International Delegate Assembly: An overview of two decades

Abstract

Globalization of Ayurveda is a continuous process. It happens due to committed collaboration of expert vaidyas from India and abroad, professionals from different countries, pharmaceutical suppliers, and patients. The obstacles to practise, regulate and educate Ayurveda, differ from country to country; however there are some common threads. The International Delegates Assembly through the platform of World Ayurveda Congress strives to bring the stakeholders together biannually to discuss the issues and find solutions. The present narrative sheds light on the objectives, status and expectations of the stakeholders and provides insights into the process.

1. Background

The twenty-first century has witnessed global outreach of Ayurvedic Sciences. Undoubtedly, India is the mother country of the age-old health care system. Over the course of the last six decades, Ayurveda practitioners, who received education from accredited Ayurvedic colleges across different states in India, have been actively engaged in professional practice on a global scale, using individual or institutional platforms. Vaidyas have developed communication with various health professionals, local practitioners, therapists and pharmacies. Vaidya mostly rely on self-prepared herbal medicines using available raw materials in the local markets of that country as well as imports from India. Many have faced difficult situations especially in countries where Ayurveda is not a regulated or licensed practice. Importantly, despite all odds, the practice of Ayurveda is alive in 26 members states which have been listed in the WHO benchmark documents [1]. Recognition by the World Health Organization (WHO) is significant because it endorses well-documented training, practice and research in Yoga and Ayurveda across the 26 member states, with government support. Acknowledgment by WHO highlights the synergy between these traditional systems, emphasizing their importance in global healthcare and research efforts. The recognition encourages collaboration and dissemination of knowledge, promoting holistic well-being worldwide. The leadership of the World Ayurveda Foundation took cognizance of the situation and initiated International Delegates Assembly (IDA) to strengthen the individual efforts, during the first World Ayurveda Congress (WAC) held at Kochi in 2001. After the birth of the Ministry of AYUSH in 2014, the Ayurveda sector has been successful in showcasing its strengths through the international cooperation (IC) initiatives at various educational, economic and industrial settings. Many previous efforts contribute to the current progress and hence it is worthwhile to take an overview of contributions of IDA. The International Delegate Assembly seeks to globally promote the training, practice, research and standardization of Ayurveda while fostering international collaborations. The IDA plans to achieve milestones like cross-border cooperation, regulatory harmonization and heightened awareness. Thus reinforcing Ayurveda's interdependent relationship with the evolving traditional medicine landscape

2. Objectives of IDA

In line with the vision and mission of WAC of propagation of scientific Ayurveda across the globe, the specific objectives of IDA for Vaidya practitioners practising outside India are as follows.(see Box 1)

Box 1. Objectives of IDA.

• ●To spread the scientific yet user friendly approach of Ayurveda.
• ●To share experiences and advancements in practice, education, health products and research from India to the country of practice.
• ●To encourage Ayurvedic professionals to maintain the records of case studies to document the outcome of various treatment modalities.
• ●To facilitating the exchange of ideas among healthcare professionals is imperative for enhancing patient outcomes through a scientific approach.
• ●To exchange valuable information to deal with local regulatory authorities regarding Ayurvedic education, scope of practice and clinical competency.
• ●To propagate Ayurvedic education in other Health professionals to improve the awareness and the communication of Ayurvedic terms.
• ●To strengthen the Vaidya community in India by contributing real time knowledge from different parts of the world.
• ●To emphasize upon the need for bilateral legal frameworks and international standard alignments which are crucial for the global practice of Ayurveda.

Alt-text: Box 1

3. Brief overview of past IDAs

Under the umbrella of World Ayurveda Congress, IDA brings together the scientific and academic community, leading practitioners and students of Ayurveda, medicines and panchakarma equipment manufacturers from across the world. Over twenty years and through eight editions organized at Kochi, Pune, Jaipur, Bangalore, Bhopal, Delhi, Kolkata, Ahmedabad,Dubai & Goa; IDA has created a strong foothold. The IDAs have always addressed current issues of the sector during its deliberations.

Generally, the Vaidyas practicing outside India are aware of the various initiatives of the Ministry of AYUSH. Prominent activities include country to country MOU for co-operation in the field of Traditional Medicine, Establishments of AYUSH academic Chairs in foreign universities, AYUSH information cells in the consulates of 34 countries and AYUSH fellowship schemes for students who wish to study Ayurveda. The noteworthy themes of some IDAs have focused on Ayurveda and World Health; Globalization of Ayurveda; Mainstreaming Ayurveda; Ayurveda for All; Enriching Public Health Through Ayurveda; Health Challenges and Ayurveda; Strengthening the Ayurveda Ecosystem; Re-aligning the Focus on Health; and Ayurveda for one health. The growth of practice and education of Ayurveda across the globe has witnessed consistent increasing response to IDA. The concept of country reports emerged during seventh and eighth WAC where the representative of the country/state/province (in case of big country like the USA) presents a narrative brief of the activities, success stories, failures and expectations of support from Indian Vaidya community, industry and the Indian government through Ministry of AYUSH (Table 1).

Table 1.

Representation of various countries for the IDA meetings.

