A Decade of Transformation in Ayush Health Care: An Integrative Review of Policy, Research, and Public Health Outcomes (2014–2025)

INTRODUCTION The Government of India upgraded the Department of Indian Systems of Medicine and Homoeopathy to a full Ministry of Ayush in November 2014.[1] The Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa, and Homoeopathy are all covered in the mandate of the ministry.[1] In 2025, the National Sample Survey Office (79th round, July 2022–June 2023) discovered that 95% of rural and 86% of urban households were found to have at least one household member who had heard about medicinal plants or local health practices.[2] Although there is good awareness, the use of the formal Ayush infrastructure and clinical outcome are not formally reported. Four objectives of this review are (1) to report the Ayush infrastructure expansion (2014–2025), (2) to review research output and Centre of Excellence achievements, (3) to assess Ayush implementation into national health programs, and (4) to determine gaps in implementation. METHODS A document review was conducted using 12 Ministry of AYUSH publications, including 11 Years of Transformation in AYUSH: 2014–2025 (184 pages), Annual Report 2020–2021, Annual Report 2022–2023, and Standard Treatment Guidelines, with a total corpus of 190 pages. The quantitative data on infrastructure, research projects, publications, international collaborations, and exports were picked. Statistical re-analysis was not carried out. Limitations are dependence on self-reported government data and are lacking long-term clinical outcomes. RESULTS Healthcare infrastructure In 2023–2025, there were 751,768 registered practitioners, 932 postgraduate colleges, 3,885 hospitals, and 37,804 dispensaries all over the country in the Ayush network.[1] The number of hospitals and dispensaries in the government sector was 3428 and 27,870, respectively. There were 8369 drug manufacturing facilities. Undergraduate colleges were growing significantly in 2013–2014 to 2024–2025.[1] Under the National Ayush Mission (NAM) up to 2024–2025, 203 integrated Ayush hospitals were supported; 518 Ayush hospitals and 6,234 Ayush dispensaries were upgraded; 2387 primary health centers (PHCs), 746 community health centers (CHCs), and 319 district hospitals (DHs) received co-location support; 1157 Ayush hospitals and 12,677 Ayush dispensaries received annual medicine supply; 21 new Ayush educational institutions were established including All India Institute of Ayurveda and National Institute of Ayurveda; 78 graduate and 46 postgraduate Ayush institutes were upgraded; 383 new Ayush dispensaries were established; 1429 Ayush Grams were supported; and 12,500 Ayushman Arogya Mandirs (Ayush) were supported.[3] Research and Centres of Excellence The Centre of Excellence scheme was launched as part of the 11th Five-Year Plan (2007–2012) and was carried over to Ayurswasthya Yojana (2021–2026). There are 51 projects under sanction, 31 completed and 20 undergoing by 2025.[4] Nine non-Ayush institutions of national repute received funding: Tata Memorial Centre (cancer), CDRI Lucknow (fundamental research), JNU New Delhi (systems medicine for rheumatoid arthritis), IIT Delhi (sustainable Rasoushadhis), IISc Bengaluru (diabetes and metabolic disorders), CIMR AIIMS Delhi (yoga in cardiac rehabilitation), NIMHANS Bangalore (neuropsychiatric disorders), ILBS New Delhi (hepatoprotective agents, NAFLD), and IIT Jodhpur (integrative precision health).[5] Four AIIMS were called Ayush-ICMR Advanced Centres of Integrative Health Research: AIIMS Delhi (gastrointestinal disorders, women-child health), AIIMS Jodhpur (geriatrics), AIIMS Nagpur (cancer care), and AIIMS Rishikesh (geriatrics).[6] The Ayurgenomics, drug discovery, immunology, infectious diseases, integrative medicine, maternal–child health, metabolic disorders, neurology, oncology, public health policy, research ethics, capacity building, and rheumatology are the areas of research of the Centre of Complementary and Integrative Health at Savitribai Phule Pune University.[7] The network of collaboration covers NCCS Pune, Memorial Sloan Kettering Cancer Centre USA, Serum Institute of India, and others.[8] In 2022, 16 central organizations released 871 articles in indexed journals (UGC-CARE, PubMed, Web of Science, and Scopus). The National Institute of Ayurveda, Jaipur (330), CCRAS (133), CCRUM (75), and CCRH (62) were the top contributors.[9] As of 2025, there were 43,722 research publications in the Ayush Research Portal.[1] The number of books, monographs, and manuals published in 2022 across all organizations amounted to 175.[9] In response to the coronavirus disease 2019 (COVID-19) pandemic, a total of 150 research studies were conducted. Ayush-64 and Kabasura Kudineer were used as COVID-19 management. A mobile app–based study called Ayush Sanjivani collected responses from 1.33 crore (13.3 million) people. After analysis of 7.24 lakh (724,000) respondents, the study found that 85.1% of participants used Ayurveda, Yoga, Unani, Siddha, or Homeopathy (AYUSH) measures, and among them, 89.8% reported experiencing health benefits. A study of 80,000 Ayurraksha, the Delhi Police personnel (published in Frontiers in Public Health) showed that the risk of COVID-19 infection is reduced by 55.6%.[1] Standard treatment guidelines In Ayurveda, the Ayush Vertical, Directorate General of Health Services, issued Standard Treatment Guidelines on Management of Metabolic Disorders (April 2025) which included diabetes mellitus, dyslipidemia, gout, nonalcoholic fatty liver disease, and obesity. All the guidelines have case definition, etiology, pathogenesis, clinical presentation, differential diagnosis, red flag signs, and prevention management.