One Nation, One Health System integrative policy: Blending wisdom of ancient and contemporary health sciences

Chandrakant Katiyar; Sunil K Dubey

doi:10.4103/jras.jras_148_22

ONE NATION, ONE HEALTH SYSTEM - SPECIAL ISSUE

Year : 2023 | Volume : 7 | Issue : 1 | Page : 47-55

One Nation, One Health System integrative policy: Blending wisdom of ancient and contemporary health sciences

Chandrakant Katiyar¹, Sunil K Dubey²
¹ Emami Ltd, 687, Anandpur, EM Bypass, Kolkata, India
² R&D Healthcare Division, Emami, 13 BT Road, Belgharia, Kolkata, India

Date of Submission	01-Oct-2022
Date of Acceptance	18-Oct-2022
Date of Web Publication	08-Dec-2022

Correspondence Address:
Dr. Chandrakant Katiyar
Emami Ltd, 687, Anandpur, EM Bypass, Kolkata 7001107
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jras.jras_148_22

Abstract

Convergence of Ayush/traditional medicines with modern medicines by bringing into effect integration of the two or more systems is the way forward for developing holistic healthcare systems throughout the country, based on the concept of the One Nation, One Health System. Adopting schemes, programs, and strategies for bringing about changes in the education system and medical practice, along with ensuring their implementation at each stratum, will aid in unifying the healthcare systems. Given the existence of medical pluralism in India, it is the need of the hour to amalgamate our ancient traditional knowledge and contemporary medicine to build a system wherein both work in unison to promote good health and confer protection from various diseases and make provision for their management in the best possible manner. The current article discusses the requirements and probable impact of developing such system.

Keywords: Ayush, Medical practice, One Nation, One Health System, traditional knowledge

How to cite this article:
Katiyar C, Dubey SK. One Nation, One Health System integrative policy: Blending wisdom of ancient and contemporary health sciences. J Res Ayurvedic Sci 2023;7:47-55

How to cite this URL:
Katiyar C, Dubey SK. One Nation, One Health System integrative policy: Blending wisdom of ancient and contemporary health sciences. J Res Ayurvedic Sci [serial online] 2023 [cited 2023 Mar 27];7:47-55. Available from: http://www.jrasccras.com/text.asp?2023/7/1/47/362939

Introduction

The objective of Ayurveda is two-fold: To maintain the health of the healthy person and to treat the person if they fall sick. This aims to provide a long, healthy, and active life and warding off diseases as much as possible. The shloka below defines the purpose of Ayurveda in a gist:

Swasthasya Swasthya Rakshanam Aaturasya Vikaara Prashamanach: ||

It translates as “Ayurveda aims to maintain the health of the healthy persons and cure the disease in those inflicted with it.” Traditional systems of medicine do not have the treatment of the disease alone as their objective; instead, it goes much beyond and helps in health promotion and prophylaxis against diseases.^[1],[2]

Our nation is blessed with the heritage of profound writings in the form of Samhita, Nighantu, and several other Ayurvedic texts, along with the texts of Unani and Siddha systems. These texts provide clarity regarding the choice of the constituents used in each preparation, their benefits, underlying mechanisms, and the philosophical basis thereof. The practices for good health as present in our collective traditional knowledge have asserted that no singular treatment approach is ever all curing; rather, holistic treatment approach, integrating different medical systems, is the ideal option.^[1],[3]

This article discusses the need of integrating the system of modern medicine with that of Indian medical systems that are based on Ayush, the initiatives that have been taken for it, and further steps that need to be implemented to ultimately lead to the One Nation, One Health System.

Deciphering Treatment Approaches

Being a doctor by profession requires the utmost dedication and grit to serve the people in the community, especially in India, given that our population is a teeming 1.38 billion people. To provide quality health care to patients with maximum efficiency, it is important that medical practitioners must be able to identify the strength and extent of application of each medical system. In India, medical health care is broadly classified as modern medicine or allopathy and Ayush. The major schools of traditional medicine have been clubbed under the umbrella term Ayush (Ayurveda, Yoga, and Naturopathy, Unani, Siddha, Sowa Rigpa, and Homoeopathy) as per the Ministry of Ayush, under the directive of the Government of India.

