The practice and regulatory effects on naturopathy in Ghana: Qualitative perspectives from naturopathic doctors in training

Is a Ghanaian Naturopathic regulation needed and why?

A respondent who appeared very to be an experienced Naturopathic Medical Student at level 300 wrote:

“For naturopathy to be embraced in the modern medical world, there is the need to establish it as an evidence-based medicine that calls for regular and long-term clinical trials on a large scale to help collect scientific evidence of the efficacy of naturopathic treatments in addition to rigorous academic training that prepares the naturopathic workforce. While efforts are underway to ensure this, the non-regulatory nature of the profession which was a major setback in many countries in which it was practiced is also being critically looked at in many countries of the world.

The importance of regulation for naturopathy has been recognized around the world. The World Health Organization (WHO) recognizes the use of complementary and alternative medicine among its member countries and has called for naturopathic regulations in member countries. The World Naturopathic Federation (WNF), also encourages professional naturopathic associations in countries where there is no national regulation to engage in self-governance activities that protect the public as they work toward regulation. Statutory regulation of the naturopathic profession currently exists in countries across most world regions including Europe, North America, Asia, and Latin America. Currently, two African countries, South Africa and the Democratic Republic of Congo, namely have regulations and Ghana will soon follow suit. Regulations are an important aspect that will help prescribe the range of treatment practices, product production, training, and determination of who uses the title of a naturopath or naturopathic doctor among others.

The naturopathic profession in Ghana is undergoing a period of rapid professional growth and change and now is the opportune time to establish regulations that will oversee the practice of Naturopathy in the country. Therefore, in line with the WHO’s Traditional Medicine Strategy, Nyarkotey College of Holistic Medicine and Technology (NCHM&T), which harbors the only world-recognized naturopathic physicians association of Ghana, with support from WNF and the Traditional Medicine Practice Council (TMPC) of Ghana, has taken giant steps to ensure regulation and accreditation of the naturopathic profession in Ghana to promote the highest quality in standards of education and practice for naturopaths in Ghana.

This laudable step taken by the NUCHMT will ensure regulatory frameworks exist to ensure practitioners meet the professional and educational requirements before they can claim to be practitioners of naturopathy. Also only legally registered practitioners with the TMPC and the national association of naturopathic physicians can practice naturopathy, with a further regulatory extension on product manufacturing and selling as well as clinical modalities and practice. In addition, the regulatory body set up for naturopathy will handle complaints from members of the public regarding the standards of treatment received by individuals who use the title of ‘naturopath’ or ‘naturopathic doctor ‘in their various facilities.

Regulation of the naturopathic profession will not only enhance the status of naturopathy and its acceptance by the biomedical world but would also serve as a mechanism for protecting the public from unqualified individuals who provide services when they are not qualified to do so. Regulation is therefore needed as an important step in the progress and practice of Naturopathy in Ghana” (Respondent 1)

Respondent Two (2) believes that it is a laudable document that aims to provide a framework for Naturopathic practice in Ghana.

“The Ghana naturopathic regulation is a policy document which seeks to standardize and give policy direction to the education and practice of naturopathic medicine in Ghana. In my view, Ghana’s naturopathic regulation is needed. Because over the years, the absence or lack of proper regulation has allowed the influx of all kinds of substandard practices in the country. This regulation is adopted; will serve as a guide for naturopathic doctors and naturopaths in their practices, both legally and clinical service delivery”(Respondent 2).

Respondent three (3) also opined that there are too many fake practitioners in the system and this regulation needs to be adopted.

“In Ghana, there are many fake practitioners in the industry who identify themselves as Naturopaths; hence appropriate regulations are needed to minimize the risks of naturopathic practice, also inappropriate regulations may increase the risks of bad naturopathic practices in the Country.

This means that standards are very important in this profession and if we want to be recognized and accepted in the modern healthcare dispensation then standardization is very necessary and serves as a measure for our practitioners. Without standards, everyone is entitled to do whatever pleases him or her in the industry” Respondent (3).

