7. AYUSH Report_Chapter 2

2AYUSH in Selected

States-Findings from Field Visits

66 Status of Indian Medicine and Folk Healing

AYUSH in Selected States-Findings from Field Visits

Odisha 67

Uttar Pradesh 75

Andhra Pradesh 91

Himachal Pradesh 102

Jammu & Kashmir 111

States Consulted (Bihar, Uttarakhand, West Bengal) 118

Annexures:

Annexure-I: List of Officers who attended meeting chaired by the 121 Commissioner-cum-Secretary, Health and Family Welfare, Government of Odisha at the request of the PI

Annexure-II: List of Faculty members the PI met at AK Tibbiya College, 122 AMU, Aligarh

Annexure-III: Treatment of choice in Ayurveda and Unani for Common 123 Disease Conditions

Annexure-IV: Letter of the PI to Principal Secretary, Andhra Pradesh 128

Annexure-V: List of Faculty and Staff PI met at the Rajiv Gandhi 130 Government PG Ayurvedic College and Hospital, Paprola

Annexure-VI: Letter sent to the Health Secretaries of West Bengal, 131 Uttarakhand, Bihar and Madhya Pradesh

Annexure-VII: Questionnaire sent to the Health Secretaries of States 132

Annexure-VIII: Anubandh for AYUSH doctors in Uttarakhand 135

AYUSH in Selected States 67

Introduction

When Part I of the Status Report on Indian Medicine (August 2011) was written, the PI had given an account of her observations based on her visits to the States of Maharashtra, Gujarat, Rajasthan, Karnataka, Kerala, Tamil Nadu, Chattisgarh and Delhi. In this Report (Part II), the PI visited the States of Odisha, Uttar Pradesh, Andhra Pradesh, Himachal Pradesh and Jammu and Kashmir. The PI also tried to collect information relating to AYUSH infrastructure, pharmacies, drug supply, patients guidelines through letters sent to the States of West Bengal, Uttrakhand, Bihar and Madhya Pradesh- using a detailed questionnaire.

The findings have been given under each State and have not been presented collectively. However they are available in the Summary of Major Recommendation.

Odisha (25-28 March 2012)

The State government has established a wide network of facilities for providing AYUSH services. There are three Government Ayurveda colleges and five Ayurveda hospitals besides three pharmacies, a drug testing laboratory and nine medicinal plant gardens including those maintained by the government colleges. There are 619 Ayurveda and nine Unani dispensaries. All 30 districts are served by a network of Ayurvedic dispensaries. The Unani dispensaries are concentrated in a few districts only.

One thousand two hundred and thirty four Ayurvedic doctors and four Unani doctors have

2AYUSH in Selected States-Findings

from Field Visits

been recruited under NRHM, and the majority of them have completed the induction training including preparation for Skill Attendant at Birth (SAB), Integrated Management of Neonatal and Childhood Illness (IMNCI), routine immunization, the management of Tuberculosis, Malaria and leprosy cases as well as implementation of the school health programme. Over 40,000 ASHAs have completed training on mainstreaming of AYUSH. The drug kits provided to the ASHAs contain Punarnavadi Mandoor, an Ayurvedic drug which works as an iron supplement. One of the points which was repeatedly brought out was that the AYUSH doctors that are working in co-located facilities are practising modern medicine wherever no MBBS doctor is available. When AYUSH doctors function as the single doctor at a health facility they have no option but to practise modern medicine; but this is not legally protected by the issue of a State notification as done in some other States.

It was also pointed out that a separate OPD for AYUSH doctors is still not available in some State hospitals and hence the strategy of making AYUSH services available across the board is working only in patches.

AYUSH Vacancies: in the standalone dispensaries, only 474 Government Ayurvedic doctors were in position as against 619 sanctioned posts. All nine Unani doctors were in position as sanctioned. In the co-located facilities, against the sanctioned strength of 796 Ayurveda doctors, 670 had been posted, leaving a vacancy of 126 doctors. There was


a shortfall of four Unani doctors against posts sanctioned for the co-located facilities.

Observations from the PI’s visit to selected Ayurveda and Unani health facilities

The PI visited a range of facilities in the Bhadrak, Cuttack, Jajpur and Puri districts of the State accompanied by Dr. Narendra Prasad Hota, the State Research Officer (Ayurveda). For a part of the visit she was accompanied by Dr. Samiullah Deputy Director in charge at the Regional Research Institute of Unani Medicine (RRIUM) at Bhadrak and Dr. Subhan Ali Khan, the Deputy Director (Biochemistry) from the Institute. It was evident from a range of conversations the PI had with numerous stakeholders that Odisha State was interested in the propagation of Ayurveda (especially) and local people needed no introduction to the system. However, mainstreaming and integration of AYUSH had not gathered momentum, and there was a need for intensive awareness building, starting with the doctors and health workers posted in the CHCs and PHCs. Additionally no AYUSH drugs were available in most facilities the PI visited. Public faith cannot be sustained only on the basis of physical co-location of the doctors.

Places visited

Bhadrak

The first stop was at village Mulla Sahi in Dhamnagar Block of Bhadrak District. The PI was encouraged by the officials of the CCRUM who were accompanying her to meet Dr.M.Siddiqui, a private practitioner who had done BUMS, and also his father Dr. Niyametullah Siddiqui. There were several patients at the clinic and they had come for treatment for filariasis, joint pain, hypertension and depression. Since the practitioner was 42 years old and he had not been appointed on contract as an NRHM doctor he felt frustrated

that his experience and BUMS qualification were not being used in the government system even when there was an opportunity to do so –only because of his age. It was evident that he had a good clientele and people were coming to him because he had earned a reputation for providing useful treatment.

Dr. Samiullah and Dr. Subhan Ullah Khan - both Deputy Directors at Regional Research Institute of Unani Medicine (RRIUM) with Dr. Siddiqui

(private Unani practitioner)

Dr. Siddiqui showing his patients

The same boy with Filariasis at Dr. Siddiqui’s clinic


View of patients at the village clinic of Dr. Siddiqui

Dobal, District Bhadrak

The PI met Dr. Shafiqur Rehman, the Unani Medical Officer working at the Government Unani dispensary at Dobal. The dispensary was running in a rented house without a signboard, unsuitable for delivery of health care services. A Unani Medical Officer, his assistant and a part-time sweeper-cum-watchman were present but showed two year old medicines, which had not been replenished in between. Some medicine bottles were lying open and exposed to moisture. It was understood that new premises had since been located and there was a plan to move the dispensary. This needs to be done at the earliest as the Unani set-up will get a bad name because of the shabby condition of the existing dispensary.

Outside Government Unani Dispensary, Bhadrak

In contrast, the Government Unani dispensary at Bhadrak, which the PI visited (although it

was being run almost in a shack), was well positioned on the main road. It seemed to be well frequented despite the fact that medicines had not been supplied for several months.

Dr. Kamal Khan who was in charge appeared to be a popular doctor. The OPD attendance figures showed that there was an eager clientele despite the fact that the doctor was simply writing prescriptions. The patients appealed to the PI to do something to see that medicines were supplied on a regular basis.

Dr. Kamal Khan, Unani physician at the dispensary

The PI also visited the Regional Research Institute of Unani Medicine(RRIUM) at Bhadrak town and was shown around by Dr. M. Samiullah, the Deputy Director in charge. The PI interviewed a few patients and listened to the presentation that the doctors had prepared. Some of the younger research officers appeared to be interested in publishing papers which was a good sign.

View of the RRIUM , Bhadrak


Display board showing the priority areas of research at RRIUM, Bhadrak

The premises were not in a good condition but the PI was shown a new building that had come up on the main road some distance away. The new building is well located and impressive but a dispute about a piece of land needed to be sorted out with the State revenue authorities. From indications given during the visit it appeared as though the building was not going to be occupied in the near future because of a tussle with local users about a thoroughfare running along the building.

View of the New building for Regional Research Institute of Unani Medicine, Bhadrak

Jajpur

The PI visited the CHC Dharmashala at Jajpur where the in-charge Medical Officer Dr. R.N. Mishra - a surgical specialist met her. The contractual AYUSH doctor Dr.Anita Bahera was present. The CHC has 16 indoor beds but there were no patients admitted at that time. The AYUSH doctor showed an OPD attendance of about 15 patients on an

average but it was apparent that there was little coordination with the rest of the doctors. Her room had been changed four times since she joined which had affected her sense of belonging. This did not seem to be intentional but it was clear that her presence was not given much importance.

At Jajpur, the PI also visited the CHC at Badachana and at the time of the visit a male gynaecologist Dr. J.J. Mishra was present. The AYUSH doctor was on leave. There was no separate OPD for the AYUSH doctor. Dr. Mishra said that the AYUSH doctor was regular in attendance but virtually no patients came for any Ayurvedic health service and was dismissive about the situation while praising the AYUSH doctor for being “always punctual”.

Later, the PI met various Unani and Ayurvedic practitioners who came to see her at the Circuit House in Cuttack with whom she interacted on the manner in which data was being collected.

Dr. Rama Krushna Mishra, Inspector of Ayurveda I/c, Cuttak Circle; Dr. Satyabrata Mohapatra, Ayurvedic Medical Officer; and Dr. Subrat Mohanty, Ayurvedic

Medical Officer

During discussion with Dr. Ramakrishna Mishra, the Inspector of Ayurveda in charge of Cuttack Circle, it was apparent that he was only collecting figures and did not question unexplained changes. While collecting the


data on the Unani dispensary at Kendrapara it was indicated that the number of patients who had been treated in 2009 and 2010 were in the range of 11,000 in the year. In 2011 the figure came down to just 3000. The inspection report only stated that the medicine position was inadequate but did not highlight that the non-availability of medicines had affected the OPD so adversely.

Dr. Md. Okar shamce, Unani Medical Officer, Govt. Unani Dispensary, Balia, Cuttak;

Dr. Rehanuddin Khan, AYUSH Doctor (Unani), City Hospital, Cuttak; and Dr. Mazharuddin, Private

practitioner, Nimasahi, Cuttak

A glance at the quarterly progress reports showed that the details of patients was being recorded haphazardly although the names of the doctors, their mobile numbers, whether an exclusive AYUSH OPD was being maintained, names of the diseases treated and total number of new and old cases were all being collected laboriously. Unless the reports are scrutinized, such reporting leads to mechanical data collection. There is every need to train the officials who are collecting data to look for “highs and lows” and comment upon any huge difference in figures. In case this is not done the data would continue to be collected but would serve little purpose.

Since it is now a policy decision to mainstream and integrate AYUSH under NRHM, it is necessary that various aspects which have been spelt out in detail in the Manual issued by the Government of India are overseen

and reported to the Health Department, which ought to have the data scrutinized for aberrations. The present reporting systems appear to be perfunctory with a lot of contradictions creeping in from time to time.

Mangalpur

The visit to the PHC was made at 8:20 AM. No staff member, doctor or health worker including the AYUSH doctor were present. Since it is a main road PHC, this kind of absenteeism would be making a poor impression on the local people who would per force have to travel to some other place to obtain medical services.

Satasankha

The PI visited the PHC (New) at 8:40 AM when there were already about 15 patients in the queue waiting to see Dr.Ashok Kumar Sitha who had already disposed off quite a few patients by then. He was attending to the patients single-handedly and appeared to be in great demand.

View of the PHC, Satasankha

Dr. Ashok Kumar Sitha (Allopathic doctor with large number of patients)


In another room the AYUSH doctor Dr. Soumya Devi set by herself but there was no patient waiting to meet her. The daily OPD register showed that she had very few patients, never exceeding a handful of patients in a day

Empty Co-located AYUSH facility

Dr. Soumya Devi, AYUSH doctor sitting alone

There was no evidence of any kind of interaction or of cross referrals being made. The PI asked Dr. Sitha whether some of the patients could not be screened by the AYUSH doctor while they were waiting in the queue and there could not be greater understanding about where Ayurvedic treatment might be useful whether as a stand-alone therapy or as an adjuvant. His response was that he occasionally sent people with joint pain to the Ayurvedic doctor. It was apparent that a busy doctor would have little time to think of anything except his immediate patient load. There is therefore a need for rationalizing the integration in a way that the public does not

feel that they are being forced to go to the Ayurvedic doctor simply because of pressure of work. Unless clear guidelines and standard operating practices are issued patients will not receive the benefits that two doctors working in unison could provide.

Puri

The visit to the Gopabandhu Ayurveda Mahavidyalaya, at Puri gave a good impression of a well-organized, clean and neat hospital.

Various procedures in progress at the Gopabandhu Ayurved Mahavidyalaya, Puri

The PI met the faculty in a meeting chaired by the Principal Professor Kamadev Das. He along with the faculty indicated that the health department of the Government of Odisha had approved that selected lectures should be taken by allopathic faculty members but this was implemented more as an exception than the rule. This affects the knowledge, competency of the doctors needs to be addressed conclusively by the Health Department. Unless the deployment of teachers of modern medicine is overseen, it is highly unlikely that the Principal of the college would alone be able to insist on their taking classes regularly.


PI’s meeting with Principal and Faculty at Gopabandhu Ayurved Mahavidyalaya, Puri

Meeting with State Health Secretary, Odisha

The list of those who attended the meeting is at (Annexure-I).

A meeting was chaired by the Commissioner-cum-Secretary Smt. Anu Garg when the PI presented the findings of her visit. Among others the meeting was attended by the Managing Director of the NRHM programme, the Director of Health Services and the Director of Medical Education &Training.

The PI discussed her findings from the visit and chiefly that there appeared to be an absence of integration and patients did not appear to be getting the full benefit of the AYUSH infrastructure created under NRHM. She pointed to the need for a higher level understanding about the missing links which included the absence of AYUSH drugs at all

the facilities visited, little understanding about what the AYUSH doctor was expected to do when posted as the incharge of a health facility and an absence of guidelines on cross-referrals between systems.

At the meeting there was little receptivity for the concept of functional integration, better counseling, or the issue of standard protocols from the allopathic experts present at the meeting. They were against any kind of integration and misgivings about the absence of published research and evidence of efficacy of AYUSH treatment were all brought up at the meeting despite knowledge of the NRHM policy on integration at the primary level.

One issue that was brought up in the meeting was the prevalence of interminable court cases often accompanied by court stays on administrative decisions. Such stays prevented the authorities from executing the procurement of drugs in a timely fashion. Court cases had also adversely affected many aspects of the running of the health sector including recruitment and promotions. Almost everyone accepted that this was the reality, and hence there was no assurance that things might improve the stay orders from the courts were reported to have disrupted on-going executive processes. Among all the States visited, this phenomenon seemed to be a major obstacle to only in Odisha State.

Conclusion and Recommendations based on PI’s findings and State inputs

1. Under NRHM since the integration and

mainstreaming of AYUSH was a part

of government policy and had been

accepted right from the Year 2006, it is

necessary that more awareness about

the availability of AYUSH doctors and

medicines is built up.

2. At all places visited it was clear that the


two-year delay in the supply of medicines had lowered public expectations from the systems. Concerns about court cases are genuine but a mechanism to improve procurement systems needs to be put in place with higher level intervention.

3. One of the recommendations relating to integration issued by the Government of India was to consider bringing the stand-alone dispensaries of AYUSH under the umbrella of NRHM. Whether that is done or not, unless there is integration at the level of senior health administrators the fruit of deploying the AYUSH manpower will not be realized. Greater orientation for the senior medical administrators working in the modern systems of medicine is needed as they must be proactive in providing leadership to the concept of integration.

4. The overall situation calls for a competent senior officer with adequate access to the Secretary of the Health Department to be given the responsibility for overseeing the integration aspects at the NRHM facilities; also to give a sense of ownership to the concept of pluralistic medical and health care. Unfortunately no one in the AYUSH hierarchy seems to have the status to be assertive. Unless a solution is found the tendency for working in strictly divided compartments will continue and even grow.

5. The Government of India Manual had emphasized that one of the important aspects of NRHM was to know about the strengths of the AYUSH systems and to promote “a culture of cross-referrals”. Therefore, apart from the infrastructural aspects, the coordination

and healthcare delivery aspects of the Manual need to be implemented under the full-time guidance of a Director for Indian Systems of Medicine. Apparently, the position had been vacant for some time. In addition, there is a need to position at least a Joint Director level officer to monitor whether the CHCs and PHCs are doing what the Manual has prescribed instead of leaving it to the officials to simply collect numerical data.

6. Better signage is necessary at the CHCs and PHCs particularly indicating how the public can benefit from the AYUSH systems and the specific areas where the systems have a strength. There is every need to have standard instructions for guidance of patients. Likewise, there is a need for operating practices being given to the AYUSH doctors so that there is some uniformity in following a regimen despite the fact that treatments may vary somewhat depending on the “constitution “ or “prakriti “ of the patient.

7. There is also a need for counseling patients that the allopathic and AYUSH doctors work are equipped to make referrals to one another or even to a higher level facility. In the case of chronic problems, many patients may get relief from AYUSH treatment but they should have the confidence that they can seek advice from any available doctor on options available. This will not happen unless it starts with ownership and understanding at the highest levels of the professional health hierarchy.

8. There was a suggestion that there should


be an Advisory Board or Standing

Committee which can give regular inputs

to the Health Department about gaps

that continue to exist and how better

coordination and awareness could be

built up. This was mentioned by the PI

during the meeting with the Secretary

that, ideally, the Advisory committee

should be headed by a serving officer

of the Department of Health who can

translate the suggestions into practical

strategies.

9. The possibility of paying the part-time allopathic lecturers who have to impart education on specific subjects should be followed through soon. As the responsibility to take classes has been given officially it needs to be taken to its logical conclusion. If honorarium and transportation charges are not being paid it is unlikely that any member of the allopathic faculty would agree to give lectures in an Ayurvedic institution. The prescribed rate for outside lecturers appears to be Rs. 450 per lecture but whether this is sufficient for those who come from a distance needs to be checked. Perhaps an arrangement could be outsourced to the Kalinga Institute of Medical Sciences (KIMS) which might be open to entering into a partnership model.

10. Several positions of medical officers both Unani and Ayurveda appeared to be lying vacant. At least contractual appointments should be made.

