Background
“I believe that the strong calls we are hearing for a renewal of primary health care create an ideal opportunity to revisit the place of traditional medicine, to take a positive look at its many contributions to health care that is equitable, accessible, affordable, and people-centred (Director General, World Health Organisation [WHO] at the Congress on Traditional Medicine, 2008, Beijing, China)” [1].
Year | Policy developments | Key feature pertaining to traditional systems of medicine |
---|---|---|
2002 | National Policy on Indian Systems of Medicine and Homeopathy | Acknowledged long neglect of traditional systems of medicine; revitalization of folk medicine mentioned for the first time |
2005 | National Rural Health Mission | Suggested mainstreaming of AYUSH and revitalizing local health traditions as part of strengthening primary health care |
2014 | Separate ministry of AYUSH formed Launch of National AYUSH Mission | To ensure optimal development and propagation of AYUSH systems of health care including LHT |
2015 | Launch of International Yoga Day | Promotion of yoga towards holistic health and wellbeing |
2017 | National Health Policy | Access to assured AYUSH services and support for documentation, validation and promotion of LHT |
Methods
Overview of the ethnographic research process
Method | Sample and field procedure |
---|---|
a) narrative synthesis of policies | 22 policy documents at the national level as well as key international policies that were contemporaneous to or are reflected in the terms and concepts used in national policies. |
b) stakeholder landscaping | Visits to and interactions with organisations and agencies in all three states, both referred to and indicated in publicly available policy documents on LHT, and as nominated by those interviewed |
c) key informant interviews with NGO staff | Interviews carried out with 18 NGO representatives involved with the revitalisation agenda as indicated in policy documents or as referred by prior key informants |
d) observations | Participant observations in meetings of 6 national, regional, and state-level healers associations and conclaves, as well as 5 scientific conferences, seminars and meetings |
e) focus group discussions | 3 discussions with convenience samples of healers at aforementioned conclaves to discuss what they do, why they attend these meetings and what they feel ought to be done to improve their situation |
f) in depth interviews | Interviews carried out with 51 healers and 15 of their patients, 20 government representatives of AYUSH department as well as AYUSH research councils at the state level, 15 academicians/researchers involved with documentation efforts or broader research/writing/advocacy on LHT in the popular media or academic literature |
g) interactive dialogue | 1.5 day long interaction involving 36 of the aforementioned stakeholders in a direct conversation with each other on themes emanating from earlier fieldwork, i.e. a) documentation, b) linkages between LHT and AYUSH, c) recognition and legitimacy and d) ways forward for research, advocacy and policy. |
h) case studies of healers | Repeated interviews carried out to develop case studies of 10 (6 menn and 4 women) healers to more deeply understand their experience in light of themes emerging from the dialogue. Care was taken to ensure diversity in gender, years of experience and representation of both those present and absent from dialogue |
Data collection process
Data analysis
Results
LHT in national policy frameworks and in everyday practices
Documentation as revitalisation of LHT
Those who practice the knowledge need to be involved in documentation. How can someone who does not know the context and has never practiced the knowledge even understand what it is all about and document? (IDI_HEL_21_KA).
Documentation of local health knowledge cannot be everybody’s business. Someone who is sincere, dedicated and who has a respect and passion for such knowledge can and should document. It should not go into the hands of those with selfish motives (IDI_HEL_11_KE).
We have collected local knowledge on health and medicine but we do not know what to do with this. Several files of such knowledge are stored in the cabinet quite safely. Perhaps now they need to be validated? (IDI_GOV_03_KA).
Most documentation efforts lacked a larger strategy or intent on what the process would lead to. Further, since the myriad of documentation efforts had multiple objectives, it would be difficult to have them cohere under such a broader strategy or intent. While some had the clear intent of discovering new drug formulation, for others, documentation aimed at active promotion of such knowledge for strengthening primary health care, yet some others found the documentation exercise itself to be a process of social legitimation of such knowledge. Each of these objectives demands different methodological process, involvement of actors and outputs. Healers we spoke to specifically raised concern about the lack of clarity of objectives and outcomes. The objective of drug discovery for potential commercial purpose, and promotion of primary health care through community ownership of health, are contrasting objectives. We came across three specific models of documentation that hold promise for a more inclusive process, in the spirit of NRHM. These were explained to us by key informants from the organizations who developed these models. According to them, these models relied on a bottom up approach with the local community and healers playing an important role in establishing the first tier of legitimacy of knowledge, healer and practice based on experiences of the community. The models involve documentation through the healers, in conversations with practitioners of institutionalized medicine (eg: Ayurveda) [42, 43]. Additionally, the dialogue drew attention to other documentation efforts that adopted the methodological approaches of active listening and cooperative inquiry. Such attempts sought to enter into the world views of traditional midwives or barefoot gynecologists, while recording their knowledge and elements of practice [22, 23]. The latter two models did not seek out to ‘document’ as such, instead they were more in the spirit of reviving and strengthening community based health knowledge and practice, in order to promote community ownership of health. The emphasis in these models of documentation is on the methodological process which relied on a dialogical approach. These documentation efforts while capturing the strengths of such traditions also pointed out areas where each tradition would need to be improved or strengthened. As the discussion in the dialogue made it apparent, a key challenge in documentation of LHT has been to capture the strengths of such knowledge in a language that is legible to more mainstream, systems-based medical knowledge and practice.Documentation has real meaning when this [knowledge contained in the documentation] is actively promoted in the community. Thus, without the practice of such knowledge, mere documentation will have limited purpose (IDI_NGO_07_KE).