Abstract

The pandemic of COVID-19, since its beginning, has been impacting the lives of people the world over. However, in India, the impact would have been catastrophic had Ayush’s intervention not been there. This paper examines the initiatives and interventions by the leadership of the Ministry of Ayush (MoAyush) to manage the pandemic situation through adaptive leadership. Effective communication, use of IT platform, HR training, engagement with stakeholders, and adaptation of R&D activities are the factors that helped the MoAyush to establish itself as the leader in the fight against the pandemic of COVID-19.

Keywords: COVID-19, leadership, intervention, stakeholders, communication, training, R&D

6.1 Introduction

The very first case of COVID-19 was detected in China on 12^th December 2019. A comprehensive package of technical guidance was issued by the World Health Organization (WHO) with advice to all countries about detection, testing, and managing potential cases on 10th January 2020. The Govt. of India immediately directed the states and UTs to take all necessary action for health sector preparedness following WHO’s advisory. The screening of incoming passengers at the airports of Delhi, Mumbai, and Kolkatta commenced on the 17^th January 2020 and further extended to airports at Chennai, Cochin, Bengaluru, and Hyderabad on 21^st Jan 2020. The first COVID-19 positive case in the country was detected on 30^th Jan 2020 in Kerala.

During times of crisis, there is a generally widespread sense of volatility, uncertainty, complexity, and ambiguity which need very prompt and high impact decisions in a limited information setting. Leaders have to manage these elements and adapt to new situations along the way. The crisis management is the set of activities targeted at reducing the negative consequence of crises. Effective crisis management saves lives, safeguards infrastructure, and restores public faith (Boin et al., 2013). Several characteristics and practices that effective leaders embody during the time of crises are communication, decision making, humanism, innovation, realism, and core values (Kaul et al., 2020). This paper examines the main characteristics and practices the MoAyush adopted during the crises.

The Ministry of Ayush, while taking stock of the situation, issued an advisory on ways to protect the general public from COVID-19 and stay healthy (PIB release 29^th Jan 2020). The advisory comprised of simple home remedies, including the use of common Ayurvedic, Homeopathic, and Unani medicines.

The Ayush Ministry kept a close watch on the pandemic spread and responded with enhanced vigour and foresightedness. It took various initiatives including an awareness generation campaign, Research and Development (R&D), and pieces of training of Ayush manpower in clinical practices to handle the future eventualities, etc. Various important initiatives have helped mitigate the impact that COVID-19 could have brought to the nation.

6.2 Ministry of AYUSH

On the 9^th of November 2014, the Department of Ayush was converted into a full-fledged Ministry by the Government. It was done with a vision for reviving the profound knowledge of ancient systems of medicine and ensuring the optimal development and propagation of the Ayush systems of healthcare. The budget of the Department of Ayush was around Rs 10 crore in 1992 and Rs. 1272 crores in 2014-2015, which became to Rs. 2970.30 crores for the year 2021-2022. There has been a significant increase in the work undertaken by the Ministry over the years. It is worth mentioning that the budget of the Ayush Ministry is a small fraction of the health budget but the impact among stakeholders has been large (PIB release 7^th Feb 2021).

The present government is very supportive of Ayush systems. Various new and innovative programmes have been launched since 2014. International Day of Yoga (IDY), the establishment of IT infrastructure in the form of AyushGrid, the launch of National Ayush Mission, and certification of yoga professionals and accreditation of Yoga Institutions were some of the significant contributions of the Ministry apart from regular Central Sector Schemes. The Ayush services are available in all major government hospitals and Ayush treatment is part of the insurance policy now. Out of 125,000 Health and Wellness Centres (HWCs) the government is planning to establish, 10% would be dedicated to Ayush systems.

6.3 Leadership Principles and Practices by Ministry of AYUSH During Covid-19

In the changing environment, the study of leadership during a crisis has become more relevant because crises are more unpredictable, longer-lasting, and costly than in the past (Pinsdorf, 2004). Leaders all across the world are grappling with the difficulties of anticipating, responding to, and trying to recover from the pandemic of COVID-19.

The pandemic of COVID-19 impacted every sector, but it put the health sector to the test. The foundations of India’s healthcare have been shaken. The public sector performed miserably compared to the private sector. However, the Ayush sector came to the rescue during this crisis through timely intervention and adaptive leadership. The following principles and practices are worth noticing.

