[op-ed snap Capacity building for primary health careop-ed snap

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Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the AYUSH.

Mains level: The newscard discusses the relevance of the AYUSH practitioners in solving issues, related to India’s primary health care system.

Contentious element of the National Medical Commission (NMC) Bill 2017 

1. Section 49, Subsection 4 of the bill
2. It proposes a joint sitting of the Commission, the Central Council of Homoeopathy and the Central Council of Indian Medicine
3. The debates around this issue have been ranging from writing-off the ability of Ayurveda, yoga and naturopathy, Unani, Siddha and homoeopathy (AYUSH) practitioners
4. Currently, AYUSH practitioner can’t cross-practise allopathy due to restrictions

How can AYUSH help?

1. India’s primary health system is struggling with a below-par national physician-patient ratio (0.76 per 1,000 population, amongst the lowest in the world) due to a paucity of MBBS-trained primary-care physicians
2. And the unwillingness of existing MBBS-trained physicians to serve remote/rural populations
3. Therefore, there is an urgent need for a trained cadre to provide accessible primary-care services
4. AYUSH practitioners can help to improve this situation

Issue of AYUSH cross-prescription

1. The issue has been a part of public health and policy discourse for over a decade, with the National Health Policy (NHP) 2017 calling for multi-dimensional mainstreaming of AYUSH physicians
2. There were 7.7 lakh registered AYUSH practitioners in 2016, according to National Health Profile 2017 data
3. Their current academic training also includes a conventional biomedical syllabus covering anatomy, physiology, pathology and biochemistry(important for primary health care system)
4. Efforts to gather evidence on the capacity of licensed and bridge-trained AYUSH physicians to function as primary-care physicians have been under way

The 4th Common Review Mission Report 2010 of the National Health Mission 

1. It reports the utilisation of AYUSH physicians as medical officers in primary health centres (PHCs) in Assam, Chhattisgarh, Maharashtra, Madhya Pradesh and Uttarakhand as a human resource rationalisation strategy
2. In some cases, it was noted that while the supply of AYUSH physicians was high, a lack of appropriate training in allopathic drug dispensation was a deterrent to their utilisation in primary-care settings
   What should be done?
3. The focus should be on deploying a capacity-building strategy using AYUSH physicians upskilled through a bridge-training programme
4. This will help to deliver quality, standardised primary health care to rural populations
5. Example: The Maharashtra government has led the way in implementing bridge training for capacity-building of licensed homoeopathy practitioners to cross-prescribe

Is capacity-building of licensed AYUSH practitioner enough?

1. AYUSH is only one of the multi-pronged efforts required to meet the objective of achieving universal health coverage set out in NHP 2017
2. Current capacity-building efforts also include other non-MBBS personnel such as nurses, auxiliary nurse midwives and rural medical assistants, etc.

Back2basics

AYUSH

1. AYUSH is an acronym that is used to refer to the non-allopathic medical systems in India. It includes the Indian medical system of Ayurveda, Yoga, Unani, Siddha, and also Homeopathy.
2. In the current terminology of the Ministry of Health in India, non-allopathic doctors are now referred to as AYUSH ( meaning “life” in Sanskrit) doctors
3. Department of Indian Systems of Medicine and Homoeopathy (ISM&H) was created in March,1995 and re-named as Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) in November, 2003 with a view to providing focused attention to development of Education & Research in Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy systems
4. Department of AYUSH come under Ministry of Health and Family Welfare
5. This is to imply that the AYUSH systems of medicine and its practices are well accepted by the community, particularly, in rural areas
6. The medicines are easily available and prepared from locally available resources,economical and comparatively safe
7. With this background, it will be more useful for the mainstreaming/integration of AYUSH systems in National Health Care Delivery System under “ National Rural Health Mission (NRHM)”
8. Presently, approx. 23,630 dispensaries are functioning and about 6,91,470 registered practitioners are available under AYUSH in the country.

Objectives of the AYUSH

1. To upgrade the educational standards in the Indian Systems of Medicines and Homoeopathy colleges in the country
2. To strengthen existing research institutions and ensure a time-bound research programme on identified diseases for which these systems have an effective treatment.
3. To draw up schemes for promotion, cultivation and regeneration of medicinal plants used in these systems.
4. To evolve Pharmacopoeial standards for Indian Systems of Medicine and Homoeopathy drugs