By Yaw Owusu-Ababio
A pluralist healthcare system or medical pluralism describes a system where there are different approaches, treatments, and institutions available to people to maintain health or treat illness (Khalikova, 2023).
It is usually characterised by the prevalence of Allopathic medicine (Western or biomedicine) and what is variously termed as ‘traditional medicine’, ‘complementary’ or ‘alternative medicine’. Like other facets of Ghanaian society, Ghana’s healthcare landscape is described as pluralistic. Western medicine and traditional medicine have existed with each other in Ghana since the advent of colonisation.
Before the arrival of Europeans, indigenous people had ways of treating diseases. Through oral tradition, African traditional religion, cultural practices, and conventions, the indigenous Ghanaian people have had techniques of treating and managing illnesses, some of which exist today.
Historians have noted the methods, characteristics, and differences of these techniques, according to the different ethnic groups existing within the country. Western medicine, on the other hand, is said to have been introduced in Ghana in 1844 when British medical officers were sent to the Gold Coast to care for colonial administrators (Twumasi, 1979).
Several factors have contributed to maintaining the pluralist nature of Ghana’s healthcare landscape. Urbanisation has continued to promote Western medicine due to the necessity for machines and equipment for allopathic diagnosis and surgical procedures.
It is no coincidence that Western medicine practitioners gravitate toward urban areas. Certain cultural and traditional practices, beliefs, and customs influence the resort to traditional medicine.
The type of illness prevailing in a certain period or area has had a bearing on the medical system that people have selected – the behaviour of people during endemics and pandemics of recent years has re-emphasised this. Undoubtedly, financial considerations and availability also inform the choice of one over the other. So, the difference in choices does not strictly rest on the rural-urban divide.
The legal system of Ghana has evolved to cater for this social context. The right to good health care, although not expressly provided as a fundamental human right under the 1992 Constitution, is an indispensable right available to the people within the territory of Ghana.
A holistic reading of the Constitution and Ghanaian case law buttresses this assertion. Statutes passed by Parliament, however, provide a clearer view of the legal framework of the pluralist health system. These statutes cover health care facilities, professionals, and related aspects of healthcare.
An important starting point in the overview is the distinction between the Health Facilities and Institutions Act, 2011 (Act 829) and the Traditional Medicine Practice Act, 2000 (Act 575) as regards regulation of health facilities. Section 25 of Act 829 explains that ‘health care services’ means ‘allopathic medicine’.
Section 42, Act 575 concerns itself with ‘traditional medicine’ being ‘practices based on beliefs and ideas recognised by the community to provide health care by using herbs and any other naturally occurring substances.’ While Act 829 concerns itself with medical and dental facilities, geriatric, nursing and maternity homes, biomedical and diagnostic laboratories as well as prosthetic and orthotic clinics, Act 575 regulates herbal centres, pharmacies, and psychic shrines.
With respect to healthcare professionals, it is observed that practitioners of Western medicine in Ghana are governed by the Health Professions Regulatory Bodies Act 2013 (Act 857).
This law consolidates the legislation governing the Medical and Dental Council, Nursing and Midwifery Council, Pharmacy Council, and Psychology Council under one statute while establishing the Allied Health Professions Council.
The Traditional Medicine Practice Council established under Act 575 retains governance over practitioners of traditional medicine. Medical herbalists, traditional birth attendants, psychic healers, and other like practitioners fall here.
The field of Complementary and Alternative Medicine, which has gained popularity in recent years, is also governed by the Traditional Medicine Practice Council. Although this regulation is not expressly stated in Act 575, the decision to subsume this field of practice under the Act is consistent with reasoning and necessary for the regulation of Ghana’s health care space. Thus, facilities and practitioners concerned with Homeopathy, Acupuncture, Naturopathy, Spas, and other alternative health practices come under this heading.
The opinions on the merits and demerits of operating such a system continue to evolve and will linger into the near future. At the end of the day, the system is borne out of people’s choices in light of available health care resources. It is therefore important for the populace to know the legal framework regulating their options.
BYLINE
Yaw Owusu-Ababio is a lawyer with expertise in, among others, health law and private healthcare regulation. He is reachable on [email protected].
