The government of Ghana in 1961, formed the Ghana Psychic and Traditional healers Association under the Ministry of health to bring all traditional medicine practitioners together to promote and protect the best psychic and traditional healing in the country. However, internal power struggles among members could not allow the association to survive.

The Centre for Scientific Research into Plant medicine, now Centre for Plant Medicine Research (CPMR), was also established in 1975 under an ACT of government to conduct and promote scientific research related to plant medicine, ensure purity of plant medicines, co-operate with the Ghana Psychic and Traditional Healers’ Association, research institutions and commercial organizations on matters of plants medicine, collaborate in the collation, publication and the dissemination of the results of research and other useful technical information, as well as establish where necessary, botanical gardens for medicinal plants, among other functions as the government may assign to it [11].

Also Traditional and Alternative Medicine Directorate (TAMD) was established in 1991 under the ministry of health to enhance the growth and sustainability of traditional medicine in Ghana, by ensuring development and integration of traditional and alternative medicine as a distinctive medical practice within the national health care system, formulating policies on traditional and alternative medicine, mobilizing resources to support traditional and alternative medicine and ensuring mechanisms exist to patenting of herbal formulations among others.

The Food and Drugs Board now the Food and Drug Authority (FDA) was also established under the ministry of health as a regulatory body to implement the food and drug law (PNDCL 305B). As part of its mandate, it regulates the manufacture, importation, exportation, distribution, use and advertisement of food, drug, cosmetics, medical devices and chemicals, by ensuring their safety, wholesomeness, quality and efficacy. The FDA again gives approval and ensures the registration of vaccines and medicines (conventional and herbal) [12].

Ghana Federation of Traditional Medicine Practitioners Associations (GHAFTRAM), was formed in 1999 as a national umbrella organization for all traditional healers in Ghana to ensure cooperation and unity among them.

Furthermore, the Traditional Medicine Practice Council (TMPC) was formed by an Act of Parliament, Traditional Medicine Practice Act-2000 (Act 575) in 2011, to regulate the practice in Ghana. The TMPC is mandated to register and issue certificates to qualified practitioners and give permit to places of practice, enforce code of ethics of the practice recognized by the Ministry of Health as referred in its Act as an Association, advice the Minister on matters relating to and affecting the practice of traditional medicine as well as promote and support training in traditional medicine [13].

The Government of Ghana in 2005 brought together almost all the relevant traditional medicine institutions and organizations to develop the Traditional Medicine Policy, with representatives from Ministry of Health (MOH), Ghana Health Service (GHS), Food and Drugs Authority (FDA), Ghana National Drugs Programme, Centre for Plant Medicine Research (CPMR), Centre for Scientific and Industrial Research (CSIR), Ghana Federation of Traditional Medicine Practitioners Associations (GHAFTRAM), Ghana Medical Association, Nurses and Midwives Council, Pharmacy Council, World Health Organization (WHO) and DANIDA, Sociology and Biochemistry Departments of the University of Ghana and the Faculty of Pharmacy and Pharmaceutical Sciences of the Kwame Nkrumah University of Science and Technology.

The objective of the policy document is to provide general policy direction or framework within which government’s short to long term plans on traditional medicine would be based. It is the policy of government to continue to research and develop Traditional Medicine with the aim of integrating the products and returns into the health care delivery system of the country, and focuses on areas such as, Practice of traditional medicine and regulatory legislation; Re-organization and management of traditional medicine associations; Intellectual Property Rights Protection; Professionalization of TM/CAM through formal training; Research and Product Development; Public I.E & C on Rational use of Traditional Medicine; Standardization, quality assurance and large scale production; Documentation, information exchange and baseline data collection; Biodiversity conservation and sustainable harvesting; Global Networking and Collaboration; Technology transfer and commercialization of best products and practices; Integration of TM/CAM into national health systems and commercialization [14].

The TAMD with the core aim to coordinate policy initiation and implementation rely greatly on the Traditional Medicine Policy to work effectively. The Directorate has three units which all help in one way or the other to implement the policies of Government to see to the growth and sustainability of traditional medicine use in the country. The Traditional and Alternative Medicine Policy and Regulation Unit is responsible for reviewing and developing policies for TAMD. It also designs and develops Traditional and Alternative Medicine regulatory and licensing schemes, systems, plans, strategies, mechanisms and standards to manage activities within the sub-sector. The Research Unit is responsible for creating and reviewing research data for the development of policies, monitoring and evaluation of the activities of Traditional and Alternative Medicine industries. Finally, the Information and Communication Unit is also responsible for the development and reviewing of information and communication strategies, creation of platforms for policy discussions, sensitization and education on alternative medicines and health care systems in Ghana.

