Country Profiles

The regulation of herbal medicines is the same as that for conventional pharmaceuticals. Herbal medicines are sold with medical, health and nutrient content claims, although these claims are unregulated. The regulation on herbal medicines was most recently updated in 2014. Regulation of the manufacturing of herbal medicines to ensure their quality requires adherence to manufacturing information in pharmacopoeias and monographs. Compliance mechanisms include periodic inspections by authorities at the manufacturing plants or laboratories, the requirement for manufacturers to submit samples of their medicines to a government-approved laboratory for testing, the requirement for manufacturers to assign a person to the role of compliance officer, and the requirement for the compliance officer to ensure the manufacturer complies with manufacturing requirements and to report back to the Government authorities. The regulatory requirements for the safety assessment of herbal medicines are the same as that for conventional pharmaceuticals. Traditional use without demonstrated harmful effects is also sufficient. The NEML includes herbal medicines and the criteria for selection are based on the traditional use of the herbal medicines, clinical data and long-term historical use. Herbal medicines are sold in outlets other than pharmacies, including special outlets, as non-prescription medicines, self-medication or OTC medicines. There are no restrictions on selling herbal products. There is a list of registered herbal medicines, which was updated in 2015.

The use of indigenous TM is considered important in the Plurinational State of Bolivia, with an estimated 6079% of the population using it. Other T&CM practices are also used, and the percentages of the population using each practice are as follows: acupuncture 1–19%, ayurvedic medicine 1–19%, chiropractic 40–59%, herbal medicines 80–99%, homeopathy 20–39%, naturopathy 1–19%, osteopathy 60–79% and traditional Chinese medicine 1–19%. The regulation of T&CM providers, including indigenous TM providers, chiropractors, herbal medicine providers and osteopaths is enforced at national, province and city levels. The regulation on T&CM practice was updated in 2015. T&CM providers practise in private clinics only. A T&CM licence or certificate – issued by the national, provincial, city or community government – is required to practise. Training programmes that the Government officially recognizes include apprenticeships with T&CM providers (without certification or licensing), certified training programmes, a training programme for indigenous TM practitioners, and training programmes for T&CM technicians or equivalent (not at university level). According to 2010 data from the national office, there are an estimated 2500 indigenous TM providers practising within the Plurinational State of Bolivia. Indigenous TM is covered by private health insurance organizations. As at end 2016, T&CM services are reimbursed by health insurance in 60 public establishments.

In Bolivia, the integration of Traditional Medicine into the healthcare system is being achieved through various strategic measures. The integration process involves aligning Traditional Medicine with the National Health System, ensuring its respectful use, protection, and promotion. This includes advancing research to preserve ancestral knowledge and practices, along with recognizing Traditional Medicine providers via the Single Registry of Bolivian Traditional and Ancestral Medicine (RUMETRAB). Upkeep of the Traditional Medicine Information System (SISMET) is being prioritized through continuous updates and monitoring. Furthermore, technical educational processes are being implemented to certify the expertise of Traditional Medicine providers. The overarching goal of the Ministry of Health and Sports, guided by the General Directorate of Traditional Medicine, is to strengthen and seamlessly incorporate Traditional Medicine into comprehensive health networks. This initiative aims to offer quality healthcare services to the population within the unified framework of the Single National Health System.

Total population (2023): 12,388,6 millions Source: CEPALSTAT Statistical Database and Publication of Economic Commission for Latin America and the Caribbean, known as ECLAC. Indigenous population 4,176,647 (41,5%) Afrodescendent population 23,330 (0,2%) Source: Bases de datos censos - CENSO BOLIVIA (ine.gob.bo), 2012 List od Indigenous Peoples: Araona Aymara Ayoreo Baure Canichana Cavineño Cayubaba Chacobo Chiman Chiquitano Ese Ejja Guaraníes Guarasugwe Guarayo Ignaciano Itonama Javeriano Joaquiniano Kallawaya Leco Loretano Machineri Maropa Moré Mosetén Movima Moxeño Murato Nahua Pacahuara Quechua Reyesano Sirionó Tacana Tapiete Toromona Trinitario Uru Uru Chipayas Uru-ito Weenhayek Yaminahua Yuqui Yuacare Source: Bases de datos censos - CENSO BOLIVIA (http://ine.gob.bo), 2012

There is an exclusive regulation for herbal medicines, called the Directors’ Collegiate Resolution (Resoluciόn de Directorίa Colegiada, DRC-Resolution No 14), which provides for the registration of herbal medicines. Herbal medicines are categorized as prescription and non-prescription medicines, and sold with medical and health claims. The legally binding pharmacopoeia used is the Brazilian pharmacopoeia. Other pharmacopoeias permitted under RDC 37/2009 are the pharmacopoeias of Argentina, the EU, France, Germany, Japan, Mexico, Portugal, United Kingdom, the United States and the WHO monographs on selected medicinal plants. GMP for herbal medicines is regulated under Resolution RDC No. 17 of 19/04/2010, which also covers GMP for conventional pharmaceuticals. The provisions on manufacturing of herbal medicines to ensure their quality require adherence to manufacturing information in the specified pharmacopoeias and monographs, as for conventional pharmaceuticals. Compliance mechanisms include periodic inspections by authorities at the manufacturing plants or laboratories, the requirement for manufacturers to assign a person to the role of compliance officer, and the requirement for the compliance officer to ensure manufacturing complies with requirements and to report back to the Government authorities. There are exclusive safety requirements for herbal medicines, with preclinical and clinical testing required when there is no available information on the safety of the extract in the literature. Testing must be verified and approved by the national health surveillance agency (Agencia Nacional de Vigilancia Sanitaria [ANVISA]), which was established in 1999. As of 2009, 519 herbal medicines were registered. The register of herbal medicines was updated in 2016. Herbal medicines are included in NEML, with the most recent update in 2014. Herbal medicines are sold in pharmacies as prescription and non-prescription medicines, self-medication or OTC medicines. In 2001, ANVISA established a process of drug monitoring that includes medicines based on medicinal plants.

