Traditional Health Practitioners Bill: public hearings

Meeting report

HEALTH PORTFOLIO COMMITTEE
15 November 2007
TRADITIONAL HEALTH PRACTITIONERS BILL: PUBLIC HEARINGS

Chairperson: Mr L Ngculu (ANC)

Documents handed out:
Traditional Health Practitioners Bill [B 20-2007]
National Coordinating Committee for African Traditional Health Practitioners of South Africa Submission
Traditional Chinese Healers Association Submission

Audio recording of meeting

SUMMARY
The Committee received further submissions on the Traditional Health Practitioners Bill (the Bill). The Ethnomedicine Practitioners Association of South Africa (EPASA) believed that the interim council should have professional boards for each traditional profession appearing in the Act, who would then regulate education, training and practice of the various professions. Institutions should train traditional healers, and they should be funded by government. All professions should be equally represented on the interim Council. Members questioned whether ethnomedicine could be considered traditional African medicine, as it seemed to cross over several disciplines, including hypnotherapy and pharmacology. EPASA was asked for its suggested definition, but Members remained concerned that this Association should be registered by the Allied Health Professions Council, and suggested that the Department of Health must take up the reasons why this was not done with the Council.

The National Coordinating Committee for African Traditional Health Practitioners of South Africa suggested a minimum period of experience of five years should be inserted into the Bill in relation to subsections of Section 7, and that the attorney or advocate representative should have five years experience in his field and some knowledge on the traditional health practices. It further suggested the removal of the proposed section 9(g). Members were concerned that this suggestion might be unduly prescriptive, although the concerns were understood.

The Traditional Chinese Healers Association was concerned that its practitioners were not registered under this Bill as the Allied Health Professions Council, their registering authority, did not recognize traditional philosophies and training methods. Members were of the view that since the practitioners were already registered elsewhere, they could not be regulated by this Bill.

MINUTES
The Chairperson welcomed the remaining stakeholders and advisors.

Ethnomedicine Practitioners Association of South Africa (EPASA): Submission
Dr Jacob Letsolo, Administrator, EPASA, said that he was not going to repeat his written presentation, but would concentrate on three matters. He submitted that the interim council should have professional boards for each traditional profession that appeared in the Act. The reason was that these boards would then be responsible for regulating education, training and practice of the various professions, and the council should only intervene when the boards failed to do their duties. The second issue was that there should be institutions that should train traditional healers. He suggested that these should be funded by the government. He also suggested that this would ensure a smooth integration in the primary health care system. Finally he believed that to make the interim council effective all professions should be equally represented.

Discussion
Ms M Madumise (ANC) asked if EPASA had ever had the chance of submitting anything during the public hearings in the provinces.

Dr Letsolo replied that EPASA did get invitations to make their submissions in Gauteng but the provincial hearings were not satisfactory, as most of the groups that were present did not get the chance to make their presentations and the hearings ended up with some groups ‘toyi toying’. As a result they were forced to submit a written presentation and did not have the chance to present their submission orally.

Ms M Matsemela (ANC) asked if ethnomedicine could be considered an African traditional medicine.

Dr Letsolo replied that ethnomedicine was an art and science of traditional medicine, and was part of traditional medicine, but it also included chemistry, pharmacology and hypnosis and other matters. In addition, EPASA expected their practitioners to have knowledge of pharmacology as well as immunology. Ethnomedicine could be considered broadly as part of African traditional medicine.

Ms Matsemela asked if he was suggesting that the traditional practitioners be covered under the health conventional council board, since he was bringing up the issue of professional boards.

Dr Letsolo replied that other professions had professional boards but traditional medicine was new. He was of the opinion that it would be beneficial to have a professional board as this meant that there would be proper standards in place and in turn this would translate to better working practices. The setting of standards would allow them to benchmark practices and this would mean that the quality of work would be high. The different professional boards would then control their own practice’s education, training and ethics.

Mr A Madella (ANC) asked for the suggested alternative of the definition of traditional health practice, since EPASA had complained that the current definition did not include ethnomedicine.

Ms R Mashigo (ANC) remarked that in some provinces there were traditional practitioners that had good working relationships with the hospitals. She wanted to know if EPASA thought that this was not enough, and whether the relationship should be formulated in another way.

Ms Madumise asked if EPASA could explain more on the accreditation of practitioners.

Dr Letsolo replied that the accreditation would be done by the professional boards, as accreditation was a process. The boards would be able to pick out the professional practitioners and the ones who still needed to be trained. Moreover, allowing the professional boards to do the accreditation would ensure equality among the various traditional medical practices.

The Chairperson remarked that Dr Letsolo’s presentation allowed the Committee to deal with the issues raised systematically. He asked Dr Letsolo what the suggestion of EPASA was for the definition.

Dr Letsolo replied that he was uncomfortable with the word “object” in the definition of traditional health practice as traditional practice did not use objects or substances for diagnosing patients. Substances were only used for the treatment of patients so he was not sure if this was the proper sounding for traditional medicine.

Mr M Kweta, Chief State Law Advisor, Office of the Chief State Law Advisor, replied that EPASA should not just read the word “object” in the definition in isolation but should read the definition holistically, taking the whole Act and what it was trying to achieve into consideration. Moreover, he should look at the fact that the definition was written in such a way that it would encompass all the traditional practices.

Ms S Kalyan (DA) commented that she was comfortable with the use of the word “object”. She was looking at it from the point of view of those practitioners who used, for example, natural stones to calm people. Stones were regarded as objects.

