Ayush systems in India- understanding the Awareness, Utilization, and Out-of-Pocket Expenditure (OOPE): Insights from the 79th round of National Sample Survey (NSS)- 2022–23

BACKGROUND: Ayush systems form a crucial component of India's healthcare system. Despite sustained policy attention, the implementation of the National Ayush Mission scheme and progress in the sector, challenges persist in the availability and utilization of Ayush services in several States/UTs. Drawing on the National Sample Survey (79th Round, 2022-23) on Ayush, this study examines state-wise variations in awareness, usage, and out-of-pocket expenditure (OOPE) on Ayush medicines, alongside the availability of infrastructure, human resources, and financial burden. METHODS: A descriptive cross-sectional analysis was undertaken using NSSO 79th Round data, supplemented with information on Ayush dispensaries and registered practitioners. Population coverage per dispensary and per practitioner served as proxy indicators for infrastructure and workforce availability. States/UTs were categorized by availability levels and usage relative to the national average (496 users per 1000). Cross-tabulations and comparative categorizations were used to examine inter-state variation. RESULTS: National awareness exceeded 95%, while usage remained around 50%, with substantial variation across States/UTs. 20 States/UTs reported above-national average usage and sixteen below. Infrastructure availability varied widely, with only five States/UTs meeting high dispensary coverage and thirteen exhibiting very low coverage. Practitioner availability was similarly uneven, ranging from zero in several Northeastern States to strong density in Kerala and Maharashtra. Higher availability did not consistently correspond with higher usage. OOPE averaged ₹523 per capita annually, with significant inter-state differences, indicating non-linear associations. RECOMMENDATIONS AND CONCLUSION: Despite widespread awareness, Ayush utilization remains uneven due to infrastructure gaps and workforce disparities. Strengthening infrastructure and human resources, improving quality of care, expanding digital systems, enhancing public financing, education and training, promoting evidence-informed communication, and reinforcing research-practice linkages are essential to improve access, utilization and financial protection.