The World Health Organization (WHO) is moving forward with the Traditional Medicine Global Library (TMGL) to systematize a database of knowledge and evidence to inform policies, standards and regulatory frameworks for safe, cost-effective and equitable use. Coordinated with BIREME, the Library aims to consolidate and disseminate knowledge on Traditional, Complementary and Integrative Medicines (TCIM) to strengthen national health policies.
Development of the portal mock-up
One of the most significant recent milestones in the development of the TMGL is the creation of the portal’s mock-up. This structural outline will provide the basis for the global instance of the library and will include regional instances to meet the specific needs of different regions of the world. In other words, each regional office of the World Health Organization will have its own information structure within the Global Library. These are: African Region (AFRO); Region of the Americas (PAHO/AMRO); South-East Asia Region (SEARO); European Region (EURO); Eastern Mediterranean Region (EMRO) and Western Pacific Region (WPRO).
Verônica Abdala, the project’s technical focal point at BIREME, highlights the global group’s concern to ensure that all WHO regions are represented in the new library. “During a recent meeting, we emphasized the importance of getting feedback from the regional focal points to ensure that the regional instances of the library are adapted to local specificities”, she shares. The first version of the mock-up will be presented to the coordination group at the end of July, marking an important step in the achievement of this global resource, reinforced João Paulo Souza, Director of BIREME and general coordinator of the project, in an exchange with the technical focal points.
Rapid review of the literature on digital sources
In parallel with the development of the portal, the TMGL team is in the final stages of preparing a rapid review article on digital sources. This document aims to map and analyze the databases, repositories, digital platforms, libraries, journals and other information sources dedicated to storing scientific information and knowledge on traditional, indigenous, complementary and integrative health practices (TICIM). The rapid review will support the identification of databases and digital sources that can be integrated into the WHO global database, ensuring that the library is a comprehensive and accessible knowledge repository.
Content registry for the TMGL collection
Content registry for the TMGL collection is already underway, following the identification and selection of databases, repositories, journals and reference documents. Moreover, content presented at important international events is being registered, such as the WHO Global Summit on Traditional Medicine held in Gandhinagar, India, in August 2023, and the WHO Global Technical Coordination Meeting on Traditional Medicine, held in New Delhi, India, in March 2024.
“These events, which brought together experts from all over the world to share knowledge and discuss advances in TCIM, provided a wealth of information for the library,” explained Veronica Abdala, who attended the Technical Meeting in 2024. BIREME was also represented by its director, João Paulo Souza, at the first WHO Summit on this subject, in 2023.
In the second half of 2024, BIREME is holding a series of five technical sessions especially aimed at the public in English-speaking Caribbean countries. The activities were launched on July 23, with the theme “Indexing documents using the LILACS Methodology”, and a presentation by Sueli Suga, BIREME’s Referential Information Sources Supervisor. The complete schedule of meetings is now available, with a calendar up to November, covering other topics, such as Diversity, Equity and Inclusion (DEI) in the editorial process of scientific journals; Reference Librarians Network; and Marketing Strategies for the MEDCARIB Network.
The initiative is part of the Center’s 2024-2025 Biennial Work Plan and aims to strengthen the MedCarib Network and the Caribbean Virtual Health Library (VHL), promoting access to scientific and technical information in health produced in the region. Focal point for technical cooperation projects with the countries of the Caribbean region, Marcia Barreto stressed that the technical sessions are also aligned with the strategic plan drawn up jointly with the MedCarib Network during the Virtual Health Library (VHL) Meeting held in November 2024 in São Paulo, Brazil. “Our goal is to support the strengthening of the MedCarib Network and cooperatively build the VHL for the Caribbean countries, promoting BIREME’s mission of facilitating access to scientific and technical information in health, supporting the decisions and guiding the practices of professionals, researchers, students and managers in the region”.
The first session opened with comments and a welcome from João Paulo Souza, Director of BIREME, Victoria Cruickshank-Taylor, Regional Coordinator of the MedCarib Network, and Verônica Abdala, Information Sources Manager at BIREME. The event welcomed 30 participants from five countries: Barbados, Grenada, Guyana, Jamaica, and Trinidad and Tobago. Check out the details of the program below.
