India – Global hub of Therapy

Introduction
India has one of the oldest healthcare systems in the world, which have been recorded in ancient scriptures such as Vedas and Charak Samhita. For example, Ayurveda, the traditional medicinal system, is even mentioned in Indian mythology, which shows its roots in history and is evidence of the healthcare practices followed in ancient India. Healthcare in India has evolved over the course of time and today the healthcare sector is very diverse and relatively affordable, making it a global hub of therapy. Healthcare includes other practices besides medical science, such as ayurveda, yoga and Unani. Moreover, India is labelled the Botanical Garden of the World.

Types of Healthcare Practices in India

Healthcare Practice		Description
	Ayurveda	It focuses on internal cleansing, followed by a specific diet, herbal treatments, massage therapy, yoga and meditation. Ayurveda practitioners in India receive state-approved, structured training.
	Yoga	It focuses on strengthening various systems of the body, including the heart and cardiovascular system, lungs, muscles and the nerve system. It helps the digestive system, promotes psychological well-being and enhances oxygen flow to tissues.
	Unani	It is a comprehensive medical system that addresses various health and illness situations systematically. It distinguishes itself by its use of elatives, exhilarants, aphrodisiacs, organ-specific tonics and immunomodulatory medications, temperament-specific drugs, correctives for unpleasant effects, purgatives and so on.
	Siddha	It focuses on the physical, psychological, social and spiritual well-being of an individual. Siddha medicine's strengths include its holistic approach to preventative, promotive and curative healthcare in general as well as its ability to handle chronic diseases in particular.
	Homeopathy	It works as a type of complementary medicine that works on the principle of treating ‘like with like’. Homeopathy purports to activate illness healing responses by giving healthy people chemicals that imitate the symptoms of diseases.

Overview of Three Medical Practices

Ayurveda:
Ayurveda is India’s most widely known form of traditional medicine that originated during the ancient times. Internal cleansing is the first step in Ayurveda treatment, followed by a specific diet, herbal treatments, massage therapy, yoga and meditation. Ayurveda practitioners in India receive state-approved, structured training.

Ayurveda has significant global presence, attracting travellers largely from Europe and the Middle East. India’s ayurvedic products market was worth Rs. 515.5 billion (US$ 6.6 billion) in 2021 and is projected to record 19.8% growth from 2022 to 2027. Some of the major players in the market are Dabur, Patanjali and The Himalaya Drug Company. North India dominates the ayurvedic market; however, the southern states are attracting more and more tourists for Ayurveda-based treatments. The market consists of more than 100 ayurvedic hospitals, 700 dispensaries, about 800 recognised ayurvedic medicine manufacturing units, and several private health centres.

Ayurveda is famous worldwide as it attempts to heal the diseased body part while keeping the other parts undisturbed and focuses on holistic healing. Ayurveda is a one-stop treatment for all body ailments with little to no side effects. Foreigners coming to India for ayurvedic treatments find it more cost-effective and diverse than the options available in their country; for example, spas in the US typically charge US$ 100 for ayurveda-style treatments.

Yoga:
Yoga is one of India’s most prominent advocates of proper healthcare and a healthy lifestyle. Although yoga has also garnered interest from a fashion and business perspective, its most valued contribution is in terms of physical and mental health. Yoga is believed to have originated thousands of years ago and is estimated to have existed during the Indus Valley Civilisation due to the depictions in the remains found.

India is the main hub to learn yoga, take a yoga teaching course or attend a yoga retreat. Foreign enthusiasts travel to the country to discover real yoga forms and learn the art in its original form, which has not changed since the practice became famous in the West. The right place to learn yoga is a yoga ashram, where the practitioner has the opportunity to live next to the teacher and follow intensive yoga practices. The yoga ashram provides a distraction-free environment where everyone aspires to learn and study yoga. The daily schedule revolves around studying and practicing yoga principles.

Rishikesh is considered the yoga capital of the world. The Chaurasi Kutia Ashram of Maharishi Mahesh Yogi is the most well-known, having welcomed celebrities such as Mia Farrow, Mike Lee and Mick Jagger. The biggest ashram in Rishikesh is Parmarth Niketan. Although there are now multiple ashrams in Rishikesh that offer lavish lodging, the ashrams are recognized for their inexpensive facilities and lifestyle, which is conducive to yoga practice. However, as yoga's value and awareness have grown, it has surpassed meditation in popularity, attracting a great number of tourists and locals interested in learning yoga directly from the gurus.

