Planning Commission of India-Access to Health systems including AYUSH

Working Group on


“Access to Health Systems including AYUSH”
Government of India

Planning Commission
D.O. No.G-20018/3/2006-P&E

July 31, 2006

Dear


Planning Commission has constituted a Working Group on “ Access to Health Systems including AYUSH” under the chairmanship of Secretary (AYUSH). Secretary (AYUSH) in turn had constituted Sub-Groups on following five issues:


(i) AYUSH Education.

(ii) Standardization and Quality Control of AYUSH drugs.

(iii) Research & Development.

(iv) Medicinal Plants.

(v) Mainstreaming of AYUSH.


The above Sub-Groups have submitted their reports which were discussed in the meeting of the Working Group chaired by Secretary (AYUSH) recently (Minutes enclosed). On the basis of a discussion in the Working Group and the Sub-Groups the Department has formulated its 11th Five Year Plan proposals. The change in priorities and schemes in the 11th Plan are reflected in the introduction chapter. The Department proposes to scale up Plan provision for Department of AYUSH from Rs.1057.26 crore (actual expenditure of first four years of the 10th Plan and B.E. of 2006 – 2007) to Rs.2473.45 crore in 11th Plan. The Department has been very cautious and realistic in making its Plan projections and it is hoped that by improving utilization of Plan funds and the quality of Plan expenditure the Department would be able to come back to the Planning Commission for raising its Plan provision midway during the 11th Plan.


Please find enclosed herewith the proposals of the Department of AYUSH for 11th Five Year Plan for AYUSH sector which have been duly approved by Secretary (AYUSH).


I am also enclosing the copies of the reports of the 5 Sub-Groups constituted by Secretary (AYUSH) on the above mentioned five subjects. The 11th Five Year Plan proposals alongwith the 5 reports of the Sub-Groups may be treated as report of the Working Group on “Access to Health Systems including AYUSH” constituted by the Planning Commission under the chairmanship of Secretary (AYUSH)..


With regards,


Yours sincerely,



( SHIV BASANT )

Prof. N.K. Sethi,

Adviser (Health), Planning Commission,

Yojana Bhawan,New Delhi.




INTRODUCTION


Department of Indian Systems of Medicine and Homoeopathy (ISM&H) was established in 1995 and renamed as Department of Ayurveda, Yoga & Naturopathy, Siddha, Unani and Homoeopathy (AYUSH) in November, 2003. There has been a three fold increase in the Plan budget of the Department in the 10th as compared as 9th Plan, most of which was on account of scaling up of the budget provision in the last two years of the 10th Five Year Plan i.e. 2004 – 2005 and 2005 – 2006 in line with the declared policy of the Central Government to increase the budgetary provision for AYUSH sector for mainstreaming it in the national health care delivery network.


Department has utilized the increased budget provisions in the 10th Plan for raising standards of AYUSH education, upgradation of national institutes set up by the Department to lay down benchmarks for teaching, research and clinical practices of different systems. With a view to prevent the mushroom growth of sub-standard colleges, the Indian Medicine Central Council and Homoeopathic Central Council Acts were amended in 2003 to provide for prior permission of the Central Government for establishing new colleges, starting new and higher courses, increase in the admission capacity in Ayurveda, Siddha, Unani and Homoeopathy colleges. The Centrally Sponsored Schemes of Strengthening of Institutions was effectively utilized for providing assistance to Government and Government aided colleges for ensuring conformity with the minimum infrastructural standards laid down by the statutory bodies. The Department would like to develop Government, Government aided and private but not for profit AYUSH colleges to the level of Centre of Excellence by providing enhanced scale of assistance on the basis of college specific upgradation plan which will clearly outline the responsibility of the college management and the State Governments for effective utilization of central assistance to be provided in the 11th Plan for the upgradation of these colleges.