2007 data from the National Health Foundation (Fundaçαo Nacional de Saύde [FUNASA]) indicates that 1–19% of the population uses indigenous TM practices. Other T&CM practices are also used. The MoH estimates that 1–19% of the population uses acupuncture and the same percentage use homeopathy. ayurvedic medicine, chiropractic, herbal medicines, naturopathy, osteopathy, traditional Chinese medicine and Unani medicine are also used by the Brazilian population, but percentage data are not available. Regulation of T&CM providers is enforced at the national level for providers of acupuncture, chiropractic, herbal medicines, homeopathy, naturopathy and osteopathy. The most recent update of the regulations governing T&CM practitioners was in 2016. T&CM providers practise in both private and public sector clinics and hospitals. A T&CM licence or certificate is required for practice, with self-regulation by delegated special technical associations. T&CM education is provided at a university level, and students can undertake the following programmes: clinical doctorate; pharmaceutical specialist (in either homeopathy, herbal medicines or acupuncture); physiotherapist specialist in acupuncture; biomedical specialist in acupuncture; doctor specialist in homeopathy; doctor specialist in acupuncture; nurse specialist in acupuncture; physical educator specialist in acupuncture; occupational therapist specialist in acupuncture; and psychologist specialist in acupuncture. The Government also officially recognizes certified T&CM training programmes. FUNASA data for 2007 puts the number of T&CM providers practising in the unified health system at 1100 for acupuncture providers and 560 for homeopathic medicine providers. T&CM services are partially insured by both government and private organizations. For example, acupuncture is fully covered by government and private insurance, herbal medicines are partially covered by government, and homeopathic medicines are fully covered by government and partially by private insurance. As at end 2016, T&CM services are reimbursed by both public and private health insurance. A consumer education project or programme for self-health care using T&CM started in 2006.

Brazil's regulatory framework for traditional and complementary medicine emphasizes interculturality and inclusiveness within its healthcare system. The foundation of this approach is evident in the *Law 8,080 of 1990* and its regulations, specifically *Decree 7,508 of 2011*, which establish the Unified Health System. This legislation promotes the promotion, protection, and recovery of health services, ensuring a comprehensive healthcare model that values cultural diversity. The country's dedication to intercultural healthcare extends to its *Indigenous Health Care Subsystem, introduced through **Law 9836 of 1999. This subsystem, established as an addition to Law No. 8080, acknowledges the unique healthcare needs of Indigenous populations and ensures their integration within the broader healthcare system. Brazil's commitment to Indigenous healthcare is further emphasized by the **National Policy for Healthcare of Indigenous Populations, established by **Ordinance 254 of 2002*. This policy ensures the right to health for Indigenous populations while recognizing the efficacy of Traditional Medicine and respecting their cultural sovereignty. In line with promoting intercultural practices, Brazil's *Program Articulating Indigenous Health Knowledge* and *Continuing Education on Indigenous Health* foster collaboration between Indigenous health systems and the official healthcare system. These initiatives aim to enhance healthcare quality and knowledge exchange within an intercultural context. The creation of the *Special Secretariat for Indigenous Health (Sesai)* through *Law 12,314 of 2014* reflects Brazil's commitment to Indigenous healthcare. This regulatory effort, constructed in collaboration with Indigenous communities, underscores the importance of addressing longstanding demands for specialized Indigenous health services. Moreover, Brazil's embrace of complementary medicine is evidenced by the *National Policy on Integrative and Complementary Practices in the Sistema Único de Saúde (National Health System). This policy, established through **Ministerial Ordinances 971 and 1.600 of 2006* and later modified, aims to incorporate integrative and complementary practices within the national health system, with a focus on primary care. The implementation of these practices is supported by the *Manual for the implementation of integrative and complementary services and practices within the national health system (Sistema Único de Saúde)*. In the realm of products and medicines, Brazil's regulatory approach emphasizes safety and quality. The *National Policy on Medicinal Plants and Herbal Medicines* established by *Presidential Decree No. 5,813 of June 22, 2006* prioritizes safe access, rational use, and sustainable development of medicinal plants. The country also ensures quality through the establishment of *Good Manufacturing Practices for Active Pharmaceutical Ingredients of Plant Origin* and *Good Manufacturing Practices for Traditional Herbal Products, outlined in **Collegiate Directorate Resolutions of 2013*. Brazil's regulatory and policy landscape reflects a commitment to intercultural healthcare and the integration of traditional and complementary practices into the healthcare system. This approach ensures diversity, equity, and quality in healthcare provision while valuing and respecting the country's rich cultural heritage.

Total population (2023): 216,422,4 millions Source: CEPALSTAT Statistical Database and Publication of Economic Commission for Latin America and the Caribbean (ECLAC) Indigenous population: 817,963 (0,43%) Afro-descendant population: 97,171,.614 (50,9%) Source: UNECLAC-CELADE: Redatam Webserver / Statistical Process and Dissemination Tool Acoña, Aikaná, Aimore, Ajuru, Akuntsú, Alaketesu, Alantesu, Amanayé, Amondáwa, Anacé, Anambé, Apalaí, Apiaká, Apinayé, Apolima-Arara, Apurinã, Araña, Arapáso, Arapiun, Arara de Rondonia, Arara de Acre, Arara do Aripuanã, Arara do Pará, Araweté, Arikapú, Arikén, Arikosé, Aruá, Ashaninka, Asurini, Asurini do Xingu, Atikum, Ava-Canoeiro, Aweti, Baenã, Bakairí, Banawa, Baniwa (Baniva), Bará, Barasána, Baré, Bora, Borari, Bororo, Botocudo, Catokin, Chamakóko, Charrua, Chiquitáno, Cinta Larga, Dâw, Dení, Desána, Diahói, Djeoromitxí-Jabutí, Enawenê-Nawê, Fulni-ô, Galibi do Oiapoque, Galibí Marwórno, Gavião de Rondônia, Gavião Krikatejê, Gavião Parkatejê, Gavião Pukobiê, Guaikurú, Guajá, Guaraní, Guarani Kaiowá, Guarani Mbya, Guarani Nhandeva, Guató, Hahaintesu, Halotesu, Hixkaryána, Hupda (Hupdu), Ikpeng, Ingarikó, Irántxe, Issé, Jamamadí, Jarawára, Jaricuna, Javaé, Jeripancó, Juma (Jumma), Ka’apor, Kadiwéu, Kaeté, Kahyana, Kaiabi, Kaimbé, Kaingang, Kalankó, Kalapalo, Kaixana, Kalabaça, Kamakã Krikati, Kamayurá, Kamba, Kambéba, Kambiwá, Kambiwá-Pipipã, Kampé, Kanamarí, Kanamanti, Kanela, Kanela Apaniekra, Kanela Rankocamekra, Kanindé, Kanoé, Kantaruré, Kapinawá, Kapon, Karafawyana, Karajá, Karapanã, Karapotó, Karijó a (Karijona), Karipuna, Karipúna do Amapá, Kariri, Kariri – Xocó Matsés, Karitiana, Katawixí, Katuena, Katukina, Ktukina de Acre, Kawahíb, Kaxarari, Kaxinawá, Kaxixó, Kaxuyana, Kayapó, Kayuisiana, Kinikinau, Kiriri, Kisêdjê, Kithaulu, Koiupanká, awa, Kokamaê, Kokuiregatej, Kontanawá, Korúbo, Krahô, Krahô-Kanela, Krenák, Krenyê, Kritati, Kubeo, Kuikuro, Kujubim, Kulina Madijá, Kulina Páno Pankaru, Kuripako, Kuruáya, Kwazá, Laiana, Lakondê, Latundê, Makú, Makúna, Makuráp, Makuxí (Makushi), Mamaindê, Manao, Manchineri, Manduka, Maragua, Marimã, Marúbo, Matipú, Matís, Matsés, Mawayána, Maxakali, Maya, Maytapu, Mehináku, Migueléno, Miránha (Miraña), Mirititapuia, Mucurim, Mundurukú, Múra, Mynky, Nadëb, Nahukuá, Nambikwára, Naravute, Nawa, Negarotê, Ninám, Nukiní, Ofayé, Oro Win, Paiaku (Jenipapo), Pakaa Nova, Palikur, Panará, Pankará, Pankararé, Pankararú, Pankararú-Karuazu, Pankaru, Papavó, Parakanã, Paresí, Parintintim, Pataxo Há-Há-Há, Pataxó, Paumarí, Paumelenho, Pirahã, Piratapuya, Piri-Piri, Pitaguari, Potiguara, Poyanáwa, Puri, Puroborá, Rikbaktsa, Sabanê Waikisu, Sakurabiat, Salamãy, Sanumá (Sanema), Sapará, Sarare, Sateré-Mawé, Sawentesu, Shanenáwa, Siriano Wayana, Surui de Rondonia, Suruí de Pará, Tabajara, Tamoio, Tapajós a, Tapeba, Tapiuns Xocó, Tapirapé, Tapayuna, Tapeba Xetá, Tapuia, Tariana, Taulipáng, Tawandê, Tembé, Tenetehara, Tenharim, Terena, Tikúna, Timbira, Tingui-Botó, Tiriyó (Tirio), Torá, Tremembé, Truká, Trumái, Tukano, Tumbalalá, Tunayana, Tupaiu, Tuparí, Tupinambá, Tupinambaraná, Tupiniquim, Turiwára, Tuxá, Tuyúca, Umutina, Urucú, Ureueu-Wau-Wau, Waiãpy, Waimiri Atroari, Wai Wai, Waikisu, Wakalitesu, Wanana, Wapixana (Wapishana), Warekena, Wasusu, Wassú, Wauja, Wayana, Witóto, Xacriabá Ashaninka, Xambioá, Xavante, Xerente, Xereu, Xéta, Xipáya, Xovó, Xokléng, Xucuru, Xucuru-Kariri, Yaipiyana, Yamináwa (Yaminahua), Yanomámi, Yanomán, Yawalapití, Yawanawá, Ye’kuana, Yudjá, Yurutí, Zo’é, Zoró, Zuruahã Afro-descendants reside in territories called Quilombolas Source: https://www.ibge.gov.br/

