Ayurveda Health Services in Nepal

Executive Summary

Ayurveda Health Services in Nepal playing vital role throughout the country. In Nepal, Ayurveda healthcare services are provided at the government level under the Department of Ayurveda and Alternative Medicine, which operates under the Ministry of Health and Population. At the federal level, this department oversees the National Ayurveda Hospital, the National Ayurveda Research and Training Center, the National Ayurveda Panchakarma and Yoga Center, and the Singha Durbar Vaidhyakhana. Singha Durbar Vaidhyakhana is the oldest Ayurveda medicine manufacturing facility in South Asia.

At the provincial level, there are Provincial Ayurveda Hospitals and District Ayurveda Hospitals, while at the local level, there are Ayurveda dispensaries and Citizen Ayurveda Service Centers.

In the private sector, there are Ayurveda hospitals, healthcare professionals, herbal traders, Ayurveda medicine industries, wholesale and retail Ayurveda businesses, as well as traditional healers. A significant number of specialist Ayurveda doctors, Ayurveda physicians, and Ayurveda health workers are employed in both government and private sectors. Even today, 80% of the Nepalese population relies on Ayurveda treatment.

The Government of Nepal has declared Ayurveda as a national medical system. As a geographically and biologically diverse Himalayan nation, Nepal has an abundant reserve of medicinal herbs in its mountains, hills, and plains. Nepali Kitchen is guided by the Shada Rasa Principle of Ayurveda Nutrition. Ayurveda is one of the significant national identities that places Nepal on the world map.

Historical Background

The origin and development of the Ayurveda medical system took place in Himalayan region of Nepal. Ayurveda, which began before the Vedic period, is the world’s oldest medical system. It is Nepal’s indigenous national medical system. According to historical accounts, Brahma, the creator of the universe and the first teacher of Ayurveda, composed Ayurveda in 1000 chapters with 100,000 verses. It was subsequently passed down to Daksha Prajapati, the Ashwini Kumars, and Indra. The practice of faith-based healing methods such as Dhami, Jhakri, Jharphuk, Pandit, Lama, Pujari, Gubhaju, and astrology has also been prevalent in Nepali society since ancient times.

Introduction to Ayurveda

Ayurveda is a medical system based on Eastern philosophy. It is Nepal’s indigenous and ancient medical practice. The universe is composed of five fundamental elements (Panchamahabhuta): earth, water, fire, air, and space. Humans, food, and medicines are also composed of these five elements. According to Ayurveda’s physiological principles, the human body consists of three doshas (Vata, Pitta, and Kapha), seven Dhatu (Rasa, Rakta, Mamsa, Meda, Asthi, Majja, and Shukra), and three Mala (Mutra, Purisha, and Sweda). Ayurveda holds that diseases arise when these elements become imbalanced and that health is maintained when they remain in equilibrium.

Ayurveda follows the principle that consuming substances similar to body elements increases those elements, while opposite substances reduce them. Since it adopts natural diet, lifestyle, behavior, and medicine methods, Ayurveda treatment is considered safe. Common Ayurveda treatments include medication, Snehana (oil application), Swedana (sudation therapy), Panchakarma, Ksharasutra, Agni karma, Jalauka therapy, Dinacharya and Ritucharya practices, Sadvritta (ethical conduct), and methods under Achara Rasayana, Yoga, and meditation. These methods are highly effective in reducing non-communicable diseases.

Definition of Ayurveda

Ayurveda is the ‘Science of Life’ (Ayuh Veda), which describes beneficial and harmful life, pleasurable and painful life, and the measurement of lifespan.

Definition of Life (Ayuh): Life is the combination of the body, senses, mind, and soul.

Four Dimensions of Life:

1. Beneficial Life (Hita Ayu)
2. Harmful Life (Ahita Ayu)
3. Pleasurable Life (Sukha Ayu)
4. Painful Life (Dukha Ayu)

• Hita Ayu: A life that benefits oneself and others, characterized by truthfulness, peace, wisdom, caution, adherence to righteousness, and spiritual knowledge.
• Ahita Ayu: A life opposite to beneficial life.
• Sukha Ayu: A life free from physical and mental diseases, full of strength, courage, fame, prosperity, and intelligence.
• Dukha Ayu: A life opposite to pleasurable life.

Objectives of Ayurveda

The primary objective of Ayurveda is to protect the health of healthy individuals and to cure diseases in the sick. Ayurveda medicines originate from plants, animals, and minerals.

Definition of Health: A healthy person is one whose doshas, digestive fire (Agni), tissues (Dhatu), and waste elimination (Mala Kriya) are in balance, and whose soul, mind, and senses are in a state of happiness.

