WHO REFERENCE/ REFERENCE OMS WHO REGISTRATION: 2010/120230-0 PURCHASE ORDER: 200313734 REGISTRATION FILE: IND-2011-T18-APW-0001 UNIT REFERENCE: HSD,WCO-INDIA WHO-APW PROJECT STANDARDIZATION OF NON-CLINICAL TERMINOLOGIES OF AYURVEDA (Drafting of Terms in a Standard Template) NATIONAL INSTITUTE OF AYURVEDA (Dept. of AYUSH, Govt. of India) Madhav Vilas Palace, Joravar Singh Gate, Amer Road, JAIPUR - 302002 (Rajasthan) INDIA Phone: 91-141-2635740 2635292 PBX: 2635744 Fax: 2635709, 2635292 Email: [email protected] Website: nia.nic.in Acknowledgements It my proud privilege on behalf of the National Institute of Ayurveda, Jaipur to put on record our appreciation for all those who have contributed to the creation of this document. At this juncture, it is a pleasure to remember the significant contribution made by Dr. DC Katoch, Joint Advisor, AYUSH, who in his capacity as former consultant to WHO, was instrumental in initiating and then steering this project. I also wish to extend our gratitude to the Department of AYUSH, Ministry of Health and Family Welfare, New Delhi for their support. I also gratefully acknowledge the generous financial support and encouragement received from Dr. Madhur Gupta, WHO Country Office for India. Prof. Ajay Kumar Sharma Director National Institute of Ayurveda Jaipur 1 INTRODUCTION Background India has a long history of traditional medicine that is well established and integrated not just within the overall medical structure of the country but also blended into the very cultural ethos of the grass root level common man.1,2 The Indian health system has perhaps the world's largest community-based indigenous system of medicine, and it includes Ayurveda, Unani medicine, Siddha medicine, yoga and naturopathy.3 These systems of traditional Indian medicine along with homeopathy are abbreviated as AYUSH. Over 65% of the population in rural areas of India is using AYUSH medicines to for the primary health care needs.4 The AYUSH practitioners (over 700,000)5 outnumber the allopathic medical doctors (approximately 633,000) in India, with over 400,000 registered practitioners of Ayurveda accounting for approximately 62% of these qualified doctors.6 Immense popularity of Ayurveda accounts for more than 200 Colleges and Four full-fledged Universities. Reasons for this popularity include a strong belief in its efficacy as a "natural" and "holistic" option, and the fact that allopathic care is often costly, inaccessible and culturally dissonant.7 Ayurveda is used to treat a wide variety of conditions, including cancer, diabetes and HIV/AIDS.8 The Government of India established the Department of Indian Systems of Medicine and Homoeopathy (ISM&H) in March,1995 and re-named it as Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) in November, 2003. 1 Lodha R, Bagga A: Traditional Indian systems of medicine. Ann Acad Med Singapore 2000, 29(1):37-41 2 Khan S: Systems of medicine and nationalist discourse in India: Towards "new horizon" in medical anthropology and history. Soc Sci Med 2006, 62:2786- 2797. 3 Government of India: Indian Systems of Medicine and Homeopathy. Annual Report. [http://mohfw.nic.in/reports/Annual0506/Ayush%20annual%20report%20final.pdf] 4 World Health Organization: Traditional Medicine: Report by the Secretariat. Geneva: World Health Organization; 2003 5 Government of India. Ministry of Health and Family Welfare: Financing and Delivery of Health Care Services in India.2005 6 National Commission of Macroeconomics and Health: Financing and Delivery of Health Care Services in India. Ministry of Health and Family Welfare. New Delhi: Government of India; 2005. 7 M Fritts, CC Crawford, etal. Traditional Indian medicine and homeopathy for HIV/AIDS: a review of the literature; AIDS Research and Therapy 2008, 5:25 8 Singh P, Yadav R, Pandey A: Utilization of indigenous systems of medicine & homoeopathy in India. Indian J Med Res 2005, 122(2):137-142. 2 The mandate of the Dept. of AYUSH includes9: a) providing focused attention to development of Education & Research in AYUSH systems b) upgradation of AYUSH educational standards c) quality control and standardization of AYUSH drugs d) improving the availability of medicinal plant material e) research and development in AYUSH systems f) awareness generation about the efficacy of the systems domestically and internationally. The Indian Government has also established a Central Council for Research in each of these core areas, as well as separate Directorates of AYUSH in 18 Indian States.10 Global resurgence of Ayurveda Ayurveda is possibly the most ancient system of medicine of the world. The basic principles of Ayurveda are universal in scope but are also context specific that the applied aspects are mostly local and specific