Nowadays, with scientific advancements, the diagnostic tools of modern medicine are unparalleled and deliver in-depth details regarding the underlying conditions. However, the drugs of modern medicine are molecules of synthetic or semi-synthetic origin, and most of them have adverse effects associated with their use. In-depth knowledge of drug–drug interactions and combination therapies is required to ensure correct prescriptions. Modern medicine focusses on specific targets, such as a particular area, organ, or organ system. In contrast, Ayush systems focus on aiding disease protection, delaying the onset of diseases, and acting as prophylactics. Achieving overall health and wellness are the tenets of Ayush systems. As stated earlier, under several conditions, the traditional approaches may not be able to provide an immediate cure; however, the health of traditional medicines has some advantages over the contemporary treatment methods. Thus, we advocate that based on the disease stage, assessing whether acute or chronic in nature and the kind of care required, an informed decision regarding adopting traditional or contemporary treatment as well as charting the treatment course has to be discussed with clarity and officially documented at the earlier stages of disease progression itself. This will help in tracking on a state level the implementation of Ayush therapies at medical facilities.

Sometimes, patients end up consuming both conventional and Ayush medicines either by design or default. This happens because of the realization of the strengths of these systems of medicine at the grass-roots level. For example, in semi-urban or rural setups still, Homoeopathy is the first choice of parents for infants and children, and Ayurveda is the first choice for lifestyle disorders or chronic diseases. Also, it is common knowledge that most patients with chronic diseases consume both modern and Ayush medicines concurrently. For example, most of the patients with type 2 diabetes mellitus take Neem (Azadirachta indica A. Juss.), Jamun (Syzygium cumini L), or Karela (Momordica charantia Mizo), besides their synthetic drugs. Most of the patients with myocardial infarction start consuming Terminalia arjuna-based products on their own as cardioprotective, irrespective of the advice of the treating cardiologist. The need is to document and regularize the complementary use of therapies belonging to both systems. This will help in laying the foundation of One Nation, One Health System-based integrated healthcare practice.^[4]

Multifaceted Roles of Ayush Systems

Given the existence of medical pluralism in the Indian society, traditional medical systems have wide-ranging applications. Each system has multitudes of practices spanning the entire nation. Broadly, the Ayush systems can be said to work toward four main objectives, namely,

Health protection,

Health maintenance,

Disease prevention, and

Disease management.

[Figure 1] depicts the multifaceted roles of Indian traditional medical systems. Traditional approaches help to maintain the health of the individual. For example, Draksharishta and Lohasava are Ayurvedic preparations that are usually recommended by the Vaidyas for the maintenance of health. These products are a rich source of antioxidants such as polyphenolic compounds, water-soluble vitamins such as Vit B3, B6, and B12, and iron which aid in maintaining an individual’s health. Traditional preparations aid in preventing the spread of a disease in several cases. Siddha practitioners and state agencies worked collaboratively and were pragmatic in advocating the use of herbal decoction Nilavembu Kudineer and papaya extracts for treating dengue fever in Tamil Nadu.^[5],[6]

Figure 1: Multifaceted roles of Indian traditional medical systems Ayush

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From a global perspective, a clinical study was conducted in Germany with guidance from the Ministry of Ayush, comparing the effect of multimodal Ayurvedic therapy and conventional arthritis therapy. It was found that the cohort undergoing Ayurvedic treatment showed higher clinically relevant improvement as assessed by the WOMAC Index (Western Ontario and McMaster University Osteoarthritis).^[7] Thus, traditional systems aid in the management of diseased conditions as well. Tracking the usage of our traditional systems, either given independently or along with modern medicine at international platforms, is required. Setting up thorough documentation of the same will establish the effectiveness of our traditional medicines among varied cohorts, thus strengthening the use of Ayurveda and allied fields on a global scale. Initiatives must be taken to set up a notification portal wherein the use of Ayush therapies at clinical facilities outside India is updated. Establishing the efficacy of Ayush therapies under the subcategory of health protection, health maintenance, disease prevention, or disease management or overlap of either combination should be sorted and documented on the Ayush database, which will facilitate ease of search based on the medical condition.