In Chile, the most recent update of the national policy and law on T&CM was in 2006. There is an Indigenous Peoples Health Policy that includes TM, and Administrative Rule No.16 on interculturality in Health Services (both from 2006). Article 7 of law 20.584 (regulating the rights and duties of people with respect to actions related to their health care), 2012, specifically covers the indigenous population; however, a policy on complementary medicine has yet to be developed. Within the MoH, there is a technical area in CM, in the Department of Pharmaceutical Policies and Regulations, Health Providers and Complementary Medicines. There is also a Special Program on Health and Indigenous Peoples, created in 2000, which is installed in 26 of 29 Health Services at national level, with allocated resources and specific workplans to develop in the field. There are advisory commissions for the three regulated therapies – acupuncture, homeopathy and naturopathy – created after the publication of the decrees that regulate them (beginning in 2009). Between 2006 and 2013, the MoH allocated resources for the elaboration of basic epidemiological profiles by indigenous peoples, and areas of coverage of the health services. There are currently 11 epidemiological profiles. No resources are allocated for complementary medicine. The MoH has been working (since 2015) on the development of a regulation that establishes the right of indigenous peoples to receive health care with cultural relevance (Article 7 of Law 20,584). The intention is to regulate health care provided in the public sector, and in no way to regulate the health systems of indigenous or native peoples; rather, the regulation recognizes, protects and respects ancestral systems of healing, religious practices, and cultural and spiritual beliefs of these peoples. The proposed regulation was developed in consultation with indigenous peoples and is currently in administrative proceedings to be implemented.

Health surveys estimate that 1–19% of the population uses indigenous TM. Other T&CM practices used by the same percentage of the population include acupuncture, herbal medicines, homeopathy and naturopathy. An unknown percentage use ayurvedic medicine, chiropractic, osteopathy and traditional Chinese medicine. The regulation on T&CM practice (Decree No. 42 of 2004), issued by the MoH, governs the “exercise of alternative medical practices as auxiliary health professions and the facilities in which these are carried out”. Three T&CM practices – acupuncture, homeopathy and naturopathy – are recognized as therapies and are governed under the following regulations: • Decree No. 123 of 2006, which grants recognition to acupuncture and regulates acupuncturists as Assistant Health Professionals; • Decree No. 19 of 2009, which grants recognition to and regulates homeopathy as an Auxiliary Profession of Health; and • Decree No. 5 of 2012, which grants recognition to naturism and regulates naturopathy as an Auxiliary Profession of Health. These regulations are enforced at national level. The most recent update of the regulations for T&CM practitioners was in 2012.There is no regulation recognizing indigenous TM practice or regulating its providers. T&CM providers practise in private and public clinics. A T&CM licence or certificate, issued by the MoH via the regional health authorities, is required to practise the recognized therapies. A bachelor’s degree is available at university level. The numbers of T&CM providers in practice in Chile (as at 2012) are acupuncture (500), herbal medicines (10), homeopathic medicine (200) and naturopathic medicine (500). A consumer education project or programme for self-health care using T&CM started in 2016. There is an ongoing project on complementary practices for self-care and well-being. The most recent study available in relation to T&CM is the 2015 documentation of good field practices in phytotherapy in the health delivery network.

