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Date posted: March 2, 2012
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The Twelfth Five Year Plan process is yet another opportunity to review the health system  our country, but more importantly, to redeem our commitments to health and to lives lived with dignity. The Report seeks to lay out some of these commitments and also present a  systemic plan for their fulfillment.

Our foremost commitment is towards evolving Universal Access to Essential Health Care  and medicines, so that the disparities in access to health care, particularly those faced by the  disadvantaged   and   underserved   segments   of   the   population,   would   hopefully   be  corrected.

The Report is organized into Chapters, which outline the key elements of an efficient health  system. It   also   recommends   some   strategic   changes   to   the   existing   health   programmes   and schemes, such that they work in conjunction with each other and collectively contribute to building a comprehensive health system. Thus it shifts the focus to a ‘systemic’ approach to  Health,   while   also   emphasizing   the   importance   of   the   individual   disease   control  programmes. Secondly, it suggests certain changes in the way we look at ‘public health’  and, its subsequent monitoring through public health systems reforms. A dedicated Public  Health Cadre is proposed as the bedrock of the system.

The   Twelfth   Five   Year   Plan   adopts   a   broad   approach   to   health,   including   as   ‘key  determinants of health’, a range of resources like food supply chains and nutrition, drinking  water and sanitation. Indeed, it takes the view that health would entail a ‘continuum of care’  across sectors. Accordingly, the health policy might encourage a multi-sectoral approach to health, which in terms of policy would translate into a ‘stewardship’ role for the Health  Ministry over other sectors, in matters that have a direct bearing on health.   This report proposes a road map, which is intended to guide the health sector in this regard.

In terms of the limitations of the Report, the needs of the health sector in the context of  India’s diversity are so complex that it is rather impossible to engage with all its dimensions. Thus, certain overarching principles have been prioritized for the purposes of this Report.

Additionally,   corresponding   key   deliverables   have   also   been   identified,   as   means   of  evaluating the fulfillment of our commitments to health. In effect, the attempt is for the new  Plan to be oriented both towards a ‘process-based’, and also an ‘outcome-based’, health  system that performs in a cost-effective and efficient manner.

An efficient assessment of system performances requires built-in measurable indicators. To make information relating to such indicators easily available, the Plan would also prioritize  the strengthening of the Health Information System.

In summary, the Twelfth Plan takes a systemic approach to health sector reforms. It seeks  to provide a safe and healthy environment to communities, delivering universal access to basic health services, and to medicines, and  regularly evaluating the health system. Also,  by using techniques of communication, behaviour change and participatory governance to make communities generally more ‘health conscious’, which would, in turn, reduce health risks.   The   broader   understanding  of   ‘health’  would   include   and   seek   to   correct  determinants   such   as   inadequate   nutrition   and   unsafe   drinking   water. The  last   two  proposals   underline   the   Plan’s   commitment   to   preventive   and   promotive   health   care. Finally,   though   a   new   range   of   innovations   and   practices   for   the   health   sector   are  recommended, which have huge financial implications, it has been the effort of the Steering  Committee to focus on efficient utilization of available resources.

Chapter-10: AYUSH – Integration in Research, Teaching and  Health Care
10.1 AYUSH sector in the country has 7.87 lakh registered practitioners, 3277 hospitals  with a bed strength of 62,649xlvi . There are 24,289 dispensaries, 489 recognized Graduate and Post Graduate colleges and 8,644 drug-manufacturing units. Achievement of national  health goals requires an integrated delivery of health services utilizing the mutual strengths of bio-medical and Indian Systems of Medicine.

10.2 The National Health Policy of 2002 noted that: “Under the overarching umbrella of the national health frame work, the alternative systems  of  Medicine   –   Ayurveda,   Unani,   Siddha   and  Homoeopathy   –   have   a   substantial   role.  Because of inherent advantages, such as diversity, modest cost, low level of technological  input   and   the   growing   popularity   of   natural   plant-based   products,   these   systems   are attractive, particularly in the under-served, remote and tribal areas.”

10.3 Similarly, the National Policy on Indian Systems of Medicine & Homoeopathy, 2002  declares as its basic objective, inter alia, the “integration of ISM&H in healthcare delivery  system and National Programmes and ensure optimal use of the vast infrastructure of  hospitals, dispensaries and physicians” .

10.4 The 11  Plan document made a commitment to “mainstreaming AYUSH systems to  actively supplement the efforts of the allopathic systems” and thus, included co-location of AYUSH services and posting of AYUSH doctors within the primary healthcare system.  Studies have reported as unsatisfactory the quality of infrastructure, presence of human  resource,   supply   of   medicines,   and   records   among   both   stand-alone   and   co-located AYUSH facilities .

10.5 The 12  Plan provides an opportunity for bringing together the world’s largest health and child  care  systems  through  flexible  frameworks  that  ensure  a  continuum  of  care with normative  standards,  while responding to local needs at village and habitation  levels.  (12  Plan Approach Paper). AYUSH systems and institutions can play a significant role in realizing this goal.

