The landscape of Ayurveda education in India: Current status and prospects

INTRODUCTION

Traditional and Complementary medicine (T&CM) is an important and often underestimated part of the healthcare system. Globally, the landscape for T&CM has been improving consistently; 88% of WHO member states have developed policies, laws, regulations, programmes and offices for T&CM.¹ WHO, in its Global Traditional Medicine Strategy 2014–2023, had set the goals of promoting the safe and effective use of T&CM towards the achievement of universal health coverage by regulating traditional medicine products, practices and practitioners. T&CM can contribute importantly to achieve WHO’s ‘Triple Billion’ targets and the health-related Sustainable Development Goal 3 if its services can be leveraged by meeting communities’ needs and building sustainable and culturally sensitive primary healthcare. The Declaration of Astana, adopted at the Global Conference on Primary Healthcare in October 2018, made it clear that the success of primary healthcare will be driven by applying scientific as well as traditional knowledge, and extending access to a range of healthcare services, which include traditional medicines.² Well-regulated accreditation mechanism for T&CM education and training institutions is one of the core entities, along with products and practices for developing quality assurance standards in T&CM. Existence of a national mechanism to ensure the quality of T&CM education and training is one of the 27 core indicators proposed for monitoring the performance of traditional medicine systems.³

Ayurveda is a centuries old traditional medicine system of India which is well regulated under the aegis of the Ministry of Ayush (MoA), with more than 400 000 registered practitioners. One of the objectives of the Ayush Ministry, formerly known as the Department of Ayush/Department of Indian System of Medicine and Homoeopathy, granted the status of Ministry on 9 November 2014, is to upgrade the educational standard of the Indian Systems of Medicine and Homoeopathy colleges in the country.⁴ As per the Forum on Indian Traditional Medicine-Research and Information System (FITM-RIS) report, the Ayush industry is undergoing a major transition with a turnover estimated at US$ 18.1 billion, and a 17% growth during 2014–20. The Indian Ayush industry, despite a slump in economic activity in 2020 due to the Covid-19 pandemic, is projected to reach US$ 23.3 billion in 2022.⁵

In view of the growing demand for T&CM services at global and national levels, the need for regulatory and monitoring standards for quality assurance of the education and training in T&CM is pivotal as it is the focal point to bring forth quality human resource essential for healthcare delivery.

AYURVEDA EDUCATION GOVERNANCE

The Indian Medicine Central Council (IMCC) Act, 1970⁶ was a legislature, under which a statutory body namely, the Central Council for Indian Medicine (CCIM)⁷ was formed in 1971 to regulate the education, standards of teaching and training, recognition of degrees and practice of Ayurveda and other traditional medicines in India. CCIM was mandated to take necessary measures from time to time for the emerging needs of Ayurveda education in India to meet health system requirements. However, many issues in Ayurveda education remained unaddressed for a long duration, such as multiple entrance examinations and counselling for admission, issues related to standards of teaching and training, distribution of colleges, non-availability of live register of practitioners and so on. There was an urgent need for transformative reforms in Ayurveda education, which were required to bring transparency, quality and accountability to the field. In this regard, one of the important steps was notification of the National Commission for Indian System of Medicine Act (NCISM Act), 2020, on 21 September 2020,⁸ which resulted in repealing of the IMCC Act, 1970 and subsequent formation of NCISM on 11 June 2021.⁹

Till the academic year 2020–21, as per the provisions of the IMCC Act, 1970, the MoA was the authority to grant or deny permission to start a new Ayurveda college, new course or increase seats in existing courses and renewal of annual permission for an existing college after examining the recommendation made by the CCIM based on physical inspection reports. The existing Ayurveda colleges were required to fulfil the minimum standards as per existing regulations under the said Act, for renewal of their permission. In case of a new college proposal or increase of seats in existing courses or new PG courses, the college was visited twice, once for a Letter of Intent (LOI) and after that, if the college gets an LOI from CCIM then for Letter for permission. After enactment of the NCISM Act, 2020 and the formation of the NCISM, NCISM became the authority for granting permission to start a new college or increase seats in existing courses and new courses as well as for renewal of annual permission for existing courses. NCISM has four autonomous boards:⁸ (i) The Board of Ayurveda; (ii) The Board of Unani, Siddha and Sowa-Rigpa; (iii) The Medical Assessment and Rating Board for Indian System of Medicine; and (iv) The Board of Ethics and Registration for Indian System of Medicine. These Boards look after the work related to UG and PG education, Medical Assessment, Rating and Ethics and Registration of practitioners.

