|ONE NATION, ONE HEALTH SYSTEM - SPECIAL ISSUE
|Year : 2023 | Volume
| Issue : 1 | Page : 26-29
“One Nation, One Health System”: The need, the challenges, and the way forward
Board of Ayurveda, National Commission for Indian System of Medicine, New Delhi, India
|Date of Submission||01-Oct-2022|
|Date of Acceptance||03-Nov-2022|
|Date of Web Publication||08-Dec-2022|
Dr. B S Prasad
Board of Ayurveda, National Commission for Indian System of Medicine, New Delhi
Source of Support: None, Conflict of Interest: None
Change is inevitable with time. When change happens, the needs, attitude, behavior, habits, etc., will also change. The same is the case with medical practices also. The public is well aware of the strengths and limitations of each medical system and is willing to accept multisystem or integrated systems of approach for their health needs. It is our duty to identify the strengths and limitations of each medical system and to complement the weakness of one system with the strengths of the other system. We aim to provide a holistic approach to alleviate suffering. It can be said that an ailing person is ready to seek advice irrespective of “pathy” or qualification and accepts medical pluralism, including advice from folk practitioners or tribal practitioners. In this method, where the patients seek pluralistic medical advice, there is a waste of time and money in consulting different systems. Also, there are chances of overdosage or synergetic or antagonistic actions of medicines. Unified medical practices that provide all types of medical services at one contact point ensure the utilization of the strengths of all medical systems at the same place, which would ultimately benefit patients. The unification or integration of medical practice needs to be done at a multilevel, and the medical systems should also be available as parallel services. The broad avenues of integration are at the practice level, medical education, and research. Integration is the key to having a patient-centric approach. The integration of medical systems has difficulties but is not impossible. Coordinated, collaborative, and accessible health care is inevitable in a patient-centered approach. Medical professionals from different systems must align their vision and values to benefit patients by crossing pathy barriers with openness. With unified medical systems in the “Indian Health Care System,” India can advance to be a global leader in the healthcare sector.
Keywords: Indian healthcare system, Integration, Medical system
|How to cite this article:|
Prasad B S. “One Nation, One Health System”: The need, the challenges, and the way forward. J Res Ayurvedic Sci 2023;7:26-9
| Introduction|| |
India is globally recognized for “unity in diversity, rich cultural and knowledge heritage, and unique ancient and traditional medical practices.” Unless built upon strong and valid fundamental principles, any culture or science will not sustain for long periods. The solid foundation of our ancient medical sciences, such as Ayurveda, remains valid and authoritative even after thousands of years. It is a well-known fact that every medical system has strengths and limitations. If strengths are unified into one system, we may be able to overcome several limitations in medical practices, and we may be able to offer holistic patient-centered care to the suffering population. Further, there is much scope for India to become global leader in the healthcare sector if we bring integrated medical practices under One Nation, One Health System.
| Changing Needs and Trends in Health|| |
As it is mentioned “Kaalohi Parinaama Utchyate” means “time may be termed as change,” i.e., change is inevitable with time. Change has happened, is happening, and will continue to happen with time. When change happens, the needs, attitudes, behavior, habits, etc., will also change. The same is the case with medical practices also. When we look back into the past decade, infectious clinical conditions are prevalent, whereas at present, we are facing more noncommunicable diseases. In the present scenario, low- and middle-income countries have a dual burden of infectious and noncommunicable diseases. In India, diabetes prevalence is rising in the urban, semiurban, and rural populations, whereas tuberculosis is experiencing 2.0 million new cases every year, as reported in 2010., Such surge in the dual front is expected to tax the healthcare delivery, which shall be countered with major healthcare reforms with urgency. It is expected that the existing medical care providers shall join hands to limit the historical barriers between various systems to address the changing health trends. Meanwhile, diagnostics and surgery have undergone incredible growth and precision. On the other hand, artificial intelligence, machine learning, and technological advancements are being integrated into medical systems and medical practices. People are becoming more and more techno-savvy and can get medical information at their fingertips. Newer generation people are comfortable with technology and prefer to utilize online consultation services and medical information available on the web to make decisions regarding consultation and type of care. Through these developments, the public is well aware of each medical system’s strengths and limitations and is willing to accept any medical system as long as it benefits them. The public also demands, and many adopt a multisystem or integrated system of approaches for their health needs.
