Issue

Context

• Ministry of AYUSH is taking various initiatives in promotion and integration of Indian AYUSH (Ayurveda, Yoga and Naturopathy,Unani, Siddha and Homoeopathy) System with modern system to increase their acceptability as scientific and reliable alternative system of medicine.

Background

• Earlier the Ministry of AYUSH, which was formed in 2014, was known as the Department of Indian System of Medicine and Homeopathy (ISM&H) and renamed as Department of AYUSH in 2003.
• AYUSH is one of the 12 champion services sectors that the government seeks to promote by offering soft loans and interest subsidies to AYUSH establishments as well as allowing 100 per cent foreign direct investment.

Objectives

• To upgrade the educational standards of Indian Systems of Medicines and Homoeopathy colleges in the country.
• To strengthen existing research institutions and to ensure a time-bound research programme on identified diseases for which these systems have an effective treatment.
• To draw up schemes for promotion, cultivation and regeneration of medicinal plants used in these systems.
• To evolve Pharmacopoeia standards for Indian Systems of Medicine and Homoeopathy drugs.

Analysis

Current scenario of health in India

• India is facing double burden of under-nutrition and communicable diseases along with the non-communicable ailments affecting millions of people.
• While communicable diseases contribute 28% of the entire disease burden, non-communicable diseases (60%) show ample rise and injuries at (12%) now constitute the bulk of the country’s disease burden.
• World Health Organisation Report for 2018 highlights that non-communicable diseases account for 63 % of deaths in India.
• Nutrition status has been dismal and is one of the causes of child mortality and morbidity. As per the Global Hunger Index (by IFPRI), India ranks 78th among 118 developing countries (with 15% of our population being undernourished; about 15% under-5 children who are ‘wasted’ while the share of children who are `stunted’ is a staggering 39% and the under-5 mortality rate is 4.8% in India.)
• There has been a steady rise in mental illnesses in the country. According to a recent publication, one in every four women and 10% men suffer from depression in India.
• At the same time progress has been marked in the field of communicable diseases as such. Polio has been eradicated, leprosy has been curtailed and HIV – AIDS cases have met the MDG target of being reduced by half in number.

Impact of AYUSH on Society

• AYUSH will provide growth opportunity to the indigenous medical research and employment opportunities in the upstream and the downstream of the AYUSH supply chain.
• In the Era of “Superbugs”, where even the best antibiotic is becoming futile, AYUSH may open the doors of future technologies for healthy life.
• This medical system is very effective towards lifestyle associated disorders. AYUSH provides natural cure,which helped in curing of many severe diseases such as Depression. This is not seen even in other conventional medical systems.
• AYUSH health system is focused on the prevention method.Promotion of sustainable lifestyle which is one of the goals under the INDCs(Intended Nationally Determined Contribution).
• However, some researcher are still sceptical about the AYUSH impact since there is not much concrete research published in the Lancet Journal upon this very subject.Some experts suggest that AYUSH may be useful as preventive drugs than prescriptive ones.

Why Integration?

• India is faced with a highly complex scenario. On the one hand, there is the unfinished agenda of under-nutrition and communicable diseases, on the other; the burden of non-communicable ailments is crippling the lives of millions.
• This is an alarming statistic to say the least and it is unlikely that modern medicine alone can provide the solutions. Systematically promoting integrative medicine — an approach that combines modern medicine with alternative systems like Ayurveda and Yoga — is perhaps more crucial now than ever before.

Integration of medicines: A real solution?

• Unlike modern medicine, alternative systems follow a more holistic approach, with the objective of promoting overall well-being instead of focussing on curing illness alone.
• Such an approach assumes greater significance in the case of non-communicable diseases which are difficult to treat once they have developed into chronic conditions.
• Internationally, greater scientific evidence is becoming available regarding the health impact of alternative systems of medicine, especially Yoga.
• Apart from a rich heritage in traditional medicine, India has nearly 8 lakh registered AYUSH practitioners whose services can be better utilised for delivering healthcare to the population.
• While the demand for alternative systems of medicine has been on the rise, there is still some scepticism perhaps due to the paucity of large-scale studies in India demonstrating its effectiveness. Moreover, the emphasis of AYUSH on overall well-being makes it less tangible compared to modern medicine which focuses on treating diseases.
• Primary health care deals with basic medicine, treatment of minor ailments, immunization, child healthcare as well as natal and postnatal care. With little or no presence of private hospitals in rural areas, this leaves a large section of the rural population effectively without access to a doctor. In such circumstances, training AYUSH practitioners to fill the gaps in healthcare delivery at primary level can improve the doctor-patient ratio and provide the poorest masses in remote areas some medical assistance.
• This integration seems a viable solution in the short term as it will reduce the public health challenges of anaemia, malnutrition, pneumonia, diarrhoea, and other communicable diseases.

