[Reader-list] Shaping Policies for Ayurveda

[harilal madhavan]

M S HARILAL/ SARAI INDEPENDENT FELLOW 2007/THIRD POSTING/ SHAPING
POLICIES FOR AYURVEDA

An analysis of the policies towards indigenous healers all over the
world, has shown that the policies adopted by many countries were
neither sufficient to promote them, nor able to provide a level
playing field to serve as a complementary system in the national
health agenda in many countries. The 'co-existence' argument has often
concealed the skewed favours that many of the national policies
offered to bio-medicine. It has been shown that most of the
international policies, since they leave the time and type of
implementation concerned to the traditional healers to the national
planners, in reality, when as these policies implemented, indigenous
practitioners are often forgotten unless the developing personnel
themselves decides the time and places. Relative to their active
promotion of other health improvement strategies, international
agencies do not take particularly active initiative in facilitating or
even encouraging the utilization of traditional practitioners. The
late 20th century experience shows that thus policies of the
international agencies leave the developing country  in exactly same
situation as they were in the past(Pillsbury 1982). Mostly the
policies of different nations made traditional midwives as a part of
their policies, but not the traditional healers. Pillsbury shows that
only sixteen countries had included traditional healers in contrast to
the forty for in which projects have incorporated traditional mid
wives (ibid p1827).  Even in the major sixteen countries, where the
traditional healers are become part of the national policy, it appears
that only in two, Zimbabwe and possibly Nigeria, are national healers
being utilized in their traditional healing roles, as service
providers in the national health-care system. Pillsbury cites the case
of Taiwan where although the pilot projects including the traditional
birth attendants shown high success, when Taiwan government expanded
its primary healthcare efforts to a twenty province programme in 1978,
the new strategy implemented the new policy didn't include any
traditional healers.  Thus many examples can be shown where, the
indigenous or alternative medical practitioners were ignored and
gradually side streamed.

With this international experience, it is quite normal to think that
the situation in India will not be quite different. Of course
variations in policies are there. Though the policies regarding
indigenous medicine don't quite follow any continuity in its effects,
there is continuity in the nature of policies followed in the pre and
post independent period. Precisely because of this Jeffery's caveats
are still more valid i.e., there may be no clear relationship between
official discussions of indigenous healers and the situation in real
and the indigenous variations was very explicit in both the periods.
In India, understanding the position of Systems of medicine in 20th
century  in the mainstream national policies often offer the varying
positions and the streams of nationalist thoughts and influence. As
Khan opines, while not an uncharted territory, medicine as a part of
social history and medical anthropology is relatively new ground for
assessing Indian nationalism and anti-imperial struggle in India (Khan
2006). It is argued that, in the varying streams, the dominance of the
voice of conformity to western science and progress did not simply
mean an inherent acceptance of western superiority and a fractured,
dislocated version of colonial governmentality (Prakash 1999), but
also a continuation of the colonial legacy of subordination and
subservience of Indian systems of knowledge, a situation fundamentally
not different from colonial past. One important element of doubt
underlined by most of the studies is what was the kind of role that
played by state and other institutions and how far their role was
effective in shaping ayurveda as a system of medicine and as a
knowledge system and the political economy framed it (Banerji 1981,
Gupta 1976, Panikkar 1992, Frankenberg 1980). Along with it is
important to understand how far this political economy constituted
ayurveda into a saleable proportion?

