Editorial-01/09/2026
Step up regulation: On AYUSH medical education
Context: AYUSH education’s rapid expansion
India’s AYUSH education infrastructure has grown sharply since 2021. The number of AYUSH colleges rose from 789 in 2021 to 971 in 2024, while total admission capacity increased from about 63,500 to nearly 79,600. Permitted-seat capacity grew even faster, from around 50,700 to over 72,500 in the same period. This expansion coincides with a nearly sixfold increase in central funding under the AYURGYAN scheme for training, research, and capacity building between 2021 and 2024.
Crucially, this growth is overwhelmingly private-led. In 2024, 86% of Ayurveda colleges and 85% of homoeopathy colleges were in the non-government sector. Across systems, only a small fraction of Unani, Siddha, and Yoga & Naturopathy colleges are government-run. Demand is strong: in 2024–25, almost all permitted Ayurveda undergraduate seats were filled, and overall ASU&H (Ayurveda, Siddha, Unani, Homoeopathy) admissions neared permitted capacity.
On paper, this looks like success: more colleges, more seats, more practitioners to staff a widened traditional-medicine footprint in primary care, wellness, and rural outreach. The editorial’s concern is that quantity is outpacing quality—and that regulation has not kept up with the scale and incentives of private expansion.
Core concerns raised
1. Long-standing quality deficits, now amplified by scale
Quality problems in AYUSH education are not new. A 2005 Comptroller and Auditor General (CAG) audit found widespread deficiencies in homoeopathy colleges: inadequate hospital beds, weak outpatient services, poor staffing, and bed occupancy rates ranging from just 1% to 71%. A 2020 article in the Journal of Ayurveda and Integrative Medicine reported that many institutions lacked over 50% of required teaching staff.
The editorial notes that the National Commission for Indian System of Medicine (NCISM) and the National Commission for Homoeopathy (NCH)—the post-2020 regulatory bodies replacing older councils—have repeatedly withheld or denied permission to colleges after inspections revealed faculty and infrastructure shortfalls. Yet, despite this, the system continues to approve large numbers of new seats and institutions, especially in the private sector.
The risk is that rapid expansion magnifies existing weaknesses: more colleges with thin faculty, inadequate clinical exposure, and variable infrastructure produce more graduates of uneven competence.
2. Private-sector incentives and regulatory non-compliance
The editorial highlights a structural incentive problem: private AYUSH colleges are incentivised to maximise student intake while minimising costs on faculty, labs, and hospital facilities. Data show that as of 2026, NCISM had denied permission to 17 Ayurveda colleges—all private—citing “non-compliance with inspection processes”. The Karnataka High Court, in a 2023 ruling concerning Hillside Ayurveda Medical College, observed that “educational institutions are often guilty of admitting excess students for financial gains”.
Similarly, the National Commission for Homoeopathy assigned the lowest grade to 41% of all homoeopathy colleges, with nearly half of private institutions in this category. Allegations range from questionable faculty strength and failures to meet inspection norms to claims of “non-existent” faculty on paper.
In this context, the editorial argues that the mere existence of regulators (NCISM, NCH) is insufficient; what matters is how effectively they can counteract profit-driven behaviour in a largely private market for AYUSH education.
3. Evidence, scope of practice, and integration with mainstream care
Beyond infrastructure and faculty, the editorial points to a deeper issue: the evidentiary basis of AYUSH therapies and the clarity of professional roles when AYUSH practitioners interact with modern medicine. As the Centre pushes for greater AYUSH integration into public health—through Health and Wellness Centres, co-location of services, and national programmes—the stakes rise for patient safety, appropriate referral, and clear boundaries of practice.
The editorial implicitly echoes broader debates (seen in other recent commentaries) on cross-prescribing rights, bridge courses, and the dangers of blurring disciplinary boundaries without robust training and accountability. Without a credible evidence base and well-defined scope of practice, large-scale expansion of AYUSH graduates could complicate, rather than strengthen, India’s primary care architecture.
