Medicines have history spread over centuries, across societies and civilization. The fast-paced lifestyle gives rise to stress and there has been a growing consciousness across the globe for improving healthcare in order to tackle the various diseases affecting people. India has a unique set of six types of traditional medicine system that goes by the acronym “AYUSH” representing Ayurveda, Yoga and Naturopathy, Unani, Siddha, Homeopathy. These systems differ from one another in their philosophical basis like Ayurveda considers human body to be made up of five elements water, air, earth, fire and ether and it states that either deficiency or excess of ‘dosas’ that is ‘vata’, ‘pita’, ‘khapa’ is the cause of diseases. Yoga and Naturopathy state that ‘five kosas’ built up human soul and their imbalance causes diseases. In Unani, diseases are supposed to be caused by imbalance either of four, that is, ‘phlegm’, ‘yellow bile’, ‘black bile’ and blood. As per Siddha System, diseases are caused when the normal proportion of three humors, that is, ‘Vaadham’, ‘Pitam’ and ‘Kapham’ are stressed or gets imbalanced due to any external or internal condition. Lastly, Homeopathy states human body is made up of a vital force and if any symptom alters the normal functioning of its force than it will cause diseases.
Present Scenario of Indian Health Sector
India is currently facing a crisis in human resource in the field of healthcare. With a severe lack in number of doctors, nurses, pharmacists, hospitals, healthcare centres, etc. India is reeling under the burden of providing healthcare to all. Though India has made significant progress in recent past in terms of providing healthcare but a rapid increase in population combined with changing pattern of diseases has proved to be detrimental for healthcare sector. Moreover, India has a dismal below par physician-patient ratio of merely 0.76 per thousand people. This is evident from reports like the states of Uttar Pradesh, Jharkhand, Bihar, etc. a patient has almost 2/3rd chances of being treated by a quack.
Further the ground level healthcare delivery in India occurs through sub-centres, public healthcare centres but about 60% of these centres have a single doctor and nearly 8% of these are functioning without a single doctor. There is also shortage or absence of lab technicians, pharmacists etc. in most of them. Adding to the woes, is the unwillingness of MBBS trained physicians to serve in rural areas which further increases the gap between trained healthcare physicians and patients.
This pathetic condition of Indian health sector evident from India’s bottom ranks among 193 countries on various critical health parameters, demands modifications in the current approach so that easily available healthcare services including early risk screening for diseases can be readily made available for the people. The enormous potential of AYUSH and its vast infrastructure with about “1350- hospitals, 53300- bed capacity, 22360-dispensaries, 450-undergraduate colleges, 99-colleges with post-graduate department, 7.2 lakh registered practioners” is being focused upon to address the issues in health sector. Certain reports from different committees also have recommended AYUSH to be a way out from the health crisis. For example, Chopra Committee, 1948 recommended integration of teaching model of traditional and modern system of medicines.
Role of Traditional Medicines In Improving The Health Sector
As discussed above, India suffers from a lack of doctors primarily in rural areas. This issue can be tackled by integration of AYUSH with allopathy. Due to enormous potential of AYUSH, it will help to address the healthcare issues and even create more employment opportunities. Opposing integration and an isolationist approach would deter scientific scouting and block some potential value addition and this would be the opposite of the ideology professed by modern medicine to accept concepts backed by evidence. In 2013, Shailaja Chandra report on status of India medicine and folk healing stated that in some states AYUSH physicians were the only care providers in public health centres. This indicates the need and importance of AYUSH to fill up the gap left by modern medicines thereby ensuring regular and efficient medical facility delivery for all people.
Apart from this, AYUSH would also help in boosting economy as it will prove to be a good source of forex earner with estimated annual turnover of about Rs. 120 billion. Moreover, India has diverse wealth of about 7000 medical Plants, herbal products and hence is 2nd largest exporter of AYUSH. Also, AYUSH has a potential to attract investments similar to IT sector as people from all over the globe visit India for alternative treatments by means of India’s ancient healthcare knowledge. Like Yoga, Ayurveda, herbal messages, etc. as these are helpful in dealing with lifestyle disorders.
Further, as the courses of Ayurveda, Physiotherapy etc have similar curriculum as that of MBBS course, a basic bridge course could provide a push needed for AYUSH practioners to practice limited allopathy. Examples of such successful integration like in USA- the physician assistant who attend to massive patient visits, UK- Physician associate model, Bangladesh-SAMCO etc can become guiding factors to promote traditional practioners.