In the early 20th century, the rising bourgeois nationalist movement
embraced the cause of Indian cultural renaissance as well as the idea
of science. The initial decade of the 20th century saw the initiation
of dominance of western medicine in 1912, with the passing the
Regulation of Medical Practitioners Act (RMPA) in Bombay Presidency.
The RMPA laid down that the state run and aided dispensaries would
employ registered medical practitioners and that no certificate would
be valid, unless signed by a medical practitioner, registered under
it. Thus the Vaids and Hakims were effectively kept out, and the
intention of government was of two folds- one, saving the profession
from 'irregularly qualified' doctor and two, most importantly to
establish dominance of western medicine (Ramanna 2006). By excluding
all indigenous practitioners from the right to get registered, the
government was seen to have cast a slur on them and favoured only
allopathy. Indian medical degrees had been refused in 1930s also and
led to the decision that Western medical standards should alone
determine the education which Indian students should receive, which in
turn resulted in hardening of the divisions between western doctors
and their indigenous counterparts. In 1919, the new Legislative
councils supported the Indian systems of Medicine on both patriotic as
well as economic grounds, though ministers in several provinces
resisted this and used their funds to invite modern medicine (Jeffery
1982).  Since its limited success, government of India restricted its
activities mainly into the investigation of pharmacopoeia of
indigenous drugs. The medical brain drain and the difficulty of
getting cheap and effective healthcare facilities to Indian villages
can be related to the tying of Indian medical standards to those of
Britain (Jeffery 1979). When the Indian medical association was
established, there was a call for incorporation of indigenous
practitioners, but when these leaders were being incorporated into the
new Indian medical council and other positions of influence; they had
drawn back from their positions because they feared that such policies
might lead to a loss of their international recognition. Since 1835
reforms, formal education in the indigenous stem was non existent,
though some efforts at regional level have succeeded from late 19th
century onwards. Most members of the Indian medical Service were
convinced that it was impossible to regulate teach these systems in a
rational way or to regulate the standard of Ayurvedic training and
tended to ignore any suggestion of incorporation of indigenous
medicine in to national health care framework. There were two options
available at that time one, to outlaw all but the western doctors; or
to integrate all medical teaching into a national system, the former
is followed in Britain and the latter in china. But according to
Jeffery, the Indian solution combined the worst of both options: a
multitude of practitioners, with no guarantee that any of them were
trustworthy; and continual bickering between the existing groups,
helping to frustrate any systematic dealing with Indian health
problems (ibid.). Indigenous practitioners were become less recognized
partly due to their internal division also. Usually the regional
teaching centres or schools necessarily depend on a teacher who
interprets the texts in his own way and hence the method of diagnosis
and techniques also differed regionally. Along with this the own
preparation of medicines by the patient (Panikkar 1992) and priority
only to certain groups of indigenous healers all lead to its
backwardness vis-à-vis cosmopolitan medicine. The growing ideological
split between the integrated systems and the pure continued to be
debated even in the post independence era no way indicated any
improvement in the system, rather put in a material relegation. The
government of India only adhered to more research and development to
find out the usefulness in the field of indigenous systems, while
completely rejecting the proposal for integration, because it was felt
that there is fundamental difference in the underlying principles of
both the systems. The resolution passed by the First Health Minister's
Conference in 1946 recognized the different systems of medicine, but
largely followed the policy of supporting any professionalizing
efforts and uniform training standards. But none of the state has so
far tried to integrate the modern medicine and ayurveda nor announced
ayurveda as a state medical system (Brass 1972 p 353).

The contentious issues like whether the indigenous practitioners to be
incorporated in the national health care schemes, what to do with the
registration of unqualified practitioners, what kind of training
whether integrated or pure should be executed, how far state support
should be given to the Indian systems of Medicine were some of the
focal issues which were debated mainly and immediately after
independence. Mainly the ultimate decision of most of the issues was
handed over to the states since health is considered to be a state
subject. Some kind of backing for the indigenous system was made
available during the Indira Gandhi Government in 1971-72 and the
Janata government during 1977, which was also revoked by succeeded
ministries. It has to be reminded that the problems and questions we
try to answer in the filed of medical field and health system has
hardly changed even after independence and even after 50years of
independence. The policies of discontinuity in the indigenous medical
system tend to remain in most of the part of India. And wherever this
confusion in the policy was less, or better co-existence of different
systems have pursued with lesser policy interventions, it is evident
that they have achieved in obtaining better healthcare provisions for
example, Travancore regions or the state of Kerala. The public policy
has freed the system with its targeted measures on manufacturing
mostly in 1990s. a discussion on this will be provided in the next
posting.

Regards,
Hari

Alt. e mail: harims at cds.ac.in