Keywords
public health - homeopathy - Government of India - homeopathy wellness centres - Central
Government Health Scheme - morbidity - education - costs
Introduction
Health is a topic of national attention in India and, therefore, anything that either
contributes to, or checks, its growth becomes a matter of nationwide concern. As the
world is becoming progressively interconnected and complex, human health is contingent
on the integrated outcome of ecological, socio-cultural, economic, and institutional
determinants. It is increasingly recognised, also in the Millennium Declaration by
the World Health Organization (WHO), that broad inter-sectoral action in tackling
these determinants of health is needed to achieve significant and more durable health
gains, especially for the poor.[1]
In many developing countries, the speed of modernisation has outpaced the ability
of governments to provide the necessary supporting infrastructures. Although India
moved up from 153rd in 1990 to 145th in 2016 in ranking on the Healthcare access and
quality (HAQ) index,[2] the advances in health care are accessible to only a very small percentage of Indians.
At one end of the spectrum, India has high-end hospitals delivering health care comparable
to any developed nation; in sharp contrast to this, just a few hundred kilometres
away in the villages, one does not even have basic primary care (akin to 19th century
health care). These striking sub-national disparities, reflecting a medical paradox,
are still a concern.[3] The High Level Expert Group constituted by the Planning Commission of India in 2011
defines universal health coverage as ‘ensuring equitable access for all Indian citizens,
resident in any part of the country, regardless of income level, social status, gender,
caste or religion, to affordable, accountable, appropriate health services of assured
quality (promotive, preventive, curative and rehabilitative), as well as public health
services addressing the wider determinants of health delivered to individuals and
the population, with the government being the guarantor and enabler, although not
necessarily the only provider, of health and related services’.[4]
If cumulatively 30% of the total health expenditure (THE) is incurred by the public
sector, the other 70% of the health expenditure is borne by consumers. Household health
expenditures include out-of-pocket expenditures (95%) and insurance (5%). In this
private expenditure dominating environment, people intuitively develop capacity to
make choices for being treated under the western or the indigenous systems of medicine.[5] Besides disparity in health care at sub-national/rural–urban levels, the key health
financing indicators for India show that THE[a] as a percentage of gross domestic product (GDP) is 3.9% for 2014 to 2015 and Ayurveda,
Yoga and naturopathy, Unani, Siddha and Homeopathy (AYUSH) is only 14.9% of that 3.9%,
while domestic general government health expenditure (GGHE-D) as a percentage of GDP
is only 0.92%.[6] The National Health Policy[7] aims to bridge the gaps by increasing public spending by government (GGHE-D) to
2.5% of GDP by 2025 and this policy looks at the problems and the solutions holistically.
To achieve the goals of universal coverage, the government would need the support
of private as well as alternative sectors at primary to tertiary care levels. The
support comes in the form of large investment, new technology, innovations and quality
services.
Developing economies, such as those of India and China, are fighting both third- and
first-world diseases.[8] India's burden of non-communicable diseases (NCDs) continues to expand and is responsible
for major health care problems. A rising dual disease burden (communicable diseases
and NCDs) in India calls for increased capacity building, which is only possible with
a collaborative approach.[9] AYUSH comprises the six core indigenous systems of medicine practised in India.
Although homeopathy is of western origin, the system is being practised in India together
with the indigenous forms of medicine, and is popular.[10]
[11]
[12] It is being effectively used along with other AYUSH systems in the Indian health
care system to ensure health care delivery is far-reaching, economical and all-inclusive.
