Department of Ayurveda and Alternative Medicine (DoAA)
Ayurveda, an ancient medical system indigenous to Nepal, is deeply ingrained in the country's customs and culture. A significant portion of the population relies on traditional practices for primary healthcare due to factors such as accessibility, affordability, and cultural alignment. With over 400,000 traditional medicinal practitioners practicing various modalities, including ritualistic and spiritual practices, diet, and self-healing, including medicinal herbs, minerals, and animal products. Ayurveda plays a pivotal role in the healthcare system with its interventions ranging from promotive, preventive, curative and rehabilitative services.
Department of Ayurveda and Alternative Medicine (DoAA) is predominantly liable for providing Ayurveda and alternative medicine amenities to the population. It operates under MoHP and is responsible for planning, programming, coordination, supervision, monitoring, and evaluation of Ayurveda and Alternative Medicine service programs.
Creating policies and guidelines for Ayurveda and other traditional medical systems is the responsibility of MoHP's Ayurveda and Alternative Medicine unit within the Policy Planning Monitoring Division. The value of Ayurvedic services in basic healthcare and NCD prevention is acknowledged by both national and international policies. The Constitution of Nepal specifically calls for the protection and promotion of traditional Ayurveda medicines, along with naturopathy and homeopathy.
In line with the federal structure, there is a need to restructure the Ayurveda system, as outlined in the National Health Policy 2076 (2019)1 and its strategy 6.7.1. The government's Fifteenth Plan (2076/77-2080/81) provides guidance for the planned development and expansion of Ayurveda, Naturopathy, Homeopathy, and other alternative medicines. Key areas of focus include:
- Structural development: This involves creating a framework suitable for the identification, prevention, collection, and promotion of locally available medicinal herbs, minerals, and animal-origin medicines.
- Management and regulation: The plan emphasizes the need for managing and regulating other alternative medicines based on standards and norms.
- Establishment of centers: This includes the establishment of Ayurveda, Yoga, and Naturopathy Centers, with a particular emphasis on utilizing Ayurveda, Yoga and Naturopathy systems of medicine for the promotion of health tourism.
The outlined strategies reflect a comprehensive approach to integrate traditional medical practices into the broader healthcare system, addressing both the healthcare needs of the population and the preservation of traditional knowledge and practices.
Box 22.1 Objectives and strategy of DoAA
Objectives of DoAA
- To expand and develop functional, physical Ayurveda health infrastructure;
- To improve the quality of Ayurveda & Alternative medicine services delivered through all institutions of all levels and to ensure easy access of these services.
- To develop and manage the required human resources;
- To promote community participation in the management of the health facility & utilization of local herbs;
- To promote a healthy lifestyle through Ayurveda and Yoga.
- To promote health status & sustainable development of Ayurveda system using locally available medicinal plants;
- To promote positive attitudes towards health care & awareness of health issues;
Strategies
- Provide preventive, promotive & curative health services in the rural areas;
- Establishment & development of Ayurveda institutions;
- Strengthen & expand the Ayurveda health services;
- Develop skilled manpower required for various health facilities;
- Strengthening of monitoring & supervision activities;
- Development of information, education & communication center in the Department;
- Develop Inter sectoral coordination with Education Ministry, Forestry, local development sector & other NGOs & INGOs;
- Establishment of regional Ayurveda Hospitals & Ayurveda Dispensaries;
- Strengthening & expansion of research & training center of international level;
- National & International level training for the capacity enhancement of its human resources
Furthermore, the BHS package includes pancha-karma, yoga and satawari for postnatal women from Ayurveda services and treatment of wart, allergy, tonsillitis, gastritis, vitiligo and arthritis from Homeopathy services which further strengthens GoN’s commitment towards encouraging utilization of the Ayurveda and Alternative Medicine services
| Box 22. 2 Organization of Ayurveda and Alternative Medicine Services | |
| Federal Level | ● Department of Ayurveda and Alternative Medicine ● Ayurveda Hospital, Naradevi ● National Ayurveda Research & Training Center (NARTC) ● SinghadurbarVaidhyakhanaVikasSamitee ● National Ayurveda Medical Council (NAMC) ● Pashupati Homeopathy Hospital |
| Provincial Level | ● Provincial Ayurveda Hospital- (Koshi- Jhapa, Lumbini – Dang, Sudurpaschim –Kailali) ● Provincial Ayurveda Chikitsalaya/District Ayurveda Health Centers |
| Local Level | Ayurveda Dispensaries (Aushadhalaya) Nagarik Arogyasewa Kendra |
22.1.1 Institutional coverage of Ayurveda and Alternative Medicine Services
There are Ayurveda health facilities from local to federal level across the nation. There are six Ayurveda health facilities at federal level and six at provincial level. There are no provincial level Ayurveda hospitals in Madhesh, Gandaki and Karnali provinces. There are a total of 77 district level Ayurveda Health Centers including the former regional Ayurveda Chikitshalaya and 305 Ayurveda Aushadhalaya across the country.