IDA: Year & Place	Country Represented	International Delegates
2002 (Kochi)	22	168
2006 (Pune)	30	220
2008 (Jaipur)	36	222
2010 (Bangalore)	23	264
2012 (Bhopal)	21	85
2014 (Delhi)	33	114
2016 (Kolkata)	18	199
2018 (Ahmedabad)	32	226
2020 (Dubai)	25	158
2022 (Goa)	43	343

4. The 9^th IDA at Goa, India

The theme of 9^th IDA was Ayurveda for One Health. In the 9^th IDA country reports were presented by 19 participants representing different countries from four continents. Two workshops were organised for International Ayurveda students studying at various institutes in India. The first was ‘Ayurveda for Perfect Health’ and the other was ‘Immunity Secrets and Gateways in Ayurveda’. The presence of over 200 international students taking AYUSH courses at different universities reaffirmed the vision of IDA (Fig. 1, Fig. 2)

Fig. 1.

Countries participated at 9^thWAC and 9^thIDA −2022.

Fig. 2.

IDA delegates with Hon. Prime Minister of India Sri. Narendra Modi.

5. Initiatives in different countries as presented at IDA

5.1. USA and Canada

USA has good acceptance towards Ayurveda. United States has fully functional Ayurvedic professional organizations for last 20 years. According to the National Centre for Complementary and Integrative Health (NCCIH), Ayurvedic Medicine is considered as one of the alternative and complementary medicines of the US. Currently, it is an emerging profession, but not a licensed healthcare practice. Eleven states of the US have adopted safe harbor practitioner exemption laws under the Health Care Freedom Act, in some form. These are Minnesota, Rhode Island, California, Louisiana, Idaho, Oklahoma, Arizona (for homeopaths), New Mexico, Colorado, Nevada and, most recently, Maine which allow Ayurvedic vaidyas to legally practice their profession to some extent (Fig. 2).

More than twenty universities offer accredited Ayurveda programs which include Maharishi International University, Southern California University of Health Sciences, Bastyr University and Mount Madonna College of Ayurveda. Ayurvedic Education is generally available at three levels. Ayurvedic Health Counsellor (AHC), Ayurvedic Practitioner (AP) and Ayurvedic Doctor (AD) or Masters in Ayurveda. Also, some specialty certificate courses like Ayurvedic Yoga Therapist (AYT), Panchakarma Therapist (PKT) are popular amongst the US students. Every year more than 500 students complete different levels of Ayurvedic Education in the US.

USA is the only country that has developed National Examination for the Ayurvedic Students at various levels. It also has separate organizations like Certification Board, Accreditation Commission and a Professional membership organization that mandates CME credits to maintain the professional status. The Southern California University of Health Science has proposed to develop the first accredited graduate level Ayurveda Doctor program in the US.

In October 2020, A Letter of Intent (LOI) was signed between the Office of Cancer Complementary and Alternative Medicine (OCCAM) of the Division of Cancer Treatment and Diagnosis (DCTD) of the National Cancer Institute (NCI/NIH) USA and the Central Council for Research on Ayurvedic Sciences (CCRAS) of India. The LOI outlines a research and training collaboration that aims to improve cancer prevention, control and treatment outcomes for both the United States and India, as well as potentially benefit other Low-and-Middle Income Countries (LMICs). The collaboration is governed by the Science and Technology Agreement signed between the two governments in September 2019.

Concurrently, the global market for herbal medicines estimated at US$110.2 billion in the year 2020, is projected to reach US$178.4 billion by 2026. The few companies where Ayurvedic herbs are sold in the US are Banyan Botanicals, Ayurvedic Healing Inc., Athreya Herbs, Kerala Ayurveda, Kottakkal USA of Arya Vaidya Shala, Life Spa, Komal Herbals Inc., Chopra Global, KSM-66 Ashwagandha (Ixoreal Biomed Inc) etc. Opening up to CAM practices consequently matches with the sales of herbal products. Also, the organizations of Ayurvedic professionals are very active in the US. National Ayurvedic Medical Association (NAMA), Certification Board (CB), Ayurvedic Accreditation Commission (AAC), American Association of Ayurvedic Professionals (AAAP), International Council for Ayurvedic Accreditation (ICAA), Ayurvedic Association of Ayurvedic Professionals in North America (AAPNA)and Global Council for Ayurveda Research (G-CAR); are active in organizing national and international level seminars and conferences for patient awareness, therapist education and meetings with state and national authorities. These operate on national as well as individual state level and offer memberships to vaidyas. with common purpose to support each other, to work with the state government to facilitate Ayurvedic professionals & educational institutions to unite, promote, accredit, do research and acquire license for Ayurveda activities. Some of the leading organizations are in contact with AYUSH & WHO. They also contribute to prepare policy guidelines for Ayurvedic Education, Scope of Practice, Clinical Competencies, Ethics and share legalities for the practice of Ayurveda at different states in the US. The certification board maintains rigorous accreditation standards for quality education. Together the state and national groups are working to become a federally recognized accreditation through the United States [2].

The Candian College of Ayurveda and Yoga established by vaidya Harish Verma functions from Richmond Ontario. There are a few senior practitioners of Ayurveda in Toronto as well. The Ayurveda Association of Canada was established in 2017 and has 200 members, as of now.

5.2. Cuba

Cuba regulates traditional medicine, including Ayurveda, under the Natural and Traditional Medicine Program. In 2019, a panchakarma department was introduced at a health center within the national health system [1]. Recently, the Universidad De Ciencia Medicas De La Habana, Cuba has signed an MoU for the cooperation about Ayurveda with All India Institute of Ayurveda [AIIA], New Delhi, India. An Ayurveda Chair has been established in Cuba.

