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Households’ responses on medical pluralism: Dynamics and determinants of access to traditional medicines in India
Abstract
The Indian healthcare practice is pluralistic and unique since it is poised with many challenges. High out of pocket (OOPE) expenditure, scanty institutional facilities, and expensive private healthcare, etc. have strong bearing on adoption of traditional health care practices besides socio-cultural and other gradients. The paper addresses the dynamics and determinants of the access to traditional medicines in India using the representative dataset of the national sample survey (71st and 75th round) conducted in 2014 and 2017–2018. The analysis includes descriptive statistics, conditional Logit regression with marginal effects and Tobit regressions models. Results confirm increased access to traditional medicines even in case of major ailments which has reduced the OOPE on healthcare. The Covid19 pandemic has synergised the use of AYUSH owing to its immunity-boosting measures. The paper also incorporates some of the recent policy initiatives taken over recently in India to facilitate the Ayurveda, Yoga and Naturopathy, Unani, Sowa Rigpa, Siddha and Homoeopathy (AYUSH).
This paper examines over 5,03,220 institutional outpatient and 42,492 inpatient cases, and 1492 patient surveys to analyse the adoption trends and utilisation patterns of Ayurveda healthcare. The analyses reveal significant adoption of Ayurveda for various non-communicable diseases (NCDs) related explicitly to neuromuscular and neurodegenerative diseases, musculoskeletal disorders and inflammatory arthritis, among other diseases across different age groups with some gender differences in their adoption. Given that the global burden of these diseases is very high, the findings underscore the importance of Ayurveda in treating NCDs and advocating for inclusive healthcare policies and increased research for empowering patients to make informed choices that contribute to universal healthcare access.
Complementary and alternative medicine (CAM) includes varied medical and healthcare systems, healing practices, and products that are outside of allopathy/biomedicine. The aim of this study was to examine US South Asian youths' beliefs, practices, decision-making, and experiences of using CAM. Ten focus group discussions with 36 participants were conducted. Data were coded deductively and inductively by four coders, working in pairs. Thematic analysis was performed. Disagreements were resolved through consensus. The results showed that CAM was appealing because of its often low cost, ease of access, family traditions to use CAM, and the perception that it was safe to use. Participants exercised pluralistic health choices. Some responses suggested a hierarchy wherein allopathy was used for serious, acute issues, and CAM for much of the remaining issues. The high use of and trust in CAM among young US South Asians raises important issues (e.g., provider support and integration to prevent potential interactions and avoid delaying allopathic treatment). More exploration is needed about the decision-making processes of US South Asian youth, including the perceived benefits/limitations of allopathy and CAM. US healthcare practitioners should familiarize themselves with South Asian social and cultural beliefs about healing to provide culturally-appropriate services and enhance patient care.
Background: India is amidst an epidemiological transition with the country’s health system being tested to manage the dual burden of communicable and Non-Communicable Diseases (NCDs) and it is prudent that policy bearers should ensure stratification of data collected through large-scale surveys like NFHS & NSS for better understanding of NCDs in India and AYUSH users for NCDs. The subject scoping review focuses on the uptake of the AYUSH system of medicines in the backdrop of NCDs in India, systems approach to healthcare, the concept of integrative medicine and the challenges it faces in terms of scalability and mass adoption. Design & Method: Through a comprehensive literature review exercise, and nationally representative NFHS data on health, the qualitative research work presents an analysis to comprehend the evident prevalence of NCDs in India and the usage of the AYUSH system of medicine to restrain these chronic conditions with mechanisms like integrative medicine. Results: Out of the 1087 articles validated, 27 were finalised for a detailed review with respect to the identified thematic analysis. The selected articles assimilated through multiple themes and theories include the theory of the classical model of epidemiological and demographic transition and its inference in Indian settings with essential data on diseases (communicable and NCDs) in India, usage of Complementary and Alternative Medicines (CAM/ AYUSH) in global/ Indian context and its mainstreaming with biomedicine, systems approach to healthcare and global innovations in digital health.
