Evaluation of implementation status of national policy on Indian systems of medicine and homeopathy...

Original Article

Ancient Science of Life / Oct-Dec 2013 / Vol 33 / Issue 2 101

Evaluation of implementation status of national policy on Indian systems of medicine and homeopathy 2002: Stakeholders’ perspective Balpreet Singh1, Manoj Kumar1, Amarjeet Singh2

1Centre for Public Health, University Institute of Emerging Areas in Science and Technology, Panjab University, 2Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India

INTRODUCTION

I ndia has the unique distinction of having seven recognized systems of medicine, which are Ayurveda, Siddha, Unani,

Yoga, Naturopathy, Amichi, and Homeopathy. During British rule despite public faith and strength of the Indian systems, these systems of medicine were dominated by western medicine. The denigration of traditional wisdom reached its zenith in 1835, when Lord Macaulay settled the controversy over whether government should support indigenous or western learning by ordering that western knowledge should be exclusively encouraged in all areas governed by east India company. Thereafter only western medicine was recognized as legitimate and eastern systems were actively discouraged.

At the dawn of 20th century, with the assertion of Indian nationalism, interest in Indian art and science reawakened and Indian systems of medicine began a gradual renaissance. Bhore Committee and Mudaliar Committee, which brought the revolution in Health System of India, identified the importance of ISM. After that, the Indian government set up several high‑level committees to advise it on the course of action it should adopt in relation to ISM.[1,2] Chopra report recommended the complete integration on ISM and modern medicine but due to the influence of the allopathic professionals on the design of health care systems, recommendations regarding the incorporation of indigenous practitioners into the national health services were simply not followed through.[3] Later on the strengths of a traditional system was internationally recognized.

In 1980, WHO advocated the adoption of the primary health care model. This focused on developing community participation through the involvement of locally acceptable people like practitioners of traditional medicine.[4] UNICEF also recommended the mobilization and training of indigenous practitioners (including traditional birth attendants or dais). In 1977, with the launch of the Community Health Worker Scheme, a fresh impetus was given to the attempt to involve rural, institutionally nonqualified, traditional practitioners as voluntary, paramedical community workers.[5] Simultaneously, serious efforts were also made to base primary health care strategies

ABSTRACTBackground: National Policy on Indian systems of medicine and homoeopathy (ISM and H policy) was formulated in 2002 to encourage the development of Ayurveda, Sidhha, Unani, Yoga, Naturopathy and Homoeopathy in India. This study proposes to assess the views of public health experts on current implementation of ISM and H Policy.Methods: An online questionnaire was designed to ascertain the views of public health experts on ISM and H Policy and mailed to 100 public health experts. The tool was tested for content validity and a pilot study was done. Results were analyzed with the help of SPSS version 16.Results and Conclusion: Response rate was 61%. Majority of experts considered implementation status of ISM and H Policy as poor. Lack of quality education was mentioned as major factor responsible for current scenario of ISM and H Policy by most of experts. Lack of funds and government support were emerged as major bottlenecks in implementation of ISM and H Policy.

KEY WORDS: AYUSH, evaluation, implementation, ISM and H policy

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Singh, et al.: Implementation status of ISM and H Policy

102 Ancient Science of Life / Oct-Dec 2013 / Vol 33 / Issue 2

on the use of indigenous plant drugs grown in local herbal gardens.

National Health Policy (1983) assigned an important role to ISM in the delivery of primary health care. A separate Department of ISM and H was created under Ministry of Health and Family Welfare, Government of India in 1995.

The most decisive step in development of ISM and H was formulation of National Policy on Indian systems of medicine and homeopathy in 2002. In general, any policy provides guidelines considering ideal situations. It is only at implementation stage that shortcomings appear in practice. Implementation of a policy depends upon various factors like governmental support, resources, organization, efficiency of institutions, etc. To assess the achievement of stated objectives of a policy, its adequacy and efficiency evaluation should be done. Thus, it is important to find out how effectively the policy on ISM has been implemented in the period of 8 years.

