Traditional, Complementary, and Integrative Medicine Governance in the Americas Region: An Analytic Framework

Introduction: This work presents an analytic framework for describing the unique features of Traditional, Complementary, and Integrative Medicine (TCIM) governance, based on datasets from across the Americas, a region globally notable for its cultural and legal pluralism. In response to World Health Organization (WHO) guidance, the Pan American Health Organization expanded its TCIM technical cooperation, investing in governance-related research and fostering a TCIM regional network. Methods: Using the Framework method developed by Richie and Spencer, the authors iteratively constructed the framework with reference to over 500 TCIM-related policy instruments, court cases, and other governance approaches. Results: Seven primary analytic categories comprise the framework: (1) jurisdiction, (2) governance type, (3) specificity, (4) TCIM type, (5) health systems elements, (6) intersectoral dimensions, and (7) TCIM aspects addressed. Together, these categories (along with related subcategories and analytic tags) enable systematic tracking of diverse Indigenous, state, civil society, and private sector governance approaches applied to TCIM systems, practitioners, practices, and products. The framework facilitates detailed monitoring of numerous TCIM governance issues (e.g., financing, human resources, service provision, information management, biodiversity, traditional knowledge protection). It also accounts for the influence of international and regional governance instruments and recognizes the intersectoral character of TCIM governance in many settings. Conclusion: The framework offers a harmonized analytic approach to tracking TCIM governance and may be transferable to other regions. As such, it provides a preliminary architecture for a future digital online repository of global TCIM governance. This kind of resource, aligned with WHO recommendations, would help to close expertise gaps—such as those related to regulatory frameworks, health systems integration, and culturally responsive practices—identified by countries as barriers to TCIM governance. It also has the potential to support horizontal cooperation among diverse interest-holders, including policymakers, health professionals, private sector representatives, researchers, Indigenous peoples, and community-based actors.