5.3. Brazil

Ayurveda gained recognition under Brazil's National Policy of Integrative and Complementary Practices in 2017 through Ordinance No. 849, joining various therapeutic modalities [1]. In Brazil, Ayurveda is recognized as one of the 29 integrative health practices by the Ministry of Health. The Embassy of India has extended support for the translation and publication of the comic book AYUSHMAN, as well as the translation of the AYUSH Ministry's COVID-19 protocol into Portuguese Language and has financed these efforts. The Brazilian Academic Consortium of Integrative Health, along with the All India Institute of Ayurveda (AIIA), is in the process of developing research protocols for cancer, cerebral palsy, COVID-19 and evidence mapping of Ayurvedic treatment in Brazil. The Suddha Dharma Mandalam is a private institute in Brazil that has been active since 1965, serving people from all over Brazil, South and North America, Europe and Africa. The institute has trained more than 2000 persons and therapists in partnership with the International Academy of Ayurveda, Pune, India [2].

5.4. Argentina

Argentina offers postgraduate Ayurveda courses for conventional doctors and health professionals since 2000, supported by the Argentine Medical Association since 2014, with some insurance companies providing coverage for Ayurvedic care [1]. In the Latin American continent the ‘Fundación Salud de Ayurved Prema Argentina’ has been active over the past 30 years in the field of Ayurveda. The Foundation is based in Buenos Aires in the Argentine Republic. It runs courses in two of the country's major medical schools - at the School of Medicine of the University of Buenos Aires and the National University of Cordoba's School of Medicine [3]. Based on a MoU with Gujarat Ayurveda University, at Jamnagar, Gujarat, the Foundation has been accredited as a Collaborating Centre for teaching, assistance and research in the field of Ayurvedic Medicine in Argentina. The foundation has led successful missions to other countries in the region where the Foundation and its associates have been able to dialogue with state governments and in places, hold sizable Ayurveda education courses. The translations of the Charak and Sushrut Samhitas in Spanish language have been done. At present, Ayurvedic medicines produced in India are officially registered in Venezuela, Costa Rica, Nicaragua and Honduras.

5.5. European countries

Ayurveda lacks statutory recognition, but practitioners and associations are growing. Private institutions, often affiliated with medical associations, offer various Ayurveda courses. The British Ayurvedic Medical Council, including the British Association of Accredited Ayurvedic Practitioners, provides a code of ethics and conduct with disciplinary procedures [1]. The European continent has been exposed to Ayurveda for a long time. It will not be right if the contribution of the Maharishi Ayurveda is ignored. Its Ayurveda Health Centre at Seelisberg, Switzerland offers world-class authentic treatments of Ayurveda and Panchakarma. The Maharishi Ayurveda Institutes in the UK, The Netherlands, Austria and Nepal have been created to provide a national vehicle for promoting the knowledge of Ayurveda for both the health professions and the general public. The status in different European countries is stated below.

5.5.1. Switzerland

In Switzerland, Ayurveda is practised as Alternative Medicine which was added to the constitution of Switzerland in 2009. Swiss medical faculties introduced introductory courses on complementary medicine, featuring Ayurveda, for undergraduates since 2012. In 2015, federal Ayurvedic diplomas were introduced, aiming to enhance recognition. Furthermore, supplementary health insurers are anticipated to reimburse Ayurvedic care in 2022 [1]. The Arya Vaidya Pharmacy along with SAMA Ayurveda, was instrumental in bringing the required recognition to the practice of Ayurveda in Switzerland. The 5 year BAMS course in collaboration with Kottakkal Ayurveda Institute and AYUSHDHARA portal are the big achievements. Some other organizations like Association Suisse de Médecine Ayurvédique are also active in propagation of Ayurveda.

5.5.2. Hungary

In 1997 The Ayurveda Medical System (as naturopathy) was officially recognized in Hungary by the 40/1997 Government Decree and the November 1997 NM Order [4]. According to the decree Hungarian Medical doctors who have taken training in Ayurveda are allowed to practice the medicine. The Hungarian Ayurveda Medical Foundation has been functional since 1990 which hosts a library of over 1000 books of Ayurveda. The initial efforts for popularization of Ayurveda in Hungary were supported by Dabur, India Ltd. Another effective practice has been at Calendula Ayurvedic and Medical Clinic, Siófok by Dr. Dmitri Skopinchev (MD) since 1993. Since 2015 Ayurvedic short courses are being delivered to health-care experts under faculty of Health in Pecs, Miskolc and Nyiregyhaza by Dr. Ivan Szalkai and others. These efforts were extended when the University of Debrecen opted for the Ayurveda Chair at their School of Medicine, which has been functional since 2015.

5.5.3. Germany

Ayurveda lack statutory recognition, but there is a growing number of practitioners and associations. Private institutions, often affiliated with medical associations, offer various levels of Ayurveda training through conducted courses [1]. Organizations like Charite University at Berlin have been sporadically interested in Ayurveda. Maharshi Ayurved Clinic, Bad Ems offers Ayurveda treatments to approximately 30,000 people till date and it is one of the biggest Ayurveda Centres in Germany. The European Academy of Ayurveda, Birstein Germany is a private organization which has spread its wings in Germany, Switzerland and Austria. They offer master's degree, diploma and certificate courses to the aspiring students [2,5].

