The most important challenge for the CAM community in Spain is to develop a reliable and high quality education system that can facilitate the regulation of CAM within the Public Health System. With some exceptions, CAM is considered a private activity, and there is no specific regulation regarding training and qualifications of CAM providers in Spain.
Some Spanish universities provide post-graduate education in acupuncture, homeopathy and naturist medicine for medical doctors (MDs), veterinaries, psychologists and pharmacists – and shorter courses for nurses (e.g. technical acupuncturists).
Most CAM practitioners in Spain do not have a degree in health sciences, but have been trained by private centers or professional organisations. They provide a broad range of CAM techniques, such as yoga, pilates, tai chi and massage. Also, CAM is provided by health professionals as e.g. veterinaries, psychologists, physiotherapists and nurses. MDs provide mainly acupuncture, naturopathy and/or homeopathy.
There are several professional CAM organisations, most of them composed of undergraduate practitioners. Regarding graduate professionals, the most important ones are the medical organisations: SAME (Spanish Medical Acupuncture Society), FEMH (Spanish Medical Homeopathy Federation) and AEMH (Spanish Medical Naturist Association).
Only limited data are available on the number of CAM practitioners in Spain. The most reliable are from the medical associations and medical colleges:
Spanish Medical Acupuncture Society:
Spanish Medical Homeopathy Federation:
Spanish Medical Naturist Association:
The only major CAM research centre is ‘Servicio Andaluz de Salud’ in Sevilla, which participates in CAMbrella. For the moment they have three active projects: Exploring the effect of acupuncture in fibromyalgia, the effect of acupuncture in migraine, and the effect of acupressure in low back pain – all of them using randomised controlled trials.
Most CAM centres without MD
Public health care is under the responsibility of the 18 Spanish regional governments. Despite national government attempts to create a common health care policy, there are still differences between the Spanish regions, including in the field of CAM.
Andalucía is the Spanish region with the highest number of CAM centres/units. Out of a total of 470 centres in the region, there are 59 authorised CAM centres (with an MD in charge). See „Situación actual de las Terapias No Convencionales (TNC) en Andalucía”:
Some of the CAM units in Andalucía are part of Public Health Service – some in hospitals, others in primary care centres. This is an exception in Spain, as CAM treatments are not reimbursed by the Regional/National Health Service.
There is no specific regulation regarding health care centres (public or private) which provide CAM, but a state regulatory framework refers to centres where some kinds of “special therapies” can be provided.
Most centres that provide CAM in Spain are not “health centres” but “non sanitary centers” or “para-sanitary centers”, where there is no need of an MD providing therapies.
The centres for non-conventional therapies are considered as health centres (public or private) if the person performing the acupuncture, homeopathy or herbal medicine is an MD and as such approved by the regional government.
Yoga and acupuncture
Most people in Spain (95.4%) have knowledge of at least one alternative treatment. The most popular ones are yoga, acupuncture/TCM, tai chi, massage and homeopathy, with all of them mentioned by more than 50% of the studied population. 12.9% of the population have used CAM during the past year (2007).
23.6% of the population has ever used CAM, especially yoga, acupuncture and chiropractic, although there are geographical differences.
The figures are:
acupuncture / TCM 31.5%
podal reflexology 16.1%
tai chi 13.3%
flower therapy 12.0%
lymphatic massage 9.1%
CAM is used primarily by women of upper middle class or higher, aged between 36 and 45 years and living in metropolitan areas.