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Analytical Framework

Question:

Disucuss about the Complimentary Medicinal System arrangement with typical Primary Care Services in Sri Lankan and Australia.

The emerging trend of shift in nature and course of diseases and an aging population have contributed to the need of therapeutic approaches that can provide comprehensive form of treatment. Complementary medicine refers to the group of diagnostic and therapeutic disciplines that when applied in adjunct with conventional medicines promotes patient wellbeign and health[1]. A rich pool of research indicates that the western medicine arena does not rely on this form of therapeutics. It can be highlighted that complementary medicines, such as aromatherapy and meditation, encompasse a diverse range of systems and practices of heathcare that have not been embraced by the mainstream western medicine for numerous reasons embedded in social, cultural and economic systems. Based on this fact it can be stated that successful and adequate complimentary medicinal system in health service delivery still remains challenging[2].

The complimentary medicinal system arrangement in health service delivery in Sri Lanka and Australia are distinct from each other and set a suitable background for undertaking a comparison between the two. Below are the statistics of the two countries that set the plartform for a comparison between the two[3].

Sri Lanka

Australia

Area

65,610 square kilometers

7,692,024 square kilometers

Population

21,203,000 as per 2016 estimate

23,401,892 as per 2016 estimate

Life expectancy

77.9 years at birth

79.5 years at birth

Literacy rate

92.5%

99%

GDP

Total $ 278.415 billion as per 2017 estimate

Total $1.39 trillion aas per 2017 estimate

Income group

Upper Middle Income

High income country

Human development index

0.757 in 2014

0.939 in 2015

The present paper is a comparative analysis of the complimentary medicinal system arrangement with typical primary care services in Sri Lanka and Australia. The paper has a brief section on the analytical framework that would be undertaken for the analysis. The next section would have a comparison between the types of services provided in complimentary medicine by these two countries. The subsequent part of the paper would highlight the differences in complimentary medicine integration with primary care services in these two countries. Reasons for inter-country similarities and differences would be discussed with the help of relevant contextual ideas. Recommendations for both countries would be provided thereafter with a key focus on changes in economic models and policy reforms for better care service delivery. A logical conclusion of the complete paper would bring an end to the paper.

The comparison of the types of services in complementary medicine and of the complementary medicinal integration with primary care services in the two countries Sri Lanka and Australia is to be done based on a strong foundation. In this regard it would be beneficial to follow a framework that would guide the analysis in a flawless manner[4]. For comparing the types of services delivered in complimentary medicine, a comparison of the costs, policies, quality of service delivery and outcomes would be analysed. For comparing the integration of the complimentary medicinal arrangement into primary care services, it would be advisable to analyse the acceptability, equity and impact on access to healthcare services. Key insights on these particular aspects would be drawn after reviewing the host of rich literature and presented in a tabular manner.

                                           Comparison of types of services in complimentary medicine between two countries in table form

 

Sri Lanka

Australia

Costs

The health sector of the country has contributed to a considerable extent to the  economic development of the country. The country is placed at an advanced position that many other countries have not been able to acquire. The healthcare sector has gained achievements that have been financed through the combination of out-of-pocket payments and general taxation. The different sources of healthcare funding include five main methods of funding. These are general taxation to the municipality, counry or state; social health insurance; private or voluntary health insurance; out of pocket payments and donations to charities. The noteworthy factor is that the heath care system of the country consists of both public and private care services; however the government plays the major role in acting as the main healthcare provider. Though the care system has free services at many ends, it deviates from the quality of care required[5].

Private health insurance ancillary cover complementary therapies. In the year 2005, 61% of patients received ancillary coverage. The majority of the public health care services are provided by the government which is funded by the combination of different payment systems  of the government. States and territories also contribute form their fiscal resources[6]

Policy

As per the National Essential Medicines list of the country, categories of medicines are divided into essential and complementary levels. The national DRA has updated the national EML which has a list of core essential and complementary drugs. The popularity of complementary medicines hve led to the promulgation of the Indigenous Medicine Ordinance in the year 1941. Off late, the Department of Ayush had been established within the Ministry of Health by the ayurveda Act 31 in 1961. Further, the Ayrvedic Physicians Professional Conduct Rules set in 1971 have  been prominent. In 1980, initiatives were taken for seting up the Ministry of Indigeous Medicine that was responsible of overseeing traditional medical hospitals providing care at affordable costs. In 1994 the Cabinet Ministry for Indigenous Medicine was set. In 1970 the Homeopathy Act recognised homeopathy as an effective medicine system. Subsequently, the homeopathic council was set[7].  