MANDATED REFORMS IN AYURVEDA EDUCATION UNDER NCISM ACT, 2020

1. Teachers eligibility test (TET): TET is essential for a PG degree holder of Ayurveda who desires to take up the teaching profession. NCISM had a mandate to make it operational within 3 years from the date of enforcement of the NCISM Act, 2020 and it has recently become operational.

2. National exit test (NExT): A common final year undergraduate medical examination namely, the NExT will be conducted to grant a license to practice as a medical practitioner of Ayurveda and for enrolment in the State or National Register. It has to become operational within 3 years from the date of enforcement of the NCISM Act, 2020. Any person with a foreign medical qualification will also be required to qualify NExT for the purpose of obtaining a license to practice as a medical practitioner in the Indian System of Medicine.

3. National register for Ayurveda practitioners: Board of Ethics and Registration for Indian System of Medicine has mandated maintenance of a national register of all licensed practitioners of the Indian System of Medicine.

4. Regulation of fees in private institutes and deemed to be universities: The commission is mandated to frame guidelines for the determination of fees and all other charges in respect of 50% of seats in private Ayurveda medical institutions and deemed to be Universities.

5. NCISM and National Medical Commission (NMC) Acts have provisions for Joint Sitting of Commissions to enhance the interface between the Indian System of Medicine, Homoeopathy and the modern system of medicine.

STATUS OF AVAILABILITY OF AYURVEDA COLLEGES AND SEATS

As per the WHO Global report on T&CM, 27 WHO member states offer a bachelor’s degree in T&CM, 24 member states offer a master’s degree, 15 member states offer a doctorate (PhD), 18 offer both bachelor’s and master’s degrees and 11 offer bachelor’s, master’s, and PhD degrees.¹

In India, as per the list available on the NCISM website,¹⁰ there are a total of 450 UG Ayurveda colleges across the country, comprising 62 government, 21 government-aided and 367 private colleges. Total available UG seats are 31 790, including 4699 government, 1386 government-aided and 25 705 private college seats as of 25 June 2022. The availability of colleges in different States/UTs is shown in Fig 1.

Close

FIG 1.

Government, government-aided and private Ayurveda undergraduate colleges in Indian states and union territories G government GA government-aided P private

Export to PPT

Further, the total seats available in PG Ayurveda courses is 4600 in 140 educational institutes consisting of 1724 seats in 40 government colleges, 297 seats in 15 government-aided institutes and 2579 seats in 85 private institutes as of 25 June 2022. Further, the availability of PG seats and colleges in different States/UTs is shown in Tables 1 and 2.

NATIONAL/ALL INDIA INSTITUTIONS FUNCTIONING UNDER MOA, GOVERNMENT OF INDIA

The Central Government has also established 4 National/All India institutions imparting Ayurveda UG and PG education, and the annual allotted budget (2020–21) to these institutions was ₹219.68 crores (₹2196.8 million) for the financial year 2020–21.¹¹

The Government of India has also changed the nomenclature and mandate of the North Eastern Institute of Folk Medicine to the North Eastern Institute of Ayurveda and Folk Medicine Research.¹²

For promoting International Cooperation in Ayush, MoA offers 104 scholarships every year to eligible foreign nationals from 99 countries under the Central Sector Scheme for pursuing UG, PG and PhD courses in premier institutes across India.¹³

ADMISSION, CURRICULUM AND TEACHING

The Ayurveda UG course is 5 years and 6 months long, including 1 year of compulsory rotatory internship, whereas the duration of PG courses is 3 years and 17 specializations are available. Two-year PG diploma courses are also available in a few colleges.⁷ PhD in different specializations is not regulated by MoA/NCISM at present and the concerned universities regulate these. Provisions for admission through the National Eligibility Entrance Test (NEET) in UG course and All India Ayush PostGraduate Entrance Test (AIAPGET) in PG courses have been made, and all India quota in all Ayurveda educational institutes has been created along with centralized counselling for all India quota seats, especially for government, government-aided institutes and central and deemed to be universities. These measures were taken by the MoA to bring transparency and quality to medical education. The curriculum of Ayurveda has both classical Ayurveda texts as well as modern subjects for all non-clinical, para-clinical and clinical subjects. One-year rotatory internship also has provision for 6 months of posting in different departments of modern district hospitals along with the posting of 6 months in various departments of Ayurveda hospitals. PG courses curriculum has core specialization subjects, research methodology and biostatistics. The current educational set-up for Ayurveda system of medicine is shown in Fig 2.

Close

FIG 2.

Current educational set-up for Ayurveda system of medicine

Export to PPT

REGISTRATION AND PRACTICE OF AYURVEDA MEDICINE

Before enactment of the NCISM Act, 2020, the scholars who completed their UG and PG in Ayurveda were required to register with State Board/Council or centrally register with CCIM. However, CCIM did not have any streamlined, live register for Ayurveda practitioners. At present, NCISM is mandated to create a live register for practitioners of the Indian system of medicine.

