Integrated and holistic approach of Ayurveda in health-care management

Diversity in any field, sector, or area is an intrinsic factor that is fundamental for the overall growth and development of the population and has real-world implications. India is richly diverse in terms of its religions, ethnicities, customs, and social structures, and its diversity serves as a key asset in propelling the development of the nation and in its rise on the global front. The health-care system of India reflects this diversity through a variety of health-care modalities that start with a variety of simple home remedies and end with the most cutting-edge technologies of modern tertiary care. India is a wealth house of knowledge about various health-care systems where Ayurveda, Yoga, Naturopathy, Unani, Siddha, Sowa-Rigpa, and Homeopathy are distinct types of scientifically supported, legitimately acknowledged, and accepted fields of complementary and alternative health-care practices being operated in the nation apart from modern allopathy health-care services. This coexistence of many systems of health care has made medical pluralism thrive here for public health at large creating an in-depth understanding of multiple health-care systems along with the expansion of the public health landscape of the nation. Traditional and Complementary Medicines (T and CM) are popular and their demand is notably rising in nearly every nation around the globe. According to the World Health Organization (WHO) Global Report on T and CM 2019, around 88% of all the WHO Member States formally acknowledge the use of T and CM; a total of 98 countries, more than 50% of the 194 Member States, had a national policy on T and CM; besides this, it is also stated that 107 Member States had a national office for TM, with around 75 Member States having national research institute. Furthermore, a total of 34 Member States have included traditional or herbal medicines in their National Essential Medicines Lists, and 124 Member States have national regulations of herbal medicines, suggesting a consistent upward trend in the number of Member States formally engaging with T and CM.[1] There are many instances, where wide utilization of T and CM in primary health care offered concrete solutions in dealing with complex emergencies. In the year 2011, after the Great East Japan Earthquake, medical assistance was provided to disaster-struck individuals by employing traditional Asian therapies in combination with Western medical practices, resulting in both mental and physical relief.[2] In Mongolia, to facilitate the safe and effective use of herbal medicines in primary health care, the Nippon Foundation, in collaboration with the Ministry of Health, developed family medical kits containing traditional medicines in compliance with national policies recognized by the Ministry.[3] A study was conducted on the basis of a nationally representative health survey in 2014 to understand the utilization of Ayush care across India, which suggests that the Ayush system of medicine had been mostly used for musculoskeletal, and gastrointestinal ailments in rural parts and in urban areas, it is mostly sought for skin, musculoskeletal, injuries, and genitourinary ailments, where the use of Ayush care was more among the elderly patients. The study also revealed that patients with chronic illness reported greater use of Ayush care both across rural and urban India.[4] The utilization of Ayush for chronic illnesses reflects an inclination of the users for Ayush treatment modalities whenever long-term intervention is desired. Ayush has great potential in managing a varied range of disorders including mental health, geriatric health, and noncommunicable disorders along with providing promotive, rehabilitative, and preventive health care. Emerging global demand for Ayurveda has given a lot of thrust to having an Ayurveda Center of Excellence such as All India Institute of Ayurveda (AIIA), which not only caters to postgraduate training, research and development in different disciplines of Ayurveda, as well as serving the purpose of imparting tertiary, holistic, and integrated health care to the global community at large, through its cutting-edge diagnostic equipment, technology, and state-of-the-art holistic as well as integrated treatment facilities. TRADITIONAL MEDICINE AND THE CONCEPT OF INTEGRATION Integration is a coherent collection of administrative, organizational, service delivery, financing, and clinical approaches and models intended to foster communication, coordination, and cooperation within and between the cure and care sectors, to improve the quality of care and life of the person.[5] It involves integrating the design and system of care delivery, to aid people in need, by optimizing the delivery of care. The principle of integration in the health-care sector acknowledges the importance of the alignment of all health systems and their functions for effective management of integrated heath-care facilities. There are many avenues in which integration can help to improve health outcomes by addressing the fragmentation of care delivered by multiple providers, at many levels such as primary, secondary, and tertiary care. Integration further ensures easy access to health care according to the preferences and perceived needs of the individual. However, there are currently many examples of integration that has been effective around the world. The most well known of these is Traditional East Asian Medicine (TEAM), which consists of herbal remedies, acupuncture, moxibustion, cupping, and manual therapies (massage, tuina, anma, and shiatsu), institutionalized in East Asian countries such as China, Korea, and Japan.[6] This pluralism in medicine reveals three different types of integrative approaches: interpenetrative pluralism in China, exclusionary pluralism in Korea, and subjugatory pluralism in Japan. The criss crossing of TEAM and biomedicine is permitted in interpenetrative and exclusionary pluralism, where these are institutionalized as independent and equivalent systems of medical practices; however, in the subjugatory pluralism, the practice of TEAM is dependent upon and subordinated to biomedicine. Furthermore, the use of different TEAM modalities is regulated by TEAM practitioners, biomedical practitioners, or integrative TEAM-biomedical practitioners in interpenetrative pluralism, biomedical practitioners alone in subjugatory pluralism, and only by TEAM practitioners in exclusionary pluralism.