Background
Systematic analysis of the determinants of choice of a treatment modality aids to the understanding of decision process of healthcare utilization. The revealed preference of a single modality may differ according to the nature of disease. Existing studies have not integrated possible causal factors in a model with respect to diseases. This study identifies major determinants and formulates their integral effect on choice of a particular modality on acute and chronic diseases in accordance to socio-behavioural model.
Methodology
A cross-sectional study on 300 samples using a 30-point questionnaire, developed in Likert scale and dichotomous scale. Possible determinants are tested on choice of CAM in case of acute disease and of chronic disease separately.
Results
Revealed single modality treatment preference (of CAM) varies widely between acute disease (13%) and chronic disease (58.67%). Bivariate associations are significant for gender (For, overall CAM preference, p=0.001, acute disease, p<0.001, chronic disease, p=0.024), Disease burden (overall and chronic: p<0.001, acute: p=0.008) and previous CAM usage (overall and chronic: p<0.001, acute: p=0.016). Social factor individually has significant influence on choosing CAM both acute (OR=1.096, p<0.001) and chronic disease (OR=1.036, p<0.001). Ideation of philosophical need factor, guided by philosophical congruence with CAM (OR=1.047, p<0.001) is a novel finding of this study. While with multiple logistic regression male gender (p=0.03), social factor (p<0.001), perception of CAM efficacy (p=0.02) and negative ideation about CAM cost-effectiveness (p=0.002) are found to be important in Acute disease; choosing CAM in chronic disease is guided by female gender (p=0.001), making decision in-group (p=0.001), low disease burden (p<0.001), philosophical need factor (p=0.001), and perception of CAM efficacy (p<0.001).
Conclusion
Demographic, social, cognitive and philosophical factors are important determinants of choosing CAM as a treatment modality over conventional medicine, but they act differently on CAM preference in acute and chronic diseases.
Education and health are commonly devolved functions to sub-national governments, even in nations which have a unitary rather than a federal structure. Education and health are the two major factors which are influencing more to the economic development. So without improvement of these two factors economic development impossible and now a day India vs. Odisha under privilege Schedule Tribe population are deprive more in all aspect. What are the main reasons behind their backwardness in health and education? On behalf of illiteracy health and nutritional consciousness among these STs Communities are low. Through various programme government can eradicate diseases. Educated mothers are more conscious about child health.
Background:
Health-seeking behaviours (HSB) are closely linked with the health status of a nation and thus its economic development. Several studies have described HSB within the context of various diseases. However, knowledge of HSB among population sub-groups is still scanty. This study aims to determine factors most important to civil servants when seeking health care.
Methods:
A descriptive cross-sectional study was conducted among 337 civil servants working in the Federal Secretariat, Ibadan, Nigeria. An intervieweradministered semi-structured questionnaire was used to collect information. Chi-square tests were used to test for associations while binary logistic regression test was used for determining predictors. All data analysis were done at 5% level of significance.
Results:
Members of the poorest quartile were 6 times more likely to have inappropriate HSB than the richest quartile (Q4:Q1= 5.83;O.R: 16.12, 95% C.I: 2.61-11.03). Visits to the hospital or clinic (62.2%) was the most common source of healthcare sought. This was followed by visits to the chemist (33.0%), traditional healers (4.3%). A little more than one-third (34.5%) of respondents considered good service delivery as the most important factor affecting HSB. This was followed by proximity (23.9%), affordability (20.4%), prompt attention (8.8%) and readily-available drugs (7.1%). Completing only basic education [O.R: 0.24 (0.06, 0.96)] and out of pocket payment [O.R: 0.04 (9.16, 82.45)] were associated with a reduction in the likelihood of seeking healthcare from formal sources.
Conclusion:
Appropriate health-seeking behaviour was found to be high among civil servants. However, lower cadre workers and those with lower levels of education need to be targeted during policy formulation to improve health-seeking behaviour. In addition, health insurance schemes should be extended to cover more of the population in order to improve health-seeking behaviour.
