: affordability, accessibility, availability, effectiveness, efficiency and cultural acceptability.

Examples of diseases or medical cases effectively
treated using local medicinal plants only: