3.6 Indian Systems of Medicine and Homoeopathy

3.6.1 The Indian Systems of Medicine and Homoeopathy consist of Ayurveda, Siddha, Unani and Homoeopathy, and therapies such as Yoga and Naturopathy. Some of these systems are indigenous and others have over the years become a part of Indian tradition. It is estimated that there are over 6 lakh ISM and H practitioners in the country. Many of them work in remote rural and urban slum areas and thus, could play an important role in improving the quality and outreach of health care. These practitioners are close to the community, not only in the geographical sense but in terms of cultural and social ethos. The cost of care is affordable and hence these systems have wide acceptance among all segments of the population. The National Health Policy visualised an important role for the ISM and H practitioners in the delivery of health services. Measures to popularise and develop Indian Systems of Medicine and Homeopathy have been vigorously pursued during the Eighth Plan. In order to give focussed attention to the development and optimal utilisation of ISM and H for the health care of the population, a separate Department for ISM and H was set up in 1995.

Indian Systems of Medicine and Homeopathy Strengths of the system are: There are over 6 lakh ISM and H practitioners The practitioners serve in remote rural areas/urban slums They are accepted by the community Problems are: Training institutes lack well qualified teachers and quality of training is not of requisite standard Lack of essential staff, infrastructure and diagnostic facilities in secondary/tertiary care institutions Potential of ISM and H drugs and therapeutic modalities is not fully exploited Existing ISM and H practitioners are not fully utilised to improve access to health care

Approach during the Ninth Plan

Primary Health Care

Secondary Health Care

3.6.4 Majority of existing ISM and H facilities at secondary care level function as separate institutions and do not have linkages with either primary health care institutions in ISM and H or with secondary health care institutions in modern system of medicine. Very often these institutions lack adequate diagnostic facilities and have inadequate infrastructure and manpower. During the Ninth Plan the feasibility and usefulness of posting ISM and H practitioners in District Hospitals will be explored as pilot projects to see how these efforts in providing complementary system of health care to patients in these hospitals are utilised by the patients and at the same time enable patients opting for ISM and H treatment to get the benefits of diagnostic facilities available in secondary care institutions.

Tertiary Health Care

3.6.5 All the ISM and H Colleges and Institutions in private/government sector have attached tertiary health care hospitals. In addition, there are tertiary care and/or speciality Centres attached to National Institutes. Private/voluntary sector institution also provide tertiary health care in ISM and H. Majority of tertiary care institutions lack essential staff, infrastructure and diagnostic facilities. During the Ninth Plan, efforts will be made to improve tertiary care institutions especially those attached to ISM and H Colleges and National Institutions so that there will be simultaneous improvement in teaching, training, R and D and patient care.

Development of Human Resources for ISM and H

3.6.6 Physicians in ISM and H broadly belong to one of the two categories:(1)those trained in the traditional manner in ISM and H (e.g., Vaids and Hakims) and (2) those who have gone through the educational institutions in ISM and H and have obtained their degrees.

3.6.7 During the last five decades there has been a progressive increase in the number of physicians who are qualifying through educational institutions in ISM and H. At present it is reported that there are 329 ISM and H colleges in the country. It is estimated that about 11,000 health care providers graduate in the system every year (Table 3.6.1). Available information indicates that the quality of training provided in a majority of ISM and H colleges is sub-optimal. The training institutes often lack well qualified teachers; the quality of education provided especially the practical training in patient management, is often not of requisite standard because of lack of adequately staffed hospitals providing care to patients according to the guiding principles of different systems of ISM and H.

3.6.8 During the Ninth Plan period there will be efforts to improve human resource development for ISM and H through: creation of an appropriate mechanism for quality assurance in educational process in ISM and H educational institutions; strengthening the infrastructure in ISM and H colleges and National Institutes of ISM and H to ensure improvement in the uniformity of standard of teaching in all the systems of ISM and H; creation of appropriate mechanism for funding the Government educational institutions so as to ensure quality and relevance of training in ISM and H colleges; promoting Continuing Medical Education for all practitioners of ISM and H

3.6.9 During the Ninth Plan attempts will be made to ensure that ISM and H colleges are strengthened/ monitored so that the manpower produced does have essential skills to tackle health problems in urban and rural areas. The Department of ISM and H has selected 40 institutions for organising re-orientation training for teachers and physicians of ISM and H.

