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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Datin Napsah Mahmud
DirectorTraditional & Complementary Medicine Division
“Updates on the new legislation pertaining to
TCM”.
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Flow of the presentation
• Government Policy on T/CM • Current Regulatory Situation• T/CM Practices• T/CM Division• Integrative medicine
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Government Policy on T/CM
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
• Malay – Indigenous; from Indonesia
• Chinese – 18th Century : Brought in from China / Korea
• Indian– 18th Century : (Ayuverda, Siddha and Unani) brought in
from India / Pakistan /Bangladesh/Sri Lanka
• Complementary Medicine– 19th Century from India & Sri Lanka (homeopathy) and
the West
• Homeopathy
T/CM in Malaysia
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
WHO Traditional Medicine
Strategy 2002-2005
1. Develop National Policy- integrate TM/CAM with national health care systems
2. Encourage evidence based practice - safety, efficacy and quality: - evaluation, guidance and support for
effective regulation3. Enhancing Access:
- public awareness, availability and affordability of TM/CAM, including essential herbal medicines
4 Rational use: - therapeutically sound use of TM/CAM by
providers and consumers
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Government Policy on T/CM
• The growing interest in T/CM that has prompted the Malaysian government to establish a special committee to look into all aspects of T/CM in the country .
• Vision to integrate T/CM optimally into the National Health system has been set.This is supported with a mission to ensure quality and safe use of traditional /complementary medicine practices and product.
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Government Policy on T/CM:
• Formation of Standing Committee for T/CM (1996)
• chaired by Deputy Director General of Health (Research and Technical Support)
• The function is to advise and assist the Ministry of Health in formulating policies as well as strategies for monitoring T/CM activities in the countries.
• Members comprise professionals from research institutions, government agencies, universities, T/CM organizations (5 practitioner bodies), Malaysian Medical Association (MMA) and World Health Organization (WHO)
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Phases of development
• 1987– Position paper for Research Agenda in Alternative Medicine
• 1996 – Post-Cabinet decision to set-up organizational structure for
Traditional & Complementary Medicine in Malaysia– Unit of T/CM was formed
• 1998 – Formation of the Standing Committee on T/CM
• 1999 – Formation of the 5 T/CM Umbrella Bodies
• 2000– Formation of The Herbal Medicine Research Centre in IMR
• 2001 – Launching of the National Policy in Traditional and
Complementary Medicine
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Phases of development-II
• 2002– Cabinet approval for the development of Global
Information Hub for Integrated Medicine
– Cabinet approval for the setting up of the National Committee for R & D in Herbal Medicine
• 2003• National Institute for Natural Products, Vaccines and Biologicals
• December 2004• Division of T/CM in the Ministry of Health
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Government Policy on T/CM
• Launching of National T/CM Policy in 2001
The ground for implementation was reinforced with the launching of the National Traditional and Complementary Policy in year 2001. Five strategic areas has been identified namely practice, products, education/training, research and international collaboration.
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
National T/CM Policy
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
The Policy statements for T/CM
Promotion of proper practice of T/CM in accordance to standard ethics particularly in the Primary Health Care delivery system
Appropriate education and training of T/CM practitioners
Adherence to acceptable standards of safety and quality for products and practice
Facilitate the development of responsible advertisement with relevant agencies
Establishment of strong research and development activities in T/CM.
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
The Policy statements for T/CM (cont..)
Promotion and advocacy of T/CMFacilitate the development and protection of
intellectual property rights related to T/CM knowledge, culture and biological resources.