In terms of regulations, the TMPC is to regulate all traditional medicine practices in the country. There are regional offices all over the country to help register and issue licenses to practitioners, inspect and give permit to premises of operation (herbal clinics, herbal shops) as well as organize qualifying examinations for students to become professionals.

The Food and Drug Authority also regulate herbal medicines as part of their mandate. All herbal products to be sold on the Ghanaian market are expected to be registered by the FDA before they go onto the market. There is currently Herbal Medicine Unit at the FDA which scrutinize and conduct safety and quality assessment on herbal medicines submitted for registration before issuing license for public patronage. All such products certified by the FDA can be identified with a unique FDA Registration number to help track unregistered products.

Knowledge on medicinal plants use has been widely known to be inherited or transferred orally through informal education over the years, however, currently in Ghana, formal training in the area of herbal medicine is offered by a number of tertiary schools and institutions to help train herbal medicine professionals.

The Kwame Nkrumah University of Science and Technology in 2001 introduce a 4-year Bachelor of Science degree in Herbal Medicine under the faculty of Pharmacy and Pharmaceutical Sciences, to produce Medical Herbalist who diagnose and prescribe herbal medicine for treatment of various ailments. Under this curriculum, students gain knowledge on medicinal plants and are trained on how to develop, formulate, standardize and evaluate herbal medicine, in addition to how to diagnose disease conditions and treat them solely with herbal medicine. After graduating, they undergo a 2-year internship program where they are attached to health related institutions which provides herbal medicine services. During the second year they spend 6 months at CPMR and 6 months at the Tetteh Quashie Memorial hospital all at Mampong-Akuapem, after which they write a professional qualification exam. On passing, they are registered and certified to be able to practice as Medical Herbalist in the country. All this training is to ensure that, the graduates are trained enough to provide quality primary healthcare to Ghanaians.

Also the Department of Pharmacognosy and Herbal medicine at the University of Ghana (Legon) runs a Bachelor of Science degree program in herbal medicine related fields. The University of Cape Coast (UCC) offers a certificate program in Traditional medicine for traditional medicine practitioners and others who have interest in traditional medicine. The college of integrated Medicine also has a certificate program in Complementary Health Care.

In addition, the Catholic University College of Ghana, Faculty of Public Health and Allied Sciences at Fiapre, in 2008 introduced a course on Complementary and Alternative Medicine at the final year, as part of the BSc Public Health degree program. The Endpoint Homeopathic Training Institution runs Diploma and Degree programs in alternative Medicine as well. The Nyarkotey College of Holistic Medicine, a science based premier holistic medicine Private University, is accredited by the Traditional and Alternative Medicine Practice Council (TMPC) of the Ministry of Health to run Diploma, Bachelor of Science (BSc), Master of Science (MSc) and Doctor of Philosophy (PhD) degrees in Homeopathy, Naturopathy and Holistic Medicine.

Moreover, some institutions and associations like the CPMR, TAMD and GHAFTRAM periodically collaborate and organize trainings for practitioners in various regions of the country on safety, microbial quality, preservation and general good manufacturing processes of herbal product to help equip them with some formal knowledge on their practices.

Plant medicine has taken a new level where scientific research and analysis is introduced to confirm its folkloric use and efficacy, as well as determine its safety and quality to improve their healing capacities. A wide range of medicinal plants used in Ghana have been researched by a number of researchers in the country to scientifically prove their efficacy and confirm their traditional uses (Table 1).

In Ghana, as part of the government’s effort to promote the use of herbal medicine in the country, the Centre for Plant Medicine Research was established with the core aim of researching plants medicine. Currently the Centre has a number of research Departments, which include Pharmacology and Toxicology, Phytochemistry, Microbiology, Pharmaceutics, Plant Development, Production and Clinic. All these Departments conduct various researches and scientific analysis into plant medicines.

