Authors: Dr. Sarin N S
It has been estimated that over 80% of the world’s population depends on traditional healing systems as their primary source of care . Traditional Medicine (TM) has been defined as “the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness” . TM consists of codified and non-codified streams of knowledge. In India, the codified stream comprises of the official AYUSH (Ayurveda, Yoga, Unani, Siddha, Swa-Rigpa and Homeopathy) systems while the non-codified stream comprises of the collective knowledge, practices and beliefs of communities in relation to health that are culture and region specific and has been sustained through oral transmission across generations. This is referred to as Local Health Traditions (LHT). This knowledge base is also synonymously referred to as ‘folk knowledge’, ‘indigenous knowledge’, ‘people’s knowledge’ and ‘traditional wisdom’ .
Do LHTs find a space in the health policy framework of our nation?
There is hardly any data available, even a substantial acknowledgement. As a token gesture, ‘revitalization of LHTs and mainstreaming of AYUSH’ has been outlined as one of the goals of the National Rural Health Mission (NRHM) without any corollary significant policy action towards actual translation on the ground . It is quite concerning that the State does not consider this as a sector worthy of consideration for tapping into. LHT’s continue to find their expression in our communities in the form of home based remedies and ethnic dietary practices in millions of households and through informal healthcare providers of the system – the Traditional Community Health Practitioners (TCHPs) also commonly known as ‘folk healers’. They act as rural informal primary health care providers, often being the first link for the community in rural India.
How do we harness the potential of this health human resource?
The World Health Assembly had called upon its member states to embrace traditional indigenous health systems by including indigenous peoples at all stages of health care development and implementation, seeking a broader, more inclusive approach to health care .
The WHO Traditional Medicine Strategy (2014-2023) document also exhorts member states to establish provisions for the education, qualification, and accreditation or licensing of Traditional and Complementary Medicine practices and practitioners based on needs and risk assessment .
Internationally, such efforts have been attempted by governments with success. Nations like China, South and North Korea and Vietnam have achieved complete integration of traditional medicine (including non-codified practitioners) into their healthcare systems.
Thailand has integrated healers into their community health network by developing legal and other standards for the certification of their status. There are over 47,000 Traditional Healers in Thailand who have been provided license for practice .
The services of traditional birth attendants and traditional healers were employed in Africa for improving primary health care and in the management of the HIV/AIDS epidemic. The total number of TCHPs in India is estimated to be above one million. This exceeds the number of officially registered AYUSH practitioners in the nation . Are we adopting an official policy here that they hold no utility in our healthcare delivery framework when other nations have demonstrated that there are means to mainstream them?
What is the role envisaged for TCHPs in India?
India has been consistently spending less than 2% of its GDP on health, since independence. The push for Universal Health Coverage (UHC) by the government continues progressively. It is evident from the experience of over 70 years of independence that the current three-tier stream of institutional healthcare delivery alone cannot achieve this target in a nation where less than 30% of the populace has access to Public healthcare services. Primary healthcare remains at the heart of the concept of UHC. Primary health care cannot be achieved only through an institution-driven delivery model. Strengthening of community-based health networks is essential to empower people with health in their own hands. TCHPs as health human resources provide their services entirely based on community support and social legitimacy.However, it is a matter of grave concern that a majority of these TCHP’s are ageing and there is a rapid erosion of their knowledge base and legacy on account of lack of policy support from the State. If we do not support and preserve this invaluable cultural resource of our nation it would perish perennially into memory on account of a myopic vision of what is officially construed and understood as ‘healthcare provision’. The role of TCHPs will always remain in relation to primary healthcare services delivery. Their legal standing in the health policy framework would be needed to be defined by the State vis-a-vis the training and orientation offered to them.
Can our policy makers wake up to the potential of Local Health Traditions for enhancing universal health coverage?
The Foundation for Revitalization of Local Health Traditions (FRLHT), Bengaluru is currently operating a National Scheme along with the Quality Council of India (QCI) for the Assessment, Training and Certification of TCHPs based on a standards competency model aligned with ISO 29990 which looks at applying stringent rigors for the process of training TCHPs being offered by the proposed training body – The Trans Disciplinary University (TDU). The government could support this as a credible model for assessment and capacity building. Such certified TCHPs should be assigned specific roles in relation to primary healthcare delivery within the health systems framework of our nation. This would be the most proximal and earliest opportunity for intervention. As the formal disciplines of Ayurveda and Siddha are codified forms of LHT knowledge streams, mainstreaming of TCHPs and LHTs can only fortify the applicability and practice of these disciplines.
© 2018 TDU, Bengaluru.