Role and effectiveness of AYUSH doctors in providing maternal health services under National Health Mission in rural India

Janmejaya Samal

doi:10.4103/JISM.JISM_88_20

REVIEW ARTICLE

Year : 2020 | Volume : 8 | Issue : 4 | Page : 246-248

Role and effectiveness of AYUSH doctors in providing maternal health services under National Health Mission in rural India

Janmejaya Samal
Independent Public Health Researcher, Bhubaneswar, Odisha, India

Date of Submission	05-Sep-2020
Date of Decision	18-Sep-2020
Date of Acceptance	20-Nov-2020
Date of Web Publication	11-Feb-2021

Correspondence Address:
Dr. Janmejaya Samal
Independent Public Health Researcher, C/O Mr Bijaya Ketan Samal, At-Pansapalli, Po-Bangarada, Via-Gangapur, Dist-Ganjam, PIN-761123, Odisha
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JISM.JISM_88_20

Abstract

With the inception of National Health Mission (NHM)/National Rural Health Mission (NRHM), Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) doctors were colocated in public health institutions and were made a part of the mainstream healthcare system. The study was conducted with an objective to understand the role and effectiveness of AYUSH doctors in providing maternal health services in public health institutions in rural India. This brief review was carried out by selecting articles through cross-references and hand search. Research on AYUSH principles/therapeutics in maternal health is found in good quantity; however, the role of AYUSH doctors in providing maternal health services is very limited. These studies assessed the theoretical knowledge regarding essential and emergency obstetric care, identifying and managing pregnancy related complications and the usage of partograph. Skills related to antenatal checkups, counseling skill on danger signs of pregnancy, vaginal delivery, neonatal resuscitation, and postnatal care were also evaluated by some studies. Studies observed variation in knowledge and skills among AYUSH doctors in different states, which reflects the support of the government and the training ambience that these doctors are exposed to at their undergraduate level and on-the-job training. The presence of AYUSH doctors in rural areas is, indeed, a great help for the community; however, they need regular training and orientation to upgrade their knowledge and skills for effective service delivery.

Keywords: AYUSH workforce, mainstreaming of AYUSH, maternal health, public health facilities, rural health, skilled birth attendance

How to cite this article:
Samal J. Role and effectiveness of AYUSH doctors in providing maternal health services under National Health Mission in rural India. J Indian Sys Medicine 2020;8:246-8

How to cite this URL:
Samal J. Role and effectiveness of AYUSH doctors in providing maternal health services under National Health Mission in rural India. J Indian Sys Medicine [serial online] 2020 [cited 2023 Jun 7];8:246-8. Available from: https://www.joinsysmed.com/text.asp?2020/8/4/246/309130

Introduction

Earlier, the Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) doctors served in silo with their own systems of medicine controlled through their own departments; however, with the initiation of National Health Mission (NHM) / National Rural Health Mission (NRHM), these doctors were colocated in public health institutions and became part of the mainstream health-care delivery system under the aegis of “Mainstreaming of AYUSH and revitalization of local health traditions” under NHM.^{[1],[2],[3],[4],[5]} Albeit, the idea of mainstreaming of AYUSH was mulled over during the ninth five-year plan; however, the same acquired ground-level implementation in 2005.^[6] Under this scheme, AYUSH doctors were mainstreamed and the services were colocated at different hierarchies of health facilities, preferably at the level of primary health centers and community health centers and in some states in both subdistrict and district hospitals.^[2],[4] As of 30 June 2018, 498 district hospitals, 2776 community health centers, and 7623 primary health centers were colocated with AYUSH facilities. About 63.9%, 49.4%, and 29.7% of the district hospitals, community health centers, and primary health centers were colocated with AYUSH facilities, respectively. Similarly, around 1.82 million, 0.33 million, and 0.12 million population were being served by the facilities colocated with AYUSH services in district hospitals, community health centers, and primary health centers in rural India, respectively, by June 2018. In addition, by June 2018, 11,840 AYUSH doctors and 3716 AYUSH paramedical staff were found working in the country.^[7][Table 1] delineates about the status of the AYUSH workforce and the population served; [Figure 1] delineates about the system-wise percentage distribution of AYUSH practitioners registered in the country.

Table 1: Status of AYUSH-human resources and population served as on 1 January 2018

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Figure 1: Percentage distribution of system-wise AYUSH workforce in India, as on 1 January 2018

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The undergraduate curricula of Ayurveda and Homoeopathy, constituting the majority of AYUSH systems of medicine, also cater to basic theoretical knowledge related to obstetrics and gynecology, which includes managing cases of normal labor and reproductive health issues. Many of the state governments in the country have offered training on skilled birth attendance to AYUSH doctors and engaged them in rendering support services on essential and emergency obstetric care services, mostly in the primary health‑care settings.^[8],[9] These skill development trainings and their academic training on obstetrics and gynecology help the AYUSH practitioners to effectively deliver maternal health-care services in different states. Further, studies report that AYUSH doctors serving in public health institutions provide effective maternal health services and this study assessed the same through a brief review of the literature.

