Today, the cumulative number of doctors, across all systems of medicine in India, is more than 1.3 million. India has just six MBBS doctors per 10,000 people, while China has 14 per 10,000. The number of doctors registered with Medical Council of India (MCI) is approximately seven lakhs. It includes MBBS, specialists and super specialists. Approximately there are four lakh registered ayurvedic practitioners and 2.5 lakh homoeopathic practitioners in India. There is an acute shortage of doctors, the existing data reveals that India has a shortage of approximately 6-8 lakh doctors.
Hence the Union Minister for Health and Family Welfare Ghulam Nabi Azad has called for bridging the gaps in healthcare with inherent strengths, holistic approach and wide range of remedies of Ayurveda, Unani, Siddha and Homeopathy (AYUSH). However, it has also been seen that the AYUSH practitioners are opting to prescribe allopathic medicines which in turn has triggered a massive ethical debate. Recently, there was a hue and cry whether AYUSH practitioners should be allowed to practice allopathy or not. While one part of the industry stresses that doing so is unethical and violating the law, the other side argues that the acute shortage of qualified doctors in India can be mitigated by allowing AYUSH practitioners to prescribe allopathy medicine if there is need.
The reasons for practising allopathy by AYUSH practitioners are varied. Some of them are as follows:
- Fast relief: Today, patients are not ready to wait to undergo a lengthy treatment as ayurvedic and homoeopathic treatment requires time to show an impact. Allopathic system of medicine gives fast relief compared to other systems, and hence patients prefer to opt for this method of treatment. Therefore BHMS (Bachelor of Homoeopathic Medicine and Surgery) and BAMS (Bachelor of Ayurvedic Medicine and Surgery) doctors are catering to the demands of patients. Ashok Vaidya, Research Director, ICMR Advanced Centre of Reverse Pharmacology Kasturba Health Society points out, “The patients’ demand for quick responses with antibiotics, analgesics, steroids, hormones etc. is a compelling reason. Our communities are not sufficiently aware of the strengths of Ayurveda, despite the long recorded use and safety. Not infrequently vaidyas too lack confidence in total Ayurvedic management in the practice settings. The pharmacists have hardly any role in hospitals and medical colleges. I had proposed to IPC that we need pharmacist-physicians as bridge professionals to monitor and guide rational drug usage in India. Currently there are almost no dialogues between doctors and pharmacists. I suggested joint conference of IPA with API.”
- Lack of MBBS doctors in rural areas: Today, while many MBBS practitioners move for better prospects to urban areas or abroad, BHMS and BAMS doctors prescribe allopathic medicines in rural settings. Since BHMS and BAMS doctors have basic understanding and knowledge of anatomy, physiology and pharmacology they prescribe allopathic medicines.
- Non availability of traditional medicines: The current availability of proprietary traditional medicines is not enough considering the size of patient pool and variety of diseases. Dr N Udupa, Principal, Manipal College of Pharmaceutical Sciences (MCOPS) highlights, “Today, the manufacturers of ayurvedic and homoeopathic medicines in the market are very few and there are serious issues with respect to availability of these products across the country. Even if a BHMS or BAMS doctor prescribes medicines related to their field, patients will not be able to receive the product. On the other hand, allopathic medicines are available at every retail chemist and it is not a problem even in rural places.”
Need for integrated cure
 “I feel the existing curriculum should also emphasise on studying modern system of medicines as this has penetrated to more extent than Ayurveda or homoeopathy system in India.”Ashok Vaidya Research Director, ICMR Advanced Centre of Reverse Pharmacology Kasturba Health Society |
Whatever the reasons, it is undeniable that India is in need of more integrated and skilled healthcare professionals and hence AYUSH practitioners are garnering a lot of attention these days. Vaidya informs that the 12th five-year plan has allocations for increasing the number of doctors in all systems of medicine. He also opines, “I hope that rather than creating more poor quality medical/ Ayurvedic colleges we retrain and use all the personnel for integrated medical care. India does not need more doctors, we need intense school heath education/ check ups, MCH care, nutrition, hygiene, and rural health care with accountability and lack of corruption.”
| 207 Ayush Colleges/ Institutes permitted to give admission in UG/ PG courses during 2012-13 |
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Revamping the AYUSH curriculum
 “What is needed is systemic efforts of all healthcare professionals with doctors including pharmacists and nurses should be encouraged that would help to strengthen healthcare system.”Dr N Udupa Principal, Manipal College of Pharmaceutical Sciences |
Recognising the need for the enhanced integration of AYUSH into the mainstream healthcare delivery system, there has been some major changes in the AYUSH curriculum. While there are many common elements in the basic courses for MBBS and BAMS/BHMS, the new curriculum for Ayurveda degree includes several modern medicine domains. Udupa explains the difference between the course curricula and says, “The course tenure is similar for all courses that is five and a half years. However, in case of BHMS course, more focus is given on study of philosophy of homoeopathy and material medica. In case of BAMS course, more emphasis is given on principles of Ayurveda and treatment of diseases based on prakriti of patients i.e. vata, pitta or kafa. He furthers avers, “I feel the existing curricula should also emphasise on studying modern system of medicines as this has penetrated to more extent than Ayurveda or homoeopathy system in India. Also they should be taught about pharmacology of allopathic medicines as this would help not only them but also the patients as they would receive medicines prescribed by BAMS or BHMS based on informed decision.”
