Indonesia has a wealth of biological resources and is home to a large number of different ethnic and cultural groups, many of which have developed their own, distinct health care systems. As a result, the country is rich in both biological resources and traditional medicinal knowledge. Moreover, it is believed that the situation of traditional medicine in Indonesia is more or less characteristic for that in several other countries in the region.
Concept of illness
A traditional healer is someone known to and acknowledged by the community as a person who can provide traditional treatments. Healers may have inherited their skills from their ancestors or obtained them by studying, via apprenticeship, by divine inspiration or by meditation. The scope of services they provide is usually quite comprehensive and may include health promotion as well as preventive, curative and rehabilitative care.
The concept of health and illness held by the traditional healers is similar to that of the local community, in which 'health' refers to a normal, proper and comfortable condition, which enables a person to undertake normal daily activities - this is in fact quite similar to the 'modern' definition. Broadly speaking, causes of illness are being categorized as naturalistic or personalistic. The naturalistic causes include environmental factors, food related factors, life style imbalances and changes in season. Personalistic causes include a belief in magic, (evil) spirits and disharmony in the relation with God or with other people as the reason for illness.
While modern or western medicine remains the mainstream of health care in the country, traditional medical treatments continue to enjoy considerable popularity and continue to be practiced by numerous healers and practitioners all over the country. Traditional medicine, apparently, is perceived as efficient, safe, cost-effective and affordable; moreover, it is accessible, especially for the poor and for those living in remote areas, who tend to depend more on traditional and herbal medicines than people living in urban areas. Furthermore, during the past decade, the utilization of traditional medicine has increased sharply, partly because formal health care became less accessible and less affordable due to the economic crisis.
Traditional and conventional health care
Apart from some experimental exceptions, in Indonesia, traditional and conventional or 'modern' health care services are not integrated; they merely co-exist. Integration only seems to take place at the level of individual patients, who are known to switch between different systems of care.
In recent years, the Indonesian Ministry of Health has adopted a policy of trying to modernize traditional medicine, while retaining its identity. This modernization encompasses several aspects, such as improving diagnosis through the use of modern techniques while providing treatment by traditional methods, as well as modernization of the production processes and quality control of traditional medicines. The latter takes place via the introduction of Good Manufacturing Practices and via the development of a registration system and of quality specifications for widely used herbal materials and preparations1. The modernization policy also includes efforts to encourage scientific research, including clinical trials, to document the effectiveness of traditional medicines; such empirical evidence is required to make the use of these products acceptable to the medical profession, and therefore, ultimately, in order to integrate these different systems of health care.
1 For practical reasons, these measures are mainly directed at large and medium-size enterprises and their products.
However, research as well as further development of Indonesian traditional medicine is complicated by a number of problems, including:
• many old recipes cannot be traced and/or are missing;
• preparations may contain multiple ingredients, rendering it difficult to establish which agent is responsible for -or contributes to- which therapeutic or side-effects;
• the same herbs, grown in different areas, may contain somewhat different active substances, may contain different quantities of those substances and may be known under different names, complicating comparisons as well as standardization efforts;
• there are no clearly defined standards for effectiveness and toxicity for most finished preparations, nor, at times, for individual ingredients.
Data and inventories
It has been estimated that Indonesia's natural wealth includes more than 10% of the world's plants, thousands of which are used for treatment of diseases. Out of those, some 900 have been investigated for medicinal properties. But while a number of efforts have been undertaken to study and/or make an inventory of the medicinal plants used in certain parts of the country, the resulting databases and inventories of biological resources and traditional medicinal knowledge are scattered among different sectors, research institutions and organizations.
Therefore, the Ministry of Health feels there is a need to coordinate the collection of data on biological resources and traditional knowledge about their medicinal use. At the same time, it would be beneficial to integrate the existing inventories in a single database, accessible to all parties concerned, notably health care providers, researchers and communities. Currently, because the data and information are not systematically arranged, it is difficult to disseminate them or to provide easy access. In fact, the Ministry envisages to establish an information and documentation network on traditional medicine; this is currently under discussion with relevant stakeholders. The idea is to develop a comprehensive traditional medicine database, covering methods of treatment and traditional drugs, in order to strengthen the development and use of traditional medicine2.
2 Note: such databases, especially if made public, have considerable IPR implications, see paragraph 6.3. Thus, sufficient protection should be provided for the knowledge holders and/or access to the database should be under their control.
Cultivation and conservation
During the last ten years, the development and use of medicinal plants has become more intensified, thus increasing the exploitation of biological resources. As a result, the importance of protection of those biological resources against unsustainable over-exploitation has increased. So far however, conservation efforts have been inadequate.
Cultivation of medicinal plants, on the other hand, has been undertaken by some research institutions and NGOs, as well as by some commercial jamu companies wanting to secure their supply of raw materials. Moreover, some years ago, the Ministry of Health has launched a campaign to promote the development of community or family medicinal gardens, in order to stimulate both the use of traditional medicine for common ailments and the cultivation of medicinal plants. The campaign, which initially took the form of a nationwide competition, among others encouraged participants to mark the names of the medicinal plants they cultivate.