AYUSH or Ayurveda (A), Yoga (Y), Unani (U), Siddha (S), and Homoeopathy (H) is the common terminology provided by the Ministry of AYUSH, Government of India (Ministry of AYUSH, 2018b). However, AYUSH is not limited to these areas of treatment, but also to Sowa-Rigpa, Naturopathy, folk medicine and traditional herbal medications. The AYUSH treatment market in India has caught up with speed with respect to sales of commercial products, popularity and research capabilities.
On the other hand, in western countries, AYUSH is more commonly known as alternative or traditional medicines or therapies (NCCIH, 2018). Apart from AYUSH; Chinese herbal treatment, spiritualism, and all other mythical treatment methods are termed alternative or traditional medicines. However, in recent years, the use of traditional medicine for treating numerous disease conditions has gained popularity globally (WHO, 2014).
Research institutions and governing bodies of AYUSH in India
The Ministry of AYUSH, Government of India, incepted in 2014 and was renamed from Department of Indian System of Medicine and Homeopathy (ISM&H) (Ministry of AYUSH, 2018a). Ministry of AYUSH is the main regulatory body for sales, export, and research of all commercial AYUSH based products. Apart from the Ministry of AYUSH, there are other statutory regulatory bodies, such as;
- Pharmacopoeia Commission for Indian Medicine and Homoeopathy.
- Central Council of Indian Medicine (CCIM).
- Central Council of Homoeopathy (CCH).
- Drug Control Cell (AYUSH).
The traditional medicine ecosystem
The traditional medicine ecosystem of a nation comprises of;
- hospitals (treatment and hospitalization centers),
- research institutions (public and private entities),
- universities and colleges (postgraduate, undergraduates, and doctoral degrees),
- governing bodies (ministry, and independent government organizations),
- and companies (private and public).
Traditional medicine ecosystem of India
According to WHO, (2014), there were 785185 registered Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) practitioners as of 2014 were reported. The report also indicated that India had 508 colleges with an annual admission capacity of 25586 undergraduate students and 2493 postgraduate students in the year 2014. In addition, the Ministry of AYUSH, (2018b) reported 3605 AYUSH hospitals and 26130 AYUSH dispensaries. Furthermore, the Ministry of AYUSH, (2018) also reported 3943 AYUSH hospitals, with 26130 AYUSH dispensaries, and 773668 registered practitioners in 2017. The growth rate, in this case, has grown by 1.7% since 2014.
Timeline for the growth of alternative healthcare institutions in India
The following graph indicates the steady growth of AYUSH based hospitals in India between 2007 and 2017. It can be implicated that the AYUSH hospitals in India have grown at a rate of 6.2% per annum between 2007 and 2017 (Ministry of AYUSH, 2018b). In this regard, the average annual growth rate of hospital beds per hospital has increased from 13% in 2007 to 16% in 2017. The hospitals can be categorized
- central government-run hospitals (1.3%),
- state government-run (98.7%),
- privately owned (4.2%) and,
- only 0.9% of hospitals were being managed by local bodies.
Thus, it can be implicated that the rise in the number of hospitals is motivated by the number of patients seeking AYUSH treatments.
A total of 27698 AYUSH dispensaries in India were reported, whereby:
- 62.9% comprised of Ayurveda,
- 5.5% Unani,
- 3.1% Siddha,
- 0.1% Sowa-Rigpa,
- 0.4% Naturopathy and,
- 27.2% dispensaries of Homoeopathy (Ministry of AYUSH, 2018b).
State-wise distribution indicated that Rajasthan has been dominating with the highest number of AYUSH based dispensaries in India, and the least being in Nagaland. However, on average, the annual growth rate of AYUSH dispensaries in India grew by 1.65% from 2007 to 2017. This is implicative from the fact that the number of hospitals has increased, which means, increased number of patients.
Year-wise distribution of AYUSH registered practitioners in India
Human capital comprises all specialized and registered practitioners of AYUSH. As of 2017, the
- 428884 practitioners reported under Ayurveda System,
- 284471 practitioners under Homoeopathy,
- 49566 under Unani,
- 8505 under Siddha and,
- 2242 under Naturopathy systems reported in 2017.
Nevertheless, registered practitioners under AYUSH have grown at 2.7% per annum between 2007 and 2017. However, AYUSH based doctors remain reported the highest in the Indian states of Maharashtra, Bihar, and Uttar Pradesh.
Although from the above figure, the sudden drop of registered practitioners in 2013 is not known. It remains speculated that the revised Drug and Cosmetics Act in 2013 and the formation of the Ministry of AYUSH in 2014, have changed the criterion for being a registered AYUSH doctor. Therefore, growth is implicative from the rising number of AYUSH healthcare centres and hospitals. Increased AYUSH healthcare centres and hospitals have indirectly motivated the need for more practitioners to tend to the needs of patients seeking AYUSH treatment.