The potential of complementary medicine to combat a wide range of national economic and health priorities has been reinforced by the leading focus being placed by Government n prevention, intervention and self-care. All of these align with the complementary medicine approach. The increasing use of complementary medicines by the common population has made policy makrs bring reforms in how this mode of treatment is included in practice. Recently,  the Federal

Department of Health and Aging (DOHA) have reviewed on the Australian Government Rebate on Private Health Insurance for Natural Therapies. Further, the Australia’s National Health and Medical Research

Council (NHMRC) have taken up initiatives to assist health consumers in making decisions around healthcare by considering complimentary medicines[8].

Seven of the country’s territories grant allopathic physicians the monopoly on medical acre by restricting the practice of medicine by persons who are not qualified. The country has a long history of initiatives taken by proponents of complimentary medicines. The Medical Act of 1894 prohibits individuals other than allopathic practitioners from practising medicine. In 1974, the Australian Parliament set up the Committee of Inquiry into different forms of complementary medicines. In 1998 there was the establishment of the Therapeutic Goods Administration for providing the national framework for regulation of therapeutic goods in the country. The Complementary Medicines Evaluation Committee acknowledges two types of proof to agree to claims on therapeutic goods: scientific evidence and traditional use[9].

Quality of services delivered

Healthcare for the people is delivered in an organised manner through private and public sector that includes practising within the western system of medicine as well as traditional system of medicine[10].

As per the census, around 8600 professionals were working as complementary health therapists in the year 2006. This was actually about 80% higher than the number of professionals employed in the year 1996. The leading professionals are chiropractors, naturopaths and osteopaths. The health complications mainly addressed by this medicine are arthritis, asthma, cancer, injuries, diabetes, cardiovascular disease, osteoporosis, digestive disease, multiple sclerosis, ankylosing spondylitis, mental health and behavioural problems[11].

Outcomes of services

Research indicates that the use of compelementary medicines have been more in treatment of conditions such as cancer. religious practices have gained more pirminence as a result of such practices. Patients consider referring to complementary therapy professionals soon after facing complications after being treated by western medicinal systems.

Patients receiving services from this group of services are mainly older than the common patient population. however, the highest proportion of patient population for such services are mainly between the age 25 and 64 years. One of the concerns that prevail is that patients might undergo risky treatments from the mainstream health system.

                                 Comparison of complementary medicine integration with primary care services in table form

 

Sri Lanka

Australia

Acceptability

There remains an ambiguity and abscence of clarity regarding the coordinated responses given by the public. The response is not coordinated, hindering tthe better understanding its applicability. There is much to be knwon of the details of complimentary medicine use, the characteristics of the users and motivations that act as a driving for using complementary medicines. Research has indicated that motivational factors are strong in this country for using this form of medicines[12].

In the last one decade the  NSW ministry for Science and Medical research have commissioned reviews of the complementary medicine research and gained a better understanding of the sectoral opportunities.  Coming to population data, there is a lower level of acceptance of complementary medicine among older people. Older patients have dissimilar priorities for treatment as compared to the younger population since their health is worse on an average while the income is significantly lower[13]. ‘pull’ and ‘push’ factors have been highlighted that act as driving factors for complimentary medicine. Patient interaction with conventionl health system have at times highlighted unsatisfactory results from conventional therapy. Patients who have embraced the form of medicine perceive it as a holistic tool for health care. In addition, they perceive the medicine to be an aid for preventive therapy[14]. The therapeutic value as an adjunctive therapy has also been highlighted by this population. there is also an aligment with the personal belief system the focuses on the medicine approach as being safe[15].

Equity

60-70% of the rural population have been found to depend on natural or complementary medicine for  their primary health care[16].

Research indicates that female patients use compelimtneray medicines more than men. Futrther, female users are more likely to fall into the category of being middleaged. They also have higer annual income and higher education level. The Caucasian population have more tendency to use complementary medicines. In certain, the urge to refer to manual therapies such as consultations with a massage therapist or chiropractor are more common amongst rural populations[17]

Impact on access to healthcare services

The Sri Lanka population has shown more intrest in using herbal dietary supplementation as a fom of complimentary medicines. Some professionals under complimentary medicines as well as products are regulated by the eminent government bodies. However, at levels beyond that, most provisions for complimentary medicines are unregulated and informal. These are not integrated into the conventional  healthcare frameworks. Since the use of complimentary medicine is growing in Sri Lanka, policy makers must respond adequately and in a meaningful manner to this component of healthcare system[18] .