Development of Ayurveda in Nepal

Before the establishment of Bir Hospital, Ayurveda was the primary medical system used by both royalty and common people in Nepal. The military also had designated Ayurveda practitioners (Vaidhya). The Singha Durbar Vaidhyakana was established in Nepal Sambat 789 (1727 AD) during the Malla period. Initially, medicines from this facility were reserved for the royal family. Free dispensaries were introduced in 1916 AD.

On April 2, 1916 (Chaitra 20, 1973 BS), Pandit Kaviraj Hariprasad Khakurel was appointed Chief Vaidya, and Nepal Royal Ayurvedic Dispensary was established in Bhimsensthan with one bed. It was later expanded and relocated to Nardevi, Kathmandu. Over the years, the hospital’s capacity was increased, and in 2019 BS, it was merged with the Ayurveda School. In 2055 BS, the hospital was expanded to 118 beds(100 general plus 18 cabins.

Other significant developments include:

• The establishment of Bir Hospital in 1917 AD
• The introduction of Unani medicine in 1933 AD
• The launch of homeopathy studies under the Colombo Plan in 1948 AD
• The establishment of Pashupati Homeopathy Hospital in 1953 AD
• The establishment of the Ayurveda Department in 1981 AD

Policy and Legal Framework

Nepal’s constitution recognizes healthcare as a fundamental right and emphasizes Ayurveda in national policies. The National Ayurveda Health Policy 1995 envisions key Ayurveda institutions such as:

• Ayurveda Medical Council Nepal
• National Ayurveda Academy
• National Ayurveda Research and Training Center
• Naradevi Ayurveda Hospital (118 beds)
• Provincial Ayurveda Hospital, Dang (30 beds)

National Ayurveda Panchakarma and Yoga center and 100-bed Ayurveda hospital under construction, two 50-bed provincial Ayurveda hospitals in Jhapa and Kailali are running with minimal human resources.

Initially, Ayurveda education followed the Guru-Shishya tradition, but formal education began in 1928 AD with the establishment of Nepal Royal Ayurveda School. Over time, Ayurveda education evolved into diploma and degree programs, with the Bachelor of Ayurveda Medicine and Surgery (BAMS) degree being introduced in 1996. MD (Kayachikitsa) studies began in 2012.

Constitutional Provisions

Nepal’s constitution prioritizes Ayurveda as part of the nation’s healthcare system. It includes:

• Schedule 5, 6, and 8: Federal, provincial, and local government responsibilities in Ayurveda
• Schedule 7 and 9: Shared authority in healthcare governance
• Article 51(j)(7): Promotion and protection of Ayurveda, Naturopathy, and Homeopathy
• Schedule 5 (16) and Schedule 7 (12): Recognition of Ayurveda and alternative medicine

Policy Arrangements

The National Health Policy 2014 aims to make all citizens physically, mentally, socially, and emotionally healthy. Strategies include:

1. Gradual development of the Ayurveda system, evaluation of service quality, and expansion of complementary medical systems like Unani and Homeopathy.
2. Structural development for effective Ayurveda implementation.
3. Conservation and proper use of medicinal plants, quality assurance, and commercialization.
4. Strengthening the National Ayurveda Research and Training Center.
5. Regulation of Ayurveda services to ensure quality healthcare.

The Nepal Health Sector Strategy 2015-2020 outlines Ayurveda’s role in public health, emphasizing service expansion and medicinal plant research.

Legal Provisions

The Nepal Health Service Act 1996 and its regulations include Ayurveda in public healthcare. Ayurveda is categorized into seven subgroups: General Ayurveda, Pharmacology, Kayachikitsa, Surgery & Anesthesia, Shalakya, Gynecology & Obstetrics, and Pediatrics. Additionally, a separate Traditional Chinese Medicine (TCM) group is proposed for TCM postgraduates.

Alternative Medicine in Nepal

Nepal recognizes various alternative medical systems, including:

• Naturopathy
• Homeopathy
• Unani
• Amchi (Sowa Rigpa)
• Traditional Chinese Medicine (TCM)

Existing Structures:

The Ministry of Health houses the Ayurveda and Alternative Medicine Branch, the Department of Ayurveda, and Singhadarbar Vaidyakhana Vikas Samiti. Additionally, there are institutions such as the Ayurveda Medical Council of Nepal, the National Ayurveda Academy, and the National Ayurveda Research and Training Center. The Naradevi Ayurveda Hospital, the country’s only central Ayurveda hospital with 118 beds, and the 30-bed Mid-Western Regional Ayurveda Hospital in Bijauri, Dang, are in operation. Two 50-bed regional Ayurveda hospitals are under construction in Laxmipur, Jhapa (Eastern Region) and Geta, Kailali (Far Western Region). Furthermore, a 50-bed National Ayurveda Panchakarma and Yoga Center is being built in Budhanilkantha, Kathmandu. There are also 14 zonal Ayurveda dispensaries, 61 district Ayurveda health centers, and 305 Ayurveda dispensaries. Out of Nepal’s 753 local levels, Ayurveda health services have been expanded to 311, while 442 local levels still lack Ayurveda health institutions.