About the Caribbean VHL
BIREME’s cooperation with the English-speaking Caribbean countries began in 1989 with the creation of the MedCarib database, a database of bibliographic references in the health sciences. This initiative saw the participation of 17 countries, forming the MedCarib Network, which uses the LILACS Methodology to promote the dissemination of scientific and technical information produced in the region.
Currently, the VHL Network and the MedCarib Network have the following instances from countries in the region: the Belize VHL, managed by the Belize National Library Service and Information System; the Guyana VHL, managed by the University of Guyana Library and the Ministry of Health of Guyana; and the Puerto Rico VHL, which operates under the responsibility of the Conrado F. Asenjo Library, Medical Sciences Department of the University of Puerto Rico.
Among the products and services available is MEDCARIB, a bibliographic database that includes documents such as books, book chapters, theses, technical reports, conference proceedings, journal articles and gray literature.
Another important resource is the CARPHA Evidence Portal, a continuously updated repository of research, syntheses and policy documents relevant to the Caribbean. In addition, VHL users in the region also have access to the Belize Database and the Guyana Library Catalog, both of which bring together national health sciences literature.
On July 16, BIREME launched a new search strategy in the Virtual Health Library (VHL) focused on Oropouche fever. The initiative seeks to respond to the recent epidemiological alert issued by the Pan American Health Organization (PAHO), and its updates. In the first half of 2024, and for the first time since 2010, PAHO published a series of six alerts and updates on the situation and the risk to communities. The Oropouche fever has affected communities in five countries: Brazil, Bolivia, Peru, Cuba, and Colombia, with more than 7,700 reported cases.
Systematic search provides visibility to information
In this context, the new VHL search strategy aims to provide critical information to support the response to the current situation. In July 2024, the VHL search yielded more than 1,300 sources of information on the subject, including 954 full texts, 39 documents from the LILACS database and seven from the PAHO-IRIS repository. It is also noteworthy that, in the last year alone, 103 full texts have been published, mostly in English, covering various research methods such as prognostic, risk factor, etiological and screening studies, among others.
Essential tools for science and public policy
The collection of search expressions in the VHL can also be applied to the development of thematic areas and other information resources, such as Evidence Maps and Knowledge Showcases, among others. The repository publishes the full description, including details of the bibliographic search expressions, which can be adapted to other sources of information such as PUBMED and EMBASE, allowing these searches to be shared and reused. The repository is constantly updated by the VHL Reference Network.
Information for Action in Health
It is part of BIREME’s technical cooperation to support countries, health professionals and decision-makers to use information and scientific evidence to respond adequately to the health needs of affected communities. The new search strategy for Oropouche fever is a significant step in this commitment, offering a solid knowledge base to face the current epidemiological challenges.
The Latin American and Caribbean Center on Health Sciences Information (BIREME/PAHO/WHO), in cooperation with the São Paulo Municipal Health Secretariat (SMS-SP), continues to make progress in maintaining, updating and developing the SMS São Paulo Virtual Health Library (VHL). In the first half of 2024, various activities were carried out, including renewing the portal, re-establishing the collaboration network and training SMS-SP’s technical areas. These efforts are part of the Technical Cooperation project, in Phase III of the agreement established between the institutions since 2010, which aims to consolidate and strengthen local information and knowledge management capacities.
Renewal of the SMS-SP VHL portal
One of the main initiatives of the current phase has been the renewal of the SMS-SP VHL portal, an activity that includes reviewing and evaluating the content offered, the information architecture and aspects of usability, considering the opinion and needs of the VHL’s target audience. During the period from January to June 2024, the server on which the SMS São Paulo VHL is hosted was available for use 97.8% of the time. The remaining 2.2% corresponds to scheduled maintenance and security updates. Moreover, the VHL, sub-portals, information sources and integrated search interface were backed up and monitored internally and externally.
Re-establishing the Collaboration Network
In order to guarantee the regular updating and completeness of the databases, the project is implementing the reactivation of the SMS-SP VHL Executive Committee and Advisory Committee to record the scientific and technical output of the Secretariat. In February, a meeting formalized a new agreement to expand the activities coordinated between SMS-SP and BIREME, addressing technical specifications for the development of an application for the SMS-SP VHL. Moreover, a diagnosis on the visibility of SMS-SP’s scientific and technical output was produced to learn about the challenges and expectations of the SMS-SP VHL Network Cooperating Centers, providing valuable considerations for planning future actions. “The suggestions include the creation of spaces to highlight the output of each SMS-SP body, access sections to external portals and databases, and document support and analysis services, holding periodic meetings, varying training schedules, partnerships with the Capes Journal Portal, and greater transparency and agility in meeting demands”, mentioned Juliana Sousa, Digital Solutions Supervisor at BIREME.