The main objective of this study was to assess the role and effectiveness of AYUSH doctors in providing maternity care in public health institutions through a review of the literature.

Materials and Methods

An initial attempt was made to carry out a systematic review on the effectiveness and role of AYUSH doctors in providing maternal health services in public health institutions in India; however, the search through PUBMED and Google Scholar search engines using key words: “AYUSH doctors,” “Maternal health,” and “Maternity care” did not yield sufficient literature on this topic. Thus, a brief review of the literature was conducted by selecting articles through cross-references of selected articles and through hand search.

Results and Discussion

The search of literature through the systematic process by using key words: “maternal health” and “AYUSH doctors” yielded scanty research on this topic; the hand search and cross-references yielded some good results, with some research limited to single digits only. Interestingly, research on the usage of AYUSH/ Ayurveda principles and therapeutics is plenty. A review of the literature carried out in 2016 identified 15 topics of research relevant to maternal health and the role of Ayurveda for the same. Of these 15 titles, 4 titles for maternal health in general, 1 article for childbirth, 2 titles for postpartum care, and 8 articles on the role of Ayurveda in pregnancy have been found through the review.^[10] In addition, the usage of drugs for maternal health-related problems has also been documented.^{[5],[11],[12]} The following studies assessed the role of AYUSH doctors in providing maternal health services and their effectiveness and the way forward.

A cross-sectional study involving 109 AYUSH doctors of 37 public health facilities across three states, Maharashtra, Rajasthan, and Odisha, assessed the knowledge and skills of AYUSH doctors in providing maternal health services. These AYUSH doctors were previously trained in Skilled Attendance at Birth (SBA) or Basic Emergency Obstetric Care (BEmOC) and were placed in either first referral units (FRUs), CHCs, or 24 × 7 PHCs with the highest number of deliveries conducted in the last three months. The study found that with regional variations 77% of AYUSH doctors scored 70% or more on items related to essential obstetrics care and emergency obstetrics care. Similarly, these doctors scored around 70% on knowledge related to identification and management of pregnancy and delivery-related complications. These AYUSH doctors could not properly articulate the answers related to managing cases of bleeding during early pregnancy, management of the second stage of labor, active management of the third stage of labor (AMTSL), neonatal resuscitation practices, and cracked nipple management.^[8] Another mixed-method observational study assessed the use of partograph by the SBA/ BEmOC trained AYUSH doctors in three different Indian states: Rajasthan, Maharashtra, and Odisha. The study was conducted among 83 AYUSH doctors who were asked to plot a partograph on a given labor case. The study used a previously devised scoring system, indicating 70% or more as competent and found that doctors in Maharashtra and Rajasthan could achieve the competency level with 82% and 72.1% scores, respectively. The doctors of Odisha had poor performance with a very minimum score of 11.1%. It was observed that the doctors committed errors in recording cervical dilatation and uterine contractions in the partograph. The study also found that the tool used by the AYUSH doctors is useful in decision making for timely referral of cases in conditions of fetal distress and prolonged labor.^[13]

Another cross-sectional study among 67 AYUSH doctors in three districts of the Jaipur division of Rajasthan revealed that 40% of the doctors could respond correctly on theoretical questions on true labor pain, placental separation, and fetal distress.^[14] One of the studies assessing the task shifting for SBA by using the AYUSH doctors explored the possibility of using AYUSH doctors for SBA. The study conducted among 73 respondents, including 37 AYUSH doctors and 36 program managers, revealed that SBA training has empowered the AYUSH doctors and improved skills for skilled birth attendance. The program managers responded that the AYUSH doctors are competent, hardworking, and enthusiastic, with good acceptance in rural areas. However, the study also found regional variations in skill development, its application on ground and acceptance by the community. It found that the acceptance is more in Maharashtra compared with Odisha and Rajasthan, with AYUSH doctors being least accepted by the community in Odisha.^[15]

All the four studies that assessed the effectiveness of utilizing the AYUSH doctors in maternal health services found mixed to positive outcomes with a basic need of further training and orientation on skill enhancement in delivering maternal health services in a more effective manner. As AYUSH doctors constitute an indispensable part of the rural health-care system in the absence of qualified MBBS doctors, it becomes very much imperative to train and orient them iteratively to get maximum benefit out of their skills for the betterment of the community.

Conclusion

The presence of AYUSH doctors in rural areas is, indeed, a great help for the community; however, they need regular training and orientation to upgrade their knowledge and skills for effective service delivery. This is important, as the academic training imparted to AYUSH doctors may not be sufficient to render effective maternal health services owing to several reasons: poor clinical exposure owing to lack of well-equipped hospitals in AYUSH institutions, inadequate theoretical exposure owing to limited syllabus on maternal health etc. Albeit, many states have started imparting SBA/ BEmOC training to AYUSH doctors; however, the same needs to be made available to all AYUSH doctors, as all of them have an equal chance of rendering maternal health services in rural India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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