Existing Educational Institutions:

One institution under Tribhuvan University offers MD (postgraduate) studies in Ayurveda. Two institutions under Tribhuvan University and three under Nepal Sanskrit University offer BAMS (undergraduate) programs. For diploma-level studies, Nepal Sanskrit University has one institution, while the Council for Technical Education and Vocational Training (CTEVT) operates two institutions. Additionally, 12 institutions under CTEVT provide Technical SLC-level education in Ayurveda.

Status of Human Resources:

In Nepal, there are 155 MD/MS (postgraduate) Ayurveda specialists, 16 Postgraduates in alternative medicine (TCM), 988 BAMS graduates, 11 Bachelor-level Ayurveda pharmacists, 1875 diploma-level graduates(AHA), and 3267 individuals with a Technical SLC (AAHW) in Ayurveda, 19 Traditional Healers & 3 PhD human resources are registered in Nepal Ayurveda Medical Council. Within the government hierarchy, MD/MS Ayurveda specialists hold the titles of Chief/Consultant Ayurveda Expert, BAMS graduates serve as Senior Ayurveda Physicians/Ayurveda Physicians, diploma holders are designated as Senior Kaviraj/Kaviraj, and those with a Technical SLC qualification are recognized as Senior Vaidya/Vaidya.

Ayurveda Service Programs:

The Department of Ayurveda operates Ayurveda service programs to provide healthcare to Nepalese citizens. These programs fall under the highest government priority (Priority 1) and are categorized into service-oriented programs, awareness programs, and procurement of essential materials and medicines.

Awareness Programs:

These include school-based Ayurveda education, public awareness programs on medicinal herbs, professional training on herbal farming for lead farmers, awareness programs for female community health volunteers, public awareness and management programs for epidemic diseases, and interactions with traditional local health practitioners.

Service-Oriented Programs:

These cover healthy living programs, free healthcare and wellness services for senior citizens, Panchakarma, Rasayana, and Yoga services, free Ayurveda medicines for lactating mothers, local herbal plantation and data collection, the establishment of model herbal gardens, production of powdered medicines at regional, zonal, and district Ayurveda centers, free health camps, free registration fee subsidies, model Yoga and Panchakarma programs, rural clinics, and non-communicable disease management.

Procurement of Medicines and Materials:

This includes purchasing essential primary care Ayurveda medicines, essential Ayurveda drugs, and hospital-based diagnostic and treatment equipment. These services are available at regional Ayurveda hospitals, zonal Ayurveda dispensaries, district Ayurveda health centers, and Ayurveda dispensaries.

Role of Provincial and Local Governments in Ensuring Continuous Service Delivery:

To ensure the sustainability of Ayurveda services at the provincial and local levels, the following initiatives must be undertaken in coordination with the federal government:

• Establish provincial Ayurveda hospitals equipped with specialist services in each province.
• Expand Ayurveda health services in all local levels by setting up Ayurveda health institutions with qualified physicians.
• Develop medicinal herb gardens (Bhaisajya Udhyan) in every local level.
• Establish herbal banks and seed conservation programs for locally available medicinal plants.
• Promote public awareness on seasonal regimens (Ritucharya), daily regimens (Dinacharya), nighttime regimens (Ratricharya), behavioral rejuvenation (Achara Rasayana), ethical living (Sadvritta), seasonal purification (Ritushodhana), Yoga, and meditation to aid in the prevention of non-communicable diseases.
• Encourage environmental conservation by increasing the plantation of trees with Natural air cooler & other beneficial properties such as Banyan, Peepal, and Sami to revive traditional cultural practices like Chautari (resting spots under trees).
• Implement programs to protect and promote Ayurveda-based health practices.

Enhancing the Effectiveness of Ayurveda Healthcare Services:

To improve the effectiveness of Ayurveda services, training, workshops, and seminars should be conducted for health professionals at various levels. Ayurveda health institutions should be developed with proper physical infrastructure, ensuring a high-morale work environment. Ayurveda, as Nepal’s national identity, should be modernized and promoted without being subsumed under modern medical institutions. Instead, independent Ayurveda institutions should be established and operated at the federal, provincial, and local levels, marking it as a matter of national pride.

At the federal level, a policy decision must be made with top priority regarding the establishment of the National Medicinal Plant Board and the National Pharmacovigilance Committee at the federal level, the Ayurveda Health Directorate in each province, local Ayurveda hospitals under the leadership of Ayurveda physicians in all 753 local levels, and Citizen Ayurveda Service Centers in all 6,743 wards.

Additionally, the procurement and training of Ayurveda, which has been taken away, should remain under Ayurveda institutions and manpower. It must be ensured at the policy level that the intellectual property of Ayurveda and all Ayurveda-related activities are handled exclusively by professionals in this sector.

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