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Behind the snazzy marketing, there is little clarity on what AYUSH should be doing

The International Yoga Day celebrations in June were a high-profile affair, but the Modi government appears to have given little thought to how to integrate AYUSH into the healthcare system. arvind yadav / hindustan times / getty images

On 27 September 2014, when Prime Minister Narendra Modi addressed the United Nations General Assembly, he launched into an unexpected digression about yoga. Yoga, he said, “is not about exercise but to discover the sense of oneness with yourself, the world and the nature.” He went on: “By changing our lifestyle and creating consciousness, it can help us deal with climate change.”

The statement made its way to the front pages of most national dailies, with some commentators mocking Modi’s attempt to link yoga and climate change. Nevertheless, in December last year, the UN General Assembly accepted Modi’s call for the adoption of 21 June as International Yoga Day. The event in Delhi to celebrate the occasion, which Modi himself led, set a Guinness World Record for the yoga class with the largest number of participants (35,985) and greatest number of nationalities (84).

It was a moment in the spotlight for the Ministry of Ayurveda, Yoga, Unani, Siddha and Homeopathy, or AYUSH, upgraded from department status in November 2014, and the focus of many of the new government’s publicity efforts. Founded in 1995 under the Narasimha Rao government, the Department of Indian Medicine and Homeopathy had its name changed to AYUSH in 2003, but nothing in its history before or since was as high-profile as International Yoga Day. The event’s scale was in keeping with the increase in funds to AYUSH: the money earmarked for these systems in the two budgets of the present government has increased by about 30 percent from the previous United Progressive Alliance government’s allocation.

This has been accompanied by several bold claims. Last month, for example, the Economic Times journalist Vasudha Venugopal reported on Twitter that the minister in charge, Sripad Yesso Naik, had claimed that there were no diseases that yoga and naturopathy could not cure. Policy decisions based on such assumptions could impact the lives of millions of people, making it imperative to examine the place of AYUSH within the wider healthcare system.

Unfortunately, there are signs that the government overestimates the ability of AYUSH systems to perform the functions of conventional healthcare. Among its most worrisome moves has been the attempt last year to introduce the Medical Termination of Pregnancy Amendment Bill, to train and allow AYUSH practitioners to conduct abortions—a potentially disastrous move, not least because abortion procedures sometimes require surgical intervention.

The proposal was dropped after it was widely criticised. But harebrained measures such as these suggest that, for all its high-volume campaigns, the government has given insufficient thought to what AYUSH should really do. It has made particularly scant progress towards achieving one of the stated aims of the ministry, to “integrate their services, at the appropriate levels, within specified areas of responsibility and functioning in the overall healthcare delivery systems, especially in regard to the preventive, promotive and public health objectives.” Rather than rushing to train AYUSH practitioners in mainstream treatments, the government could gain insights by looking at how the complex question of integrating different systems has been dealt with by other countries.

Though the history is complex, and contested, China’s experience in the mid-twentieth century is particularly instructive. Faced with the problem of providing healthcare to millions of the rural poor who had no easy access to modern medicine, the Chinese government under Mao Zedong instituted a system of training hundreds of thousands of people in the villages in basic healthcare. This training covered traditional as well as allopathic practices. In many cases where conventional drugs were unaffordable and hard to find, traditional prescriptions, such as herbal extracts, offered a solution. The programme evolved to allow primary healthcare workers, known as “barefoot doctors,” to undergo further training and examination, and be appointed “village doctors.” An emphasis on basic preventive care allowed the spread of some diseases, such as schistosomiasis, to be brought under control.

At a central level, the Chinese Ministry of Public Health, founded in 1954, enabled doctors trained in Western medicine to study traditional medicine, and encouraged research into integration methods. Colleges of traditional medicine were set up across the country to develop and propagate these systems.

One direct outcome of these measures was the development of artemisinin which even today forms a key component of malaria treatment. The treatment was developed by Tu Youyou, a Chinese doctor trained in Western medicine, who researched traditional medicine in the 1950s and 1960s and, in her own words, worked on “the extraction and isolation of constituents with possible antimalarial activities from Chinese herbal materials.” Artemisinin, part of a Chinese therapy involving the sweet wormwood plant, is a prominent example of a traditional therapy crossing over to modern medicine.