Before Indian independence, the Bhore Committee was set up by the British imperial
government in 1942 to design a blueprint for health planning, entirely based on modern
biomedicine, and this was adopted as the guide for the development of health services
in post-independence India. However, soon after independence, the Chopra committee
was set up in 1948 to supplement the Bhore committee and recommended the role of Indian
Systems of Medicine & Homeopathy (ISM&H) (eventually re-christened as Department of
AYUSH). It suggested moving towards a ‘synthesis’ of all the systems to formulate
one Indian system. There has been a reiteration of ‘integration’ by several subsequent
documents over the six decades since then, thereby leading to infrastructural progress
of homeopathy in terms of education, research and clinical access by the public. The
mandate of the government of India, that all its recognised modalities should be used
optimally for maximising health options available to its people, is clearly reflected
in the twelfth Five-Year Plan for the period 2012 to 2017, which, besides other integration
measures, proposed some important recommendations to address the issue of shortage
of medical practitioners and to improve the quality of health care by mainstreaming
of AYUSH doctors.[13] The elevation of the AYUSH Department into an independent Ministry (in November
2014) is a noteworthy policy decision to further upgrade AYUSH educational standards
with emphasis on traditional strengths, quality standardisation and stewardship.[10]
Health is thus a shared responsibility in India, and homeopathy is, in that sense,
playing an important role. Government aims at providing wider access to homeopathy
by the people of India. This inclusion is, in fact, a reflection of the novel approach
that the world is now adopting, whereby patients and health care providers alike are
demanding that health care services be revitalised, with a stronger emphasis on individualised,
person-centred, care. This includes expanding access to traditional and complementary
medicine (T&CM) products, practices and practitioners, in particular in primary health
care.[14] However, in a country like India which is home to so many traditional medicine systems,
it is essential to understand these patterns in conjunction with allopathic medicine.
Advocating the use of pluralism, the National Health Policy 2017 of the Government
of India[7] aims at providing AYUSH care to patients who choose, as and when appropriate, access
to AYUSH care providers based on documented and validated local, home and community-based
practices. The policy is being looked at as one of the most evident marks of acceptance
by the government for AYUSH systems. It even mentions that these systems, inter alia,
would have government support in research and supervision to develop and enrich their
contribution to the extent of meeting the national health goals and objectives through
integrative practices. Further, it proposes seven key policy shifts in organising
health care services, one of which is mainstreaming AYUSH services in public health
as an integrated medical care pathway. This has huge potential for effective prevention
and therapy that is safe and cost-effective.[4] Further, policy would prioritise the utilisation of AYUSH personnel in urban health
care. The policy is being welcomed for these features, as it is well known that health
systems focused on strong primary care deliver better population health outcomes at
lower cost.[15]
Aim of Study
As much as homeopathy is being embraced in the health care delivery structure of India,
the position of homeopathy in integrated public health care is still an inadequately
analysed area. To understand the position of homeopathy in the changing health scenario
of India, this article aims to take a closer look at the trends in the health units
(wellness centres), run under the Central Government Health Scheme (CGHS), that have
homeopathic centres co-located within the allopathic set-ups, as a case in point.
There are four health schemes operated by the central government that assure a comprehensive
package of services, including out-patient and in-patient care, tertiary care and
prescription drugs to its employees, pensioners and their families. These schemes,
which cover 23 million families (82 million persons: i.e. 6.5% of India's population),
comprise the CGHS for civilian employees and pensioners, Retired Employees Liberalized
Health Scheme and Railway Health Service, Ex-Servicemen Contributory Health Scheme
for retired armed forces personnel, and Employees' State Insurance Scheme for workers
and their families in the organised sector with an annual income of INR 180,000 (approximately
£1,800, €2,100, US$2,400) or less.[16]
Of the above four schemes, the CGHS has been identified for detailed study because
it sets the trend for other schemes in terms of policy and procedures and has maximum
fiscal space for reform. As it is directly managed by the Ministry of Health and Family
Welfare (MoHFW), the CGHS can benefit from knowledge and best practices in India and
could in turn influence state governments to reform their health systems.
Data and Methods
A literature review of recent surveys and articles assessing the morbidity trends
in India and the treatment modalities being sought by patients was carried out to
collect information on the available understanding of the health scenario in India.
Elaborate attempts were made to identify and access all available data sources to
estimate the spread of government homeopathic wellness centres, the patient footfall,
their morbidity profiles, average expenditure and number of homeopathic practitioners
in India. The data sources included are National Health Profile 2017,[17] AYUSH in India 2017[18] and Annual Reports of Ministry of AYUSH[19] and MoHFW[20] (2015–2016 and 2016–2017). The National Health Profile, an annual publication of
the Central Bureau of Health Intelligence, is a source of substantial health information
under six major indicators: namely demographic, socio-economic, health status, health
finance, health infrastructure and human resources for the specified calendar year.
