Pratibha Shah
An overview of AYUSH (Dept. of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy) and its place in the Healthcare System of India
INTRODUCTION
No single system of health care has the capacity to solve all of society’s health needs. This is especially true for a large, densely populated, developing nation like India whose health needs are acute. The AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy) systems of medicine have been used in India for centuries. Their wide acceptability, affordability, accessibility and availability make them ideal candidates for integration into the mainstream preventive and curative healthcare services in the country today.
This paper is an attempt to answer the questions – what is AYUSH* and why it was formed? The paper will talk briefly about the inception and history of AYUSH and also summarize the role and contributions of AYUSH in the healthcare system of India. Finally, the paper will outline the successes and challenges faced by this initiative of integration, and recommendations for future.
BACKGROUND
Up until the early 19th century, Ayurveda – the traditional holistic Indian system of medicine, which primarily uses herbal formulations, was the main system of medicine used by the Indians. But with British colonization in 1857, modern Western medicine – the system of medicine used by the British, was introduced to Indians. It gained rapid popularity and inspired awe, not only because its usage provided instant relief, but also because the elite British Lords used it. This resulted in dislodging and sidetracking of the traditional systems of medicine. Modern medicine
*Please see bibliography page
gained firm holding in the country in the century that followed.
But since independence in 1947, growing concerns about the adverse effects of chemical-based drugs and escalating costs of conventional health care, have led to a resurgence of public interest in holistic systems of health care. For the Government, a major area of concern has been the flailing healthcare infrastructure in the country. Although healthcare is one of the largest and rapidly growing sectors in India, in terms of revenue and employment, healthcare infrastructure in the majority of the country’s regions has not kept pace with the economy’s growth1.
Addressing these issues, the National Health Policy, formulated in 19832, pointed out that the vast infrastructure available in the form of thousands of hospitals and dispensaries, registered practitioners and hundreds of colleges, belonging to AYUSH systems, was being underutilized. This was because regulations and standards for this sector had never been developed or formalized, in the post independence era. The Policy suggested formation of Councils and Administrative bodies to help regulate and standardize the practice as well as education of AYUSH systems. This would not only help fill the large infrastructural gaps in the healthcare system, but would also strengthen the deep rooted traditional systems of medicine, thus preserving ancient heritage and knowledge base. The Policy stressed on planned efforts to integrate the AYUSH systems with modern medicine services, at appropriate levels, especially in regard to the preventive, promotive and public health objectives2.
As an outcome of this policy, the Ministry of Health and Family Welfare (MOHFW) created the department of Indian Systems of Medicine and Homoeopathy (ISM&H) in 1995, which was re-named AYUSH in November, 20033. Moving a step forward, a separate National Policy on Indian Systems of Medicine & Homeopathy was formulated in the year 20024, in order to augment the development of traditional systems of medicine in a systematic manner. This was in accordance with the WHO strategy for Traditional Medicine5. A few of the major objectives of the national policy for AYUSH are4:
1) To promote holistic health and expand the outreach of healthcare to people through preventive, promotive, mitigative and curative intervention of AYUSH;
2) To integrate AYUSH in healthcare delivery system and national health programs and ensure optimal use of the vast infrastructure of hospitals, dispensaries and physicians;
3) To provide full opportunity for the growth, development and utilization of AYUSH systems.
A separate Policy on AYUSH has helped establish a more specific framework of guidelines and goals for this move of integration.
PROGRESS MADE:
With increased focus from the Govt. and support in terms of policy and funds, excellent progress has been made in regard to expanding the base of AYUSH systems at all levels of health care delivery. Some of the main achievements and successes have been listed below -
- Expansion of services - AYUSH services, in the form of out patient primary care and in patient specialized care, have been integrated with the existing Allopathic hospitals and dispensaries under the Ministries of Coal & Mines, Labor, Defense and Railways and also in the Central Govt. Health Scheme (a Scheme that provides subsidized healthcare to Central Govt. employees). This has facilitated provision of multiple modalities and systems of treatment under one roof, enabling people to avail treatment of their choice6.
- Augmentation of Infrastructure – As of 2007, several thousand new AYUSH clinics and around 250 hospitals and nursing homes for in patient care and specialized therapies have been opened, in the private and not-for-profit sector7. AYUSH dispensaries have been set up in 3528 PHCs (Primary Healthcare Centers) in different States7.
- Policy support – Administrative and policy measures (like the National Policy on AYUSH systems) have been taken to facilitate functional integration of AYUSH and allopathic systems of healthcare at primary, secondary and tertiary levels6.
- Rural outreach – Under National Rural Health Mission (NHRM) established in 2005, mainstreaming of AYUSH is the core strategy for improving the quality and outreach of healthcare in rural areas8.