ADAVED is an umbrella organisation in Germany united for Ayurveda since 2019. It is working to establish quality criteria for the education and qualification in Ayurveda and quality standards of Ayurvedic products. Incidentally, many Ayurvedic vaidyas trained in India have been moved to Germany. They founded the Indian Professional Association of Ayurveda (IPAA, Germany and are actively conducting Ayurveda awareness movements in Europe. Evangelisches (Lutheran) Hospital at Hattingen Germany is major clinical research hospital working exclusively in Neuroscience and is consistently exploring therapeutic potential of Ayurvedic treatment modalities under the leadership of Dr. Sandra Szimanski and Dr. Sandeep Nair with herbal medicines and panchakarma.

5.5.4. Sweden

A recent report from the Sweden Government on Complementary medicine shows that almost 50 % of the patients who have chronic diseases are open to trying alternative medicine [6]. Ayurveda is practiced as alternative medicine here. 300 primary health care centres and hospitals are using Medical Yoga successfully.

5.5.5. Italy

The National Federation of Medical and Dental Orders, under the Ministry of Health, recognized Ayurveda as a medical act in 2002. Only medical doctors, surgeons and dentists, after certified training, are authorized to practice clinical Ayurveda. In 2019, the Italian National Organization for Standardization established normative UNI 11756:2019, officially acknowledging and protecting the profession of Ayurveda technicians (therapists) under Law April 2013. The recognition requires verification of education, examination and certification by Federazione delle Associazioni per la Certificazione, recognized by the Italian Government. Education programs in Ayurveda are preferably certified by third parties, such as ISO 9001 certification for teaching quality [1]. In Milan and many other cities, local Councils of MDs and Dentists have opened specific Registers for physicians expert in Ayurveda. Registration requires the doctor concerned to have had sufficient education in Ayurveda. In 2018 Faculty of Medicine of State University of Milan commenced an elective course titled Introduction to Ayurveda for 5^th & 6^th year medical students. Italian Scientific Society for Ayurvedic Medicine, in Italian, the Società Scientifica Italiana di Medicina Ayurvedica (SSIMA), the Permanent Consensus Committee for Non-Conventional Medicine and the Ayurvedic Point (AP) institute in Bologna, Guido Sartori founded the “Atah” Ayurvedic Patients Association (APA) [2,7]. A module of the Post-Doctoral specialization course in “Health Sociology and Non-Conventional Medicine” at the Faculty of Sociology, University of Bologna has been introduced.

5.5.6. Latvia and Lithuania

Latvia is a small country in the Baltics. It has successfully hosted Ayurveda Chair with University of Latvia. Prof. Dr. Valdis Pirags and Prof. Dr. Shanthala Priyadarshini are giving various courses. Lithuania, adjacent to Latvia is a small yet very active country about propagation of Ayurveda. It has roots in SriSri Ravishankar's organization where they introduced a wellness course of Ayurveda [8]. With support and advice from Jiva Ayurveda, Dr. Lina Lukosiene, Director of Ayurveda Academy at Vilnius has extended Ayurveda education and practise for commoners. Books based on Ayurvedic concepts of Tridosha are included in the school curriculum. Ayurveda restaurants are found in this small country. Jiva Ayurveda has been instrumental in taking authentic Ayurveda to this country. The University of Lithuania is in the process of offering a course of Ayurveda for the physicians, though the discussions are yet to reach fruition.

5.5.7. Portugal

The old connection of Ayurveda with Portugal, through the Hindu Pharmacy of Goa is revived during the past two decades. The Portuguese Association of Ayurvedic Medicine AMAYUR plays an active role in the regulation of Ayurvedic Medicine Technicians and Therapists courses in Portugal. There are 5 major centres of Ayurveda study and training in Portugal at Castelo Branco, Setúbal, Lisboa, Coimbra and Porto. AMAYUR has good relations with India through the International Academy of Ayurveda and also with Brazil, Escola Yoga Brahma Vidyalaya and it also works with European Ayurveda Association (EUAA), Germany for the legal recognition of Ayurveda in Europe [2]. Establishment of Ayurveda centre that can assist the needy population and launch of the first scientific Ayurveda Research Journal in Portugal are future projects.

5.6. Russia

This country has a long history of successful Ayurveda education and practice. It has a connection with IPGT and RA (now ITRA). Dr. Boris Ragozsin is the first Ayurveda BAMS MD graduate from Jamnagar. The Ayurveda Chair in Russia has been hosted by Peoples Friendly University since 2017. Dr. R. Sarashetty was the dynamic professor who designed and delivered the advanced courses for medical doctors practicing ophthalmology, gynaecology, nano medicine, cosmetology etc. Also, general awareness and self-health or wellness programs are delivered [9]. (At the moment the chair is halted due to the war situation.)

5.7. Australia

The Australian Government officially recognized two Ayurveda training programs: the Diploma in Ayurvedic Lifestyle Consultation (HLT52615) and the Advanced Diploma in Ayurveda (HLT62615). These qualifications, each with a defined scope of practice, enable certified Ayurveda doctors to practice in Australia without additional qualifications [1]. Therapeutic Goods Administration (TGA) is the regulatory authority in Australia that regulates import of any type of traditional medicine including Ayurvedic medicine and herbs. It is important that many herbal drugs including Curcuma longa Andrographis paniculata, Garcinia cambogia, Asparagus racemosus are regulated in Australia through TGA. This TGA works for all types of traditional medicine, especially entry of the products in Australia. Most practitioners have a Bachelor of Ayurvedic Medicine and Surgery (B.A.M.S) from India or Sri Lanka and private colleges offer professional training courses. In 2019, the All India Institute of Ayurveda signed an MOU with Western Sydney University, as part which they established an Ayurveda Academic Chair at Western Sydney University's NICM Health Research Institute [10].