Keeping the above points in view, this study was undertaken with the objective to assess the views of public health experts on implementation for current status of ISM and H policy in 2010‑2011.

MATERIALS AND METHODSAn online questionnaire was designed to assess the views of public health experts and concerned authorities on content and implementation for current status of ISM and H policy. The tool was given to some of the experts for content validity. Based on their suggestions and recommendations, restructuring of tool was done. A pilot study was conducted on 20 Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH)/public health experts attending 4th World Ayurvedic Congress to find out the feasibility of the study. Questionnaire contained cover page stating purpose of study and researchers’ name. Questionnaire contained nine questions. In first seven questions, respondents were instructed to rank implementation of strategies on the four‑point scale of excellent, good, fair and poor. Eighth question was regarding the bottlenecks in implementation status of policy and ninth question was for other comments.

Websites of related institutions/agencies were visited and a list of E‑mail ids of concerned experts was prepared. A list of 51 institutions, five international agencies and four associations was made. These websites were searched for personal E‑mail ids of concerned experts. Thus, a list of 327 experts was made with their E‑mail ids. Of these,

100 experts were selected purposively. Questionnaire was mailed to them. Respondents included faculties, researchers and consultants of prominent institutions, departments or agencies.

Data were then analyzed with the help of International Business Machines Corporation Statistical Product and Service Solutions (IBM SPSS) for windows version 21. Frequencies, percentages, mean, and standard deviation were used to draw inferences as data set was most appropriate for it. Demographic data were entered in string format. Responses of first eight questions were converted into numerical format. For purpose of conversion, these were scored as: Poor = 1; fair = 2; good = 3 and excellent = 4. Qualitative information was analyzed by coding to extract theme.

Consent of the respondents was taken with the condition that identity of his/her will remain confidential.

RESULTSResponse rate was 61%. Majority of respondents marked implementation status of various strategies of ISM and H policy as “poor” or “fair.” Mean score of responses of experts regarding implementation was found to be 1.869 out of 4. Responses of experts on implementation status and Mean score with standard deviation are presented in Table 1.

Lack of funds and lack of government will came out as major bottlenecks in implementation of ISM and H policy. Some of other bottlenecks emerged were red tapism, political will, corruption, lack of monitoring and evaluation, lack of public awareness, lack of leadership and many health systems under AYUSH.

DISCUSSIONComplementary and alternative medicine is the sum total of the knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures.[6] India is patron to plural health systems and officially recognize AYUSH systems.[7] All these systems have faced ups and downs in history. It is essential to assure the preservation of traditional and alternative knowledge and to utilize its benefits.[8] National policy on ISM and H is an effort in this direction.

However, policy formulation is usually never an end in itself. It needs to be converted to worthwhile strategies and






programs. This requires regular and continuous discussion and debated about the policy among stakeholders, in particular, the experts in the concerned field. In this context, our study revealed that in general public health experts rated implementation status of ISM and H policy as “poor”. ISM and H policy has recommended that 10% of central health budget should be allocated to AYUSH. However this has not been followed until date. AYUSH get only 2‑4% of total health budget. Lack of funds adversely affects research, availability and upgradation infrastructure, replenishment of various resources and enforcement mechanisms for quality control. However, here is vast disparity in government support provided to modern medicine and AYUSH; both at center level and state level. There are many governmental schemes to mainstream AYUSH but experts in our study did not find such efforts as effective. Infrastructure of AYUSH facilities is in poor condition in most of states in India. This interferes with service delivery in AYUSH institutions. Government support and political commitment are the keys to development and revival of AYUSH system in India.