It was also consulted for the data required to analyse the situation of homeopathy
in public health in India.
The secondary data of health wellness centres being run by the Government of India
under CGHS were sourced on official requests to the officials concerned. Some officials
of central government were also consulted through formal meetings or correspondence
to understand the standard structure of the CGHS wellness centres and to know their
first-hand experience in handling patients in co-located set-ups. A site visit to
one such CGHS centre, located in the Mayapuri area of Delhi, was made. The subjects
of discussion included average patient footfall per day in allopathy and homeopathy
units, estimated cost incurred per patient in each of these units, and staff structure
of these centres, including salaries. The budget distribution within a CGHS centre
is information that is not readily available in public records or even in official
annual reports. The Homeopathy Medical Store Department In-charge was also consulted
for these details.
Data thus gathered were analysed for understanding the trends for homeopathy, or for
AYUSH as a common entity, as opposed to conventional (allopathic) medicine.
Results
Central Government AYUSH Wellness Centres
The Government of India caters to the health care needs of its employees through various
health wellness centres. Of 673 AYUSH wellness centres being run by the government,
255 belong to homeopathy, which is 37.8% of total wellness centres. Ayurveda, the
ancient medical science of India, makes 42% of the total count. The ‘within’ breakdown
of these 255 homeopathic wellness centres is shown in [Fig. 1]. Thirty-six homeopathic units are currently functioning under the CGHS in the country.[19]
Fig. 1 Central government-run wellness centres under AYUSH by system. AYUSH, Ayurveda, Yoga
and Naturopathy, Unani, Siddha and Homeopathy; CGHS, Central Government Health Scheme.
Spread of Homeopathy Wellness Centres in India
The CGHS covers 37 cities across 18 states and 2 union territories[b] through 279 units, leaving out 11 states and 5 union territories without a presence.
AYUSH services are present in 85 of these 279 centres, of which homeopathy is available
in 36 units. Within AYUSH, homeopathy is second only to Ayurveda in terms of demand.
The number of government-run homeopathic hospitals/wellness centres in India is 8,151,
which is 31% of total AYUSH wellness centres (26,375) in CHGS set-ups in India. However,
this figure is not as significant when it comes to total number of health care units
in India, which comprises largely non-AYUSH (or conventional) facilities (85.5%),
as opposed to AYUSH ones (14.5%). For every 19 CGHS wellness centres housing allopathic
units, only one has the co-located facility of a homeopathic unit ([Fig. 2]).[19] How these homeopathic wellness centres fare in terms of patient turnover and sharing
disease burden is discussed elsewhere.
Fig. 2 Total number of government (central/state) wellness centres by system. AYUSH, Ayurveda,
Yoga and Naturopathy, Unani, Siddha and Homeopathy.
Patient Turnover in CGHS Wellness Centres
Homeopathy, combined with other systems of AYUSH, makes for about 10% of total patient
footfall in CGHS wellness centres. The total number of patients turning up at a CGHS
wellness centre to see a homeopathic doctor annually (2016–2017) was found to be 258,113,
which is one-fifth of the total number of patients seeing an allopathic doctor in
these wellness centres (1,228,962) (data sourced through a personal visit to the Monitoring
Computerization and Training Cell, CGHS Wellness Center Building, Kalibari, New Delhi
& AYUSH in India, Ministry of AYUSH, New Delhi on 20th April 2018) ([Fig. 3]).
Fig. 3 Outpatient department registrations (Hom.) (Delhi, 2016–2017). AYUSH, Ayurveda, Yoga
and Naturopathy, Unani, Siddha and Homeopathy.
Morbidity Profile
The top 10 diseases reported at homeopathic wellness centres are musculoskeletal disorders,
anaemia, allergic and skin diseases, gastric disorders, respiratory, gynaecological,
endocrine/genitourinary, cardiovascular, ear-nose-throat and paediatric diseases,
in decreasing order. This profile, if compared to the top 10 diseases recognised as
national burden in a nationwide survey, has at least 7 diseases in common.[19]
[21]
It may be noted that the category headings cardiovascular, respiratory, endocrine/genitourinary
and musculoskeletal disorders are the same in both the profiles being compared: that
is to say, for the graph that illustrates the top 10 diseases as national burden,
and for the graph that is a result of our secondary analysis from the patient morbidity
data from CGHS homeopathy units of wellness centres. However, the heading ‘lower respiratory,
gastric and other infectious diseases’, as reflected in the national graph, has been
compared to ‘gastric disorders and other infectious diseases’, since lower respiratory
cases were not segregated from other respiratory infections in the homeopathy data,
and thus those patients were already included in the category of respiratory infections.