He continues that the pharmacy profession in India now offers D Pharm degrees that is based on studying clinical aspects of medicines. If pharmacists are asked to work with BHMS and BAMS doctors, this would immensely benefit patients. As pharmacists would be having knowledge of clinical aspects of drugs, they can work in tandem with doctors and provide them with useful information related to medicine.
Udupa is of the opinion that as all the systems of medicines work on different principles, it would be improper to standardise curriculum, however the principles of each system of medicine i.e. allopathic, ayurvedic and homoeopathic should be included and taught for all systems of medicine. On the issue whether AYUSH practitioners should be allowed to practice allopathy or not he says, “The decision to permit BHMS, Diploma in Homoeopathic Medicine and Surgery (DHMS) and other practitioners to prescribe allopathic medicines rests with the government depending on need of society. If in a particular state the number of allopathic practitioners are sufficient per 1,000 population, government may not permit BHMS and BAMS to prescribe allopathic medicines whereas where need exist, it may be permitted. This may not have adverse effect on students opting as this is an issue to be decided based on the requirements.”
“Today no person would be satisfied with only MBBS degree. Doctors are moving towards specialisation and super specialisation. What is needed is systemic efforts of all healthcare professionals with doctors including pharmacists and nurses should be encouraged that would help to strengthen healthcare system. Also the role of physiotherpists, yoga practitioners should be emphasised so as to have a holistic approach towards healthcare profession, “ he adds.
Vaidya states, “Ayurvedic doctors are trying to do their best for their patients. The Central Council of Ayurveda and Siddha’s Past President Late Sri Ram Sarmaji said that vaidyas can use drugs of other system, with adequate background knowledge, in the interest of their patients. It is rational to train all the doctors in the use of essential drugs, emergency medicines and CPR. The defensive stand of some IMA officials, calling vaidyas as quacks etc., and the restrictions on pluralistic drug usage have to be countered by awareness and education. Even MBBS doctors are often innocent of the state-of-the art pharmacology. They learn more from the medical reps. They too need CMES in therapeutics.” He also informs, “Several courses have been started to teach modern pharmacology to vaidyas. I feel this integration will do good to enhance therapy.” However, he feels that a total switch to allopathic practice by vaidyas is to be discouraged.
Government’s initiative
Ghulam Nabi Azad, Union Minister for Health, announced that three more institutes, namely All India Institute of Ayurveda, North Eastern Institute of Ayurveda and Homeopathy and North Eastern Institute of Folk Medicine are expected to be functional in the current year.
With regard to improving the standards of education and regulation of drugs, he said, in the last two years, some unprecedented steps have been taken to enforce the quality education norms and prevent the mushrooming of substandard colleges. For the first time, minimum standard requirements of ayurveda colleges and attached hospitals have been notified and relaxation given in certain eligibility conditions to facilitate objective inspection and reporting of college infrastructure and quality of teaching-training facilities. Azad informed the members that the Department has also been strategic in bringing regulatory and quality control reforms and a proposal for creation of posts has been moved to the Department of Expenditure to set up AYUSH Drug Controller at central level.
Regarding taking the Indian system of medicines to International forums, Azad mentioned that AYUSH Information Cells have already been set up in Malaysia, Trinidad and Tobago and Mexico for awareness building about AYUSH. International cooperation with China, Malaysia, Trinidad and Tobago, and South Africa has been initiated and is also under consideration with Nepal, Sri Lanka, Serbia and Mexico. Recently, the Department has approached WHO headquarters to extend its support and undertake collaborative activities for the development of traditional medicine with focused outcomes.
Future plans for AYUSH
AYUSH has grown significantly over the Five Year Plans, many new initiatives are proposed in the 12th five-year plan to shape the development of AYUSH, including flexi-funding for main streaming of AYUSH activities in the states like collocation of AYUSH facilities in PHCs, CHCs and district hospitals. Global trends indicate that the natural medicine is going to be preferred resort of healthcare for chronic lifestyle and geriatric disorders and Indian systems of medicine can play a significant role in tackling emerging health problems.