6.4 Effective Communication

Effective communication is very crucial during any crisis. Communication done with urgency, transparency, and empathy is effective. It helps the public to adjust to the tremendously changing conditions during any crisis like the pandemic of COVID-19 has shown. The Ministry of Ayush, without waiting for the widespread of Corona Virus, provided effective communication in the form of press releases and advisories to Chief Secretaries of the States/Union Territories and various stakeholders in January 2020.

The Ministry launched a dashboard on its website which provided COVID-19 related information in English as well as in Hindi. Immunity boosting measures for subject care were placed at a very conspicuous place and visible immediately on the landing page. The Ministry also opened an outlet for an immunity booster kit at its Headquarters and also made it available on the Amazon online platform. One of the aspects of effective communication during a crisis is the efficacy of communication. The Ministry through its website, social media, and autonomous bodies regularly communicated with the stakeholders and public at large. Various campaigns like “Ayush for Immunity” and “Yoga for Wellness” were launched on a mass scale. The Ministry also invited suggestions and proposals from various organizations under its Extra Mural Research Scheme to fight COVID-19. Hundreds of proposals were received and considered.

Further, MoA also issued directives to all State/UT licensing authorities and drug controllers of Ayush to increase the production of immunity booster medicines. On one side, efforts were on for promoting immunity efforts but some unscrupulous people were advertising and promoting misleading information about Ayush intervention and were adverting claims for treatment of Covid-19 and cheating people. The ministry took this misleading information very seriously and directed all Regulatory Authorities in the States/Union Territories, through its circular dated 1st April 2020, to stop and prevent publicity and advertisement of Ayushrelated claims for COVID-19 treatment in print, TV, and electronic media and to take necessary action against the persons/agencies involved in contravening the relevant legal provisions and the aforesaid National Disaster Management guidelines (NMMA).

6.5 Sharing of Resources

COVID-19 drastically changed the way people work, shop, eat, travel, and meet. The pandemic set up a paradigm in employment landscaping that required re-scaling and re-training. The Ayush practitioners, though equally competent, were only a fraction of those engaged in clinical management. With conventional health infrastructure coming under huge stress, Ayush infrastructure provided the balance in supply and demand for clinical management. The Ministry enabled the availability of infrastructure in all Ayurveda, Siddha, Unani, and Homoeopathy institutes to act like hospitals, labs, and ICUs along with medical and Para-medical staff to compete with the COVID-19 pandemic. The States and the UTs were suggested to use Ayush infrastructure, which comprises of 50000 beds attached to 750 Ayush Colleges and 86 clinical facilities and Research Councils under the Ministry. All the hospitals, colleges, centres, and facilities were shared.

6.6 Shared Decision Making

Shared decision making involves the bidirectional exchange of information and values, better implementation of the decisions, and enhancement of management strategies (Abrams et al., 2020). Before all the advisories and directions, MoAyush not only consulted the stakeholders but also made shared decisions. The India Institute of Ayurveda (AIIA) launched the Ayuraksha programme for Delhi Police and their families (PIB, 30^th April 2020). All the research councils and national institutes were consulted by the Ministry on regular basis. Ayush-64, an Ayurveda medicine found effective in mild and moderate cases, was freely distributed for COVID-19 positive cases in the second wave. Further, as part of AzadikaAmrutMahotsav, the immunity booster medicines would be distributed to 75 lakh people across the country, with special attention on the geriatric population and front line workers (PIB release 2^nd Sept 2021).

6.7 Training of Manpower

The Ministry of Ayush and the Ministry of Health and Family Welfare jointly organized training of around 33000 Ayush Master Trainers for further training of the Ayush workforce, considering the future requirement to manage the pandemic in April 2020. Over 66000 Ayush personnel were trained at the Integrated Government Online Training (iGOT) portal. The effectiveness of training on iGOT can be seen in that over 37000 Ayush staff were successfully deployed for COVID-19 related health services. In order to attain a high degree of uniformity in sickness care, the ministry has set rules for registered practitioners of distinct Ayush systems (Guidelines for Ayush Practitioners for COVID 19).

