Licensure Without Oversight: Impact of Regulatory Supervision on Traditional Medicine Practice in Ghana

Introduction: Regulatory frameworks for traditional and alternative medicine commonly emphasize licensure as a mechanism for ensuring safety, quality, and sustainability. However, limited evidence exists on whether licensure without ongoing oversight meaningfully regulates practitioner conduct or promotes sustainable practices. This study examined the relationship between licensure, regulatory supervision, compliance, and sustainability-related practices among traditional medicine practitioners (TMPs). Methods: A cross-sectional survey was conducted among 303 TMPs. Data were collected on sociodemographic characteristics, licensing status, regulatory supervision, compliance with regulatory schemes, sources of raw materials, and cultivation practices. Associations were assessed using chi-square tests. The study is reported in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Results: While licensed practitioners were significantly more likely to report regulatory supervision than unlicensed practitioners (χ 2 = 39.64, p < 0.001), half of licensed practitioners had never experienced supervision. Overall compliance with regulatory schemes was low (12.2%) and was not significantly associated with perceived regulatory performance (χ 2 = 0.53, p = 0.465). Most practitioners relied on wild harvesting for raw materials (65.0%), with limited engagement in self-cultivation (17.2%) or intention to cultivate in the future (25.7%). Neither licensure nor supervision was significantly associated with adoption of cultivation practices. Discussion: The findings suggest that licensure without sustained supervision regulates entry into practice but does not effectively regulate conduct, compliance, or sustainability. Strengthening postlicensure oversight and integrating sustainability-focused regulatory mechanisms may be essential for achieving meaningful regulation of traditional medicine practice.