For instance, the Pharmacology and Toxicology Department has an Animal Experimentation Unit attached to it which enables it to conduct in-vivo research of pharmacological bases in search of anti-inflammatory, anti-malaria, anti-diabetic, anti-hypertensive, etc plant agents. The Department again undertakes toxicological studies (acute, sub-acute and chronic) on medicinal plants and herbal products. The Microbiology Department is also engaged in the search of antimicrobial medicinal plants employing bothin-vitro andin-vivo assays and contributes to the microbial quality assessment of herbal products to be submitted to FDA for registration. The Phytochemistry Department also conducts research into plant medicines, screening them for phyto-constituents present and isolating active compounds for identification and characterization. The Plant Development Department is into research of plant conservation and sustainability, ethnobotany, cultivation trials to determine optimum conditions for the growth of specific medicinal plants species and systematics using the medicinal plants herbarium in the department. The Pharmaceutics and Production Departments are much involved in research leading to product development, through formulation and reformulation of herbal products out of medicinal plants with confirmed efficacy and safety. The clinic as a research Department leads in clinical studies of herbal products upon approval from the FDA.

There are other Research Institutions, like Noguchi Memorial Institute for Medical Research (NMIMR), Centre for Scientific and Industrial Research (CSIR), Ghana Atomic Energy, as well as Tertiary education Institutions all over the country which conduct various researches into plant medicine.

Preparations of herbal medicine in the country has advanced greatly from mostly being boiled in individuals’ kitchen and taking any quantity of choice to a well-prepared, preserved and packaged products with specified doses per kilogram body weight. A lot of potent herbal products of different dosage forms (decoctions, tablets, capsules, powders, teas, ointments, eye/nasal drops, etc.) have been formulated and well labeled for use in the country. Some researchers

have surveyed and reported a number of finished herbal product on the Ghanaian market for treating various disease conditions [15] [16]. The CPMR alone has over thirty (30) different herbal products of different dosage forms used at the clinic for treating various ailments. Individual herbalists and herbal medicine manufacturing companies have also come out with a wide range of products which are been sold on the Ghanaian market (Table 2).

Even though an Alternative Medicine Bill is yet to be passed by the Ghanaian parliament, Policies are being implemented to help integrate plant medicine into the health care system. Plant medicine practice is already recognized as an alternative and complementary to the existing conventional health care system by a lot of Ghanaians.

There are private herbal clinics all over the country which provide herbal remedies for various disease conditions. The Ministry of Health, in addition to the CPMR clinic, has also introduced Herbal Units in some Government Hospitals as an alternative health care and by way of integrating herbal medicine in the

country’s health system. These herbal clinics engage the services of qualified Medical Herbalists who diagnose based on laboratory test results and prescribe appropriate herbal medicines for treatment of various disease conditions. They prescribe solely plant medicine which are known to be efficacious through research and have been registered by the FDA.

The Ministry of health is currently compiling a list of herbal medicines to be part of the essential medicine list to be captured and absorbed under the National Health Insurance Scheme, as part of efforts to integrate plant medicine in the health care system.

Even though plant medicine practice started by sourcing medicinal plants from only the wild, efforts have been made to get institutions and individuals to cultivate medicinal plants domestically for use to prevent plants from going extinct. The CPMR has about 150 acres of farm lands at different locations in the Eastern regions of Ghana, which is managed by the Plant Development Department (PDD) for conservation and cultivation of medicinal plants which are mostly used by the Center in producing herbal products and for research. The CPMR again identifies individuals with interest in medicinal plants farming and engage them in its medicinal plants out-grower programs, where seedling are often supplied to them for cultivation. The PDD has established a nursery to raise seedlings for supply to their medicinal plant farms and out-growers.

Tissue culture technology is also employed by researchers of some institutions to generate seedlings of plants which are difficult to raise through the natural methods of using their propagation parts. This technology helps to conserve plants by producing challenging plant which are likely to go on extinction much easier and faster, with increased plant yield and improved secondary metabolites [17] which can support the plant medicine industry.

The Government of Ghana by way of conserving medicinal plants and plant diversity at large, has established Botanical Gardens, Forest Reserves and National Parks to preserve some important plant species for educational, recreational and tourism purposes. Some of these botanical gardens and forest reserves also have nurseries where seedlings are raised for medicinal plant farmers to purchase and cultivate on their private gardens and farms [18] [19].