10.6  Research:  The   National   Policy   of   2002   set   an   objective,   which   involved   a   reorientation and prioritization of certain researches, which would gradually validate AYUSH  therapies   and   drugs   that   address   chronic   and   life-style   related   emerging   diseases.  However, the progress on Pharmacopoeial work has been slow and research on preclinical and clinical studies has been negligible over the 11    Plan, especially for Unani and Siddha.

Moreover,     cross-disciplinary     research     and     practice     requires     standardization     of  terminologies   and   of   classical   therapies,   and   development   of   Standard   Treatment Guidelines, which must be taken up as a priority. Also, classical drugs listed in formularies  and therapies should be validated for their safety and efficacy, as recommended in the  National Policy of 2002 mentioned above. To take the ambitious research agenda forward,  all five Research Councils of AYUSH need to pool resources, particularly human resource,  clinical facilities and information, so as to avoid duplication. For this to happen on an institutionalized basis, a common governance structure for the five Research Councils   should be put in place. A joint ICMR-AYUSH decision making body with representation of  all Research Councils should also be constituted for promoting interdisciplinary research in areas of national interest.

10.7 Human Resources Development:  Practitioners of modern Medicine, Nursing and Pharmacy need to be exposed to the strengths of the AYUSH systems. This would require introduction of short orientation modules on AYUSH in Medical, Nursing and Pharmacy  courses. Codes for cross-referral across all systems should be developed jointly by experts, after an honest appraisal of the strengths of each system.

10.7.1 Cross-disciplinary learning between modern and AYUSH systems at post-graduate levels should be encouraged. Details of modifications in syllabi that would be required at  the undergraduate level, in order to make such cross-disciplinary learning possible, should be worked out by a team of experts from the different Professional  Councils. AYUSH chairs should be established in medical colleges, which would provide the necessary technical  expertise to jointly take up research, teaching and patient care. Once cross-disciplinary  education is allowed, there would be a new class of professionals who would be able to  leverage   the   strengths   of each   system  to   develop  the  most  appropriate  and  effective  treatment regimes.

10.7.2 The proposed NCHRH offers a forum for realizing the integration agenda if AYUSH  professionals   are   also   brought   within   its   purview.   The   Department  of   AYUSH  can   be represented on the Governance structure of the NCHRH.

10.8  Practice   and   promotion   of   AYUSH:  Department   of   AYUSH   should   develop  standards for facilities at primary, secondary and tertiary levels on the lines of IPHS;  Standard Treatment Guidelines and Model Drugs List for community health workers. All  primary,   secondary   and   tertiary   care   institutions   under   the   MoHFW,   State   Health Departments and other Ministries like Railways, Labour, Home Affairs etc. should have  facilities to provide AYUSH services of appropriate standards.

10.8.1 Roles and responsibilities of AYUSH colleges should be defined for contributing  towards national health outcomes.

10.8.2 Joint behavioural change plans should be worked out after incorporating AYUSH based lifestyle guidelines for RCH, Adolescent Health, Geriatric Care, Mental Health, Non- Communicable Diseases, Anemia, Nutrition and health promotion.

10.8.3 To enable the prescription of essential allopathic medicines by AYUSH practitioners, their extended training through bridge courses and appropriate modifications in regulations  should be jointly reviewed.

Download the full report : www.similima.com/pdf/str_health.pdf

Source : http://planningcommission.nic.in/aboutus/committee/strgrp12/str_health0103.pdf

AYUSH Integration: http://planningcommission.nic.in/aboutus/committee/wrkgrp12/health/ayush_integrating.pdf

Comments

4 Responses so far.

  1. Dr. R.N. WAHI says:

    The planning commission report is indicative of Govenment’s desire to encourage the AYUSH systems. The ball is in our court. We must be pro-active now, and participating to improve not only the education, but also in the opportunities to involve our system in the main stream. The ball lies in the court of the Homoeopathic Departments under AYUSH

    • Dr Nitesh Jangid says:

      The Twelfth Five Year Plan adopts a broad approach to health, including as ‘key determinants of health’, a range of resources like food supply chains and nutrition, drinking water and sanitation. Indeed, it takes the view that health would entail a ‘continuum of care’ across sectors. Accordingly, the health policy might encourage a multi-sectoral approach to health, which in terms of policy would translate into a ‘stewardship’ role for the Health Ministry
      and to achive the national health target.It is benificial for all health systems.

  2. Dr.dkdixit says:

    Govt. Is looking for wonders from ayush systems without their help.its not possible in rural areas without govt approch.govt.should encourage homoeopathy and ayurveda in rural areas and should estabilise ayush health centres.

  3. Dr.Manu Pradeesh says:

    This is a great turning point in AYUSH departments, if implemented.And defenitly not only for AYUSH but also for the Western Medicine people, as they are struggling to incoperate AYUSH practices in their practice with out proper knowledge and training.I am sure that it will change the health of Indian population

    Dr.Manu Pradeesh BNYS (RGUHS)

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