I have reviewed the report on the Status of Indian Medicine and Folk Healing 2011 submitted by Smt. Shailaja Chandra former Secretary to the Govt. of India, Department of AYUSH. I have also seen the summary of this report recently published in AYU and J-AIM. I was also invited by Smt. Chandra to speak on the educational component of this report in a panel discussion on this report by experts on March 19, 2012, at India International Center, which was moderated by Smt. Shailaja Chandra herself. She very kindly encouraged me to present a critical appraisal of this report. At the very outset, when this beautifully printed voluminous report authored by a well-known name came in my hands, I was struck with the title of the report, “Indian medicine and folk healing.” This report deals with the current status of Ayurveda, Siddha, and Unani systems of medicine. But these age-old words could not grace the cover page of the report.[1,2]
It is for the first time that an evidence-based report has been drafted by a very distinguished senior bureaucrat based on opinion survey and field visits by the PI, duly illustrated with field data produced well in a massive report of over 300 pages. The report laudably covers the features of historical evolution of ASU systems down the ages, specially dwelling upon the current issues focusing on the benefits that ASU systems have given to the public, making recommendations how to maximize these benefits now and in days to come. The recommendations are related to the ASU education, research, and practice besides associated sectors such as drug availability and medicinal plants sector. I am sure if these recommendations are implemented, it may bring improvement in the degree of benefits from these systems to the health care of the people. However, as a reviewer, I am analyzing this report for its deficiencies from AYUSH fraternity point of thinking. I believe if these points were taken care of, the report could have proved much more realistic. Some such deficiencies are as follows.
1. This is not the first report of its kind. There have been nearly half a dozen status reports submitted to the Govt. of India time to time in the past. The Chopra committee of 1948 and Udupa committee report of 1958 are the prominent ones; many recommendations from these reports seem to have been implemented.[3,4] Most of these committees recommended integration and scientific validation of ASU, which is in progress now. The main distinction seems to be the fact that most of earlier reports were made by the committees consisting of technocrats and professionals who had first-person knowledge of the subject, while the present report is written by a senior bureaucrat with rich experience of managing and administering this sector. This is why this report displays a bureaucratic temper and repeatedly swears that the main concern of the PI is to focus on the benefits that these systems have given to the public without much concern about strengthening the system itself. All civil servants use this idiom probably as a custom of their clan.
I have difficulty to agree with this undue emphasis and dichotomy of the benefactor and the beneficiary because unless these systems are strengthened infrastructurally, they cannot really serve the people as per expectations. This report has not cared much to know why ASU systems have remained weak, why they could not be mainstreamed, why they have not proved much beneficial to the public, and further what more could be done in terms of infrastructural and manpower support to empower these systems for their mainstreaming and globalization on one hand and better service to the people on the other.
2. The recommendations on education sector focus exclusively on curriculum and syllabus reform. The report deliberately avoids commenting on issues related to provision of infrastructure and teaching faculty on the pretext that this aspect is controlled directly by the Department of AYUSH, hence no comment is being made. This cannot be a justifiable argument from any angle. It is well known that educational institutions in this sector are extremely poor in terms of their infrastructure, so much so that in nearly half of the colleges, new admissions are currently banned by CCIM for want of training facilities. There is acute shortage of teachers in all ASU colleges including the national institutes and apex institutions. There are over 250 Ayurvedic colleges and as such there are about 20,000 teaching posts, and the minimum qualification to become a teacher is MD degree. From where so many MDs will come when this country is producing only 1200 MDs (Ay) in contrast to 21,000 MDs in modern medicine per year. I was expecting this committee to comment on this crisis and to recommend a substantial hike in PG education in these subjects, which may require immediate strengthening of the infrastructure, besides planning fast track strategies in consultation with CCIM. We need more and more PGs to become teachers and also to become specialist practitioners. This report emphasizes on launching of specialty clinics in Ayurveda to practice Ayurveda as specialists. It is a good recommendation, but it is too much to expect raw BAMS graduates to become specialists. The specialists need postgraduate training; otherwise, this ambition may turn into a laughing stock.
The fast track hike in PG education will have to be planned through proactive discussion among the authorities of the Department of AYUSH, CCIM, CCRAS, Senior faculty in existing AYUSH institutions, the affiliating Universities, management of private colleges and other stakeholders. Some of the possibilities which I visualize could be :
- a)On priority strengthening of PG departments of existing colleges.
- b)Appropriate liberalization of CCIM regulations for PG, Ph.D. registration.
- c)Empowering the selected peripheral research institutes of CCRAS (numbering about 30 spread all over the country), to take MD/ Ph.D. registrations after formal affiliation with regional Universities and outsourcing certain facilities from near by Ayurvedic colleges to conduct PG education and research together, authorizing the CCRAS scientists to guide MD and Ph.D. scholars with bilateral benefit. This will make these institutes more dynamic and productive free from ongoing monotony. These scientists could be given necessary reorientation training for the new kind of work assigned to them. It cannot be overemphasized that PG education and research should go hand in hand as the integral part of higher education.