Training for skills development
Training sessions on registering scientific and technical publications in the SMS-SP VHL databases were held in May, with the participation of professionals from various SMS-SP technical areas. The methodology combined theory and practice, with practical exercises carried out directly in the system. On May 21, the focus was on bibliographic records and notions of database indexing. On May 22, the Website Catalogue (LIS), the Events Directory (DIREVE), Multimedia, Experience Reports and Windows of Knowledge were covered.
The event was attended by 12 representatives from institutions such as the Municipal Health School (EMS), Vila Nova Cachoeirinha and Campo Limpo Hospitals, the People Management Coordination Office (COGEP), the Health Surveillance Coordination Office (COVISA/DVZ), and the Health Region Coordination Offices CRS-Center, CRS-West, CRS-South and CRS-East. Each participant brought examples of documents, selected according to the selection criteria established by the SMS-SP VHL for registration in the respective information source.
Furthermore, with the aim of promoting the continuous improvement of the activities coordinated by BIREME, the participants answered an evaluation survey, measuring the effectiveness of the training and identifying strengths and weaknesses, and including the collection of comments and testimonials from the participants, which can be seen below. The results of the survey showed that the overall evaluation was positive, with 58% of the participants giving it top marks. Most participants considered the face-to-face format to be adequate, and indicated satisfaction with the methodology, the venue, the knowledge of the speakers, the practical activities, the clarity of the information, the dynamics of the practical exercises and the group interaction.
Maintaining operations and new developments
During the semester, BIREME offered continuous technical and methodological support for the regular operation of the SMS-SP VHL portal. Occurrences related to access to the new Google Analytics, guidance on WordPress and information updates on the portal were recorded. Meetings were also held with the SMS-SP team to provide guidance and follow up on database migration activities.
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The progress made in the first half of 2024 reflects the commitment of BIREME and SMS-SP to promote the efficient management of knowledge and information in health. The activities developed consolidate the SMS-São Paulo VHL as a vital space for the dissemination of the scientific and technical production of the Secretariat, contributing to the continuous improvement of health services in the municipality of São Paulo.
“I work at the Municipal Health School of the Western Regional Health Coordination (CRS-West), in permanent education.
This training and the discussion of this topic allow us to broaden our view of what can be disseminated, what we need to give visibility to, what outputs of the territory or the secretariat need to be disseminated or have greater visibility, and how to organize this information, these outputs, in a way that facilitates their use on the VHL platform. So, I believe that the relevance is organization, stimulation, dissemination and, in short, the expansion of knowledge, putting knowledge into action.
In our collection, we have worked on completing residencies and specializations in nursing. We also have reports on the experiences of professionals with their equipment, in other words, in the daily practice of their services. We also produce protocols, healthcare flows, videos, training courses, online courses, and many events, among others”.
Hernani Correa Medola, librarian, COVISA/DVZ
“I think this type of training is key because it enables us to make the information developed and produced within the secretariat more accessible to the entire population, which is the main purpose of our service, to give visibility and make this information accessible. This kind of training helps with standardization and the quality of records.
I’m a librarian at the Zoonosis Surveillance Division of the Health Surveillance Coordination (COVISA). Our collection has a multitude of documents, ranging from books, bibliographic material, to reports, manuals, educational material, which is distributed to the population. So, everything that is produced by the Zoonoses Surveillance and Health Surveillance are the materials that make up our collection.”
Marine Arakaki, librarian, Municipal Health School, Coordination of the SMS-SP VHL
“I think this version of face-to-face training was very important. Compared to the previous versions, which were online, in 2022 and 2023, we had a slightly smaller number of participants. However, as it was the first training course after the change of management system to the FI-Admin platform, it was very important that we held face-to-face training. Even so, there were only a few librarians who had this knowledge and close contact with the tool.
And the SMS-SP VHL network is made up of health professionals who are not information professionals, so they need more attention to understand the methodology, fill in the records and define the type of document. And in this respect, I think that BIREME’s training, together with the other colleagues who were present with us, was necessary. There was discussion, people raised their doubts, criticisms, suggestions, in short, I thought it was very useful.”