Department of AYUSH attaches very high priority to laying down of pharmacopoeial standards for single and compound formulations, scientific validation of herbo-metallic compounds, standardization and quality control of AYUSH drugs. It is proposed to set up a Pharmacopoeial Commission for Indian Medicine in the 11th Plan which will be housed in the newly constructed building of the Pharmacopoeial Laboratory of Indian Medicine, Ghaziabad. The basic objective is to create an independent scientific body which will undertake laying down of pharmacopoeial standards and their revision from time to time on a more permanent footing. The Centrally Sponsored Scheme of Drugs Quality Control in the 10th Plan was utilized for providing financial assistance to the State Drug Testing Laboratories and State Pharmacies. The experience has not been a happy one as inspite of provision of financial assistance, State Drugs Testing Laboratories have been functioning at a sub-optimal level due to a variety of managerial problems. Offtake under the strengthening of enforcement mechanism component has also been very poor. The Department would like to shift the emphasis in the 11th Plan from strengthening of State Drug Testing Laboratories to utilization of a vast network of NABL accredited laboratories all over the country for random testing of Ayurveda, Siddha and Unani drugs and Homoeopathic mother tinctures for ensuring quality control of AYUSH medicines. It is proposed to modify the existing drug quality control scheme to provide financial assistance to States in terms of reimbursement of expenditure incurred by them on random testing of AYUSH medicine through NABL laboratories. The Department has enforced Good Manufacturing Practices and mandatory testing of heavy metals for export of purely herbal Ayurveda, Siddha and Unani medicines. Hon’ble Members of Parliament and informed sections of the public are also pressing for mandatory testing of AYUSH medicines for domestic consumption as well which would require in-house quality control laboratories in most of the AYUSH manufacturing units. A large number of AYUSH manufacturing units fall in the small and medium scale, it is felt that without a liberal financial assistance from the Government they would not be able to purchase costly equipments like Atomic Absorption Spectrometer for testing of heavy metals, TLC/HPTLC/GLC for testing of crude drugs. Therefore, it is proposed to provide backended subsidy of Rs.50.00 lakh or 50% of the project cost whichever is less to Ayurveda, Siddha and Unani drug manufacturing units for acquisition of requisite equipments and instruments for enabling them to test their ingredients, their raw materials and finished products inhouse. The subsidy would be released only through scheduled banks on the basis of a certificate to be issued by State Licensing Authority or any NABL Laboratories to the effect that the concerned manufacturing unit has obtained the requisite equipments and has started inhouse testing of raw materials and medicines. This assistance will be provided only to those units which has an annual turnover not exceeding Rs.25.00 crore. Units whose annual turnover exceeds Rs.25.00 crore should be able to avail of soft known facilities under the Pharma Development Fund which is administered by the Department of Science & Technology. As regards the State Drug Testing laboratories for which 1st instalment of upgradation grants has been released in the 10th Plan would be eligible for 2nd and 3rd instalment in the 11th Plan on proper utilization of funds.


Mainstreaming of AYUSH is one of the key strategies under the National Rural Health Mission (NRHM) under which it is envisaged that all PHCs/CHCs would be provided AYUSH facilities under the same roof. While the AYUSH manpower would be arranged either by relocation of AYUSH doctors from existing dispensaries or from contractual hiring of AYUSH doctors under NRHM funds. The other infrastructure and supply of medicines to PHCs/CHCs would be done through the Centrally Sponsored Scheme of Hospitals and Dispensaries which has received a very good response from States in the last two years of the 10th Plan. Hence, it is proposed to substantially increase the Plan provision for this scheme to Rs.625 crore in 11th Plan. A minor modification in the scheme for providing upgradation and assistance to existing AYUSH hospitals and dispensaries is also proposed.


The need for in-situ conservation and promotion of ex-situ of medicinal plants cannot be over emphasized. On the basis of the recommendations of the Task Force of Planning Commission the National Medicinal Plants Board (NMPB) was set up in the 10th Plan which is still grappling with infrastructural constraints. However, the National Medicinal Plants Board has been able to provide a strong impetus to medicinal plants sector through promotional and contractual farming schemes. Keeping in view the vast experience and constraints in the implementation of these two schemes, it is now proposed that the promotional and conservation scheme of the NMPB would be continued as Central Sector Scheme while the contractual farming scheme should be converted into a Centrally Sponsored Scheme for better monitoring and implementation by the State Medicinal Plants Board (SMPB). It has been felt that the States have not strengthened their Medicinal Plants Board as NMPB has been directly implementing the contractual farming scheme as a Central Sector Scheme. Conversion of this into Centrally Sponsored Scheme will provide the right impetus to the States to strengthen their SMPBs for better planning, implementation and monitoring of the contractual farming scheme which has a huge potential of generation of additional employment and income to the farmers through crop diversification. The Central Sector Scheme of the NMPB will concentrate on conservation/regeneration through joint forest management committees in forest areas, establishment of Gene Bank and community herbal gardens, etc. Whereas the Centrally Sponsored Scheme would encourage cultivation by farmers and provision of post harvest management and marketing support by State Medicinal Plants Boards and other State agencies in collaboration with National Medicinal Plants Board. Accordingly it is proposed to scale up the plan financing of the NMPB from approximately Rs.134.64 crore to Rs.465 crore in the 11th Plan.