Chile's approach to traditional and complementary medicine is deeply rooted in interculturality and holistic healthcare. *Law 19,937, known as the Health Authority Law, assigns the Ministry of Health the responsibility of developing policies that integrate the intercultural perspective into health programs, particularly in regions with a significant indigenous population. This commitment is further evident in **Exempt Resolution No. 91 of 2006*, which advocates for the development of an intercultural health model to improve the well-being of indigenous peoples and their participation in health decision-making. Chile's dedication to intercultural health is reflected in various regulatory instruments, such as the *Special Health Program for Indigenous Peoples* outlined in *Exempt Resolution N° 1190 of 2000*. This program aims to progressively develop an intercultural health model in collaboration with indigenous communities and organizations, addressing the specific health needs of indigenous populations. To operationalize interculturality within healthcare services, *Administrative General Norm No. 16* was introduced through *Exempt Resolution N° 261 of 2006*. This norm provides guidelines for implementing cultural relevance, interculturality, and complementarity in health services, promoting respectful and inclusive healthcare practices. Chile also recognizes the importance of traditional medicine within an intercultural context. *Law 20584*, enacted by the National Congress of Chile, mandates the development of an intercultural care model validated by indigenous communities, protecting and strengthening traditional healing systems within indigenous territories. In terms of complementary medicine, Chile has taken a comprehensive approach. It has regulated various practices such as acupuncture, homeopathy, and naturopathy as auxiliary health professions through decrees issued by the Ministry of Health, exemplified by *Decree Nº 123 of 2006, **Decree Nº 19 of 2009, and **Decree Nº 05 of 2012*, respectively. Moreover, the country has focused on the integration of complementary medicine into its healthcare system. The *Technical Guidance for Complementary Medicine and Health Wellbeing Practices in Primary Care* seeks to institutionalize and develop complementary medicine practices within the Comprehensive Family and Community Health Care Model (CFCHCM), promoting well-being and reducing health inequities. Chile's regulatory landscape underscores its commitment to holistic healthcare by acknowledging indigenous practices, interculturality, and complementary medicine. These efforts ensure that the nation's healthcare system is not only inclusive but also respects and draws from its diverse cultural and healing traditions.

Chile's regulation recognizes Complementary Medicine (CM) as auxiliary health professions, refers to as alternative and complementary medical practices, establishing requirements for the recognition and regulation of these professions, their practice, and the facilities in which they are carried out. Acupuncture, Homeopathy, and Naturopathy are recognized and regulated. The Health Code stipulates that the practice of unregulated practices will be supervised by the health authority. CM has been integrated into all three levels of care in the public health system, offering 28 different therapies, grouped into: a) Individual care practices: Acupuncture, Homeopathy, Naturopathy, Apitherapy, Auriculotherapy, Biomagnetism, Herbal Medicine, Massage Therapy, Anthroposophic Medicine, Chiropractic, Reiki, Pranic Healing, Sintergetics, Flower Therapy, and Neural Therapy, b) Group and community care practices: Art Therapy, Biodanza, Listening Circles, Qi Gong, Family Constellations, Dance Therapy, Medicinal or Food/Medicinal Gardens, Meditation, Music Therapy, Sound Therapy, Tai Chi and Yoga. The products associated with CM correspond to human use medicines, medical devices or food, depending on their nature. The Ministry of Health has developed a participatory process for the elaboration of the "Complementary Medicine and Health Wellbeing Practices Policy," which includes an Action Plan that addresses the way to close the regulatory gap in this matter.

In Chile, there's a training gap for complementary medicine therapists by higher education institutions such as universities, professional institutes, or recognized Technical Training Centers. Additional entities have emerged, aligning with regulations for each practice. Graduates validate competencies through prior evaluation and an exam. The process is overseen by Regional Ministerial Health Secretariats.Given that these recognized training institutions still lack a consistent offering that meets the training needs in complementary medicine and well-being practices, the supply of programs from unrecognized schools or training centers, both for regulated and non-regulated therapies, has increased. The "Action Plan for the Policy on Complementary Medicine and Well-being Practices" in Health aims to promote the training, education, and accreditation of public health officials in complementary medicine and well-being practices. The modification of existing regulations is currently underway to strengthen the training of professionals in these practices.

Total population (2023): 19,629,6 millions Source: CEPALSTAT Statistical Database and PUblication of Economic Commission for Latin America and the Caribbean (ECLAC) Indigenous population: 2,185,792 (12,8%) Afro-descendant population: N/D Source: UNECLAC-CELADE: Redatam Webserver / Statistical Process and Dissemination Tool. Indigenous Peoples: Atacameño o Lickan Antai, Aymara, Colla, Chango, Diaguita, Kawésqar, Mapuche, Quechua, Rapa Nui, Yagán Source: Economic Commission for Latin America and the Caribbean (ECLAC)

Decree 2266, issued in 2004 (modified by Decree 3553 in 2004), regulates health registers, health surveillance and control, and advertising of herbal medicines. There is a regulation exclusively for herbal medicines (productos fitoterapéuticos), which are regulated as non-prescription medicines, and are sold with medical claims. The legally binding pharmacopoeias used are the British herbal pharmacopoeia (4th ed., 1996), the British pharmacopoeia (2010), the Spanish pharmacopoeia (3rd ed., 2005), the combined United States pharmacopeia and National formulary (USP–NF) (USP34/NF29, 2010), the Brazilian pharmacopoeia (4th ed.), the Pharmacopoeia of the united Mexican states (9th ed., 2008) and the Codex Français (2004). The monographs used, also legally binding, are the Colombian vademecum of medicinal plants (2008) (119 monographs published), the WHO monographs on selected medicinal plants, and Plantas medicinales iberoamericanas, Gupta (243 monographs). The GMP for herbal medicines is covered in GMP for pharmaceuticals based on natural products (Resolution 3131 of 1998; the GMP compliance instrument was adopted by Resolution 5107 of 2005). The regulations for manufacturing of herbal medicines to ensure their quality require adherence to manufacturing information in pharmacopoeias and monographs. The mechanisms to ensure compliance include periodic inspections by authorities at the manufacturing plants or laboratories; also, laboratories must obtain a certificate in GMP for herbal medicines before manufacturing products, and manufacturers must have a technical director in chemical pharmaceutics in charge of products quality and reporting to health authorities. The safety requirements for herbal medicines are exclusive, as determined by a specialized panel on natural products of the reviewing commission of the National Surveillance Institute of Medicines and Foods (Instituto Nacional de Vigilancia de Medicamentos y Alimentos [INVIMA]). As of 2019, 913 herbal medicines were registered. The NEML does not include herbal medicines. Herbal medicines categorized as prescription medicines are sold in pharmacies. They are also sold in pharmacies, other and special outlets as non-prescription medicines, self-medication or OTC medicines; by licensed practitioners; and via other unregulated media such as the Internet and telesales.

The use of indigenous TM is considered important in Colombia, with use by 1–19% of the population in 2005, according to the National Administrative Department of Statistics. Other practices used include T&CM practices such as acupuncture, ayurvedic medicine, chiropractic, herbal medicines, homeopathy, naturopathy, osteopathy, traditional Chinese medicine and Unani medicine; and other practices such as electromagnetic polar balance, neural therapy and sintergetics. However, data on percentage of use by the population are not available. Law 1164 of 2007 dictates provisions on the practice of T&CM; these provisions are taken up by Resolution 2003 of 2014, which regulates all health care services, including CM. It defines the minimum requirements for physical spaces where services are to be provided, equipment and training of professionals; also, it includes the standards for health professionals in T&CM. Decree 2753 of 1997 (Article 4) limits CM practice to physicians. It mandates that health care providers consult with indigenous communities when setting up services. Resolution 2927 of 1998 defines and regulates different types of CM practices. The regulations on T&CM providers, enforced at national level, are for acupuncture (2006), ayurvedic medicine (2006), herbal medicines (2006) and homeopathic medicine (1962 and 2006). T&CM providers practise in private and public clinics. A T&CM licence or certificate, issued by a relevant academic institution, is required to practise. A master’s degree and clinical doctorate degree in T&CM are available at university level. T&CM services such as acupuncture, chiropractic, homeopathy, osteopathy and traditional Chinese medicine are partially covered by private health insurance. As a result of participatory work with the expert committees for TM and CM, there is a proposal to define the profile and professional competencies of health professionals, to guide the formation and performance in each of the recognized systems.