Leading by Example: Collaborative Efforts During the COVID-19 Pandemic

COVID-19, the grave pandemic that had taken the entire nation by a storm, especially during the second wave, wreaked havoc and left the medical community gasping to contain the situation, has served as an eye-opener. As doctors across all hospitals and care facilities were overworked and strained and no “single specific therapy’ was declared as the cure for COVID-19, people started retorting to traditional herbal therapies to prevent and manage COVID-19 infections. Several studies have been published which substantiate the effectiveness of Ayush remedies such as Chyawanprash, Kaishoreguggulu, Ashwagandha Churna (Withania somnifera), AYUSH Kwath, AYUSH-64 either as protective or to reduce the symptoms.^[8],[9]SanshamaniVati and Arsenicum album-30, an Ayurvedic and Homeopathic preparation, respectively, were distributed across several states to boost immunity. AYUSH-64, a polyherbal preparation, was repurposed for COVID-19 and was found to be very helpful in reducing the symptoms and severity of the infection in addition to standard care. The distribution of Ayu-Raksha kits and AYUSH-64 by the Ayush Rath in Uttarakhand; the Dhanwantari Rath mobile vans in Gujarat providing door-to-door healthcare services; the launch of “AYUSH Qure” app in Madhya Pradesh, “AYUSH Kavach” app in Uttar Pradesh, and so on are few examples of notable work done by the Ministry of AYUSH. The Ministry also released guidelines for specific AYUSH practitioners, immunity-boosting self-care measures, and home-care guidelines, which were updated timely as per newer research.

NITI Aayog, in collaboration with the Ministry of Ayush, in 2022 published “Mitigation and Management of Covid-19: Compendium of Ayush-Based Practices from Indian States and Union Territories,” summarizing the initiatives taken by the Ministry of Ayush for combating the pandemic at the grass-roots level in each state. The initiatives by Ayush encompassed several advisories, guidelines, and protocols, for example, self-care guides for improved immunity and respiratory health, a protocol “National Clinical Management Protocol” advocating Ayurveda and Yoga for managing COVID-19. As per the compendium, 139 research studies, being clinical/pre-clinical or epidemiology-based have been conducted during the pandemic for Ayush systems. Setting up a Project Management Unit (PMU) by the Ministry of Ayush and monitoring all clinical studies by the Data and Safety Monitoring Board were proactive efforts to strengthen research. Repurposing of AYUSH-64 and Kabasura Kudineer was also beneficial for COVID-19. Several works have been published in peer-reviewed journals recommending the use of Kaba Sura Kudineer, a Siddha formulation, as a preventive measure against COVID-19.^[10],[11]

The Ministry of Ayush, in collaboration with the Ministry of Health and Family Welfare, facilitated the training of Ayush personnel, and 28,473 Ayush staff personnel were providing healthcare services during the pandemic. The utilization of 50,000+ beds at around 750+ Ayush hospitals and medical colleges for catering to COVID-19-affected patients was a great testament to the unified working that our nation requires. Similar activities have to percolate at the level of education as well. The “AYUSH for Immunity” campaign, the “Ayush Sanjivani” mobile app, and routine “AYU-SAMVAD” awareness programs are noteworthy platforms that have focussed on generating awareness and providing assistance for COVID-19 management.

It is the situations of acute, pressing needs which propel invention to take place. The COVID-19 pandemic was one of the worst hits to mankind in recent times, and no singular medical system could curtail or manage the spread of the infection. Developing a vaccine was the only hope, but it took more than a year to launch it. In the interim, millions of people lost their lives. Proactive initiatives were being taken by apex government bodies of all countries to save the lives of their citizens. The government of India also utilized its rich repository of Ayush therapies. As a national program, it brought out products such as Chyawanprash, Aswagandha, and Giloya to boost immunity and protect the population from COVID-19. Besides this, repurposing products like AYUSH-64 for the sufferers of COVID-19 was a fruitful prompt decision when vaccines were still being developed. This strategy of utilizing our Ayush heritage was a novel approach of the One Nation, One Health System which came to our rescue and saved the lives of millions of people at a time of global doom.