Regulatory architecture: NCISM, NCH, and their limits
Post-2020, AYUSH education is governed primarily by two statutory commissions:
- National Commission for Indian System of Medicine (NCISM): regulates Ayurveda, Siddha, Unani, and Sowa-Rigpa education and practice under the NCISM Act, 2020.
- National Commission for Homoeopathy (NCH): regulates homoeopathy education and practice under the NCH Act, 2020.
These bodies replaced older councils (CCIM and CCH, respectively) and were meant to introduce stronger standards, competency-based curricula, a national exit test (NExT-like for ASU&H), and teacher eligibility assessments (such as NET/NTET-type mechanisms). They conduct inspections, grant permissions for new colleges and seat increases, and can withdraw recognition for non-compliance.
However, the editorial suggests that:
- Inspections do identify deficits, but permissions and seat expansions continue at a pace that outstrips corrective action.
- Denials of permission (e.g., 17 Ayurveda colleges) are significant but may be too few relative to the total number of private institutions and the scale of expansion.
- Grading exercises (as by NCH) reveal large shares of low-performing colleges, but the systemic response—beyond individual penalties—remains unclear.
In effect, the regulatory framework exists but appears under-resourced, reactive, and insufficiently deterrent against repeated non-compliance, especially where political and economic incentives favour expansion.
Structural drivers of the quality–quantity gap
1. Private dominance with weak public counterweight
With 86% of Ayurveda and 85% of homoeopathy colleges in the private sector, the state’s direct leverage over AYUSH education is limited. Government colleges can model best practices in faculty recruitment, clinical training, and research, but their small share means they cannot set system-wide norms by example alone.
Private institutions, often reliant on tuition fees, face strong pressure to fill seats. Where regulation is weak or enforcement uneven, the rational strategy is to minimise fixed costs (faculty, hospital beds, equipment) while maximising intake. This creates a classic market failure: individual institutions benefit from cost-cutting, but the system as a whole suffers from degraded quality and reputation.
2. Faculty shortages and attrition
Faculty deficits are chronic. Past studies and audits have shown many AYUSH colleges operating with less than half the required teaching staff. Beyond numbers, there are qualitative issues:
- Limited research training and weak incentives for high-quality publication.
- Bureaucratic burdens and committee overload that discourage research-active faculty.
- A mismatch between stated goals (research-driven, evidence-based AYUSH) and actual institutional environments (compliance-heavy, teaching-heavy, research-light).
Recent commentary on Ayurveda academia notes that only a small fraction of research in the Ayush Research Portal qualifies as high-grade (e.g., randomised controlled trial-level) evidence, while the majority falls into the lowest WHO evidence grades. This suggests that even where research output is counted, its quality and international recognition remain limited.
3. Clinical training and hospital infrastructure
AYUSH education requires robust clinical exposure: inpatient beds, outpatient departments, diagnostic support, and a steady patient load. The 2005 CAG audit already flagged low bed occupancy and inadequate services in homoeopathy colleges. If many colleges still struggle to maintain functional teaching hospitals, students graduate with insufficient hands-on experience.
This is especially problematic as AYUSH is increasingly positioned for frontline care. Practitioners with weak clinical training are more likely to misdiagnose, delay appropriate referral, or overstep their competence—raising patient-safety concerns and eroding trust in traditional systems.
4. Evidence base and integration dilemmas
The editorial’s call to scrutinise “the evidence supporting AYUSH medicinal practices” is central. India’s policy ambition is not to replace modern medicine but to integrate AYUSH as a complementary component of a broader health system. For this to work:
- Therapies promoted at scale must have credible evidence of safety and efficacy for defined indications.
- Curricula must teach students to recognise red flags, understand limitations, and refer appropriately.
- Regulatory frameworks must clearly define scope of practice and discourage informal cross-prescribing without structured bridge training and legal clarity.
Without this, expansion risks creating a large cadre of practitioners whose training and legal status are ambiguous, complicating efforts to build a coherent, safe primary-care workforce.
Policy roadmap: how to “step up regulation”
1. Strengthen inspection, transparency, and enforcement
- Risk-based, surprise inspections: Move beyond scheduled inspections to unannounced, risk-based audits focusing on colleges with past violations, rapid seat increases, or low grades.
