The role of the indigenous systems of medicine 1-8 within the overall health care system, and their development, has been the subject of deliberation by several committees both in the pre- and post- Independence periods. A revived interest in the heritage of medical practices of pre-British India is associated with the rise of the Swadeshi movement.. The National Planning Committee, established by the Indian National Congress in 1938,

1. Aspects of the social history of health culture development in ancient, medieval and colonial India, is not dealt with in this chapter. Useful references on this subject are Charles Leslie, "The Modernization of Asian Medical System", in J.J. Poggie and R.N. lynch(eds)Rethinking Modernisation : Anthropological Perspectives,(New York : Greenwood Press, 1974);D.Banerji,"Place of the Indigenous and the Western Systems of Medicine in the Health Services of India", Paper presented at the IIth World Congres of Sociology, Uppsale 1978; R.Jaffery,"Policies Towards Indigenous Healers in Independent India",Socialist Health Review, Vol. II,No.3, December 1985, pp. 116-123.
   
2. For details about Ayurveda see, P.N.V. Kurup, Bird’s Eye-View on Indigenous System of Medicine in India, (Delhi : Deepak Art Press, 1977);K.N.Udupa, Promotion of "Health for All" by Ayurveda and Yoga, (Varansi: The Tara Printing Works,1985).
   
3. Hakkim Razzack and U.Fazal,"Unani Medicine", Reader’s Digest, Part I November/December 1978: Central Council for ` Research in Unani Medicine (CCRUM),Research Activities in Unani System of Medicine.(New Delhi:MMinistry of Health & Family Welfare, 1979).
   
4. Kurup, 1977; Central Council for Research in Ayurveda and Siddha(CCRMS), Simple Remedies of Siddha Medicine (in Tamil), (New Delhi : Ministry of Health & Family Welfare, 1979).
   
5. Kurup, 1977;
   
6. ‘bid; K.N. Udupa, Presidental Address on the Occasion of the Asian Congress of the Indian Association for Traditional Asian Medicine, (Bombay 6-9 March,1983); Yoga Sadhak Groups,Self Improvement, Bombay: The Yoga Institute, 1980).
   
7. For a report of a recent workshop on Local Health Traditional, see the Update Section of the Radical Journal of Health, Vol. I, No.1, 1986.
   
8. See chapter on Health Organization and manpower Development in the volume.

** Reproduced from Health Status of the Indian people FRCH, Bombay December, 1987, Courtesy FRCH.
Resolved to absorb the practitioners of ayurveda and Unani systems into the state health organization of Independent India, by providing them scientific training where necessary.9 However, the Bhore Committee report,10 which became the blue-print for the development of health services system in India, was ambiguous in its assessment for the potential role of the indigenous systems. It observed that it was not in a position to assess the real value of these systems of medical treatment in the absence of investigations, and felt that these systems had little to contribute to public health, preventive medicine, obstetrics or advanced surgery. It called for the Western, but based on scientific knowledge and practice belonging to the whole world.
However, the 1946 Health Ministers’ conference adopted the NPC proposals on the subject of indigenous systmes, and resolved to make financial provisions for:

1. research based on the application of scientific methods, in Ayurveda Unani;
   
2. the establishment of colleges & schools fot training in Diploma & Degree course in indigenous systems.
   
3. the establishement of post-graduate course in Indian medicine for graduates is Western medicine;
   
4. the absorption ofvaids andhakims as doctors, health workers etc., after scientific training where necessary;
   
5. the inclusion of departments and practitioners of Indian medicine on offical boards and councils.11

The appointment of the Committee on the Indigenous Systems of Medicine, under the Chairmanship of Col. R.N. Chopra 12 to provide guidelines for the implementation of the above proposals, and for the absorption and development of practitioners, was the outcome of the conference. The Chopra Committee’s report supported synthesis of the Indian and Western systems through integrated teaching and research. The integrated curricula would be designed to strengthen and supplement the weakness in one system by the other, while research would focus on clearing Indian

9. Mational Planning Committee, Sub-Committee on National Health Bombay Committee),Report.(Bombay : Vora, 1948).
   
10. Government of India, Health Survey and Development Committee (Bhore Committee) Report, (Delhi : Manager of Publications, 1946).
    
11. Report of the Proceedings of the Central Provinsional Health Ministers’ Conference, cited in Jaffrey, 1985.
    
12. Govt. of India, Committee on the Indigenous Systems of Medicine (Chopra Committee), Report, (New Delhi : Ministry of Health, 1948).