Advocating for One Nation, One Health System by Integrating Medical Systems: The Progress so Far and Steps Ahead

The One Nation, One Health System should be an ambitious target for India but to achieve this lot of efforts are required for integration between medical systems at the following levels:

Education;

Medical practices;

Governance;

Research; and

Infrastructure.

Integration at the level of academics

It is an essential requirement to enlighten the doctors of modern medicine in India about the priceless treasure our Ayush systems hold. This is only possible by adopting an “Integrated Medical Education System” rigorously. The MBBS curriculum, as a bare minimum, should include courses on gaining a theoretical and practical understanding of the several over-the-counter traditional medicine preparations that have been in use for centuries. Students enrolled for their medical degree should have a separate duration of training and research in Indian traditional systems. It is not required that the MBBS doctors have to become Ayush experts, but that they should have an overall understanding of the most common traditional therapies for the effective management of ailments such as hypertension or diabetes. Similarly, when an Ayush practitioner is treating a patient, they should have clarity about whether the patient is in need of modern medicines, what are the pharmacological actions, treatment duration, adverse effects, and interactions with one another if any.^[12] The Central Council of Indian Medicine (CCIM) and the National Medical Commission responsible for the syllabi and educational regulations of Ayurvedic and MBBS courses, respectively, should work together for integrating medical systems and implementing the same across all colleges. There are 720+ Ayush colleges in India; the Ministry of Ayush should mandate the tracking of “degree-outcomes” of the respective students of each batch and also collect information of graduated students to assess their current professional standing. The CCIM maintains a central register of all Ayurvedic practitioners, and similar central tracking should be implemented for all Ayush branches. This will aid in assessing the cluster areas across India where Ayush-based therapy is flourishing or is in deficit. This will assist in expansion of Ayush colleges, improving their governance and assessing degree-outcomes of the students.

Integration at the level of medical practice

When a patient consults with a doctor, they may have questions about things like whether the traditional therapy they have been receiving will work with modern medications or whether there are any potential interactions between the two, as well as situations in which the patient is interested in receiving an Ayush-based treatment but is unsure of how it would work. In such instances, the doctor must be capable of addressing these questions. They should be able to make suggestions regarding which Ayush modality can be adopted, what particular approach will be most suitable for the patient, and so on. With the implementation of these integrated modules, hospitals should be single units under whose roofs both modern and traditional medicine-based therapies are readily available and the choice lies with the patient to choose accordingly.

When patients enter the hospital, they undergo a battery of tests to diagnose the specific ailment or condition. This is ascertained by undergoing blood tests, testing samples from areas of concern, and so on and using modern medical devices such as an MRI or CT scan or PET scan and many more. Testing for genetic/epigenetic factors may also be performed. Having received a copy of the reports and a brief on the diagnosis, the patient should be given a choice to opt for a treatment modality or a combination of the same depending on the seriousness of the condition. The choice can be modern medicine or any of the Ayush-based approaches. For such a scenario to be possible, first, the patient should have knowledge of the same, and the doctor should have a comprehensive idea about all the respective fields so as to impart proper guidance. This model of integrating modern diagnostic tools with Ayush therapies at the level of deciding the treatment module is required for implementing the One Nation, One Health System.

In a study conducted at Safdarjung Hospital, New Delhi in collaboration with WHO for integrating Ayurveda with modern medicine for the management of 201 patients with knee arthritis, it was seen that the pain and other symptoms of osteoarthritis reduced, the dependence on non-steroidal anti-inflammatory drugs decreased, and overall ease of performing day-to-day activities improved. This served to establish a good referral system in the Safdarjung hospital wherein, now, doctors of both disciplines communicated well, and the incoming patients also became aware that they can avail both types of treatments.^[13] Adapting modules of integrated treatment approaches and envisioning the multiple disease areas, Ayush therapies, patient population, and so on that can be combined for studies will serve to be the basis of developing integration between medical pluralities.