Similarly, the heading ‘nutritional deficiencies’ has been correlated with ‘anaemia’
alone, which make 12% of the top 10 diseases being reported to the homeopathy centres.
Other nutritional diseases like protein-deficiency malnutrition, delayed milestones,
teething problems in infants etc. were not distinctly segregated in the data. Further,
the heading ‘neonatal disorders’ in the national graph has been likened with the heading
‘paediatric diseases’, as the homeopathy data of this category are inclusive of the
neonatal disorders that reported to the CGHS homeopathy centres ([Fig. 4]).
Fig. 4 Burden of disease. AIDS, acquired immune deficiency syndrome; CGHS, Central Government
Health Scheme; HIV, human immunodeficiency virus.
Education Infrastructure
Out of 1,006 medical academic institutes, 45.9% (461) belong to allopathy alone, while
the remaining 54.1% (544) comprise AYUSH colleges combined. Among AYUSH, homeopathy
colleges are second highest in number: that is, 35.8%, (195 out of 544), and so also
in student intake, 42.3% (13,658 of 32,256 combined)[19] ([Figs. 5] and [6]).
Fig. 5 Undergraduate colleges by system. AYUSH, Ayurveda, Yoga and Naturopathy, Unani, Siddha
and Homeopathy.
Fig. 6 Undergraduate student intake by system. AYUSH, Ayurveda, Yoga and Naturopathy, Unani,
Siddha and Homeopathy.
Practitioners in India
AYUSH practitioners together make 43.5% of the total practitioners in India (773,668),
while conventional (non-AYUSH) practitioners make a bigger proportion of 56.5% (numbering
1,005,106). Within AYUSH, homeopathy practitioners are 284,471, which is 37% of the
total number of AYUSH practitioners[19] ([Fig. 7]).
Fig. 7 Registered practitioners by system. AYUSH, Ayurveda, Yoga and Naturopathy, Unani,
Siddha and Homeopathy.
Growth in Wellness Centres
The total number of homeopathic wellness centres in India, combining the state and
central government sectors, has seen consistent growth of about 28% in the last 10
years, from 5,910 wellness centres in 2007 to 7,544 in 2017. This growth factor is
similar to that of the Ayurveda units (25%). The thrust has, however, considerably
reduced if we assess the trend of growth between 2007 and 2012, vis-à-vis 2012 and
2017 ([Fig. 8]).[22]
Fig. 8 Growth in wellness centres.
Budget Breakdown
During the financial year 2016–2017, AYUSH was allocated a budget amounting to INR
10,500 million, which was 10.3% of the national health budget. However, there has
been a linear (factor of four) growth in the budget allocated to the AYUSH sector
by the government in the last 15 years ([Fig. 9]).[17]
[23]
Fig. 9 Budget allocated by system in Indian rupees. AYUSH, Ayurveda, Yoga and Naturopathy,
Unani, Siddha and Homeopathy.
Case study: CGHS Centre in Mayapuri
We conducted a case study by visiting the CGHS wellness centre located in the densely
populated area of Delhi, Mayapuri. On an average, the wellness centre records a monthly
turnover of 200 patients for the homeopathy centre and 500 patients for the non-AYUSH
centre. The manpower engaged in this centre includes four allopathy doctors and two
homeopathy doctors. Further, two paramedical and two multi-task staff members are
engaged separately for each facility. The salary structure of the staff depends solely
on the designated post and not on the facility under which the professional or the
staff is serving. The major differentiating criterion in assessing the functioning
cost of each of the clinics of the respective facilities thus remains the cost incurred
for medicines. Upon request, it was reported to us that an average patient visiting
a homeopathic wellness centre would receive medications worth not more than INR 100
following a 5-minute consultation. On the other hand, a patient visiting the allopathic
centre receives medications of anywhere between INR 250 and INR 1000, following equally
long or short consultation, depending on the case. We were also informed that the
allopathic medicine store in this unit spends around INR 4 million on a monthly basis,
which includes around INR 1.5 million spent for life-saving drugs or injections. On
the other hand, the monthly expense of the homeopathic unit is around INR 50,000.