Further, the practice of medicine varies from state to state. As per the Constitution of India, public health and sanitation, hospitals and dispensaries are in the state list;¹⁴ therefore, they are under the state government. Some state government allows the practice of both Ayurveda and allopathy medicine to Ayurvedic practitioners such as in Maharashtra.¹⁵ Whereas, in most states, Ayurveda doctors can practice only Ayurveda medicine.¹⁶ Ayurveda graduates are being recruited in Central Government Health Services, State Health Services as Medical officers, at Sub-Health Centre Health and Wellness Clinics as Community Health Officers and National Rural Health Mission/National Health Mission.

COMMENT

Among the total 450 UG Ayurveda colleges, only 62 are government, consisting of 4699 government seats out of 31 790 seats. Thirteen Indian States/union territories do not have any government Ayurveda UG college. Ten States/union territories do not have any Ayurveda colleges. Only 3 states have more than 5 government colleges, and the maximum number of UG government colleges in a state is 9. Three Indian states namely, Karnataka, Maharashtra and Uttar Pradesh, have more than 50% of the colleges (259 of 445). Another major issue is the small number of PG seats (14.5% [4600]) available against 31 790 UG seats. Further, of 4600 seats, only 1724 seats are in government colleges. Government PG seats are only available in 19 states; among them, 7 have less than 50 seats, 6 states have 51–100 and 4 states with 100–200 PG seats.

Further, among 4600 seats, 2503 (54.41%) seats are available only in 2 states namely, Maharashtra and Karnataka. No PG seats are available in 12 states/UTs. It is evident that there is a huge disparity and skewness in the availability of Ayurveda colleges in different states/UTs and the availability of seats in these states/UTs. Seats are few in the government sector, and the filling rate of the private seats is low, especially in the states with a large number of colleges, which is evident through a reduction in NEET and AIAPGET percentile qualifying criteria in recent years by MoA due to vacant seats in private colleges. The central and state governments need to increase seats in the government sector as well as fill the chronic shortfall of teaching and hospital staff in state government owned colleges to improve the standards of teaching and training. The availability of more seats in the public sector will contribute to the selection of more meritorious students and towards standards of education. It will also help in equitable and accessible Ayurveda education. The central government may frame a centrally sponsored scheme to increase the number of government colleges and seats, especially in states/union territories, which do not have public sector colleges. State governments need to assess the requirements of new Ayurveda college before issuing ‘no objection certificate’ to any organization to stop mushrooming of such colleges.

Implementation of NEET and AIAPGET have ensured uniform standards for admission in UG and PG courses across the country. Provision for all India quota seats has provided opportunities to study Ayurveda to aspirants from all the states, especially for those where government seats are not available in the aspirant’s domicile state and also to enroll in colleges in states such as Kerala, where Ayurveda practice is more prevalent. All India quota for PG seats needs to be increased from 15% to 50%, similar to allopathic PG seats as the number of PG seats is low compared to UG seats and distribution of seats is skewed among states/union territories, to provide better and equitable opportunities to the aspirants.

Medical education comes under the concurrent list of the constitution of India. However, coordination and determination of standards in institutions for higher education or research and scientific and technical institutions come under the central list, which lays more responsibility on the central government for necessary reforms in medical education to meet the requirements of the country. NCISM needs to work closely with the central government, state governments and universities for better implementation of the provisions of the Act. The current regulations for standards of teaching and training are more focused on physical requirements such as infrastructure and human resources; however, importantly, focus is also required on pedagogy. In this regard, a few measures can be the establishment of training institutes for teachers and skill laboratories in colleges for better teaching and training. The NCISM formulates curriculums of Ayurveda UG and PG courses, and the same is followed by all universities/institutions across the country. However, other organizations such as universities, Ayurveda Research Council and its institutes, central/state drug testing laboratories and various e-learning portals such as SWAYAM can also contribute in the skilling and capacity building of Ayurveda scholars. Further, UG and PG curricula should be modified to include the management of diseases of national importance and public health, and obsolete content should be removed from the curriculum. The curriculum should be made competency-based. PG degree/diploma seats in specializations such as Geriatrics and Manovigyan evam Manas Roga (Psychiatry) need to be started or increased, considering the burden of disease and the potential of Ayurveda in the management of these diseases.