During the early stages of disease onset, medical practitioners should prefer managing the disease by adopting Ayush remedies with the least aid from modern medicine, apart from cases that require immediate care. This mandate can be set up as an approach for primary health care. When the patient is diagnosed with any condition that has progressed and requires immediate care, the therapy should be a combination of modern and traditional medicines. This will fall under secondary health care. Finally, when the disease has progressed, and the patient requires acute care, the therapy should give more preference to modern medicine. This will fall under tertiary health care. [Figure 2] depicts the treatment approach that can be adopted.

Figure 2: Treatment approaches for medical practitioners for disease management

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Integration in research as facilitated by governing bodies

The Delhi Medical Council (DMC) decision prohibiting allopathic practitioners from prescribing Ayurvedic preparations has led to an uproar in the medical community. The DMC emphasized this decision by citing Section 30 of the BharatiyaChikitsaParishad Act, 1998, which articulates that “Cross-pathy” is a punishable offense. This Act of 1998 states that “False assumption of medical practitioner under this Act to be an offense. Any person who falsely improvises that he is a practitioner, and practices BharatiyaChikitsa (Indian System of Medicine), shall be punishable with rigorous imprisonment of up to three years and a fine of up to Rs 50,000/-.”^[14] Strong opposition by the medical doctors and leading Ayurvedic companies was seen, who argued that as these Ayurvedic preparations are easily available as over-the-counter (OTC) drugs, why is it an offense if doctors prescribe the same Ayurvedic preparations? Philipe Haydon, the Chief Executive Officer of Himalaya, released a statement saying “The DMC order is creating confusion. We have asked the government to bring clarity on what is a prescription product and what is not. If OTC products can be sold through a retailer, why can they not be recommended by a doctor?”^[14]

When such laws are in place, they prevent the inclusion of Ayurveda with modern medicine and vice versa. These situations reiterate the need for mandating the implementation of Ayurvedic and modern medicine courses in each other’s respective curricula. This will facilitate the ease of prescribing drugs/preparations of each domain by a practitioner from the other domain. Adopting this strategy would legalize the practice of prescribing by either practitioner and circumvent the recurrence of legal confrontations that happened with the DMC mandate.

The Central Council of Research in Ayurvedic Sciences (CCRAS) collaborated with the Directorate of Health Services on a state-wise basis to assess the usefulness of collaborating with Ayush and the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) program. This pilot strategy was implemented in three districts of three states: Rajasthan, Gujarat, and Bihar across 3 district hospitals, 49 community health centers, and 183 primary healthcare centers. Around 16 Ayurvedic formulations were advocated for preventing and managing the concerned non-communicable disorders. They suggested that integration at the rural levels, starting from villages, will be most appropriate for the best outcomes in managing the disease burden. Herein the patient groups were divided into groups A1, A2, B1, and B2; the A1 group underwent lifestyle modifications and started practicing yoga, A2 started taking Ayurvedic medicines in addition to what A1 was doing, the group B1 underwent lifestyle modifications, practiced yoga, and took conventional medicines and lastly the group B2 underwent all therapies (conventional treatment +Ayurvedic medicines + yoga + lifestyle modifications). This program is still functional and has boosted the cross-referral system.^[15]

The CCRAS made another effort to analyze the feasibility of integration with support from ICMR, wherein Ayurveda was integrated with the Reproductive and Child Health program at primary healthcare facilities in the Himachal Pradesh districts providing ante-natal care. It was observed that the pregnancy-related complications were reduced, more women reached full-term, the hemoglobin levels increased, and neonatal deaths or stillbirths reduced.^[16] On a global scale, the World Health Organization (WHO) launched the “WHO Traditional Medicine Strategy 2014–2023,” which aims to support its Member States’ traditional medicinal systems by developing policies, implementing action plans, and protecting the traditional systems. Implementing disease-specific integrated models which employ a combination of interventions, such that they can be modified and adopted as per the conditions, needs to be well-documented and established clinically. This will facilitate long-term holistic treatment of several chronic lifestyle disorders.