| Limitations and Strengths of Each Medical System|| |
It is well known that “no medical system is complete by its own; each medical system has strengths and limitations.” For example, in the case of emergencies, management of infectious conditions, surgery, as well as in diagnostic technologies, Allopathy system is effective, and at the same time, its role in a preventive avenue for many lifestyle diseases is limited. In contrast, Ayurveda has potential in primordial prevention, especially with noncommunicable diseases, as well as curative and promotive aspects, which cater to the patients through an individualized approach. It is our duty to identify the strengths and limitations of each medical system and to complement the weakness of one system with the strengths of another system and thus enrich the medical systems through a complementary, integrative approach to provide holistic care.
| Medical Pluralism at Consumer Level|| |
Any individual suffering from any medical illness does not bother about “pathy” but is concerned with relief from the ailment. Usually, any ill person would seek medical care and advice irrespective of “pathy” or qualification and even resort to folk medicine or care depending upon the nature of the illness. In doing so, the patients are ready to overcome all odds of communication and transportation to reach folk or tribal practitioners. Patients are adopting advices from print or electronic media. This attitude of patients indicates that the patient is more concerned about relief, and at the consumer level, medical pluralism is well accepted, and the “pathy” barriers are between professionals. In this method, where patients seek pluralistic medical advice, there is a waste of time and money in consulting consultants of different systems, and also, there are chances of overdosage or synergetic or antagonistic actions of medicines. If integrative practices are made available, patients receive the best options across medical systems and thus save precious time and money and will not face complications of mixopathy.
| Emerging Areas|| |
With the improved living conditions including improved nutrition and hygiene, infectious diseases are declining, and at the same time because of altered life styles, noncommunicable diseases or lifestyle disorders are escalating. Even if infections are occurring, they are hitting back us with resistance, and also super bugs are emerging, which are not responding to any antibiotics. Pollution, usage of chemical agents, pesticides, etc., are leading to several health issues as well as various types of cancers and genetic disorders. As infections are coming back with resistance, vaccines are becoming ineffective. Newer and newer viruses are being identified. Instead of specific vaccine for each variety of infection, it is better to think of broad-spectrum vaccines that provide wide coverage. Any steps that enhance innate immunity will play a pivotal role in future. Protocols for epigenetics are readily available in Ayurveda. The magnitude of the dual burden of noncommunicable and infectious diseases is propelling our country to make significant health reforms that would encourage combined disease surveillance approaches and integrated healthcare services tailored to national and regional needs. Such strategies shall have the potential to support the strained public health service delivery systems.
| Unified Medical Practices|| |
The convergence of care at a single point may be the best solution to address the above-discussed issues. This permits availing the strengths of all medical systems at a single contact point for patients to save time and money and to prevent complications of mixopathy. However, there are many barriers in unifying medical systems toward a One Nation, One Health System.
Problems in unifying
The successful integration of care would require changes on different levels, sufficient resources, well-structured service delivery system with clear definition of new roles and responsibilities, and willingness among healthcare professionals to co-work while overcoming the pathy barrier. The professionals of respective systems have their boundaries and egos. The identification of the strengths in each system and mutual understanding of where each system is effective and at what level to switch to which system is a big challenge. Conflicting ideals, objectives, dissonance within systems, poor coordination, and limited resources may all be considered barriers to the effective convergence of healthcare services. Fragmented and uncoordinated services are also a significant issue that hampers integrated care delivery.
Steps of unifying
Unifying of medical practice needs to be multilevel and parallel. The broad areas are unification at the practice level, medical education, and research level.