to the individual. It is an eco-friendly, costeffective, organic, natural, holistic, lifestyle-integrated and easily replicable (due to its “global yet local” approach) model which primarily has only one requirement – the presence of expert well-trained experienced Ayurveda physicians.11 While in many parts of the world, Ayurveda is practised without the knowledge of the word “Ayurveda”; in the last two decades, official Ayurveda due to its holistic approach using lifestyle modification, healthy diet and safe natural drugs attracted a large population in different countries around the world.12 9 Website of AYUSH: http://www.indianmedicine.nic.in 10 Department of Ayurveda, Yoga, Unani, Siddha and Homoeopathy: 2003–2004 Annual Report. 11 Praful Patel: Global Resurgence And International Recognition Of Ayurveda, Ayurveda and Its Scientific Aspects: Opportunities for Globalisation, CSIR (New Delhi: AYUSH, 2006) 12 AAJ Pushpa Mumara, Global Resurgence of Ayurveda and the New Paradigm shift in health care, Sri Lankan Journal of Humanities and Social Sciences Vol.1 (2) Oct 2009 3 Though the trade, practice and education of Ayurveda are prevalent, the level of government recognition and support varies considerably across the world. WHO Initiatives The WHO draft Regional Strategy for Traditional Medicine in the Western Pacific (2011–2020) identifies five strategic objectives: (1) to include traditional medicine in the national health system; (2) to promote the safe and effective use of traditional medicine; (3) to increase access to safe and effective traditional medicine; (4) to promote the protection and sustainable use of traditional medicine resources; and (5) to strengthen cooperation in generating and sharing traditional medicine knowledge and skills. Globalization of health practices, technology and other health products has an impact on traditional medicine, including its availability, accessibly and affordability. Member States and areas should be encouraged to cooperate with each other in sharing traditional medicine knowledge and practices and in developing and exchanging scientific knowledge and training programmes on traditional medicine. For traditional medicine to attain its potential in health care in the Region, effective communication about traditional medicine within stakeholder groups, and productive cooperation within and between nations having common interests in traditional medicine, are essential. There are three key components to achieving this Objective: (1) To enhance cooperation and communication within and between countries and areas, at all levels of policy, regulation, education, practice and research related to traditional medicine (2) To strengthen communication between Western and traditional medicine providers and with their patients 4 (3) To facilitate international standardization and harmonization Directions (1) Enhance national, regional and international cooperation to facilitate harmonization of traditional medicine policies, regulations and standards and guidelines for practice, products and research. (2) Develop and maintain databases and information systems and facilitate access as the foundation for evidence-based traditional medicine practice and research. Strategic Actions (1) Prioritize policies, regulations and standards for harmonization of traditional medicine in the Region. (2) Encourage interdisciplinary and regional collaboration for training in research methods and contemporary technologies in traditional medicine research. (3) Create national and regional centres of excellence as resources for training, research, and information. (4) Respect and preserve indigenous healing practices and facilitate the sharing of this resource. (5) Encourage the use of English for international communication in traditional medicine. Standardization of data collection and storage will aid access to traditional medicine information and assist in its inclusion in evolving healthcare applications, including computerized health information systems, reimbursement policies, treatment, health care funding allocation and public health programmes. Standardization in this context relates to the use of common terms for access to the literature, as a building block for electronic health records and as the basis for a classification system to enable collection of uniform data concerning traditional medicine practice and utilization. It aims to avoid duplication of effort and create economies of scale, raise the standard of traditional medicine in clinical practice, public health, research, clinical trials, education, policy development, resource allocation and to allow exchange of 5 health records and inclusion of traditional medicine data in health information systems in a