Tamara Leite Cortez, veterinarian, COVISA/DVZ
“The importance of this type of training is so that, in fact, we can make the records properly, so that they are retrievable and, with that, give visibility to the production, in our case, of COVISA, which is the cooperating center of which I am a member. In fact, BIREME’s training courses always meet my expectations, and this is not the first. I’ve been following the SMS-SP VHL project since its inception in 2009. What I’ve noticed over time is that, despite the turnover of professionals who act as the VHL’s focal point, we’ve managed to see this VHL growing and changing, adapting to today’s conditions.
And that’s where I think the beauty of health information lies in being able to show what we do. Because, as a health professional, I’m a veterinarian, we work a lot and have little time to show what we do. And the VHL gives us this opportunity to democratize information, to have free access to information and, often, to replicate what we do in the units in São Paulo, which have such diverse realities, in other Brazilian states, but, above all, in other countries.”
Coordinated by the Latin American and Caribbean Center on Health Sciences Information of the Pan American Health Organization / World Health Organization (BIREME/PAHO/WHO), the multilingual thesaurus of Health Sciences Descriptors/Medical Subject Headings (DeCS/MeSH) received 394 new descriptors in its latest annual update. The 2024 edition was made available for consultation in May 2024.
Highlights of the DeCS 2024 Edition
Highlights of this edition include new records added to the thesaurus, with 311 coming from MeSH, and 83 new descriptors added in categories exclusive to Latin American literature. With this update, DeCS now contains more than 729,000 terms, including descriptors and synonyms, available in four languages. Highlights also include the insertion and changes of descriptors in the Special MeSH Project related to “Psychological Stress” and advances in the review of the “Homeopathy” category, an exclusive category of DeCS that should be fully revised by the 2025 edition.
Ana Cristina Campos, from the Terminologies and Classifications in Health Sector at BIREME, explains that the annual updates aim to ensure that DeCS maintains its relevance and accuracy as a tool for locating information. “As part of the LILACS and VHL information management methodology, the use of controlled vocabulary in the health field makes research and retrieval of scientific and technical health literature more effective,” she clarified.
The annual editions of DeCS are published in accordance with MeSH updates, involving the inclusion of new terms, as well as the removal and repositioning of others. “As a reflection of the transformations of scientific knowledge and the changes inherent to languages, the terminology used in indexing is dynamic and requires constant review and adaptation,” observes Luciana Piovezan, librarian of the Digital Solutions and Emerging Technologies team at BIREME.
Notable Changes in DeCS 2024
In 2024, the category “Chemicals and Drugs” received the highest number of new descriptors, with the inclusion of 129 new terms. “Homeopathy” and “Public Health” received, respectively, 61 and 34 new descriptors. Check below the list of categories that received the most descriptors and the number of additions in the annual update. The total number of terms in each category can be seen in the image below.
D –
Chemicals and Drugs …………………………………………………..
129
HP –
Homeopathy ……………………………………………………………………………..
61
SP –
Public Health ……………………………………………………………………………..
34
B –
Organisms ……………………………………………………………………………..
28
N –
Health Care ………………………………………………………………….
28
G –
Phenomena and Processes ……………………………………………………………
24
C –
Diseases …………………………………………………………………………..
20
E –
Analytical, Diagnostic and Therapeutic Techniques and Equipment ….
19
F –
Psychiatry and Psychology ……………………………………………………………..
17
I –
Anthropology, Education, Sociology, and Social Phenomena …………….
14
L –
Information Science ……………………………………………………………….
11
A series of new terms were added to the area of “Psychological Stress,” such as Emotional Exhaustion, Financial Stress, Job Security, Media Exposure, Medical Abandonment, and others. In the subcategory “[I01] Social Sciences,” six alternative terms were elevated to descriptor status. These are Diplomacy, Environmentalism, Political Maneuvers, Stakeholder Participation, Political Activism, and Voting.
Regarding the review of the Homeopathy category, an activity that has been carried out since 2022, the current edition focused on the adjustment of the term “Hierarchies.” Previously organized alphabetically, the terms are now classified by the origin of the medications, such as “Homeopathic Medicine of Animal Origin” or Plant, Viral, Bacterial Origin, etc. With this, nine new descriptors were added to structure more specific concepts, and about 1,558 descriptors had their hierarchy changed, making this the largest number of changes ever implemented in the category since the beginning of its review.