5.8. Singapore

In Singapore, Ayurveda practice operates under self-regulation facilitated by an operations handbook, practice guidelines and a code of ethics provided by the Singapore Ayurveda Practitioners Association. All products, including Ayurvedic medicines, undergo scrutiny by the Health Sciences Authority, which issues consent for each batch of manufactured medicines [1,9]. Ayurveda has been practiced here for around 60 years and has grown in popularity with over 16 Ayurveda centres operating across the country. However, Ayurveda is not recognized as an alternate healthcare system and practitioners are regulated under PLRD regulations as massage establishments. Ayurvedic practice is not covered by insurance. Ayurveda education is available through local institutes and Ayurvedic medicines are regulated by the Health Sciences Authority on a batch to batch clearance basis.

5.9. Malaysia

Malaysia officially recognizes and regulates Ayurveda medicine through laws and frameworks, including the Programme Standards: Traditional and Complementary Medicine established in 2009 (revised in 2021) and legislation enacted in 2016 [1,9]. Traditional and Complementary Medicine (TCM) has been institutionalized through the TCM Act (2016) and is incorporated into the national health care system through policies and regulations enforced by the government [11]. TCM services are available in 15 public hospitals including Panchakarma. Under the auspices of ITEC program of Govt. of India, a panchakarma specialist from NIA Jaipur was deputed to the TCM division of Ministry of Health, Malaysia (2014–2017) and the initiative is active today as well. The Ministry of Health has taken steps to ensure TCM is of high quality and safe for consumers.

5.10. Thailand

Thailand also has a long history of traditional medicine practices, yet Ayurveda is not officially supported by the Thai government. The government has shown a general interest in the integration of traditional and alternative medicine in the country & healthcare system. Some of the popular private Ayurveda courses in Thailand include Ayurveda Wellness Practitioner Course at Kamalaya Koh Samui, Ayurveda and Yoga Teacher Training Course at The Sanctuary Thailand, Ayurveda Panchakarma Therapy Course at AyurClinic Thailand, Ayurveda Massage Course at Wat Pho Thai Traditional Massage School. The AYUSH Chair established in 2018 at the University of Phayao in Thailand, is a collaborative effort between India and Thailand aimed at promoting traditional medicine practices. The AYUSH Chair in Thailand serves as a platform for research, education and exchange of knowledge between India and Thailand on traditional medicine practices [12].

5.11. UAE

In 2002, the Traditional Complementary and Alternative Medicine Unit, under the Ministry of Health, set up the Department of Traditional Complementary and Alternative Medicine in the United Arab Emirates. This department initiated the licensing of Ayurveda medicine practices. The regulatory framework encompasses unified healthcare professional qualification requirements, a Traditional, Complementar and Alternative Medicine (TCAM) examination and considerations for TCAM practitioners. Guidelines for the scope of practice for TCAM practitioners and the registration of pharmaceutical products derived from natural sources are managed by the Ministry of Health and Prevention [1,9]. In the UAE, there is an increasing demand and public interest in Traditional Complementary and Alternative Medicine (TCAM), including Ayurveda. Ayurveda is approved as a ‘Medical System’ in Gulf countries Saudi Arabia, Oman, Bahrain, Qatar except Kuwait and licensed practitioners and therapists are authorized to practice [1,9]. Ayurveda consultations, medicines and therapies are covered under medical insurance. Dr. V. L. Shyam started his ayurveda practice in UAE in 2001 and he became first ayurvedic doctor licensed by the Ministry of Health, UAE in 2003. There are over 200 licensed Ayurveda practitioners and therapists in the UAE and licensed doctors are conferred with Golden Visa. 107 herbal products are registered under the UAE Ministry of Health, with 58 are from India. The Emirates Ayurveda Graduates Association (EAGA) is working extensively in the field of Ayurveda.

5.12. Sri -lanka

In Sri Lanka, Ayurveda medicine is recognized and regulated as medical systems. Specific laws and frameworks are in place to govern the training and practice of these systems. It is also integrated into the health system establishments, including both government and private establishments. The relevant acts and laws include Act Nos. 31 of 1961 and 5 of 1962, the Ayurveda Act No. 31 of 1961, the Ayurveda (Amendment) Law (No. 7 of 1977) and Ayurveda rules [1,9]. The council is responsible for licensing and regulating T&CM practitioners, Ayurveda Practitioners, Ayurveda Nurses and Ayurveda Dispensers. Ayurveda Education and Hospital Board is responsible for regulating undergraduate and postgraduate education in Ayurveda, Siddha and Unani medicine in Sri Lanka. Three government Ayurveda institutions are affiliated with universities offering BAMS, BSMS and BUMS degrees. India offers scholarships for postgraduate education to Sri Lankan students. Ayurveda Research Committee is responsible for regulating Ayurvedic pharmacopoeia and research. The Bandaranaike Memorial Ayurveda Research Institute is the first government Ayurveda research institute established in Sri Lanka in 1962.