Figure 22.1 Institutional coverage of Ayurveda Health Center and Ayurveda Aushadhalaya per 100,000 population
| Provinces | Ayurveda Health Centers/ 100,000 population | Ayurveda Aushadhalaya/ 100,000 population |
| Koshi | 0.28 | 1.01 |
| Madhesh | 0.13 | 0.87 |
| Bagmati | 0.21 | 0.83 |
| Gandaki | 0.45 | 2.23 |
| Lumbini | 0.23 | 0.90 |
| Karnali | 0.59 | 1.01 |
| Sudurpaschim | 0.33 | 1.22 |
| National | 0.26 | 1.05 |
22.1.2 Major Activities in FY 2080/81…………………………
| Federal level |
| Establishment of open Gym in different places of all seven Provinces.Development of MSS for Central, Provincial and local level Ayurveda health institutions and approved from MoHPGuidelines, Protocol, Manual development of NagarikAarogya/Lifestyle management NCD Prevention and Control) Program.Establishment and development of Ayurveda Health Management Information System (AHMIS)Strengthening of National Ayurveda, Panchakarma and Yoga Center in Budhanilkantha and building is under construction of BudhanilkanthaPanchakarma center. Strengthening of Provincial Ayurveda Hospital at Kailali&Jhapa. Strengthening program of Naturopathy, Yoga, Homeopathy, Unani, AamchiMonitoring of services provided by private Ayurveda & Alternative Medical Systems.Annual review meetings.Evaluation and monitoring and co-ordination with province and local levelNational/International Yoga Day; National Naturopathy day; National ArogyaDiwas&DhanwantariJayanti celebrations |
| Province and Local Level |
| Yoga and Lifestyle Management Training Program Workshop and Discussion with Local Traditional Healers Preparation of IEC Materials on AyurvedaSchool Ayurveda Health Program Construction of Buildings for Ayurveda Institutions Promotive Health Program for Senior Citizens Awareness Program on Medicinal PlantsProgram for Lactating Mothers (Distribution of Galactogogue Medicine) Procurement of Essential Ayurveda Drugs & Treatment Equipment Ayurveda Health Promotion and Public Awareness Program through Nagarik Arogya Program Skill Development/Empowerment ProgramPrevention, Reduction, and Management of NCD Ayurveda Health Information Management Training Program Citizen Wellbeing (NagarikArogya) Program Yoga/Skill Development Training for Ayurveda Personnel Lifestyle Management Program in PHC Training on "Operation & Management of Ayurveda Programs" for Ayurveda Personnel Procurement & Transportation of Ayurveda MedicinesFree Health Camps Citizen Health Campaigns and Community Health Education Programs through Citizen Wellbeing Group Information Communcaition SwasthaJivanSailiKaryakram (Healthy Lifestyle Program) Vidhyalaya Ayurveda ShikshaKaryakram (School Ayurveda and Yoga Program) NagarikArogya Clinic for NCDsHealthy Life (SwasthaJeevan) Program Production of ChurnaAushadi (Medicine) Establishment of Citizen Wellbeing (NagarikArogya) Centers at the Local Level National/International Yoga Day; National Naturopathy day; National ArogyaDiwas&DhanwantariJayanti celebrations Purva Panchkarma Sewa (Purva Panchkarma Service) |
22.1.3 Key Service Indicators
Users of BHS Ayurveda services in FY 2080/81
Figure 22.2 Users of BHS Ayurveda services per 10,000 population in FY 2080/81
In FY 2080/81, the users of Purba-pancha karma were 486,594, yoga services were 237,056 and among 57734 postnatal women Shatavari was distributed. There was provincial variation in the number of the users. (Table 22.2) This utilization of Ayurveda services across the provinces demonstrates that there is attraction towards therapeutic Ayurveda practices and Yoga services. Understanding the preferences in healthcare and tailoring strategies to ensure equitable access and promotion of province specific relevant traditional and alternative medicine systems will be crucial.