6.8 Use of IT Platform

The complete lockdown was announced in the country on 24^th March 2020, commencing at midnight. All services including healthcare services in OPD were at a standstill. There was an urgent need for guidelines on Telemedicine for Ayush systems to the community of service. The ministry issued the guidelines on 7^th April 2020 on its website.

On May 7, 2020, the Ministry launched the “Ayush Sanjeevani” mobile app to collect data on experience, usage of Ayush advocacies within the population, and its impact on COVID-19 prevention. This app would gather information on the measures applied by the people for enhancing immunity and keeping themselves healthy during COVID-19 situations (PIB release dated 7^th May 2020). Data from over 723 thousand respondents for three months, May-July 2020, revealed that 85.2% used Ayush methods for maintenance of body immunity during the COVID-19 pandemic and around 89.8% of them benefitted from AYUSH measures. (Srikanth et al., 2021).

Further, the Ayush Clinical Case Repository (ACCR) portal (https://accr.ayush.gov.in) was established and developed by the Ministry as a platform to support both Ayush practitioners and the public to portray the strength of the Ayush System. In this portal, Ayush practitioners from anywhere in the world can enrol themselves and share relevant information about their successful treatment for the benefit of all. It was launched on 27^th May 2021 (PIB release dated 26^th May 2021). As of now, it has 28 cases including 12 on COVID-19.

The Ministry of Ayush already initiated the Ayush Grid Project in the year 2018 for creating a comprehensive IT backbone for the entire Ayush Sector (Yadava & Ps, n.d.). Through the Ayush Grid, the entire Ayush Sector would be digitalized and it would lead to sector transformation in the field of healthcare delivery at all levels and would help research, education, drug development, and regulation of various health programmes of the Government. The Ayush Grid would be beneficial for all the stakeholders of Ayush at the National and Global levels. Under the Ayush Grid, the project of the Ayush Health Management Information System (AHMIS) had been developed into a quality based information system and over 100 clinical establishments of the Ministry are using it successfully. The Ministry also offered the AHMIS to all the Ayush units outside the Government umbrella so that the entire Ayush Sector benefits. The components of Ayush Grid initiatives would gather and connect all the folks and stakeholders of the Ayush Sector. The Ayush Grid is expected to emerge as a comprehensive IT backbone serving 0.85 million Ayush physicians and over 500 million citizens within 3 years. The Ayush Grid has been integrated with the National Digital Health Mission (NDHM) and will be useful to the public for varied options of health needs. The integration of the Ayush Grid into NDHM will speed up the mainstreaming of Ayush systems of healthcare (PIB release dated 2^nd Oct 2020).

The Ministry also launched a dedicated yoga portal (https://yoga.ayush.gov.in/) to meet the demand of Yoga in the country as well as abroad. The portal contains information on Common Yoga Protocol (CYP), the audiovisual source material for training and practice on CYP, and information related to IDY. Further, a Yoga Break (Y-Break) mobile app was also launched for practising 5 minutes of yoga at the workplace. The protocol has a set of stretches, pranayama, and meditation developed by experts. Y-break, when practised twice a day, would reduce stress and refresh and refocus the workforce.

A pilot project of Telemedicine was launched in the Siddha System of medicine in 100 villages in Tamil Nadu in Nov 2019 by the Ministry with the help of Common Service Centres. Detailed guidelines of telemetry of Ayurveda, Unani, and Siddha practitioners were issued by the Central Council for Indian Medicines on 7^th April 2020 and these guidelines are also made available on the website of the Ministry in line with India’s digital health policy. The Ministry of Ayush also developed a dashboard (https://dashboard.ayush.gov.in/) for various information in the Ayush Sector like Ayush health infrastructure, health, drug industry, institute, research, budget, etc. Another project launched by the Ministry of Ayush is “Ayush Next” to support Ayush education. It is a digital platform intended to enhance the realm of information exchange by providing career recommendations, an interactive forum, quizzes, and more. The group of professionals and domain experts is well-versed in resolving concerns about careers and employment in the Ayush sector. Information on various degrees and certifications is also available. It is a place for young people of the Ayush sector to share their thoughts and knowledge, seek guidance and counselling, discuss, and continue to learn.