3. The report seems obsessed with the controversial issue of inclusion/exclusion of modern medicine component in ASU curriculum without coming out with any logical policy and clear recommendation. The report vaguely pleads to strengthen the knowledge and skill of modern medicine in ASU doctors to equip them to be good professionals so that they may help the national crisis of shortage of doctors. While on the other hand, the report does not give clear recommendation for the legal practicing rights for these doctors. The conflict and contradiction prevails. Also, no comments have been made on the probable fallouts of promoting this category of doctors with ambiguous status, which is good neither for the health of the ASU systems nor for the health of the people. The report does not spell out the need and strategies for fuller revival and development of ASU as unique systems of health care, which could be a matter of national pride and could open newer vistas of total health care at global level.
4. This report makes certain statements which do not appear really true. The report says that a debate between purists and modernists which started in the 19th century is still alive even today and remains unresolved. I am of the view that such a dichotomy is now largely bridged and everybody in this sector as well as the public at large is in favor of a scientific approach of course with an emphasis on true exploration of the uniqueness of ASU. Nobody is against science and scientific research. Nobody is a purist now of the brand of 19th and early 20th century. The mainstream Ayurvedic profession has now rejected the extremist views on either side.[5,7]
5. The recommendation for creating a separate central regulatory organization on the lines of the proposed NCHRH is most welcome. Similarly, the recommendations regarding promotion of ASU in central universities with the vision to bring AYUSH education within the ambit of university system may have a far-reaching positive impact on ASU education. I admire the author of this report for touching upon this innovative point which may transform the face of ASU education and quality human resource.
6. The report makes several good recommendations to promote good practice of ASU systems. But there is no easy way recommended for overcoming the non-availability of affordable quality drugs for use in governmental hospitals and for private practitioners, which is the main barrier in today's ASU practice. I could not locate any clear comment or recommendation on the functioning of ambitious NRHM project where, as per the original mandate, ASU components were to play a central role, but the scheme has not been implemented in true spirit of the mission. A comment and decisive recommendation on right working of NRHM is awaited. The reform suggestions made in this report for registration of practitioners, creation of a directory for public information, opening of ASU units in other governmental sectors such as CGHS, Railways, etc., and launching of specialty clinics for treatment of different chronic intractable diseases and Panchakarma therapy centers are most welcome. The issues related to insurance coverage for ASU treatment and the provision of accreditation system to promote quality service in this sector seem to be excellent recommendations and could be easily implemented if the Department of AYUSH displays some degree of will for action now.
7. The report submitted by Smt. Shailaja Chandra recommends to promote pure modern diagnosis for Ayurvedic treatment and categorically suggests not to use Ayurvedic diagnostic terms in Ayurvedic practice as in the opinion of the PI of this report it is confusing if the parallel diagnosis is made. But in my opinion it is much more confusing if pure modern diagnosis is done for attempting Ayurvedic treatment because unless we know the modern pharmacology of all Ayurvedic drugs we cannot prescribe a real Ayurvedic treatment, hence parallel diagnosis is currently essential. Further if the educators and practitioners bypass Ayurvedic diagnosis the science of Ayurveda will be reduced to merely few medications and such a serious science of Ayurveda will be lost on the way of its modernization. This is why the Udupa Committee of 1958 suggested four open options for diagnosis and treatment by Ayurvedic practitioners as per their convenience and expertise viz:
- Ayurvedic diagnosis and Ayurvedic treatment,
- Modern diagnosis and Ayurvedic treatment,
- Ayurvedic diagnosis and modern treatment,
- Modern diagnosis and modern treatment
As a matter of fact the Udupa committee did not create these options of their own rather noticed that these four options were prevalent among the practitioners of Indian medicine and had evolved spontaneously over the years. This should not be confused with as the recommendation of the committee. This was merely the observation of the committee during their field visits. This was suggested with the hope that in due course of time whatever will be relevant and viable will evolve itself. The restrictions of any kind will obstruct natural evolution, hence should be avoided. Thus unlike the present report the Udupa committee was fairly liberal and respected the tradition and possibilities of positive evolution and gradual development of one unified national system of medicine possibly through bilateral integration on the lines of contemporary Traditional Chinese Medicine.
8. This report ignores the issue of wide gap and disparity between the two broad wings of Indian Health Care System, namely, conventional medicine and Indian traditional medicine, and extremely poor public sector support to the latter. The Government of India seems to provide only 1.0% of GDP on health sector, which is only one-fourth of the total expenditure, indicating that three-fourth support comes from private sector. This health allocation is already extremely low as compared to 10–15% allocations in developed countries for health. Also, the share of AYUSH in national health budget is still more dismal, i.e. 2.5% of the total 1.0% GDP for health sector. The 97.5% of public fund expenditure on Health goes for Allopathy. This huge gap and disparity is not only responsible for poor maintenance and development of ASU systems, rather is also the cause of overall frustration and apathy among ASU professionals. Surprisingly, a recommendation for reducing the gap and a reasonable hike in public funding for ASU is missing in this report in spite of the fact that the issue is already in hot national debate including in Planning Commission. In the words of Banerjee Madhulika this seems to be a part of the process of designed and deliberate marginalization of AYUSH systems.
The purpose of this communication is not to criticize a good work done by Smt. Shailaja Chandra in this report. It is also not to undermine the commendable services that she extended while in position as the Secretary in the Department of AYUSH through her innovative vision and superb administrative skill. Many of us consider her period as the Secretary AYUSH as the golden period of this department. The present communication only aims to present the additional views of a professional partner as a complement in the long journey of development and utilization of the wisdom of Indian medical heritage for better care of the health of the people of this country.