Administration of AYUSH is still in developmental phase in India. Recommendations of ISM and H policy have not been completely implemented so far. Due to poor administrative set up and continuous negligence, plans, and efforts to revive AYUSH get struck in intricate bureaucratic processes. This is reflected by the fact that red tapism also emerged as major

listed bottleneck in our study. Moreover, corruption in government system also got the attention of experts. Due to poor vigilance system in AYUSH, corruption is prevalent at each level. Experts in our study also mentioned corruption at bottom level by making false outpatient department records and nonmaintenance of head quarter by doctors and staff. Monitoring and evaluation of various schemes is not done properly which does not yield much information for improvement of AYUSH systems. This leads to poor performance of AYUSH health systems. Most of AYUSH district officers do not have any official vehicle for monitoring of health facilities unlike the allopathic district officers. This reflects the step motherly treatment to AYUSH by authorities.

Efforts for awareness regarding benefits of AYUSH were also found inappropriate by experts in this study. There is a need to spread such awareness in public especially in educated youth. Older ways of presenting AYUSH systems may deviate today’s modern educated youth from AYUSH systems. Therefore strengths of AYUSH systems must be presented in scientific ways.

Few experts described lack of leadership in AYUSH responsible for poor implementation of policy. One expert expressed that inclusion of different health systems under a single entity like AYUSH was responsible for the poor situation. All the systems of AYUSH are different in their

Table 1: Implementation status of strategies to achieves of objectives of National Policy on Indian Systems of Medicine and Homoeopathy (n=61)ISM and H policy objectives Implementation status of strategies to

achieve objective (number of respondents)

Mean score±SD

Poor Fair Good ExcellentTo promote good health and expand the outreach of health care to our people, particularly those not provided health cover, through preventive, promotive, mitigating and curative intervention through ISM and H

27 24 6 4 1.787±0.878

To improve the quality of teachers and clinicians by revising curricula to contemporary relevance and researchers by creating model institutions and centers of excellence and extending assistance for creating infrastructural facilities

28 17 15 1 1.819±0.866

To ensure affordable ISM and H services and drugs which are safe and efficacious 25 22 12 2 1.853±0.853To facilitate availability of raw drugs which are authentic and contain essential components as required under pharmacopoeial standards to help improve quality of drugs, for domestic consumption and export

20 30 8 3 1.902±0.810

Integrate ISM and H in health care delivery system and National Programs and ensure optimal use of the vast infrastructure of hospitals, dispensaries, and physicians

21 21 12 7 2.082±1.005

Re‑orient and prioritize research in ISM and H to gradually validate therapy and drugs to address in particular the chronic and new lifestyle related emerging diseases

30 16 12 3 1.803±0.928

Create awareness about the strengths of these systems in India and abroad and sensitize other stakeholders and providers of health

25 26 8 2 1.770±0.804

To provide full opportunity for the growth and development of these systems and utilization of the potentiality, strength and revival of their glory

21 24 15 1 1.934±0.814

Overall implementation status of ISM and H policy 197 188 88 23 1.869±0.871SD: Standard deviation, ISM: Indian systems of medicine






principles and practices. Some systems like Yoga and Naturopathy are nonmedicinal systems while others use mixed approach. Ayurveda, Yoga and Homoeopathy are popular in entire nation while others are restricted to specific areas. Hence, common policies and plans are not able to work for development of each of these systems. Ayurveda being dominant system in AYUSH surpass the existence of other systems. Combined administration of different systems of medicine cannot do justice for each system.

Most of experts in our study ranked implementation status of strategies for AYUSH education as “poor”. Moreover situation of education is different for different systems in AYUSH. Udupa et al. recommended the formation of a Council of Indian Medicine to regulate the educational standards. Government of India has established regulatory councils for Ayurveda, Unani, Siddha and Homoeopathy. Ayurveda, Sidhha and Unani fall under ambit of Central Council of Indian Medicine (CCIM).[9] While Central Council for Homoeopathy regulate homoeopathy education in India. Still there is no separate regulatory council for yoga and naturopathy education. Rather education for nursing in AYUSH has been started by various education institutions. Similarly, pharmacy courses for different systems of AYUSH have also been initiated. Diploma, graduate and postgraduate courses are being provided in Ayurvedic medicine by various institutions. There are regulatory councils for nursing and pharmacy of Allopathy. However, there is no regulatory body for AYUSH nursing and pharmacy. Patwardhan et al. stated that even after the functioning of regulatory bodies like CCIM, standard of Ayurveda education has been deteriorated in recent years.[10] Absence of regulatory bodies can lead to mushrooming of AYUSH colleges with poor quality education.