This study contributes to the health policy debate on medical systems integration by describing and analysing the interactions between health-care users, indigenous healers, and the biomedical public health system, in the so far rarely documented case of post-conflict Burundi. We adopt a mixed-methods approach combining (1) data from an existing survey on access to health-care, with 6,690 individuals, and (2) original interviews and focus groups conducted in 2014 with 121 respondents, including indigenous healers, biomedical staff, and health-care users. The findings reveal pluralistic patterns of health-care seeking behaviour, which are not primarily based on economic convenience or level of education. Indigenous healers' diagnosis is shown to revolve around the concept of 'enemy' and the need for protection against it. We suggest ways in which this category may intersect with the widespread experience of trauma following the civil conflict. Finally, we find that, while biomedical staff displays ambivalent attitudes towards healers, cross-referrals occasionally take place between healers and health centres. These findings are interpreted in light of the debate on health systems integration in Sub-Saharan Africa. In particular, we discuss policy options regarding healers' accreditation, technical training, management of cross-referrals as well as of herb-drug interactions; and we emphasise healers' psychological support role in helping communities deal with trauma. In this respect, we argue that the experience of conflict, and the experiences and conceptualizations of mental and physical illness, need to be taken into account when devising appropriate public or international health policy responses.
It is frequently stated in the scientific literature, official reports and the press that 80% of Asian and African populations use traditional medicine (TM) to meet their healthcare needs; however, this statistic was first reported in 1983. This study aimed to update knowledge of the prevalence of TM use and the characteristics of those who access it, to inform health policy-makers as countries seek to fulfil the WHO TM strategy 2014-23 and harness TM for population health. Prevalence of reported use of TM was studied in 35 334 participants of the WHO-SAGE, surveyed 2007-10. TM users were compared with users of modern healthcare in univariate and multivariate analyses. Characteristics examined included age, sex, geography (urban/rural), income quintile, education, self-reported health and presence of specific chronic conditions. This study found TM use was highest in India, 11.7% of people reported that their most frequent source of care during the previous 3 years was TM; 19.0% reported TM use in the previous 12 months. In contrast <3% reported TM as their most frequent source of care in China, Ghana, Mexico, Russia and South Africa; and <2% reported using TM in the previous year in Ghana, Mexico, Russia and South Africa. In univariate analyses, poorer, less educated and rural participants were more likely to be TM-users. In the China multivariate analysis, rurality, poor self-reported health and presence of arthritis were associated with TM use; whereas diagnosed diabetes, hypertension and cataracts were less prevalent in TM users. In Ghana and India, lower income, depression and hypertension were associated with TM use. In conclusion, TM use is less frequent than commonly reported. It may be unnecessary, and perhaps futile, to seek to employ TM for population health needs when populations are increasingly using modern medicine.
For the first time, we have a comprehensive database on usage of AYUSH (acronym for Ayurveda, naturopathy and Yoga, Unani, Siddha, and Homeopathy) in India at the household level. This article aims at exploring the spread of the traditional medical systems in India and the perceptions of people on the access and effectiveness of these medical systems using this database. The article uses the unit level data purchased from the National Sample Survey Organization, New Delhi. Household is the basic unit of survey and the data are the collective opinion of the household. This survey shows that less than 30% of Indian households use the traditional medical systems. There is also a regional pattern in the usage of particular type of traditional medicine, reflecting the regional aspects of the development of such medical systems. The strong faith in AYUSH is the main reason for its usage; lack of need for AYUSH and lack of awareness about AYUSH are the main reasons for not using it. With regard to source of medicines in the traditional medical systems, home is the main source in the Indian medical system and private sector is the main source in Homeopathy. This shows that there is need for creating awareness and improving access to traditional medical systems in India. By and large, the users of AYUSH are also convinced about the effectiveness of these traditional medicines.
p class="abstract"> Background: Understanding of health seeking behaviour (HSB) is essential to provide need based health care services to the population. Many factors like sex, age, type of illness, access to services and perceived quality of the services, influences the health seeking behavior. This study assessed the HSB among rural population of a coastal area in Tamil Nadu.
Methods: A community based descriptive study was done in a rural coastal area of Villupuram district in Tamil Nadu state of India. Using simple random sampling method, 559 participants were selected. A pre-tested structured questionnaire was used to collect the data. Information about socio-demographic characteristics, presence of acute or chronic illness, health care seeking behavior and reasons for non-utilization of particular health facilities etc. was obtained. Chi square test was applied to find the association of health care seeking behavior with various participant characteristics.
