South Africa's comprehensive regulations for homoeopathy have set a high standard for how homoeopathic doctors are able to practise, but proposed restrictions in the Department of Health’s published draft scope of practice for homoeopathy which recently closed for public comment, could jeopardise patient access to essential treatment, writes Bianca de Canha in Health-e News.
The homoeopathy profession is legislated under the Allied Health Professions Act and regulated by the Allied Health Professions Council of South Africa (AHPCSA).
Registration with the council also requires homoeopaths to have completed a six-year full-time degree at one of two accredited tertiary institutions: the University of Johannesburg and the Durban University of Technology.
The scope of practice published by the National Department of Health sets out how homoeopaths can practise in the country, including the procedures and actions they can undertake and medicines they are allowed to dispense. The public submissions are currently being collated by the department, after which they will be reviewed by the AHPCSA.
The council will decide whether to incorporate amendments based on the submissions and gazette these changes.
Regulation of homoeopathy should be supported because it advances the common goal of ensuring safe use of homoeopathic medicine and effective healthcare. But harmonising the laws and regulations governing homoeopathic practice and integrating them into the public healthcare system can only make it stronger.
Impact of the limitations in the draft scope of practice
The latest draft scope of practice has raised some concerns because it places limitations on hundreds of medicines and therapies required by homoeopaths to do their work.
Homoeopaths must have access to the full range of medicines they require to do their job. This includes injectable homoeopathic medicines and a range of combination complementary medicines, both of which are limited by the current draft scope of practice.
Complementary medicines have been previously available to us to use and prescribe.
If these limits remain in the final version published by the Department of Health, it will have a significant impact on thousands of patients who have chosen homoeopathic care for themselves or their families, as well as those who use homoeopathic care in combination with conventional medicine.
This includes rural communities, where homoeopathy is playing a growing role in providing healthcare in under-resourced areas.
The Khula Natural Health Centres are rural homoeopathic clinics helping to treat thousands of people in communities in Limpopo, the Eastern Cape and KwaZulu-Natal. An independent survey conducted at the KZN clinic showed that 95% of people attending the facility reported that their health had improved since visiting (versus 20% at clinics and hospitals).
In some areas, people travel more than 100km to seek healthcare at these clinics, which are bringing services closer to communities while also alleviating some of the burden on public healthcare facilities. It’s therefore essential that the homoeopathic doctors at these clinics can access the full range of medicines needed to provide quality care.
We have seen the impact that incorporating homoeopathic care into the primary healthcare system has had in other BRICS countries. In India, for example, including homoeopathy and traditional medicines into the public healthcare system has helped the country reach the universal healthcare target ratio for doctors to patients.
Homoeopaths could also play a valuable role in task-shifting, freeing up medical doctors for more complex cases. Task-shifting is already being done in the healthcare system, for example, specialist primary healthcare nurses can dispense the contraceptive pill, rather than requiring a doctor to prescribe it.
Allowing homoeopaths to play a role in task-shifting would free up doctors to take on more pressing cases, it would also allow patients quicker access to the healthcare service they need.
The average cost to treat a patient at a Khula Clinic is R600, compared with R3 332 in the public healthcare sector. At almost six times cheaper, incorporating homoeopathy would allow budgets to stretch even further.
Access to essential medicines list
Because we believe homoeopaths have a significant role to play in advancing healthcare access in South Africa, our submission on the draft scope of practice also made an additional request – access to prescribe drugs on the essential medicines list.
Homoeopaths are not conventional medical doctors, nor do we seek to be. However, there are instances where access to certain conventional medicines could have a real impact for patients – especially in rural areas.
As an example of this, a woman taking her baby to the Khula Natural Health Centre for care must also travel to her local clinic for contraceptive care. With access to specific medicines like these, both she and her baby could be helped in the same place without having to use more of her time and limited resources to travel further to access this essential care.
This kind of collaborative approach between conventional medicine and homoeopathic care provides a significant opportunity to improve public health outcomes in a cost-effective way. The government has an opportunity to improve public health outcomes by harmonising the laws and regulations governing homoeopathic practice and integrating them into the healthcare system.
Getting the scope of practice right is a critical first step, because without access to medications, the accessibility and reach of this vital healthcare option will be significantly compromised.
Bianca de Canha is president of the Homoeopathic Association of South Africa
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