- 1. Integrated clinical practices:
- a. Sensitizing medical professionals to cross Pathy boundaries toward patient-centric thinking and training workforce for collaborative working
- b. Development of integrated treatment protocols: A group of clinicians from different medical systems practicing the same specialization can come together to identify the strengths of each system and develop integrated treatment protocol in effectively complementing one system with the strength of another system. The crossreferral and integrated care protocol shall specify which system is effective in which clinical condition and when to switch to another system. Such a holistic care delivery provides individualized care that focuses on the patient’s needs when planning and delivering care and thus provides a patient-centric approach.
- c. Colocation of practitioners of different systems under one roof where the patients can choose any system as per their choice. Other facilities such as diagnostics, surgical, etc., are common to all system practitioners. In this cafeteria approach, a holistic approach and a patient-centric approach are missing. However, this system facilitates the development of evidence-based medicine as all medical advances are available for all practitioners.
- 2. Integration of medical education:
- a. Medical education is the area where medical professionals are created. Hence, unless and until we integrate medical education, we will not be able to achieve One Nation, One Health System. To integrate medical education, the graduate medical program may be split into two parts: a common foundation/fundamental/basic course followed by stream-specific course. The graduates of one system may be allowed for lateral entry of any other system. That is to say, the common foundation/fundamental/introductory course for 2–2.5 years that deals with Anatomy, Physiology, Biochemistry, Microbiology, Basic Pathology, and Basic Pharmacology. This 2–2.5 year course is common to all medical streams. This can be followed by system-specific course with respective clinical exposure for 3–3.5 years. Once graduated in any medical stream, the graduate is eligible to join for lateral entry into system-specific courses of any other medical stream. In this way, one can graduate in multiple medical streams, so such medical professionals will be capable of selecting treatment modalities judiciously [Figure 1].
- b. Integration may also be within medical systems of similar principles and then to unify into one system. For example, at the first step, by identifying the uniqueness of Ayurveda, Unani, Siddha, and Sowa-Rigpa systems, which are built upon almost similar fundamental principles, can be converged. Similarly, Allopathy and Homeopathy as Homeopathy follows all Allopathy subjects except Materia medica and principles of clinical management. Later on, these two grouped systems unified into one single medical system “Indian Health Care System.”
- c. On the same line in the postgraduate/speciality courses, the same system graduates will join laterally into the second semester. In contrast, graduates of other streams shall join the first semester where fundamentals of that particular medical stream are taught, so that by the second semester, all graduates are uniform and can pursue the specialty course.
- d. Allowing fellowship programs, i.e., specialist of one medical system getting fellowship in the same speciality in another system. This helps in producing experts in multiple streams and can better judge where to use which system for better results. Such experts will be future teaching faculty to teach integrated courses.
- 3. Integrated research: Though initially drugs belonging to two systems may not be administered, there may be a need to administer a combination of drugs in the due course of time. Hence, there is a need to establish interaction between drugs of different medical streams. Once established, the findings are incorporated in curriculum and integrated into treatment protocols to strengthen integrated practices.
| Conclusions|| |
Integration is the key to have patient-centric approach. Further, in rural areas where only one medical practitioner is available, irrespective of the type of medical system to which the practitioner belongs, he/she has to offer the required medical care. The integration of medical systems has difficulties, but is not impossible. Medical professionals from different systems have to come forward with the patient as a central focus and by crossing pathy barrier/borders and openness. Several studies adopted integrated protocols and endorsed the strength of integration and stressed the future scope. With unified medical systems into the “Indian Health Care System,” India can advance toward global leadership in healthcare sector.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Remais JV, Zeng G, Li G, Tian L, Engelgau MM Convergence of non-communicable and infectious diseases in low- and middle-income countries. Int J Epidemiol 2013;42:221-7.
Engelgau MM, El-Saharty S, Kudesia P, Rajan V, Rosenhouse S, Okamoto K Capitalizing on the Demographic Transition: Tackling Noncommunicable Diseases in South Asia. Washington, DC: The World Bank; 2011.
World Health Organization. Global Tuberculosis Control. WHO Report 2010. Geneva: WHO; 2010.
Kozlowska O, Lumb A, Tan GD, Rea R Barriers and facilitators to integrating primary and specialist healthcare in the United Kingdom: A narrative literature review. Future Healthc J 2018;5:64-80.