China’s success with this form of integrated medical practice even influenced the World Health Organisation, which adopted “health for all by 2000” as a goal at its 1978 conference in Alma Ata, Kazakhstan. In 2008, the organisation went further, at a conference in Beijing that focused specifically on traditional medicines. There, it issued a statement that “The knowledge of traditional medicine, treatments and practices should be respected, preserved, promoted and communicated widely and appropriately based on the circumstances in each country.” This message was a signal to the international community—and particularly to countries with ancient medical systems, such as India, Egypt and Greece—to adopt more lucid policies for integration towards achieving universal health coverage.

Thailand, too, has conducted noteworthy efforts in this regard. Since the 1970s, the country has included Thai traditional medicine in its national health plans, particularly in primary healthcare. The push for traditional medicines has included a programme of clinical trials, overseen by the Thai Food and Drug Administration, which incorporates Thai as well as WHO guidelines. As one consequence of these efforts, 19 herbal medicinal products are currently on the country’s national list of essential drugs, having passed considerable scrutiny. India, which has a far less systematic approach to clinical trials for traditional medicines, lists none of them on its own national list of essential medicines.

There have been some disagreements over the Chinese and Thai approaches, but they do represent substantial efforts at integrating different streams of medicine. Today, in India, the tenor of the government’s declarations suggest it is more interested in proclaiming the superiority of Indian systems than in having any meaningful conversation about integration.

AYUSH’s precursor, the Department of Indian Medicine and Homeopathy, initially focused on research and education. The first National Democratic Alliance government changed its name to AYUSH—a choice that foreshadowed the current prime minister’s penchant for acronyms. When the UPA government launched the National Rural Health Mission in 2005, integrating healthcare methods became significant to its efforts. At present, the ministry’s mission includes the promotion and “co-location of AYUSH facilities" at healthcare centres across the country.

This work began some time before Modi was voted into power. A 2011 report by the Planning Commission noted that AYUSH services had been “co-located” in 18,222 healthcare facilities, including primary healthcare centres, community health centres and district hospitals. But the report also noted several problems with implementation. For example, states often restricted the flow of funds to AYUSH programmes. It also found that the collection of information about these services was inadequate, and identified a need for “better knowledge management” and “better research questions” to strengthen the programme.

Though the government launched the National AYUSH Mission in September 2014, it has not, so far, made clear what its specific plans are for deploying resources, and for integration. Instead, its approach has been characterised by grand theatrics such as Yoga Day, and unscientific statements such as that from Naik, and from others who work closely with the government, such as the spiritual leader Ramdev, who once publicly declared that yoga can “cure” homosexuality.

Most worryingly, this emphasis on AYUSH has been accompanied by cuts to other major health programmes, including those for HIV/AIDS and tuberculosis intervention, and the National Health Mission. The National AIDS Control Organisation, or NACO, the nodal body for tackling AIDS in India, was allocated R1,785 crore in the 2014 budget, but went on to receive only R1,300 crore, resulting in a rollback in prevention activities. The programme needs to be expanded, but the funding it receives is shrinking. Its budget for fiscal year 2015 is R1,397 crores, an increase so marginal that NACO can barely keep its existing programmes running. For the same period, the Department of Health Research, which supports the government in key health initiatives, including epidemic prevention and tackling new diseases, received a budget allocation of R1,018 crore, just one crore more than the previous year’s allocation. A senior health economist told me last month that an emphasis on traditional medicine wasn’t itself a problem, but “it seems like this thrust is coming at the cost of investment in modern medicine. This is the most worrying aspect of the current government’s policy.”

AYUSH’s marketing blitzes will only shift focus from incremental, scientific processes to chest-thumping and boastful claims meant to boost “national pride.” Although the U in AYUSH stands for Unani, a medical tradition largely associated with Muslim practitioners, the BJP government’s enthusiastic promotions so far seem comfortably Hindu in their inclinations. With self-proclaimed spiritual figures such as Ramdev and Ravi Shankar dominating the discourse on AYUSH, and on yoga in particular, the popular conversation has become politically charged, to the detriment of scientific nuance.

If the government is sincere about integrating AYUSH into the mainstream medical system, it must turn the conversation away from national pride and religious jingoism. Among the reasons for the successes of the Chinese and Thai approaches is that they focused on the nitty-gritties of delivering healthcare to the population, rather than on publicity. Without rational and scientific efforts at integration, the government’s endeavour to promote AYUSH will prove to be a disservice to those who rely in any way on traditional healthcare in India