[10] International cooperation As of 2022–2023, India had entered 24 country-to-country Memorandums of Understandings (MoU) to collaborate in the field of traditional medicine, 43 MoUs with international institutes to conduct joint research, and 15 Ayush Academic Chair MoUs in foreign universities and created 39 Ayush Information Cells in 34 countries. As of 2022–2023, there were 277 students enrolled by the Ayush fellowship scheme (2022–2023).[9] On March 25, 2022, with a Host Country Agreement and ground-breaking on April 19, 2022,[1] the World Health Organization (WHO) Global Traditional Medicine Centre (GTMC) was inaugurated in Jamnagar. WHO-GCTM has a total approved budget of US$85 million over a period of 10 years.[9] The International Classification of Diseases 11th Revision (ICD-11) Traditional Medicine Module 2 (Ayurveda, Siddha, and Unani morbidity codes) was launched by the WHO in Delhi on January 10, 2024. India has established the Group of Friends of Traditional Medicine in May 2023.[1] The technical post of the WHO at Geneva was promoted to the P-5 level, with an Ayush expert being deputed.[9] Ayush and herbal product exports increased from US$539.9 million (2020–2021) to US$689.3 million (2024–2025), a compound annual growth rate of 9.9%.[1] On July 27, 2023, a distinct Ayush Visa was introduced and has four subcategories: Ayush Visa (AY-1), Ayush Attendant Visa (AY-2), e-Ayush Visa, and e-Ayush Attendant Visa.[11] Digital initiatives and International Day of Yoga There are 22 digital initiatives in the Ayush Grid.[1] The Ayush Hospital Management Information System was introduced in over 95 health facilities.[9] In May 2025, the Yoga Portal was re-engineered and registered 3.6 crore participants with 10+ TB data at International Day of Yoga (IDY) 2025. The Y-Break mobile application has a heart rate monitor, body mass index calculator, and step tracker. On May 29, 2025, the Ayush Nivesh Saarthi Portal of investors was released. The Ayush Suraksha Portal is a pharmacovigilance portal that was launched on May 30, 2025. NAMASTE Portal offers standard terminologies in line with WHO ICD-10 and ICD-11.[1] IDY 2025 registered over 1.3 million Yoga events throughout India. The biggest meeting, presided by the Prime Minister in Visakhapatnam, involved more than 300,000 people. Two Guinness World Records were established, one being a Surya Namaskar by 22,122 tribal students. Participation reached 191 countries. IDY 2022 reported a total of 22.13 crore participants, and the IDY 2023 included 192 countries with 23.44 crore participants.[1] DISCUSSION We assessed the Ayush sector transformation of India in 2014–2025 based on government documents. There are four key findings. Infrastructure expansion versus utilization gap The increased number of registered practitioners (751,768) and educational institutions (932 UG colleges) is significant investment.[1] Nevertheless, the National Sample Survey Office (NSSO) 79th round concluded that 46-53% of the population used Ayush in the last year,[2] which implies that the formal sector only represents a part of the total Ayush usage. The Ayush co-location in 2387 PHCs, 746 CHCs, and 319 DHs is a rational approach,[3] yet there is no report on cross-referral rates, patient satisfaction, or clinical outcomes of these integrated facilities. Research output: Quantity versus concentration The number of published articles is 871 in 2022, which is good.[9] Nevertheless, the National Institute of Ayurveda, Jaipur, had 330 (38) of these articles; 10 of 16 organizations had less than 20 articles each.[9] The capacity of the research is very centralized. Inclusion of premier institutions such as Indian Institute of Science(IISc) and National Institute of Mental Health and Neuro Sciences (NIMHANS) in the Centre of Excellence scheme is healthy, but the results of such collaborations are not provided outside the list of funded projects.[5] Global positioning and trade It is interesting how India has been at the forefront of setting up of WHO GTMC[1] and ICD-11 Module 2.[1] India is a standard-setter with the establishment of ISO/TC 249/SC 2 (Ayurveda and Yoga) with India in the secretariat roles. However, Ayush exports have been increasing at 9.9% Compound Annual Growth Rate (CAGR)[1] even as the world market in herbs has been estimated to be US83 billion; India is not yet getting anywhere near 1%. Pharmacovigilance network has reported adverse drug reactions, yet the figure is low compared to 8369 manufacturing units.[1] There is still a culture of spontaneous reporting of ADR. Recommendations Our recommendations are: (1) create a national Ayush clinical outcomes registry to prioritize conditions, (2) expand the number of Peripheral Pharmacovigilance Centres to at least 97 centers per district, (3) publish state-wise utilization report on NAM and central schemes, (4) carry out mixed-method Ayush-PHC services evaluation, and (5) create a special Ayush export facilitation cell. CONCLUSION Between 2014 and 2025, the Ministry of Ayush developed the significant institutional infrastructure: 751,768 registered practitioners, 932 undergraduate colleges, 3885 hospitals, and 37,804 dispensaries.[1] In 2022, research output was 871 indexed publications,[9] with 51 Centre of Excellence projects[4] and four AIIMS-ICMR advanced centers.[6] WHO GTMC,[1] ICD-11 Module 2,[1] and Ayush Visa[11] improved its international recognition. Nevertheless, the shortage of clinical outcomes on a population-level and reduced share of exports is still an issue. The second step must focus on potential clinical registries, enhanced pharmacovigilance, and intensive testing of models of integrative care.