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Present Status of Ayurveda System in Nepal

Existing Situation
Nepal has a great history of Ayurveda. Thousands of ancient Ayurvedic manuscripts are found here. It is an integral part of national medical system and widely practiced in Nepal. Parallel to the Allopathic system of medicine, Ayurveda medicine is popular in all spheres because of its efficacy, availability, safety and affordability. More than 75 percent of the population used Traditional Medicine mainly based on Ayurveda Medicine (legal status,WHO,2001) The Department of Ayurveda is the apex body for the Ayurveda Medical System in the country under the Ministry of Health and Population. One hundred bedded Central Hospital, and 30 beded Regional Hospital, 14 Zonal Dispensaries, 61 Ayurvedic Health Centres, and 214 Ayurvedic Clinics. Only 220 Doctors are registered in NAMC(MOHP,2004)

In the pharmaceutical sector, National Manufacturing Unit of Ayurveda Medicine is Singha Durbar Vaidhyakahana which was established during the regime of King Pratap Malla. Any Ayurvedic medicines have to be registered by the Department of Drug Administration, at the Ministry of Health and Population. Nepal at present imports Ayurvedic drugs of more than 150 cores rupees and it is increasing 25% each year. About two hundred different brands of Ayurvedic drugs are produced in Nepal by more than 30 private companies. More than 150 Indian Ayurvedic drug companies are currently supplying Ayurvedic medicines to Nepal. There is no doubt that significant amount if not all raw materials of these Ayurvedic drugs have their origin in Nepal.

Estimated number of traditional practitioners in Nepal is 4000.There are nearly 40,000 copies of hand written classical manuscript and more than 1600 types of medicinal aromatic plants in Nepal. Different Ayurvedic Manuscripts are yet to be documented. There are 623 qualified practitioners under the Department of Ayurveda .

There is one hospital for every 9.2 million population, one District Health Centre for every 0.36 million population and one dispensary for every 87 thousand population.

The service is provided to about 8%. Ayurveda sector budget was allocated Approx. 0.17% of the total national budget and 3.49% of the health budget (Source: Annual Health Report, DHS, 2062)
National policies on Ayurveda were issued in 1996. The programmes for health services included in the FifthFive-Year Plan make provision for four ayurvedic hospitals, one in each of the fourdevelopment regions. The tenth Five Year Plan has committed to phase wise implementation of the policies prescribed by the National Ayurveda Policy 2052 (1996 ). Not any national institute of Ayurveda or any other traditional medicine is established. Neither national pharmacopias nor national monographs are being prepared yet.

As per the Ayurveda Health Policy-1996,There is the policy on Ayurveda dispensary will be established for every five VDC, Every district head quarter will have District Ayurveda Health Center providing specialized Ayurveda Health Services as much as possible, regional hospital in the five regions of the country, Central hospital of 100 beds in Naradevi providing all specialized Ayurveda Services as a Model Hospital, establish Model Herbal Garden, orientation to health workers in the use of local herbs so that they may not have sit at inactive if the medical supplies do not arrive and also make the health care more cost effective and available to the community in the remote areas where supply of drugs essential or otherwise is a difficult proposition and emphasizes for the production of quality manpower in Ayurveda by establishing a National Institute of Ayurveda.

Formal education in the Ayurvedic system is under Institute of Medicine of Tribhuvan University. Only B.A.M.S (Bachelor in Ayurvedic Medicine and Surgery) programme has been running under Institute of Medicine.15 students enrolled every year and eleven batches running In 1997 BAMS course restarted and five batches passed out till date No own teaching hospital and sufficient building. Inadequate allocation of resources for this sector The certificate level and Auxiliary Ayurveda Worker training programme has been running from the under Mahendra Sanskrit University and Council for Technical Education and Vocational Training.

Opinionnire/ Survey was conducted in the National Conference of Ayurveda Doctors' Association of Nepal. The total 100 Doctors were participated in the conference. All Doctors were covered this study, only 70 Doctors were responded the main instrument of the study was Open type of containing health services education, policies related to Ayurveda field. Questionnaire were distributed for 100 doctors in the conference representing from Different Distric Ayurveda Health Centre,Zonal Ayurveda Ausadhalaya and Hospitals, Educationist, Policy makers.