Patwardhan et al. identified an urgent need to improve quality education. He questioned the hybrid curricula which produced inadequately trained graduates in modern and traditional systems.[11] An expert in our study blamed course curricula responsible for not preserving the interest of students in field of traditional medicine. Course curricula of ISM and H are dominated by components of modern medicine. This encourages doctors of AYUSH to deviate towards practice of allopathy. Patwardhan et al. expressed an urgent need to review and restructure curriculum of Bachelor of Ayurvedic Medicine and Surgery course.[12] They advocated that AYUSH courses must have relevant topics such as laws, procedures of standardization, healthcare management, methods of evaluating toxicity of products, cultivation, and marketing of medicinal plants. They advised that AYUSH academicians should be trained in research methods and documentation skills. One expert in our study

favored to include biochemistry and biostatistics in curricula of ISM and H. Lack of quality education was mentioned as a major factor responsible for current scenario of ISM and H in our study. An expert in our study opined that emergence of substandard colleges has deprived students from acquisition of practical knowledge. In their study Patwardhan et al. also they found that exposure to practical and basic clinical skills is not adequate in AYUSH institutions.[10]

However, no accreditation system has been introduced for academic AYUSH institutions. Accreditation system can force AYUSH institution to compete with each other in terms of good infrastructure and services. This may lead to improved quality of education and growth of health system.

AYUSH systems have cultural, geographical, linguistic and religious impacts. Ayurveda and yoga are mainly taught in Sanskrit/Hindi while Unani is taught in Urdu/Persian. Students of Ayurveda and Unani have to qualify courses in Sanskrit and Urdu/Persian respectively. One expert in our study disfavored the study of Sanskrit for Ayurveda and Urdu or Persian for Unani. He argued that due to this, Hindus are not interested to study Unani and Muslims are not interested in studying Ayurveda and yoga. There is therefore a need to free the education of AYUSH systems from the boundaries of languages.

Similarly, experts in our study claimed implementation of strategies related to research as “poor”. They also questioned the allocation of large amount of money in the name of research. Eight experts mentioned lack of research as factor responsible for current poor scenario of ISM and H. This indicates that there is a need to strengthen research and development in AYUSH. Good quality research is major factor to ensure the sustenance of health system in this scientific era. In 1969, the government established a Central Council for Research on Indian Medicine and Homoeopathy to develop scientific research on different systems of indigenous medicine. Later on, in 1978, it was split up into four separate research councils; viz Central council for Research in Ayurveda and Siddha (CCRAS), Central council for Research in Homoeopathy, Central council for Research in Unani Medicne, Central council for Research in Yoga and Naturopathy. Recently, CCRAS has been split into Central Council for Research in Ayurveda Sciences and Central Council for Research in Siddha. Experts in our study were not satisfied with the status of research in AYUSH. They opined that research in AYUSH institutions in not as per international standards. One expert stated that research in AYUSH is mainly concentrated on clinical trial of few drugs. Diet and lifestyle modification is neglected area in AYUSH research.




https://www.researchgate.net/publication/26748262_The_Ayurveda_Education_in_India_How_Well_Are_the_Graduates_Exposed_to_Basic_Clinical_Skills?el=1_x_8&enrichId=rgreq-0cb83ba2-4715-46f9-85e7-5d1194c08e0a&enrichSource=Y292ZXJQYWdlOzI2NjYyNjg2MDtBUzoxNjg0NzQ4NTI3MzI5MjhAMTQxNzE3ODk0Mzc5NQ==

https://www.researchgate.net/publication/7445897_Ayurveda_and_Traditional_Chinese_Medicine_A_Comparative_Overview?el=1_x_8&enrichId=rgreq-0cb83ba2-4715-46f9-85e7-5d1194c08e0a&enrichSource=Y292ZXJQYWdlOzI2NjYyNjg2MDtBUzoxNjg0NzQ4NTI3MzI5MjhAMTQxNzE3ODk0Mzc5NQ==



Most of health systems in ISM and H are primarily herbal based. But the implementation status of strategies to ensure the availability of authentic herbal raw material was marked as ‘fair’ by most of experts. Few experts stated that plants and minerals used by pharmacies are not as per standards described by texts.

