Health Sector Reforms that the Modi Government can Initiate – Shri Darshan Shankar

Health Sector Reforms that the Modi Government can Initiate

Limitations of Indian Public Health System

Darshan Shankar, Vice- Chancellor

Darshan Shankar
Vice- Chancellor

The Indian public healthcare system has 3 tiers. The 3 tiers operate through a large number of Government i.e tax payer financed, primary secondary and tertiary healthcare institutions and a larger number of private (for profit) institutions and a much smaller number of private (not for profit) organizations. At the base of the pyramid of the health system, are the primary healthcare institutions in the form of dispensaries and small sized general hospitals. A substantial number of them are in the government-sector but they have a larger presence in the private sector. Higher up the pyramid are the secondary institutions (like district hospitals and private hospitals) and at the top are the tertiary services provided by few well equipped medical college hospitals and mostly by corporate, super specialty establishments.

Experts have identified a host of operational issues and gaps that plague the public health system. These relate to inadequate infrastructure, financing, human resources, drugs, HR policies, health information system, insurance and governance. It is therefore in need of radical reform. However since the government is the manager of the public health system, while the gaps do get addressed from time to time, reform happens in the typical piece-meal fashion, that characterizes government interventions.

The officially declared goal of the public healthcare system is free and universal primary healthcare. However even after 66 years around 70% of the population do not receive satisfactory or free healthcare and they are therefore forced to seek help from private providers and thus pay out of their own pocket.

Public health experts in recent times have observed that safe drinking water, sanitation, nutrition life style and the environment are key determinants of health and that the health system must address these needs. In practice however, the health system does not have any influence, mechanism or programs, to address these key determinants of health.

Skewed funding and poor integration denies the public of advantage of synergy arising out of the richness of India’s Medical Heritage.

The ‘content’ of India’s post-independence health system is mono-cultural. It is almost wholly based on western bio-medicine. In fact 97% of the national health budget, since 1947 has been allocated to Allopathy. Post-independence, the idea of integrating and mainstreaming 7 other legally sanctioned health systems with Allopathy has been mentioned in the introductory paragraphs, of all national 5 year plan and policy documents. In practice the 8 systems of healthcare viz., Allopathy, Ayurveda, Siddha, Swa-rigpa, Unani, Yoga, Naturopathy and Homeopathy function in silos. The 7 AYUSH systems receive only 3 % of the national health budget and the departments of AYUSH across all Indian States operate with this meager funding. The AYUSH department despite their limited funding, operate a parallel national health service, unconnected to the mainstream 3 tier health system, with around 25,000 dispensaries and 3000 small general hospitals, across 30 States. This service is uninformed by national health priorities and is mostly at the level of primary care.

The official AYUSH budget has sub-critical allocation for extramural research, education and for regulation of safety and quality. This is the reason why the AYUSH systems during the last 60 years have hardly generated any evidence based clinical, pharmacological or pharmaceutical outputs and also the reason why the regulatory system is ineffective.

The not for profit private sector in AYUSH, is the public face of AYUSH. Despite its limited coverage, it is the most effective provider of AYUSH health services to the community. The Indian public availing AYUSH depends on this sector for quality health services. The limited evidence based AYUSH research available in public domain, is generated by this sector through small, non-government funding.

An overview of the Indian public healthcare system thus clearly suggests that despite the fact that 8 legally sanctioned health sciences operate within the health system, due to their skewed funding and poor integration, the public does not receive the advantage of synergy arising out of the richness of India’s Medical Heritage.

The writing on the wall: Integrative healthcare appears to be the future framework for healthcare in the 21st century.

All over the world there is evidence of growing public demand for making available healthcare choices, based upon best knowledge and practices, drawn from different healthcare systems . In India also we see this trend reflected in the actual health seeking behavior of communities wherein people seek to combine or choose for different health conditions Allopathy or Ayurveda, Siddha, Swa-rigpa, Unani, Homeopathy or Yoga or a combination. For emergencies and surgery Allopathy is the first choice, for common ailments it is Ayurveda, Sidha, Yoga, Unani, Swa-rigpa or homeopathy, for chronic conditions it may initially be Allopathy and then a rebound to some other system, when there is insufficient relief. The public demand for pluralism in healthcare is based on a realistic assessment by ‘laypersons’ of the inadequacy of any single system of healthcare to solve all their contemporary health needs. Governments and regulatory bodies also appear to have accepted the imperative for pluralistic approaches in healthcare with the caveat that all new, potentially useful healthcare interventions, must establish their safety, quality and efficacy. An objective manifestation of the global acceptance of medical pluralism is reflected in the creation of government sponsored national research institutes for CAM in the United States and in Europe (Norway, Sweden) and in the introduction of introductory modules on Integrative Medicine (IM) in medical schools in many countries, spanning regions of the world. It is probably this public assessment that is responsible for the dramatic growth of the Complementary and Alternative Medicine (CAM) movement and the nascent evolution of different models of Integrative Medicine (IM) in both the public and private sector.

From the globally observed health seeking behavior trends, it is apparent that the era of monoculture in healthcare is coming to an end. Integrative healthcare appears to be the future framework for healthcare in the 21st century.