Another novelty of the 2024 Edition, available only in Portuguese so far, is the adjustment of terms according to Inclusive Language guidelines. The initiative met the demand of researchers from the NAI Research Group – Accessibility and Inclusion Center, of the University of Vale do São Francisco, and resulted in the revision of terms related to people with disabilities. Reflecting the impact of this innovation, the term “Deaf Culture” was added to the MeSH thesaurus as a new descriptor.
“At the request of users, the 2024 Edition also includes a series of new descriptors in the Public Health category, such as Femicide, Voluntary Delivery, Birth Plan, Migrant Health, Psychiatric Reform, School Violence, and Prison Overcrowding,” highlighted Ana Cristina. The complete list of new descriptors added in 2024 is available on the DeCS Portal, at the link: https://decs.bvsalud.org/.
DeCS Panorama and other new features on the portal
The redesigned DeCS Portal Home now provides direct access to the “DeCS Finder” resources and the “How to Search” toolbox. Another new feature is the “DeCS Panorama” section, which regularly publishes highlights, news and specific tips for thesaurus users. Check out the content already available at Panorama DeCS – (decs.bvsalud.org).
The Latin American and Caribbean Center on Health Sciences Information of the Pan American Health Organization/World Health Organization (BIREME/PAHO/WHO), in coordination with the Secretariat of Indigenous Health (SESAI/MoH) and the PAHO/WHO Representation in Brazil, organized a workshop aimed at aligning their new work plan with the Virtual Health Library (VHL) Model, as well as addressing the information and knowledge management priorities and needs of SESAI. The event took place on April 18th and 19th, 2024, at the PAHO/WHO Representation headquarters in Brasília and was attended by approximately 20 representatives from the promoting institutions and Fiocruz.
Photo: Karina Zambrana (PAHO/WHO).
Global action to strengthen traditional health practices
Among the priorities established for the new work plan are the improvement of the Indigenous Peoples’ VHL, the strengthening of information and knowledge management at SESAI, and the promotion of the exchange of experiences and dissemination of knowledge between health systems and services in the context of national and international cooperation.
At the opening of the event, BIREME Director João Paulo Souza presented the “WHO Global Action to Strengthen Traditional Health Practices”. He highlighted the importance of valuing the indigenous knowledge of Brazil, aligning it with global discussions. “We are experiencing a new phase in seeking to integrate traditional and indigenous knowledge and medicines into conventional health systems and knowledge production in this area. With this, we are seeking to ensure that more people have access to culturally appropriate care, thus expanding the capacity of health systems to meet the needs of all,” emphasized João Paulo Souza.
The Workshop’s agenda included a series of activities for the work plan specifications. “We followed a script to review and detail the entire scope of the Project, including defining the mission, objectives, expected results, indicators, and lines of action,” said Veronica Abdala, Manager of Information Products and Services at BIREME. Other definitions agreed upon by the participants included technical aspects for the construction of the Indigenous Peoples’ VHL portal, such as the sources and types of information corresponding to the information needs of the VHL’s target audience. The program also included the construction of a network for the governance of the Indigenous Peoples’ VHL and the identification of the target audience and their information needs. “These are essential factors for the success of a VHL,” explained Veronica Abdala.
Celebration of National Indigenous Peoples’ Day
Highlighted in the program, one activity was dedicated to celebrating Brazil’s National Indigenous Peoples’ Day, commemorated on April 19th. The reference to the date featured an intervention by Giovana Mandulão, General Coordinator of Knowledge Management, Information, Evaluation, and Monitoring of Indigenous Health (CGCOIM/SESAI), who presented herself as a Macuxi Wapichana indigenous woman, representing the peoples of the triple border territory between Brazil, Venezuela, and Guyana.
At the beginning of her speech, Giovana Mandulão invited her relatives who attended the Workshop to join her in front of the microphone and camera, marking the moment of political action with strong emotion and a sense of belonging. “First, I would like to invite my relatives who are here, powerful warrior women, Hellen Pankararu, Cleizy Baré, and Raylene Baré, to be here with me. We never walk alone, so come with me, our warrior sisters. It is a very important moment to be here, it is even a historic moment, very symbolic, to be here in this space,” she began.