6.9 Finding Opportunities for R&D During the Crisis

Ayush Systems have been criticized for not being practically scientific and lacking evidence. The pandemic brought a different type of opportunity before the Ayush Sector to collect fresh evidence and re-establish itself with modern medical science. An Interdisciplinary Ayush R&D Task Force was constituted with Prof. Bhushan Patwardhan as chairperson and other members from the Council of Scientific and Industrial Research (CSIR), the Indian Council of Medical Research (ICMR), Department of Biotechnology (DBT), All India Institute of Medical Sciences (AIIMS), and prominent Ayush Institutions in the first week of April 2020. It designed and formulated clinical research protocols for prophylactic studies and add-on interventions in COVID-19 positive cases. Further, The Ministry of Ayush solicited research ideas from diverse stakeholders in order to develop scientific proof. Over 125 clinical research projects and basic experimental investigations were initiated in over 150 centres across the country based on the recommendations of the Interdisciplinary task group. To name a few, these studies were conducted by King George Medical University Lucknow, All India Medical Institute New Delhi, Institute of Medical Sciences BHU, Govt. Medical College Nagpur, KEM Hospital Pune, National Institute of Pharmaceutical Education and Research Kolkatta, DMIMS Wardha Indian Institute of Integrative Medicine Jammu, and Institute of Genomics and Integrative Biology (IGIB) New Delhi. In addition, the Central Council for Study in Yoga and Naturopathy (CCRYN) has initiated a research initiative to validate the efficacy of Yoga in supporting early recovery of COVID– 9 patients in collaboration with Rajiv Gandhi Super Speciality Hospital, Delhi, AIIMS Delhi, AIIMS Rishikesh, and RML Hospital, Delhi.

The All India Institute of Ayurveda (AIIA) discovered that Ayurvedic therapies such as Ayush kwatha and Fifatrol pills might be helpful in mild to severe COVID-19 infection in a “quite short period” with “total regression of symptoms.” As per the case report published in the AIIA journal ‘Ayurveda Case Report’ in October 2021, the use of four Ayurvedic interventions, Sanshamanivati, Ayush kwatha, Laxmivilasa rasa, and Fifatrol tablets, not only improved the condition of the COVID-19 infected patient but also gave a negative report on the fast antigen test within six days of medication.

6.10 Collaborating with Stakeholders for International Day of Yoga (IDY)

The United Nations General Assembly (UNGA) unanimously recognised 21st June as the International Day of Yoga (IDY) on the appeal of PM Narendra Modi. The day has been celebrated around the world in everincreasing numbers. The Ministry of Ayush is the nodal ministry responsible for managing and promoting the practice of Yoga and coordination activities for the observation of IDY every year. The IDY observance for the year 2021 could not be more timely, as the world and India at large reel from a deadly wave of the pandemic as new variants emerged. Hence, in that spirit, the theme of this year was kept as “Yoga for Wellness” to remind the world about Yoga and the holistic approach to health and wellbeing it takes.

Despite IDY observances, though overcast by restrictions due to the pandemic for a second time, the Ministry learned from previous years’ experience. The Ministry followed a three-pronged strategy which included taking a digital-first approach, activating Government of India stakeholders and their networks which have a wide-ranging reach, and collaborating with the private sector in a greater way to pave the road for the adoption of Yoga at a larger scale and development of the sector in the years to come.

In the digital-first approach, the Ministry leveraged its existing IT platforms and social media including Facebook, Twitter, Instagram, YouTube, the Ministry’s website, and the Yoga Portal; it also leveraged new platforms such as Koo, Josh, and Bolo India to reach wider viewers which consume diverse kinds of content and prefer local and regional languages. The Ministry released additional digital assets apart from improvements in the existing ones, namely the Namaste Yoga application. Further, the Government’s MyGov platform was used for the first time to launch citizen-centred awareness building and engaging activities. People were encouraged to practice yoga based on Common Yoga Protocol (CYP) virtually across the country. Various IT tools and online resources were created during the pandemic. Yoga has been very useful for the well-being of people during the pandemic. The Prime Minister of India himself leads the nation for IDY celebration. He launched the “mYoga” application, developed in house by the Morarji Desai National Institute of Yoga in collaboration with the World Health Organisation (WHO) on 7^th IDY on 21^st June 2021. The app can be used by all to promote one world, one health. (PIB release 21st June 2021). The mYoga application focuses on WHO’s theme of ‘Be He@lthy, Be Mobile (BHBM)’, which is in line with the United Nations’ Sustainable Development Goal of achieving Universal Health Coverage by 2030. The app addresses diseases and risk factors with an opportunity to navigate upon the m-Health programme for Yoga. It offers a collection of learning modules and practice sessions in both audio and video formats, which enable users to practice Yoga anytime from the comfort of their homes. The mYoga app is available in the Google Play Store and Apple App Store. As per the AppBrain ranking report, (https://www.appbrain.com/), the WHO mYoga app is placed at a Google Play store rating of 4.75. It has over 50+ thousand downloads.