Medicine of accretions of doubtful value and making its science/art intelligible to modern minds. The objectives of research would be the synthesis of Indian and Western medicine in order to evolve a unified system of medical relief and education which was suited to Indian conditions. The drugs would be standardised. The Committee envisaged a 2-tier integrated medical care system, which would involve indigenous practitioners with 6 months training at the primary level and institutionally qualified (in integrated medicine) persons at the secondary level.13 (This is similar to the Chinese approach, and gained wide acceptance with the WHO in the 70s).
In general, the post-Independence period is marked by State and Central Government patronage to the professionalization of the Indian Systems and of Homeopathy, particularly with regard to education, regulation of practice and research. However this trend has not been free of debate over policies as discussed below.

A. Establishment of Educational Facilities and Regulation of Practice
In 1954, the Dave Committee14 was constituted by the Government to study the question of establishing standards in respect of education and regulation of practice. The Committee formulated a model syllabus for the integrated course of 51/2 years duration, including one year of internship. It recommended the establishment of faculties for Ayurveda in Universities, and the upgrading of existing colleges by providing indoor hospital facilities and post-graduate courses.
The response of the different states to these recommendations was varied. Some states established "Integrated" colleges which taught subjects of modern medicine and Ayurveda concurrently. In others, the "Shuddha" type of institions emphasising pure training in Ayurveda, were established. The number of integrated medical institutions increased immediately after Independence. According to one estimate, in 1958 of the 76 institutions imparting Ayurveda education, 49 were integrated and 27 were Shuddha. 15

13. Ibid
    
14. Government of India, A Committee to study & Report on the Question of Establishing Standards in respect of Education and Regulation of the Practice of Indigenous Systems of Medicine (Dave Committee), Report, (New Delhi:Ministry of Health, 1956).
    
15. Kurup, 1977, p.30.

The support for pure training grew amongst the qualified practitioners in the 1960s, posing a major issue for policy. The latter pointed out the popularity of the indigenous practitioners; the higher cost of integrated courses due to requirements of modern equipment; the tendency to spend too much time on allopathy; the availability of indigenous graduates for rural practice; and the inherent incompatibility of the two systems rendering integration impossible. The supporters of ‘integrated’ training however argued that science was universal; that the low cost argument would promote unscientific practice in rural areas and harm research and development; and that indigenous practitioners actually used western drugs and treatment. The supporters of pure training had gained Government support by the early seventies. 16

Educational Facilities
The Central Council of Indian Medicine (CCIM) established in 1971 and the Central Council of Homeopathy (CCH) established in 1974, regulate educational standards and professional practice among indigenous and homeopathy practitioners. The Council have formulated a standard syllabus for the under-graduate (and post-graduate in the case of the Indian Systems) course, and are responsible for maintaining uniform standards of education. State boards are also functioning in all states for the regulation of practice in Indian medicine.17
There are (1982 estimates) 98 undergraduate colleges for Ayurvedic education with an admission capacity of over 3,751 seats; 17 colleges for Unani education with 595 seats; 1 college for Siddha education with 75 seats; and 123 colleges for Homeopathic education with over 8,387 seats (Table 1).
There is a wide variation in the statewise distribution of these educational facilities. Some 66 per cent of all Ayurvedic colleges are concentrated in just six states (Maharashtra, Bihar, Gujarat, Uttar Pradesh, Karnataka and Madhya Pradesh), while Maharashtra alone accounts for some 20 per cent. In the case of Homepathic education, the 5 states of Bihar, Maharashtra, Uttar Pradesh, Madhya Pradesh and West Bengal together account for 89 colleges (72%) admitting 6,326 students (Table 1). Volunatry support for

16. Jaffrey, 1985, p.122. See for discussion of the law cost argument, G.A.A. Britto,Indian Systems of Medicine & Homeopathy. (Bombay: the Foundation for Research in Community Helath, August 1984).
    
17. Government of India,Annnual Report 1984-85, (New Delhi : Ministry of Health & Family Welfare, 1985).

Table 1

Number of Colleges of Indian Systems of Medicine and Homeopathy and
Their Admission Capacity - 1.4.1982.

(*) One college in Kerala is awaiting sanction from Government for restarting. Hence admission capacity not included.

