thoughts on AYUSH mainstreaming. presented during a WHO consultation.

1. Bringing AYUSH Systems intoPublic Health Mainstream:Vision and a Possible Roadmap Presentation during a WHO initiated Consultation at Raipur organised by Directorate of AYUSH, Chhattisgarh on 07.10.2009 V R Raman, Public Health Resource Network Consultant, ICICI Centre for Child Health and Nutrition For Setting up SHRC Jharkhand

2. Vision Positioning AYUSH systems on the public health mainstream towards Comprehensive Primary Health Care and for achieving Health for All, with: Equitable identity and parity with modern systems Better outreach, access and coverage, Indigenous knowledge streams are seen, studied and examined in scientific terms, according due attention and dignity, Proper political and administrative environment as well as supportive measures Time-bound plans of action

3. Why Mainstreaming Emerged as a need ? Almost all systems under AYUSH got a strong structure, still they are to be mainstreamed and internally strengthened: but why? The growth of modern systems negated the footage and the legacy of existing systems AYUSH systems too, negated the necessary learning from modern medicine- how had it updated itself through self-correction, diagnostics, biochemistry, and many other developments Interesting read: Bandopadhyay, Tarashankar: ArogyaNiketan, a novel

4. Mainstreaming: are the objectives clear? Different perspectives:- Mainstream Health Services lookout: a stop gap arrangement, to provide at least an “underqualified physician”, for the underserved areas GoI: a cafeteria approach to give choices to the clientele Modern Medicine Doctor: a useless initiative for them, as no understanding of these systems AYUSH outlook: sheer showcasing measure People: No idea, as nothing has reached them so far; however, they welcome and need holistic approach, if provided Private (vested) AYUSH establishments: don’t want it, as it may finish off many of their golden egg hen avenues..

5. Mainstreaming: Possible Goals or Positive Meanings Getting proper space within Health Acts, Policies and Programmes Securing well-deserved identity amongst system leaders as well as people Attaining parity in terms of position with other systems Identifying Priority/ effective interventional areas for AYUSH Ensuring scope for advanced learning of these system Initiating advanced research and documentation for standardisation, accreditation and dissemination of knowledge Rebuilding the community trust and inclination Creating comradeship with practitioners of modern system Achieving trust within- amonst different components of AYUSH systems themseleves

6. Mainstreaming: Strategies 2 way convergence with modern systems Departure from traditional teaching-learning processes: Revise AYUSH systems curricula to include modern diagnostic approaches, technologies- also develop language, IT skills in students Introducing AYUSH system briefs in MBBS curricula, from the very beginning- Yoga etc, however with care not to project them as a solution for each and every health problem Introducing concurrent research guided by experts both in modern and AYUSH systems- not the traditional research which gets a full stop at a PhD award or a wage hike or promotion Comparative medicine to be taught and holistic medicine in practice Joint Diagnosis in place of cafeteria approach which takes care of patient’s choices only, not their need (KottakkalAryaVaidyaShala)

7. Strategies Contd.. Clinical / House Surgeon posting: cross-posting from AYUSH to modern and vice-versa Capacity building of AYUSH HRH, to reduce the inferior feeling Equipping AYUSH facilities with advanced communication and computing systems, technologies CME, journals, knowledge repositories Regulatory measures: control of magical remedies a must to regain the trust on AYUSH as a systems of medicine Accreditation of Traditional Healers with documentation and validation of their existing knowledge, identifying gaps and training

8. Strategies Contd.. Uniform classification of diseases in line of ICD, though based on the school of thought represented by each systems Computerised diagnostics (Rog-Nidan) Protocols, like the ones already available for Homoeo Comparative, symptom based treatment protocols, indicating cross-referrals Standardised pharmacopeia reforms: production based on new technologies and combinations are largely controlled by private players and profit interests Coordination to be established with patents and IPR procedures- no idea on how are the things evolving and patented Essential Drug Lists, procurement and storage procedures, Drug formularies, including old as well as new formulations

9. Strategies Contd... Promotion of SwasthaVrutha or similar measures, updated based on changed life-styles and surroundings Defining clear boundaries for Home remedies, traditional care and for systemic care- what to do and what not and when- with suggestions on when to refer for advanced or specialised care

10. Priority Intervention Areas, where acceptance will be immediate and high.. Geriatric Care Life-style diseases control and life style modifications: YOGA etc Mental Health Care Antenatal and Post-natal mother care: GarbhaRaksha Malnutrition Management Anaemia Management Community Eye Care Community Dental Care Community Skin care Control of Non-communicable Diseases: Diabetics, Asthma, Liver disorders, Rheumatic care, etc Supplementary role in TB, Leprosy, HIV management

11. Mainstreaming: Pre-conditions Priority to be accorded- beyond current prominence Not lucrative, but sufficient resources to be allocated Equity/parity issues Orientation and fellow-travelling of modern systems in mainstreaming efforts Survival of the sickest too, within AYUSH systems, kept in focus... Not just AYURVEDA and YOGA

12. Mainstreaming: Conclusions The Roads are ahead.... Thanks