Integration of medical systems for furthering research

Inter-Ayush–allopathy integration

Integrating allopathic medicines with Ayush therapies is an approach that can stand to be most recommended and also most fruitful in terms of outcomes. Managing any chronic disease in the best possible manner should involve integrating Ayush and modern medicine. The treatment approach will no longer be limited to any specific specialty; rather, a combination of modern and complementary medicine that is the most effective and safe treatment will be adopted. Effective management of the COVID-19 pandemic by the Tamil Nadu government by incorporating Siddha formulations for preventing as well as treating the infection made it possible to reduce the load on the modern medical fraternity. In a randomized clinical study conducted by Chitra et al.,^[17] two groups of 100 COVID-19-positive patients in each group had add-on Siddha formulations as part of the regimen apart from the ongoing allopathic standard treatment of care and the other group was on allopathic care alone. It was seen that in the first group, there was a significant reduction of symptoms, such that 78.33% of the subjects had negative RT-PCR results within 11–14 days, and, in contrast, only 33.33% of the patients in the second group had negative results at the same time.

Intra-Ayush integration

A clear understanding of the different disciplines of Ayush among the respective practitioners of each stream is important for ensuring the correct practice of the same. Standardizing the terminologies of all the traditional systems of medicine in India is a herculean task. This task was undertaken by the Ministry of Ayush and led to the launch of the National Ayush Morbidity and Standardized Terminologies Electronic Portal (NAMASTE portal in 2017), which provides information about the standardized Ayurveda, Unani, and Siddha terminologies along with National Morbidity Codes of each respective discipline.

Integration at both these levels is crucial for establishing the best treatment modality and understanding the combination thereof. This will also serve to explicate research directions for the future and can be guided by the Ministry of Ayush. The modern medical system is under stringent regulation, has a well-established regulatory framework, and is at par with international standards. Indian pharmaceutical products and medical devices are widely marketed outside India. The traditional Indian medicine systems are yet to reach this pinnacle. The directives and efforts being taken by the National Ayush Mission and National Health Mission are full-fledged, the Indian traditional systems still have a long way to go and successfully disseminate their benefits, internationally establish the products, and gain foothold in untapped markets, all culminating in establishing a unified One Nation, One Health System.

Efforts should be concerted toward unifying the different pharmacopoeias of Ayush; this will help in the corroborating relationship between the uses and outcomes of the same. Prior to this, establishing protocols for developing pharmacopeial standards is necessary. Implementing the use of plant DNA barcodes/fingerprints to ensure purity is a good strategy. Another area that requires unification and open access made possible by the government for advancing research is establishing an “ Atlas ^{More Details} of chromatographic techniques” for all known phytochemical marker compounds. A separate database, accessible to all, serving as a repository of all Ayush-related studies, be it at in-vitro, pre-clinical, or clinical level or of marketed products, should be made available in a well-segregated manner. [Figure 3] gives an overview of the prerequisites that need to be established for strengthening the Indian Medical System framework, which will serve to be the basis for implementing the integration of medical systems. Once well-integrated medical systems come into existence across the nation; our healthcare infrastructure will be much more balanced and effective in patient management. The document titled, “Ayurveda and Conventional Medicine—A Cross Referral Approach for Select Disease Conditions” by the CCRAS, published in 2021, is one of the latest milestones. It contains extensive research by the experts of Ayush practitioners and medical doctors, who have worked collaboratively in releasing this document that is well-supported by a lot of evidence backing its use.^[18]

Figure 3: Prerequisites: Establishing framework for attaining integrated medical systems

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Establishing functional infrastructure: Institutional bodies, referral systems, and online communication portals