Results: Among 559 study participants, majority (56.4%) visited public health care facilities for various illnesses. Almost one-third of the study participants visited the private health facilities and another 11.6 percent visited other health facilities including pharmacies. Among various causes, febrile illnesses (39.5%) and pain (20.8%) were the most common reasons for visiting a health care facility. Individual’s income was significantly associated with the HSB (p value <0.05). Availability of services, free of cost was reported as most common reason for preferring to the public health facility. On other hand, private practitioners were preferred due to their better availability and quality of care.
Conclusions: Public health care facilities were preferred by due to low cost of services and HSB varies with the type of illness and income of the individuals.
Health defined as a state of ‘well being’ is understood from a functionalist perspective among tribes – a perspective which considers a person as afflicted by disease often only when one’s capability to perform one’s expected roles in life is impeded either partially or completely. When such situation arises they seek health services from various health care systems influenced by socio-cultural factors where one lives in. Often one finds them shifting between health care systems or using more than one health care system at the same time. This study brings out concept of health as conceptualization by the tribal communities in India, their health issues and status, and health seeking behaviour from socio-cultural perspective. The study is based on review of secondary literature and attempt made to develop a model of health seeking behaviour among the tribes.
This paper presents estimates of the human development index, human poverty index and gender development index for the scheduled tribes in India. The HDI and HPI for STs are found to be around 30 per cent lower than the corresponding all-India indices. In an international comparison, development and deprivation among the STs of India are similar to that in the poorer countries of sub-Saharan Africa.
The demand for cure and for the care of a growing range of health conditions which elude any particular system of medicine has made pluralism in therapeutic options a way of life. The spread and continuity of indigenous systems of medicines, namely, ayurveda, siddha and unani, have thrown up a lot of concerns as well: how to incorporate these systems into a centralised health infrastructure; their expansion through the pharmaceutical industry for herbal products, massage centres and spas; the relations and negotiations between the practitioners of different coexisting systems of medicine; the position of psychosocial and spiritual dimensions of cure and care in contemporary forms of indigenous systems of medicine and the debate on notions of efficacy in multiple, coherent systems of medicine. All these are worth serious study as they raise fundamental questions not just about ISMS, but about organising healthcare in India. A framework for the analysis of ISMS requires not only recognising the presence of diverse medical systems, but engaging with them as live and efficacious traditions. The collection of papers in this special issue attempts to address some of these matters.
Despite the wealth of studies on health and healthcare-seeking behaviour among the Bengali population in Bangladesh, relatively few studies have focused specifically on the tribal groups in the country. This study aimed at exploring the context, reasons, and choices in patterns of healthcare-seeking behaviour of the hill tribal population of Bangladesh to present the obstacles and challenges faced in accessing healthcare provision in the tribal areas. Participatory tools and techniques, including focus-group discussions, in-depth interviews, and participant-observations, were used involving 218 men, women, adolescent boys, and girls belonging to nine different tribal communities in six districts. Data were transcribed and analyzed using the narrative analysis approach. The following four main findings emerged from the study, suggesting that the tribal communities may differ from the predominant Bengali population in their health needs and priorities: (a) Traditional healers are still very popular among the tribal population in Bangladesh; (b) Perceptions of the quality and manner of treatment and communication can override costs when it comes to provider-preference; (c) Gender and age play a role in making decisions in households in relation to health matters and treatment-seeking; and (d) Distinct differences exist among the tribal people concerning their knowledge on health, awareness, and treatment-seeking behaviour. The findings challenge the present service-delivery system that has largely been based on the needs and priorities of the plainland population. The present system needs to be reviewed carefully to include a broader approach that takes the sociocultural factors into account, if meaningful improvements are to be made in the health of the tribal people of Bangladesh.
