Dangerous endorsements: Exposé on herbal medicine advertising in Ghana

At about a quarter to 10 a.m. on May 21, 2022, a phone rang in the office of The Fourth Estate.

I have low sexual libido, the caller said to the journalist who answered the call.

This was not the usual call that comes to the office of the accountability journalism outlet. This caller was searching for medicine that could cure sexual dysfunction.

I was hoping your medicine would improve my performance in bed, the voice continued. I heard your advertisement on radio, so I picked up your number and decided to call.

Where are you calling from? The Fourth Estate journalist enquired.

Kintampo, the caller replied.

The caller was one of the numerous unsuspecting herbal medicine users who called the office of The Fourth Estate after Macofa Herbal Mixture was advertised in the media.

Eight media platforms across four regions in Ghana marketed Macofa Herbal Mixture which was presented as a medicine that could cure all menstrual-related problems, impotence in men, infertility, and heightened libido in men and women. The media outlets comprised radio and television stations, as well as newspapers.

But, in truth, Macofa Herbal Mixture did not even exist. The herbal mixture was prepared in the office of The Fourth Estate from a mixture of three popular soft drinks in Ghana – Malt, Coca-Cola, and Fanta. The brand name was coined from the first two letters of the names of the soft drinks.

Without registration or approval from the Food and Drugs Authority (FDA), The Fourth Estate sought advertising spots for the herbal mixture in the media. This was to test widespread concerns that some media outlets put the lives of consumers at risk by validating and advertising unlicensed herbal products and fake traditional medicine practitioners without the required due diligence.

Advertisement on Macofa

The Macofa Herbal Mixture did not have FDA approval for usage. It did not also have approval for its advertisement. But The Fourth Estate sought advertisement spots to test the media’s compliance in terms of strictly ensuring that the FDA’s regulations and guidelines are adhered to.

Reporters of The Fourth Estate reached out on the phone to marketing and advertising officers of some of the top media houses across the country, posing as marketing officers of Krodwoa Enterprise, the producers of Macofa Herbal Mixture. The agreement to advertise the herbal medicine was only based on phone conversations and the transfer of money.

TV3 and Onua TV

After the team called the office of Media General, the parent company of TV3 and Onua TV, a marketing officer reached out.

My name is Xorlali. My boss Nicholas gave me your contact. He says you want to do some business with us, he said.

Xorlali engaged The Fourth Estate’s reporter for days without even asking about FDA’s endorsement of the product. It was all about the money.

Given the kind of viewership on TV3, you would need a commercial advert and product placement for it to be effective. But since you don’t have them, I would advise you to do LPM and interviews on Captain Smart’s show. You’d need a jingle too. Captain Smart’s show on Onua FM and TV is very hot. The show is on TV, radio, and Facebook Live. Three different platforms,” he advised.

At a fee of GH₵ 100.00, Xorlali also created a squeeze-back for the reporter for TV3’s morning show.

On April 25, 2022, Onua TV advertised the Macofa Herbal Mixture on the station’s morning show, Onua Maakye:

“… Macofa Herbal Mixture: I give this medicine a standing ovation. It’s very potent. Macofa Herbal Mixture: Listen to the name well so you don’t mix it up at the herbal and pharmaceutical shops. Macofa Herbal Mixture: It’s a very good medicine. For my sake, just take one. Listen to what it does: If you have any sex-related problems, you need Macofa Herbal Mixture. Simple! It’s a potent medicine. It works! Also, if you have become a calendar for people because of your monthly menstrual-related pains and cramps, this is your medicine. Don’t let people use you as a reminder for their monthly salary,” the co-host announced.

On May 10, at exactly 9:22 a.m., a squeeze-back advertisement for Macofa Herbal Mixture was aired on TV3’s morning show programme, New Day.

Angel FM, TV

At the Lapaz-based office of Angel Broadcasting Network (ABN) in Accra, Justice Amankwaah, who gave his designation as the “Commercial Director of ABN, in charge of radio and TV”, offered to help The Fourth Estate’s reporter to advertise the herbal product.

On our morning show one effective tool we use is the LPM, interviews, and TV commercials. I can assure you that that will make you break into the market, Justice said.

However, the reporter declined the offer to appear for an interview and added that the company was not done working on a television commercial.

Justice: An LPM on our morning show, when it is read once, will be 550.

Reporter: 550 Ghana cedis?

Justice: Yes, when it is read once on the morning show because it passes through the radio and TV at the same time. So, when someone is not watching, someone will hear. When someone is not hearing, someone is watching.