Respondent 22

“Yes needed! No doubt the importance of naturopathic regulation has been recognized around the world. The World Naturopathic Federation (WNF) is an organization for the promotion of the naturopathic profession on a world scale and is building a relationship with the World Health Organization WHO to improve global access to naturopathic medicine.

In line with WHO’s Traditional Medicine Strategy, the WNF supports regulation and accreditation of the naturopathic profession around the globe and aims to promote the highest quality standards of education and practice for naturopathic practitioners, and since is a medical profession, it needs regulations so that its members would be protected and for that matter any individual who do not meet the required training standards, requirements and license could not practice naturopathy in Ghana.

The regulation would also help to implement the education and practice standards for the profession. For example, an individual must meet the expected training and practice standards set by the Ghana Medical and Dental Council before they can claim to be a ‘medical doctor. So, whoever wants to be called a naturopathic doctor or naturopath or practice naturopathic medicine in Ghana must have attained medical training from an accredited institution and also pass licensure exams from the board to be qualified to practice naturopathy.

At present, due to the absence of statutory regulation of naturopathic medicine in Ghana, anyone can claim to be a naturopathic doctor or naturopath or herbalist without no medical education and licensure which has become a public threat by causing more harm to the public.

Therefore, the need for naturopathic medicine regulation in Ghana would help to standardize the practice for only medically trained professionals to allay the quackery practitioners from the system by promoting a safe healthcare delivery system and also protecting its members, and ensuring successful completion of naturopathic education from an accredited naturopathic medical school, acquisition of license with competence-base practice and high in-depth in the field of naturopathy”.

Respondent 18 also explains

“The essence of regulation in any jurisdiction, institution or profession is to instill law and order in the profession, supervise and monitor activities of the profession to safeguard and protect the lives of people who patronize the products of that profession.

Professionals like lawyers, doctors, pharmacists, nurses, and midwives, etc are all regulated by state-sanctioned, legally constituted bodies that have rules and regulations, a code of conduct that covers every area in their profession. This is expected to serve as a guide for the members and refrain them from all acts of indiscipline, lawlessness, and misconduct.

Because these regulatory bodies are up and doing, members also conduct their duties with a sense of obligation and responsibility within the confines of the laws that regulates them.

In any profession which is regulated by a regulatory body, members who breached any of the rules and regulations of the profession are subject to all the disciplinary measures and when found culpable their licenses could even be suspended and at worst withdrawn from practicing in the country.

In conclusion, there is an urgent need for a strong and vibrant regulation to roll out a strict and high standard code of conduct that reflects best practices from other jurisdictions. This will weed out quackery, indiscipline, lawlessness in the profession, elevate professional standards to earn the trust and confidence of those who esteem the practice of Naturopathy”.

Respondent 15

“Regulation is a law or administrative rule issued by an organization and used to guide or prescribe the conduct of members of that organization. Given the above definition, Ghana Naturopathic Regulation(GNR) is needed to set and maintain the standards of education, training, and practice of naturopathic medicine as well as the competency required of a naturopath or naturopathic doctor and to deliver and achieve the purpose of the set standards in the Ghanaian jurisdiction”.

Do you envisage the negative impact of the regulation if adopted in the Naturopathic Profession?

Respondent (1)

“No. on the contrary it will help with challenges that relate to the profession of naturopathic medicine such as conventional medicine’s perception of the role of naturopathic medicine in treating patients, practitioners’ educational background, methods of product manufacturing, and patient safety issues”.

Respondent 2 asserts that this regulation is likely to restrict many people in the Naturopathic profession.

“The naturopathic regulations have enormous benefits which we appreciate, that notwithstanding we cannot downplay or lose sight of the negative impact it may have on the indigenous practitioners in Ghana. Their practices are inherited knowledge passed on to them from generation to generation without certification, standardized procedures, or scientific proof regulations if adopted may restrict their practice or even be flushed out of the system.

Regulations come with a cost, so if this regulation is adopted cost of naturopathic medical services will be expensive which would affect both the practitioner as well as the client. This may also lead to self-medication by the ordinary Ghanaian who cannot afford to pay for such a high-cost health care delivery”.