In this study, implementation status of the strategies for standardization and quality control of AYUSH was considered by most of experts as “poor”. WHO also considered safety and efficacy of complementary and alternative medicine of important concern.[13] Thatte et al. and Gogtay et al. stated that safety and efficacy of AYUSH medicines was major problem.[14,15] In 2004 December, Journal of American Medical Association published a research paper, which concluded that ayurvedic medicines contained potentially harmful levels of lead, mercury and/or arsenic.[16] Traditional knowledge of herbs and modern standardization techniques should be incorporated to result in “Total Quality Management” which should not idealize traditional medicine but seriously consider safety, efficacy, and quality.[17‑19] Banerjee found that standardization and validation of traditional medical products were the key issues addressed in ISM and H policy.[20] There is a definite need to strictly implement directions of ISM and H policy for ensuring drug safety and standardization. This is essential for finding good international market for AYUSH products.

ISM and H policy 2002 directed the Government of India to integrate AYUSH in health facilities of Allopathy. In 2005, National Rural Health Mission implemented this under mainstreaming of AYUSH. AYUSH clinics with system of local preference were established in primary health centers, community health centers, sub district and district hospitals.

Vaidya and Unnikrishnan found it essential to appropriately integrate traditional medicine with mainstream health system without compromising diversity and unique aspects.[19,21] Rao et al. advocated comprehensive national policy for human resources to achieve universal health care in India. He stated that such a policy might also encourage task‑shifting and mainstreaming doctors and practitioners who practice traditional Indian medicine and homoeopathy to work in these areas while adopting other innovative ways of augmenting human resources for health.[22] Kumar and Chanana have also recommended the use of Ayurvedic and Homoeopathic workforce in public health.[23,24] Protocols for goal oriented role and responsibility of AYUSH workforce are lacking. Thus, it is clear that National Policy on ISM and H has not able to deliver at implementation level. Utilization different health systems must be promoted based on their strengths and weaknesses.[25]

Limitation of studyAs the total number of experts contacted in the study was 100 and only 61 of them responded, there are chances that many experts in concerned area might have been left out. Moreover, the sample was not random and hence the results may not be truly representative of the actual situation. Moreover this is an opinion based study, so findings may biased by perceptions of experts. There is a need for similar studies with randomly selected larger sample.

CONCLUSIONThe overall implementation status of ISM and H policy considered as “poor” by majority of experts. Implementation status of the strategies for creating awareness about the strengths of these systems in India and abroad and sensitize other stakeholders and providers of health was assessed as “fair” by most of the experts. ISM and H policy seeks to ensure to provide full opportunity for the growth and development of these systems and utilization of the potentiality, strength and revival of their glory. However, the implementation of strategies to achieve this objective was marked as “poor” by majority of respondents. The implementation status of strategies to improve quality of drugs for domestic consumption and export was also marked as “fair” and the affordability of drugs was rated as “poor” by most of experts.

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Address for correspondence:Dr. Balpreet Singh, Centre for Public Health, University Institute of Emerging Areas in Science and Technology, Panjab University, Chandigarh ‑ 160 014, India. E‑mail: [email protected]

How to cite this article: Singh B, Kumar M, Singh A. Evaluation of implementation status of national policy on Indian systems of medicine and homeopathy 2002: Stakeholders' perspective. Ancient Sci Life 2013;33:101-6..

Source of Support: Nil. Conflict of Interest: None declared.

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