Context: Healthcare in India is a complex mix of providers, facilities and payment systems with low budgetary
support from the government. After decades of neglect there is realisation that health is a priority and spending
should be increased. Also there is a shortage of evidence and subsequently a need to suggest direction based on this
evidence. Aims: To determine the burden of illness in the study population; find out the types of healthcare facilities used
during illness; study the medico-social and economic factors influencing utilization of healthcare services. Settings and
Design: 10 locations, 5 villages and 5 urban areas in the field practice areas of department of Community Medicine, AMU
Aligarh. Methods and Material: Cross sectional field based study on 2518 individuals using systematic random sampling.
Participants interviewed and data collected on a piloted proforma. Data Collected in two parts, initial information about
burden of illness and later information of treatment seeking behaviour. Statistical analysis used: Chi Square tests,
Proportions. Results: Disease severity and economic reasons play a part in treatment seeking behaviour. Some kind of
treatment is sought in majority of illnesses. Treatment seeking increases with the perceived severity of illness. Choice of
treatment facilities depends on various factors including availability, cost and type of illness. Conclusions: There is a
hidden need for healthcare in rural areas which is expected to increase with rising awareness about health. Poverty is
the major reason for not seeking any treatment in urban areas reflecting an urgent need of health provision for poor.
Medical pluralism (MP) can be defined as the employment of more than one medical system or the use of both conventional and complementary and alternative medicine (CAM) for health and illness. A population-based survey and linkage with medical records was conducted to investigate MP amongst the Taiwanese population. Previous research suggests an increasing use of CAM worldwide.
We collected demographic data, socioeconomic information, and details about lifestyle and health behaviours from the 2001 Taiwan National Health Interview Survey. The medical records of interviewees were obtained from National Health Insurance claims data with informed consent. In this study, MP was defined as using both Western medicine and traditional Chinese medicine (TCM) services in 2001. The odds ratio (OR) and 95% confidence interval (CI) were estimated for factors associated with adopting MP in univariate and multiple logistic regression.
Among 12,604 eligible participants, 32.5% adopted MP. Being female (OR = 1.44, 95% CI = 1.30 - 1.61) and young (OR = 1.38, 95% CI = 1.15 - 1.66) were factors associated with adopting MP in the multiple logistic regression. People with healthy lifestyles (OR = 1.35, 95% CI = 1.19 - 1.53) were more likely to adopt MP than those with unhealthy lifestyles. Compared with people who had not used folk therapy within the past month, people who used folk therapy were more likely to adopt MP. The OR of adopting MP was higher in people who lived in highly urbanised areas as compared with those living in areas with a low degree of urbanisation. Living in an area with a high density of TCM physicians (OR = 2.19, 95% CI = 1.69 - 2.84) was the strongest predictor for adopting MP.
MP is common in Taiwan. Sociodemographic factors, unhealthy lifestyle, use of folk therapy, and living in areas with a high density of TCM physicians are all associated with MP. People who had factors associated with the adoption of MP may be at risk for adverse health effects from interactions between TCM herbal medicine and WM pharmaceuticals.
Very little information is available on the utilization of Indian systems of medicine and homoeopathy (ISM&H) in India. A study was undertaken on the usage and acceptability of indigenous systems of medicine to provide estimate of utilization of different indigenous systems of medicine in the country along with the reasons for preferences as well as the cost of treatment.
The study covered 35 districts spreading over 19 States of the country. From 16 major States, two districts each were selected randomly one from the list of districts with high utilization level and another with low level of utilization. From other 3 States, one district each was selected randomly. From each selected district, 1000 households with at least one sick person were covered. This was achieved by selecting 50 Urban Frame Surveys (UFS)/villages and 20 sick persons each per village/UFS. Allocation of 50 First Stage Units (FSUs) among rural and urban sectors was made in proportion to rural-urban population of the district. From selected FSUs, 20 households with at least one sick person was selected randomly. The data were collected on the health seeking behaviour of persons who were sick (with common or serious ailments) in the last three months before survey including at the time of survey.
About 45,000 sick persons from 33,666 households from 35 districts of the country were covered. The preference of ISM&H for common ailment was about 33 per cent while only 18 per cent preferred to use these systems in case of serious ailments in the country. The sick persons actually availing ISM&H treatment were about 14 per cent. Of those who preferred ISM&H, the reasons were mainly "no side effect" and low cost of treatment. Slow progress was the main reason for not preferring the indigenous systems.