Respondent raised an interesting area of concern and asserts that too much strict regulation averts research funding by investors.

“Yes for instance, if regulatory standards in a certain research area are too strict, companies may refrain from investing in it. In many cases, regulations may do more harm than good especially if they were introduced by people who have little knowledge in that particular field of practice. However, many regulations are introduced by people who do not know what they are doing and the outcome are pretty poor. The regulatory standard increases the costs for the government since authorities have to implement proper control mechanisms. Finally, the implementation of regulation also implies certain welfare costs, since free market forces will not be able to work properly anymore” Respondent (3).

Respondent 22

“No. Many people who have not tried holistic medicine before are concerned about whether it may be dangerous. It is important to understand that taking medical advice from an untrained and unlicensed practitioner comes with high risk and we do not recommend that same as you may not be recommended to see an unlicensed dentist or gynecologist.

One must at all times consult a licensed and a medically trained naturopathic physician, so the adoption of the naturopathic regulation in Ghana would rather help to standardize the naturopathic profession and also protects its members for effective healthcare delivery”

Respondent 18 is of the view that there is no positive thing without agitation.

“Any good agenda or movement, under the sun, is expected to trigger both positive and negative impacts in this world. However, if the effects, positively impact the majority of the population, such an agenda or movement eventually gains root and grows to fruition.

Jesus Christ, with all the His good intentions to deliver mankind from the powers of darkness and did miraculous activities, had enemies who eventually succeeded and killed Him (although His death was divinely orchestrated and influenced by God). However, those whose lives were greatly impacted by His works could not keep quiet but stood up boldly to defend Him and propagated the good works of Jesus Christ over 2000 years ago to date.

It is obvious that, when the Naturopathic profession adopts a vibrant regulation to monitor and supervise the conduct of all naturopathic professionals in Ghana, will most likely affect a segment of practitioners whose activities are not backed by law neither nor are they regulated by any legal body.

When this happens, quack naturopathic practitioners will no longer be in active business, ie, if they are not willing to get the minimum educational requirement to legalize their practice by registering with the appropriate regulatory body.

Thus, if the majority of the practitioners are quacks, then adopting a regulatory framework in the naturopathic profession will create massive unemployment- thus making the move (ie adoption of regulation in the Naturopathic profession) hurt the country. This could also add more tension to the high unemployment rate in the country”.

Respondent 15

“The GNR also includes some negative impacts as follows;

Respondent 12 is of the view regulation is not enough.

“Regulatory frameworks are not enough to prevent and fight corruption on their own. However, they are a prerequisite for any such effort. They must be accompanied by positive incentives, education, and guidance. Together, building integrity measures and the corresponding regulatory frameworks constitute a system of checks and balances that can prevent and curb corruption. Corrupt practices must be sanctioned, corruption rewards confiscated, and corrupt behavior deterred and prevented. This is done with the help of both positive (education, ethical guidelines, codes of conduct, rules and regulations) and negative measures (sanctions)”.

Do you envisage the positive impact if the regulation is adopted and why?

Respondent (1)

“Yes, because regulation will identify naturopathic medicine practitioners from other complementary and alternative medicine practitioners, set the educational standards for training, determine the standards of practice, set conditions for registration as a practitioner and outlay the code of ethical practice for naturopathic doctors. It will also give the profession legitimacy; provide the public with a clear definition of the profession, and the treatment practices offered, as well as the assurance of the level of care that may be expected.

Ultimately, it will protect the public as regulation will ensure uniform standards are met across different practitioners in offering services. It will also create mechanisms for enforcing the standards so that those who provide services are held accountable when they are not qualified to provide services, engage in professional misconduct, or otherwise contravene their governing legislation”.

Respondent 2 believes this document will help weed out unqualified practitioners from the system.