Practical Challenges

• The broad philosophical orientation of each system of medicine is distinct. For example, while the allopathic system addresses symptoms and treatment of causes of illnesses based on a biomedical model understood with the help of epidemiological investigations, the Ayurveda system largely operates on a holistic approach to illness
• The National Commission on Macroeconomics and Health background paper on integrative medicine does highlight some important illnesses where the AYUSH system seems to have better remedies compared to allopathy.
• Legally, cross practice has been prohibited by the Supreme Court of India, where there is a clear direction that non allopathic practitioners may not practise allopathic medicine. The Common Review Missions of the NRHM have shown that AYUSH practitioners are practising Allopathic medicine in several states, including Uttar Pradesh, Chhattisgarh and Bihar.

Ethical perspective in mainstreaming of AYUSH

• Applying the outlines of any of these frameworks to the process of mainstreaming of AYUSH would yield a detailed ethical analysis. But it would be an inappropriate exercise as it would not be relevant to the specific contextual issues unique to this situation.

Mutual respect and trust

• The need for mutual respect between the allopathic and AYUSH practitioners is paramount. Unless they respect each other’s system of practice and work as a team, there is a likelihood of the system becoming competitive and counterproductive.

Public accountability

• Accountability of the system to the public is an essential component of the health system as it ensures community acceptance, involvement and participation. The document on mainstreaming of AYUSH does mention the establishment of patient welfare societies for AYUSH hospitals at the district and tertiary care levels. But there is no mention of accountability at the level of integrated care at the primary and secondary levels. Though there is a clear mention of training the ASHA in AYUSH, the village health plan does not emphasise AYUSH.

While integrating AYUSH and modern healthcare system in India, some of the important measures that need to be considered are:

• Clear role definitions of AYUSH practitioners and allopathy practitioners in their treatment of patients, in their mutual interactions, and in community accountability mechanisms is important. This should include the process of proper identification of allopathy and AYUSH practitioners by patients, understanding of the limits and restrictions of each other’s practice boundaries, and establishment of specific accountability mechanisms for each system.
• Obtaining community acceptance by accountability, transparency, necessity, and justification.
• Active advocacy about AYUSH and integration of AYUSH and allopathy in the community.
• Providing ample opportunities for patients to make a fully informed decision about the type of care they want.
• Paying proper attention to the ethical perspectives in integration of AYUSH into mainstream medical practice is very important for taking correct public health decisions. It is understood that this cannot be an overnight process. Protocols and regulations can be a starting step. This has to be supplemented by active research, development, standardisation and advocacy at the policy and the grassroots level.

Recent initiatives for streamlining AYUSH systems

• Ministry of AYUSH co-locates AYUSH facilities at Primary Health Centres (PHCs), Community Health Centres (CHCs) and District Hospitals (DHs), thus enabling choice to the patients for different systems of medicine.
• This Ministry along with Directorate General of Health Services (DGHS) is implementing NPCDCS (National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke) for health promotion, prevention and management of Non-communicable diseases or Lifestyle related disorders
• It has been decided that 10% of the Sub-centres are to be upgraded as Health and Wellness Centres (HWCs) under Ayushman Bharat which will be developed by the Ministry of AYUSH to provide comprehensive Health care to the needy community.
• Central Council for Research in Homoeopathy (CCRH)has developed a public health program on ‘Homoeopathy for Healthy Child’ which has been integrated with RashtriyaBalSwasthyaKaryakram (RBSK).
• Central Council for Research in Siddha (CCRS) conducts special OPD for non-communicable diseases and geriatric population.
• Morarji Desai National Institute of Yoga (MDNIY), an autonomous organization under Ministry of AYUSH has established 19 Preventive Health Care Units of Yoga in CGHS Wellness Centres in Delhi and NCR. Regular Yoga training programmes are being held in these Units.
• e-AUSHADHI Portal
• The portal has been launched by Ministry of AYUSH for online licensing of Ayurveda, Siddha, Unani and Homoeopathy drugs and related matters.
• The portal is intended for increased transparency, improved information management facility, improved data usability and increased accountability.

Way forward

• The co-location of AYUSH with facilities providing allopathic medicine needs to be ramped up considerably. The ‘Strategy for New India @ 75’ released by NITI Aayog recently sets out the explicit target of co-locating AYUSH services in at least 50 % of primary health centres, 70 % of community health centres and 100 % of district hospitals by 2022-23.
• Investments in AYUSH education and research need to be stepped up. Mechanisms should be identified for integrating modern medicine and AYUSH curricula at the undergraduate and postgraduate levels in educational institutions. In China, for instance, traditional medicine is already taught alongside Western medicine. Developing a credible research base is also critical as it will help to embed AYUSH within the overall framework of healthcare by addressing the lingering concerns around its effectiveness.
• A range of communication channels should be leveraged to popularise Ayurveda and Yoga and inform citizens about their preventive and curative properties. While Yoga has gained immensely in popularity as a form of exercise, the full range of physical and mental health benefits it can yield are still not widely appreciated.
• Essential AYUSH medicines must be included in various national health programmes and guidelines should be developed for ensuring their quality.
• The time is ripe to systematically promote and mainstream integrative medicine. India is facing a dual disease burden on the one hand and hasa rich history of traditional medicine to tap into, on the other. While the last few years have witnessed a number of enabling policy interventions, more needs to be done to reap the full benefits of integrative medicine.

Learning Aid

Practice Question

Do you think that integration of Indian AYUSH System with modern medicine system is a viable solution? Support your answer with illustrations.