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Evidence-Based Practice and Allied Health Professions: A Modern Take on Ancient India

The country of my birth, India, has always had a special place in my heart. While I left India when I was still teenager to undertake my university education in Adelaide, Australia, I return to India regularly; the charm and the mystic of the sub-continent seems eternal. India is often considered the land of contrasts for many reasons, including its diversity in culture, geography, language, cuisine, and peoples. In recent times when I visit India as a health professional, I often reflect how this title of land of contrasts also applies to health care. With a growing economy and burgeoning middle class, quality and safe health care seems to be accessible to some but not to many. I am sure this inequity extends to many other aspects in Indian society.

Recently, we, at the International Centre for Allied Health Evidence (iCAHE), had the opportunity to host an Indian physiotherapist who is based in the southern Indian city of Mangalore. During his time in Adelaide, we discussed a number of issues pertinent to allied health professions in India, including evidence-based practice (EBP). It became clear to me that the land of contrasts was, as it had done for centuries before, yet again generating a unique perspective on how allied health professionals were able to integrate evidence-based practice in 21st century Indian health care.

While the advancement in the health sciences and technologies had brought a paradigm shift in the health care delivery in India, given historical traditions and cultural practices, there are a range of other complementary and alternate health care practices. The Indian Systems of Medicine and Homoeopathy (ISM&H) consist of Ayurveda, Siddha, Unani, and Homoeopathy, and therapies such as Yoga and Naturopathy. Some of these systems are indigenous, and others have become a part of Indian tradition. In India, there are over eight million ISM&H practitioners who work in remote rural areas/urban slums across India. From a personal perspective, when I used to visit my maternal grandparents in a rural part of India during my summer holidays, I vividly remember accompanying my grandparents on numerous trips to one of these ISM&H practitioners to treat their ailments.

For many Indians, especially for those who cannot access western medicine because of geographical and/or resource issues, these ISM&H practitioners have historically been the sole providers of health care. Therefore, these ISM&H practitioners, along with the growing number of western medicine practitioners, dominate the Indian health care sector.

It is in this context, allied health professions (AHP) in India continue to be under-recognised, not fully utilised, and minimally engaged. During my many trips back home to India, when people enquire what I do and I respond that I am a physiotherapist, it is invariably followed by the next question, "What is that?” I suspect similar issues confront other allied health professions. Increasingly though, India faces a modernity-paradox, whereby in addition to the ongoing challenge of combating infectious diseases, there is now the emerging challenge of lifestyle disorders and chronic conditions and their associated disabilities. Involving AHPs in addressing these health issues may pave the way for increased mainstream acceptance of allied health professions in India.

While involving AHPs in addressing India’s contemporary health issues may increase AHPs profile, it may also shine light on another challenge confronting AHPs in India. Allied health professionals in India, unlike many western countries, are not regulated, do not have professional autonomy, and are not primary contact practitioners. A recent initiative by the government of India identified that important challenges continue to persist for AHPs, including lack of regulatory monitoring, lack of consistent, coordinated education and training of AHPs (due to diverse curriculum), and lack of ongoing professional development opportunities and standards.1

While these challenges will take time to resolve, especially those that require significant engagement with external stakeholders such as regulatory issues, AHPs can take the initiative, tackle some of these challenges, and drive the change. Evidence-Based Practice (EBP) may act as a vehicle for this purpose. Evidence-based practice integrates the best research evidence with clinical expertise and patients’ morals, values and beliefs within the context of the clinical practice environment. Allied health professions can contribute to the generation of research evidence about its safety and effectiveness, which will enable it to achieve professional autonomy. While undertaking high quality primary research can be time and resource intensive, as a short term measure, allied health professions can access research evidence from other countries and contextualise it to local health care needs. There are a number of methodologically sound clinical practice guidelines for a range of health care conditions that could be utilised in the Indian context.

Creating awareness, knowledge, and skills of EBP can be achieved through innovative means such as the iCAHE’s journal club model.2 By equipping the allied health professions with the knowledge and skills of EBP, such as through the iCAHE journal clubs, allied health professionals in India will have exposure to and awareness of EBP, its importance in contemporary health care, and its philosophy of promoting safe and high quality health care.

Allied health professions in India, as in many developing countries, face a number of significant and complex challenges. To quote H.L. Mencken "For every complex problem, there is an answer that is clear, simple, and wrong,” and in this context, it is wrong to say EBP can solely overcome these challenges. Evidence-based practice, however, does provide a unique vehicle where health care service delivery can be tailored to meet the needs of the local population (patients and allied health professionals) while recognising local health care contexts, and be underpinned by best research evidence. This model of developing and implementing best practice may just as well be the first modern take on ancient India when it comes to allied health professions.

References

  1. Health Ministry releases report on status of allied health professionals in India. 21 December 2012; http://indiagovernance.gov.in/news.php?id=1897 (accessed on 18th July 2013)
  2. Lucylynn M.L, Saravana Kumar, Karen Grimmer –Somers. Exploring the impact of a structured model of Journal club in allied health – a qualitative study. Creative education .2012; 3: 1094 – 1100. DOI: 10.4236/ce.2012.326164

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