Quality Assurance in Education in ISM and H

3.6.10 It is essential to have appropriate regulations and agencies for implementing these regulations in order to ensure that quality of education is maintained. The Central Council of Indian Medicine (CCIM), a statutory body constituted in 1970 and the Central Council of Homoeopathy (CCH) constituted in 1973 are responsible for laying down and maintaining uniform standards of education for Courses in Ayurveda, Siddha and Unani and Homoeopathy, regulating the practice in Indian Medicine and prescribing standards of professional conduct, etiquette and code of ethics for practitioners and advising the Central Government in matters relating to recognition of appropriate qualifications of Indian Medicines and Homoeopathy. These Councils also maintain Central Registers for Indian medicine and Homeopathy respectively. These central professional bodies work in co- ordination with State Board/Councils in maintaining the standard of medical institutions of ISM and H in the respective States. However, the monitoring procedures and schedules are not adequate. The recommendations of CCIM and CCH are often not acted upon. A system of periodic monitoring by an accreditation committee will be worked out and implemented during the Ninth Plan. Periodic inspection and certification will later be made mandatory for the recognition of the institutions.

3.6.11 In order to improve the manpower development in ISM and H it is important to ensure uniformity in entry standards, and uniformity in the curricula. It is imperative that the condition of hospitals where the students learn the essential clinical care are improved so that appropriate clinical training is given. The focus during the Ninth Plan will be over ensuring quality and relevance of the undergraduate training and over improving clinical skills through a period of internship with possible multi- professional interaction.

National Institutes in ISM and H

3.6.12 Under the Department of ISM and H, some Institutes are being developed as Centres of Excellence such as National Institute of Ayurveda, Jaipur; National Institute of Homoeopathy, Calcutta; Institute of Post-Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar.

3.6.13 These institutions will be strengthened during the Ninth Plan so that they act as centres of excellence in teaching, service delivery and R and D.

Para-professionals in ISM and H

3.6.14 Currently there are no arrangements in the Department for a degree or diploma in pharmacy nor is ISM and H pharmacy included as one of the options in general pharmacist course. There are no nursing trainees in ISM and H. These areas need to be looked into and the lacunae rectified during the Ninth Plan.

Continuing Medical Education in ISM and H

3.6.15 Majority of the ISM and H practitioners have qualified from recognised Institutions and could be utilised for delivery of primary health care. Most of these practitioners are in the private sector and require periodic updating of the knowledge and skills through continuing medical education courses. It is also important to provide ISM and H practitioners with sufficient knowledge of the ongoing national health programmes so that they could provide necessary counseling and act as depot holders for selected items such as condom and ORT packages. Increasing the involvement of ISM and H practitioners in counselling and improving the utilisation of services under the National Health and Family Welfare programmes are envisaged during the Ninth Plan period. The ISM and H practitioners will strengthen (i) health education, (ii) drug distribution for national programmes, (iii) motivation for family welfare, (iv) motivation for immunisation, and (v) improvement in environmental sanitation. Necessary curricular changes will be introduced in graduate and CME courses, and appropriate course contents will be developed so as to design learning experiences related to expected task performance. The CME programme may be linked to a system for periodic recertification of practitioners as a part of efforts to ensure quality of care.

Preservation and Promotion of Cultivation of Medicinal Herbs and Plants

3.6.16 With the new thrust for ISM and H, there will be an increasing demand for drugs used in these systems. Over the last two decades the cultivation of medicinal plants and herbs have been unable to meet the increasing demands. Several medicinal plants are no longer available at affordable cost. Some of the species of medicinal plants are also reported to be endangered because of increasing pressure on the forests.

3.6.17 The Department has initiated a scheme for development and cultivation of medicinal plants. The objective of the scheme is to augment the production of raw herbs of plant origin by providing Central assistance for their cultivation and development . In addition, during the Eighth Plan period several States such as Himachal Pradesh have also set up herbal gardens and linked them to production units of drugs for ISM and H. There is a need to create such herbal farms in public, private and joint sector to ensure that the essential plants and herbs of appropriate quality are produced in adequate quantity to meet the demands and the cost of drugs is maintained at affordable levels. Use of appropriate bio- technological tools for preservation and propagation of important medicinal plants have to be taken up. Inter-sectoral co-ordination with Departments of Biotechnology, Horticulture and Medicinal and Aromatic Plant Research Institutions are important for ensuring that appropriate herbs are grown taking into account agroclimatic conditions. The Department has utilised three gene banks (at Delhi, Lucknow and Trivandrum) under the Department of Bio- technology to store 2000 species of medicinal plants (Germ plasm) required for ISM and H drugs.