[6] INCORPORATION OF AYURVEDA INTO MODERN MEDICINE AND VICE VERSA Ayurveda has a holistic approach, i.e. it views man in his totality within a wide ecological spectrum and emphasizes ill health/diseased state as an imbalance in his total ecological system, not by a causative agent and pathogenic evolution. The Ayurveda concepts and philosophy adhere to a more comprehensive strategy focusing on holistic lifestyle, wellness, diet, and homeostasis, equally encircling and involving the ideas of the modern conventional system and biomedicine. Thus, the integration of systems must be done through the development of a transdisciplinary framework of medical pluralism that is based on the pragmatic conformance of holistic Ayurvedic notions and molecular insights into modern biomedicine must be developed. In India, although dominated by a conventional system of medicine, the Ayush system of medicine is gaining momentum, and cross-system linkages at the level of academic, research, and professional/practice are very much visible. In view of the perspective of integration in the knowledge sector, the Central Council for Indian Medicine (now, the National Commission for Indian System of Medicine) has mandated modern anatomy, physiology, and pharmacology etc. be included in the curriculum for Ayurveda graduates. Integration at the level of providing health services to the public sector at large is quite evident through the colocation of Ayurveda/Ayush services in biomedical health facilities and hospitals, where Ayurveda and conventional system of medicine are combined under one roof, providing patients a choice for care. This colocation serves as an opportunity for interaction among different medical knowledge systems along with adequate use of the knowledge. Owing to this, the Ministry of Ayush (MoA) is implementing the Centrally Sponsored Scheme of the National Ayush Mission with the goal of providing affordable Ayush services with a universal access through upgrading Ayush Hospitals and Dispensaries; colocating Ayush facilities at Primary Health Centers, Community Health Centers, and District Hospitals; and strengthening Institutional capacity at the State level by upgrading Ayush educational facilities.[7] Under the Ayushman Bharat scheme, Ayush Health and Wellness Centers (AHWCs) are being established, and as per the proposals received from State/UT Governments, around 9068 units of existing Ayush dispensaries and subhealth centers have been approved to be upgraded as AHWCs and 4830 AHWCs have been made functional.[8] The Ayurveda Research Councils under the Ministry are also conducting research using integrated clinical research protocols adopting Ayurveda parameters and parameters of conventional biomedicines with an expert consultation of Allopathic and Ayurvedic experts at hospitals such as All India Institute of Medical Science (AIIMS), New Delhi; Banaras Hindu University, Varanasi; and many other reputable institutions. The Department of Integrative Medicine of AIIA was established at Safdarjung Hospital with the aim to provide holistic care, with provisions of providing Panchakarma therapies, promotive, preventive, curative, and rehabilitative therapy to the patients. This will play a crucial role in creating integrated standard patient care protocols and educating patients about diet-related consultations.[9] During the era of the pandemic of COVID-19, MoA played a significant role in addressing the crisis, owing to the successful conduction of integrative research, proactive initiatives with the active participation of private and public stakeholders, mutual understanding between various organizations, and in the end, most important, the widespread acceptance of Ayush measures by the general public. The first legitimate scientific study on Yoga in the nation started at the Center for Integrative Medicine and Research (CIMR), which was founded on the AIIMS-Delhi campus in 2016 as part of the Ayush Center of Excellence initiative and has been published, preliminary findings and interim findings from the heart, neurology, pulmonology, and gynecology sections which are getting acknowledged and verified by review groups and international medical publications. Owing to the excellence, endeavors, and accomplishments of CIMR, initiating dedicated Outpatient Department (OPD) and Inpatient Department (IPD) beds for CIMR could be a boon to the growth and development of CIMR. Considering the increased interest of patients at AIIMS in the CIMR and the growing body of research work at the center, a standalone Department for Integrative Medicine at AIIMS with the help of committed professors and employees in the near future can be expected. On a similar ground, an Integrated Ayush Cancer Care facility at the National Cancer Institute at Jhajjar, Haryana, a specialty tertiary health-care institute is functioning efficiently.[10] Under the Memorandum of Understanding (MoU) signed by the Central Council for Research in Ayurvedic Sciences (CCRAS), Jawaharlal Nehru University (JNU) and Institute of Liver and Biliary Sciences (ILBS), several initiatives are being taken on developing strategies to foster appropriate integration, regulation, and supervision in traditional medicine. This research collaboration with these cutting-edge institutions will be able to produce verifiable proof of the basic Ayurvedic principles through their multiomics studies along with the safety and efficacy of Ayurvedic interventions for health problems.