The ratio of the monthly expenditure for the homeopathy versus allopathy unit at this
centre is 1:80.
Discussion
Popularity of Homeopathy
Homeopathy is a well-integrated part of AYUSH modalities. However, if its position
in Indian health care is understood with respect to non-AYUSH (conventional) facilities,
its presence is far from extensive, with only about 13% of CGHS health centres housing
homeopathy units. Conventional medicine, on the other hand, is represented more widely
in terms of the wellness centre set-up and also caters to a larger number of patients
in those settings.
Among AYUSH, homeopathy is popular and successful. Despite its arrival in India in
the early nineteenth century as a foreign system, homeopathy has been very well adapted,
as also reflected in the trends studied. It has surpassed, in popularity and usage,
many other medical systems in India that have been prevalent for a long time, such
as Unani, Siddha and Naturopathy. From many perspectives, it is second only to Ayurveda,
the most ancient and original medical system of the country. This is no surprise,
however, given the connection of this system to the cultural ethos of the people of
India who have always considered illness as more than just a physical disease.[24]
Despite the fact that there exists only one homeopathic wellness centre for every
19 allopathic wellness centres, the total number of patients seen by these homeopathy
units in 1 year is only one-fifth in comparison to those seen by the allopathy units.
This reveals the popular demand for homeopathy in the CGHS centres. In fact, these
figures may be taken to suggest that, in the units where homeopathic wellness centres
are not present, some percentage of patients willing to seek homeopathic treatment
could be getting diverted towards the conventional system, owing to limited options
and not by their own preference. Alternatively, it is arguably the case that trends
would be more in favour of homeopathic wellness centres if more co-locations were
in place. This could be true especially for diseases that have been found to respond
well to homeopathy, such as allergic, skin and paediatric diseases,[25] musculoskeletal,[26] respiratory[27] or gynaecological disorders[28] and genitourinary problems.[29]
Costs
Out of its CGHS budget, AYUSH wellness centres are using only 13.3% of the allocated
amount. The remaining 86.7% is consumed by conventional units, along with other expenses
that do not fall under the AYUSH domain. With AYUSH wellness centres present in about
16% of the CGHS wellness set-up, this budget is limited to less than 1% per AYUSH
centre. This further reflects the cost-effectiveness of having AYUSH wellness centres,
especially when these wellness centres cater to a large number of patients.
Typically, a CGHS centre has at least two allopathic doctors and one to two doctors
for each of the other co-located facilities available in the centre. The paramedical
or other assisting resources in the centre vary only slightly, consisting of one nurse
(in the case of allopathy), one to two pharmacists, and one to two staff personnel
at the registration desk or other assistants.
Manpower is a collective expenditure of each wellness centre, with salary of the engaged
staff in any of the units remaining the same, depending solely on the designations
of the staff, and not on the type of treatment modality they are serving under. A
wellness centre would typically spend under three headings: human resources, infrastructure,
and costs of medicines. Since the first two expenses are borne as a common expense
across all units by the wellness centre, the third one, the costs of medicines, is
one major criterion on which the functioning cost of each clinic can be assessed for
differential purposes.
The case study at the Mayapuri CGHS wellness centre revealed that the major difference
in expenditure of a homeopathic unit compared to an allopathic one comes in its running
costs. While an estimate from our case study suggested a homeopathic unit will spend
no more than INR 100 on a patient per visit, given the much lesser cost of the medicines
(including patents[*]), an allopathic unit spends at least INR 250 to INR 300 on an average patient visit.
This may reach INR 1000 or more, in some cases, dependent on the illness. This per-patient
cost in a homeopathy unit corroborates other similar assessments.[30] The costs of homeopathy units compared with allopathic units is reflected in a ratio
of 1:80 in our case study. Similar budget structure exists in the other units, but
due to limited information available on this in the public domain, the same could
not be corroborated for other wellness centres. However, it is worth mentioning that
this ratio is even higher than a previous finding on costs of homeopathy clinics in
Delhi.[31]
Further, realising the economic viability of AYUSH services, the primary health centres
(PHCs) are being strengthened under the National Health Mission by the government.