11. An awareness programme needs to be built up on the State television channels where doctors and administrators with good communication skills can use the

Government of India instructions to speak about how the integration of the systems under NRHM can benefit the patients.

Uttar Pradesh (28-29 April and 2-3 May 2012)

Visit of the PI to AYUSH facilities in the State of Uttar Pradesh

Being a large state, the visit was undertaken in two parts as suggested by the Central Council for Research in Unani Medicine (CCRUM) and the Central Council for Research in Ayurvedic Sciences (CCRAS). In the first lap of the visit, the PI was accompanied by Dr. Pradeep Dua and Dr. Raheem, both Research Officers who had been deputed by the Ayurveda and Unani Research Councils.

Findings from Field visits (28-29 April 2012 by road)

The first visit was to the interiors of Western Uttar Pradesh namely to Sambhal, Aligarh and Khurja. CCRUM had suggested a visit to a renowned practitioner of the traditional Unani system in the town of Sambhal. Hakim Zafar said he was the 131st descendant of a family of Hakims and lived in the same building as his forefathers (although his personal lifestyle was quite modern). The Hakim only used pulse diagnosis to decide treatment.

He prescribed freshly prepared decoctions using a combination of crude herbs besides prescribing do’s and don’ts. The drugs were dispensed from an attached outlet managed by his staff who looked at the pictures he had ticked off on the illustrated prescription slip. Accordingly small newspaper packets were made using ingredients which had been ticked by the Hakim.


The staff of Hakim Zafar preparing decoction packets for dispensing to individual patients

Silk cocoons used in Unani decoctions

The patients included both middle class and poor patients who had come from both rural and urban areas well as from nearby States like Punjab, Haryana and Delhi.

The visit was an eye opener for the reason that a large number of patients of all age groups, communities and both sexes were visiting the Hakim continuously for hours together. The PI was permitted by him to observe how he was attending to patients. In around one hour,

Hakim Zafar disposed of nearly 40 patients standing in two queues running along the left and right corridors outside his consultation room. At a time the Hakim was looking at two different patients sitting to his left and right as the idea was to save every second of his time.

The style of management entailed no interaction with the patient except pleasantries. The Hakim held the pulse for a few seconds and proceeded to tell the patient his or her symptoms and to tick mark the prescription sheets where the list of single ingredients and medicines had been printed with illustrations of the items. If the patient mentioned a specific complaint the Hakim did not respond, but told the patient he may also be suffering from certain other general conditions like headache, stomach ache, pain in the legs etc. He did not ask for the veil to be raised to see the condition of some women patients. The disposal of all patients was extremely rapid not more than a minute for each patients, and the thumbnail pictures show the kind of people that accessed him. Two things were apparent from the visit to Hakim Zafar:

1. The registration of patients showed that on average day 200 to 300 people were disposed of in a matter of a few hours unassisted by any case sheets. People made a beeline to see the Hakim prompted by the belief that he had healing powers. The Hakim’s sons had graduated with a BUMS degree or acquired other professional qualifications but they were not connected with the diagnosis and treatment of patients. They seemed more interested in the manufacture of medicine and starting a new educational institution for Unani Medicine. This spells that this kind of traditional healing as a family vocation is on the wane.

2. While there did not seem to be any great thought given to the selection


Hakim Zafar examining a stream of patients in his clinic at Sambhal, Uttar Pradesh

of single herbs which were being dispensed in dry form for being boiled down to a decoction (by the patient), the ingredients were such that would have health building properties. This kind of approach was also found to be adopted by the Government Unani College in Lucknow which dates back to 1902, by the AK Tibbiya College in AMU Aligarh, by the Government Nizamia Tibbia College in Hyderabad and seems to be long respected tradition. Therefore the practice of using a combination of dried herbs to be boiled into a decoction continues to be a strong Unani tradition, which is treated with respect by common people from all communities.

What was remarkable was the tremendous faith that people seemed to have in the healing properties of the Hakim and his drugs.

No questions were asked by any of the patients regarding the possible improvement of their condition or lack of it, what exactly was being

prescribed and why. It would appear that people had received relief from the use of the decoctions and have implicit faith in the properties of the drugs.

Visit to the AK Tibbiya College under the Aligarh Muslim University

The PI visited different wards of the hospital after having a meeting with the Dean, the Principal and several faculty members.

The list of doctors she met are at (Annexure-II). Since a description of the Departments, OPD and IPD of the AK Tibbiya hospital had already been described in Part-I of the project report in the chapter on Medical Practice, only those aspects directly connected with the visit are highlighted here.

The large number of patients attending the OPD and the care given to the indoor patients was indicative of the commitment of the doctors and the quality of treatment offered.


Patients outside the AK Tibbiya College Hospital

Patient of Jaundice at the Hospital

Patient of Herpes at the Hopital

Decoctions were being prepared in all the hospital wards and each patients had his earmarked mug in attached pantry.

Picture of pantry and individual mugs for supplying fresh decoctions

After going around the hospital and viewing the work done, the PI used the opportunity to engage the faculty members to discuss the utilization of different single herbs for the treatment of specific conditions, to understand areas of similarity and dissimilarity between the approaches of Ayurveda and Unani. A meeting was organized where discussions took place between Dr. Pradeep Dua, Research Officer of Ayurveda and the senior faculty from the A.K. Tibbiya College and Hospital.

Discussions with faculty at AK Tibbiya College. Picture shows PI and Dr. Pradeep Dua (Ayurvedic Research

Officer) talking to faculty members

Faculty members at AK Tibbiya College expressing their views on the use of common ingredients

used in the Unani system of medicine

Regional Research Institute of Unani Medicine is also functioning at Aligarh and conducting collaborative research with AK Tibbiya College, Aligarh in the field of Ilmul Advia and Moalejat.


PI with Deputy Director, Dr. Latafat Ali Khan and Dr. Soofia Abbas,a staff member at RRIUM, CCRUM

Unani system of Medicine: Dr. Pradeep Dua - An Ayurvedic doctor’s perspective

Commonalities and Dissimilarities within Ayurveda and Unani Medicine

Dr. Pradeep Dua, was asked to give his assessment on points of similarity and difference with a focus on the use of single drugs. According to Dr. Dua:

“The prescription pattern of the Unani practitioners appeared to be similar to the practice adopted by the Ayurvedic practitioners. Majority of the herbs prescribed by the Unani experts seemed to be similar as in Ayurveda. However, a noticeable difference could be observed in indications for which the drugs were used (given at Annexure-III).

The Unani system of medicine advocates the use of certain medicinal plants for specific indications and these are different from those followed in the Ayurvedic system for the same conditions. Also, certain ingredients like Silk (Bombyx mori)-‘Abresham’ are widely used in Unani practice but are never used by Ayurvedic practitioners. The Silk cocoon (Abresham muqriz) is used in simple herbal formulations for the management of hyperlipidemia, atherosclerosis, and hypertension.”

Vaidya Yagya Dutt Sharma Ayurved Mahavidyalaya, Khurja

View of the Vaidya Yagya Dutt Sharma Ayurved Mahavidyalay and attached hospital

The college and hospital have a good building. The PI could only reach the hospital late in the evening when the OPD was closed. The hospital was spacious and fairly affluent patients were occupying the private rooms.

Dr. Gopal Dutt Sharma with a Female patient of RhematoidArthritis at the private rooms of college hospital

Vd. Gopal Dutt Sharma’s son is an allopathic doctor and under that umbrella, surgical procedures were being carried out. The PI was told about a particular patient who “had not been accepted by any allopathic hospital” and was to undergo a hysterectomy operation the next morning at his Ayurvedic hospital. The operation was to be conducted by an Ayurvedic doctor, a faculty member from the Department of Ayurvedic surgery. There appeared to be no doubt in his mind or that of Dr. Gopal Dutt Sharma or the surgeon about the legal right of the Ayurvedic Surgeon who had been


trained in surgery to perform surgeries like hysterectomies despite the prevailing law in Uttar Pradesh which forbids such surgeries being undertaken by Ayurvedic doctors.

Visit to Lucknow (2-3 May 2012 by air)

The PI was accompanied throughout this visit by Dr. Raksha Goswami, Director Ayurveda; Dr. AA Hashmi, Deputy Director (Unani Services) and Dr. Arvind Srivastava, Lecturer, Ayurvedic College. Dr. MS Qasmi, Director (Unani) also accompanied her to some places.

In UP, there are eight Government Ayurvedic & seven private Ayurvedic Colleges besides 2106 hospitals (340 out door dispensaries, 1625 four-bedded, 70 fifteen-bedded and 71 twenty five-bedded hospitals). 2186 Ayurvedic Medical Officers were reported as working in the above hospitals.

During this visit to Lucknow, the PI visited the State Takmil-ut-Tib College and Hospital which was established in 1902. Although the college has moved to its new premises which are modern and spacious, the hospital continued to function from the old hospital. That is good because the public has grown accustomed to this facility, which has existed for over 110 years and which is located in a very congested area of the city accessed by a large number of patients from all communities.

Plaque of 1902 at the entrance to the Takmil-ut-Tib College and Hospital

Women waiting at the registration counters

Three things were apparent at this hospital:

1. The patients were from different communities and the lines at the registration counters were long.

2. There was a long line of patients waiting to collect their Joshandas (decoctions) which was freely supplied for different conditions. These decoctions were in high demand but each patient could fill one bottle full only.

3. The two medical conditions for which patients seemed to be coming to the hospital were skin diseases and women’s gynaecological problems.

Patients waiting for consultation

Patient consulting Hakim Hussain Ahmed Azmi


Patient filling bottle with Joshanda (Decoction)

Ingredients for Joshanda Humma1

Ingredients for Joshanda Mussaffi2

Herbal garden at the Regional Research Institute of Unani Medicine (RRIUM), CCRUM, Kursi Road, Tedipuliya Lucknow

The PI visited the herbal garden and although there was considerable enthusiasm over the visit, the positive and negatives that were evident need to be noted.

The premises are well maintained and the research staff was enthusiastic and committed. The herbal garden was well located and there was sufficient land to manage better growth and display of medicinal plants. However there was no flexibility available with the in charge of the Institute for investment in gardening equipment, promoting water conservation, or spreading nets to prevent destruction of plants by monkeys. There is a need to devolve greater financial authority on the local officers and to leave it to audit to check on the prudence of incurring expenditure. Centralizing all authority curbs initiative and the utility from an overall point of view remains a question mark.

There also appears to be a need to involve students of both Ayurveda and Unani to visit the herbal garden and to play a more substantive role in the management of the garden to increase their understanding of the properties of various plants. Several useful lateral linkages can be established but this requires a degree of confidence and capability. There is a need for commitment to use the herbal garden for hands-on study of medicinal plants regardless of the professional discipline of the student. Keeping this herbal garden as to a small unit of CCRUM with no sustainable linkages with botanists, faculty members both from Unani and Ayurvedic side

1. Ingredients are Althaea officinalis, Malva sylvestris, Glycirrhiza glabra, Caccinia glauca, Zizyphus sativa, Tinospora cordifolia, Swertia chirata, Cordia obliqua

2. Ingredients are Sphaeranthus indicus, Tephrosia purpurea, Swertia chirata, Zizyphus sativa, Rosa damascene, Azadirachta indica


and university faculty and students has very limited benefit. Such units need to be judged by their linkages and outreach performance and not merely by day-to-day, routine activities. The tendency to vertically subdivide facilities like herbal gardens, laboratories and investigation facilities between Unani and Ayurveda research facilities restricts the benefits of cross-fertilization of ideas.

Greater cohesion will benefit stake-holders much more, and the recommendation of the Steering Committee for the 12th Plan to have a common governance structure for CCRAS and CCRUM is needed without which the benefits derived from so many units all over the country would remain of limited value.

State Ayurvedic College, Lucknow

The PI visited this college which was first established in 1948 at the King George’s Medical College campus from where it has been moved to the King’s English Hospital. A five-year degree course was started in 1959 and postgraduate classes were started in 1971. Today apart from PG, graduation and diploma courses the college also runs Nursing and Pharmacy courses. The college has a library with over 13,000 books and a seating capacity of nearly 80 readers at a time.

State Ayurvedic College & Hospital Name board

College principal with the faculty members

The Panchakarma unit was highly subscribed to, despite the standard of lighting and cleanliness being in need of much maintainance.

Entrance to the Hospital Panchakarma unit in great demand

Ayurvedic surgeon performing Ksharsutra procedure at the State Ayurvedic Hospital, Lucknow


Besides Panchakarma, other outdoor and indoor therapies were also being provided. Recently a new ward and OPD complex had been established for paediatrics, gynaecology and obstetrics with facilities for ECG, USG and X-ray. The attached 20-bed King’s English Hospital has modern facilities and functions completely in tandem with the Ayurvedic hospital.

The integration seen at this complex was among the best examples of both systems working together and could be one model to go by in hospital settings.

Visit to the Lavanya Cancer Centre at Chinhut near Lucknow

View of Lavanya Ayurvedic Cancer Center

CCRAS had recommended a visit to the Lavanya Ayurveda claims to be engaged in treating patients of diseases like Cancer, AIDS, Hepatitis-B and C, Asthma and Diabetes for the last 15 years. The centre claims that “a very large number of Cancer patients have shown their faith in the treatment provided to them and subjective as well as objective relief is invariably reported.”

Ayurvedic medicine store at the Lavanya

The treatment includes chanting of hymns, fumigation, pacifying various Zodiac signs, Crystal and Gem therapy based on medical astrology. Drugs containing purified mercury, gold, silver, copper and minerals are being administered to the patients along with Panchkarma Therapy. Leech therapies, various Bastis, Agnikarma (Cauterization with silver rods) are also being undertaken.

The Lavanya Centre claims to have an Intensive Care Unit (ICU), Ventilators with an operation theatre to “provide assistance for early recovery in Cancer cases.” The PI did not visit these units.

The medical claims that were being made through brochures, presentations and as gathered from the website of the Lavanya Centre lacked scientific evidence. It was evident that families looking after terminally ill patients came to the centre in the hope of prolonging the life of the patient, where different styles of faith healing were used along with the drugs and therapies aimed at improving the quality of life of the patient. The medical capabilities and claims do not appear to have been


investigated either by the Central Council for Research in Ayurveda which recommended the PI’s visit or by the state AYUSH officers. The visit of the PI, accompanied by officers of the State Government gave immense credibility and legitimacy to the centre which from the PI’s point of view was avoidable.

State Ayurvedic & Unani Pharmacy

The PI visited the State pharmacy at Lucknow which once had a huge capacity for manufacturing Ayurvedic and Unani medicines. The staff at the pharmacy appeared proud of the work they were doing which followed the traditional methods of making Ayurvedic and Unani drugs. The pharmacy in charge as well as the Director Ayurveda Dr. Raksha Goswami proudly informed

Entrance of the pharmacy

Work area of the pharmacy

the PI that if they were given sufficient raw material and funds, the pharmacy had enough capacity to provide drugs to all the AYUSH facilities throughout the State. The PI found that the stocking of the medicines was organised and the variety of products and the size of the inventory was impressive.

Raw drugs Store

Preparing Asavarishta

Mechanised pulveriser for Tamra bhasma


Making churna

Sorting Ingredients

Furnace for preparing decoction

Wooden container for preserving Ashokarishta

Station for keeping finished products

Station for keeping Ayurvedic finished products

Station for keeping Unani finished products

This is one pharmacy which could become a showpiece for people who wish to know how classical Ayurvedic and Unani drugs are prepared and the buildings and premises which are extensive can be made to look impressive with a little maintenance and upkeep. The pharmacy staff were enthusiastic and no one made any complaints on any score.


Visit to the bone setter Sabir Ali Ansari at Unnow

This visit can be better described through photographs. Sabir Ali owns a semi-pucca building in an interior part of a village in situated some 60 kms from Lucknow by road.

Bone setter Sabir Ali Ansari’s name board

Bone-setter’s daughter who assists him with the preparation of pastes and bandaging

The day that the PI visited the bone setter there were about 40 patients who were being treated by him, a large number of them as “in patients”. The facilities provided were rudimentary - each patient was given a Takht or wooden slab to sleep on. Belongings were either hooked on to nails or strung across the ropes attached to the mosquito nets. A family member would cook the food for each patient, sitting next to his “takht”. Altogether it was a vibrant community life. Pictures showing “indoor patient facilities” in and

around the Sabir Ali’s bone setting facility


The patients were not destitute or even from the very poor. Asked what was being paid, one of the patients who had remained an “in-patient’ stated that he had paid Rs.18,000 for a four month stay including treatment. Food was arranged by the patient. It was noticeable that there were quite a few small children who had suffered fractures or dislocation and the parents had brought the child with great confidence that the treatment would be successful.

Sabir Ali and his daughter relaying the splints

It was interesting that the Central Council of Research in Unani Medicine had suggested that the PI visit this bone setter. The State Government officials too were well aware of this local healer and his work and confirmed that people from all over the district and even the region came to him. However when asked whether the improvements (or absence thereof) could be observed and documented, there was no interest either from the research staff of the CCRUM or the State Government Unani Officers. This aspect deserves the attention of the two research councils who should have examined the efficacy of such treatment in a variety of settings.

Sabir Ali showed the PI how he changed the bandage and repositioned the splints every third day. The injured area was covered with an application of herbs which had

been ground into a paste. The bone setter’s daughter showed the herbs which were easily recognised by the AYUSH doctors that were accompanying the PI. Sabir Ali showed the PI a vast array of bamboo splints which had been chiselled and kept in stock for different kinds of fractures. The bone setter seemed familiar with reading X-rays brought by his patients and went about his task with great confidence.

Bone setter showing an array of bamboo splints

All the patients whom the PI spoke to said that they had come to Sabir Ali to avoid surgery and being immobilized in a hospital or at home. Since the bone setter advised constant movement, assisted by a family member, the patients felt more confident of early recovery. The biggest benefit from the point of view of the patients was non-dependency on a government hospital which they felt was impersonal; also recovery through traditional bone-setting was known to be quicker with no adverse outcomes.