Conservations of plants and animals for progress of T/CM development with participation of all relevant agencies
Enhancing international technical co-operation and exchanges relevant to T/CM
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Current Regulatory Situation
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
The regulatory situation
(For traditional medicine products):
Control of Drug and Cosmetic Regulation, 1984
• Registration for Traditional Medicine Products – January 1992
• Ensure safe and quality product• More than 10000 products registered
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
The regulatory situation
(For traditional medicine products)Quality and Safety Criteria:
• Limits for heavy metals and microbial contamination
• Absence of steroids and other adulterants
• Prohibitions of herbs with adverse effect • Compliance to Good Manufacturing
Practice
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
The regulatory situation
(For traditional medicine products)Enforcement Activity:
• Control at entry points• Surveillance and Raids• Inspections – distributors and
retail outlet.• Prosecutions, confiscation and
penalties
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
The regulatory situation
(For traditional medicine products):Other laws that regulate the T/CM product industry:
• Poison Act 1952,• Sale of Drug Act 1952,• Advertisement and Sale Act 1956• Protection of Wild Life 1972 and
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
RESEARCH
• National Committee for Research and Development in Herbal Medicines (NRDHM)
• Ministry of Health as lead agency
- Set directions for research- Co-ordinate research, integrate clinical trials using
T/CM in Malaysia- Already produced guidelines for research to improve
standards of evidence
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Guidelines
• Guidelines for levels and kinds of evidence to support claims for therapeutic products
• Guidelines for the clinical evaluation of T/CM interventions
• Guide to intellectual property management
• Guidelines for standardisation of herbal medicinal products
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Published
Malaysian Herbal Monograph and Compendium of Medicinal Plants Used in Malaysia.
Established an Information Hub on Integrated Medicine for the World through Malaysia utilising strategic partnership with other agencies.
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
T/CM Practices
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Definition
• Conventional /Allopathic/Modern Medicine is defined as
Practice by holders of MD/MBBS or equivalent and by their allied health professionals (Physiotherapists, registered nurses etc)
Form of medicine supported and used by most government
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Definition
• Traditional Medicine The sum total of knowledge,
skill and practices on holistic health care,
Recognised and accepted by the community for its role in the maintenance of health and the treatment of diseases.
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Definition
Traditional Medicine (cont…) based on theory, beliefs and
experiences, that are indigenous to the different cultures and developed and handed down from generation to generation
WHO 2000
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Definition
Complementary Medicine
Refers to a wide range of health interventions which is recognised and accepted by the community for its role in preventing or treating illness or or promoting health and wellbeing.
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Definition
Traditional and Complementary Medicine (T/CM)
Traditional and Complementary Medicine practice together , is other than practice of medicine or surgery, by registered medical practitioners as defined in Medical Act 1971.
Malaysian Medical Council,Ministry of Health, Malaysia, 2001
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
T/CM Practice
• The government recognizes the role played by T/CM, supports its proper use, particularly as a community and individual practice
• Initiates efforts to bring proven traditional and complementary medicine into mainstream health services
• Takes measures to control its safe practice although not part of mainstream medicine
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
T/CM Practice
• Formation of practitioner bodies in 1999• 5 bodies namely; Malay, Chinese, Indian ,
Complementary and Homeopathy• MOH set up term of reference for the
practitioner bodies• T/CM practitioner bodies self regulate and
have developed criteria and standard of practice endorsed by MOH.
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
T/CM Division
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Director General Of Health
Deputy Director General[Research & Tech. Support]
DirectorT/CM Division
Practice TrainingPolicy & Development Administration & Finance
Organization Chart T/CM Division
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Objectives of T/CM Division
• To coordinate and implement various activities on T/CM especially in areas related with the practitioners, training and policy
– Product: by the National Pharmaceutical Control
Bureau– Research: NRDHM (IMR/NIH for MOH)
• Integration of T/CM into the National Healthcare
Delivery
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Current Initiatives of T/CM Division
• T/CM Bill – Currently Drafting• T/CM Division monitor entry of
foreign T/CM practitioners.• T/CM Division is in the process of
listing all the T/CM practitioners in the country
• Standardisation of training and practice
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Foreign Practitioners
• Thai Traditional Massage
• Ayuverdic Therapist
• Chinese Physician
• Reflexologist
• Acupuncturist
• Chiropractor
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Current initiatives of T/CM Division
– Establish standards of practice, procedure,
training etc for common modalities
– Technical Working Group (TWG) for each practice
– Start with acupuncture, reflexology, chinese physician, aromatherapy and massage (malay, thai, swedish, tuinalogy indian etc )
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
T/CM Training Centres
• Existence of Training Centres conducted by practitioner bodies– Federation of Chinese and
Acupuncturist Association of Malaysia– Federation of Chinese Physicians and
Medicine-Dealers Associations of Malaysia
– Chinese Physician’s Association of Malaysia
– Homeopathic
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Common T/CM Practices and Facilities
• Acupuncture together with moxibustion• Outpatient treatment for minor ailments• In patient rehabilitation for stroke
patients• Chinese Physician prescribing herbs and
decoction
• Pharmacy dispensing raw herbs.