- Public dashboards: Publish college-level data on faculty strength, bed occupancy, patient load, exam pass rates, and inspection outcomes. Transparency can empower students and create reputational incentives for institutions.
- Stricter penalties for repeat offenders: Beyond denying permission for new seats, consider time-bound suspension of recognition, fines, and mandatory remediation plans for colleges repeatedly found non-compliant.
2. Realign incentives for private institutions
- Link permissions to performance: Tie approval for new seats or courses to multi-year performance metrics (faculty retention, research output, graduate employment, patient outcomes in teaching hospitals).
- Support for quality upgrades: Instead of only punitive measures, offer targeted grants or low-interest loans for private colleges that invest in faculty development, hospital infrastructure, and research capacity, conditional on meeting standards.
- Cap growth where absorption is weak: In states or systems where postgraduate seats, faculty pipelines, and employment opportunities are limited, consider capping undergraduate intake to match systemic absorption capacity, as suggested in broader medical-education debates.
3. Faculty development and research ecosystem
- Faculty recruitment and retention: Create dedicated AYUSH faculty cadres with clear career paths, research time, and incentives for high-quality publication and teaching innovation.
- Research quality over quantity: Shift focus from counting publications to improving research design, encouraging multi-centre trials, and seeking international indexing and collaboration.
- Mentorship and networks: Establish national and regional networks of research-active AYUSH faculty, linked with institutions like the All India Institute of Ayurveda and national institutes under the Ministry of Ayush, to raise standards through mentorship and shared protocols.
4. Clarify scope of practice and integration model
- Statutory clarity on cross-prescribing: Either legally permit limited cross-prescribing with a mandatory, examined bridge curriculum and clear protocols, or explicitly prohibit it and enforce scope-of-practice boundaries.
- Standardised referral pathways: Embed referral algorithms and red-flag training in AYUSH curricula, ensuring graduates know when to refer to modern-medicine facilities.
- Role in public health: Define AYUSH practitioners’ roles in Health and Wellness Centres, national programmes (e.g., NCDs, mental health), and wellness promotion, with clear guidelines and monitoring.
5. Evidence generation as a regulatory priority
- Priority research agenda: NCISM, NCH, and the Ministry of Ayush should jointly identify priority conditions for rigorous evaluation (e.g., chronic pain, metabolic disorders, certain mental health conditions) and fund well-designed trials.
- Independent evaluation: Encourage independent, multi-institutional studies, including collaborations with ICMR, AIIMS, and other premier bodies, to enhance credibility.
- Curriculum integration: Teach evidence appraisal skills in AYUSH courses so graduates can critically assess claims and guidelines, not just memorise formulations.
Implications for India’s health system and federalism
AYUSH education regulation sits at the intersection of health, education, and federalism. While the Union government sets standards through NCISM and NCH, states play a key role in:
- Affiliating universities and approving private colleges.
- Deploying AYUSH practitioners in public facilities.
- Enforcing local clinical establishment laws (as seen in Andhra Pradesh’s draft regulations for private AYUSH facilities).
Kerala’s move to establish an independent AYUSH University illustrates how states can take the lead in integrating education, research, and clinical services under a dedicated umbrella. Such models could be replicated, with strong quality mandates, to create centres of excellence that raise standards across affiliated colleges.
At the national level, a coherent AYUSH education strategy must align with broader health workforce planning: how many AYUSH graduates are needed, where they will work, and what roles they will play in a mixed public–private system.
Conclusion: from expansion to excellence
India’s AYUSH ambition cannot rest on numbers alone. A larger pipeline of graduates will strengthen traditional medicine only if their training is rigorous, their clinical exposure adequate, and their practice grounded in evidence and clear professional boundaries.
“Stepping up regulation” means:
- Making inspections more frequent, transparent, and consequential.
- Reconfiguring incentives so that quality, not just intake, drives private investment.
- Investing in faculty, research, and hospital infrastructure as seriously as in new seats.
- Confronting the evidence question honestly, and defining scope of practice with legal and clinical clarity.
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