An issue related to integration of complimentary therapy is the use of minerals and vitamins and natural and herbal medicines. Population of the rural areas have more likelihood of using complimentary medicines. However, access to suitable care services remain a key issue for this population. healthcare practitioners have been showing interest to use complementary medicines as part of their traditional system[19].

Comparison of Types of Services Delivered in Complimentary Medicine

Australia is now found to be well placed for undertaking further research on complementary medicine and become a leader in evidence-based complementary medicine treatment, services and products on an international basis. Nationally, an estimated $2.3 billion was spent in the year 2000 by Australians on complementary medicine (CM) products and therapists. Australia has been found to hold a strong reputation for fostering mainstream health and medical research that also considers a well-respected approach to complementary medicines. Complementary therapies have become increasingly popular in the last few decades. There was an initial congruence with the enthusiasm for having an alternate lifestyle. The status of this form of medicine has been re-visited in different areas, such as legal regulation, inclusion in medical education, stances of physician’s association and scientific research[20]. A number of universities in the country have been teaching courses on complimentary medicines that include the Royal Melbourne Institute of Technology, the University of Technology in Sydney, and the Victoria University of Technology. The main subjects include Chinese medicine, naturopathy and acupuncture[21].

Sri Lanka is still lagging behind in using complimentary medicines on a substantial basis across the communities. The involvement in managing, providing and organising this form of services is to be made mindful of the use of complimentary medicine. The translation of theory into practice is far from accurate in this country. The concerned authority has restricted the use of this valuable medicinal form in adjunct to conventional treatment options. A large section of the population is waiting for the wider practice of complimentary medicine that is based on research shreds of evidence pointing out the safety, effectiveness and coordination of complimentary medicines. Traditional medicines are considered as an integral part of the healthcare delivery system in Sri Lanka[22]. The most common form of complementary medicine practised in this country is Ayurveda. In light of the inclusion of this subject in the educational domain, it is to be noted that less number of universities are engaging in providing qualifications through training and courses. One of the prominent university in this field is the Institute of Indigenous Medicine at the University of Colombo. There is a consistent and rich pool of literature that highlight that Sri Lanka does not optimally utilise the potential therapists and products of the field of complementary medicine[23]. The focus given by the government is to be made more sharper for including the wider contexts of complementary medicines into primary health care[24]. The country lacks research and a strong evidence base that can act as the driving force behind implementation of the therapies and procedures in accordance with safety and efficacy guidelines. However, it is to be noted that there remains a significant amount of interest from the public’s end in understanding how best can complimentary medicines be used for addressing the wide range of disease[25].

Comparison of Complimentary Medicinal Arrangement into Primary Care Services

The reasons for similarities and differences between Sri Lanka and Australia in context of integrating complementary medicines in primary healthcare can be attributed to a number of factors hailing from cultural, historical, demographic and financial arrangements.

Australia has a prime location as compared to Sri Lanka. Since it is located in the Asia-Pacific region and has the available expertise, the likelihood of having advanced infrastructure is more in Australia as compared to Sri Lanka. Australia also as an attractive environment for undertaking different clinical trials that act as a stepping stone to the European and US markets. The strength of research infrastructure needs special mention which is not present in case of Sri Lanka. The economic base of Australia is capable of supporting the sector growth for complimentary medicines. Development of appropriate metrices provides is witnessed in Australia that provides a suitable picture of value, capacity activity revolving around complimentary medicines. Sri Lanka shows more keenness to use complimentary medicines on a larger scale and integrate the same into primary healthcare services. The historical background of Sri Lanka is rich when it comes to use of traditional medicines.The country has a unique and praiseworthy history with regards to the complimentary medicine practice[26]. The different forms of indigenous medicines in Sri Lanka include Siddha, Ayurveda and Unani, all of which are not cultivated in other parts of the globe, including Australia. All these systems are widely practised in Sri Lanka. However, in spite of the wide practice and availability over time, the domain of traditional medical stream has been known to keep away complimentary medicine. This has thereby hindered the chances of useful research that augment interventions.