Ms Matsemela commented that she did not think that ethnomedicine fell under what they would typically call traditional health practice.

The Chairperson asked if the association ever considered registering with the Allied Health Professions Council.

Dr Letsolo replied that they had considered this but the Allied Health Professions Council was of the opinion that EPASA’s practice did not fall under their regulation. A similar response had been obtained from other medical practitioners whom they had asked first.

Ms Kalyan commented that she was of the opinion that the Association’s request that they be considered as part of the African traditional health practitioners was a last resort, considering that they had been refused by the other boards. She definitely did not think that they should be regulated by the Bill because their practice was not limited, but contained a lot of overlapping between the disciplines. These included hypnotherapy and psychotherapy, which could not even be considered as African traditional practice.

Dr Letsolo replied that he was offended by Ms Kalyan’s remarks because, based on the definition he gave the committee; ethnomedicine was a pure component discipline of traditional medicine.

Ms Kalyan apologised that she did not mean to offend Dr Letsolo.

Ms R Ramatsoi, Administration, NDOH, commented that the categories that were covered in the bill were those that the Committee defined as being based on African medicine traditional practices. Ethno medicine was not included because it was not entirely based on African traditional medicine.

Prof Ronnie Green-Thompson, Special Advisor to the Minister, was of the opinion that the ethnomedicine association should be regulated by the Allied Health Professions Council. He did not understand why their request was refused. He suggested that the Department of Health should go to the Council and find their reasons for refusing to regulate the ethnomedicine association as this was a discipline that was clearly in their field.

The Chairperson asked how long had EPASA existed.

Dr Letsolo replied that they had been in existence since the 1980’s. During this time there were no traditional organisations that were being recognized, and EPASA was the first African traditional medicine outfit to be given any form of recognition.

The Chairperson supported Prof Green-Thompson’s suggestion as he agreed that EPASA should be regulated somewhere.

Mr M Walters (DA) asked if the Committee were going to get the feedback before the close of the public hearings.

The Chairperson replied that this was impossible as it was the last day of the public hearings.

Dr Lotsolo remarked that he was dispirited about the outcome as EPASA had such high hopes considering that ethnomedicine was part of the African traditional medicine.

National Coordinating Committee for African Traditional Health Practitioners of South Africa (NCC): Submission
Mr L Nduku, General Secretary, National Coordinating Committee for African Traditional Health Practitioners of South Africa informed the committee that the headquarters of the organisation were in Umthatha, Port Elizabeth. The NCC had been fully consulted throughout the drafting process of the Bill and they fully supported it. However, they were of the opinion that in Chapter 2, Sections 7 (a) (b), (e), (h) and (i) the Chair and his Vicechair should have five years experience. They also believed that the various practitioners should have at least five years experience of the law as well as some general knowledge of the African medicine. The community representative should have some knowledge on the traditional health practices. They further submitted that Chapter 2 section 9(g) should be removed or alternatively that its operation be suspended for a certain period.

Ms Matsemela asked if the NCC did not think that there were contradictions between the sections they had clearly outlined in their presentation, and the one they had not.

Mr Nduku replied that this was the reason they their submission suggested that the minimum prescription of five years be clearly outlined.

Mr Walters asked why the NCC was not concerned over the requirement of five years for the community representatives.

Mr Nduku replied that these were representatives to the committee and needed simply a general knowledge, whereas the other named professions were acting in a professional capacity. The nature of their profession was such that experience counted for everything.

Ms Kalyan asked if he could clarify whether NCC meant that the attorney or advocate should have five years experience, as well as knowledge of the traditional health.

Mr Nduku replied that indeed that was the NCC submission. It would be counter-productive for the Council to have a representative who did not even know the workings of the traditional health.

Ms Kalyan commented that she was not even sure that they would find attorneys or advocates of such caliber, as the pool was either very small or non-existent. If the NCC could suggest where such people could be found then this would be a good start.

Ms Kalyan asked why NCC wanted the different categories of Traditional Health Practitioners to have at least five years experience as this very prescriptive. and one could get an experienced and competent practitioner who might have less than five years experience. The five years did not necessarily translate to competency. She wondered if outlining this would not be unduly prescriptive.

Mr Nduku hoped the Committee understood the complexities of the profession. The whole profession was primarily based on the number of years of experience. There were some things that a person with fewer years of experience would not have gone through, and it was believed that having a less experienced person would definitely compromise the quality of their work.

Mr Nduku remarked that he hoped they would take the issue of experience into consideration when looking at the Chairperson of the Council, since the profession was experience based.

The Chairperson commented that the Committee did understand their anxiety but said that perhaps it would not be necessary to repeat everything and codify everything, as some matters could be left to logic.

Traditional Chinese Healers Association (TCHA) Submission
Mr Peter Siyata, Traditional Chinese Healers Association (TCHA), told the committee that the Bill must be commended for its acknowledgement of traditional health. The TCHA was concerned that their practitioners were not covered under the definition of traditional health practice. He added that although they were registered under the Allied Health Professionals Council the board did not recognise traditional philosophies and training methods. He submitted that the Bill could accommodate the classical Chinese Healers without any adaptation, because they were of the opinion that they should be regulated by the Traditional Health Practitioners Council.

The Chairperson remarked that what they had been presented fell outside the ambit of the Bill. The Traditional Chinese Healers were already being regulated by the Allied Health Professions Council, and therefore they could not be included in the Traditional Health Practitioners Bill.

The meeting was adjourned.