Unani:
The Unani System of Medicine (USM) is a type of medicine system that began in Greece and was brought to India by the Arabs and Persians. Since it is readily available, less expensive and safer than many other conventional medications as it causes few side effects, USM has gained wide acceptance. India has recognised USM as an alternative healthcare system and has granted it social standing.

Unani medicine caters to tourists who visit India seeking medical care and those seeking rejuvenation treatment. Certain diseases are exclusively treated by Unani medicine, such as chronic liver disease, rheumatoid arthritis, diabetes mellitus, and male and female infertility. Unani also has a unique set of treatments that coincide with leisure such as Hijamat (cupping), Ta’liq (leeching), and Dalk (massage).

In 2017, there were 48,213 registered Unani practitioners that provided health treatment throughout the country as well as 259 Unani hospitals with 3,744 indoor beds. Moreover, there were 1,483 Unani clinics across the country. Some of the Unani medicine manufacturing companies are The Tayyebi Dawakhana Unani (Indore) Private Limited, Avni Herbals & Healthcare, Amar Pharmaceuticals and Shahi Laboratories Private Limited. About 46% of all Unani drugs developed in India are sourced from the forests of Himachal Pradesh.

Medical Tourism in India
India has been steadily rising as a top destination for medical tourism. The country experienced a 40% rise in foreign tourist arrivals on medical visas, with the total number of tourists increasing by 201,944 to 697,000 from 2017 to 2019. India ranks third in terms of wellness among Asian countries. Medical tourists largely come from Asian and African nations such as Oman, Afghanistan, Pakistan, Maldives, Nigeria and Kenya. India offers affordable and good quality medical treatment. Its pricing is the lowest in 13 out of 19 medical procedures compared to close competitors for treatments ranging from heart bypass and spinal fusion to liposuction and IVF. For example, a heart bypass surgery would cost US$ 5,200 in India as against US$ 27,000 in Mexico and US$ 28,900 in South Korea. India is Asia’s fourth-largest medical device industry, valued at US$ 11 billion, and is expected to reach US$ 50 billion by 2025. The diagnostics market stands at about US$ 4 billion, with large organised firms accounting for 25% of the market. India not only has access to international standard healthcare but also has a strong allied sector that completes the healthcare ecosystem. The Medical Tourism Association ranked India 10 out of 46 nations worldwide in the Medical Tourism Index 2020–21. By 2022, the MVT market is projected to reach US$ 13 billion.

Cost of Heart Bypass (in US$)

Source: American Medical Association, 2020

Government Initiatives to Make India a Global Hub of Therapy
The Indian government has taken various steps to strengthen MVT. It added medical visits to the e-tourist visa regime, which was introduced in 2014 in order to streamline the visa procedure. Medical attendants were included in e-tourist visas under the provision, and the medical visa process was simplified to enable numerous entries and long-term stays. The National Medical & Wellness Tourism Board was established in 2015 to serve as the umbrella organization for providing an institutional framework as well as promoting medical and wellness tourism. In the Union Budget 2021-22, the government allocated an additional Rs. 2,970 crore (US$ 384.3 million) for the Ministry of Ayush to promote health and wellness tourism internationally. The Ministry of Tourism's most recent initiative in this sector is the development of a Draft National Strategy and Roadmap for Medical and Wellness Tourism. The strategy aims to create an institutional framework, build a brand, and reinforce the ecosystem in order to ensure availability and quality.

Road Ahead:
The Indian healthcare market is expected to grow to US$ 133.44 billion by 2022, more than triple its size in 2021. The pharma and healthcare industry plans to build on the experience of the last two years, strengthen the partnership with the government and maintain momentum in 2022, having demonstrated its capability to the world by supplying 60% of COVID-19 vaccines globally during the difficult times of the pandemic. India's health industry is unique in that it encompasses various schools of therapies, each with its own X factor, which cater to a certain goal and are distinct from one another. This has and will continue to draw a large crowd to India for a very important reason, i.e., ‘to heal’.