Strengthening infrastructure facilities to make possible the smooth integration of diverse medical systems in our nation is crucial for implementing One Nation, One Health System plans at the grass-roots level. Erecting infrastructure entails provisioning of online platforms and offline bodies, offices, and so on, which will work toward this. With ample information available related to every medical field, interested people and patients are often left with a multitude of data from varying sources that are inconclusive in nature, creating only more confusion. Such individual sources are generally biased and maybe present only positive information about their medicines. Platforms providing complete and comparative data related to traditional and modern medicine are the need of the hour. These systems can be built to aid decision-making for the doctor and patient both if they have any particular knowledge gaps pertaining to the use of any herbal active/drug, its mechanism, or side effects.^[12],[19] The same platform can have different sections for doctors and patients, respectively, to provide information accordingly. This would lead to rational decision-making and serve as a repository of vetted data. Stratifying the data can be done using several angles, based on the disease or the pharmacological action of the actives or the side effects, and so on.^[20] Several noteworthy initiatives by the Ministry of Ayush are the Ayush Hospital Management Information System, Siddhar app, DHARA, AYUSH Suraksha, TriskandhaKosha, e-Aushadhi, Research Management Information system, e-Charak, Traditional Knowledge Digital Library, AYUSH research portal, and AYUSH Sanjivaniapp.^[21]

The document mentioned earlier, titled “Ayurveda and Conventional Medicine—A Cross-Referral Approach for Select Disease Conditions,” outlines the cross-referral approach that can be adopted for several diseased conditions. The entire document is divided into sections dealing with varied conditions such as communicable and non-communicable diseases, gastrointestinal conditions, geriatric care, mental and neurological disorders, reproductive health, and so forth, wherein the general guidelines and roles of the concerned physician are discussed.^[18] In a similar manner, it is necessary that a system of extensive cross-referral is established among doctors at all healthcare facilities, dispensaries, and hospitals in a much more aggressive manner with good documentation of the same. The Government of India may take initiatives to provide financial support and administrative assistance to healthcare facilities that undertake the implementation of integrated treatment approaches. Setting up One Nation, One Health System facilities providing integrated treatment, advocating the same among the people of the area, and increasing awareness are all dependent on development of infrastructural facilities for the same. [Figure 4] summarizes the radical changes that are required for integrating the different systems of medicine and achieving the vision of the One Nation, One Health System.

Figure 4: Radical changes required for One Nation, One Health System: The steps for the way forward

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Conclusion

The picture of the One Nation, One Health System involves the blending of the best of Ayush (health maintenance, health promoter, and disease prevention aspects) and modern medical systems (disease prevention with biologics such as vaccines and disease management, especially for acute and life-threatening conditions) together, so as to bridge the gap and make integrated healthcare accessible to all. The people in the smaller cities and villages should not be restricted to traditional systems alone, such that availing benefits of modern medicine is a challenge for them, involving long travels and waiting in queues. Similarly, for people in larger cities and metropolitan areas, modern medicine should not be the only option available. As outlined earlier, the logical reasoning behind advocating the integration of health systems can lead to an overall improvement of immunity, better monitoring of patients, and ultimately lead to the establishment of holistic treatment approaches. In matters of urgency, modern medicine will serve to provide immediate relief and save the life of the patient and after this, integrating Ayush therapies in the treatment module will lead to holistic and effective treatment. In others, traditional approaches can be adopted much earlier. Ayush therapies serve as a “Kavach,” boosting immunity and conferring protection from infections.

Model of One Nation, One Health System utilizing proportionate uses of Ayush and modern medical systems as proposed at primary, secondary, and tertiary healthcare levels in this article may work as examples for other Asian countries also to follow. With the trend of the resurgence of interest in traditional medicines, India stands to be on the frontier, leading this change and having high potential of being the world leader in this sphere owing to its rich heritage and diversity of traditional medicines such as Ayush.

Acknowledgment

The authors acknowledge the contribution of Anuradha Dey, Research Associate, R&D Healthcare Division, Emami Ltd. in preparing the manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Authors’ contribution

The authors have equally contributed to the conceptualization, designing, and development of the manuscript.

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