The PI suggested that the case sheets of the patients and the documentation available, including the X-rays , pre- and post-recovery if studied might confirm whether the recovery had been satisfactory in a large cross-section of cases – not with the purpose of checking the competency of the bone setter but more to understand whether such skills indeed had a place in fracture management.


The bone-setting practice is very popular in Kerala and at one point the PI had observed a large number of patients waiting for fracture treatment at the Government Ayurvedic College in Thiruvanantapuram for fracture treatment. The same style of fracture management was being used routinely in many parts of the North-East also. There appears to be every reason to study these skills and to use them to selectively equip ASU students to manage fractures, if patients are benefitting from this kind of management. For most people a fracture signifies either complete immobility or encasement of a limb into an uncomfortable cast leading to all kinds of after-effects like shortening, bending, and shrinkage of the limb besides acute discomfort. Bone setting skills need to be mainstreamed into Ayurvedic practice, and since patients seem to be benefitting, the public is likely to be benefited if regular check-ups are done to see the progress of healing.

A group of experts should be able to decide on the inclusion of such skills in the ASU syllabus.

Meeting with Shri J P Sharma, Principal Secretary, Medical Education and AYUSH in the Secretariat, Lucknow.

The PI shared her findings and observations with those present at the meeting chaired by the Secretary. The meeting was attended by the following:

1. Shri JP Sharma, Principal Secretary, Medical Education, UP

2. Shri SK Saxena, Special Secretary, Medical Education, UP

3. Dr. Saudan Singh, Director General, Medical education, UP

4. Dr. Raksha Goswami, Director Ayurveda Services, UP

5. Prof. MS Qasmi, Director Unani services, UP

6. Dr. AA Hashmi, Deputy Director Unani Services, UP

The Principal Secretary looking after AYUSH was unconnected with NRHM and was not dealing with co-location plans. The allopathic doctors who had been requested to attend to enable a discussion on how best patients could be benefited through better guidelines and counselling on providing integrated access to allopathy and ASU treatment were openly critical of ASU doctors and questioned their competence. It seemed that the development of Ayurveda and Unani medicine was not a matter of importance for senior health professionals.

Later in August 2012, the PI spoke to the Principal Secretary in charge of NRHM Shri Sanjay Aggarwal who informed her of a change of policy and that the programme to post contractual doctors under NRHM has started. He added that he was in regular touch with Department of AYUSH, Government of India and assured the PI that AYUSH was well cared for. The PI requested him for a copy of the policy guidelines and budget provisions which had been introduced recently but the documents were not sent.

It is understood that recruitment of contractual doctors under NRHM is in progress. According to the briefing given to the PI, the absence of a DG for AYUSH was the reason behind the fact that there was delay in rolling out the AYUSH component of NRHM. It would appear that structurally AYUSH officers, professional staff and colleges report to the Principal Secretary (Medical Education). However, NRHM is entirely under the Principal Secretary (Health) of the State and operates under the Mission Director. The co-location of AYUSH doctors may take time judging from the progress noted during the visit. Considering the large population involved, there is every need for focused attention to the provision of services as envisaged.


Meeting chaired by Sh. J.P.Sharma, Principal Secretary, Medical Education UP. Picture shows those present

at the meeting listed in the write-up

In Maharashtra State also, AYUSH comes under the Medical Education Department and not the Health Department. But since the Director (Ayurveda) is able to make his presence felt, the system is operating efficiently. In a large State like UP, there is every need for AYUSH to be under one umbrella both for the standalone component which is quite large, and the NRHM component to bring some organizational strength to the management of the sector.

Conclusions and Recommendations

1. Since the State is very large and there is huge diversity within regions, districts and communities, if Ayurveda and Unani systems are to gain primacy,

reorganization of the structure and systems would be necessary. At the organizational level, it was apparent that with the absence of a senior unifying force to look after both Ayurveda and Unani systems, the hierarchy of each system was working independent of the other without any functional collaboration. Therefore, there is a need to have a focal point which can act as a bridge between the professional people belonging to both the systems, to be able to plan, make overall recommendations and follow them up with the State Government. A position of Commissioner AYUSH which could be filled from the Indian Administrative Service (IAS) or from the Indian Forest service (as is the case in Andhra Pradesh) would provide much-needed leadership. Officials of both the Directors – Ayurveda and Unani systems would like the position of Director General to be created but the Andhra Pradesh example of having a generalist officer might work better as the gaps to be filled are organizational and administrative not technical.

In States like Himachal Pradesh, Kerala, Karnataka, Gujarat, Rajasthan, Jammu and Kashmir, and Odisha, there is a common Principal Secretary in charge of all aspects including Health, Medical Education and AYUSH. However in the States of Maharashtra, Uttar Pradesh, and some others, AYUSH is combined under the Principal Secretary (Medical Education) while NRHM is handled by another Principal Secretary and the Mission Director. The PI found that in such a situation, the interface between the established AYUSH hierarchy and the NRHM AYUSH doctors is virtually non-existent. The advantages of sector


knowledge and technical background are lost.

In Maharashtra, the system is functioning because the Director (Ayurveda) is a very senior academic expert who has worked with WHO’s Regional Office and has had a lot of exposure. He has the negotiating ability which was found to be missing among the Directors for Ayurveda and Unani systems working in Lucknow. Therefore it is recommended that there should be a common supervisory officer of a sufficiently high level to act as a Commissioner for AYUSH in Uttar Pradesh who can see that functional linkages are established between the regular AYUSH infrastructure and the NRHM AYUSH infrastructure being provided to co-located facilities. This would be cost-effective and will give a spurt to the propagation of Ayurveda and Unani systems.

2. There is a great need for improving and expanding the utilization of the Lucknow State pharmacy which is preparing Ayurvedic and Unani medicines. If more drugs are supplied directly by the State pharmacy it would improve the availability of drugs round the year which is the only way that patients would care to take advantage of the systems. Between Lucknow and Pilibhit pharmacies, at least 50percent of the requirements of all facilities can be met.

3. As far as traditional skills like bone setting up concerned, the practice is very popular even in a Government Medical College in Kerala and it needs to be investigated further, particularly when numerous people are taking advantage of such facilities. At least to

start with, there should be an effort to see whether the healing is satisfactory and to consider mainstreaming such skills into Ayurvedic practice with proper protocols.

4. There is a need for much greater understanding about what is hoped to be achieved by co-locating AYUSH doctors under NRHM. Uttar Pradesh state would eventually be recruiting a very large number of doctors if they adopt the NRHM policy and strategies. There is every need to evolve an understanding of how integration is to be brought about between doctors providing services in the same facility. There is a need to address the issue of the use of modern medicine which is not permitted in UP as the chapter on legal issues has shown.

5. Reporting systems about treatment given under AYUSH need to be able to capture the patient’s health seeking behaviour. The work being done in Ayurvedic and Unani colleges should also be taken into account as there is considerable specialization in the State and university owned hospitals including those attached to medical colleges. There is a need to also evolve guidelines on adjuvant use of AYUSH therapies for certain chronic diseases as there is considerable experience available with the Benares Hindu University (BHU) and the Aligarh Muslim University’s Tibiya College.

6. As far as the Central Government institutions are concerned, whether it is the Regional Research Institute or the herbal gardens under the CCRUM, there is every need for basic facilities like laboratories, medicinal plant gardens


and statistical support systems to be shared. The vertical division between the institutions of the two systems only means that they lose out on interaction, interdependence and distance themselves from familiar initiatives taken elsewhere, instead of learning from them. As was recommended by the Steering Committee that met for the 12th Plan there is a need for a common structure to be evolved to derive best advantage from the outcome of research.

Andhra Pradesh (8-12 May 2012)

The Principal Secretary (Health), Government of Andhra Pradesh had asked the PI to complete a visit to Rayalseema region and then to give her observations in a meeting to be chaired by him at Hyderabad. Accordingly, the PI undertook visits to Naravari Palli, Chandragiri (tehsil) of Chittoor district, to see the status of co-location of facilities at Government Ayurvedic dispensaries. This was followed by a visit to the P. Kottakota, Poothala Pattu (tehsil), again in Chittoor district to see another Government Ayurvedic dispensary co-located under NRHM. There was one Ayurvedic graduate woman doctor working there and an MD in Biochemistry was the incharge at the facility.

Outside the PHC, Naravaripalli, Chandragiri Mandal, AP with Ayurveda co-located facility

Incharge doctor sitting extreme left at the PHC Kottakota, Poothlapatthu Mandal,

AP with AYUSH woman doctor

Picture of scanty Ayurvedic drugs available at PHC

Chart of Ayurvedic lifestyle displayed at the PHC


The co-location work had not gathered momentum judging from the conversations

the PI had with the Regional Director of Ayurveda, Dr. Ramanna who accompanied her throughout. While efforts had been made to display pictures of medicinal plants and various charts showing the properties of easily available herbs used as home remedies, there were hardly any medicines or patients in the facilities. The registers also showed that the public was not accessing Ayurvedic treatment as envisaged in the NRHM approach to mainstreaming AYUSH.

Chart on Ayurveda drugs displayed at PHC

The PI found that reporting systems were quite diffused and the Regional Director although he was enthusiastic and supervised a dedicated network of AYUSH doctors under him, was not in a position to make the co-located facilities more vibrant. During discussion, the PI was not able to derive a meaningful idea of whether the data relating to co-located facilities revealed anything about patients’ acceptance of the provision of AYUSH services.

Chart on different diseases displayed at PHC

On its own Andhra Pradesh has good coverage with almost as many AYUSH primary level facilities (above sub-centre level) as are available for modern medicine. The State has a post of Commissioner of AYUSH where an IAS officer is generally posted. When the PI visited the State an Indian Forest Service(IFS) Officer was looking after the work of Commissioner of AYUSH. It is understood that this arrangement has since been made into a regular one. There is a clear advantage in posting a senior officer dedicated to the overall management of AYUSH at the State level. The PI was told that the alternative of posting IFS officers to head the AYUSH structure in fact works well. This is because IFS officers already have a strong knowledge of plants and can get into AYUSH-related issues quite easily–particularly those relating to medicinal plants and drugs. IAS officers get transferred frequently and new initiatives taken lose momentum with each transfer. An IFS officer is likely to stay for a longer duration and would welcome the opportunity to work in a health-related area. However, the availability


of a position of Commissioner AYUSH seems unique to Andhra Pradesh and Tamil Nadu States. Even a State like UP has only a Director (AYUSH) and a Director (Unani) for the whole State. Maharashtra, Gujarat, Karnataka and Chhattisgarh States all have a position of Director (Ayurveda) and J&K has a Director (ISM). Although a person at that level provides leadership and continuity of administration within the AYUSH sector, the officer usually lacks the visibility, weight and negotiating ability to get the attention of the State Health Secretary and the Health hierarchy. Therefore a position of Commissioner does help to raise the level and is a good model to follow.

The State Medicinal Plant Board was doing well and the Commissioner for AYUSH Dr. Srivasuki, IFS was deeply interested in the development of AYUSH. However, no links between growing plants and linking cultivation to improving raw drug supply to the single State Pharmacy had been established.

The Vth Common Review Mission of Ministry of Health & Family Welfare had also found

that convergence and co-ordination were lacking at all levels in the AYUSH sector in Andhra Pradesh. The PI found that approach to AYUSH was enthusiastic at the college level but ownership at the facility level was weak. There was a universal shortage of drugs and the AYUSH doctors did not appear to have much work. The allopathy-AYUSH interaction within the co-located facilities was friendly but there was no system of referrals or of giving guidance to patients. There appeared to be no system for evaluating the output of the AYUSH doctors as an integral part of the Health System.

Sri Srinivasa Ayurveda Pharmacy, Tirupati

The PI visited the Sri Srinivasa Ayurvedic Pharmacy attached to the Tirupati Ayurvedic Hospital which was managed efficiently. The Ayurvedic Medicine dispensed in the 240-bed SV Ayurvedic Hospital at Tirupati was being supplied by this Pharmacy. It presented an excellent example of which an inhouse pharmacy can achieve in a cost-effective way.

Photographs of the Sri Srinivasa Ayurveda Pharmacy


Photograph showing display of samples dry herbs with their basic info at the Sri Srinivasa

Ayurveda Pharmacy, Tirupati

Sri Venkateshawara Ayurvedic College & Hospital, Tirupati

This institution is run by the Tirumala Tirupati Devasthanams, an autonomous quasi Government organization setup under the Andhra Pradesh State Charitable, Hindu Religious Institutions and Endowment Act (1987) of the Government of Andhra

Pradesh. Since 2011, the attached hospital has an increased bed strength of 210 beds and provides specialty Ayurvedic treatment, free of cost to poor patients. The hospital presents one of the best examples of a well-run Ayurvedic hospital. The PI found the functioning efficient and the patient load was indicative of the useful work being done at the facility. The Panchakarma and Ksharasutra techniques of Ayurveda were very popular and people seemed to have come from all parts of Andhra Pradesh and adjoining States for undergoing these two procedures.

Specialized Ayurvedic therapies were also being performed on children affected by cerebral palsy, Attention Deficit Hyperactive Disorder (ADHD), Autism and mental retardation. The out-patients department of the hospital has an average load of 350 patients daily and medicines worth Rs 50-/ per patient were being supplied free of cost for 15 days at a time. All

Photographs of the Inpatient services at the SV Ayurvedic College Hospital, Tirupati


the Bio-chemical, radiological investigations, Panchakarma therapies, ano-rectal operative procedures, medicines and diet were being provided to all in-patients without levying any user charges. About Rs.100/- is spent on each in-patient every day (excluding diet). Some details are captured below to give an idea of the work undertaken and costs incurred in a well-run facility because it presents an efficient model which gives an idea of the budgets necessary to maintain efficient hospital services. The annual budget for drugs is around what is presently spent on AYUSH drugs by the entire State.

Data sheet on S.V.Ayurvedic College Hospital from April 2011 to March 2012

Out-patients - 1, 09, 571In-patients - 39,170 (Bed occupancy

days = No of beds occupied by patients on every day x 365)

Admissions - 2,378 (Number of patients admitted)

Surgeries - 120 (Ano-rectal surgeries)

Panchakarma therapies

- 27,990

Bed distribution among various specializations1. Panchakarma - 42 (Upgraded to PG

Dept)2. Shalya - 42 (Upgraded to PG

Dept)3. Kaumarabhritya - 42 (Upgraded to PG

Dept)4. Kayachikitsa - 365. Shalakya - 126. Prasuti sthree roga

- 12

7. Hospital Unit 24Total 210

Annual Budget for drugs purchase in the financial year 2011-12

: Rs.1,00,13,322/-

Drugs supplied from Sri Srinivasa Ayurveda Pharmacy, Narasingha Puram (Chandragiri)

: Rs. 58,51,300/-

Drugs purchased from outside companies through call of annual tenders

: Rs. 27, 22, 489/-

Cost of Surgical items, lab chemicals, kits, X-ray films etc.

: Rs. 78, 422/-

Cost of stationary items : Rs. 1,02, 175/-

Miscellaneous expenditure

: Rs. 63, 519/-

Total budget utilised in financial year 2011-12

: Rs. 88,17,905/-

Total budget of the Hospital including salaries to staff (excluding clinical teaching staff that are paid from College budget).

: Rs.2,69,15,000/-

Number of medicines manufactured in SSA Pharmacy which are being supplied to Hospital

: 85 Nos

Number of medicines purchased from outside pharmacies by calling tenders

: 90 Nos

The AYUSH systems (ASU) require a continuous supply of drugs without which patients loose interest. A facility wise norms need to be drawn up for supply of drugs which should be adjusted periodically depending on patient load at each facility. A model like the Tirupati Hospital should be followed at least in all Government hospital facilities which would attract many more patients. The hospital also serves as a model of time management and could be studied as a good working example.

Meeting with Principal Secretary (Health) Andhra Pradesh

A meeting was chaired by Shri Ratna Kishore, Principal Secretary, Government of Andhra Pradesh attended by Dr. Srivasuki, IFS, Commissioner, AYUSH; Dr. K. Vishnu Prasad, Director, Medical Education; Dr. N.Satya


Prasad, Principal, Dr. B.R.K.R. Government Ayurvedic College, Hyderabad and the Principal, Government Nizamia Tibbia College, Hyderabad.

The PI gave her observations on the status of AYUSH in co-located facilities and her impressions of visits to rural PHCs in Rayalseema region and at the Tirupati Hospital.

During the discussion she raised points relating to integration and mainstreaming of AUYSH which had been sent in advance to the Secretary. The main point which she had made in her letter before her visit was that there was a universal need for more organized integration at the primary health care level. The availability of doctors and drugs was not uniform and counseling on the use of ISM needed to permeate to the patient’s level. Integration if built upon operational guidelines and protocols could provide useful information to the patients instead of leaving the patient to try permutations and combinations on the basis of limited knowledge. In her letter she had requested the Principal Secretary for the presence of clinicians (both allopathic and having an Ayurveda/Unani background) to provide a forum for a frank discussion so that the PI could benefit from a brain-storming keeping in mind the ground realities. The letter is at (Annexure-IV).

In the meeting under the Secretary’s Chairmanship, it was apparent that the idea of integration hed not received much consideration although the Principal Secretary was personally appreciative of its need. By contrast the senior allopathic doctors were not geared up to accept the concept of integration. The mind-set of the higher level health professionals in charge of administering health services showed that the concept of cross-referrals was considered unworkable and unacceptable. The policies enunciated in the joint letters of the Health and AYUSH Secretaries regarding mainstreaming and integration had apparently not percolated except for physically positioning the contractual AYUSH doctors.

There was an apparent need for the concepts and strategies for integration to be adopted across the government health doctors.That would not come only through the issue of instructions. In Andhra Pradesh as in other States visited by the PI, there was no understanding about how integration could be strengthened not just in physical terms but in a way that the services enabled the patient to derive the best advantage from the facilities provided. There is every need for devising a central set of guidelines and operational systems so that patients derive greater benefit

Photographs showing PI’s Meeting with Principal Secretary, Health AP and other Officials


from co-location. Leaving it to patients to decide is an easy way out but it is the responsibility of the architects of the mainstreaming policy to also lay down the strategies for efficient management of the patients.