AYUSH research councils have done a lot of research based on survey of medicinal plants and observatory clinical trials. Department has been emphasizing on focused, protocol based and peer reviewed research in a specified time frame and with specified outcomes. The major hindrance in the working of the AYUSH research councils has been non-implementation of the flexible complimentary scheme made applicable to other scientific institutions for in-situ Assured Career Progression as a result of which AYUSH councils are not able to attract talent. This matter has been taken up with the Department of Personnel & Training and Ministry of Finance on a number of occasions without much success. It is hope that the Sixth Pay Commission on the anvil will be able to address this anomaly. Another area of weaken of the AYUSH research councils has been lack of adequate equipments and good laboratories for standardization and quality control work. The Department has now entrusted the Pharmacopoeial work to the AYUSH research councils so that laying down of pharmacopoeial standards and SOPs can be attended to on a sustained basis in a scientific environment. Keeping in view the requirements for upgradation of various peripheral units of the research councils, it is proposed to scale up the Plan provisions** of Central Council for Research in Ayurveda and Siddha (CCRAS) from Rs.54.37 crore to Rs.100.00 crore in 11th Plan, for Central Council for Research in Unani Medicine (CCRUM) from Rs.59.45 crore to Rs.90.00 crore and for Central Council for Research in Homoeopathy (CCRH) from Rs.37.39 crore to Rs.77.50 crore.


** Plan Provision indicates actual Plan expenditure of that 1st four years of 10th Plan and Budget Estimates of 2006-07.

Suitable scaling up of Plan outlays for other Central Sector Schemes of the Department, namely, IEC and International Exchange is also proposed. The proposal for setting up of a National Ayurveda Hospital in Delhi and North-Eastern Institute of Ayurveda and Homoeopathy was conceived in the 10th Plan. Land has also been acquired for the National Ayurveda Hospital in Delhi and detailed project reports for these projects are being revised keeping in view the advice received from Expenditure Finance Committee. A Plan provision of Rs.75.00 crore for National Ayurveda Hospital in Delhi and another Rs.75.00 crore from out of that 10% NE corpus for North-Eastern Institute of Ayurveda and Homoeopathy is proposed in the 11th Plan.


The Department has showed in the last two years of the 10th Plan that it has the capacity to plan for and utilize higher Plan allocation in priority areas of strengthening of AYUSH institutions, standardization and quality control of AYUSH medicines, mainstreaming of AYUSH in national health care delivery network and focussed research for meeting national health goals. Keeping in view the enhanced Plan provisions a second post of Joint Secretary was sanctioned in the Department for strengthening planning, coordination and monitoring of various Central Sector and Centrally Sponsored Schemes. The posts of Directors, CCRUM/CCRAS/CCRH and the posts of Director of National Institutes were upgraded in the last two years of the 10th Plan and the proposal to upgrade the post of Director, PLIM to the Joint Secretary level is on the anvil. Due to sustained efforts, the Department has been able to find regular Directors for its research councils and autonomous institutions and fill up such vacancies timely. The Department of AYUSH has been maintaining a constant dialogue with all the stakeholders including the AYUSH industry. Successful launching of the Golden Triangle research initiative in collaboration with the ICMR, CSIR and creation of Traditional Knowledge Digital Library (TKDL) for defensive protection of ASU classical formulations from misappropriation are indicative of the fact that the Department of AYUSH has been providing effective leadership and momentum to the scientific validation and mainstreaming of AYUSH systems in the national health care delivery network. Keeping in view the tremendous potential of these systems for better health care for Indian citizens and for obtaining a better share of the world herbal market, these systems need to be supported by a quantum jump in Plan funding of the various Central Sector and Centrally Sponsored Schemes of the Department of AYUSH. Accordingly, it is proposed to scale up Plan provision for Department of AYUSH from Rs.1057.26 crore in the 10th Plan to Rs.2486.45 crore in the 11th Plan. The Department has been very cautious and realistic in making its Plan projections for 11th Plan and it is hoped that by improving utilization of Plan funds and the quality of Plan expenditure the Department would be able to come back to the Planning Commission for raising its Plan provision midway during the 11th Plan.


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