- Special programs – Seven AYUSH drugs have been supplied to nine States and four cities as part of the ongoing National Reproductive Child Health (RCH) Program, for treatment of common ailments of children and pregnant women9.
Success of AYUSH at all levels of healthcare delivery has led to a three fold increase in percentage of National Health budget allocation to the Department in the last 5-10 years10. A large chunk of this budget will be utilized in setting up AYUSH treatment centers for primary and specialized care and to ensure Good Manufacturing Practice (GMP)11 compliance of complementary medicine manufacturing units.
CHALLENGES AND RECOMMENDATIONS:
For a country like India which is facing increased demands on its healthcare system in the face of limited resources and funds, looking inwards for increasing utilization of pre-existing resources has great potential for far reaching success. With the formation of a separate Department and National Policy for AYUSH, some giant strides have already been made in a short span of time as enumerated under successes. But along with successes, challenges have also risen. Some of these challenges and proposed recommendations for them have been outlined below:
Education –
- Despite establishment of Central Council of Indian Medicine12 in 1971 for setting standards of education, the quality of education in most of the AYUSH institutions does not meet prescribed standards.
- Reforms need to be initiated to improve functioning and assessment of these regulatory bodies. National systems of testing and accreditation need to be established.
Standardizing plants and herbal formulations –
- This is a very complex and difficult process. Most formulations have multiple ingredients and also the same compound may have two or more variations in their formulation in terms of ingredients.
- Setting up of a Central Drug Authority for centralized licensing and enforcement of the provisions of existing Drugs and Cosmetics Act and Rules would go a long way in ensuring quality and safety of AYUSH drugs. Standards for around 40% of the raw materials and around 15% of formulations have already been published by committees working on the process of standardization.
Research –
- Currently, there is dearth of evidence based research on AYUSH herbs and formulations.
- Collaborative research with modern medicine/modern science institutions should be initiated. Indian Council of Medical Research, All India Institute of Medical Sciences, Central Drug Research Institute and some other apex scientific Institutes have recently stepped into the arena for collaborative research on AYUSH drugs.
CONCLUSION:
Providing accessible quality healthcare in a large, densely populated country like India is a challenging task by any measure. Integrating indigenous and complementary systems of medicine into the central and state healthcare delivery streams at both public and private levels, has huge potential in terms of increasing access and availability of health services, especially for the large rural population of India. However, it is too early to assess how significant a health impact the AYUSH interventions and integration have had, by way of complementing and enhancing the previous conventional national health programs.
Bibliography:
1. PricewaterhouseCoopers. Healthcare in India, Emerging market report 2007. Available at: http://www.pwc.com/en_GX/gx/healthcare/pdf/emerging-market-report-hc-in-india.pdf [Accessed May 1, 2010].
2. NATIONAL HEALTH POLICY. Available at: http://www.mohfw.nic.in/kk/95/ii/95ii0101.htm [Accessed May 1, 2010].
3. Department of AYUSH. Available at: http://indianmedicine.nic.in/ [Accessed May 1, 2010].
4. National Policy on Indian Systems of Medicine & Homoeopathy-2002. Available at: http://www.whoindia.org/LinkFiles/AYUSH_NPolicy-ISM&H-Homeopathy.pdf [Accessed May 1, 2010].
5. WHO | WHO traditional medicine strategy. Available at: http://www.who.int/medicines/publications/traditionalpolicy/en/index.html [Accessed May 1, 2010].
6. Current Status & Infrastructure of Ayurveda. Available at: http://herbalnet.healthrepository.org/bitstream/123456789/2075/6/3.%20Ayur53-65.pdf [Accessed May 1, 2010].
7. Health and Family Welfare and AYUSH. Available at: http://planningcommission.nic.in/plans/planrel/fiveyr/11th/11_v2/11v2_ch3.pdf [Accessed May 1, 2010].
8. National Rural Health Mission
( 2005-2012 ) Mission Document. Available at: http://mohfw.nic.in/NRHM/Documents/Mission_Document.pdf [Accessed May 1, 2010].
9. WHO Country Cooperation Strategy, 2006-2011, India. Available at: http://www.searo.who.int/LinkFiles/WHO_Country_Cooperation_Strategy_India_WHO_CCS-India_supplement.pdf [Accessed May 1, 2010].
10. Government of India. Press Information Bureau. Available at: http://www.pib.nic.in/release/release.asp?relid=51813&kwd [Accessed May 1, 2010].
11. Drugs and Pharmaceuticals
Industry Highlights. Available at: http://www.cdriindia.org/Ihighlightconent/I5_2008_content_page.pdf [Accessed May 1, 2010].
12. ::Central Council of Indian Medicine:: Department of Ayush, Govt. of India. Available at: http://www.ccimindia.org/ [Accessed May 1, 2010].
*In this paper, the term AYUSH will be used to denote the Department of AYUSH and also the systems themselves.