Dr. B.R.K.R. Government Ayurvedic Medical College, S.R. Nagar, Hyderabad

The PI met the Principal and faculty members and went around the in-patient facilities.

This was followed by a visit to the attached

Government Ayurvedic Hospital. The level of

interest being taken by the faculty and students

was good and the institute gave a favourable

impression. She was told that it was one of

the oldest Ayurvedic Institutions in India and

several renowned Ayurveda experts like Dr. I.

Sanjeev Rao, Dr. HS Kasture, Dr. VS Chauhan

etc.,were products of this college.

View of the Dr. BRKR Government Ayurvedic College, Hyderbad with Commissioner (AYUSH), College Principal, the faculty and students

Photographs showing the entrance of the Government Ayurvedic Hospital, SR Nagar, Hyderbad where PG education is imparted


Later, a meeting was held with Dr. Srivasuki, Commissioner, Department of AYUSH and Dr. N. Satya Prasad, Principal, Dr. B.R.K.R. Government Ayurvedic College, Hyderabad and faculty members of the hospital.

Government Nizamia Tibbia College, Charminar, Hyderabad

The PI also visited Government Nizamia Tibbia College, Charminar in the old city of Hyderabad where she interacted with the faculty and ascertained about possibilities for better coordination intra the Unani and Ayurveda faculties aimed at learning from each other’s experiences in handling certain diseases. The faculty opined that interaction would give a lot of boost to move ahead with research and better management of diseases.

The PI went around the hospital and observed a large cross-section of patients admitted in the Hospital and the treatment and procedures followed. The hospital was supported by modern medicine doctors, a surgeon,

an anesthetist, a dental surgeon and an Obstetrics or Gynecology specialist to support the teaching of traditional Unani Medicine. A large number of young girls (aged between 5 and 12) had been admitted for the treatment of vitiligo and had been left to hospital care by their parents which showed faith in the security and safety that the institution provided. The unique feature of this hospital is its location in the old city where facilities for both Unani and Ayurveda treatment is provided.

Outside view of the Govt Nizamia Tibbia College, Charminar, Hyderabad

Dr. Srivasuki, IFS, Commissioner (AYUSH) chairing the meeting with the faculty in the Principal’s chamber at the Dr. BRKR Government Ayurvedic College, Hyderbad


Meeting with the faculty at Govt Nizamia Tibbia College Hospital and Commissioner AYUSH

in the chair at the right

Patients at the Paediatric ward at Government Niazamia Tibbia College Hospital, Charminar,

Hyderbad

The PI enquired about any examples of interaction between Ayurveda and Unani experts. She was told about an AYUSH Seminar which was conducted at Hyderabad which had given a good boost to AYUSH doctors of different streams as many of them presented papers on their research work before a combined audience.

Central Research Institute of Unani Medicine (CRIUM) at Hyderabad

The PI visited the Central Research Institute of Unani Medicine at Hyderabad. The Institute was established in 1971. The Government of Andhra Pradesh had provided 5 acres of land for the institute. It has emerged as a centre for the treatment of several diseases and has treated over 100,000 patients of vitiligo alone. Over 2,000 new vitiligo cases are registered each year and the patients come from various parts of the country and even from abroad.

View of the CRIUM (A major centre of the CCRUM), Hyderbad

View of the Herbal garden at CRIUM

The Institute is developing a clinical trial site as per WHO Guidelines with funding from the Department of Science and Technology and Department of AYUSH. The researchers are being given advanced training in research techniques particularly in the field of clinical research methodology to upgrade the quality of research being carried out at the Institute.


Dr. MA Waheed examining a vitiligo patient

The general up-keep of the Institute and the patient load gives the impression of an institute of professional standing and the high patient demand is evident. Considering the expertise that has been developed this Institute ought to become a focal national point for treatment of Vitiligo and certain other conditions.

For people coming from all over the country it may not be possible to stay at the Institute’s hospital continuously. It is necessary to build awareness about the facilities, the level

Patients undergoing treatment for Vitiligo and other skin conditions at CRIUM, Hyderbad


From L to R : Dr. M.A. Waheed, Deputy Director(Unani); Dr. M. Ataullah Sharief, Director Incharge; Dr. S. Mazhar-ul Haq, Research Officer Pathology; Dr. M.A. Wajid, Assistant Director; Dr.

Alokananda Chakraborty, Research Officer Physiology at CRIUM, Hyderabad

of research work and patient care and to start a website which answers questions on the probable duration of treatment and of intermittent stay. Paying guest/hotel arrangements need to be identified and listed on the website to give confidence to out-station patients and to facilitate them. The availability of treatment facilities needs to be notified along with timings and payments through the website. Details of Unani treatment, herbs and other ingredients used should also be available on the website which should be developed using the IT services of a specialized institute like National Institute of Indian Medical Heritage (also located at Hyderabad) so that users can also avail of links that describe Unani drugs and their properties. This is because some skin conditions like vitiligo carry immense stigma and people would go anywhere in search of treatment. People who are internet savvy would feel encouraged if all loose ends could be tied up before coming to a new city for treatment. The CRIUM, Hyderbad has the potential to become a flagship Institute for skin diseases, but the physicians should be trained in handling questions and ideally the treating physician should not be changed mid-stream. The PI was told by some patients who had gone from Delhi for treatment

that the treating Hakim changed with each visit. Curious and educated patients will not accept such an approach for treating chronic conditions.

Suggestions for Reorganization made by AYUSH doctors from Andhra Pradesh

In Andhra Pradesh almost all AYUSH dispensaries have been co-located with the PHCs but the attendance of patients is very poor. The AYUSH supervisory officers find it very difficult to maintain supervision over the dispensaries which have been co-located with the rural PHCs. Better road connectivity to nearby towns has given people more choice than before. It is common to share autos which provide comparatively speedy transportation to the district headquarters or towns at an affordable cost. Government ambulances are functioning on a 24 X 7 basis quite effectively. The penetration of mobile phones even in rural areas makes it possible to summon ambulances in the event of an emergency. This has reduced interest and dependency on AYUSH in rural areas. This requires reorganization of the AYUSH staff bearing in mind patient preferences in rural areas. In urban areas the spread of education has brought about a shift in people’s health-seeking behaviour. There is now a growing demand for AYUSH services in urban areas with a heightened awareness about the side-effects of modern drugs whereas in rural areas people show marked preference for modern medicine.There is a misconceived opinion among the majority of policy makers (politicians and senior bureaucrats as well as the media) that AYUSH systems do not fit into the current lifestyles of people and their utility is minimal. This opinion has gained ground mainly because no thought has been given to prioritization of core areas of strength within AYUSH.Instead of expanding AYUSH facilities in rural areas it is necessary to establish Ayurvedic speciality centres in urban areas where treatment can be provided for identified diseases and conditions. The possibility of receiving treatment at speciality centres would create a lot of interest and would prevent the need to visit quacks. The AYUSH dispensaries functioning in rural areas co-located or standalone need to be linked with the proposed specialty centres which can be established in municipal towns. The following suggestions are made for better utilisation of strength of AYUSH systems:


• Five-bed Speciality Ayurvedic Centres should be set up at the municipal level with a Panchakarma/Kaya Chikitsa (Internal Medicine) Specialist, an Ayurvedic surgeon and an Ayurvedic Gynecologist.

• A Fifteen-bed Specialty Centre should be established at the District Headquarters or at any large township in every district. A Specialty centre should be dedicated to diseases affecting the nerves, for dermatology for specialized intervention for diabetic foot and non-healing wounds , also for mental health conditions. The centres should be located either in teaching hospitals or in the District Hospital or a Government Allopathic hospital.

Conclusion and Recommendation

The suggestions made by AYUSH doctors in Andhra Pradesh regarding reorganisation of the AYUSH manpower in the state needs to be discussed and the view taken. The suggestions have weight but they are state specific.

Himachal Pradesh (16-19 May 2012)

The State gives a picture of strong commitment to the development and utilization of Ayurveda. While the Unani system has a very small presence in the State, public faith in the Ayurvedic system seems to be strong and growing. The PI found that the network of government-run Ayurvedic hospitals, health centres and private practitioners all have a dedicated clientele but paucity of medicine and irregularity in supply are recurring problems which are affecting the continuity of treatment adversely. There is every need to step up internal production of drugs in the state pharmacies to cater to the growing needs, instead of depending on commercial purchase or government supplies which do not seem to reach in time.

The places visited by the PI are described as per the itinerary followed.

Mandi

The PI visited the Ayurvedic Regional Research Institute, Mandi, (under Central Council for

Research in Ayurvedic Sciences, Department of AYUSH). It is located on the first floor of a building in the heart of the marketplace and the discussions with the in charge of the Institute showed that people from the district as well as neighbouring districts visited the OPD for Ayurvedic consultation and treatment. The institute runs a general as well as a geriatric OPD and offers treatment for “flu like illnesses” and also supplies free medicines.

View of the Ayurveda Regional Research Institute, Mandi

This Institute like many others under the Research Councils of Ayurveda follows the principle of widening the OPD clientele base to be able to locate patients that can fit into research projects. The PI found that in the process everyone received general treatment and the division between research and clinical practice was blurred.

Dr. Om Raj Sharma, Research Officer attending to patients at Ayurveda Regional Research

Institute, Mandi


So far the institute has conducted clinical research on rheumatoid arthritis, malaria, malnutrition, acid peptic diseases, iron deficiency anemia, hypertension, skin diseases, jaundice, obesity, piles, leucoderma, gout, irritable bowel syndrome (IBS), hypertension and type II diabetes mellitus using Ayurvedic medicine. That is obviously too diverse a range for any meaningful research to be done and the outcomes would be based on a very small sampling of patients. The Institute had organized a “National Campaign Programme in Ayurveda 2010-2011” in collaboration with the Department of AYUSH, and the State Government and provided treatment for Ano-rectal disorders, Geriatric Care, Anemia, Mother and child health, in five districts of the State. In all 5,965 patients were examined and treated during the campaign. The feasibility of introducing Ayurveda as a part of the National Reproductive and Child Health Programme was also investigated in two blocks of Kangra and Mandi districts in collaboration with R.G.G.P.G. College at Paprola.

The PI was shown a picturesque location where a new building is to come up but being on a steep hillside, it is questionable how many people would take the trouble of reaching the spot which would need four-wheeled transportation for the most part. It was observed that the annual OPD of this Institute even when it is located in the heart of the marketplace was just over 18,000 persons. The number might reduce substantially by moving to what appears to be a scenic location but not very practical from the point of view of getting sufficient patients from where research subjects would need to be identified. This needs re-consideration. More importantly the research needs to be linked to publications and unless there is independent assessment of outcomes,

the results cannot be taken at face value.

Ayurvedic Health Centre,Urla Mandi

Dispensing room at the Ayurvedic Health Centre, Urla Mandi

State facilities visited

The PI interacted with Dr. Vidyasagar Gupta, District Ayurveda Officer, Mandi who informed the PI that 166 Ayurvedic Health Centers were functioning in the remote areas of the district. There were 18 co-located facilities under NRHM but modern medicine doctors were available only at five of these facilities and the rest were being managed by Ayurvedic doctors only.

Joginder Nagar Herbal Garden

A visit to the herbal garden and herbarium at Joginder Nagar presented a rich display of medicinal plants with an interesting range of both live specimens and dry herbs. Located


on a 24 acre plot just off the main road, the Herbal Garden sells germplasm/planting materials and undertakes experimental cultivation. Several exposure visits and training camps have been held for the benefit of farmers, students, research scholars, NGOs and departmental officers.

Entrance view of the Joginder Nagar Herbal Garden

Display of plants at the Joginder Nagar Herbal Garden

Museum at the Joginder Nagar Herbal Garden

The general upkeep of the nursery as well as the preparation of planting material was being done professionally. According to the version of the in-charge of the Institute Dr. Subhash Rana, around 2500 people including farmers had benefited during one year. This number could increase if the Institute widens its network.

Dr. Subhash Rana, Incharge of the Joginder Nagar Herbal Garden

With little investment, the institute could easily become a hub for the display of good cultivation practices for medicinal plants. Since the specimens available in the garden as well as the herbarium are so plentiful, it would be worthwhile to place this institute on the tourist map of Himachal Pradesh as has been recommended by the PI in the case of Jammu and Kashmir also. The display of exotic medicinal plants, their properties, followed by a live demonstration of how decoctions are prepared could all be combined to become an interesting and educative visit for tourists. An explanation about the properties of the herbs followed by serving a freshly made decoction would help propagate the benefits available.

The Institute seems to have immense scope for partnering with universities and colleges to be able to have lectures and hands on display of the cultivation of medicinal plants for those pursuing courses on botany, pharmacology and Ayurvedic Dravyaguna. The Institute also offers an excellent location for meetings


of State Medicinal Plant Boards. Even if the temperate climate available at Joginder Nagar is unique only to Himachal Pradesh and other mountain states, it should be possible to engage stakeholders from Uttarakhand, Sikkim and the North-Eastern States in an exchange of experiences. This would facilitate interaction between cultivators, collectors and tribal people, and give greater visibility to the Institute. The Department of AYUSH/ NMPB should consider setting up a group of experts both from the academic field of botany, medicinal plant cultivation as well as tourism to use the potential of this institution to benefit a wider group of stakeholders and build awareness about the potential of plant-based decoctions (fresh and dry).

Joginder Nagar Pharmacy

The PI held discussions with the Manager of the pharmacy on methods of procurement of raw material, processing, manufacturing and supply of various formulations. The pharmacy which was established in 1953 has over 5000 square meters of covered space. As against 93 sanctioned positions of pharmacy staff, only 44 were in position. The cost of medicines prepared in 2011-12 was about Rs 1.5 crore and the total expenditure on raw material was around Rs 80 lakh. Many among the pharmacy staff complained about outdated equipment which was in poor condition, so exposing them to risk. There is considerable scope for upgrading this pharmacy but what is essentially needed is more vibrant leadership. According to the figures given to the PI, the annual production capacity was 300 quintals but both in terms of land availability, proximity to the Joginder Nagar herbal garden, and the Ayurvedic Pharmacy College located next door, there is immense potential for increasing production. Human resources, plant material and space being

readily available, with greater investment and co-ordination the pharmacy can expand production and provide sustained support to hundreds of Ayurveda dispensaries. In Himachal Praesh the Ayurvedic dispensaries are widely used by the local population living in dispersed hamlets and villages.

Owing to problems of leakage, seepage and fungus, which are common in hilly places, it is unlikely that supply of medicines procured from other States would remain in good condition for long. It would be far better to augment the supply from within the State and to see that at least 30 high-quality medicines produced by the State pharmacies are collected by the District Ayurveda Officers every quarter. Steady availability of at least basic medicine would give a huge spurt to the propagation of Ayurveda. Almost universally, every District Ayurveda Officer and the patients that the PI interacted with showed a strong preference for medicines manufactured at the government pharmacies, and there was a persistent complaint that the supply of Ayurvedic drugs was irregular.

The PI also visited the College of Ayurvedic Pharmaceutical sciences at Joginder Nagar. Classes were in active progress at the college which the PI visited without any notice. The students (predominantly girls) showed interest in what was being taught.

Entrance to the Joginder Nagar College for Pharmaceutical Sciences


Picture shows that girl students dominate at the Pharmacy College

Rajiv Gandhi Government PG Ayurvedic College and Hospital, (RGGPGAC&H) Paprola, Kangra

The PI visited the hospital and met the acting Principal Dr. YK Sharma, Dr. Eena Sharma, Dr. Sanjeev Sharma and the District Ayurveda Officer. She went around the hospital wards and observed the medical conditions for which patients were admitted. Strategies to help people quit smoking seemed a priority for the Institute as many hill people are heavy smokers and suffer from respiratory diseases.

View of the Rajiv Gandhi Post Graduate Ayurvedic College & Hospital (above),

Dr. YK Sharma and Faculty members (below)

Picture shows inpatient ward at the RGGPGA Hospital

Although Dr.Y.K. Sharma spoke about the faith of local people in Ayurvedic treatment, the general approach of the faculty gave the impression of greater focus on teaching and practising allopathic medicine as compared to other colleges visited by the PI. Particularly in the area of gynaecology and obstetrics, it was argued that the hospital as well as the faculty was entitled to perform surgeries and use modern medicine based on a letter issued by the Ministry of Health and Family Welfare. (Annexure-V)

Apart from the R.G.G.P.G. Ayurvedic College, Paprola the following activities were also reported for promoting different aspects of Ayurveda:

I. Zonal Centre of Excellence for Geriatrics, Paprola had received Rs. 5 crore from the Department of AYUSH, Government of India for establishing a 20-bed state-of-the-art hospital to cater to geriatric patients.

II. A pilot project on Anaemia-free Himachal Pradesh was started under NRHM.

III. 155 Ayurvedic medical officers had been appointed at various PHC/CHCs under NRHM.

IV. Kwathshalas have been set up at various hospitals to provide fresh decoctions to patients.


V. Panchkarma treatment centers had been expanded from six to sixteen and Kshar Sutra Centres increased from two to nine.

VI. Fifty-seven training camps had been organized to train farmers in medicinal plant cultivation.

District visits

The PI was able to hold discussions with seven out of 12 District Ayurvedic Officers during the course of her tour to those districts. Some of the observations are described below.

Kullu

The PI held discussions with Dr. Baldev Awasthi, District Ayurvedic Officer (DAO), Kullu. He was very knowledgeable about the dispensaries under his charge and had all details at his fingertips. It was clear that he was undertaking regular tours. However asked whether the dispensaries were having sufficient stock of Ayurvedic medicine he indicated that drug supply was irregular and that affected patient attendance adversely.

Co-location: Regarding the status of co-location, there were five co-located facilities under NRHM and 63 Ayurvedic health centres (standalone facilities). The PI was not shown any co-located facility. However, it appears that in all the five co-located NRHM facilities there are no allopathic doctors and an Ayurvedic doctor functions as the in-charge of the facility.

Kangra

Kangra district has 227 Ayurvedic health centres dispensaries and just 10 co-located facilities under NRHM. Half the co-located facilities (five) are manned by Ayurvedic

doctors and the other half have modern medicine doctors. The PI was informed that in all the remote facilities it was only the Ayurvedic doctors who performed all the functions as In-charges.

