There is an indication that the Working Group of the Mahamana Declarations-2020 is concluding that Ayush practitioners are not fully equipped to be the first point of care at the Health and Wellness Centers (HWCs) of the Union government’s Ayushman Bharat programme.
Well-trained Ayush practitioners could become a reliable workforce to address acute illness-related healthcare needs of people living in remote rural villages. The 2018 GOI Scheme on Health and Wellness Centres, stated Ayush practitioners, are slated to be posted as the only doctor of primary contact across the 1.5 lakh HWCs. It is here a Special Interest Group of the Mahamana Declarations examines the extent to which the Ayush practitioners are equipped and ready to handle this responsibility.
Meenakshi Datta Ghosh, member Mahamana Declarations, former secretary, Government of India and Chair Vertical 4 during an interaction, wherein Dr. K K Aggarwal, Co-Chair and former president, Indian Medical Association, drew attention to what would potentially happen on a regular basis at any given HWC. “Incoming persons could require routine attention and treatment as in dengue or malaria; urgent and priority attention, as in a caesarean, or paediatric encephalitis; and emergency attention, as in a road accident, onset of a thrombotic stroke, need for immediate drainage of sepsis, and so on. At these HWCs unless there is clinical competence to perform life-saving emergency and critical care to save lives during the most important Golden Hour, we could be in for adverse outcomes,” pointed out Dr Aggarwal The Ayurveda and Siddha representatives at that meeting uniformly responded that they have no significant training to handle emergency care. They expressed a serious lack of confidence till such time as they are given comprehensive, targeted and differentiated training on lifesaving technologies and related, feasible interventions. They do not feel clinically competent to handle emergency care. They expressed that archaic curriculum across Ayush medicine has ensured inadequate exposure to a cross-section of medical conditions, which is needed to acquire clinical proficiency. This infirmity needs to be addressed upfront. It would transform their image as well as capabilities, said Ghosh. Ayush practitioners were confident that preventive and promotive medicine is their forte, and hence routine handling of maternal-infant care, and non-communicable diseases is no problem at all.
Ghosh added that the changing role of the Ayush practitioner is also an issue. Today, no more than 18 per cent Ayush practitioners function from rural India, while 82 per cent are functioning from urban areas. Among these, a majority are seen to be practising allopathic medicine. At the rural HWCs, they will be called upon to implement central and state government health schemes of which they now have only a vague idea. The younger Ayush practitioners find that remuneration and living conditions in rural areas are a problem. Recently vacancies announced for Haryana and Madhya Pradesh saw a gap of Rs. 40,000/ per month between allopathy and Ayush salaries, she added.
The Mahamana Declaration on Ayush is a platform with nine verticals, coming together in a Working Group once every six weeks, to take stock of the tasks covered. One Working Group meeting convened online, by Bejon Misra, advisor-consultant IMS, BHU, recently was chaired by Prof. YB Tripathi, Faculty of Ayurveda, Institute of Medical Sciences, BHU, Varanasi. The nine verticals address standard setting among the different streams of Ayush, regulatory oversight, value of bringing scientific rigor, leadership, and so on.
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