Ayurveda and medicalisation today: The loss of important knowledge and practice in health?

Ayurveda translates as ‘life science’. Its knowledge is not limited to medicine, cure or therapy and is forlaypersons, households, communities, as well as for physicians. Throughout its evolutionary history,Ayurveda and Local Health Traditions have reciprocally influenced each other. In modern times, theinfluence of biomedicine on Ayurveda is leading to its medicalisation. Over the past century, theintroduction and perspective of biomedicine into India has made the human being an object for positiveknowledge, a being who can be understood with scientific reason and can be governed and controlledthrough medical knowledge. This paper explores how this shift towards medicalisation is affecting theknowledge, teaching, and practice of Ayurveda. It examines the impact and contribution of processes likestandardisation, professionalisation, bio-medicalisation and pharmaceuticalisation on Ayurveda education, knowledge, practice and policies. To maintain health and wellbeing Ayurveda's ancient knowledgeand practice needs to be applied at individual, community and health care provider levels and not belimited to the medical system. The current over medicalisation of society is a potential threat to humanhealth and well-being. Ayurveda and LHT knowledge can provide essential teachings and practices tocounter-balance this current trend through encouraging a population's self-reliance in its health.© 2018 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Sustaining PPM-DOTS the case of Pimpri Chinchwad, Maharashtra, India.

Background: Globally, Public-Private Mix (PPM) models of service delivery are recommended as a strategy for improving tuberculosis (TB) control. Several models of PPM-DOTS have been initiated under the Revised National TB Control Programme (RNTCP) in India, but scaling up and sustaining successful projects has remained a challenge. Aim: This paper examines factors accounting for the sustainability of a PPM-DOTS initiated in 1998 in Pimpri Chinchwad (PC), a city in Maharashtra, India. Methods: A two-year intervention research project documented the workings of the PPM–DOTS programme. This paper draws on in-depth interviews with programme officers and staff, and semi-structured interviews with private practitioners (PP) practising in the study area. Results: PPM-DOTS was originally introduced in PC, in order to increase access to DOTS. Over the years it has become an integral part of the RNTCP. Multiple approaches were employed to involve and sustain private providers’ participation in PPM-DOTS. Systems were developed for supervision and monitoring DOTS in the private sector. Systematic use of operations research and successful mobilisation of available local resources helped set future direction for expanding and strengthening the PPM. The private sector’s contribution to case detection and treatment success has increased, however ensuring referrals of TB suspects from all private providers continues to present a challenge. Conclusion: PPM-DOTS in PC is one of the few Indian models implemented as envisaged by global and national policy makers. Its successful operation for over a decade reiterates the importance of public sector initiative and leadership and makes it an interesting case for study and replication.

"It's 100% for me": hospital practitioners' perspectives on mandatory HIV testing.

This article explores the thinking of medical practitioners working in nine hospitals spread across five cities in India, on a contested subject - mandatory HIV testing of patients prior to surgery. We used in-depth interviews with practitioners and an interpretive analytical approach to understand their decisions to conduct mandatory tests. While many in the public health community see mandatory testing as an unacceptable violation of patient autonomy, the practitioners widely regarded it as a valuable cost-saving innovation for obviating transmission of infection during surgery. These conceptions are rooted in the day-to-day logic of practice which defines practitioners’ actions - imperative of personal security, investment in core occupational roles and the importance of harmonious relations with co-workers. The experiences of hospitals with contrasting policies on mandatory HIV testing shows how an approach that balances patients’ needs with an appreciation of practitioners’ perspectives may result in more workable solutions for field-level ethical dilemmas.

Urban private practitioners: potential partners in the care of patients with HIV/AIDS.

BACKGROUND: The private medical sector is an important source of healthcare in India. Increasingly, concerns have been raised about its role in the care of patients with HIV/AIDS. Evidence about private practitioners' existing management practices will help to create policies addressing this sector. METHODS: A central urban area of Pune city was selected for its high density of healthcare facilities. Private practitioners in the area were interviewed using a structured interview schedule. Based on a 1-year recall period, the schedule covered different aspects of the practitioners' HIV/AIDS management practices including diagnosis, treatment and referral. RESULTS: Of the 215 practitioners interviewed, 66% had tested and diagnosed HIV infection. Fifty-four per cent had been consulted by HIV-infected clients 'shopping' for alternative diagnoses or treatment. Overall, 75% of the respondents had been consulted by HIV-infected clients for treatment. Of these, 14% had prescribed antiretroviral drugs, sometimes without adequate knowledge of the guidelines for their use. Other supportive and symptomatic treatments were also frequently prescribed. Private practitioners commonly referred HIV-infected clients for management to other private doctors, or to public hospitals. There were variations in respondents' practices by sex and system of medicine. CONCLUSION: Private practitioners are actively involved in diagnosing and managing patients with HIV/AIDS. Some of their management practices are inappropriate and need to be remedied. There are also concerns about gaps in the continuity of care of HIV-infected persons, for which networks between providers need to be strengthened. Public-private partnerships must be created to improve the flow of information to private practitioners, and Include them in the national health framework.