Ayush-man bhavah: Need to tap the changing consumer preferences in favour of traditional remedies – The Financial Express

By Shobha Ahuja

There has been a renewed interest in public and policy circles to reposition the traditional system of medicine, or Ayush (Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homoeopathy), as a provider of lifestyle and wellness solutions to the people. In fact, Ayush is sought to be promoted as a niche and contemporary product, to cater to healthcare needs of the consumer in the domestic and global markets. Accordingly, it has been identified as one of the 12 champion services sectors that the government wants to promote. Given the situation, the question is: Has Ayush received adequate government support to hasten its transition to the centre stage of healthcare activity?

Let us begin with funding support. Preliminary observations indicate that the allocations made by the government have, by and large, been unequal to the resurgence of policy interest in traditional medicine.
To begin with, there was a stupendous rise of 74% in public expenditure on Ayush in 2015-16, a year after the formation of the separate Ministry of Ayush. This came after a secular fall in public expenditure on Ayush between 2010-11 and 2014-15. But the rise has not been sustained. The subsequent year (2016-17) witnessed a comparatively modest escalation of around 16% in public spending and a moderately higher 23% in 2017-18.

Further, a perusal of data from 2010-11 onwards up to 2016-17 at current prices shows that the revised estimates for Ayush have been lower than the budget estimates, while actual spending has been even lower. What is happening is that, in the next year, the budget estimates are once again enhanced only for the actual spending to be pushed downwards in the final estimates. No doubt, from 2015-16 onwards, the gap between the budget estimates and the actual expenditure narrowed and the actual expenditure exceeded the budget outlay in 2017-18, the first time since 2010.

However, this trend was sharply reversed in 2018-19, with the growth in the actual expenditure over the previous year being the lowest in the decade (see graphics).

Even at the states’ level, while the approval of the National Ayush Mission (NAM) in 2015-16 led to the initial rise of funding to the state governments during the year, this trend has not been sustained; in subsequent years, the fund flow to the states has slowed. Besides, most state governments have a poor record when it comes to utilisation of the available central funds for promoting Ayush.

In fact, many states seem to falter when it comes to utilisation of funds for strengthening the traditional system of medicine. A Lok Sabha question reported that states have utilised just around 37% of the central funds allocated to them under the NAM between 2015-16 and 2017-18. During this period, the central government has allocated funds amounting to Rs 1,237 crore to the states, of which only Rs 465 crore have been utilised.

The impact becomes visible by way of inadequacy of supportive infrastructure and poor services in hospitals and dispensaries. There are problems related to bed capacity, personnel, emergency services, essential diagnostic equipment, ambulances and medical record, etc, across states. This is corroborated by a CAG report, which alludes to about 60% shortfall in essential medicines in Delhi during 2012-17 in Ayurvedic and Unani dispensaries.

Second, we turn to the quality of healthcare and standardisation amongst healthcare providers. The numbers indicate that of the around 4,000 Ayush hospitals in the country, only 87 meet the standards of the National Accreditation Board for Hospitals and Healthcare Providers (NABH). This is just 2% of the total. Four states, namely Kerala, Karnataka, Gujarat and Maharashtra, account for around 70% of the accreditations, with Kerala alone accounting for 30%. It needs to be understood that without emphasis on standardisation and world-class quality, Ayush would fail to garner the trust of the patients, both domestic and foreign.

Third, there are issues related to quality and safety of the Ayush product. This happens because there exist ambiguities on whether the product should be classified under the food category or treated as an Ayurveda medicine? This leads to confusion on whether the Food Safety and Standards Authority of India (FSSAI) or the Ministry of Ayush norms should be considered as the sole authority for granting approvals for quality and safety? The government is working on exploring the possibility of treating Ayurveda Aahar as a separate category in the food supplements regulatory framework. These standards could either be part of food supplements and nutraceutical regulations, or there could be a separate set of regulations for Ayurveda Aahar.

The fourth issue relates to paucity of medicinal plants and herbs that go into the making of Ayush medicines. According to the Ministry of Ayush, 93% of wild medicinal plants used for making Ayurvedic medicines in the country are endangered. About 50 medicinal plants in the state of Uttarakhand alone fall into the category of endangered species, as notified by the state.

The other issues pertain to inadequacy of human resources and skills, lack of comprehensive data about the size of the market, ambiguities in product classification, lack of product traceability, inadequate R&D, and variations in regulatory policies at the state level.

Hence, there is a need to tap the changing consumer preferences in favour of traditional remedies, by enhancing public investment in alternative medicine, not only by the Centre but also by the states. The engagement of the private sector is also important. Besides, attention should be paid to augment product and service quality, improve documentation, invest in research and innovation, encourage use of technology, build a conducive regulatory environment, incentivise start-ups, and plug the skills gaps in the sector.

The option of integrating Ayush with modern medicine should be explored further as these are being used concurrently by the people. This has been attempted in Tamil Nadu and a few others states, which have integrated Ayush with Allopathy in government hospitals.

Such measures would help Ayush gain credibility and emerge as a fulcrum of healthcare activity at a time when health-conscious citizens are turning to holistic healing.