5.13. Mauritius

The Ayurveda and Other Traditional Medicine Act in Mauritius came into effect in 1989. Following this, Ayurvedic clinics were established in Government hospitals and clinics in 1992. Today, Ayurveda is seamlessly integrated within the Mauritian health system [1,9]. The Ministry of Health and Quality of Life has set up an Ayurvedic committee that looks after overall practice of ayurveda and regulates medicinal trade [13]. This tiny country hosts 16 outlets of Ayurveda. Out of which 6 are ayurvedic centres, 3 pharmacies, 2 clinics and 5 are retail shops. Approximately 80% of medicines are imported from India. Remaining 20% are manufactured by local pharmacies or at the treatment centres. Recently Mauritius hosted Ayurveda Chair, which is led by Dr. Ish Sharma.

5.14. Nepal

Nepal recognizes and regulates Ayurveda and Unani medicine as medical systems through the Ayurveda Medical Council Act of 1988. The country has established codes on the sales and distribution of drugs, health service acts, drug policies and health policies to govern these traditional medical practices [9,14]. Government Ayurveda educational institutes offer Ayurveda degree programmes and there are important research bodies in the country such as the Nepal Academy of Science and Technology, Nepal Ayurveda Research and Training Center, Naradevi Ayurveda Hospital and various their universities of Nepal are also involved in Ayurveda education and research.

6. Initiatives of Ministry of AYUSH

According to the latest information sourced from Press Information Bureau (PIB), Govt. Of India, and the annual report (2022-23) many steps have been taken to promote AYUSH sector, globally; where Ayurved has a lion's share.

The Ministry of AYUSH is actively involved in promoting the globalization of Ayurveda through various avenues. The comprehensive approach encompasses academics, research, business, clinical work, preventive measures, the pharmaceutical industry, AYUSH Visa facilitation, medical tourism, AYUSH scholarships, product promotion, training programs, research initiatives and regulatory frameworks. To achieve these goals, the Ministry focuses on integrating Ayurvedic principles into academic curricula, conducting rigorous research to evaluate its efficacy, expanding Ayurvedic businesses both domestically and internationally, integrating Ayurveda into mainstream clinical practices, promoting preventive healthcare measures, advancing the Ayurvedic pharmaceutical industry, facilitating the issuance of AYUSH Visas for individuals seeking Ayurvedic treatments, promoting medical tourism for Ayurveda, supporting educational opportunities through AYUSH scholarships, enhancing the global promotion of Ayurvedic products, providing comprehensive training programs, conducting impactful research studies and establishing robust regulations to ensure safety and quality control. Through these concerted efforts, Ayurveda is gaining recognition and accessibility worldwide, enabling individuals from diverse backgrounds to benefit from its holistic healthcare practices (Table 2).

Table 2.

International cooperation in the field of AYUSH [15]

Sr. No	International Cooperation Activities	Details
1	Memorandum of Understanding with different Countries	●24 Country to Country MoUs for Cooperation in field of Traditional Medicine and Homoeopathy with Nepal, Bangladesh, Hungary, Trinidad & Tobago, Malaysia, Mauritius, Mongolia, Turkmenistan, Myanmar, WHO- Geneva, Germany (Joint declaration), Iran, Sao Tome & Príncipe, Equatorial Guinea, Cuba, Colombia, Japan (MoC), Bolivia, Gambia, Republic of Guinea, China, St Vincent and The Grenadines, Suriname, Brazil and Zimbabwe. ●Under these MoUs, the Ministry is conducting various activities for promotion of AYUSH. ●43 MoUs for undertaking Collaborative Research/Academics signed with foreign institutes/universities.
2	Establishment of AYUSH Academic Chairs at foreign universities/institutes	●15 MoUs for setting up AYUSH Academic Chairs have been signed with foreign institutes in Armenia, Australia, Bangladesh, Hungary, Latvia, Malaysia, Mauritius, Russia, Slovenia, South Africa, Thailand etc.
3	AYUSH Information Cell	●AYUSH Information Cell have been set up in 39 countries to disseminate authentic information about ASU&H systems of Medicine. ●Ayurveda day, International Yoga Day etc. Are also being celebrated every year through AYUSH Information Cells.
4	Signing of MoUs with foreign institutions for research collaboration and for establishing AYUSH Academic chairs	●Central Council for Research in Ayurvedic Science (CCRAS) and Universidad Autonoma De Nuevo Leon Mexico for establishment of Academic chair. ●All India Institute of Ayurveda (AIIA) and University Health Network, (UHN) Canada. ●All India Institute of Ayurveda (AIIA) and the Federal University of Rio De Janeiro (UFRJ) and The Brazilian Academic Consortium for Integrative Health (CABSIN), Brazil. ●National Institute of Ayurveda Jaipur and Philippines Institute of Traditional and Alternative Healthcare, Philippines. ●Rashtriya Ayurved Vidyapeeth (RAV) and Fundacion De Salud Ayurveda Prema, Argentina. ●MoU on Cooperation in Traditional Medicine was signed on Nov. 4, 2022 on the sidelines of 15th India Taiwan Economic Consultation in Banijya Bhawan, New Delhi. ●All India Institute of Ayurveda, New Delhi and National Institute of Advanced Industrial Science and Technology, Japan on Research Collaboration in Ayurveda ●All India Institute of Ayurveda and University of Medical Sciences of Havana (UCMH), Havana, Cuba for the establishment of an academic collaboration in Ayurveda
5	Collaboration with WHO	●Establishment of a WHO Global Centre of Traditional Medicine in India ●The Ministry of AYUSH, India's existing Technical Post at a grade equivalent to the P-4 level in the professional grading scale of WHO at TCI, Unit, WHO Hq., Geneva has been upgraded to P-5 Level. Accordingly, the Ministry has deputed an AYUSH expert on secondment basis at P-5 Level at WHO headquarter. ●Interaction with multilateral forums like- BRICS, IORA, G-20 etc. In the field of AYUSH/Traditional Medicines
6	Export of AYUSH & Herbal Product	●Consequent to concerted efforts of Government of India, the Export of AYUSH and Herbal Medicines in 2021 has increased substantially ●Ayurved Day Celebration on the occasion of Dhanwantari Jayanti (Dhanteras) in befitting manner at National as well as international level: MEA/all Indian Missions abroad were requested to celebrate Ayurveda Day in best possible way and to undertake various activities like organizing Radio Talks/RoadShows/TV Shows etc. Public lectures and other related programs on the identified theme for promotion of health through Ayurveda. ●The Ministry of AYUSH celebrates the International day of Yoga on 21st June in India as well as across the globe and provides technical support to Indian Missions abroad every year. ●The Ministry of AYUSH through ICCR offers scholarships to the eligible foreign nationals from more than 100 countries for pursuing undergraduate (UG), postgraduate (PG) and Ph. D courses in AYUSH stream in premier Institutes in India. ●A delegation from the Ministry of AYUSH headed by the Secretary AYUSH visited Helsinki, Finland to participate in the workshop and meeting of ITU/WHO Focus Group on Artificial Intelligence for Health (FG-AI4H); The Secretary, Ministry of AYUSH delivered a presentation on “Role of Artificial Intelligence in Traditional Medicine and Digital Initiative of AYUSH”