On April 24, 2022, the team paid for LPM for two days on the Angel morning show, Anopa Bofoͻ. The following day, the advertisement started running on the programme.

EIB Network

Excellence In Broadcasting (EIB) Network’s Marketing Officer, Duke Odamtten-Sowah, engaged The Fourth Estate’s reporter. In series of calls with the reporter, Duke’s interest was more about the money than ensuring due diligence. He directed the reporter to make a payment of GHC 1,400.00 for LPMs to a mobile money number with the registered name of Sharon Odamtten-Sowah.

A script and details of the non-existent herbal medicine were sent for the LPM but just before giving the green light, Duke requested FDA approval. The reporter said the FDA approval was not ready yet and, therefore, demanded that the payment be reversed.

The marketing officer said that, at EIB, monies received could not be refunded. After heated arguments with the reporter, Duke had a solution to the problem. He sent the proposed solution via email on April 20 upon the request of the reporter:

I wish to bring to your notice our inability to execute your three-day running LPM which was slated for the Morning Starr Show with Francis
Abban from Monday to Wednesday last week.

As you are aware, this was due to your inability to furnish us with the required copy of the Food and Drugs Authority approval.
I, however, propose that we instead have an exclusive 10 minutes interview in return.

Please let me know when you can be available for this interview so I can confirm [the] time for you.
Thank you,
Duke.

On May 5, 2022, the reporter was hosted in a phone interview on the mid-morning show on Starr FM to advertise the herbal product. For the entire period of the interview, Blessing, the show host, asked only the questions the reporter had submitted to the production team.

Volta Star Radio

Naasan Real Estate @Invoice-scan by Adwoa Adobea-Owusu on Scribd

Volta Star Radio, Ho, GBC’s regional station issued a wrong receipt for the LPM.

On April 24, in Ho, the advertisement for Macofa Herbal Mixture was aired on the state-owned regional radio station, Volta Star Radio. The marketing manager of the station, George Nunyuie, facilitated the placement of the LPM.

Skyy Power FM

In Takoradi, on Skyy Power FM, an advertisement for Macofa Herbal Mixture was aired during the mid-afternoon drive time on April 23, 2022. This was after Gifty, the marketing officer, had engaged with her ‘boss’ following enquiries from the reporter.

The impact of the LPM on Skyy Power was instant. A day after the advertisement, The Fourth Estate received a call from a potential client in Takoradi, who confirmed hearing about the herbal medicine on the radio station.

Oyerepa FM

In Kumasi, Oyerepa Afutuo, a mid-afternoon media programme in the Ashanti Region, marketed Macofa Herbal Mixture. The Oyerepa FM and TV programme, which discusses marital and domestic problems, advertised the herbal medicine for two days. The marketing officer, who gave his name as Richmond, facilitated the herbal product’s advertisement without any enquiry about FDA approvals.

Though the reporter submitted a script to the station, the presenter misinformed the audience about the herbal medicine’s indication.

Macofa Herbal Mixture. What this medicine resolves are menstrual problems and candidiasis. There are many ailments hidden in the body. When you start taking Macofa, all of them will vanish, the presenter said.

Daily Graphic 

The media’s disregard for FDA’s regulation on herbal medicine was not limited to the broadcasting outlets.

At the Graphic Communications Group Limited, the engagement was brief and straight to the point. The front desk officer, who responded to the reporter’s call, doubled as the advertising officer. The officer, who introduced herself as Rosemond Mann, shared the rates for the advertisement through WhatsApp, and payments were made through mobile money.

On May 12, 2022, the advertisement was published in Ghana’s biggest and most-read newspaper, the Daily Graphic.

For all the radio and television platforms, the reporters requested Live Presenter Mentions (LPMs) and whenever a media house insisted on FDA approval before advertising the products, the reporters backed down.

LPMs are spontaneous extempore delivery or reading of a written marketing text on a product. Apart from grabbing the attention of the audience midway through a programme, LPMs leverage on the voice and credibility of the show host or journalist, who may have a huge public following. This undoubtedly increases believability and trust in the brand or product. It is also prone to misinformation and the use of unapproved advertising language, a reason the FDA has outlawed it in the marketing of medicinal products.

Porous and ineffective regulatory system

The Traditional Medicine Practice Council (TMPC) is an agency of the Ministry of Health. Established by the Traditional Medicine Act 2000, ACT 575, the Council is mandated to regulate the registration of traditional medicine practitioners and their place of practice. This place could be a company that manufactures herbal medicine or a traditional medicine health facility.

“A person shall not operate or own premises as a practitioner or produce herbal medicine for sale unless that person is registered in accordance with this Act,” Section 9 (1) of ACT 575 says.