Pancharukhi

The PI met Dr. Ashwini Sharma, a leading Ayurvedic private practitioner, and he explained how he had developed his practice over the last 25 years. He received a daily patient load of nearly 200 patients. The PI observed that he relied on Himalaya Drug Company’s single drugs which were available on his table while also dispensing Ayurvedic medicines in syrup form from a small compounding section within the clinic.

Dr. Ashwini Sharma at his clinic attending to patients (above) and packaged single drugs displayed

on his table (below)


Private practitioner Dr. Ashwini Sharma’s crowded clinic

At the time that the PI visited his clinic

there were numerous patients waiting for

consultation. Dr. Ashwini said he charged

Rs.70/- for a three-day supply of medicines

but did not ask for consultation fee. The PI

found that the patients were from different

economic backgrounds. Patients with high

fever were also lying on the benches awaiting

consultation. This was unusual as in most

States (except in South India), the tendency

is to start on a course of modern medicine

as soon as there is any fever. Dr. Ashwini

Sharma seemed to be relying substantially

on Ayurvedic medicine which seemed to have

high acceptance among the patients.

Nagrota Bagwan

This place is in Kangra District where the PI

visited the residence-cum-clinic of Dr. Manik

Soni and Dr. (Mrs.) Soni, private practitioners

who were products of the Ayurveda College

at Paprola. The clinic stocked a wide range

of both Ayurvedic and allopathic medicines

and the husband-wife couple saw patients

anytime of the day or night. According to

Dr. Soni, patients just rang the bell and

when required he would provide emergency

treatment for acute conditions, at night. This

included administration of intravenous fluid

and injections and life-saving drugs.

Dr. Manik Soni at his clinic inside his residence

Hamirpur

The PI visited the District Ayurvedic Hospital and held discussions about various facilities and services like panchakarma, Ksharasutra which were being provided at the hospital. She took a round of the indoor wards and asked the admitted patients about the treatment being provided to them. They appeared satisfied.

View of the District Ayurvedic Hospital, Hamirpur


She was informed that Hamirpur had 69 Ayurvedic Health Centres. There are only two co-located facilities under NRHM one of which was manned by an Ayurvedic doctor exclusively.

Bilaspur

The PI met Dr. Uttam Chand Chandel, the District Ayurveda Officer who told her that except for shortage of drugs the Ayurvedic system had great public support in the State. There were 65 Ayurvedic dispensaries/centres but just two co-located facilities, both manned exclusively by Ayurvedic doctors.

Shimla

The PI had a useful meeting with Shri Ali Raza Rizvi, Principal Secretary, Health & Ayurveda Government of Himachal Pradesh who chaired the meeting. The Director of Ayurveda Shri P.S. Draik, Shri Rameshwer Sharma, Additional Director and Dr. Rakesh Pandit, OSD, Directorate of Ayurveda and Dr. Om Raj Sharma, Assistant Director, ARRI, Mandi were present at the meeting. Shri Ali Raza Rizvi, Principal Secretary was aware that Ayurvedic Doctors were manning the PHCs in remote areas and that most of the allopathic doctors recruited under NRHM (42 out of 155) were posted in Shimla District. It was evident that integration of health services from the patient’s point of view had not taken place even when Himachal was one State where public faith and acceptance of Ayurveda was comparatively high.

Regional Ayurvedic Hospital, Shimla

The PI visited the hospital and viewed various facilities offered at the hospital. She held discussions with Dr. SK Sharma, Medical Superintendent, the District Ayurveda Officer and other medical officers about various

projects and programmes undertaken by the hospital and the general response of the public. She took a round of the indoor wards, the kwathashala and the panchakarma and ksharasutra units. The annual OPD (from 1.4.2011 to 31.3.2012) had provided treatment to 45,000 patients.

View of Ayurveda Regional Research Institute, Shimla

Medical store at Shimla Regional Ayurvedic Hospital

Dr. Asha Sharma attending to a patient at Shimla Regional Ayurvedic Hospital


Kwathasala at Shimla Regional Ayuvredic Hospital

Quatha containers at Kwathasala, Shimla Regional Ayuvrvedic Hospital

The PI also met Vaidya Kripa Ram, a traditional healer from Arki village who displayed many varieties of medicinal herbs for treating chronic diseases. The healer was prepared his own decoctions and supplied them, and was being awarded respect by the regular doctors.

Vaidya Kripa Ram – a local healer

Solan

The PI visited the District Ayurvedic Hospital and held discussions with Dr. Hemraj Sharma, District Ayurveda Officer about

various facilities available. He informed that Ayurvedic doctors provided health services in institutions where allopathic physicians were not available. The data showed that there were 76 Ayurvedic facilities and three Co-located NRHM facilities where three modern medicine doctors were available.

Gleaming, new OPD hall at Solan Ayurvedic Hospital

Interaction with private practitioners

The PI also interacted with Vaidya Ram Kumar Bindal, a popular Ayurvedic practitioner who shared his experience of 40 years practice. He mentioned that he had maintained documentary evidence of his patients and also ran an Ayurvedic Pharmacy. The claim to have cured cancer and other intractable diseases was made with great confidence.

View of a private Ayurvedic Clinic at Solan


Vaidya Ram Kumar Bindal, traditional Ayurvedic practitioner along with Dr. Hem Raj Sharma,

District Ayurvedic Officer

Suggestions for Reorganization made by AYUSH doctors from Himachal Pradesh The state governments should give regular AYUSH doctors (non-contractual) the responsibility for both coordination and monitoring medical and health activities at the block and below block level and their output should be a part of the NRHM reporting systems in specific terms. The AYUSH Doctor (non-NRHM) can then use his/her special education and training to additionally spread AYUSH concepts of preventive health in the community and can supervise the use of AYUSH drugs, planting and utilization of medicinal plants for which he has full knowledge. Such a move would provide the services of a senior person to coordinate between stakeholders. The district functionaries in charge of RCH, tuberculosis and Nutrition would have the advantage of better inputs from a medical functionary with 10-20 years service, who can be easily oriented to report on location specific features of each programme. The strategy will require a policy decision through the NRHM hierarchy and would require the AYUSH doctors (non-NRHM) to get assimilated into the NRHM reporting systems and organizational hierarchy. Such doctors (as opposed to the NRHM contractual doctors) have several years of experience and know the district and the talukas intimately.

Conclusion and Recommendations

The State has a natural advantage as the faith in and the use of Ayurveda is very strong and widely respected. The State Government has invested funds and time into expanding the infrastructure. However, there was a universal paucity of drugs for which the potential of

the State pharmacy and the herbal garden at Joginder Nagar needs to be exploited.

The suggestions made by AYUSH doctors in Himachal Pradesh regarding reorganisation of the AYUSH manpower in the state needs to be discussed and the view taken. The suggestions have weight but they are state specific.

Jammu & Kashmir (2-5 September 2012)

The State of Jammu and Kashmir has established one 25-bed Ayurvedic Hospital at Jammu and one ten-bed Ayurveda/Unani facility attached to 17 district hospitals. The Regional Research Institute of Unani Medicine under CCRUM and the Regional Research Institute of Ayurvedic Medicine also have attached hospitals. There are 485 standalone AYUSH dispensaries, and co-location has been done at 396 PHC’s using 438 doctors appointed under NRHM. During 2010-11 over 20 lakh patients received treatment in the standalone dispensaries and other AYUSH facilities excluding the number of patients treated in the co-located facilities under NRHM. Over 1000 patients received indoor treatment during the year. It was reported that 90 percent of the co-located PHCs have AYUSH doctors who had received induction training under NRHM.

The State does not have a single government college for Ayurveda and Unani medicine in the public sector, there being only three private colleges in the State, one in Jammu Division and two in Kashmir Division. Without any educational institution in the public sector, research and specialization may not develop. Two private Medical Colleges one each for Kashmir and Jammu Division are under construction which will fill the gap of doctors to some extent.

The PI was accompanied for most of the visit by Dr. Kabir Dar, the Director (ISM) of the State.

During the PI’s visit to the State, it was


lamented out that there was huge expenditure on propagating general health benefits under NRHM but no money had been made available for conducting training or issuing advertisements for the propagation and promotion of AYUSH systems. Hence awareness about how the systems could benefit the public was poor. The Director (ISM) felt that a separate budget provision was needed to conduct seminars at the block/tehsil/district levels and for publishing best practices and the beneficial effects of Ayurvedic and Unani systems for preventive and promotive healthcare. Besides, intra-AYUSH (Unani to Ayurveda and vice-versa) cross-referrals need to be encouraged for which there is a need for better understanding among the Ayurveda and Unani doctors.

Overall, the number of facilities was quite extensive. There were 485 standalone facilities which compared favourably with the provision of public sector allopathic facilities excluding sub-centres. There was one Government AYUSH doctor for every 16,000 people (compared to one Allopathic doctor for 12,000 people. Ayurveda and Unani are the dominant systems in Jammu & Kashmir although the Amchi system is also prevalent. Over 90 percent of the PHCs have been co-located and AYUSH doctors are available but it was reported that in remote, rural and underserved areas only the AYUSH doctor were managing the facilities. The general perception was that the quality of AYUSH services was better in the standalone facilities as compared to the co-located facilities. As a result of this and as has been pointed out by the report done by NHSRC3, in the absence of drug supply it is the AYUSH doctors who have been mainstreamed and not the system. The findings of the report and the PI’s

observations point to give wider orientation to the contractual AYUSH doctors which goes beyond the national programmes as they are doing general allopathic practice most of the time. Presently there are no guidelines or restrictions on what they can and cannot do.

Pharmacies and Drugs Supply

A State pharmacy has not been commissioned and drugs are being purchased using the State budget allocation which is not being released regularly. Sometimes drugs are purchased as part of the centrally sponsored scheme under the Department of AYUSH, Government of India. No supplies had been received through NRHM during the last three years. The stock position of drugs was reported to be unsatisfactory.

Practice of modern medicine by AU doctors

It was pointed out that the responsibilities to be fulfilled by Ayurvedic/Unani doctors functioning as single in-charges of the Primary Health Centres, had not been issued. These doctors were conducting deliveries/postpartum procedures and were attending to emergencies according to their own competence. They were being put on night duty/emergency roster duty regularly. The PI was told that a proposal to notify the use of essential allopathic medicine by AYUSH doctors was under active consideration of the health department and had been submitted by the Directorate of Indian systems of medicine for consideration.

The introduction of regimental therapy like cupping, leeching and panchakarma procedures in the regular AYUSH facilities had increased the demand for OPD services and this has resulted in a growing interest among the public about the benefits of these systems.

3. Ritu Priya and Shweta A.S. Status and role of AYUSH and Local Health Traditions under the National Rural Health Mission – Report of a study, National Health Systems Resource Centre (NHSRC), National Rural Health Mission, Ministry of Health & Family Welfare, Government of India, New Delhi, 2010.


Ayurvedic Panchakarma had been introduced in many facilities and the quality of tables and other equipment was very good.

Referrals: a system of referrals did not seem to exist at any of the places visited by the PI. while it was claimed that a large number of cases were being referred by allopathic doctors but when even one document was asked to be seen, it was evident that such referrals were being made orally only. This is not in keeping with the guidelines issued for mainstreaming and steps need to be taken to overcome the resistance of allopathic doctors to writing simple referrals.

Supervision and Reporting systems

The Director (ISM) and his hierarchy of AYUSH doctors do not have any role to play in the NRHM organizational structure and reporting systems. Only AYUSH doctors can oversee and suggest correctives when it comes to the work of the AYUSH doctors recruited under NRHM. Unless the Director (ISM) has an official position, he has no authority to check the AYUSH work being done in the public health institutions. The tendency to do only allopathic work as backup support for NRHM and public health activities is growing and the objective of positioning AYUSH doctors will not be met, particularly if the supply of drugs also remains non-existent. Therefore, there is every need to strengthen coordination and reporting systems and the Director (ISM) has a specific role to play in the State Health Society. Ideally, all the district officers ought to coordinate and report on the AYUSH component of the work being done in the co-located facilities.

Harmonization and integration

There is every need to sensitize the AYUSH contractual doctors and paramedics about their primary responsibility towards giving AYUSH treatment. Eventually, the patient will lose out and the money being spent on recruiting so

many contractual AYUSH doctors would be used only as a back-up to give relief to modern medicine doctors from getting posted in difficult places or having to undertake night duties. This needs to be corrected as without supervision by senior AYUSH doctors who have the technical knowledge of what ought to be done, the contractual AYUSH doctor will only work as an appendage or helpfill the gaps in the availability of regular modern medicine doctors. The latter may be welcomed by the contractual AYUSH doctors but would be short-circuiting the intention behind the policy of integration.

Tour Highlights

Srinagar

The PI visited the AYUSH centre located at the Government Medical College and the attached SHMS Hospital and the Jawaharlal Nehru Memorial Hospital, Srinagar.

Patients waiting at registration counter of the hospital

The PI was accompanied by Dr. Kabir Dar, Director (ISM) who had established an excellent rapport with all the allopathic doctors, including the Director, Health Services, Mission Director, NRHM, Principal, Govt. Medical College, and the Medical Superintendents of SMHS Hospital and JLNH, Srinagar. Good work was being done in the AYUSH setup and there was an air of involvement and professionalism. It was evident that given proper leadership there is a climate of mutual respect and acceptance of different systems could be built up. This kind of co-operation was not evident in any other State.


Gulmarg

The PI also visited the Primary Health Centre at Gulmarg. It was manned entirely by an AYUSH doctor.

View of the PHC, Gulmarg manned only by AYUSH doctor under NRHM

Director of ISM Dr. Kabir Dar speaking to NRHM AYUSH doctor working as I/C of PHC, Gulmarg

There were about five other persons present in a large PHC which had facilities for investigation as well as X-ray which were not being used. All beds were empty. The PI asked the Ayush doctor what work he did. It was admitted that no AYUSH medicine had been made available and since he functioned as the In-Charge of the PHC he had to perform all duties. He said he was confident about prescribing and administering IV fluids but when asked to demonstrate, he asked the AYUSH pharmacists to do the demonstration who in turn had to depend on the ward boy.

There is nothing exceptional about this situation. This is often the case in many other

parts of the country wherever regular allopathic doctors are hesitant or unwilling to get posted. Therefore the reality must be confronted. In case the AYUSH doctor is expected to attend to the administration of parenterals and to use emergency life-saving drugs, he should be trained and his competence should be overseen by a method of proctoring. It was evident that because the allopathic facilities at the sub-divisional headquarters at Tanmarg are located within a half hour drive, there is a complacency that real emergencies can be sent there. In that case it begs the question whether at all there is a need to maintain such a huge infrastructure if it is not being used. AYUSH doctors must therefore know the extent to which they are expected to use the modern medicine drugs and therapies, and the first priority ought to be towards providing AYUSH services and not only in stepping in to fulfill gaps created by the absence of the modern medicine doctor.

Shalimar Garden and Herbal garden at Nehru Memorial Botanical Garden (NMBG) Chasmashahie

In the evening the PI was taken to see an ancient Hammam (Turkish bath) which had been excavated during Mughal era at the Shalimar gardens in Srinagar. This was being restored so that visitors and tourists could see the traditional Bath in their original form.

Herbal garden at Nehru Memorial Botanical Garden (NMBG) Chasmeshahi

The PI was shown a herbal garden which was a part of the botanical garden. It was a good initiative to sensitize visitors about medicinal plants but stopped short of becoming a bridge to actually enable people to know how to use medicinal plants as home remedies. Since it was simply an ornamental garden, the purpose was served in a very limited kind of way. The PI suggested that there was immense scope to do


things differently, to heighten interest among visitors and tourists. It appears that funds that have been given by the ISM Department to the Directorate of Horticulture under Medicinal Plant Mission had not been used.

Pulwama

The PI was taken to visit the AYUSH standalone facility at Ratnipora Pulwama. The facility was very well attended and work was in progress even after working hours were nearly over.

AYUSH Centre at District Hospital, Pulwama

Display board showing facilities available at co-located AYUSH centre at District Hospital, Pulwama

Patient availing facility of wet cupping at AYUSH District Hsopital, Pulwama

Medical store at the District hospital

The PI was also taken to the AYUSH unit at the allopathic facility where also the interface with the allopathic doctor and the ISM doctors was quite collaborative. All facilities were neat and clean and Ayurvedic treatment was also being provided along with Unani treatment. There was no evidence of segregation of the two systems as is generally apparent elsewhere in the country.

Call on the State Health Minister

The PI called on Shri Sham Lal Sharma, Health Minister of J& K, which was very useful because he had a deep interest in the development of Indian Medicine and more importantly besides being Health Minister was also in charge of both Floriculture and Horticulture. This gave a rare opportunity to bring together the strengths of the three departments and in particular the Health Minister agreed that the strategy of promoting health tourism with special reference to the use of medicinal plants was something that the State was well positioned to undertake and which he would be taking up in due course of time.

Meeting with Chief Secretary and State Health Secretary

The PI appreciates that the State’s Chief Secretary Shri Madhav Lal (IAS) gave time to listen to all the developments that were brought to his notice. The State Health Secretary Shri MK Dwivedi was also present. The point


about non-availability of medicines and the fact that the contractual AYUSH doctors were being mainly used as backup support for doing the normal functions related to NRHM and public health was discussed and the Chief Secretary gave instructions on the subject.

The PI told them that although the level of participation and integration of departments like tourism, horticulture were excellent initiatives, perhaps a focus on medical tourism including a display of high altitude plants, their healing properties, a demonstration of the preparation of decoctions and a visit to an AYUSH facility would give both foreign and Indian visitors a better idea of how these systems work.

Directors from health sector and related departments at Srinagar

The Director (ISM) had taken the trouble of organizing a meeting with all stakeholders from the AYUSH and related sectors. The interactions turned out to be participatory and supportive of AYUSH. It was clear that the

Director (ISM), Dr. Kabir Das had built up good connections with the allopathic doctors at the helm of affairs. They had an open mind to integration and did not show the overt distaste for any talk of integration which was observed in other states. They were willing to find ways of making it easier for patients to avail of services and the atmosphere at higher levels for from being hostile was friendly and receptive.