(a) Three colleges in Bihar, 2 in M.P. & 1 in Rajasthan have not reported admission.
Source : GOI, DGHS, CBHI, Health Statistics of India 1984. (N. Delhi : MOHFW, 1984)

Ayurvedic education and colleges is largest in Maharashtra, Bihar, Haryana, Tamil Nadu, Punjab and Delhi; Government supported Colleges predominate in madhya Pradesh, Uttar Pradesh, Andhra Pradesh, West Bengal, Assam and Himachal Pradesh (1980 estimates). 18
The post-graduate admission capacity for Ayurveda is 225 seats, spread over various college departments, and those of the National Institute of Ayurveda, Jaipur (60 seats), Gujarat Ayurvedic University, Jamnagar (30 seats), and Benaras Hindu University (20 seats). There are 20 seats for post-graduate education in Siddha in two departments in Tamil Nadu,and 27 seats for post-graduate Unani studies in departments at Hyderabad and Aligarh. There is no post-graduate course in Homeopathy at present.19 All post-graduate institutions and departments are wholly financed by the Central Government. Four autonomous national level institutes, namely the National Institute of Ayurveda, Jaipur, the National Institutes of Homeopathy, Calcutta, the National Institue of Unani, Bangalore and the National Institute of Naturopathy, Pune are responsible for evolving and demonstrating high standards of teaching, training and research. 20

Manpower Position
Table 2 gives the 1983 estimates of the number of practitioners of the Indian Systems of Medicine & Homeopathy in India, registered with the State Boards of Indian medicine and of Homeopathy.
The registered practitioners belong to two categories, namely those who have acquired a degree/diploma from a University/Board, and those who have obtained diploma after taking correspondence courses and examination, but have not undergone formal training. However, the registration

• 18 See Government of India, Directorates General of Health Services, Central Bureau of Health Investigation, Pocket Book of Health statistic of India 1980. (New Delhi : Ministry of Health & Family Welfare, 1981),
  
• 19 GOI, MOHFE, 1985.
  
• 20 GOI, MOHFW, 1985.

figure exclude a third category of practitioners (mainly of the Indian systems) whose numbers are estimated to equal those of the qualified and registered. The latter mainly practice in the rural areas and have gained experience as apprentices working with traditional physicians. 21 A second major contraversial issue in the policy field has been regarding the registration or banning of unqualified practitioners. The establishment of the Central Council standardised registration; the procedure however appears to vary from state to state. 22

• 21 Kuruo, 1977, p. 25; World Health Organization Traditional Medicine Programme, Report on a Seminar, Colombo, 1-5 April 1977 (mimeograph), p.3
  
• 22 Jaffrey, 1985, p.121

Growth Pattern
At present there is one ISM + H practitioner per 1770 population (Table 2). In rank order Ayurvedists top list, with an average ratio o 1. Ayurvedists per 2951 population.
Table 3 indicates the overall growth in the number of Ayurvedic, Unani + Homeopathic practitioners between 1969-1981. In this period, the overall growth rate was 6,135 practitioners per annum. However, the quantum of growth varies from system to system. The number of Ayurvedic practitioners rose by 76,419 in 1969-81 period, or by 6,368 practitioners per annum. However, Unani registered a negative growth, and its number declined by 1, 774 practitioners in the same tweleve year period. Homeopathy similarly recorded a drop of 1,201 practitioners in this same period.

In general, a definite decline in the number of these professionals is discernible. Even Ayurveda, the most widespread of the Indian systems, has declined or not kept pace with population growth in several states, Table 4 highlights the regional growth patterns with respect to Ayurveda through a comparison of 1958 and 1981 data.
It would appear that qualified Ayurvedists have almost ceased to practice in Himachal Pradesh, Manipur & Tripura. In Assam, West Bengal and Jammu & Kashmir the number of practitioners have declined, while Tamil Nadu, Orissa, Rajasthan, Uttar Pradesh, & Delhi have recorded lower growth rates vis-a vis population growth.
A number of reasons can be suggested to explain the drop in the growth rate of ISM & H practitioners, but these need further research.

1. From 1975 onwards, the registration of practitioners who had not undergone a regular college course of post-matric five years was stopped as a result of regulation.
   
2. Certain technical modalities such as the requirements to register at the time of the IMCC election in 1983, may have helped to remove from the list those hereditary practitioners registered for life.
   
3. A high drop-out rate from practice, as most of the experienced practitioners are above 50 years of age.
   
4. Several college have either stopped new admissions, reduced the number of seats, or have themselves closed down due to lack of prescribed minimum amenities.
   
5. Natural death and old age.
   
6. Graduates may be indifferent to registration. Hence, though in reality a large number is entering practice, this is not reflected in the official records.
   