The aim behind this exercise is to provide a package of essential public health services
and support for outreach services including for regular supplies of essential drugs
and equipment. The government is trying to achieve this by upgrading single-doctor
PHCs to two-doctor PHCs by posting AYUSH practitioners (and not other conventional
doctors) in that setting, together with provision of three Staff Nurses in a phased
manner based on patient load.[7] This mandate ensures not only wider treatment options but also economic affordability,
considering the lesser expense of an AYUSH wellness centre, even when the salary of
the doctors and that of the paramedical staff of each stream remains the same.
Infrastructural Strength
Data for registered medical practitioners in India reveal that, even though allopathic
units make up 84% of CGHS health coverage, the remaining 16% have co-located AYUSH
units, among which homeopathy is the second most preferred. The total number of registered
practitioners for homeopathy in 2017 was 280,000, as opposed to approximately 1 million
allopathic practitioners. If we add to this the remaining AYUSH practitioners in India,
we recognise that there is a huge AYUSH-skilled resource of 770,000. A major portion
of this number is young and looking out for employment at central or state government-run
PHCs. Currently, however, recruitment of these resources in the central government
service is minimal, owing to the small number of homeopathic (36)/AYUSH (85) wellness
centres being run by the CGHS. In fact, the 36 CGHS-run homeopathic wellness centres
in the whole of the country represents merely 28% of the total number of CGHS allopathic
centres.
Homeopathy Practitioners as Skilled Resources
To utilise optimally the resources available in the form of homeopathy practitioners,
who are trained to work at PHC/CGHS level, more homeopathic wellness centres need
to be opened. A report reveals there is a current deficit of allopathic practitioners
in CGHS centres, which is attributable to low rates of recruitment as well as non-availability
of eligible SC/ST[c] candidates for reserved posts.[32] The low recruitment rate, in turn, could be due to poor working conditions or inadequate
professional incentives.[33] Allopathic practitioners in India are spoilt for choice, especially in urban locations,
whereas homeopathic practitioners are willing to join government health services due
to their lack of options in the private sector, such as hospitals and nursing homes.
Looking at the current scenario of shortage of public health professionals and intense
demand for community health services, the contribution of homeopathic practitioners
in the field of public health becomes imperative, given the popularity of homeopathy
in PHCs and the good morbidity profile that homeopathic clinics witness. However,
knowledge about public health issues and concepts will ultimately decide whether they
can be successfully integrated into the community health arena or not. A study conducted
to assess the knowledge level of 90 homeopathic practitioners and recent graduates
revealed a deficient understanding about public health issues, concluding that curriculum
and training related to homeopathic education therefore needed to have more public
health-related content.[34]
Morbidity Profile of Homeopathy Users
Given the present health trends in India, 7 out of the top 10 diseases recognised
as a national burden have a considerable overlap with the top 10 diseases that patients
reported to the homeopathic clinics.[35] The seven conditions common in both sets comprised cardiovascular diseases, gastric
disorders, respiratory diseases, endocrine/genitourinary diseases, musculoskeletal
disorders, anaemia and paediatric diseases.
Further, the set of top 10 diseases treated with homeopathy is similar to those identified
previously from India and other countries.[31]
[36] Since patients with these diseases are already coming to homeopathy clinics, as
evident from the average morbidity profile of CGHS homeopathic wellness centres, more
co-located homeopathic wellness centres could prove to be an advantage in several
ways. One, it would divert some patient traffic to homeopathic wellness centres, thus
reducing burden on the corresponding conventional unit. Two, it would mean that patients
would receive homeopathic or conventional treatment based on choice and not on availability.
Three, it would lead to more inclusive health care delivery, as also proposed in the
National Health Policy 2017.[7]
With the overlap of diseases most commonly encountered in homeopathy wellness centres
and those that pose a major burden on the health status of the country, it is obvious
that CGHS wellness centres are being visited frequently by patients suffering from
these illnesses. However, since these areas of illness have also been recognised as
strength areas of homeopathy,[31]
[36]
[37] it may be interpreted that homeopathic treatment is benefitting the patients in
these areas, and hence the footfall for these cases remains fairly constant.