[sourced from PiB and rewritten Annual report 2023]

7. Expectations presented by IDA delegates

All the IDA delegates expressed their gratitude towards India and the authorities of the Ministry of AYUSH, for the support they generally receive. They are hopeful that the Ayurvedic system of medicine will gain the status of an independent recognized medicine, under complementary category, in their respective countries. All of the delegates voiced their concerns towards quality assurance of ayurvedic products, public safety, professional accountability, recognition and legitimacy, adherence to global standards and facilitating comprehensive data collection for research. The delegates are willing to take responsibility and contribute on the below mentioned cumulative action points in their respective countries.

• ●There should be a countrywise, global database of Ayurveda practitioners and therapists practising within and outside India accessible to the practitioners and authorities.
• ●Traditional Medicine health governance strategy should be developed and member states of WHO should adopt it within the framework of the respective country.
• ●Establishment of the International or Global Traditional Medicine Research Council will be helpful to pool data from different ethnic populations which in turn will enrich the knowledge base of Ayurved
• ●Establishment of International Accreditation Board for Ayurveda Education should be put in place.
• ●A mechanism for pharmacovigilance of Ayurvedic products that are sold outside India should be devised. This should be aligned with the WHO strategy for safe use of traditional medicines.
• ●A web or cloud based authentic Ayurveda and Alternative Medicine database should be put together to provide real time research-based information for health care professionals across the globe.
• ●Development of Global and country specific Digital Ayurvedic Formulary would help the practitioners to know availability of permissible AYUSH products in a specific country.
• ●Initiation of research collaborations towards establishing Ayurvedic perspective of native herbs with local research institutes through local government would be of value addition to the country in particular and to Ayurved in general.
• ●A mechanism to have dialogue with all the countries on a regular basis, twice or thrice in a year, should be initiated using online systems through the International Cooperation section of the AYUSH.

8. Vision for future

Since the decade of the seventies, under the aegis of the then Department of ISM and H, Ministry of Health and Family Welfare, Government of India has made policies for spread of Ayurveda in the world. With the support from three premier institutes of the country; Gujarat Ayurveda University, Jamnagar [ITRA], Banaras Hindu University, Varanasi and National Institute of Ayurveda Jaipur); foothold of Ayurveda in different countries on education and research is achieved. The efforts of the companies such as Arya Vaidya Pharmacy Coimbatore; Shri Dhootpapeshwar Ltd., Mumbai; Dabur and Himalaya, Maharishi Ayurved Delhi; Sri Sri Ayurveda Bangalore; ISKON; and many more have been at the forefront in delivering services and products. As an outcome of the different approaches, populations from different countries are sensitized to Ayurveda whereby demand of authentic Ayurvedic knowledge and practice increased. The global interest, led the Govermnent of India to make a resolution of establishment of Ayurveda Chairs at different universities in 2008, which is a pathbreaking step. The first chairs began disseminating the knowledge from official mode. This process has taken commendable speed after establishment of the separate ministry in 2014. A network of the chairs to deliver country and area specific educational programs, research projects and need based counselling/treatment centres will strengthen the deliverables of the chair. The chairs should be treated as a baby step in a new country to ensure entry of authentic ayurvedic products and clinical practice supported by education. The chairs should be able to avail support of IDA members from the country of operation.

A noteworthy and major achievement of the targeted efforts of the Ministry of AYUSH along with the Traditional Medicine Department of the World Health Organization, Geneva; has culminated into publication of WHO Benchmark Documents for Practice of Ayurveda and for Training of Ayurveda. This will be helpful for the regulatory authorities of different countries, where Ayurveda is being practised and will be delivered at different levels based on region specific scope. It will certainly boost the confidence of practitioners. Additionally, sensitizing the out of India practitioners and providing them with data collection templates, valuable information of practice, covering different ethnicities can be collated. It will enrich the repository of AYUSH systems.