The growth of AYUSH treatment market on the basis of manufacturing units
The proportion of AYUSH licensed pharmacies increased from 80.3% in 1994 to 85.2% in 2017 in India (Ministry of AYUSH, 2018b). Furthermore, 9038 manufacturing units were registered in 2017 with respect to AYUSH based products, whereby 7698 manufacturing units were registered with Ayurveda drugs, 567 for Unani, 374 for Siddha and 399 for Homoeopathy manufacturing units (Ministry of AYUSH, 2018a).
In addition, the states of Andhra Pradesh, Gujarat, Kerala, Maharashtra, Madhya Pradesh, Tamil Nadu and Uttar Pradesh remain reported with the largest numbers of AYUSH manufacturing units whereas, proportions of Siddha and Homoeopathy licensed pharmacies decreased from 6.1% and 9.7% in 1994 to 4.1% and 4.4% in 2014 respectively. Increased manufacturing units indicate increased production of drugs which indicates the fact
The trend of AYUSH based expenditures by the Government of India
The trendline indicates a steady rate of planned expenditure for the years 2012 to 2017 at between USD 147.2 million (INR 1050.00 crores) in 2017 and USD 138.8 million (INR 990 crores) in 2012. However, the growth rate of AYUSH based expenditure between 2007 and 2017 stands at approximately 60% (Ministry of AYUSH, 2018b). This might be from the fact that over the years the number of AYUSH healthcare institutions have increased and the number of patients seeking AYUSH based treatments for different diseases may have also increased.
On the other hand, the statistics also indicate that actual expenditure from budgeted expenditure in AYUSH sector is approximately 70% on an average. In other words, the Government of India is efficiently expediting its expenditures for AYUSH treatment market. Furthermore, increased expenditures also remain evident from the fact that the number of AYUSH hospitals, dispensaries, registered manufacturing units and the number of educational centres has significantly increased in the past decade (2007-2017).
Revenues generated from the AYUSH treatment market
Revenue generation from the AYUSH treatment market comes from domestic as well as international sales of AYUSH based commercial products. International sales mainly comprise of the export of commercial over the counter products, prescribed products, and raw materials. According to the annual report of the Ministry of AYUSH, (2018a), revenues of USD 2813 million was generated by the AYUSH manufacturing companies in India. The report also indicated that USD 984 million in revenues generated by the AYUSH sector is solely from exports to countries like the USA, Europe, and the Middle East.
On the other hand, the annual report by the Ministry of AYUSH, (2018a), indicates that the export potential of the AYUSH treatment market and business opportunities in India will increase by 2025. In addition, the report also forecasted that the exports of AYUSH products will increase by at least 20% in 2025.
The trendline of revenues generated from exports of AYUSH products has depleted from 2013 to 2017. However, the overall generation of revenues from exports of all commercial and raw products rather indicated a steady increase of 7% (Ministry of AYUSH, 2018b). This depletion of revenues from USD 3479.8 million in 2012 to USD 2210.6 million in 2013, is evident from the fact that the Ministry of AYUSH was formed in 2014 and the Drug and Cosmetics Act (D&CA) was updated in 2013. Updation of the D&CA included AYUSH guidelines of stricter export and production policies with respect to volumes and quality. However, speculation rises to the fact that the import of AYUSH based products has increased between 2014 and 2017.
Import of AYUSH products in India
Unlike export, the import rate of AYUSH products to India has significantly increased between 2012 and 2017 (Ministry of AYUSH, 2018b). However, it is implicative from the statistics that importing AYUSH products mainly comprises raw AYUSH products like medicinal plants and herbs and not endemic to India or its neighbouring countries such as Arctostaphylos uva-ursi, Damiana sp. and their by-products. Increasing demand for treatment of various diseases and increased expenditures by the government has motivated importing of exotic medicinal plants and their by-products for improving the research capabilities as well as to improve the AYUSH treatment market of India.
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- Ministry of AYUSHa. (2018). Annual Report 2017-2018. Available at: http://ayush.gov.in/sites/default/files/Ayush%20AR%202017-18-8.pdf (accessed on 7-2-2019).
- Ministry of AYUSHb. (2018). AYUSH in India. Available at: http://ayush.gov.in/genericcontent/ayush-india-2017-0 (accessed on 7-2-2019).
- NCCIH. (2018). About Us. Available at: https://nccih.nih.gov/about (accessed on 7-2-2019).
- WHO. (2014). WHO traditional medicine strategy: 2014-2023. Available at: http://apps.who.int/medicinedocs/documents/s21201en/s21201en.pdf.