[11] ALL INDIA INSTITUTE OF AYURVEDA: AN EMERGING BENCHMARK FOR INTEGRATION AIIA, an Ayurveda tertiary health-care facility, was established with the objectives of providing interdisciplinary teaching and research in the many branches of Ayurveda, as well as meeting the increasing demand for Ayurveda globally. AIIA is thriving to establish itself as a Tertiary Care Hospital Facility with an integrated as well as holistic health-care approach. Integrative medicine places a greater emphasis on wholeness, vitality, and recovery, not only giving emphasis on the treatment of disease only. AIIA is working with an objective to treat people with integrative medicine where a subtle combination of Ayurveda and Western medicine along with a holistic approach is served to the person. AIIA has come up with an Integrative Medical Services Unit on its campus, with different integrative centers, with an intention to provide preventive, promotive, therapeutic medical services, lifestyle counseling, Yoga, diet advice, and stress management. This model of integration includes the colocation of the consultants of different systems of medicine (Ayurveda and Conventional system of medicine) and also covers integrative facilities within the system (OPD services for integrative Ayush therapies). The health-care facility delivers its care facilities through Standalone Ayurvedic treatment or Conventional Medicine, as per the chronic/acute, nature of the disease/condition of the patient. Various Integrative Medical Units have been established under this initiative which includes a range of services such as the Center for Integrative Cancer Therapy, Center for Integrative Dentistry, Centre for Integrative Critical Care and Emergency Medicine, Center for Integrative Orthopedics, and Center for Integrative Dietetics and Nutrition and Casualty OPD Section. AIIA has signed 26 National MoU with various organizations/institutions such as Council of Scientific & Industrial Research-Institute of Genomics and Integrative Biology (CSIR-IGIB), New Delhi; Indian Institute of Technology (IIT), Delhi; National Institute of Food Technology Entrepreneurship and Management (NIFTEM), Sonipat, Haryana; Delhi Police, Ministry of Home Affairs; Vardhman Mahavir Medical College, and Safdarjung Hospital (VMMC and SJ Hospital). Under its separate division, namely Translational Research for Fostering Quality Research, several research proposals have been received and approved. A joint venture of the AIIA and the National Institute of Cancer Prevention and Research (NICPR) and Center of Integrative Oncology (CIO) has been established with the intention of integrative practice in the field of cancer prevention and management, under which an integrative Cancer OPD at AIIA is running successfully. Under its collaboration with VMMC and SJ Hospital, the development of unique model center of Integrative Health Facility for tertiary care is being sought, where the two institutes will jointly work to treat patients using the best of both Ayurveda and modern medicine. AIIA is also extending its health-care services through the establishment of the Ayurveda Wellness and Medical Center at Lal Bahadur Shastri National Academy of Administration (LBSNAA), Mussoorie and providing holistic and integrated health services to the officer, trainees, faculty members, staff, and their families. As a part of this initiative, a noble step was taken to initiate free Ayurveda OPD camps under the “Academy Amrit Aarogya – Ayush Seva” campaign in 75 rural and semi-urban areas, and schools, and encouraging steps such as delivering awareness talk on the topic, “Ayurveda for Mental Well Being” to the teachers and school students were also taken. To date, a total of 8500 patients have taken the benefit of Ayurvedic OPD and a total of 2632 Panchakarma patients have taken benefit of Panchakarma procedures at the academy. Besides providing top-notch Ayurveda health-care facilities through its 14 specialized Ayurveda clinics, AIIA is equipped with a six-bedded integrated Intensive Care Unit (ICU), where integrative treatment is provided to the patients. Through the successful amalgamation of modern technology for the advancements in diagnostic, preventive, promotional, and therapeutic techniques of Ayurveda, AIIA is working toward the adoption of integrated approaches in the health-care services offered to the general public and producing scientific proof for Ayurvedic principles and pharmacological therapies. To address the present health demands, significant enhancement of Ayurveda, through raising opportunities and standards, is important, thus, it is crucial to establish innovation and advancement in areas including pharmacovigilance, digital innovations, technologies, health and wellness, clinical practice, education, research, and public health pertaining to Ayush and nurture new innovations.[12] AIIA has come across as a successful model for integration in traditional medicine with its emphasis on comprehensive, person-centered care, and community orientation, along with generating evidence through integrated research approaches, which has significantly created a stable platform for Ayurveda as an “evidence-based science.” This is a matter of utmost pride, that the MoA gets its recognition and acknowledgment from the former Prime Minister, who postulated the slogan of “Jai Vigyan” underlining the importance of science and knowledge in the progress of India, the sector of Ayurveda aided by transdisciplinary researches and initiatives is broadening its perspectives, enhancing research integrity and ensuring successful integration for the benefit of the society at large. Being inaugurated by the hands of the Hon’ble Prime Minister of India, AIIA has gained wide National and International recognition through its high-quality patient care and research and has developed benchmarks for Ayurvedic education, research, and health care. The satellite institute of AIIA in Goa was also dedicated to the nation with the goal of replicating and building upon the accomplishments and success of AIIA, Delhi. AIIA is successfully establishing itself as an “Outstanding Center of Excellence for Ayurveda Tertiary Health Care” and is strongly dedicated to promoting the contributions of Ayurveda to global health, representing as a key component for providing cost-effective modalities of traditional medicine as well as setting itself as the best example for integration.