Homeopathy in Public Health
Going by the recognised disease burden on the above conditions, and its vast impact
on the day-to-day lives of the affected people, it is prudent that government considers
launching exclusive health programmes for integrating homeopathy in treatment of these
diseases for wider and better health delivery or provides homeopathy as an adjunct
to the ongoing programmes for prevention and/or treatment of these 10 identified diseases.
Interestingly, it is reported that users of homeopathy, both within India and in other
parts of the world, seek this form of treatment for many of the diseases identified
as a part of the global burden.[31]
[36]
A cross-sectional survey was conducted among 659 adult patients visiting randomly
selected secondary-level conventional health care set-ups in Kolkata, Mumbai, Kottayam
and New Delhi, revealing that 82.4% of the participants were in favour of integrating
homeopathy services in public health.[12]
For the last six decades, the CGHS in India has provided comprehensive medical care
to central government employees and pensioners enrolled under the scheme. In fact,
the CGHS caters to the health care needs of eligible beneficiaries, covering all four
pillars of the democratic set-up in India: namely Legislature, Judiciary, Executive
and Press. As a health care facility provider, the CGHS is unique of its kind due
to the large volume of beneficiary base, and its open-ended generous approach to providing
health care. The CGHS provides comprehensive health care, through allopathic as well
as AYUSH systems, to more than 3 million beneficiaries in 37 densely populated cities
of the country.[38] Expansion in the spread of homeopathic services in the CGHS is a desirable outcome
of both government support and public demand.
Despite the above evident merits of homeopathic wellness centres in providing holistic
and economically viable health care, and their burden-sharing with conventional wellness
centres, the rate of growth of homeopathic wellness centres in the CGHS in the last
10 years has been only 1%. However, if all kinds of central or state government-run
homeopathic wellness centres are combined (7544), the rate of their growth is about
8% over the last 10 years. The growth of homeopathic wellness centres within the CGHS
sector is thus not consistent with the conspicuous popularity of homeopathy in that
setting.
If, in addition, we consider that India is producing, on an average, 13,658 homeopathic
graduates every year through 195 academic institutes, we can imagine the taskforce
that is being generated every year in the homeopathy sector, in addition to the existing
count of 0.28 million, which is 37% of the AYUSH practitioners in India. Most of these
students do not consider working in remote rural circumstances and its exam-based
stringent selection as a medical officer. On a tangential note, this lack of employment
eventually leads to many young homeopathy doctors changing their profession. It is
not unusual to see these students switching careers and entering other jobs that require
minimal medical background such as medical transcription or coding, medical insurance
claims assessment or health care administration as a (not preferred) alternative profession.
The potential of homeopathic doctors is thus conspicuously under-utilised. If more
avenues were opened up by the government to engage these trained resources in primary
public health care, their worth could be optimally utilised potentially to deliver
the WHO's directive of universal health coverage in a developing country such as India.
A few government-run pilot projects integrating homeopathy in national health programmes
have proven beneficial, with homeopathic practitioners using their soundly trained
clinical judgment for exercising their own role as a public health care provider or
in referring patients to the higher health care centre for conventional or more specialised
care. The ability to differentiate between these two pathways has made these programmes
more holistic as well as successful.[39]
[40] In Tuscany (Italy) too, integration of allopathic and homeopathic treatment has
proven useful.[41]
Conclusion
Homeopathy is playing an important role in shaping the health scenario of India under
the patronage of its government. Homeopathy services, wherever available, are being
used fully and thus contributing to sharing the patient load in those centres. However,
the pace of establishment of homeopathic clinics in CGHS centres is exceptionally
slow and not keeping in tune with the growing demand of this treatment modality among
the masses.
Further, it is imperative that the huge numbers of skilled homeopathic practitioners
is engaged in public health care wellness centres and other national programmes, which
would help achieve universal health coverage in India, as well as employing capable
students looking for public health care jobs.
Lastly, the promotion of homeopathic practice, especially in those areas of morbidity
that are commonly seen in the homeopathy clinics and are also part of the national
health burden, should be extended through dedicated health programmes and public health
advisories.