Next, with the aim of prompting those present to reflect, Giovana Mandulão read a passage from the “Manifesto for the Life of Indigenous Peoples” and then concluded: “We left our territory so that we could be heard by you, by the State, and here, with great pride, all of us recognize this journey, we left our territory and came here to qualify ourselves to discuss with you. May our demands be heard, our struggle, because there is a much larger movement, our peoples are there in the territory. And it is for them that we are here.”
Launch of the new Indigenous Peoples’ VHL portal
The cooperation project is being developed by BIREME in coordination with SESAI, through Cooperation Term number 93, in its fourth additional term (TA4/TC93). According to the project’s schedule, the launch of the new VHL Portal for Indigenous Peoples’ Health is scheduled for the end of the second semester of 2024.
Developed to promote access to and use of scientific and technical information for public health policy formulation, the new Health Information Network (Ripsa) portal is now available online for public use. The portal’s reactivation is a significant step in resuming Ripsa’s activities, which have been coordinated by the Department for the Evaluation and Dissemination of Strategic Health Information the Secretariat of Information and Digital Health of the Ministry of Health Brazil (DEMAS/SEIDIGI/MoH) since 2022.
New Ripsa Portal
The development of the new Ripsa portal was coordinated by the Latin American and Caribbean Center on Health Sciences Information of the Pan American Health Organization/World Health Organization (BIREME/PAHO/WHO) through a technical cooperation agreement established with SEIDIGI/MS in 2023. Focal point for this project, Juliana Sousa, Supervisor of Digital Solutions and Emerging Technologies and Project Management at BIREME, explained, “This is a tool for disseminating and giving visibility to the information products developed by the Network. It was built considering Ripsa users’ needs and incorporating best practices in design, usability, and functionality.”
BIREME presented the new portal during the 30th Interagency Workshop (OTI) of the Network, held on April 4-5, 2024, at the PAHO Brazil office in Brasília. Juliana Sousa led the presentation, detailing the development stages, advancements since the last OTI, and the next steps for managing the information produced by Ripsa. Over sixty Ripsa members attended, representing 43 institutions, including CONASS, CONASEMS, ANS, Abep, Abrasco, INCA, IPEA, IBGE, PAHO, and others from public agencies and universities. BIREME Director João Paulo Souza also participated in the event, engaging in workshop discussions and activities of the Indicators Management Committee for Risk and Protection Factor .
The 30th OTI also aimed to share preliminary results of the situational diagnosis of Ripsa’s “Basic Indicators and Data” (Base IBD). The situation analysis has been conducted by the Indicators Management Committees (CGI) since the 29th OTI in August 2023, reviewing and updating all IDBs in Ripsa’s indicator matrix. For the diagnoses, each CGI has undertaken several procedures, including:
Critical analysis of indicator qualification forms;
Evaluation of the current availability of databases;
Assessment of the primary or secondary sources used in indicator calculation regarding coverage, quality, and timeliness;
Evaluation of the relevance of continuing to use the same calculation method for the indicators, based on each indicator’s qualification forms.
The CGIs are technical-scientific bodies tasked with continually improving Ripsa’s indicator base, organized into seven thematic subsets: Demographic, Socioeconomic, Morbidity, Mortality, Coverage, Resources, and Risk and Protection Factors.
Technical Cooperation for information management
In addition to building the new Ripsa Portal and reactivating it as a dissemination and visibility space for Network products, the technical cooperation project between BIREME and DEMAS/SEIDIGI/MS includes two more action lines: managing the Portal Ripsa content collection and developing a new platform for publishing qualification forms on the Ripsa portal. “Activities for these action lines are in development and follow the product schedule proposed by Ripsa’s Technical Secretariat, which plans to complete all diagnostics and updates by the end of 2024,” explained Juliana Sousa.
The 2024 operational and product launch schedule for Ripsa also includes making all revised and updated Indicator Qualification Forms (FQI) available and developing and publishing a Glossary of common and specific technical terms used in the FQIs. The next Network workshop, the 31st OTI, is scheduled for December 5-6, 2024, at the PAHO office in Brasília/DF.
VHL TCIM Americas will serve as a model for the development of the future WHO Global Library on Traditional Medicine
Posted in 30 April, 2024
From March 19 to 22, 2024, the World Health Organization (WHO) brought together experts and technicians in India to plan the activities of its Global Traditional Medicine Centre (GTMC). To be launched in 2025, a new Global Library will be developed by BIREME based on the experience gained with the Virtual Health Library on Traditional, Complementary and Integrative Medicine and the TCIM Americas Network. Read more in the interview with BIREME’s director, Dr. João Paulo Souza.