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Common T/CM Practices and Facilities
• Reflexology • Massage
– Tuinalogy– Swedish massage– Thai Massage– Malay Massage (Post Natal Care)
• Homeopathy• Ayurvedic • Yoga, Reiki and others• Diet modification
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
INTEGRATIVE MEDICINE
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
T/CM in Primary Care
Widespread use of T/CM Continue to use T/CM as a result
of historical circumstances and cultural beliefs.
Availability of registered products – evaluated on safety and quality.
Use of Complementary therapies in wellness paradigm
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Definition
Integrated Medicine
Medicine that combines mainstream medical therapies and T/CM therapies, for which some high-quality scientific evidence of safety and effectiveness.– Practising medicine that selectively incorporates
elements of TM into comprehensive treatment plans alongside solidly orthodox methods of diagnosis and treatment
Alternative Medicine
The practice of medicine that is other than modern medicine, which offers as an alternative approach for treatment or management of health conditions. Alternative medicine is used in place of conventional medicine.
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Prerequisites before endorsing Integrated Medicine
– Adequate Information of T/CM• Potential clinical benefits, safety, risks
– Enough Scientific Evidence• Credible evidence-based information
– Appropriate Legislation & Enforcement• Law against illegal practices or misleading
labelling or claims
– Formalised training for T/CM practitioners
– Identify areas for integration: incremental
– Adherence to National T/CM Policy
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Planning ….
• Type of service to be provided
• Raise awareness
• Identify client/patients needs
• Keep people informed
• Identify existing networks and integrated services
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Planning ….Selecting practitioners:• Qualifications • Experience• Training history• Affiliations to professional
organisations• Code of conduct• Practice• Ethics
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Training
• Qualifications from accredited centres
• In service training
• Talks and demonstrations
• Practitioner networks and forums
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Allopathic Practitioners need to know T/CM
They may be asked on T/CM Patient wish to consult further on its
usage Possible interaction with modern
drug Contents of T/CM Clinical problems and
complaints resulting from usage.
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
RM-9
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Goal 1- Prevent and Reduce Disease Burden
To promote public awareness and education on the availability of safe T/CM practice
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Goal 2- Enhance Healthcare Delivery System
1. Regulation of T/CM practice and practitioners
2. Implementation and enforcement of T/CM Act
3. Accreditation of training centres4. Training (credentialing) of registered
practitioners5. Training of MOH personnel in selected
T/CM6. Pilot selected T/CM to be integrated into
existing healthcare facilities
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Goal 3 – Optimise Resources
To harness interagency collaboration locally and globally with all relevent stakeholders to ensure the availability / access to safe, efficacious, affordable T/CM Services.
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Conclusion
Global population ageing bring greater incidence of chronic disease and T/CM offer a potential means for managing such diseases.
In developed countries, more and more people are using T/CM in combination with allopathic medicine — to help relieve chronic pain and/or to improve quality of life.
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia
Conclusion To ensure optimal use of T/CM. ➤ integrate T/CM with national health care
systems, and implement National T/CM Policies and Programmes
➤ promote the safety, efficacy and quality of T/CM by expanding the knowledgebaseon T/CM, and by providing guidance on regulatory and quality assurance standards
➤ promote therapeutically sound use of appropriate T/CM by providers and consumers.
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Traditional and Complementary Medicine DivisionMinistry of Health Malaysia