The Namaste Portal of MoA includes Standardized terminology of Ayurveda, Siddha and Unani with an intention to reduce ambiguity. The national morbidity codes for the 3 systems coupled with current lists of International Classification of Diseases ICD 10 and ICD 11 are easily accessible. The use of the standard terms with its standard equivalent term from modern medicine will help students, teachers and practitioners of traditional systems to bring a large visibility to their work published in quality journals. On the other hand, the practitioners of other medicine systems, scientists from various fields like biochemistry, nano medicine, nutritionists, and journal referees will be able to source authentic data from this portal. It will provide leads to new research to fulfil multiple unmet needs of the population. In a couple of years, the benefits should reach a measurable level.

India is making efforts to become a leading destination for Medical and Wellness Tourism through its ‘Heal in India’ initiative. The Ministry of Health and Family Welfare has established a Medical Value Travel Digital Portal to facilitate foreign patients seeking treatment in India, providing comprehensive healthcare across various medical specialties. ‘Heal by India’ aims to make traditional systems of medicine more accessible and affordable, both domestically and globally. This includes training programs, research collaborations and awareness-building initiatives to promote the benefits of AYUSH medicine.

The original Samhita are digitised and available from the CCRAS portal. Also, the lecture series by Prof. Dr. M. S. Valiathan and others are availble online. Some of the Samhitas are translated in different languages like Spanish and Portuguese. A lot of popular literature in the form of books translated in the local languages are available in the above-mentioned countries. There is a scope to design curriculum-based books and handbooks for the courses approved by Rashtriya Ayurveda Vidyapeeth (RAV) across WHO member states. Use of AI based tools to deliver the courses in MOOC mode with paid certificates have a huge scope. These should be out of the regulation of NCISM. Bimodal courses i. e. online theory coupled with offline practical and clinical modules will be the new area. These will bring authenticity to the AYUSH system taught anywhere in the world. More projects like AYURCELL, where successful cases are documented and analysed, should be developed at regional centres to facilitate project based or case-based learning.

The practitioners educated in AYUSH systems in India who are relocated abroad, face difficulties in registering themselves as Ayurveda Doctors or Health Counsellor. Some interface at the level of Equivalence for Ayurvedic Indian degrees through the national and global associations Association of Indian Universities (AIU) and International Association of Universities (IAU) should be thought of. One of the challenges that needs immediate attention is regarding the possibility of higher education to the BAMS graduates residing and practising abroad. They are not able to pursue the natural future education step like a master's degree in Ayurveda, which is a full time postgraduate program. The MD doctors trained in western bio-medicine yet, practising Ayurveda in the above-mentioned countries also seek authentic education to begin practice and after 5 years they need updating through CME. Presently, advanced European countries offer a block system where the lectures and evaluation are conducted in online mode, while the clinical teachings and viva are covered in offline mode during 6–8 weeks through hands on modules. There should be a policy decision and strategic plan to resolve the above mentioned issues on similar lines. Getting enrolled into Ph. D. or Postdoc program is comparatively easy because it is a totally research based degree and anyone possessing master's degree in Health Science or hardcore medicine can enrol for it.

A dialogue with the local Ayurveda practitioners (trained in India or in the host country) through Indian embassies and consulates which are hosting AYUSH information cells should be initiated. Though there are limited funds, awareness lectures with focus on wellness using locally practising Ayurveda graduates; for influential officials and elite in the society can be organized at the embassy. This opens a lot of new opportunities.

It will be the most important task to formulate a strategy for the coming decade to address the expectations of the international stakeholders together with MoA and WHO offices. Maximum utilisation of the existing framework of Indian consulates, embassies and practitioners can be done coupled with Ayurvedic industry and academic and research organizations like RAV and CCRAS. It will yield substantial multidimensional data which can be utilised to strengthen the Science of Ayurveda. The recent reports show 8 times growth in sell of all types of AYUSH products which range from raw materials to tablets, capsules, oils and others. By making use of Various autonomous Indian bodies like The Associated Chambers of Commerce & Industry of India (ASSOCHAM), The Federation of Indian Chambers of Commerce & Industry (FICCI), The Confederation of Indian Industry (CII) and the IDA members in the different countries, the export of AYUSH products can take a further leap.

The globalisation of Ayurveda is a complex and ongoing process that relies on the collaborative efforts of Indian vaidyas, international professionals, pharmaceutical suppliers and patients. The International Delegates Assembly, held biannually through the World Ayurveda Congress, plays a crucial role in addressing obstacles and fostering collaboration. The G20 platform offers India a significant opportunity to promote Ayurveda principles in the healthcare policies of various nations, potentially leading to its global recognition and legal acceptance.

Sources of funding

None.

Author contributions

Dr. Gunvant Yeola: Conceptualization, Methodology/Study design, Writing – review and editing, Supervision.

Dr. Abhijeet Shirkande: Methodology/Study design, Writing – original draft, Visualization.

Dr. Ankita Shirkande: Methodology/Study design, Writing – original draft, Visualization.

Dr. Asmita Wele: Conceptualization, Methodology/Study design, Writing – review and editing, Supervision.

Declaration of generative AI in scientific writing

We have not used generative AI in scientific writing.

Declaration of competing interest

Prof Asmita Wele is the associate editor of the journal, but she was not involved in the peer review process and editorial decisions related to this paper.

Appendix A. Supplementary data

The following is/are the supplementary data to this article.