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AYUSH and the challenges ahead
While the Government attempts a shift on the perspective of alternative medicines and treatment, it would help to direct resources on scientific research and cross-field learning which make evidence more conclusive
One of the major shifts in health policy by the present Government has been its increased focus on the integration and use of traditional medicine into mainstream public health delivery systems. The Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) was formed in November 2014 and superseded the earlier Department of Indian System of Medicine and Homoeopathy. The Ministry funding has been tasked to ‘ensure the optimal development and propagation of AYUSH systems of healthcare.’ In the Government’s view alternative medicine is not a science meant to kept at the sidelines, but instead to be more organically integrated into the health delivery mechanism. In essence, traditional and allopathic medicines are not parallel tracks but rather a single convergent road to good health and well-being. This policy transferal is best reflected in the recently released National Health Policy 2017 (NHP) document of the Union Government, which intends to move AYUSH from a “stand-alone, to a three dimensional mainstreamer” in the health delivery mechanism. Further, the policy seeks to take a wider, more compsehensive view of health delivery, to include ‘providing access to assured AYUSH healthcare services, as well as support documentation and validation of local home and community practice’. It looks to augment the delivering-capacity and resources by ‘prioritising’ ‘the utilisation of AYUSH personnel for urban health care’. Clearly, in the coming years the Government intends to make alternative medicine an important part of its service-supply-mix and resource mobilisation armamentarium.
One major challenge to this shift is the assemblage of alternative medicine into a common cohort. The first major challenge, both in terms of scientific reliability and trust amongst end-users that yoga and Ayurveda, do provide proper cure for a range of conditions by helping in maintaining overall fitness. The Government’s move to make Yoga more widely practised in schools, notwithstanding the entirely facetious ‘Yoga is anti-secular’ argument, is therefore, a welcome change.
Similarly, Ayurveda; the ancient science that employs the use of plants and natural sources to treat a host of conditions, has many believers. Data suggests,, that many conditions can be better managed through Ayurveda than pharmaceutical means that can produce side effects. Having said that, Ayurveda has had its fair share of criticisms as well with practitioners promising it as a cure-all for all illnesses’ and repeated news stories on the presence of heavy metals and other toxic substances being constituents of Ayurveda.
Therefore, Yoga and Ayurveda, do enjoy a relatively higher degree of trust amongst users as a scientifically proven medical application. The Chief Medical Officer of the UK’s National Health Service recently dismissed homeopathic treatments as “rubbish” and calling any investment in the science a “waste of taxpayers money”. Similarly, Unani and Siddha branches of alternative medicines have very few credible peer-reviewed medical evidence that prove their efficacy and safety.
If the Government is indeed serious about mainstreaming AYUSH branches in the public health system, the system itself will have to undergo the A.Y.U.S.H trial by fire. The system needs acceptability and a proven range of applicability for various medical conditions. This is possible through credible research, which would need investments, infrastructure and resources. Then, it needs appropriate yardsticks that measure efficacy and success. Equally important would be young Indian’s support, if this cohort were to be mainstreamed into our health system. The system also needs to be nationwide accessible to a wider reach than it currently is. This is possible through formal challenges of availability through the health system. Most people do not persist long enough with treatments under this system. The need for sustainability is, therefore, important. This would require adequate supply practitioners to make this a reality. Most importantly, the health impact of AYUSH medicines need to have a valid record as reflected in the NHP 2017, which aims to ‘standardise and validate Ayurvedic drugs and ensure quality of medicines, develop infrastructure, foster research and link AYUSH systems to the Accredited social health activists network’. This aspect will be critical to AYUSH’s success and credibility and hence, needs to be fast-tracked.
The challenges are many. On one hand, its thrust on making AYUSH an adjunct to the medical community has been opposed by doctors associations before. On the other hand, questions about the credibility of the evidence to support the efficacy of alternative medicine have not found conclusive rebuttals. While the Government attempts a shift on a perspective of AYUSH, it would be more beneficial to direct resources on scientific research and cross-field learning which make evidence more conclusive. AYUSH does need to pass its own AYUSH Rubicon.
(The writer is general manager, Operation &Public Affairs, Indraprastha Apollo Hospitals)
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