Approach of Government Towards This Sector
Indian Government has been striving to develop and promote AYUSH. Some initiatives have been adopted like creating AYUSH wings in different hospitals, financial assistance for encouraging private AYUSH hospitals, building institutes for training and research in AYUSH etc. Government has accepted AYUSH to be of importance for achieving its goal of ‘Healthcare for all’. Further in 2010 report of 4th common review mission of National Health Mission reported that number of states like Assam, Maharashtra, Chhattisgarh, Uttrakhand etc, AYUSH physicians have been practicing as medical officers in primary healthcare centres. Also IKP centre for technology in public health has been focusing on capacity building of AYUSH practioners by means of bridge training programmes to ensure quality and standardized health care to rural people. Similar attempts at integration of AYUSH Systems with existing healthcare have been made by Government. For example- 2008, National Rural Health Mission aimed to address issues in healthcare for rural people.
A major development in this sector was the governments step to elevate the department of Indian System of Medicine and Homeopathy to an independent ministry that is AYUSH Ministry in 2014. Government also allocated funds to the ministry to launch ‘National AYUSH Mission’ aimed at development of the sector. A regulatory regime for traditional medicine system is also being planned by government. The AYUSH ministry has different ideas also like setting up of standalone AYUSH clinics besides the modern medicine departments which would give people the choice to opt for any way for their treatement. The annual National Health Policy of 2015,2017 suggesting integration of AYUSH and Modern medicine, Multidimensional mainstreaming of AYUSH physicians and other efforts by governments to promote the traditional medicine sector.
Recently, the government has passed the National Medical Commission Act,2019 against the wishes of orthodox medical practioners. This act proposes a joint sitting of the commission, the central council of homeopathy, and central council of Indian medicine to put appropriate bridge course for traditional practioners to enable them to prescribe certain modern medicines as per need. Apart from the efforts of central government, some of State governments like Tamil Nadu, Delhi, Maharashtra etc have introduced bridge course extending from 6 months to 1 year which would train the AYUSH practioners so that they can prescribe certain drugs in primary healthcare centres. These steps would help fill up the resource gaps in primary healthcare centres. The government’s scheme of ‘Ayushman Bharat’ aims to upgrade the primary healthcare centres into Health and wellness Centres would require Staff to fill up vacancies and AYUSH integration in mainstream would also serve as a bonus to achieve its goal.
Traditional Medicine- An Alternative for Modern Medicine?
AYUSH has been used in India since ancient times and it has its fair share of advantages. However, it does have certain lacunae which requires a through and efficient approach. For example- In the lack of proper regulatory strategy, quackery by AYUSH practioners becomes a menace. Also due to mindset of people and low awareness about benefits of AYUSH, treatments are not considered to be effective and people prefer allopathy over AYUSH. There exists a status gap between traditional and modern medicine system which hampers overall healthcare facilities. Also, practioners of traditional medicines lack in appropriate expertise in allopathic drugs which acts as a hindrance. Further, both sectors that is traditional and modern medicines have radically different approaches due to difference in the understanding of anatomy, physiology, etc. Also lack of credible evidence of results and benefits of AYUSH treatment gives it a setback.
Besides these issues improper integration of AYUSH with mainstream will have some ethical drawbacks like it would create confusion among public about plurality in approach, lack of proper accountability measures would have a negative impact on healthcare facilities. Certain diseases respond better to traditional medicines and some to modern medicines but at present due to absence of a clear explicitly mentioned framework there occurs a confusion as to opt for which method for treatment. Further there is a clear lack of understanding of strengths and weakness between traditional and modern medicine which makes the idea of cross-pathy a tedious one. Lastly, cross-practice is legally prohibited in India so without modification in this provision it would be difficult for AYUSH to achieve its full potential.
The above discussion clearly indicates that a through integration with clearly mentioned roles for each branch is the need of the hour. Considering AYUSH as an alternative for modern medicine would increase the chaos and confusion subsequently it will cause a defunct mechanism that would ultimately harm general public.
Allopathy and AYUSH are two different approach for treatment of diseases and both are equally important. One cannot be favored at the cost of other because in certain cases like effective treatment for certain diseases like anorectal problems, meeting the demands for well trained practioners mainly in rural areas, AYUSH physicians would come in handy. On the other hand, in case of certain ailments modern medicines would be needed for an immediate result. Therefore, there is need for establishment of an effective collaboration between practioners of modern and traditional medicines along with proper accountability framework in order to prevent quackery. An either-or approach pushing people to opt either modern or traditional medicine is doomed to fail. Present, healthcare scenario in India calls for a trust building mechanism between the 2 philosophically different approaches of modern medicine and traditional medicine.