3.6.18 At the village level, cultivation of medicinal plants through appropriate utilisation of waste land will have to be undertaken with active collaboration of agriculture Department, Krishi Vigyan Kendra and Department of Rural Development.

Pharmacopoeial Standards

3.6.19 Pharmacopoeial standardisation of Ayurveda, Siddha and Unani Medicine, both for single and compound drugs, is essential. The Department had taken up the task of developing Pharmacopoeial Standards through Pharmacopoeia Committees. Four Pharmacopoeial Committees are working for preparing official formularies/pharmacopoeias to maintain uniform standards in preparation of drugs of Ayurveda, Unani, Siddha and Homoeoapathy and to prescribe working standards for single drug as well as compound formulations. The Pharmacopoeia Committees in Ayurveda, Siddha, Unani and Homoeopathy are headed by experts in their respective fields.

3.6.20 Pharmacopoeial Laboratory for Indian Medicine,Ghaziabad, was established in 1970 as standards setting-cum-drug testing laboratory for ISM at the National level. The standards worked out are published in the form of monographs. During the Ninth Plan period the ongoing pharmacopoeial work, development of pharmacopoeial standards, listing essential drugs and formulations will be completed expeditiously . The work of pharmacopoeial laboratories attached to the Department will be supplemented by laboratories of CCRAS and university/college departments of Chemistry and Bio-chemistry. Strengthening of State Drug Testing Laboratories will also be taken up to ensure quality of drugs used in ISM and H. In addition GMP for production of drugs of good quality and strengthening of quality control laboratories will be encouraged .

Research and Development (R and D)

3.6.21 There are four Research Councils in ISM and H; these are Central Council for Research in Ayurveda and Siddha (CCRAS); Central Council for Research in Unani Medicine (CCRUM); Central Council for Research in Homoeopathy (CCRH); and Central Council for Research in Yoga and Naturopathy (CCRYN). They initiate, aid, guide, develop and coordinate basic and applied research, medico-botanical surveys, research on the cultivation of medicinal plants and pharmacognostical studies. These Councils are the apex bodies for research in the concerned systems of medicine and are fully financed by the Government of India.

3.6.22 The Central Research Councils' R and D programmes will be strengthened during the Ninth Plan period, if necessary, by reorganisation and by providing adequate infrastructure and resources. These Councils will also collaborate with outside research institutions and research funding agencies as well as universities.The major focus will be on developing new drug formulations. These, as well as formulations traditionally used in ISM and H for treatment of illnesses for which there is no effective remedy in modern system of medicine will be tested for safety and efficacy. Clinical trials will also be undertaken in formulations traditionally used in tribal societies and reported as being effective.

3.6.23 Formulations found useful will be patented. The Department has established a Patent Cell to keep track of patents being filed in India and other parts of the world with respect to Ayurveda, Siddha, Unani drugs and to extend professional and financial assistance to Government/Private scientists in the ISM and H sector in connection with filing of patents. An Expert Group has been constituted for rendering advise to the Department with regard to the Patent issues relating to ISM and H. This will receive increased attention in the Ninth Plan. The potential contribution of drugs and formulations from ISM and H to meet the national as well as global demands for safe and effective drugs will be fully exploited. Drug safety and pharmacopoieal standards setting will receive due attention. Preventive and curative role of Yoga and Naturopathy in life style related disorders will be fully investigated and utilised.

Outlays and Expenditure

3.6.24 The outlays and expenditure during the Eighth Plan period are given in Table 3.6.2. During the initial four years there was underutilisation of the funds provided. However in the last year, after the establishment of the Department of ISM and H, utilisation of funds has markedly improved.

3.6.25 The strength of ISM and H lies in the fact that the practitioners serve in private sector even in remote rural areas and urban slums. Strengthening of undergraduate and post graduate training in ISM and H, establishment of speciality clinics in major hospitals, standardisation of drugs, enhancing availability of raw materials, research and development and IEC are some of the major areas of input by the Deptt of ISM and H at the national level; they will continue to be the focus during the Ninth Plan. Development of human resources and establishment of speciality clinics are activities that take time and have to be achieved in phases. Taking all these factors into consideration an outlay of Rs. 266.35 crore has been provided to the department of ISM and H for the Ninth Plan period. The outlay for the Annual Plans will be adjusted depending upon the requirements of the department and availability of the funds. The State Governments will be making necessary provisions for development of ISM and H in their budget.