Ayurveda, Yoga and Naturopathy, Unani, iddha, and Homepathy (AYUSH)

There is a resurgence of interest in holistic systems of health care, especially, in the prevention and management of chronic lifestyle related non-communicable diseases and systemic diseases. To mainstream AYUSH by designing strategic interventions for wider utilization of AYUSH both domestically and globally, the thrust areas in the Eleventh Five Year Plan were: strengthening professional education, strategic research programmes, promotion of best clinical practices, technology upgradation in industry, setting internationally acceptable pharma-copeial standards, conserving medicinal, fauna, metals, and minerals, utilizing human resources of AYUSH in the national health programmes, with the ultimate aim of enhancing the outreach of AYUSH health care in an accessible, acceptable, affordable, and qualitative manner. Step s were taken in 2006’07 for mainstreaming AYUSH under NRHM with the objective of optimum utilization of AYUSH for meeting the unmet needs of the population.

The AYUSH sector across the country supported a network of 3203 hospitals and 21351 dispensaries. e health services provided by this network largely focused on primary health care. The sector has a marginal presence in secondary and tertiary health care. In the private and not-for-profit sector, there are several thousand AYUSH clinics and around 250 hospitals and nursing homes for in patient care and specialized therapies like Panchkarma.

Despite having a different scheme of diagnosis, drug requirements, and treatments as compared to the mainstream health care system, preliminary efforts to integrate AYUSH in NRHM were initiated during the Tenth Plan. NRHM has mainstreamed AYUSH into the rural health services by co-locating AYUSH personnel in primary health care facilities resulting in increase in utilisation of AYUSH treatment. AYUSH practitioners are also used to ll in the position of Allopaths in Primary Health Centres particularly in States that have a substantial shortage of MBBS doctors.

Sources of Financing Healthcare

By source Central Government accounted for Rs. 90,667 million (6.78%) while State Governments contributed Rs. 160,171 million (12%). Under private expenditure, households contribute a significant portion at 71.13% of total health expenditure with social insurance funds at 1.13% and firms at 5.73%. The total external w during 2004’05 has been Rs. 30,495 million with a major portion having been routed through the Central Government.

Weaknesses of Healthcare System in India

Expensive treatment cost

Affordability of health care is a serious problem for the vast majority of the population, especially in tertiary care. The lack of extensive and adequately funded public health services pushes large numbers of people to incur heavy out of pocket expenditures on services purchased from the private sector. Out of pocket expenditures arise even in public sector hospitals, since lack of medicines means that patients have to buy them. s results in a very high financial burden on families in case of severe illness. A large fraction of the out of pocket expenditure arises from outpatient care and purchase of medicines, which are mostly not covered even by the existing insurance schemes. In any case, the percentage of population covered by health insurance is small.

Worsening future

The problems outlined above are likely to worsen in future. Health care costs are expected to rise because, with rising life expectancy, a larger proportion of our population will become vulnerable to chronic Non Communicable Diseases (NCDs), which typically require expensive treatment. The public awareness of treatment possibilities is also increasing and which, in turn, increases the demand for medical care. In the years ahead, India will have to cope with health problems reecting the dual burden of d isease, that is, dealing with the rising cost of managing NCDs and injuries while still battling communicable diseases that still remain a major public health challenge, both in terms of mortality and disability.

Inadequate availability of health care

Availability of health care services from the public and private sectors taken together is quantitatively inadequate. This is starkly evident from the data on doctors or nurses per lakh of the population. At the start of the Eleventh Plan, the number of doctors per lakh of population was only 45, whereas, the desirable number is 85 per lakh population. Similarly, the number of Nurses and Auxiliary Nurse and Midwives (ANMs) available was only 75 per lakh population whereas the desirable number is 225.

Low public expenditure on health

The total expenditure on health care in India, taking both public, private and household out-of-pocket (OOP) expenditure was about 4.1 per cent of GDP in 2008’09 (National Health Accounts [NHA] 2009), which is broadly comparable to other developing countries, at similar levels of per capita income. However, the public expenditure on health was only about 27 per cent of the total in 2008’09 (NHA, 2009), which is very low by any standard. Public expenditure on Core Health (both plan and non-plan and taking the Centre and States together) was about 0.93 per cent of GDP in 2007’08. It has increased to about 1.04 per cent during 2011’12. It needs to increase much more over the next decade.

Varying quality of health care services

Quality of healthcare services varies considerably in both the public and private sector. Many practitioners in the private sector are actually not qualified doc tors. Regulatory standards for public and private hospitals are not adequately deed and, in any case, are ineffectively enforced.