Table 22.2 Users of BHS Ayurveda services per 10,000 populations in FY 2080/81
(……….data not matched with factsheet and ppt shared… to verify by respective department – recommendation from Dhulikhel workshop)
| Provinces | Purva Panchkarma service | Yog Service | Stanpayi Aamako lagi Satawari Vitaran |
| Koshi | 97819 | 20379 | 8904 |
| Madhesh | 54724 | 60466 | 7362 |
| Bagmati | 103202 | 14731 | 8689 |
| Gandaki | 48835 | 50703 | 3918 |
| Lumbini | 76259 | 54992 | 14445 |
| Karnali | 38910 | 19411 | 6793 |
| Sudurpaschim | 66845 | 16374 | 7623 |
| Nepal | 486594 | 237056 | 57734 |
Table 22.3 Total Users of Ayurveda Services in FY 2080/81
| Provinces | Koshi | Madhesh | Bagamati | Gandaki | Lumbini | Karnali | Sudur Paschim | National |
| Total Number of patients served | 279057 | 349872 | 441348 | 295509 | 523942 | 185028 | 229548 | 2304304 |
Morbidity among users of Ayurveda services
In addition to basic health service utilization there are a range of the Ayurveda services available, in FY 2080/81, an impressive total of 2304304 individuals availed themselves of Ayurveda services, indicating a remarkable level of user engagement. However, the number of patients served is slightly lowered than previous year. The most frequently reported morbidities included acute peptic disease, musculoskeletal and nervous disorders, respiratory disorders, abdominal disorders, anorectal disorders, rheumatoid arthritis, cardiovascular diseases, gynaecological disorders, and geriatric problems. (Figure 22.3, Table 22.1)
Notably, there is a discernible trend wherein users with non-communicable and chronic conditions exhibit an increasing preference for Ayurveda services. This shift in preference underscores the growing recognition and acceptance of Ayurveda as a viable and effective healthcare option for addressing enduring health challenges especially those related to NCDs control and management. The data suggests a significant role for Ayurveda in catering to the healthcare needs of individuals with persistent health issues, highlighting its relevance and effectiveness in managing a diverse range of morbidities. District-wise Model School for “School Ayurveda and Yoga Program” has been selected to conduct “My health, My responsibility" campaign to prevent non-communicable diseases (including mental disorders).
Table 22.1 Common morbidities reported among Ayurveda service users
| Top 10 Morbidities among Ayurveda Service Users in FY 2080/81 |
| Acute Peptic Disease |
| Musculo-skeletal and Nervous Disorder |
| Abdominal Disorder |
| Respiratory Disorder |
| Gudavikar-Haemorrhoids |
| Rheumatoid Arthritis |
| Hypertension |
| Asthma and COPD |
| Griatric Problem |
| Pediatric Disorder |
Source: AHMIS/DoAA
Figure 22.4 Reporting rate of Ayurveda Health Facilities in FY 2080/81
| Program Indicators | Koshi | Madhesh | Bagmati | Gandaki | Lumbini | Karnali | Sudurpaschim | National |
| Ayurveda Health Facilities Reporting Status (In Percent) | 96.1% | 82.1% | 84.7% | 96% | 93.3% | 92% | 90.3% | 90.1% |
Annex table
| Ayurveda and Alternative Medicine | 2078/79 | 2079/80 | 2080/81 | Koshi | Madhesh | Bagmati | Gandaki | Lumbini | Karnali | Sudurpashchim |
| No. of Health Facilities (Ayurveda) | 388 | 388 | 388 | 65 | 61 | 67 | 66 | 59 | 27 | 43 |
| Public Ayurveda Hospitals (Number) | 6 | 6 | 6 | 1 | 0 | 3 | 0 | 1 | 0 | 1 |
| District level Ayurveda Health Centre (Number) | 77 | 77 | 77 | 14 | 8 | 13 | 11 | 12 | 10 | 9 |
| Ayurveda Aushadhalaya Number) | 305 | 305 | 305 | 50 | 53 | 51 | 55 | 46 | 17 | 33 |
In FY 2080/81, overall, 97.2% have reported their data to DoAA; and province wise, the reporting rate from AyurvedaHealth Facilities in Koshi, Lumbini and Karnali provinces was 100%.
Minimum service standards of Ayurveda Health Facilities
Leveraging insights gained from the implementation of the MSS for health facilities under DoHS, DoAA developed and endorsed from MoHP, the MSS tailored for Ayurveda Health Facilities. MSS for four different level of the AyruvedaHeath Facilities have been developed – MSS for Ayurveda Aushadhalaya, MSS for District level Ayurveda Health Centers, MSS for Province Level Ayruveda Hospital and MSS for Federal Level Ayurveda Hospital. (Fig 22.5) There are three major components of MSS- leadership and governance, support service management and clinical service management with clinical section focused on the Ayurveda services. This achievement by DoAA signifies a noteworthy milestone, laying a strong foundation for delivery of quality Ayurveda services. MSS for Ayurveda Health Facilities is poised to boost operational efficiency, and streamline management processes, and ultimately contribute to the exemplary Ayurveda services. MSS (Minimum Service Standard) for Ayurveda has been conducted at 21 provincial and district level Ayurveda health facilities for the provision of exemplary Ayurveda healthcare services.
Figure 22.5 MSS for different level of Ayurveda Health Facilities