Even though plant medicine practice is well advanced in the country and majority of Ghanaians have been exposed to the use of medicinal plants in the treatment of various diseases and the important role plant medicine plays in the health care delivery system has been established, there is still a section of the population who consider the whole idea as superstitious and hence are yet to welcome the practice.

Most allopathic practitioners despise the use of herbal medicines and will never encourage their patients to patronize them [254]. Others are often quick to attribute most organ damage cases like kidneys and liver dysfunction to the use of plant medicines, even when they do not have enough evidence to back it. Interestingly, traditional herbalists who receive such comments normally get agitated and furious but unfortunately, they are not able to disprove the claims of the allopathic practitioners due to the huge uncertainties associated with their practices. This has created enmity between the two groups of practitioners and hence, retarded the development of herbal medicine and for that matter medicinal plants usage in Ghana.

The herbal medicine industry like any other industry requires huge capital investment for large scale production of quality products. However, most herbalists are indigenous people with little or no money to go into research and large scale production even though they have all the knowledge and ability to produce great and efficacious herbal medicines. Most of such great herbal products only stay with the herbalist in their respective homes and communities without reaching other parts of the country. With a little financial support to conduct research and produce on a large scale well packaged and registered herbal medicines, patronage among Ghanaians will be increased and it will lead to acceptance on the international market.

There is currently no government subside on the purchase of plant medicines. Patients who choose to go for herbal treatment in government hospitals pay for full amounts for their herbal prescriptions unlike patients who choose the orthodox and enjoy being served free medications through the National Health Insurance Scheme (NHIS) which caters for most orthodox health services, replacing the cash and carry system [255]. This alone discourages a lot of Ghanaians from assessing and patronizing plant medicine.

In Ghana and neighboring countries in West Africa, human activities predispose the environment to contaminants such as pesticides, heavy metals, microbial contaminants and mycotoxins. Plants are mostly affected by environmental pollution which tends to accumulate levels of the contaminants and pass them onto other organisms due to their position in the food chain.

The identification and authentication of the right medicinal plant is a basic requirement that borders on toxicity and efficacy. Due to the increasing number of closely related species of medicinal plants with similar phenotypes, it is easy to mistake one plant for another, for example, Taraxacum officinale and Emilia sonchifolia. On the other hand, the same species of plant may also show differences morphologically under different environments. This poses a huge challenge to herbalists and end users, since there have been cases of people who developed complications and died all because of the wrong identification and hence the wrong use of plant materials in preparations.

Adulteration of medicinal plants and products can be classified into three; addition of orthodox drugs to the herbal medicine, substitution of material and addition of foreign materials. Adulteration is targeted at enhancing efficacy or maximizing profit but it should also be noted that, safety is compromised in most cases.

Majority of herbal medicine practitioners in Ghana are extremely individualistic and secretive, thus the practice is shrouded in secrecy and fading off gradually [5]. They mostly are suspicious of colleague herbalist and especially plant medicine research institutions, claiming their medicinal plants and formula for producing will be stolen. This attitude impedes research, documentation and transfer of knowledge on plant medicine, and Ghana is gradually losing vital information on traditional uses of plants in treatment of diseases since the herbalists, a repository of these information, are fading out.

Lots of efforts are being made by the government and FDA to regulate traditional medicine, however, there are still a lot of products on the market which have not gone through the required quality assessment and registration. Herbalists with no licenses, with product without FDA approval are all over information centers and market places making ambiguous claims on such products. This may be as a result of inadequate enforcement of regulations and leads to loss of interest in herbal medicine by a lot of Ghanaians.

Standardization has become a focal point in ensuring the safer use of medicinal plants. This is because it ensures that batch to batch productions contain the same or similar levels of phyto-constituents. However, this has been quite challenging in the country due to lack of defined regulations, lack of marker compounds and challenges with the identification of the active principle(s) in the plant or the product [261]. Aside from the challenges with identification and isolation of the active constituents especially in poly-herbal formulations, the whole concept of standardization and the need to standardize limits the understanding of the scientific community to herbal medicine. This is because, the concept of synergy can easily be excluded since the active constituents may not be acting in isolation, but may require other naturally occurring compounds to be more active. That is, there are cases where the whole crude extract from the medicinal plant has greater therapeutic activity than the sum of the activity of the active constituent alone [262].