“Haven stated above the negative effects the regulations may bring, it is important to throw some light on its tendency of solving the numerous challenges the sector is facing in the naturopathic profession if adopted. Challenges such as low confidence level in the practitioners and to some extent the profession by the public due to lack of understanding, misconceptions, and misrepresentation. Naturopathic education presents a very good opportunity for the youth in Ghana with an interest in studying alternative medicine, unfortunately, this is not happening due to the lack of enough naturopathic training schools in the country.

Another challenge also has to do with the influx of quark doctors taking advantage of the lack of regulations to deceive innocent people with outrageous promises of an instant cure.

If this regulation is adopted the above-stated challenges would be solved thereby flushing out the quack doctors from the system. Secondly, the public would have more confidence in the practice of alternative medicine in general. Lastly, it would encourage the establishment of more naturopathic training schools which would go a long way to reduce the pressure on conventional healthcare in Ghana”(Respondent 2)

Respondent 3 believes that this will help protect the practitioners by providing some form of security

“Yes in the scene that it is going to help put the practitioners on their toes not to go the dubious way and also allows only qualified practitioners to practice and that will bring about good recognition to the system of practice.

These may provide social security for the poorest in the industry and may help bring health improvements to the general public as an assurance that the system is safe and secure to patronize.

This can also help to avoid the monopoly in the system as everyone is working to their limit and will refer cases that are higher than their current state of qualification, and also tax revenue will improve as regulatory bodies can easily track practitioners according to their data and scope of practice.” Respondent(3)

Respondent 22

“Yes. Naturopathic medicine has been gaining more and more popularity as a beneficial route to better health, either on its own or as a complement to traditional healthcare, this regulation in Ghana would help to provide greater public protection, raise training and practice standard, promotes appropriate integration within the healthcare system and eliminate, prosecute or quackery practitioners”.

Respondent 18 has strong support for this project

“Most definitely, adopting the regulation will have a great and positive impact on the naturopathic profession. As I stated earlier in my response to question one, adopting the regulation will spell out rules and regulations, and a code of conduct to guide members of the professions in the discharge of their work.

The regulation will also set out the requirements to be met before one can acquire the license to practice, It will also approve the type of premises or facility the profession is practiced (as in other jurisdictions).

When the regulation is adopted and given legal backing by the state, it will embolden the law enforcement agents, the police, and the regulatory body, to go after quack naturopaths and flash them out of the system. This might take time and suffer some setbacks and opposition, nonetheless, the light will prevail over darkness.

More importantly, the negative or bad image killing the practice of this noble profession as a result of numerous unlicensed, uncertified and untrained naturopaths who are not following the appropriate modalities to treat the sick, will change drastically to the amazement and admiration of the critics of the profession.

When the image of the profession takes a good shape ( in the eyes of the general public) due to the strict enforcement of the regulations, it will result in the following;

Respondent 15

“Some of the positive impacts of the GNR is to;

Respondent 10 asserts this will avert fraud in Naturopathic practice in Ghana

“Well in this case for example, -The regulations will successfully, prevent fraud and minimize uncertainty in the Healthcare system. In addition, the framework assists regulators to live up to the expectations of the community and thus bringing about public confidence. Implementing a regulatory framework allows regulators to give objective reports on their administrative activities and determine if their efforts have been carried out fairly, efficiently, and effectively. As a regulatory body is also an invaluable tool for regulators to spot where there is room for improvement and thus better allocating resources for maximum impact. With the implementation of a framework, it is easier to identify where improvement could reduce compliance costs”.

What is your general assessment of the draft document?

Respondent (1)

“It is a comprehensive document comparable to any international standard of practice document that highlights the areas of concern in training, continuous professional development, and clinical practice that would guide the naturopath or naturopathic doctor in the field of naturopathy. With this document, practitioners have a guideline for daily practice, public health and patient safety is assured and the regulatory entity knows exactly what to look out for in monitoring of the naturopathic profession”.

The second respondent recommends that the current state of the Naturopathic regulation may not be in the best form and hence recommends a periodic review.

