As Slikkerveer (2003) states, since the times when the European countries made great discoveries in the non-Western world, medicinal plants and herbs have always played an important role in the development of medicine and public health in both Western and non- Western countries. Gradually, however, the interest in traditional medicinal plants as a potential resource for the Western medical world had weakened in the wake of the discovery of more advanced medical technologies and antibiotics which have been produced since the end of the nineteenth century.
However, growing dissatisfaction with the ineffectual responses and unaffordability of bio-medicine in treating various diseases such as cancer, hepatitis and HIV/AIDS, not to mention mental disorders, has elicited a debate on the possible integration of traditional and modern medical systems, as alternative therapies seem to provide low-cost solutions.
In addition, Farnsworth et al (1985) point out, that in the estimation of WHO, about 80% of the world population uses some kind of herbal medicine and that the majority of the population in developing countries continue to depend on the use of traditional herbal medicine for their primary health care needs. Considering difficulties in meeting the need for essential drugs in many developing countries, the revitalisation of interest in traditional medicine in developing and developed nations has led to an overall reassessment of the way in which basic health services are made available in the 1970s, causing the WHO (1978) suitably to redefine its strategy of accomplishing ‘Health for All’ by introducing the concept of Primary Health Care (PHC). The new strategy, developed at the conference in Alma Ata (WHO 1978) refers to: ‘essential health care made accessible at a cost that the country and community can afford’, and is based on the principles of fairness, participation, suitable technology, prevention and an intersectoral approach to public health problems. Among the programmes which are executed, the provision of essential drugs, the promotion of health and the partnership with traditional healers and birth attendants opened up new health policy options for making use of local resources, especially traditional and herbal medicines.
Meanwhile, Quah (2003) has stated that various factors have begun to encourage mutual study between the biomedicine and traditional medicine although these two fields have already existed together concurrently in the same place in corresponding but diverse worlds. The most important of these factors is the search for success in the controlling and curing some serious diseases; new developments in science and technology; a revived interest in cultural heritage; and the fascinating possibility of finding concealed treasures in each other’s field. Warren et al (1995) claim that this new strategy has resulted largely from a renewed theoretical interest in ethnoscience; an essential step required to operationalize and apply indigenous peoples’ ideas and practices in the socio-economic development process. Later, this successful integration of local knowledge into the health care development process was well documented for various cooperation projects and programmes around the world. The outcome has been, as Slikkerveer (2006) elaborates, that many health care development programmes have been successful in increasing the integration of indigenous medical remedies, perceptions and practices into the formal health care systems, on the basis of
economic factors and even more in appealing to a more participatory and sustainable form of integrated health care for the entire population in the country.
However, Quah & Slikkerveer (2003) note, in spite of the success of some of the approaches and strategies which are intended to integrate traditional and modern medical systems. It has to be acknowledged that the related concept of ‘Health for All 2000’ (WHO 1981) has not yet been realised. Currently, a large number of people living in the rural areas in the tropics still have no access to adequate health care, which is often only partly based on the incorporation of traditional healing and midwifery. Mostly, as a result of the artificial division which sometimes opposes bio-medicine and ethnomedicine, the expected integration is still facing several theoretical and methodological complications which need further study and analysis.
In line with the Recommendation of the International Conference on Primary Health Care of the WHO/UNICEF in Alma Ata (1978), confirming that proven traditional remedies should be incorporated in the national health care services, and the subsequent Global Strategy for Health for All by the Year 2000 (1981) with the purpose of improving the health care system in the country, the Indonesian government has officially incorporated the use of herbal medicine into its health policy. The legal basis of the use of traditional medicine has been ratified in three legal documents: in the guidelines for national health care (Article of Law No 9/1960); on pharmacy (Article of Law No 7/1963); and the National Health Care System and its policy on the use of traditional medicines (cf. Slikkerveer & Slikkerveer 1995).
Traditional medicinal practices which use tried and tested methods are rooted in the socio- cultural background of the community and can be categorized as an appropriate technology, since the necessary materials are found around about in the environment of the community and are easily available, cheap and easy to prepare. As Balick & Cox (1996) note, the World Health Organization (WHO) claims that approximately more than 3.5 billion of the population of the developing world still depends on the use of plants in Primary Health Care.
Countries in South-East Asia have a long heritage of traditional medicine which has been used in the health care of its people from time immemorial. In spite of the influx of modern medicine, traditional medicine is still widely popular and provides a very large component of health care. Accordingly, a number of developing countries have decided to integrate traditional medicine into their primary health systems. These countries have realised the potential of traditional medicine and have taken steps to promote it as part of their national health care systems.
As traditional medicine has existed throughout the whole of Indonesia from the beginning of time Indonesian people have been using herbs and medicinal plants for the treatment of ailments for centuries. Traditional healers or dukun treat a variety of illnesses, whether physical, emotional or spiritual origin using combinations of herbal and sometimes magical means. In North Sumatra, some ethnic healers such as the Karo bone-setters are traditional healers who are specialists in setting broken bones and who practise their skill in clinics.The ubiquitous herbal medicines and tonics called jamu are both home-made and mass produced. Home-made jamu is often simply used as a home-remedy for ailments occurring in the family but home-made jamu is also sold by the jamu gendong7. Commercial brands of herbal medicines and tonics are sold throughout the country by jamu vendors penetrating far into remote areas.
Traditional herbal medicine is a cultural heritage which has been handed down from generation to generation. Initially, plants used for home-remedies are cultivated in home- gardens, called Apotek Hidup (Living Pharmacy). More recently, the use of medicinal plants as well as the cultivation of medicinal plants for the family (tanaman obat keluarga or
TOGA) has contributed to building up the knowledge of medicinal plants among the local people (cf. Slikkerveer & Slikkerveer 1995).
In its effort to empower the community, especially in the field of traditional medicine, and to improve the level of health condition through self-care and use of home-remedies, the Centre for Development and Application of Traditional Medicine(Sentra Pengembangan dan Penerapan Pengobatan Tradisional or SP3T) was established in the province of West Java in 1997. The establishment of the centre was based on the Decree of the Health Minister in 1995 (SKM No.0584/Menkes/SK/VI/1995), showing its concern in the increase of the use of traditional medicine in the country. The functions of SP3T are to monitor, study and conduct research on traditional medicine and to execute pre-clinical and clinical trial testing of traditional medicine. It also has a duty to organize education and training of selected traditional treatments (SP3T 2001). It must be especially vigilant to stamp out the production of the so-called illegal jamu. These jamu are mass produced by irresponsible jamu
manufacturers, who do not follow the regulations for a properly manufactured product, and therefore can harm users of traditional medicine.
Meanwhile, the dissemination of information about medicinal plants to be used by the family (TOGA) 9,to people living in urban and rural areas has issued a new challenge to the Community Health Centre Development in Indonesia in general, and to the province of West Java in particular. It has to be said that the use of local resources and the involvement of the community in health care are both very much in line with the concept of Community Health Care. In 1997, to socialize the cultivation and use of medicinal plants, the SP3T arranged an annual competition for TOGA in co-ordination with the prominent Pemberdayaan Kesejahteraan Keluarga (PKK) (Family Welfare Empowerment).