On April 20, 2022, two reporters of The Fourth Estate visited the office of the TMPC to assess the Council’s regulation process by attempting to register a traditional medicine practitioner and a herbal medicine manufacturing company.

According to ACT 575, to qualify for registration as a traditional practitioner, an applicant must have had “adequate proficient practice in traditional medicine” and be endorsed by a district chairman of a recognised traditional medicine practitioners association or a district co-ordinating director.

To register a facility, the law requires an applicant to present the block plan of the premises and provisional approval from the district planning authority or relevant authorities on the land housing the premises. An applicant must further present evidence of the ability of proposed practitioners in the practice, proof of registration, and testimonials from a traditional medicine practitioners association he or she belongs to.

On paper, the requirements by the regulatory body are comprehensive enough to deter fake manufacturers and practitioners.  In practice, however, the experience is different.

At the TMPC office, The Fourth Estate’s reporters met a lady who was brash and appeared disinterested in their mission to register a practitioner and a facility. After reading the requirements, including a visit by TMPC to inspect the facility, she added that the Council was unable to do the inspection.

She said the registration would be completed in the office after the team had paid the required money. This would be after presenting the address of the facility, business registration, name of a guarantor, and photo identities of the practitioner.

When the team agreed to make the payment, she tore part of a crumpled paper and wrote the list of items and corresponding costs in a way that suggested it was a regular practice done at the office.

The items included building the capacity of the applicant through training. Though the Council was not going to inspect the facility, the TMPC officer added a GHC 200.00 inspection fee.

Below is the breakdown of the total cost:

Form – GHC 10.00

Endorsement – GHC 20.00

Certificate – GHC 80.00

License – GHC 400.00

Inspection – GHC 200.00

Training – GHC 150.00

Total – GHC 860.00

About a week later, on April 28, The Fourth Estate’s reporters returned to the TMPC office. They gave the name of the herbal medicine manufacturing company to be registered as Krodwoa Enterprise Limited. They presented another name, Maxwell Akroma Duah, as the founder and practitioner who wants to be certified.

The narrative the team presented to the Council was that Mr Duah was a prominent Kumasi-based herbalist who wanted to start packaging his ‘efficacious’ traditional medicine into a product called Macofa Herbal Mixture.

Having paid the registration fees, the reporters provided a non-existing address as the location of Krodwoa Enterprise, a guarantor name, contact numbers, and business documents.

About a month after The Fourth Estate’s visit to the TMPC, the team called to follow up.

Please it is not yet ready. When it is ready, we will call you, the attendant who introduced herself as Exornam said. She wouldn’t say when the registration would be ready but gave the team the green light to start operating.

If it’s a shop, you can start selling once you have the receipt, she said.

Eventually, in November 2022, about seven months after the registration, two new documents were presented to The Fourth Estate: A registration conferring a traditional doctor title on Mr Duah and a certificate validating Krodwoa Enterprise as the certified premises for the manufacturing of herbal medicine.

There was no inspection of the premises of Krodwoa Enterprise or the training for Mr Duah.

Media advertisements on medicinal and herbal products

As more herbal medicine products are being approved, figures from the FDA show a commensurate rise in competition in the market and a scramble for advert placement in the media.

In the first quarter of 2021, the FDA gave approval to 81 medicinal, chemical, and pharmaceutical companies to place advertisements for their products in the media. From June to December 2021, the number of companies rose to 319, which is almost four times the number it approved at the beginning of the year. While some of the companies had as many as 10 products, on average, each company had about five products approved to be advertised.

According to the State of the Ghanaian Media Report, published in April 2023, the traditional media is “heavily dependent on advertisements from pharmaceutical companies, especially herbal medicine.” The study showed that advertisements for herbal medicines dominate the media, contributing 25% of advert revenue for television and 22% for radio.

The study echoes the concerns of many stakeholders in the advertising industry that the media sleeps on its gatekeeping role when it comes to herbal medicine. Stakeholders even blame some media personalities for being purveyors of false information on herbal medicine.

“There’s a lot of misinformation going on, there’s a lot of exaggeration going on,” Dr Abena Animwaa Yeboah-Banin, the Head of the Department of Communication Studies, at the University of Ghana, shared her worry about how media houses advertise herbal products on their platforms.

Dr Yeboah-Banin, who led a team of researchers to study consistency in radio advertisements about some selected herbal products with the actual information provided on the packaging of the same products, found many inconsistencies.

“There was an instance where what had been promised on the package of an oil product was that it would add flavour to your food and make it tasty. In the LPM on the radio, the presenter said the product can cure breast cancer,” Dr Yeboah-Banin said.