Declining Medicinal Plant Resources – A Concern — D K Ved

Declining Medicinal Plant Resources – A Concern

DK Ved, Emeritus Professor

D K Ved
Emeritus Professor & School Advisor

Various recent studies relating to the biological diversity have clearly established that the rate of species loss is greater now than at any time in human history, with extinctions occurring at rates hundreds of times higher than the normal extinction rates. This has serious implications for India’s traditional systems of medicine which largely rely on plant resources for preparation of a large variety of herbal formulation. In India more than 80% of the plant species currently in commercial trade, for preparation of herbal formulations, are obtained from the wild and many of these wild Indian medicinal plants are threatened with extinction, quite like the much discussed wild animals. However, quite unlike such prominent wild animals known to be under extinction threat like the tiger, the lion, the elephant and others, which have drawn much attention of the policy members and managers, these plant species threatened with extinction, do not draw enough attention. In-fact we do not know really know about how many, and which ones of these species, are under such threat and where these need to be conserved in the wild. Going by the global estimates of plant species under threat, around one thousand wild Indian medicinal plant species are likely to be under threat of extinction and perhaps around 300 out of these could be endemic to Indian region i.e. not found elsewhere. Extinction of such endemic species will wipe out the unique genetic resource which has evolved over several millennia.

Only a very small number of such wild Indian medicinal plant species of conservation concern have been assessed so far. This gap in our knowledge has to be addressed through a combination of comprehensive database building as well as extensive field studies involving competent plant taxonomists. The efforts in this direction have been totally subcritical and in spite of several seminars and discussions on these issues the pace of action on the ground is highly inadequate with very little to show.

The fact that quite a few very well-known wild trees of India, which are also acknowledged for their medicinal applications, are now facing threat of extinction is not well known. Some examples of such species are Saraca asoca, Pterocarpus santalinus and Taxus wallichiana.

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Food is Medicine — Dr. Mahadevan Seetharaman

Food is Medicine
Dr. Mahadevan Seetharaman, Professor & School Advisor

Dr. Mahadevan Seetharaman,
Professor

Growing up, there was a lot of emphasis in my family regarding the food we ate. I used to eat at certain fixed times, hardly ate any old food or for that matter we used to eat out at restaurants may be once a year. I never realized or appreciated the fact that my parents were doing what is right for me and their choices put me at an advantage for the rest of my life in-terms of my health.

Although many communities do not even know the term Ayurveda, the fact is, that all Indian eating habits and ethnic recipes are designed knowingly or unknowingly, based upon Ayurvedic principles. According to Ayurveda theory, all foods are classified as those increasing or decreasing kapha, vata and pitta. Similarly all foods are known to be either hot (ushna) or Sheeta (cold). These concepts have been internalized into the design of ethnic food in the north, south, east and west of India across all castes, ethnicities and classes of Indian communities. The concept of hot and cold is about the metabolic activity of food. Thus it can be observed that no Indian ethnic recipe has food dishes which are all ushna or all sheeta, nor are there recipes that are entirely kapha or vata or pitta causing. They are always balanced with ingredients that have a healthy proportion of kapha, vata and pitta foods including a balance of ushna and sheeta foods. Ayurveda thus influences every Indian kitchen in an informal way.
Let me illustrate this with some examples.

Look at the design of idli, a popular South Indian breakfast food. The two principal ingredients of idli are urad dal and rice. Urad according to both Ayurveda and western nutrition is the most protein rich (mams-vardak) pulse. However Ayurveda recognizes that it is difficult to digest, it causes acidity and it is Ushna (exothermic) during metabolism. Therefore nowhere in the country do traditional Indian communities eat this pulse on a daily basis despite its high protein content. South India Ayurvedists in the past did a brilliant piece of food processing technology related to urad. They conceived of a nutritious dish called idli. The method of preparing idli, changes the properties of urad so that it becomes easily digestible even for a child and its other side effects are reduced. Thus it can be eaten every day. This preparation known to millions of households is actually based on Ayurvedic principles of nutrition.

Another example is the way we consume potato, an exotic tuber food, which only came into India in the 17th century from Central America. Due to Ayurvedic understanding, it was observed that potato eaten on its own causes flatulence (vata). Thus all over India the recipes for potato include ingredients that reduce vata like hing, jeera, mustard, garlic, ginger, methi and so on.

Hundreds of other examples of ethnic foods can be given to show their underlying Ayurvedic design. Ayurvedically designed foods are essential for balanced nutrition. A fine tuning can happen to your own diet if you know your own unique constitution.

If food is responsible for the development of a healthy individual, it should also play a significant part in the manifestation of disease. Food is also a natural healer. It is associated with the way your mind and body feels. Food keeps your body fit, maintains your health, provides stamina and calms the mind.

From an Ayurvedic perspective, the key to health of an individual man or woman is knowledge about his or her unique constitution. All bodies are born with a particular naturally given proportion of kapha, vata and pitta. What are these three entities? They are three key physiological processes also referred to as doshas that regulate biological changes in a human body. Equilibrium in these processes spells health and conversely disequilibrium results in disease.

Foods like raw vegetables, irregular eating habits, excessive physical exercise, and emotional stress increase vata. Foods that are too much spicy, sour or salty, skipping meals, or exposure to the sun aggravates pitta. Heavy, oily foods, too much sweet, sour or salty food, excessive rest and oversleeping, aggravates kapha.

By now, you should have a fair idea of why food is considered as medicine in Ayurveda. Most diseases can be due to inadequate food or not having food in a proper manner or not eating the right kind of food. I generally don’t agree with the notion of eating food that is not tasty but supposed to be healthy for you. I believe that food that is not tasty might not be as good for you as food that is tasty. It is important to eat food that also appeals to all your senses and it has a positive impact on your well-being. Ayurveda helps identify your body type, teaches appropriate cooking methods, gives recipes for different body constitutions and conditions and body types and teaches appropriate cooking methods. Do look out for some excellent recipes based on the principles of Ayurvedic nutrition.