Colombia's approach to regulating traditional and complementary medicine is deeply rooted in intercultural principles and a commitment to inclusivity. The country has implemented a series of supportive norms and legislation that reflect its dedication to preserving the health rights and cultural integrity of its diverse population. Noteworthy among these regulations is the *Law 691 of 2001*, which seeks to regulate the participation of ethnic groups in the General Social Security System. Developed to safeguard the health rights of Indigenous Peoples, this law ensures the protection of their cultural heritage and societal permanence, aligning with constitutional terms and international treaties. Colombia's engagement with traditional and complementary medicine extends further through *Law 1164 of 2007*, which provides provisions on Human Resources in Health. This law allows health professionals to integrate Traditional, Complementary, and Integrative Medicine (TCIM) within their disciplines. Decree *1953 of 2014* introduces a special regime for Indigenous Territories, focusing on the administration of indigenous peoples' systems. This decree defines the Indigenous Intercultural Health System, emphasizing ancestral wisdom as the cornerstone. It aligns and complements the Social System of Social Security in Health, reflecting the government's commitment to merging traditional and contemporary healthcare systems. Colombia's dedication to healthcare inclusivity is further manifested in the *Statutory Law 1751 of 2015, which establishes the fundamental right to health and sets forth protection mechanisms. The integration of interculturality into Colombia's healthcare model is evident in the **Ten-Year Public Health Plan 2012-2021, presented as a medium-term plan to ensure health as a fundamental right, human development, and peace. The government's vision for a harmonized healthcare landscape is solidified in the **Resolution 050 of 2021*, which adopts the Indigenous Chapter into the Ten-Year Public Health Plan, underscoring the significance of indigenous communities' health within the national agenda. Colombia's comprehensive approach also involves creating frameworks for collaboration. The *Directive 0011 of 2018* outlines guidelines for advancing the Indigenous System of Own and Intercultural Health (SISPI) at the territorial level, in alignment with the General System of Social Security in Health. Additionally, the creation of the *Committee on Alternative and Complementary Medicine and Therapies (MTAC)* in support of the National Council of Human Talent in Health (CNTHS) demonstrates Colombia's commitment to fostering collaboration between traditional and complementary healthcare practices. In summary, Colombia's regulations and policies in traditional and complementary medicine reflect a holistic approach, emphasizing interculturality, inclusivity, and the preservation of cultural heritage. These measures strive to harmonize various healthcare practices, ensuring that both traditional and contemporary methods contribute to the overall well-being of the population.

Colombia's approach to regulating traditional and complementary medicine is deeply rooted in intercultural principles and a commitment to inclusivity. The country has implemented a series of supportive norms and legislation that reflect its dedication to preserving the health rights and cultural integrity of its diverse population. Noteworthy among these regulations is the *Law 691 of 2001*, which seeks to regulate the participation of ethnic groups in the General Social Security System. Developed to safeguard the health rights of Indigenous Peoples, this law ensures the protection of their cultural heritage and societal permanence, aligning with constitutional terms and international treaties. Colombia's engagement with traditional and complementary medicine extends further through *Law 1164 of 2007*, which provides provisions on Human Resources in Health. This law allows health professionals to integrate Traditional, Complementary, and Integrative Medicine (TCIM) within their disciplines. Decree *1953 of 2014* introduces a special regime for Indigenous Territories, focusing on the administration of indigenous peoples' systems. This decree defines the Indigenous Intercultural Health System, emphasizing ancestral wisdom as the cornerstone. It aligns and complements the Social System of Social Security in Health, reflecting the government's commitment to merging traditional and contemporary healthcare systems. Colombia's dedication to healthcare inclusivity is further manifested in the *Statutory Law 1751 of 2015, which establishes the fundamental right to health and sets forth protection mechanisms. The integration of interculturality into Colombia's healthcare model is evident in the **Ten-Year Public Health Plan 2012-2021, presented as a medium-term plan to ensure health as a fundamental right, human development, and peace. The government's vision for a harmonized healthcare landscape is solidified in the **Resolution 050 of 2021*, which adopts the Indigenous Chapter into the Ten-Year Public Health Plan, underscoring the significance of indigenous communities' health within the national agenda. Colombia's comprehensive approach also involves creating frameworks for collaboration. The *Directive 0011 of 2018* outlines guidelines for advancing the Indigenous System of Own and Intercultural Health (SISPI) at the territorial level, in alignment with the General System of Social Security in Health. Additionally, the creation of the *Committee on Alternative and Complementary Medicine and Therapies (MTAC)* in support of the National Council of Human Talent in Health (CNTHS) demonstrates Colombia's commitment to fostering collaboration between traditional and complementary healthcare practices. In summary, Colombia's regulations and policies in traditional and complementary medicine reflect a holistic approach, emphasizing interculturality, inclusivity, and the preservation of cultural heritage. These measures strive to harmonize various healthcare practices, ensuring that both traditional and contemporary methods contribute to the overall well-being of the population.

In the realm of Alternative and Complementary Medicines (CAM), despite its early beginnings in the country through informal homeopathy training and study groups, its formal integration into academia faced historical disruptions due to legislative challenges that hindered its implementation in higher education institutions. Nonetheless, the efforts of medical collectives, who learned, promoted, and practiced CAM, paved the way for academic incorporation from the 1970s and 1980s. The University Nacional de Colombia established an undergraduate course titled "Medical Knowledge and Society" in 1970, offering insights into various medical rationales, including CAM. Subsequently, in 2001, the National University initiated extension courses in the Fundamentals of Alternative Medicine, spanning specific areas like Homeopathy, Neural Therapy, Traditional Chinese Medicine, and Osteopathy. Collaborating educators formed an academic group in alternative medicine from which the Master's program in Alternative Medicine emerged in 2006. In parallel, the Fundación Universitaria Juan N. Corpas, conducted research and training in Alternative Therapies and Herbal Pharmacology. They introduced a Course in Alternative Therapies in 1994 and subsequently expanded their diploma offerings in MTAC-related subjects, some for healthcare professionals and others exclusively for physicians. The university also launched the Medical Specialization in Alternative Therapies and Herbal Pharmacology in July 2007. Postgraduate programs were introduced following the establishment of these programs, including the University Manuela Beltrán in 2009, and other programs currently in development. Notably, the Instituto Luis G. Páez, providing education in Homeopathy since 1914, established a specialized university foundation for postgraduate education in this field. Presently, Colombia boasts four postgraduate programs at Universidad Nacional de Colombia, Fundación Universitaria Juan N. Corpas, Fundación Universitaria Luis G. Páez, and Universidad Manuela Beltrán. Furthermore, there are elective courses at various undergraduate health-related programs, offering students opportunities to become acquainted with ACM. Over 3500 healthcare professionals have graduated from these postgraduate programs.