The Advertising Agency of Ghana (AAG) is part of the advertisement vetting committee of the FDA. AAG’s President, Francis Dadzie, says a product needs FDA approval and approval for its advertisement before it can be marketed in the media.

“But what we are seeing now is that there are a lot of these herbal medicine products that do not have the advert certification of the FDA to be advertised on radio or television but are being advertised,” he said.

In a response to The Fourth Estate for a request for comment, the FDA confirmed Mr Dadzie’s position that a company needs approval on the content for a product and another for its advertisement.

Regarding advertising traditional herbal medicines, the FDA said, “LPMs in any form are not permitted as a form of advertisement.”

The letter, signed by Dr Mrs Akua Amartey, Deputy Chief Executive Officer, Technical Operations Division, referred to the FDA’s Guideline 3.2.5: “LPM in any form is not permitted as a form of advertisement.”

Abuse of traditional medicine practice and herbal medicine intake  

Traditional medicine is a vital part of healthcare delivery in Africa. According to the World Health Organisation (WHO), herbal medicine, made up of various plant parts, constitutes 80% of traditional medicine in Africa and it is the main or the only source of healthcare for over 80% of the population. In Ghana, WHO estimates that 80% of patients use herbal medicine.

The preference for herbal products stems from the country’s historical faith in and the cultural relevance of traditional healthcare. Compared with conventional treatment, traditional healthcare is considered more accessible and available, studies say.

“Many Ghanaians prefer our traditional and herbal medicine to the one from the Whiteman because our medicine is indigenous and it is what they know and have since been using,” Nana Kwadwo Obiri, the General Secretary of Ghana Federation of the Traditional Medicine Practitioners (GHAFTRAM), told The Fourth Estate.

Dr Elliot Koranteng Tannor, a consultant Nephrologist and senior lecturer at the Kwame Nkrumah University of Science Technology(KNUST), says herbal medicine plays an important role in healthcare delivery in Ghana.

“If it’s well regulated, most likely, [herbal medicine] has a major role to play,” Dr Tannor said. “You would realise that now there’s integrative medicine. You will go to some hospitals and there’s a herbal doctor and there’s an orthodox. People are allowed to decide on what to choose.”

Data from the FDA shows a steady rise in the number of herbal products approved for the market annually. For instance, in 2020, 655 herbal products were approved by the FDA. In 2021, the number rose to 931.

The common usage among the Ghanaian population is the reason there are many concerns about prevalent abuse in traditional medicine practice and herbal medicine usage.

In his practice as a kidney specialist, Dr Tannor says his average patient’s condition can be traced to herbal medicine abuse.

“It can shut down your kidney acutely,” Dr Tannor explained. “We also know that if you have been taking it for a long period of time, it can affect your kidneys for a long period of time.”

In the absence of adequate oversight, Nana Obiri Yeboah of GHAFTRAM admits that there are abuses in the traditional medicine practice and the danger of a porous regulatory system.

“Some people can even offer acid as medicine for consumers to drink. It is the regulation that is helping us to weed out all these quackeries in the system. Regulation is very important,” he said.

By regulation, Mr Yeboah is referring to the mandate of the TMPC.

Media houses that said No

Not all the media outlets gave in to The Fourth Estate’s requests to advertise the unregistered herbal medicine product on their platform.

At the onset, New Times Corporation’s Ghanaian Times demanded FDA approval before the conversation on advertising Macofa Herbal Mixture would continue.

It was the same experience with Accra-based Peace FM. The sales officer requested FDA approval at the first enquiry by the reporter. Without it, he said it was not possible to place an advertisement.

At The Multimedia Group Limited, a Marketing Officer, Rita Naa, was excited at the prospects of securing a new client and so did not request FDA approval after days of engaging the reporter. She opened an advertising folder for Krodwoa Enterprise for Adom FM. But eventually, she came asking.

The FDA approval is something the company needs, Naa detailed her conversation with her supervisor. My boss won’t agree to it unless we provide an FDA certification, she stressed.

Responses

The Fourth Estate requested an interview or comment from the media houses cited for negligence in this investigation. None of them responded to the request, except the Ghana Broadcasting Corporation who, in a letter, denied ever running an advertisement on Macofa Herbal Mixture on any of its platforms across the country. However, the State Broadcaster clearly failed to conduct a proper internal check as its Volta Star Radio in Ho aired the advertisement with the support of the marketing manager.

Though the TMPC agreed to grant an interview, the regulator never made itself available for their response.

Disclaimer: Macofa Herbal Mixture was never packaged and sold to any member of the public.