BIREME team arrives in Jamnagar for the second part of the WHO mission to India in March 2024.
The World Health Organization has recently coordinated a couple of meetings to follow up on priority work for the WHO Global Traditional Medicine Centre. Held in March 2024, the mission aimed to “translate the evidence-informed action agenda from the Gujarat Declaration into implementation and impact”. As a participant in these events, can you give us more details about the context of the new Center and its priority projects?
The first part of the mission took place in New Delhi and was a discussion meeting to identify general lines of action, especially those related to the first year of work on the new Center that is being established in Jamnagar. So, in this first stage, we had a large group of experts from the community of traditional medicine and indigenous knowledge, or traditional knowledge of indigenous peoples. We had specific sessions to address major issues, such as biodiversity, sustainability and planetary health, protection of intellectual property rights, coding of information for ICD-11, and others.
At that time, while still working on the structural aspects of the new Center, we also defined and specified the development of what was then being called a “global repository,” or a “knowledge bank” or library. We then discussed content, implementation strategies and challenges. We talked about standards, criteria, and methodologies for inclusion of evidence-based information, and we evaluated the requirements for hosting on digital platforms. Joining me in these discussions were Verônica Abdala, manager of Information Products and Services at BIREME, and Jonas Gonseth-Garcia, advisor on Quality in Health Services and Systems and focal point on Traditional Medicine at PAHO/HSS.
How is WHO working to recognize safe and effective practices developed in a paradigm different from the biomedical model, which is more conventional in public health?
I’m going to talk here about my perception of how this work is being done, rather than speak on behalf of the organization. I see that a lot of the work is related to the epistemic discussions that shape and sustain the different models for producing knowledge about healthcare. So we had a lot of work there related to biodiversity, intellectual property, trying to understand how to ensure that, for example, the traditional knowledge of communities generates benefits for them, and is not just ‘extracted’ from these communities for use by a particular industry. There is a great concern about developing guarantees for the communities that hold traditional knowledge, and that this knowledge can also be a means to economic development for these communities. Another issue widely discussed was the integration, registration, and evaluation of the use of traditional practices into national health systems.
Indeed, one of the ideas driving the establishment of the WHO GTMC is precisely to recognize practices that positively contribute to the process of health production, practices that can be considered in some way effective, safe, and culturally appropriate. Because health systems that operate within a Euro-Western biomedical paradigm, so to speak, have their limits and do not meet all the healing or health needs of our populations. Let’s not forget that about 80% of the people in the world use some form of natural resources to promote their health or alleviate health problems, and that a good portion, if not the majority, of today’s allopathic medicines are derived from natural resources. The idea of this new specialized WHO Center is to help find a way to improve the integration of traditional health practices into health systems, especially those that are safe, effective, culturally relevant and appropriate.
WHO and PAHO teams at work in Jamnagar, India, on March 22, 2024.
How do different models of knowledge production influence the integration of traditional and indigenous knowledge into scientific evidence?
That was a significant part of the discussion we had there, and it even goes back to epistemological models, because the epistemic approach that we use in so-called “Western” science is very much derived from ideas that developed in the 18th century, especially empiricism, rationalism, and skepticism. The epistemic model that supports evidence-based medicine, for example, is largely derived from these frameworks, especially empiricism. However, this empirical model has some limitations that need to be considered, mainly the difficulty of dealing with the complexity of “real life,” the heterogeneity of people, contexts, interventions, and even evaluations, and the difficulty of eliminating residual confounding effects. These are limitations that often make it difficult to apply scientific-empirical knowledge to complex real-life situations.
Another point to consider is that traditional interventions are often highly individualized or highly contextualized. That is, it is often difficult to conduct large standardized and decontextualized evaluations, contributing to the incompatibility with the conventional empirical model in these situations. So, part of the discussion is how to generate this kind of evidence that is valid, methodologically speaking. Innovations have emerged within the Euro-Western scientific paradigm itself, such as complexity science and the evaluation of complex interventions, and there are emerging epistemic models from the Global South that need to be considered. Furthermore, we have integrative epistemic approaches, such as knowledge encounters developed by Professor José Jorge de Carvalho, for example, which seeks to enable a dialogue between these traditional sciences and what would be Euro-Western sciences.