Respondent 2

“The naturopathic regulation document may not be perfect in its current state as with every document but my general assessment of the drafted document by far is satisfactory in that it touched on areas like the educational qualifications required before one can practice as a naturopath or naturopathic doctor, the code of ethics and standard practice that governs practitioner's conduct, the scope of practice or limitations to what a practitioner can and cannot do in the practice, the legal obligations of practitioner’s just to mention a few. In my opinion, these have been well elaborated on. Going forward I recommend that the document should be subjected to periodic review to match up with global standards”.

Respondent 3 notes

“My general view is to restructure the field of naturopathy to make sure the right people are allowed to practice. Whatever certificate one has, he or she should practice to the limit; either 2 years being a Naturopath or 4 years being a Naturopathic Doctor or physician should go according to their scope of practice to bring sanity into the Naturopathic field of practice to separate the quakes from the professionals.

In another way, if this is not done, everyone will go his or her own way by doing what they want which will bring chaos to the naturopathic system of practice will leads to insanity and improper recognition.

Hence when regulatory bodies are properly implementing their directives and everyone is on his or her lane doing the right thing; Naturopaths and Naturopathic Doctors both adhering to their specific limits, there will be sanity in the field and their clients or patients will have the full benefit and confidence in the practice and that of the practitioners”.(Respondent 3)

Respondent 22

“In this draft document as it has been accepted by law in some states of the USA and Europe would help to standardize naturopathic medicine in Ghana the same way conventional medicine is regulated and standardized since it is very crucial to understand that the level of education and training that a licensed naturopathic doctor ND has is very similar to that of an MD, they simply specialize in different aspects of medicine.

The educational qualification for naturopathic doctors and naturopaths, thus five (5) years and three (3) years respectively is a standardized duration for naturopathic education.

As per WNF recommendations and the Accredited Naturopathic Medical Colleges ANMC in the USA like Bastyr University, National University of Natural Medicine, etc, has a naturopathic medical examination board that provides license to all practitioners after successful completion of the naturopathic medicine course and successfully passed the NPLEX, so the Ghana Board of Naturopathic Examiners (GBNE) would set the standard for the profession so that after successful completion of the five-year medical education for naturopathic doctors and two to three years for a naturopath, the students will therefore sit for the Ghana Naturopathic Physician Licensing Examination GNPLEX that will then qualify the individual to practice as NDs, the same way as applied to the medical doctors MD who also writes licensure exams with Ghana medical and dental council after successful completion of the medical education.

Again the code of ethics and standard of practice would enable all naturopathic physicians to practice with care and professionalism and also prosecute fake practitioners and revocation of certificate of an incompetent practitioner that causes harm to the public that conflicts with the first principle of naturopathic medicine (First do no harm)

Since naturopathic medicine and conventional medicine correlate, while conventional medicine is highly regulated and standardized, naturopathy must also the have same standardization as they all diagnose, treat, and also prevent diseases by using the same therapeutic order where they all order diagnostic tests, x-rays, medical imaging MRIs, minor surgeries and some other office procedures.

Finally, this document will help safeguard naturopathic practice, protects its members, set standard and also enhance optimal and quality healthcare delivery system with medically trained, competent and licensed naturopathic doctors of Ghana”.

Respondent 18 clarifies

“The document looks very detailed, is waterproof - no sector was left out. Has a high level of clarity – no room for ambiguity. Very purposeful - Have the power to convince critics of CAM, Cuts across all areas of the profession – from training level to professional practice level.”

Respondent 15

“The draft document for the naturopathic regulation would streamline and create professional standards for naturopathic practice in the Ghanaian jurisdiction. However, it should not be static and rigid and should be subjected to timely amendments to suit the changing needs of the society”.

Respondent 19 believes regulation is paramount in all sectors

“No matter which sector you are looking at, whether it is Healthcare, Banking, or the Agricultural industry, companies operating within a defined and regulated Framework have a clear understanding of the legal regulations they must abide by. Companies operating according to a Regulatory Structure are aware of the legal basis of their activities and that if they operate according to the laws of that framework they don’t have to worry about sanctions from the authorities. If a company holds a legal license and is operating according to clear regulations, there is less risk of legal complications or sanctions”.