Complementary medicines are known to be a form of diagnosis, treatment and prevention tool that complements the mainstream treatment approach through contribution to a satisfying and whole conceptual framework of medicine. These are also to be perceived as holistic medicines that address a number of health complications such as diabetes, drug addiction, and cancer. Some examples of noteworthy complimentary medicines include acupuncture, aromatherapy, naturopathy, reiki and herbal medicines. The underlying principle is that the body is able to heal itself when the healthy state is maintained and that the whole person is to be treated instead of the disease[27]. Integration of complementary medicines in primary healthcare services would be highly appreciable for diversifying the approaches used for treating patients with multifactoral and multidimensional health complications. It is worth mentioning that the medicinal and clinical world is facing an undeniable crisis at the present times. Reforms in healthcare can only be brought about when unconventional approaches are put at the forefront of scientific discussions[28]. Further, integrating complementary medicines would eliminate dissatisfaction with conventional medical approaches. Prescription medicines have been known to lead to dissatisfaction due to limited success rates. This can also be addressed with complimentary medicines. Moreover, complementary medicines would be appealing when applied to primary healthcare services since the root cause of the health problems can be addressed adequately[29].

Reasons for Inter-Country Similarities and Differences


At this juncture, it would be advisable to highlight the concerns emerging in relation to integrating complementary medicines in the primary healthcare system. Firstly, most of the complementary treatment options are still lacking strong standards and dose specifications. The consistency in quality is also far from being accurate. Scientific validation of the treatment options is not in a position to satisfy the criteria for being flawless. Therefore the integration of this form of medicine into the traditional care system would involve the understanding of need gaps in existing form[30].

At the core of the recommendations for Sri Lanka and Australia lies the concept that the present scenario in the two countries regarding integration of complementary medicines into primary health system is complementary to each other. While the acceptability of complementary medicine is more in Sri Lanka, there is much to be done to provide support to such services. The country must learn from Australia the approaches that are to be taken for developing this sector of medicine. Sri Lanka must consider enough funding for carrying out research in this arena. Strong and rigorous research only would ensure that complementary research is integrated into mainstream medicine system. Funding is also required from other non-government sources that can contribute to much growth. A collaborative approach is needed among the different stakeholders for ensuring that research is directed in the proper direction[31] .

Both Sri Lanka and Australia have much to attain in terms of integrating complimentary medicine in primary healthcare services. It is recommended that public information and awareness level can only enhance the use of complimentary medicine on a larger scale. Easy and accessible information would serve as the guide for healthcare consumers to consider using complimentary medicines. The government must come forward to educate the public on the importance, value and potential of this form of medicine. Easy-to-access information can be disseminated through mass media as well. For facilitating the use of complimentary medicine, healthcare professionals must also come forward and join hand with public initiatives. Since care professionals play a key role in educating the public, they are to be trained and given formal instructions to impart education on complimentary medicine.

Advice is given to the governments of the two countries to include institutional level education on complimentary medicines. Universities should start teaching courses on this subject so that a large pool of professionals is created who can cater the diverse needs of the increasing patient population. Structures and processes of education at the university and research level need to be considered for revision if better outcomes are to be achieved in this regard[32] .

Conclusion

Scientific and empirical research has time and again pointed out the benefits of integrating complementary medicine into primary healthcare services. The literature supports the benefits and advantages of such form of medicine including manual therapies, herbal medicine, acupuncture for treating mild and chronic disease alike. The effectiveness of such medicines and approaches have been demonstrated through laboratory experiments as well as clinical trials. From a comparative analysis of Sri Lanka and Australia, it has been highlighted that though both the countries have shown an intention to integrate complementary medicine, Australis has shown more achievements in this field in comparison to Sri Lanka. The cultural and social context of using complementary medicine is more predominant in Sri Lanka; however, the country has not been successful in taking this forward in the contemporary era. In contrast, Australia has set up a strong base to carry out research on this domain and set an effective market base. Research of international reputation is been carried out in this country that Sri Lanka needs to learn from. The financial system of Australia has a major contribution in this achievement. In light of understanding the utility of complementary medicine, it is recommended that both the countries would benefit much in future if they exploit the potential complementary medicines have. Parallel to research there is a need of disseminating the valuable findings of the research to the public at large. Benefits of using complementary medicine and concerned risk are to be accordingly shared with the wider population. Funding is crucial in this regard. It is hoped that with the advent of modern research tools and initiatives taken by the government, both the countries would be in a tough competition with each other for making a mark on the global scale by successfully integrating complementary medicine into primary healthcare services.

References

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