7. Inaccurate or poor reporting and coverage of data by the CBHI.

B. Research

The Central Council for Research in Indian Medicine and Homeopathy (CCRIMH) was established in 1969. Through is five scientific Advisory Boards, one each for Ayurveda, Siddha, Unani, Homeopathy, and Yoga Naturopathy, the Central Council guided and supervised research activities in a number of institutions. It was dissolved in January 1979, and four central councils on the lines of the Indian Council of Medical Research (ICMR) were constitued. These are the Central Council for Research in

Table 4
Statewise Approximate Population per Ayurved Practitioner :
A Comparison 1958 and 1981

* Reorganised subsequently, hence data not comparable.

** There are no Ayurvedists reported in these places in 1981.

Source: For 1958 : Government of India, Committee to study the Status of Ayurveda in India (Udupa Committee), Report,(New Delhi : Ministry of Health, 1958). For 1981 : GOI, DGHS, CBHI, 1983.

Ayurveda and Siddha (CCRAS), the Central Council for Research in Unani Medicine (CCRUM), the Central Council for Research in Homeopathy (CCRH), the Central Council for Research in Yoga and Naturopathy (CCRYN). These four apex bodies, wholly centrally financed, aid, guide, develop and co-ordinate scientific research through a number of Central & regional Research Institutes, Regional Research Centres, Clinical and Drug Research Units.
The research activities include drug research, clinical research, health care or medicine research, literary research and research on indigenous contraceptive drugs.
The Pharmacopoeial Laboratory for Indian Medicine and the Homeopathy Pharmacopoeia Laboratory, both offices of the Ministry of Health and Family Welfare, are national level laboratories entrusted with the responsibility of laying down standards regarding single drugs and compound formulations, and drug testing procedure.₂₄ The former has a museum of medicinal plants which can facilitate the identification of herbs.
The public sector undertaking Indian Medicines Pharmaceutical Corporation Ltd. (IMPCL), a number of multi-nationals and several small scale units produce the drugs. Almost all state Governments have established pharmacies to supply drugs to the state’s dispensaries and hospitals. The primary source of raw materials for drugs have been natural resources, particularly forests, and to a smaller degree herbal farms.₂₅ The drug control of these systems are being enforced by the State Government under the Drugs and Cosmetics Act.
The top priority in research has been given to the preparation and standardisation of drugs. The Sixth Plan emphasised the need for co-ordinated research efforts for providing drugs for communicable diseases such as Malaria, TB etc., as also Cancer, Diabetes etc. and for developing effective methods of contraception.₂₆

• 23. GOI, MOHFW, 1985
  
• 24. I bid.
  
• 25. C.R.Bijoy. "Wealth: Emerging Trends and Indian Reality". Paper presented at the Third Annual Conference on Manpower Resources for 2000 AD. Sept. 10-12, 1982 (Goa).
  
• 26. Government of India, Planning Commission, Sixth Five Year Plan 1980-1985. (New Delhi : Planning Commission, 1981), p. 372.

C. Medical Care Facilities
Medical Care Services under Indian System of Medicine and Homeopathy are provided by various hospitals and dispensaries functioning in the State (Table 5). In addition to the Government has established an Ayurveda hospital, and Ayurveda Siddha, Unani dispensaries under the Central Government Health Scheme (GHS). There are a number of Ayurvedic Dispensaries under the Labour Ministry and the Coal Development Authority.

D. Primary Health Care and Indigenous Practitioners
As mentioned earlier in this section, soon after Independence, policy recommendations favoured the incorporation of indigenous practitioners into the national health services and the development of an integrated medical care system. However, this was never implemented,. and the training of auxiliary medical personnel for the extension of rural medical care was preferred.
In the early 1970s international concern was voiced in the World Health Assembly debates, that the existing health services in developing countries were not meeting the requirement of the majority. The two important developments for the promotion of national health services were the adoption of the primary health care approach, and the setting of the main social target for Governments, of Health for all by 2000 A.D.₂₇ The search for new programmes and strategies focussed on developing community participation through a variety of locally acceptable people like practitioners of traditional medicine. The joint UNICEF/WHO study that recommended the mobilisation and training of indigenous practitioners (including traditional birth attendants), partly drew its inspiration from the Chinese experiment of harnessing the legacy of health culture to the needs of its vast rural population, and combining it with western medicine.
At the national level too, the 1970s witnessed a resurgence of discussions

• 27.World Health Organisation,The Work of WHO 1976-77, Biennial Report of the Director - General to the World Health Assembly and to the United Nations. (Genevo :WHO, 1978).
  
• 28. V. DjuKanovich and E.P.Mach (eds), Alternative Approaches to Meeting Basic Health Needs in Developing Countries, A joint UNICEF/WHO study, (Genevo : WHO 1975).