The presence of officials from the Departments of General Health Services, Agriculture, Floriculture and Integrated Medical Research far from being symbolic showed their conversance with the AYUSH sector and its interface with other Departments. Their contribution was very positive.

Those present included:

1. Mr. Syed Iftikhar, Special Secretary, Health & Medical Education, J&K Government.

2. Dr. Yashpal Sharma, Mission Director, NRHM, J&K

3. Dr. Saleem-ur-Rehman, Director, Health Services, Kashmir

4. Dr. Abdul Kabir Dar, Director, Indian Systems of Medicine, J&K

5. Dr. AS Shawl, Sr. Scientist (Ex-HOD) Indian Iinstitute of Integrative Medicine (IIIM).

6. Mr. KA Qasba, Joint Director, Agriculture

7. Mr. Pran Dullo, Joint Director, Floriculture

8. Smt. Geeta Garg, Professor, Jammu Institute of Ayurveda Research

9. Dr. Krishana Kumari, Assistant Director, ARRI Jammu

10. Dr. Mohammad Iqbal, Principal, KTC Srinagar

11. Dr. Khurshid Ahmad Bhakshi, Principal, IAMS Srinagar

12. Dr. KS Manhas, Dy. Director, ISM, Jammu


13. Dr. Abdul Lateef, Assistant Director(Unani), ISM

14. Dr. Rakesh Kumar Raina, Assistant Director(Ayurveda), ISM

15. Mr. Munish Dutta, Assistant Director, ISM, Planning

16. Dr. Syed Ashiq Hussain, ADMO, Srinagar

Visit to 50-bed Government Unani Hospital

This is the first ever referral hospital providing Unani treatment and has taken several years to be completed and started. Located on the National Highway at Shalteng Srinagar, the OPD facilities have been started by internal arrangement of staff pending sanction of staff. Among other facilities this hospital provides the good facilities to patients through regimenal therapies of Unani Medicine like: Cupping (Wet & Dry), Hammam (Steam Bath), Massage, Leeching, and Ayurvedic Panchkarma procedures.

Intra-AYUSH cross-referral is very much available in the hospital which can become a model for other institutions. There was excellent display of the medicines available in stock so that the general public had an idea of availability, date of manufacture and date of expiry of the medicines. This was a commendable initiative.

The only Government Unani Hospital

Day care facility for Regimenal therapy

Hammam (steam bath) procedure at the hospital

Conclusions & Recommendation

The extensive use of AYUSH doctors to man PHCs in remote areas should be overseen. If they have to primarily provide modern medical services their training to do so would need to be upgraded.

There is a need to give a role to the Director (ISM) and his district Officers to supervise the availability of AYUSH drugs in co-located PHCs and to guide the AYUSH doctors about this primary aspect of their work.

The State has unique opportunity to capitalize on its strength as a high altitude State with huge tourist potential by organizing a live demonstrations of the strengths of medicinal plants by for visitors and tourists.

The linkages established with Floriculture and Tourism Departments need to be taken forward with greater enthusiasm. Finally, the


supply of AYUSH drugs must be overseen regularly as otherwise the goals set out under NRHM will not be achieved.

States Consulted

The PI wrote letters and sent a questionnaires to the States of Bihar, Uttarakhand, West Bengal and Madhya Pradesh to elicit information on specific aspects of AYUSH in those States. The letter and the questionnaire are at Annexure-VI and Annexure-VII, respectively.

Bihar

Infrastructure

There were five graduate level governments colleges, three private colleges and one post-graduate college. There was one graduate level Unani college under the government and three private colleges. There were 69 Ayurvedic and 30 Unani dispensaries. Under NRHM 1384 (704 Ayurvedic, 252 Unani and 428 Homoepathic) + 426 (50% Ayurvedic, 20% Unani and 30%Homoeopathic) functional facilities were being run on co-located basis. The annual IPD figures were not provided. Seven hundred and seventy-two Ayurvedic and 252 Unani doctors have been appointed under NRHM.

Pharmacies and Drug supply

The major supply of drugs was through the State Pharmacy, purchase made by the State Government and supplies from the Department of AYUSH. The stock position of AYUSH Drugs was stated to be unsatisfactory. The reasons for the state pharmacy being unable to produce more drugs was started to be due to shortcomings of infrastructure, manpower and funding.

Instructions have been issued to the DHs/MOs Incharge of CHCs & PHCs relating to

Ayurvedic/Unani doctors appointed under NRHM. Role and responsibilities guidelines had been issued by the State including on expected performance from Ayurvedic/Unani doctors positioned in co-located facilities.

No response was given on whether guidelines for patient counselling on the usefulness of Ayurveda/Unani treatment for specific conditions had been issued.

No guidelines had been issued on the combined use of allopathic and Ayurvedic medicine.

Government and private practice

There was no Government notification regarding the use of allopathic medicines by Ayurvedic/Unani doctors.

No response was given as to whether the State was providing allopathic drugs to Ayurvedic/Unani dispensaries run by the Government. Also, no notification or instructions had been issued relating to Medical practice by Ayurvedic/Unani practitioners using modern medicine under the Drugs and Cosmetics Act, 1940.

However, instructions had been issued on the responsibilities to be fulfilled by Ayurvedic/Unani doctors functioning as single Incharges in CHCs & PHCs so far as National programmes are concerned:

The reply given by the State stated that more grass root level awareness about Ayurvedic, Unani and Homeopathy medicines and the involvement of AYUSH Government and private doctors in the National health delivery system and implementation of different scheme is required. The use of local herbal medicinal products and traditional knowledge regarding prevention and promotion of health needs to be publicised.


Uttarakhand

Infrastructure

There are two government and three private Ayurvedic colleges with attached hospitals functioning in the State. There are 546 government Ayurvedic and Unani dispensaries and 183 functional facilities co-located under NRHM. One hundred and fifty-four doctors have been appointed for the PHCs and 29 for the CHCs making a total of 183 doctors. The annual OPD (2010-11) was 44,86,461 and the annual IPD (2010-11) was 51587. There was a growth in OPD attendance as well as bed occupancy over the previous year.

Pharmacies & Drug supply

It was reported that the drug supply from the State pharmacy was poor but the stock position of drugs was reported as satisfactory because of supplies received by Government of India agencies. The reason given for the State pharmacy being unable to increase production was shortage of skilled persons and shortage of funds.

Instructions had been issued to the DHs/MOs in-charge of CHCs and PHCs relating to Ayurvedic/Unani Doctors appointed under NRHM through an “Anubandh” (Annexure-VIII).

No guidelines had been issued relating to patient counselling on the usefulness of Ayurveda/Unani treatment for specific conditions. No guidelines had been issued regarding the use of Ayurvedic and Allopathic treatment in combination either.

Government and private practice

No notification has been issued regarding the use of essential allopathic medicines by Ayurvedic/Unani doctors under the national programmes. No supply of allopathic drugs was being made to Ayurvedic/Unani

dispensaries run by the Government. No guidelines had been issued regarding medical practice by Ayurvedic/Unani practitioners under the drugs and Cosmetics Act, 1940. Regarding instructions issued on the responsibilities to be fulfilled by Ayurvedic/Unani doctors functioning as single in-charge in CHCs and PHCs as far as the National Programmes were concerned, reference was made to the Anubandh signed by the doctor (Annexure-VIII).

The State Government recommended that the public can be benefited through Ayurveda both in urban and rural areas particularly for rejuvenation but there was a need to counsel them about specific diseases.

West Bengal

Infrastructure

There State has three government and one private Ayurvedic college and one private Unani college with attached hospitals. There are 295 state Ayurvedic dispensaries, 200 Gram Panchayat Ayurvedic dispensaries and four Unani dispensaries. There are no co-located facilities under NRHM.

The annual OPD in 2010–11 of the AYUSH facilities was 7,11,429.

The State reported 20 percent increase in patient attendance compared to the previous year.

The annual IPD in 2010-11 was 28,137 (Bed days) with a 10 percent increase in patient-bed occupancy compared to the previous year.

Pharmacies & Drug supply

The State pharmacy supplied 40 percent of the required medicines and the remaining drugs were purchased from IMPCL using the Grants-in-aid provided by Government


of India, Department of AYUSH. The stock position of drugs was stated to be satisfactory. The reason given for the State pharmacy being unable to increase production was stated to be on account of the pharmacy staff which had been resolved.

Modern Medicine Practice, Performance Levels and Patient Counselling

There being no co-located facilities and no appointments made under NRHM, no instructions had been issued. Asked whether there were any guidelines issued for patient counselling on the usefulness of Ayurveda and Unani treatment, the response was that standard operational guidelines existed, but these were not sent to the PI. It was also stated that there were standard operational guidelines in force regarding the combined use of Ayurvedic and allopathic medicines but no such document was sent. The response stated that there was no notification relating to the use of essential allopathic medicines by Ayurvedic/Unani doctors under the national

programmes and nor was there any supply of allopathic drugs to Ayurvedic/Unani dispensaries run by the Government.

No instructions had been issued regarding modern medical practice by Ayurvedic/Unani practitioners under the Drugs and Cosmetics Act, 1940 and no instructions had been issued relating to the responsibilities of Ayurvedic/Unani doctors functioning as single in-charges in CHCs and PHCs. However, the State Government had constituted a Committee to review the matter of allowing AYUSH doctors to prescribe life-saving allopathic drugs during emergency. The State AYUSH Department made the following suggestions:

All district hospitals should have Ayurvedic/Unani wings for which proposals had been included in AYUSH Project Implementation Plan (PIP) 2011-12 & 2012-13 sent to Government of India. The State reported that integration under NRHM was essential to promote pluralism in the interest of improving public health services.


Annexure-I List of Officers who attended meeting chaired by the

Commissioner-cum-Secretary, Health & Family Welfare, Government of Odisha at the request of the PI

1. Anu Garg Commissioner-cum-Secretary to Govt. of Health & F.W. Department

2. Pramod Meherda M.D., NRHM (O)

3. Dr. Upendra Kumar Sahu DHS (O)

4. Padmalochan Behera DIMH (O), Joint Secretary to Govt. of Health & F.W. Department

5. Dr. PK Das DMET (O)

6. Dr. BK Mishra Special Secretary to Govt. of Health & F.W. Dept.

7. PK Mallick Conservator, State Medicinal Plant Board, Odisha

8. Dr. MV Acharya Scientist, National Research Institute of Ay. Drug Development

9. Dr. RN Acharya Scientific Officer, DTL (ISM), BBSR

10. Dr. Surendra Kumar Mishra I/c Inspector of Ay. Eastern Circle, Bhubaneswar

11. Dr. LK Nanda Former Principal Dr.ACHMC&HC, Bhubaneswar

12. Dr. NP Naik Dy.Supdt., Govt.Ayurvedic Hospital, Bhubaneswar

13. Dr. Subham Allakhan R.R.I.U.M., Bhadrak

14. Dr. L Samiulla Dy. Director, R.R.I.U.M. Bhadrak

15. Dr. Manoranjan Mohapatra Consultant AYUSH, Odisha

16. Adait Kumar Pradhan SPM, NRHM (O)

17. Dr. Balakrishna Panda Joint (Director) Technical

18. RN Sethy Establishment Officer, DIMH (O)

19. Dr. Gaurav Giri Drugs Inspector (Ay.), DIMH (O)

20. Dr. BB Behera Dy. Director Homoeopathy, DIMH (O)

21. TD Hansda Accounts Officer, DIMH (O)

22. Dr. NP Hota A.M.O.-cum-R.O., DIMH (O)


Annexure-II List of Faculty Members the PI met at AK Tibbiya College, AMU, Aligarh

1. Prof. Saood Ali Khan, Principal and Chief Medical Superintendent

2. Prof. Shagufta Aleem, Dean, Unani Medicine

3. Prof. Mukhtar Husain Hakim, Prof. and Consultant Department of Moalijat

4. Prof. Abdul Mannan, Prof. and Consultant Department of Moalijat

5. Prof. MMH Siddiqui, Prof. and Consultant, Department. of Elaj Bit Tadbir (Regimental Therapy)

6. Dr. Misbahuddin Siddiqui, Associate Prof. and Consultant, Department of Moalijat

7. Dr. Tafseer Ali, Assistant Prof. and Deputy Medical Superintendent, A.K. Tibbiya College & Hospital

8. Dr. M Wasi Akhtar, Assistant Prof., Department of Moalijat

9. Dr. Mohd Belal, Guest Facility, Department of Amaraze jild

10. Dr. Younus Siddiqui, Associate Prof. and Consultant, Department of Moalijat

Other Expert present at the meeting:

Dr. Latafat Ali Khan, Deputy Director, RRIUM, Aligarh


Annexure-III Treatment of choice in Ayurveda and Unani for

Common Disease Conditions*

S. No.

Clinical condition

Ayurvedic Drug of Choice

Botanical Name Unani Drug of Choice

Botanical Name

1 Jaundice Kutaki Picrorhiza kurroa Royle ex Benth.

Nausadar —

Punarnava Boerhavia repens L. var. diffusa (L.) Hook.f. syn. Boerhaavia diffusa L.

Makoya Solanum nigrum L.

Bhumyamalki Phyllanthus amarus Schmach. & Thonn.syn. Phyllanthus fraternus G. L. Web.

Kasni Cichorium intybus L.

Arogyavardhini Vati

— Kutaki Picrorhiza kurroa Royle ex Benth.

Majoon-e-dabidulvarda

—

2 Cough with expectoration

Karkatshringi Pistacia integerrima Stewart

Kakrasingi Pistacia integerrima Stewart

Vasa Justicia adhatoda L. syn. Adhatoda zeylanica Medik.

Sapistan Cordia dichotoma Forst. f. syn. C. obliqua Willd.

Talishaadi Churna

— Adusa/Vasa Justicia adhatoda L. syn. Adhatoda zeylanica Medik.

Kantakari Solanum virginianum L. syn. Solanum surratense Burm.f.

Katan —

Amaltas Cassia fistula L.

Banafsha Viola pilosa Blume

3 Inflammation of Joints

Guggulu Commiphora wightii (Arn.) Bhandari

Suranjaan Colchicum luteum L.

Suranjaan Colchicum luteum L. Guggulu Commiphora wightii (Arn.) Bhandari

Kulanjan Alpinia galanga (L.) Swartz

4 Fever Guduchi Tinospora cordifolia (Willd.) Hook. f. & Thomson

Karanjava Caesalpinia bonduc (L.) Roxb. emend. Dandy & Exell

Sudarshan Crinum asiaticum L. Giloy Tinospora cordifolia (Willd.) Hook. f. & Thomson

* The list was compiled by Dr. Pradeep Dua, Research Officer (Ayurveda), Central Council for Research in Ayurvedic Sciences, New Delhi who accompanied the PI.


S. No.

Clinical condition



Botanical Name

Chirayata Swertia chirayita (Roxb. ex Flem.) Kars. syn. S.chirata (Wall.) Clarke

Khaksi Sisymbrium irio L.

Afsanteen Artemisia absinthium L.

5 Hyperacidity Muletthi Glycyrrhiza glabra L. Amla Phyllanthus emblica L.syn. Emblica officinalis Gaertn.

Amla Phyllanthus emblica L.syn. Emblica officinalis Gaertn.

Papita Carica papaya L.

Shatavar Asparagus racemosus Willd.

Muletthi Glycyrrhiza glabra L.

Tabasheer —

6 Hypertension Sarpagandha Rauwolfia serpentina (L.) Benth. ex Kurz

Sarpagandha Rauwolfia serpentina (L.) Benth. ex Kurz

Ashwagandha Withania somnifera (L.) Dunal

Asrol Rauwolfia serpentina (L.) Benth. ex Kurz

Punarnava Boerhavia repens L. var. diffusa (L.) Hook.f. syn. B. diffusa L.

Tukhm-e-hayat —

Arjuna Terminalia arjuna (Roxb. ex DC.) Wight & Arn.


Badi Elaichi Elettaria cardamomum (L.) Maton

7 Diabetes Mellitus

Jamun guthli Syzygium cumini (L.) Skeels

Jamun guthli Syzygium cumini (L.) Skeels

Karela Momordica charantia L.

Karela Momordica charantia L.

Gudmaar Gymnema sylvestre (Retz.) R. Br. ex Schult.

Gudmaar Gymnema sylvestre (Retz.) R. Br. ex Schult.

Methi Trigonella foenum-graecum L.

Methi Trigonella foenum-graecum L.

Kalaunji Nigella sativa L. Kalaunji Nigella sativa L.

Sadabahaar Catharanthus roseus (L.) G. Don

Sadabahaar Catharanthus roseus (L.) G. Don

Vijaysaara Pterocarpus marsupium Roxb.

Vijaysaara Pterocarpus marsupium Roxb.


S. No.

Clinical condition



Botanical Name

Paneer doda Withania coagulans (Stocks) Dunal

Tukhm-e-hayat / Paneer doda

Withania coagulans (Stocks) Dunal

Shilajeet — Shilajeet —

8 Diarrhoea Bel Aegle marmelos (L.) Correa

Bel Aegle marmelos (L.) Correa

Kutaja Holarrhena pubescens (Buch.-Ham.) Wall. ex G. Don syn. Holarrhena antidysenterica Wall. ex A. DC.

Atees Aconitum heterophyllum Wall. ex Royle

Jaharmohra —

indrajau Wrightia tinctoria (Roxb.) R. Br.

Marodaphali Helicteres isora L.

Gizzard —

Jeera Cuminum cyminum L.

Triphala —

9 Eczema Haridra Curcuma longa L. Chirayata Swertia chirayita (Roxb. ex Flem.) Kars. syn. Swertia chirata (Wall.) Clarke

Chirayata Swertia chirayita (Roxb. ex Flem.) Kars.syn.Swertia chirata (Wall.) Clarke

Shahtara Fumaria indica (Haussk.) Pugsley syn. F. vaillantii Loisel.

Neem Azadirachta indica A. Juss.

Sarfonka Tephrosia purpurea (L.) Pers.