The Central Council for Research in Ayurvedic Sciences (CCRAS), its institutions (30 across the country) and other central/state laboratories are also potential sources for learning. There is a need to make provisions for internships in such institutions/laboratories for better learning opportunities and hands-on training. CCRAS can start short-term courses related to research for UG and PG scholars. Universities can also play an important role through periodic Ayurveda teachers’ training, faculty development programmes, skilling of Ayurveda scholars and promoting new teaching methods, for example inclusion of artificial intelligence/machine learning in teaching/training. They can also play an important role in research-related training and approving only quality research proposals for PG and PhD thesis to contribute to the advancement of Ayurveda.

Ayurveda scholars are also eligible for courses such as Masters in Public Health, integrated PhD courses and some of the trans-disciplinary courses being offered by many reputed institutions such as Indian Institute of Technology (IIT) and Council for Scientific and Industrial Research (CSIR). Institutions such as NITI Aayog and National Institute for Health and Family Welfare offer an internship to various streams of UG and PG scholars; Ayurveda scholars may also use these opportunities for valuable exposure to health policy and public health domains.

Education of Ayurveda pharmacy, nursing and other allied courses are not centrally regulated at present, and these courses are being offered in different states/union territories in diverse form. There is a need to regulate these courses at the central level to ensure standards of teaching and training.

For developing a research culture in Ayurveda, teaching standards for research needs to be well defined as research is a crucial entity for the development of any system of medicine and global acceptance. NCISM may also make it mandatory to pursue the ‘Basic Course in Biomedical Research’ being offered by the Indian Council of Medical Research–National Institute of Epidemiology, for Ayurveda PG scholars and teachers, similar to the provision made by the NMC to improve research skills.

Research outcomes need to be incorporated into the Ayurveda curriculum to make Ayurveda scholars more aware of the latest scientific trends.¹⁷ There is a need to improve the training methods for giving essential clinical skills to Ayurveda scholars. A study of 1022 participants published by Patwardhan et al. concludes that the current graduate-level Ayurveda education system has serious flaws, and the study indicates that the practical application of the theoretical constructs is not being done sufficiently.¹⁸ The issue won’t be resolved unless theory- and textbook-focused instruction is changed to clinically- and practice-focused instruction.

Connecting students with practicing Ayurveda doctors is necessary to gain better clinical knowledge. The opportunity to gain such knowledge is offered to a limited number of Ayurveda graduates under the Guru Shishya Parampara scheme of Rashtriya Ayurveda Vidyapeeth. Provisions of visiting Ayurveda clinicians need to be introduced in Ayurveda colleges for better clinical skill training. Knowledge base and skills of Ayush practitioners also need to be updated from time to time, which can be ensured by introducing continuing medical education and re-orientation programmes with credit points for Ayurveda practitioners. Minimum credit points requirement provision should be made and linked with the renewal of their registration with respective boards periodically. Practitioners should be sensitised regarding journals such as Journal of Ayurveda Case Reports (AyuCaRe), which publishes successful clinical case management outcomes of Ayurveda practitioners.

Another essential work mandated to NCISM is to create a National Register for Ayurveda practitioners. It will help in the verification of registered practitioners, the status of availability of practitioners in different states and better opportunities for practice in foreign countries, where Ayurveda practice is legislated so that such countries can verify the practitioner credentials through the online live register and prevent cumbersome process for verification of such practitioners.

The National Education Policy 2020, issued by Ministry of Education, enumerates that healthcare education needs to be re-envisioned, so that the duration, structure and design of the educational programmes match the role requirements that graduates will play. Students will be assessed at regular intervals on well-defined parameters primarily required for working in primary care and in secondary hospitals. Given that people exercise pluralistic choices in healthcare, our healthcare education system must be integrative meaning that all students of allopathic medical education must have a basic understanding of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (Ayush) and vice versa. There should also be a greater emphasis on preventive healthcare and community medicine in all forms of healthcare education. NITI Aayog is also working on framing an Integrative Health Policy including integration at the level of education. NCISM and NMC need to work in a close coordination to achieve the same.

Regulation of fees and other charges in private institutes and deemed to be universities will ensure affordable Ayurveda education, reduce the burden on students, ensure probity in medical education and bring down the costs of education.

NCISM has to roll out the operationalization of NExT in a mission mode. NExT will ensure quality of healthcare services by keeping a check before registration as a practitioner.

Further, the era of widespread health has raised the bar for Ayurveda education. The growth of the Ayush health industry creates new opportunities and platforms for social services, as well as new opportunities for advancement in Ayurveda colleges and universities. Ayurveda education should broaden its traditional advantages, optimise professional structure, improve curriculum content, utilize available resources and increase professionals’ adaptability to society and ability to serve society. As a result, high-quality, versatile personnel with Ayurveda thinking and international competitiveness will be developed.