The findings of this study showed that about 14 per cent sick persons utilizing indigenous system of medicine. Slow progress and non availability of practitioners were the main reasons for not preferring the ISM & H treatment.
Socio-Economic and Health Conditions of Some Major Tribes in Andhra Pradesh
The study discusses the influence of social, economic and cultural factors on health-seeking behaviours of the Santals living in six villages of Birbhum district in West Bengal, India. By employing both qualitative and quantitative methods, data were collected for the study. The analysis shows the link between educational, social, economic and cultural factors and health-seeking behaviour. Lack of economic freedom was found as the predominant indicator in restricting access to better health-care facilities. Poor occupational standards, low levels of income and less investment in maintaining health influence the health-seeking behaviour of Santals in the studied area. The study argues that the existing services are inadequate and often inappropriately implemented. The findings have implications for enhancing the role of education and improving the quality and quantity of services.
Research interest in hospital chaplaincy has increased, in part because it is believed to contribute to the development of just models of religious pluralism. This research note brings attention to hospital chaplaincy in Sweden, a country where religious diversity has substantially increased due to migration but where research in hospital chaplaincy is scarce. In order to advocate for future research, this research note describes the organization of hospital chaplaincy in Sweden, presents new analyses of official data showing its extent and religious composition, and proposes that the organization of hospital chaplaincy in this country needs to be re-considered now that religious diversity is a given. Showing that hospital chaplaincy in this country is still under the overbearing influence of Christianity, this research note argues that there is a need for research that sheds light on the asymmetrical power relations that exist and that paves the way for innovations in religious pluralist models for health care chaplaincy.
Indigenous knowledge research is a recent trend in the sociological and anthropological domains. Hither to fore, all developmental programmes initiated especially by the Government agencies have adopted a top-down approach, i.e., planning, distribution, and resources in-flow and perceptions flow from top to down. This trend has been recently reversed with a growing realization that for any successful implementation of planned programme, people’s participation becomes imperative. In this context, participatory research techniques have been generated in different social sciences. The main thrust in such an approach is to make the people or the subjects into active collaborators in bringing about desired change. In this background research on Indigenous knowledge systems is growing steadily and anthropological contributions in this area have been greatly acknowledged, as the basic research methodology adopted by Anthropologists is participant observation method. In fact, the pioneers in documenting indigenous knowledge systems all over the world, especially among the less advanced, disadvantaged tribal and rural masses were none other than the Anthropologists. In the area of health and disease too, many anthropologists have undertaken documentation of health-related issues. Nonetheless, explanations offered in this domain are mostly divinatory in nature implying the divine wrath as causative of all diseases. In this paper, an attempt is made to illustrate the health status of the Tribals of Eastern Ghats and their health seeking behaviour and beliefs. Despite the fact that tribal societies exhibit similarities in many aspects related to health and disease, local variations persist.
Study was conducted comprising the socio-economic variables like, age, sex, education, family education status etc having importance in maintaining the health status, on 320 Toto, Santal, Sabar and Lodha respondents of Jalpaiguri and Purulia District of West Bengal using a pre-tested structured interview schedule for data collection. The practice of education was found common in Santal, Lodha, Toto than Sabar. Cultivation was the main occupation on maximum respondents of all selected tribes. Majority of the Sabar respondents were under low-income group. Family size was large in Santal; than other three tribes. Education, occupation, income, house types were highly significant in relation to health status among the Santals. Family education status, land type, land holding, family size, family type and personal cosmopolite were highly significant to health status amongst the Lodhas.
The maldistribution of biomedical services creates a dilemma for Indian patients. They encounter a bewildering array of medical services, ranging from qualified traditional medical practitioners to untrained, self-taught purveyors of medicines and cures. Research on Indian healthcare has decried the inefficient distribution of services in rural and urban areas. The studies discussed here reveal the ground reality of the consequences of limited choices for patients, characterised as "forced pluralism," with no state regulation of type of care, quality of care, or credentials of practitioners.
Sociodemographic factors associated with health seeking behavior of chest symptomatics in urban slums of Aurangabad city , India
- Karanjekar