Neem Azadirachta indica A. Juss.

Mehandi Lawsonia inermis L.

Kalaunji Nigella sativa L.

Jaitoon oil Olea europea L.

10 Cardiotonic Amla Phyllanthus emblica L. syn.Emblica officinalis Gaertn.

Amla Phyllanthus emblica L.syn.Emblica officinalis Gaertn.



Mukta — Marvareed/ Mukta

—

Abresham Bombyx mori

Ghulab Rosa centifolia L.


S. No.

Clinical condition



Botanical Name

Kewara Pandanus odoratissimus Roxb.

Turanja Citrus limon (L.) Burm.f.

Gajvan Onosma bracteatum Wall.

Tukhm-e-raina —

Zaafran Crocus sativus L.

11 Leucorrhoea Mocharasa Bombax ceiba L. Mocharasa Bombax ceiba L.

Lauha bhasma Marvareed —

Kadali svarasa Musa sapientum Majoon-e-dabidulvarda

—

Kanchanaara Bauhinia variegata Sharbat-e-faulaad

—

Ark Makoya Solanum nigrum L.

12 Menstrual Regulator

Ashok Saraca asoca (Roxb.) de Wilde

Ashok Saraca asoca (Roxb.) de Wilde

Hansaraj Adiantum philippense L. syn. A. lunulatum Burm.f.

13 Constipation Sanay Cassia senna L.syn.Cassia angustifolia Vahl

Sanay Cassia senna L.syn.Cassia angustifolia Vahl

Eranda Ricinus communis Banafsha Viola pilosa Blume

Ghulab Rosa centifolia L.

Nilofar Nymphaea alba L.

14 Hemostatic Lodhra Cissempelos pereira Kehroba —

Doorva Cynodon dactylon Habis —

Muletthi Glycyrrhiza glabra L. Geru —

Sangejarahat —

15 Bronchial Asthma

Karkatshringi Pistacia integerrima Stewart

Barahsingi kushta

—

Vasa Justicia adhatoda L. syn. Adhatoda zeylanica Medik.

Kantakari Solanum virginianum L. syn. Solanum surratense Burm.f.

Banafsha Viola pilosa Blume

16 Chronic Sinusitis

Haridra Curcuma longa L. Kusht-e-marjaan (corals)

—

Lakshmivilasa Rasa

Khamira gajvaan

Onosma bracteatum Wall.


S. No.

Clinical condition



Botanical Name

Sitopaladi Churna

Shadbindu Taila

17 Urinary Calculus

Varuna Craeteva nurvalla Kulthi Vigna unguiculata (L.) Walp. syn. Dolichos unguiculatus L.; D. biflorus L.

Kulattha Dolichos biflorus Hajrul yahood —

Pashanbheda Berginia ciliata Majoon Sange Saremaahi

—

Bhutta ka resha

Zeamays L.


Annexure-IV Letter of the PI to Principal Secretary, Andhra Pradesh*

Subject: Report on the Status of Indian Systems of Medicine with Special Reference to the Benefits the Systems has given the Public. Principal Investigator: Shailaja Chandra.

Dear Shri Kishore,

Background: This refers to earlier correspondence from the Department of AYUSH which is attached for ready reference. There has been some delay in visiting Andhra Pradesh which I hope to make good now.

Part I of the report titled “Status of Indian Medicine and Folk Healing -- with special reference to Benefits that the Systems have given to the Public” was published and has been with the Government last September. If you have not received a copy, I will bring it with me and in the meantime it can be seen on the internet at http://reporttraditionalindianmedicine.blogspot.in/

I have now started work on Part II of the Report. Generic points which apply to all Ayurvedic and Unani institutions and programmes have been covered in detail in Part I and these will not be repeated in Part II as they are applicable to all such activities, subject to Government’s acceptance of the recommendations.

Visit to Andhra Pradesh to observe Medical Pluralism: During the forthcoming state visit to AP, I wish to observe the ground realities relating to the utilisation of AYUSH treatment at the District hospital, the CHCs and PHCs to enable me to suggest how we can deepen the existing pluralistic health policy framework to make it more robust and functional. No other country in the world gives legal recognition to so many systems of health care. Today the NRHM through its stated policy of integrating AYUSH already has an operational framework for implementing pluralistic health strategies.

Trends in Health Seeking Behaviour of Patients: The general behaviour of the public shows that pluralistic preferences in health behaviour are widespread but more so in some states. For different needs people go to different systems and at different stages of the progression of a medical condition. For emergencies, practically everyone relies on allopathy. But when there are acute conditions like diarrhoeal symptoms patients first try home remedies and then Ayurvedic/Unani medicine to avoid taking “strong” drugs. For chronic problems, including old-age related conditions people tend to rely on a combination of systems. Patients also try and reduce hypertension or blood sugar levels by taking ISM drugs side-by-side with allopathic drugs. They hope thereby to also reduce the intake of allopathic drugs.

Absence of Integration at the Operational Level: When to combine the systems and how to do it is purely a personal decision. Educational, research and health service institutions and practitioners have always operated in separate compartments leaving the patient to decide. True integration if built upon operational guidelines, case studies and protocols giving useful

* This is the typical template used in the letters sent to the State Governments.


information to the patient would be more meaningful instead of leaving the patient to try permutations and combinations on the basis of limited knowledge. While physical integration has begun with the co-location of health facilities and practitioners from different systems under NRHM, presently there is no system of counselling or of following protocols either for the doctors or the patients.

Meeting with the Principal Health Secretary: As the Health Secretary of the state, I would feel privileged to have your views on how you feel the Indian systems of medicine can be integrated in a more organised way down to the patient's level so as to make better use of the systems. If you could kindly chair a meeting it would help me to get the responses of clinicians –both allopathic and having Ayurvedic/ Unani background. It would be more like a brain-storming viewing the realities in the context of patient behaviour and the need to have broad operating guidelines to deal with such pluralistic demands.

Advice of Private Practitioners at Brainstorming meeting: It is not necessary that we restrict the discussion only to government facilities and doctors. The presence of private practitioners might also be useful- particularly covering areas where patients tend to use both the allopathic and Ayurvedic/Unani systems simultaneously. Arthritis, bronchial asthma, skin related conditions, liver disorders, women’s and children's problems, infertility treatment are some of the areas- besides diabetes and hypertension.


Annexure-V List of Faculty & Staff PI met at the Rajiv Gandhi Government

PG Ayurvedic College and Hospital, Paprola

Dr. Yoginder Sharma Prof. & Head Department of Kayachikitsa

Dr. Bhagat Ram Sharma District Ayurvedic Officer, Kangra at Dharamshala

Dr. Ramesh Arya Prof. & Head Department of Shalya

Dr. Eena Sharma Prof. & Head Department of Stri & Prasooti Tantra

Dr. Sanjeev Sharma Prof. & Head Department of Asthi Sandhi Rog

Dr. Sanjeev Awasthi Reader & Head Department of Shalakya

Dr. Sushil Nag AMO, Casualty

Dr. Thakur Singh Bhatt AMO, Casualty

Dr. Virendra Kaul AMO, Casualty

Dr. Vikram Rana AMO, Casualty


Annexure-VI Letter sent to the Health Secretaries of West Bengal,

Uttarakhand, Bihar and Madhya Pradesh

Dear Health Secretary/Secretary in charge of Ayurveda and Unani Medicine

Subject: Status of Indian Medicine and Folk Healing with a focus on benefits that these systems have given the public.

As you are aware, a project titled “Status of Indian Medicine and Folk healing with a focus on Benefits that the Systems have given the public” is being pursued by me as commissioned by the Ministry of Health and Family Welfare, Department of AYUSH. In this regard, a letter had been written to you by the Joint Secretary in the Department and the copy is attached for ready reference.

When the first part of the project was undertaken, I had visited several states and sent detailed questionnaires relating to education, consumer preferences and the concerns of Industry to the colleges where Ayurveda, Unani and Siddha medicine are being taught; likewise questionnaires relating to consumer preference were got filled in as a survey. T he Associations representing the Ayurvedic, Unani and Siddha drugs industry were also contacted and responses obtained through the Association (ADMA.) The result of all these efforts as well as other research done by me has been published as Part I of the report. The Report is available on-line at http://reporttraditionalindianmedicine.blogspot.in

In order to do the above work, I had toured a large number of states but because of the need to submit my generic findings and recommendations before the 12th plan was finalised, it was not possible for me to visit all the states. As I undertake Part II of the project, I have begun visiting different states but the focus this time is different. The attached questionnaire seeks to collect information relevant to what is being covered in Part IIand I would be grateful if the questionnaire could please be got filled up and sent back to me for amalgamation in the Report.

I request you to entrust this task to a resourceful and knowledgeable officer so that the picture of your state is reflected fully.

With regards,

Yours sincerely,

Shailaja Chandra, (Principal Investigator)

Former Secretary Department of Ayush, Ministry of Health and Family Welfare, Government of India.


Annexure-VII Questionnaire sent to the Health Secretaries of States

Information required by Project Investigator Smt Shailaja Chandra (IAS Retd) for the project titled Status of Indian Medicine and Folk Healing with a focus on benefits that these systems have given the public.

Background: A project titled “Status of Indian Medicine and Folk healing with a focus on Benefits that the Systems have given the public” has been assigned to by me by the Ministry of Health and Family Welfare, Department of AYUSH.

When the first part of the project was undertaken, the Principal Investigator (the undersigned) had visited several states and sent detailed questionnaires relating to education, consumer preferences and the concerns of Industry to the colleges where Ayurveda, Unani and Siddha medicine are being taught; likewise questionnaires relating to consumer preference were got filled in as a survey. The Associations representing the Ayurvedic, Unani and Siddha drugs industry were also contacted and responses obtained through the Association (ADMA.) The result of all these efforts as well as other research undertaken has been published as Part I of the report which is available on-line at http://reporttraditionalindianmedicine.blogspot.in/

Part II of the project addresses concerns which were not covered in Part I. It is requested that information pertaining to your state may please be supplied within 15 days of receipt of this communication. If no response is received the information cannot be included in the Report and hence it may be sent within time.( All information is such as would be readily available with regional and district AYUSH officers.

1. Infrastructure:

Please give the number of Ayurvedic/ Unani institutions engaged in education, service delivery and other activities as follows:

(a) colleges, graduate and postgraduate __________________________________

(b) hospitals __________________________________

(c) health centres and dispensaries __________________________________

(d) functional facilities that are co-located under NRHM _______________________________

(e) annual OPD of all Ayurveda/Unani facilities in the state for last year (2010-2011)

_____________________________________________________________________________

(f) Whether there has been growth in patient attendance compared to the previous year.

_____________________________________________________________________________

(g) Annual IPD of all Ayurveda/Unani facilities in the State for the last year (2010 – 2011)

_____________________________________________________________________________

(h) Whether there has been growth in patient bed occupancy compared to the previous year. (Yes/No) ____________________________________________________________________


2. Pharmacies, Drugs Supply and Patient Guidelines

1. What percentage of drugs required for patients uses are being supplied by the state pharmacy? Are the remaining drugs coming from state purchase or are they supplied under NRHM or by Government of India, Department of AYUSH?

_____________________________________________________________________________

_____________________________________________________________________________

2. Is the stock position of drugs satisfactory?

_____________________________________________________________________________

_____________________________________________________________________________

3. What are the reasons, if any, for the state pharmacies being unable to produce the majority of drugs needed for government facilities?

_____________________________________________________________________________

_____________________________________________________________________________

4. What instructions have been issued to the district hospitals/medical officers in charge of CHCs and PHCs relating to the Ayurvedic/Unani practitioner appointed under NRHM? What is the AU doctor’s job responsibilities which have been issued in writing?

_____________________________________________________________________________

_____________________________________________________________________________

5. How many Ayurvedic/Unani doctors have been appointed under NRHM and are functioning from co-located hospital/primary health care facilities?

_____________________________________________________________________________

_____________________________________________________________________________

6. Are there any guidelines, operating practices or instructions issued by the state relating to the expected performance from the Ayurveda/Unani doctors positioned in co-located facilities?

_____________________________________________________________________________

_____________________________________________________________________________

7. Have any guidelines been issued for patient counselling on the usefulness of Ayurveda/Unani treatment for specific conditions?

_____________________________________________________________________________

_____________________________________________________________________________

8. Have any guidelines been issued about combined use of both Ayurvedic and allopathic treatment by the patients?

_____________________________________________________________________________

_____________________________________________________________________________


3. Government and private practice:

(a) Is there a government notification indicating that the Ayurvedic/Unani doctors can use essential, life-saving drugs and administer allopathic medicines to treat acute conditions in the event of there being no other doctor available. A copy of the orders may be made available Yes. No.

(b) Is the state supplying allopathic medicines and life-saving drugs to Ayurvedic/Unani dispensaries run by the state government? Yes. No.

(c) Are there any instructions/orders about medical practice by Ayurvedic/Unani practitioners issued under the Drugs and Cosmetics Act, 1940? Yes. No.

If yes, specify (with the copy of the order.)

(d) Please supply instructions issued on the responsibilities to be fulfilled by Ayurvedic/Unani doctors who are functioning as Single in-charges in PHCs and CHCs in so far as National Programmes are concerned.

4. Any other information:

The present project deals with how the public can be benefited through Ayurveda and Unani medicine.Itisgenerallyfoundthatpatientsaccesstraditionalmedicinesystemsontheirown—usually on word-of-mouth recommendations. Patients do not have an idea of the do’s and don’ts concerning the use of different systems together, at the same time. Under the Drugs and Cosmetics Act 1940 as well as under the policy of integration under NRHM, the effort has been to promote medical pluralism. Some states have taken steps to inform and educate the public and such best practices need to be shared with other states. Comments and advice in this regard would be appreciated.

_____________________________________________________________________________

_____________________________________________________________________________


Annexure-VIII Anubandh for AYUSH Doctors in Uttarakhand

vuqcU/k i= ¼,u-vkj-,p-,e-½ lafonk fpfdRld vk;qosZfnd@gksE;ksiSfFkd

eSa Mk0 &&&&&&&&&&&&&& iq=@ iq=h Jh &&&&&&&&&&&&&& fuoklh &&&&&&&&&&&&&&

,u-vkj-,p-,e- ds vUrxZr vk;qosZfnd@gksE;ksiSfFkd foHkkx lkeqnkf;d@izkFkfed@vfrfjDr izkFkfed

LokLF; dsUnª &&&&&&&& tuin &&&&&&&&&& mRrjk[ka.M esa lafonk fpfdRld ds in ij fnukaad &&&&&&&&& ls ,d o"kZ vFkok ;kstuk lapkfyr gksus rd tks Hkh igys ?kfVr gks ds fy, foHkkx }kjk

fu/kkZfjr fuEu lsok "krksZ dks Lohdkj djrk@djrh gWw&

1- ;g fd izFke i{k ¼foHkkx½ }kjk ubZ fu;qfDr ds le; mDr lsok dk ykHk fn;s tkus gsrq eSa dHkh

fdlh izdkj dk nkok ugha d:Wxk@d:WxhA

2- ;g fd izFke i{k ¼foHkkx½ ij fu/kkZfjr ekuns; vfrfjDr egaxkbZ HkRrk] edku fdjk;k HkRrk ,o vU;

fdlh Hkh izdkj ds HkRrs gsrq dksbZ nkok izLrqr ugha d:Wxk@d:WxhA

3- ;g fd foHkkx fdlh Hkh izdkj dh nq?kZVuk gksus ij ftEesnkj ugha gksxkA

4- ;g fd foHkkx ls fdlh Hkh le; dk;Z lUrks"ktud u ik;s tkus ij lafonk esa j[ks x;s vk;qosZfnd@

gksE;ksiSfFkd fpfdRld dks lsok ls fudkys tkus dk vf/kdkj eq>s ekU; gksxkA

5- ;g fd izFke i{k foHkkx }kjk fn’kk funsZ’kks dk ikyu ’kklukns’k la[;k office order No. 532-

chi.2-2002/261/2002, dated 26th July, 2002 ds vk/kkj ij ikyu djus dsk eSa viuh lgefr

nsrk gWw@nsrh gWwA mDr ’kklukns’k ds Øe ls eSa HkyhHkakfr ifjfpr gWw fd eq>sa fuEu dk;Z lEikfnr

djus gSA

a) Cykd esa rSukr leLr vk;qosZfnd ,oa gksE;ksiSfFkd fpfdRlkf/kdkjh] lkeqnkf;d LokLF; dsUnz@

izkFkfed LokLF; dsUnz dh ekfld cSBd esa Hkkx ysuk lqfuf’pr d:Wxk@d:Waaxh ftlls fd

foHkkxks esa csgrj LkeUo; LFkkfir gks ldsA

b) Tkuin Lrjh; vk;qosZfnd ,oa gksE;ksiSfFkd fpfdRlkf/kdkjh eq[; fpfdRlkf/kdkjh ds dk;kZy; esa

izR;sd ekg esa gksus okyh ekfld cSBd esa Hkkx ysuk lqfuf’pr djsaxsA

c) jktdh; vk;qosZfnd ,oa gksE;ksiSfFkd fpfdRlky; vkj-lh-,p dk;Zdze dh ekfld izxfr eq[;

fpfdRlkf/kdkjh@lkeqnkf;d LokLF; dsUnz ds fpfdRlkf/kdkjh@Cykd Lrjh; fpfdRlkf/kdkjh

}kjk miyC/k djk;s x;s fu/kkZfjr izk:Ik ij lkeqnkf;d LokLF; dsUnz ds fpfdRlkf/kdkjh@