Total population ( 2023): 52,085,2 millions Source: CEPALSTAT Statistical Database and PUblication of Economic Commission for Latin America and the Caribbean (ECLAC) Indigenous population: 1,905,617 (4,37%) Afro-Descendant population: 2,982,224 (6,8%) Gypsies population: 2,649 (0.06%) Source: DANE - Grupos étnicos información técnica 2018. Indigenous Peoples: Achagua, Ambaló, Amorúa, Andakies, Andoque, Arhuaco, Awá, Baniva, Bara, Barasano, Bari, Betoye, Bora, Calima, Cañamomo, Carapana, Chimila, Chiricoa, Chitarero, Cocama, Coconuco, Coreguaje, Cubeo, Cuiba, Cuna Tule, Curripaco, Desano, Dujo, Embera, Embera Chamí, Embera Katio, Emberá Dobida, Eperara Siapidara, Guanaca, Guane, Guariquema, Guayabero, Hitnu, Hupdu, Inga, Je´Eruriwa, Juhup, Jupda, Kakua, Kamëntsa, Kankuamo, Karijona, Kawiyarí, Kichwa, Kizgó, Kofán, Kogui, Letuama, Macaguaje, Macahuan, Makú, Makuna, Mapayerri, Masiguare, Matapí, Miraña, Misak, Mokana, Muinane, Muisca, Murui, Nasa, Nonuya, Nukak, Nutabe, Ocaina, Panches, Pastos, Piapoco, Piaroa, Pijao, Piratapuyo, Pisamira, Polindara, Puinave, Quillacinga, Quimbaya, Sáliva, Sikuani, Siona, Siriano, Taiwano, Tanigua, Tanimuka, Tatuyo, Tayronas, Tikuna, Totoró, Tsiripu, Tukano, U’wa, Wanano, Wayuú, Wipiwi, Wiwa, Wounan, Yagua, Yamalero, Yanacona, Yarí, Yaruro, Yauna, Yeral, Yukpa, Yukuna, Yuruti, Zenú Afro-Descendants Peoples: Called Black people, mulatto and afrocolombianos; also are Palenqueros from San Basilio de Palenque and Raizales from Archipelago of San Andrés, Providencia and Santa Catalina Gypsies live on territories called Kumpany - Vitsas: Pasto, Ibagué, San Pelayo, Sampués, Sahagún, Sabanalarga, Cúcuta, Girón and Envigado Source: DANE - Grupos étnicos información técnica, 2018.

The Health Control Registry regulates the registration, manufacture, distribution and marketing of both herbal medicines and homeopathic medicines (under the regulation for health registration and control of processed natural products for medicinal use, and establishments where such products are manufactured, stored, distributed and marketed). There are registered herbal medicines, but the NEML does not include herbal medicines.

The most recent update for regulations on T&CM practitioners was in 2014. T&CM practices and providers are regulated under the alternative therapies and alternative medicines laws mentioned above. As for indigenous TM, public policy provides for its strengthening, self-determination and recognition (under the mandate of the constitution), which means that communities themselves identify legitimate indigenous TM practices and providers. In the case of traditional midwives, there is a manual (issued in 2016) that defines the mechanisms for integrating them with health teams (at primary care level), sets out the process of community legitimation, and establishes parameters for the certification given by the ministry to midwives based on a methodology of dialogue of knowledge.

Ecuador has established a comprehensive framework for the integration and regulation of traditional and complementary medicine (T&CM) within its healthcare system. The *Political Constitution of the Republic of Ecuador* in *2008* recognized the right to access and promote T&CM, setting a foundational precedent. The *Organic Health Law* (Ley 67 of 2006) served as a pivotal step, regulating actions to realize the universal right to health as enshrined in the constitution and organizing the health system. The *Integral Care Model of the National Community and Intercultural Family Health System* (Acuerdo Ministerial 725-1162 of 2012) reflects Ecuador's commitment to comprehensive healthcare. This model establishes policies, strategies, guidelines, and tools to address health needs at various care levels, emphasizing a community-centered approach. Ecuador recognizes the significance of T&CM by promoting ethical guidelines and practices. The *Code of Ethics of the Ancestral-Traditional Medicine of the Nationalities and Peoples* aims to self-regulate, recognize, and complement ancestral-traditional medicine within the national health system. Additionally, the country acknowledges the vital role of ancestral midwives through the *Manuals of Articulation of Practices and Knowledge of Ancestral Midwives* (Acuerdo Ministerial 070 of 2016 and Acuerdo Ministerial 00161 of 2023), facilitating collaboration with the National Health System to enhance maternal and neonatal health. Interculturality is integral to Ecuador's healthcare policies. The *Regulations for the Application of the Intercultural Approach* (Acuerdo Ministerial 0082 of 2017) emphasize inclusion, reducing barriers, and ensuring comprehensive health care for communities with difficult access. Technical guidelines for culturally appropriate childbirth care (Acuerdo Ministerial 0000000474 of 2008) and delivery area specifications (Acuerdo Ministerial 00112 of 2020) reinforce an intercultural approach to maternal and neonatal health. Ecuador's commitment extends to organizational structures. The *Creation of the National Directorate of Intercultural Health and Equity* (Acuerdo Ministerial Nro. 00023-2022) highlights the formulation and coordination of policies to ensure access, respect, and diversity recognition within the National Health System. Furthermore, Ecuador is making strides to strengthen its intercultural health policy through the *Project to Strengthen Intercultural Health* (Acuerdo Ministerial 00082 – 2023), reflecting its dedication to holistic and culturally sensitive healthcare. Finally, regulatory frameworks extend to complementary medicine, as evidenced by the *Regulation of the Exercise of Professionals Specialized in Alternative Medicines* (Acuerdo Ministerial N° 5001-2014) and the *Regulations for the Practice of Alternative Therapies* (Acuerdo Ministerial N° 037-2016), demonstrating Ecuador's comprehensive approach to healthcare integration and regulation.