A further major concern that resonated with the discussions that took place in India had to do with strategies to avoid a neo-colonialism of knowledge. How we can ensure that, even well-intentioned, we do not inadvertently favor an extractivist and colonial approach. To give an example, there was a very interesting discussion that took place about “Open Science.” Here at BIREME, we promote and talk about open science all the time, because in a certain way it’s a model that facilitates transparency in the process of knowledge development and the democratization of access to this knowledge. But from another perspective, an open and transparent approach to traditional knowledge may not always be in the best interest of the communities that hold the traditional knowledge.
Imagine a situation where the publication of a certain “drink” or a certain combination of herbs could allow the identification of a new therapeutic resource that could be industrialized. Without the necessary care, this knowledge can be developed and patented by the industry and duly “packaged” for these same communities. There are many examples of this colonial model of interaction between indigenous communities, traditional knowledge, and the health-industrial complex. How can we ensure that the indigenous communities that have preserved this knowledge and maintained the biodiversity necessary to develop this therapeutic resource can benefit from the use of this knowledge? So it was interesting to see limits even to “open science.” Developing a proposal for open science with safeguards for communities seems to be both a challenge and something very important.
Visit to the building site of the new WHO GTMC in Jamnagar, India (March 2024).
What were the key definitions for this WHO project, which aims to systematize all this knowledge in a Global Library of Traditional Medicines?
In a structuring way for all this discussion is the library. And that was the main reason we went there, to support the development of this platform that will organize all the evidence base that GTMC/WHO will systematize. In the first part of the mission, we coordinated focus groups with experts to discuss the library project, who are the potential users, to define the vision, user needs, and other high-level specifications.
So BIREME has been commissioned to develop a Global Library of Traditional Medicine that will have a global scope and will be composed of six regional portals, one for each WHO region, as well as country profiles and national libraries. We already have a portal for the Americas, the VHL TCIM Americas, which is 95% ready, let’s say, for this model we want to develop globally, so we’re going to do a little bit of tweaking to achieve what we want.
The VHL TCIM Americas will be the model for the regional libraries, so we will have a Global Library of Traditional Medicine and six regional instances: the VHL TCIM Americas, which will maintain its name; and also, the African Library of Traditional Medicines, the European Library of Traditional Medicines, the Middle Eastern Library of Traditional Medicines, the Southeast Asian Library of Traditional Medicines, and the Pacific Library of Traditional Medicines. These are all provisional names. In addition, we will also develop some instances of national libraries to serve as models. We agree to develop models of national libraries for the Ministries of Health of the countries, in collaboration with the local PAHO offices in our case, and with WHO globally.
And our schedule is as follows: from April to October 2024, we will develop and present a minimum viable product of the Global Library; and from October 2024 to March 2025, we should have the beta version ready for use, but still in development. All this in order to have the final delivery already tested, reviewed and ready for use at the next WHO Global Summit, scheduled for the second semester of 2025.
João Paulo Souza, BIREME director, and Verônica Abdala, manager of Information Products and Services at BIREME, during a visit to the ITRA Hospital – Institute of Teaching and Research on Ayurveda, in Jamnagar, India (March 2024).
What does it mean for BIREME to have another global project in its portfolio, especially a Global Library that will facilitate access to indigenous and traditional knowledge and medicines for all peoples?
For BIREME, and I think for PAHO as well, it is a distinction to have the mission to develop this Global Library. It is a recognition of decades of expertise in building digital libraries. And particularly in the area of traditional medicines, it is a recognition of the efforts of BIREME and PAHO in structuring a network, a TCIM library that is serves now as a model for the rest of the world. I think this is a source of pride because we will develop both the global and regional libraries based on the experience of the Americas. It has an institutional importance.
It is also a satisfaction to be able to support the creation of another WHO center that will integrate this small family of specialized centers. In addition to the Pan American Centers, which are centers of technical excellence in their fields, we have the WHO Centre for Health Development in Kobe, Japan, this new Centre in India, the International Agency for Research on Cancer (IARC) in France itself, and other initiatives that can reinforce and complement each other in the regional and global structure.
Finally, we must not forget that this is a question of progress towards the collective dream of “health for all”.