Cykd Lrjh; fpfdRlkf/kdkjh dks miyC/k djkuk lqfu’pr djuk eq[; fpfdRlkf/kdkjh ds

Lrj ij ekfld izxfr ds ladyu esa foHkkxokj miyfC/k vyx ls fn[kk;h tk;sxhA eq[;

fpfdRlkfèkdkjh vuqJo.k gsrq iz;ksx esa yk;s tkus okys izk:Ik ,oa jftLVj vkfn vk;qosZfnd ,oa

gksE;ksiSfFkd fpfdRlkf/kdkjh dks miyC/k djk;saxs rFkk Hkfo"; esa mudh fujarj miyC/krk Hkh

lqfuf’pr djsaxsA

d) jktdh; vk;qosZfnd ,oa gksE;ksiSfFkd fpfdRlky; muds {ks= esa fdlh Hkh izdkj dh egkekjh

dh lwpuk lkeqnkfk;d LokLF; dsUnz ds fpfdRlkf/kdkjh@Cykd Lrjh; fpfdRlkf/kdkjh dks


rRdky miyC/k djkuk lqfuf’pr djsaxs ,oa mldh jksdFkke rFkk fu;=.k gsrq iw.kZ lg;ksx iznku

djsaxsA

e) jktdh; LokLF; ,oa ifjokj dY;k.k foHkkx }kjk leLr vk;qosZfnd ,oa gksE;ksiSfFkd

fpfdRlkfèkdkfj;ksa dk jk"Vªh; dk;ZØeksa gsrq lans’khdj.k djuk lqfuf’pr fd;k tk;sxk rFkk

leLr vk;qosZfnd ,oa gksE;ksiSfFkd fpfdRlkf/kdkfj;ksa tuin rFkk jkT; Lrjh; izf’k{k.k dk;ZØeksa

esa ,ykSisfFkd fpfdRlkf/kdkfj;ksa ds lkFk izfrHkkx djsaxsA

f) vk;qosZfnd ,oa gksE;ksiSfFkd fpfdRlkf/kdkjh ckg~; jksxh foHkkx ds ykHkkfFkZ;ksa dks jk"Vªh; dk;ZØeksa

ds lapkyu gsrq izkIr fn’kk funsZ’kks ds vuq:Ik lqfo/kk;s miyC/k djkuk lqfuf’pr djsaxsA

g) eq[; fpfdRlkf/kdkjh jk"Vªh; dk;ZØeksa ds lapkyu esa vk;qosZfnd ,oa gksE;ksiSfFkd fpfdRlkfèkdkfj;ksa

ds izHkkoh izfrHkkx gsrq dk;ZØe lEcU/kh lkexzh dh le; ls miyC/krk lqfuf’pr djsaxsA

h) iztuu ,oa cky LokLF; dk;ZØe esa Cykd Lrjh;@lkeqnkf;d LokLF; dsUnz@izkFkfed LokLF;

dsUnz }kjk fu/kkZfjr izkFkfed ikB’kkyk ds cPpks dk Ldwy gSYFk izksxzke ds vUrxZr fu;fer

fpfdRld LokLF; izf’k{k.k djkuk lqfuf’pr djsaxs ,oa bldh lwpuk Cykd Lrjh; lkeqnkf;d

LokLF; dsUnz@izkFkfed LokLF; dsUnz ds izHkkjh fpfdRlkf/kdkjh ;g ifjHkkf"kr dj nsaxs fd dkSu

ls Ldwy ij fdl fpfdRlkf/kdkjh dk Ik;Zos{k.k jgsxkA

i) vk;qosZfnd ,oa gksE;ksiSfFkd fpfdRlkf/kdkjh vks-ih-Mh- ds vUrxZr mipkj izkIr jksfx;ks esa ls

oSDlhu ls jksdFkke dh tkus okyh chekfj;ksa rFkk ethyl ,oa VsVul ls ihfMr cPpksa dh igpku

dj bldh lwpuk Cykd Lrjh; lkeqnkf;d LokLF; dsUnz@izkFkfed LokLF; dsUnz dks miyC/k

djkuk lqfuf’pr djsaxsA

j) vk;qosZfnd ,oa gksE;ksiSfFkd fpfdRld jktdh; fpfdRlky;ksa esa mfpr O;oLFkk gksus dh n’kk esa

ifjokj dY;k.k f’kfojksa dk vk;kstu djuk lqfuf’pr djsaxs ,oa fpfdRlky;ks esa mfpr O;oLFkk

miyC/k u gksus dh n’kk esa {ks= esa vk;ksftr gksus okys ifjokj dY;k.k f’fojksa esa viuk ,oa

fpfdRlky;ksa ds deZpkfj;ksa dks iw.kZ ;ksxnku nsuk lqfuf’pr djsaxsA egkfuns’kd LokLF; }kjk

funs’kd vk;qosZfnd ls fopkj&foe’kZ djrs gq, ,sls fpfdRlky;ksa dks bafxr djrs gq, lqn`< fd;k

tk;sxk tgkW ifjokj dY;kx f’kfoj Hkfo"; esa yxk;s tk ldrs gSA bldk foRr isk"k.k Hkkjr

ljdkj dh ;kstukvksa vFkok ckg~; O;kolkf;d ;kstukvksa esa fd;s tkus gsrq egkfuns’kd iz;kl

djsaxsA

k) Cykd Lrjh; lkeqnkf;d LokLF; dsUnz@izkFkfed LokLF; dsUnz }kjk fu/kkZfjr vk;qosZfnd ,oa

gksE;ksiSfFkd jktdh; fpfdRlky;ksa esa Vhdkdj.k f’kfojksa esa vk;kstu dh O;oLFkk lqfuf’pr

djsaxsA izfrj{k.k dk;Z gsrq oSDlhu rFkk vU; lkeku dh vkiwfrZ dh O;oLFkk Cykd Lrjh;

lkeqnkf;d LokLF; dsUnz@izkFkfed LokLF; dsUnz }kjk dh tk;sxhA

l) Cykd Lrjh; lkeqnkf;d LokLF; dsUnz@izkFkfed LokLF; dsUnz }kjk p;fur vk;qosZfnd ,oa

gksE;ksiSfFkd jktdh; fpfdRlky;ksa esa vkj-lh-,p- dSEi ,oa vkj-lh-,p vkmVjhp ls’ku vk;ksftr

fd;s tk;saxs ftlds fy;s iw.kZ O;oLFkk Cykd Lrjh; lkeqnkf;d LokLF; dsUnz@izkFkfed LokLF;

dsUnz ds }kjk dh tk;sxh ,oa bu vkj-lh-,p dSEi }kjk vkj-lh-,p vkmVjhp ls’ku esa vk;qosZfnd

,oa gksE;kiSfFkd fpfdRlkf/kdkjh rFkk deZpkjh iw.kZ lg;ksx nsuk lqfuf’pr djsaxsA


m) vk;qosZfnd ,oa gksE;ksiSfFkd fpfdRlkf/kdkjh jk"Vªh; dk;zZØeksa gsrq izkIr fn’kk&funsZ’kksa ds vuqlkj

lkefxz;ksa dk forj.k ykHkkfFkZ;ksa dks djuk lqfuf’pr djsaxs ftldh O;oLFkk Cykd Lrjh;

lkeqnkf;d LokLF; dsUnz@izkFkfed LokLF; dsUnz }kjk dh tk;sxhA

d ik= nEifr;ksa dks fujks/k forj.kA

[k ik= efgykvksa dh tkWp ds mijkUr vksjy fiYl dk forj.kA

Xk xHkZorh efgykvksa ,oa f’k’kqvksa dks vk;ju rFkk QkWfyd ,flM dk forj.kA

?k 3 o"kZ ds de vk;q ds cPpksa dks foVkfeu&, dh [kqjkd A

M nLr jksx ls ihfMr cPpksa dks vks-vkj-,l dk forj.k A

Pk xzh"e ,oa o"kkZ _rq esa tulk/kkj.k dks ikuh ls ?kfVr gksus okyh chekfj;ksa ls cpko gsrq

Dyksjhu dh xksfy;ksa dk forj.kA

N jk"Vªh; dk;Zdzeksa ds O;ikid izpkj&izlkj gsrq vkbZ-bZ-lh- lkexzh dk forj.kA

n) vU; jk"Vªh; dk;ZØe

(i) eysfj;k%&leLr jktdh; vk;qosZfnd ,oa gksE;kiSfFkd fpfdRlky; Toj mipkj dsUnz

,Q-Vh-Mh- dk dk;Z djsaxsA Toj ls xzflr jksfx;ksa dh jDr ifVVdk rsS;kj dj lkeqnkf;d

LokLF; dsUnzksa dks miyC/k djkuk lqfuf’pr djsaxs ,oa ,sls jksfx;ksa dks DyksjksDohu nok ls

mipkj djsaxsA

(ii) dq"B jksx %&leLr jktdh; vk;qosZfnd ,oa gksE;ksisfFkd fpfdRlky; ckg~; jksxh foHkkx

esa tkWaps x;s Ropk ,oa gYds jax ds nzO; ,oa xkBksa okys jksfx;ksa dks lkeqnkf;d LokLF;

dsUnz@izkFkfed LokLF; dsUnz esa dq"B jksx dh tkWp ,oa mipkj gsrq Hkstuk lqfuf’pr djsaxsA

lkeqnkf;d LokLF; dsUnz ds fpfdRlkf/kdkjh@Cykd Lrjh; fpfdRlkf/kdkjh ds fn’kk

funsZ’k vuqlkj dq"B jksx ls xzflr jksfx;ksa dks ,e-Mh-Vh miyC/k djkuk lqfuf’pr djasxsA

(iii) {k;jksx%&leLr jktdh; vk;qosZfnd ,oa gksE;ksiSfFkd fpfdRlky; okg~; foHkkx esa tkWps

x;s lEHkkfor {k; jksx ls xzflr jksfx;ksa dks lkeqnkf;d LokLF; dsUnz@izkFkfed LokLF;

dsUnz lEHkkfor djuk lqfuf’pr djsaxs ,oa lkeqnkf;d LokLF; dsUnz ds fpfdRlkf/kdkjh@

Cykd Lrjh; fpfdRlkf/kdkjh ds fn’kk funsZ’k vuqlkj {k; jksx ls xzflr jksfx;ksa dks {k;

jksx mipkj miyC/k djkuk lqfuf’pr djsaxsA

(iv) ,p-vkbZ-oh-@,Ml% leLr jktdh; vk;qosZfnd ,oa gksE;ksiSfFkd fpfdRlky; ckg~; foHkkx

esa tkWps@ns[ks x;s lEHkkfor ,p-vkbZ-oh-@,Ml@,l-Vh-Mh- jksx ls xzflr jksfx;ksa ds y{k.k

ds vk/kkj ij flUMªksfed VªhVesaV mipkj lqfuf’pr djsaxs ,oa ifjokj LokLF; tkx:drk

i[kokMk vfHk;ku esa iw.kZ lg;ksx iznku djsaxsA

(v) vU/krk fuokj.k dk;ZØe% leLr jktdh; vk;qosZfnd ,oa gksE;ksiSfFkd fpfdRlky; ckg~;

jksxh foHkkx esa tkWaps x;s o`) jksfx;ksa esa lEHkkfor eksfr;kfoUn ls xzflr jksfx;ksa dk

lkeqnkf;d dsUnz@izkFkfed LokLF; dsUnz@us= f’kfojksa esa tkWp ,oa mipkj gsrq Hkstuk

lqfuf’pr djsaxsA


buds vfrfjDr leLr jktdh; vk;qosZfnd ,oa gksE;ksiSfFkd fpfdRlk vf/kdkjh LokLF; ,oa

ifjokj dY;k.k }kjk pyk;s tk jgs vfHk;ku ¼iYl iksfy;ksa bR;kfn½ esa iw.kZ lg;ksx nsuk

lqfuf’pr djsaxsA

(vi) izfrj{k.k% leLr jktdh; vk;qosZfnd ,oa gksE;ksiSfFkd fpfdRlkf/kdkfj;ksa dks LokLF; ,oa

ifjokj dY;k.k egkfuns’kky; }kjk lapkfyr jk"Vªh; dk;ZØeksa ds rgr izf’k{k.k dk;ZØeksa

esa izf’k{k.k iznku fd;k tk;sxk fofHkUu dk;Zdzeksa esa vk;qoZsfnd fpfdRlkf/kdkfj;ksa ds

lkFk lkeatL; LFkkfir djrs gq, egkfuns’kd ¼LokLF;½ dk;ZØe fØ;kUo;u gsrq okafNr

ykftfLVd liksVZ lgk;d lkexzh lqfuf’pr djsaxsaA

mijksDr O;oLFkk ds fujUrj vuqJo.k gsrq jkT; Lrj ij egkfuns’kd ¼LokLF;½ ds v/khu ,d leUo; lSy

xfBr fd;k tkrk gS ftlesa vij funs’kd LokLF; izHkkjh jk"Vªh; dk;ZØe rFkk funs’kd vk;qosZfnd }kjk

ukfer uksMy vf/kdkjh ,d ekg ds vUnj la;qDr izf’k{k.k ,oa vU; fo"k;ksa ij viuh O;k[;k izLrqr djsaxsA

;g lSy bl O;oLFkk ds lQy lapkyu gsrq bldh fujUrj leh{kk djds lfpo fpfdRlk ,oa LokLFk;

dks voxr djk;saxsaA

6- ;g fd izFke i{k foHkkx }kjk vko’;drkuqlkj mRrjk[k.M {ks= esa dgh ij Hkh fu;qfDr@LFkkukUrfjr

djus ij eq>s dksbZ vkifRr ugha gksxhA

gLrk{kj

ftyk vk;qosfnd@gksE;kiSfFkd vf/kdkjh vkosnd ds gLrk{kj ,oa uke@irk

xokgksa ds uke@irk ,oa gLrk{kj

1

2

TRANSLATION OF “ANUBANDH”

I Dr.______________________ s/o / d/o Shri________________________ R/o________________

_____________________________ have been appointed at the Community/Primary/Other Primary Health Centre________________________________Uttarakhand in Department of Ayurveda/Homoeopathy under NRHM on the post of contractual doctor from date__________till one year or till the completion of programme whichever is earlier. I accept the following terms and conditions laid by the Department:

1. that I will not claim for the benefit of this service whenever the Department holds new appointments.

2. that I will not claim for HRA/DA/any other allowances other than the renumeration fixed by the Department.

3. that the Department will not be responsible for any kind of mis-happening during contractual period.

4. that in case of non-satisfactory service, my service shall be liable to be cancelled.


5. that I extend my consent for the acceptance of instructions issued by the office order no. 532-chi. 2-2002/261/2002 dated 26th July, 2002. I am well versed with the following terms and conditions under the above mentioned order:

a) To attend the monthly meeting of all Ayurvedic/ Homoeopathic doctors at CHC/PHC to ensure better coordination among all Departments.

b) To attend the monthly meeting of all Ayurvedic/ Homoeopathic doctors at District Level.

c) To submit monthly progress of RCH programme in the desired format to the CHC/PHC.

d) To immediately inform the Medical Officer Incharge or Block level Medical Officer of Community Health Centre (CHC) in case of an epidemic and extend full support to prevent and control it.

e) To participate alongwith their allopathic counterparts in the dissemination of messages under National Health Programmes (Under Dept. of Health & Family Welfare)

f) To provide services according to the instructions issued for the delivery of National Programmes for the benefit of OPD patients.

g) Chief Medical Officers would ensure timely availability of material to the Ayurvedic and Homoeopathic Medical Officers for their effective contribution in conduction of National Health Programmes.

h) To ensure regular medical health training to the children of primary schools allotted by the Chief Medical Officer under School Health Programme {Reproductive Child Health (RCH) programme through block level/CHC/Primary Health Centre (PHC)}.

i) To inform block level CHC/PHC about the number of children affected by measles, tetanus and other diseases falling under vaccination programme in the OPD.

j) To organize family welfare camps at State Government Hospitals/Dispensaries where all the facilities are available and in case of inadequate facilities, will extend full support to arrange family welfare camps in other places. Further, in discussion with the competent authorities, some dispensaries may be selected for upgradation. The financial support will be arranged by the Director General, Health through various schemes under Government of India.

k) To organize immunization camps in Ayurvedic and Homoeopathic state dispensaries selected by block level CHC/PHC. The vaccines and other necessary requirements will be fulfilled by the CHC/PHC.

l) To extend full cooperation in RCH camps and RCH outreach session organized by the block level CHC or PHC in selected Ayurvedic and Homoeopathic state dispensaries.

m) Ayurvedic and Homoeopathic MO’s would ensure distribution of material to the real beneficiaries according to the provisions under the National Programmes.

i) Distribution of “Nirodh” to couples


ii) Distribution of oral pills to the women after check-up

iii) Distribution of Iron and Folic Acid to pregnant ladies and children.

iv) Distribution of ORS to diarrhea infected children

v) Distribution of Vitamin-A supplement to children under the age of 3 years.

vi) Distribution of chlorine tablets for prevention of water borne diseases during summer and rainy season.

vii) Distribution of IEC materials for widespread promotion of National Programmes

n) Other National Programmes:

1) Malaria: All state Ayurvedic & Homoeopathic dispensaries would work for fever treatment depots (FTD) and send blood samples of fever affected patients to the CHC and treat the patients with chloroquine.

2) Leprosy: To send all the patients found with light coloured patches or nodules to the CHC or PHC for examination of leprosy and further treatment and make sure that all affected patients are given MDT according to the instructions of MOs of CHCs

3) Tuberculosis: To send all the suspected cases of TB to the CHC or PHC and ensure that affected patients receive treatment according to the instructions of the doctor.

4) HIV or AIDS: To provide symptomatic treatment to the suspected cases of HIV or AIDS or STD at OPD level and extend full cooperation in family health awareness week campaign.

5) Blindness Eradication Programme: To send all the elderly patients with suspected cataract to the CHC or PHC for examination and treatment.

6) Training Programmes: To ensure that desired logistic support is provided for training programmes organized by the Health and Family Welfare Department.For this, a coordination cell comprising of a Nodal Officer (nominated by Deputy Director, Health and Director, Ayurveda) would submit their report within one month after completion of the Training Programme.

6. that I wont have any objection in my being posted /transferred anywhere in Uttarakhand.

Signatures

District Ayurveda/Homoeopathy Officer Signature of Applicant and Name & Address

Name, Address & Signatures of Witness: 1.

2.

7. AYUSH Report_Chapter 2

Documents

pi annexure

madhya pradesh annexure

andhra pradesh

states of odisha

ayush doctors

selected statesfindings

himachal pradesh

uttar pradesh