"En el Ecuador la interculturalidad es uno de los derechos fundamentales de la Constitución en reconocimiento a la diversidad étnica. En este contexto reconoce, además, la diversidad de conocimientos. En el Sistema Nacional de Salud (SNS), se distingue oficialmente tres sistemas de medicina que son la convencional (alopático), la ancestral - tradicional practicada por las diversidades étnicas del país, transmitido de generación en generación y con una estrecha conexión con la naturaleza; y el alternativo y complementario representado por las medicinas alternativas (homeopatía, moxibustión, acupuntura) el cual requiere una formación de pregrado en medicina y postgrado en una de las Medicinas Alternativas, y las terapias alternativas y complementarias agrupadas en tres grandes categorías: integrales o completas, de manipulación basadas en el cuerpo, y las prácticas de bienestar de la salud, las cuales requieren de un proceso de capacitación continua hasta alcanzar el nivel técnico.

Total population (2023): 18 190.5 millions. Source: CEPALSTAT Statistical Database and PUblication of Economic Commission for Latin America and the Caribbean, known as ECLAC. Indigenous population 1.018.176 (7,03%), Afrodescendent population 1.041.559 (7,2%) Source: UNECLAC-CELADE::Redatam Webserver | Statistical Process and Dissemination Tool. List of indigenous peoples: Achuar, Andoa, Awa, Chachi, Chibuleo, Cofan, Epera, Kañari, Karanki, Kayambi, Kichwa de la sierra, Kisapincha, Kitukara, Natabuela, Otavalo, Paltas, Panzaleo, Pastos, Pueblo Huancavilca, Pueblo Manta, Puruhá, Salasaka, Saraguro, Secoya, Shiwiar, Shuar, Siona, Tomabela, Tsachila, Waorani, Waranka, Zapara Source: http://www.ecuadorencifras.gob.ec/

Total population ( 2023): 813,8 thousand Source: CEPALSTAT Statistical Database and Publication of Economic Commission for Latin America and the Caribbean, known as ECLAC.

There is a regulation specific to herbal medicines (although the same regulation includes homeopathic products). Herbal medicines are categorized as non-prescription phytopharmaceuticals, and are sold with claims based on popular use. The pharmacopoeias used are the national pharmacopoeias of Paraguay (1938), Argentina and Brazil. The monographs used are the WHO monographs on selected medicinal plants. These publications are not legally binding. There is no regulation on manufacturing of herbal medicines to ensure their quality. The safety requirements are the same as that for conventional pharmaceuticals; traditional use without demonstrated harmful effects and reference to safety data in documented scientific research on similar products are sufficient. The NEML does not include herbal medicines. Herbal medicines are sold in pharmacies, other outlets and special outlets as non-prescription medicines, self-medication or OTC medicines. The list of registered herbal medicines was most recently updated in 2017.

Indigenous TM is considered important in Paraguay. T&CM practices such as acupuncture, ayurvedic medicine, chiropractic, herbal medicines, homeopathy, naturopathy, osteopathy, traditional Chinese medicine and Unani medicine are used. T&CM providers practice in private clinics only. As at 2017, there is a draft regulation for T&CM providers that is being reviewed by the MoH’s legal advisory office.

Total population ( 2023): 6 861,5 millions Source: CEPALSTAT Statistical Database and Publication of Economic Commission for Latin America and the Caribbean, known as ECLAC. Indigenous population: 88.529 (1,7%) Afrodescendent population N/D Source: SISPPI, CELADE (2007) List of Indigenous Peoples: Aché Angaité, Ava Guaraní Ayoreo Enlhet Norte Enxet Sur Guaná Guaraní Occidental Guaraní Ñandeva Maká Manjui Mbyá Guarani Nivaclé Pai Tavytera Qom, Sanapaná Toba Maskoy Tomáraho Ybytoso Source: INE - Instituto Nacional de Estadística

Regulation of herbal medicines comes under the regulation for registration, control and health surveillance of pharmaceutical and related products, approved by Supreme Decree No. 010, and the law on pharmaceutical products, medical devices and health care products (Ley de Productos Farmacéuticos, Dispositivos Médicos y Productos Sanitarios No. 29459), which is in the process of being implemented. Under this legislation, herbal medicines are categorized as herbal medicines, dietary supplements and functional foods. The monographs used are not legally binding; they include a medicinal plants formulary (Formulario de Plantas Medicinales del Seguro Social de Salud) comprising 54 monographs (2002), a phytotherapy manual (Manual de Fitoterapia) comprising 73 monographs (2000) and a database of medicinal plants of the Peruvian Amazon (Banco de Datos de Plantas Medicinales de la Amazonίa Peruana) comprising 80 monographs (2007). The GMP for herbal medicines are specified in the manual of GMP for all pharmaceutical products (Manual de Buenas Prάcticas de Manufactura de Productos Galénicos y Recursos Terapéuticos Naturales), issued in 2000. There are specific regulations on manufacturing of herbal medicines to ensure their quality. Compliance mechanisms include periodic inspections by authorities at the manufacturing plants or laboratories, the requirement for manufacturers to assign a person to the role of compliance officer, and the requirement for the compliance officer to ensure the manufacturer’s compliance with manufacturing requirements and to report back to the Government authorities. There are specific safety requirements for herbal medicines according to their classification: norms of medicines for herbal medicines, certificate of traditional use and toxicity studies for herbal products, and certificate of traditional use and botanical certificate for herbal resources. Between 2002 and 2007, 962 herbal medicines were registered (435 natural products from Peru and 527 foreign ones). The most recent update of the register of herbal medicines was in 2017. Herbal medicines are included in the NEML, most recently updated in 2016. Herbal medicines are sold in pharmacies and other special outlets as non-prescription medicines, self-medication or OTC medicines. A consumer education programme for self-health care using T&CM was established in 2011. In 2013, EsSalud’s Complementary Medicine Directorate developed a health education programme for people with metabolic syndrome, titled “Life Reform Program”, and a programme to train peer educators (former patients) as health promoters using T&CM-related interventions.

Indigenous TM is considered important in Peru. Other T&CM practices are also in use. T&CM providers practise in private and public clinics and hospitals. Education provided at the university level includes a diploma in alternative therapies (48, 54 and 60 graduates in 2007, 2008 and 2009, respectively). The Government also officially recognizes a certified training programme. Providers of indigenous TM and other T&CM practices such as acupuncture, chiropractic, floral therapy, herbal medicines, homeopathic medicines, mind–body medicine, naturopathic medicine, neural therapy, osteopathic and traditional Chinese medicine are all found in Peru. With regard to health insurance, the MoH, through the integrated health system (serving the poor population of the country), covers some acupuncture services. Government social security insurance (EsSalud), which provides care to about 30% of the population, provides T&CM services for those it insures.