Main Findings
The barriers in the Ayurveda health institutions (DAHC, ZAA,Regional Hospital,Central Hospital) to provide quality health services, the respondent felt that the following barriers which contribute to hinder the development of Quality Ayurveda health service : lack of resources and budget in DAHC, ZAA and Hospital, lack of Supply of medicine and equipments. lack of programme as per need of community people and Malpractices of herbal medicine in the local areas, Commitment to do works among Ayurveda professionals lack of Training/ workshops / seminars for doctors, Pathology and Radiology Services for the investigation to the patients in the DAHC manpower as per need of DAHC, awareness among people of available Ayurveda services and Leaderships and Team sprite among health workers and Doctors.

Respondent suggested to take wipe out barrier which are following Government commitment : allocate the budget rationally, establish good management system in the Department of Ayurveda, good coordination from central to local levels, conduct various people friendly programmes, should improve existing resources as much as much possible ,fair evaluation of employees, system of reward /punishment, Should be complete required manpower, Create more vacancies like First Class, Second class in ratio of existing Ayurvedic Physician, Conduct Awareness programme to the community people, national level committee should formulate with having commitment, formed infrastructure in all districts, modernize health delivery system as per need of the present context, launch people friendly Ayurveda Health Programme as per need of the community people, strengthen of present Ayurveda System, provide opportunities on Human Resource and development and fulfil new vacancies.

Reasons behind Government hesitate to effective implementation of Ayurveda health Policy-1996 and effective implementation of quality health services from Ayurveda Health Institutions, respondent responded :government should formed high level committee immediately, formulate strategies, formed network from central to grass root level ,strengthen Nepal Ayurveda Medical Council(NAMC) immediate launch different activities, regular monitoring and follow up, educational standardization and specialized management , coordinate to international Council, organize interactive meeting , research workshop and seminar , identify the traditional knowledge and skill and recognize their legal basis, ensure IPR, establish Data Bank/ national monographs, give honorary degree those who have exclusive traditional knowledge and skills organizational structure should be reformed, create vacancy, increase manpower, make clear vision with having policies and strengthen present structure.

Issues of Quality Ayurveda system
the respondent mainly emphasized following things
• Lack of Clear-cut vision/planning
• Lack of proper qualified manpower
• Lack of teaching hospital and research activities
• Lack of Continuous Medical Education (CME)
• Lack of International affiliation
• Lack of Integration and linkage to Modern Technology
• Lack of understanding and utility of some Modern Medicines and technology which have been proved very effective in different conditions
• Lack of clear cut strategy and effective implementation programme from central level to grass-root level
• Participation of National Health Programme
• Lack of co-ordination Approach/Linkages to WHO, UN, NHRC, IUCN along with other institutes

The responded suggested following recommendation
• Recognized BAMS course in CCIM
• Update Curriculum
• The Curriculum should be focus on the competencies of the students preparing for the role and responsibilities determined by Department of Ayurveda, MOHP,
• Curriculum should be problem based integrated and community based learning
• Continuing Medical Education (CME)
• Conduct and participate in Research Activities
• Effective Implementation of Ayurveda Health Policy-1996
• Responsibilities and accountabilities of professionals
• Strengthen and Restructure of Department of Ayurveda
• Strengthen role and responsibilities of NAMC
• Institute of Ayurveda/ National Academy of Ayurveda Sciences
• Establish Research Institutes having support for clinical research into use of Ayurveda Medicine for treating country's common health problems
• National pharmacopoeias and monographs for medicinal plants, minerals and animal products
• Establish own Teaching Hospital having all facilities required for effective practical training and Ayurveda health services according to its different specialities ie Kayachikitsa,Salyatantra and Prasutitantra.

(This paper was presented by Dr. Rajendra Kumar Giri at International Conference entitled Research Advances in Traditional Medicine: Challenges and Opportunities” was held in New Delhi on October 30-31, 2007 at Convention Centre Jamia Hamdard University)

- By Dr. Rajendra Kumar Giri
Ayurveda Physician
Department of Ayurveda, MOHP


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