The yoga portal of the ministry had a viewership of over 1.05 million. The Yoga Certification Board (YCB) for the Yoga Appreciation Programme and Yoga Volunteer Training (YVT) Course, reported an outreach of about 1.214 million. The Prime Minister addressed the nation on IDY through various DD channels, emphasising the role of maintaining health and well-being in the lives of people, especially at a time when the world was reeling from the COVID pandemic.

All the Central Ministries, State Governments, public sector undertakings, autonomous bodies, various yoga organizations, Universities, National Cadet Corps (NCC), National Social Service (NSS), Nehru Yuva Kendra (NYKs), schools, hospitals, railways, postal services, and GramPradhans were brought on board. To reach the nooks and corners of the country, MoAyush also used services of various Common Service Centres (CSC) and Community Radio Stations to promote IDY activities and motivate people to practice yoga. The Ministry also had a partnership with Nickelodeon and HealthifyMe to reach different segments of people. Indian Missions Abroad were also equally active in the promotion and observation of IDY. The coordinated efforts of MoAyush have made Yoga a mass movement and around 156.86 million people participated during IDY 2021 (Table 6.1).

6.11 Providing Hope When Nothing Seemed to be Working

Ayush, through its communications, continued to inform the citizens to use Ayush products, particularly home remedies for improving immunity in the fight against COVID-19. This hope has helped millions, which is evident from the demand for Ayush immunity booster products, including Chavanprash. The social media of the Ayush Ministry kept engaging people on the use of Ayush products. Prime Minister spoke on Ayush Kadha in mannkibaat. The Secretary of the Ministry, Rajesh Kotecha, who himself is a prominent Ayurveda expert and a Padma Shri awardee, on almost all forums emphasized that Ayush systems were effective tools in the management of COVID-19. Yoga sessions were arranged in Covid Care Centres and were well received.

6.12 Leveraging Old Knowledge

Yoga and Naturopathy have been known for their long term positive impact on the body, mind, and spirit. In the lockdown period, commencing in March 2020, more than physical fitness, the mental and emotional health of people was put to the test. Yoga came as a saviour. The Ministry of Ayush through its autonomous bodies, the Morarji Desai National Institute of Yoga, and the National Institute of Naturopathy (NIN), conducted regular yoga sessions for health and wellbeing. Further considering the impact on mental well-being, the Ministry of Ayush in collaboration with SVYASA and NIMHANS also released a protocol for psychosocial rehabilitation of COVID-19 infected patients.

In October 2020, the Ayush Ministry issued suggestions to incorporate “Ayurveda and Yoga therapies” into India’s national clinical management plan for COVID-19 infection. It suggested treating COVID-19 with warm water gargles, medicinal ghee in nostrils, steam inhalation, drinking “golden milk” (turmeric mixed with hot milk), and kashayam/kadha/kwath (hot infusion with Ayurvedic herbs) in addition to a healthy diet, sleep, and exercise. The clinical protocol advised patients to take Ayurvedic formulations such as Guduchi and Guduchi Ghana Vati, with Asvagandha and Pipalli, even if they were suffering from hypoxia (a lack of oxygen in the body) and dyspnea caused by COVID-19 infection.

6.13 Conclusion

The crisis of COVID-19 has impacted the whole country, but for the Ayush sector, it brought tremendous opportunities. The ministry of Ayush provided timely intervention and has helped reposition Ayush therapy not only at the national level but worldwide. It was made possible with IT tools and the use of the digital platform. Effective and regular communication during the continuity of the crises, sharing of resources with other stakeholders, use of IT platform regressively, training and preparedness of existing manpower, and leveraging old wisdom were some of the practices which helped MoAyush to establish itself as a true leader at the time of crisis.

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