Peru's comprehensive regulatory and policy framework for traditional and complementary medicine embodies a commitment to interculturality and holistic healthcare. The General Health Law, Ley N° 26842 of 1997, establishes the foundational structure of the healthcare system, encompassing health authority, disease control, environmental health, health personnel, establishments, and more. The protection of indigenous collective knowledge related to biological resources is evident in Ley N° 27811 of 2002. Peru's commitment to intercultural health is further evident in the Intercultural Health Sectorial Policy, defined by Decreto Supremo 016-2016-sa in 2016, which focuses on inclusive health services for indigenous and Afro-descendant communities. The comprehensive family and community-based healthcare model outlined in Resolución Ministerial No. 464-2011 emphasizes a territorial approach and prioritizes intervention at the family and community levels. Technical documents like the Intercultural Dialogue in Health guidelines, as detailed in Resolución Ministerial 611 of 2014, emphasize collaboration between indigenous populations, traditional medicine agents, and authorities. The specific and comprehensive Intercultural Health Care Model for river basins in the Loreto Region, outlined by Resolución Ministerial 594 of 2017, underpins Peru's commitment to Amazonian diversity. Additionally, laws like Ley Nº 27657 of 2002 establish the National Center for Intercultural Health to enhance intercultural healthcare strategies. Furthermore, the Institute of Traditional Medicine, established by Resolución de Presidencia Ejecutiva 097-IPSS-92 in 1992, conducts multidisciplinary research and offers complementary therapies. Resolución Ministerial Nº 598- 2005/MINSA provides the regulatory framework for vertical delivery care with intercultural adaptation, emphasizing cultural inclusivity. Peru's regulations extend to complementary medicine as well, such as D.S.N°013-2006-SA, which regulates health establishments and medical support services. Resolución Ministerial Nº 902-2017/MINSA outlines instructions for the registration and coding of alternative and complementary medicine activities. These norms and policies collectively reflect Peru's dedication to intercultural healthcare and the integration of traditional and complementary medicine into its healthcare model.

In Peru, there are experiences of articulation of traditional medicine with conventional medicine, generated by the population; health services or by private organizations. These experiences are in the process of systematization. The Ministry of Health is promoting the incorporation of some complementary medicine therapies that have sufficient scientific evidence to ensure benefit and safety for the user, in Hospitals (phytotherapy, mind-body therapies and expressive art therapies) and in the primary health service mind-body therapies are the ones mainly used. In the Social Security of Peru (ESSALUD) a system that depends on the Ministry of Labor, there is a service that offers alternative and complementary medicine therapies. In 2023, the government of Peru, inaugurated the first intercultural hospital in the Province of Atalaya - Ucayali that serves the Amazonian population of the indigenous Shipibo - Konibo, Ashaninkas, Yine, Matsigenkas, Nahuas and they are implementing a botanical garden of medicinal plants, in order to strengthen health care, with cultural relevance.

In Peru, the Ministry of Health, operating through the National School of Public Health, provides various courses related to TCIM as an integral component of training focused on non-communicable diseases and various life stages.

Total population ( 2023): 34,352,7 millions Source: CEPALSTAT Statistical Database and Publication of Economic Commission for Latin America and the Caribbean (ECLAC) Indigenous population 6,383,284 (26,8%) Afro-Descendant population 877,429 (3,7%) Source: UNECLAC-CELADE: Redatam Webserver / Statistical Process and Dissemination Tool List of Indigenous Peoples: Achuar Aimara Amahuaca Arabela Ashaninka Asheninka Awajún / Aguaruna Bora Cashinahua Chamicuro Chapra Chitonahua Ese Eja Harakbut Ikitu Iñapari Iskonawa Jaqaru Jíbaro Kakataibo Kakinte Kandozi Kapanawa Kichwa Kukama Kukamiria Madija Maijuna Marinahua Mashco Piro Mastanahua Matsés Matsigenka / Machiguenga Muniche Murui-Muinanɨ Nahua Nanti Nomatsigenga Ocaina Omagua Quechua Resígaro,Secoya Sharanahua Shawi / Chayahuita Shipibo – Konibo Shiwilu Ticuna Urarina Uro Vacacocha Wampis Yagua Yaminahua Yanesha Yine Source: Map of Indigenous groups. Ministry of Culture Peru

Uruguay has taken significant steps to regulate and integrate complementary medicine practices within its healthcare system. The country has established specific normativity for various complementary medical techniques and products. Acupuncture was formally recognized as a medical technique through Decreto N° 32/001 in 2001, highlighting its legitimacy within the medical field. Similarly, in 2009, Uruguay regulated homeopathy as a medical technique under Decreto N° 447/009, affirming its status as a recognized and regulated practice. The country has also shown dedication to the regulation of complementary medicine products. The Regulatory Framework for Homeopathic Medicines was approved in 2016 through Decreto 404/016, ensuring the proper oversight and quality control of homeopathic products. Additionally, Uruguay established the Regulatory Framework for Medicinal Herbs, Herbal Specialties, and Phytotherapeutic Drugs in the same year, as outlined in Decreto 403/016, further demonstrating the country's commitment to regulating and ensuring the safety and efficacy of herbal and phytotherapeutic products. These regulatory measures underscore Uruguay's efforts to provide a comprehensive and well-regulated environment for complementary medicine practices and products, promoting their integration into the broader healthcare landscape.

Uruguay has a National Integrated Health System since 2008.All Citizens ,residents and foreigners have equal and free access to health sistem. Uruguay has an Advisory Commssion on Tradicional Medicine since 2004 working towards the regulation of the different aspects of this practice. Although Traditional Medicine practices are not included in the catalog of Benefits and programs of health providers . However Acupuncture is currently available in 3 public and 5 Private Institutions. Acupuncture Training is available at Private University Level , though it has not yet been , it has not recognized by the Postgraduate Center of the University of the Republic of the Republic. Uruguay has a legal framework for Acupuncture and Homeopathic practice. Acupuncture and Homeopathic should be performed only by MD’s ,Dentist and Veterinaries-for animal use. Ayurveda training and practice are available only in the private level. We have several precedents of cooperation with the Government of the People's Republic of China, through the AUCI - International Cooperation Agency in Uruguay and the Ministry of International Affairs, where multiple delegations have trained in TCM at Universities of China, as well as in virtual meetings and training courses.

Uruguay offers a only one university-level program: a postgraduate degree in Acupuncture offered by a private university. This program is exclusively available to medical doctors. However, it's important to note that none of the Traditional and Complementary Integrative Medicine (TCIM) programs are acknowledged by the Postgraduate Center of the University of the Republic. While there are additional institutions providing training in TCIM, they are all privately operated. A few among them hold registration with the Ministry of Education and Culture.

Total population (2023): 3,423,1 millions Source: CEPALSTAT Statistical Database and Publication of Economic Commission for Latin America and the Caribbean (ECLAC) Indigenous population 76,452 (2,33%)Afro-Descendant population 149,689 (4,8%) Source: UNECLAC-CELADE: Redatam Webserver | Statistical Process and Dissemination Tool List of indigenous peoples: Bohanes, Chanñas, Guaraní, Guayanás, Guenoas, Minuanes, Yaros Source: van der Boor C, et al. BMJ Open 2022;12:e066738. doi:10.1136/bmjopen-2022-066738