The recent celebration of the first National Siddha Day on 4 January by the AYUSH Ministry is good optics, indicating intent to promote traditional health systems. The potential of siddha, a millennia-old medical system with roots in Tamil culture, has been largely unexplored in both medical research and public healthcare delivery.

This ancient system, the literature of which is entirely in Tamil, is considered to originate from Agastya and has been developed by the siddha spiritual lineage which has strong links to the Nath Sampradaya in central India. For the siddhas, the goal was to attain siddhi (perfection) which included perfecting the body, leading to the development of a holistic medical system. Their spiritual and medical discoveries are recorded in texts written in seemingly simple Tamil, but with multiple layers of mystical meaning.

The medical system is similar to Ayurveda but has broader framework of looking at health and nutrition in terms of balance among three bio regulators vata, pitta, kapha. There is also a stronger emphasis on use of metals, minerals and salts as compared to Ayurveda, which is largely herb based, leading to many unique remedies. Siddha places great importance on preventive healthcare and revolves around the notion of unave marunthu (food by itself is medicine). Traditionally, and to a large extent even today, this knowledge has been handed down through families devoted to this practice without much institutional support.

There have been a few stray attempts by the Indian government to create institutional mechanisms for siddha education and practice. There is a five-and-half-year Bachelors in Siddha Medicine and Surgery (BSMS) programme, with the last year dedicated to on-field training. This degree is technically considered to be on par with MBBS, with the Central Council on Indian Medicine under AYUSH Ministry acting as the national regulator. Graduates are absorbed into the public healthcare system through the 300 National Rural Health Mission centres or go on to set up independent practice.

There are a few research centres like the National Institute of Siddha in Chennai which undertakes national-level research initiatives. The educational institutes, research centres and healthcare postings are scarce and predominantly restricted to Tamil Nadu and Kerala with the system being virtually unknown on a national scale. While Yoga and Ayurveda have immensely benefited from increased awareness, sustained research, institutions, grants and documentation of traditional knowledge, siddha has not garnered that degree of research and policy attention. It is in this backdrop of inadequate institutional and policy support for siddha education, practice and research that the current initiative sends the right signal.

The state is uniquely positioned to address service delivery mechanisms for public goods like research, innovation and education in healthcare, which cannot be completely addressed by markets. State intervention in health can lead to powerful and positive externalities that benefit the common citizen and lower primary healthcare expenditure. With less than 1.5 per cent gross domestic product (GDP) allocation, India ranks lowest among BRICS countries in healthcare spend leading to major concerns about out-of-pocket expenditure.

The country also faces a burgeoning health crisis in the rapid growth of lifestyle-related diseases including cardiovascular diseases, diabetes and chronic respiratory diseases. Coupled with this, there is a dire need to address lack of access to medical care due to shortage of trained medical personnel. While it is important to work towards increasing insurance coverage, there is a pressing need to direct efforts towards scalable, cost-effective preventive and primary healthcare. Siddha, with its strong emphasis on preventive and primary healthcare holds great promise in this regard. But to realise these benefits, the government needs to have a clear and sustained focus on building an ecosystem for siddha research, education and medical practice.

Recent medical history including the Nobel Prize winning malaria treatment based on Traditional Chinese Medicine (TCM) and the recent publication in Nature, that establishes a potential genomic basis to Ayurveda’s tridoshic physiology that paves way for personalised medicine, shows the tremendous benefits of interdisciplinary research based on traditional medicine systems. Compared to TCM and Ayurveda, the siddha system, which has been practised for millennia, has hardly received research attention. The government, particularly the AYUSH Ministry can play an important role in providing much-needed institutional backing and grants for siddha research. This would provide empirical verification of treatments and also spur new approaches to disease prevention and treatment.

This research can feed into augmenting existing primary healthcare mechanisms nationwide. To achieve this, there is a need for a large pool of trained practitioners. As of 2010, there are only 7,195 nationally registered siddha practitioners all based out of Tamil Nadu and Kerala, as compared to 478,750 Ayurveda practitioners nationwide. There are only seven under graduate institutions and three post graduate institutions where siddha can be studied, all based in Tamil Nadu and Kerala.

This crippling shortage needs to be addressed by improving quality and enhancing capacity in existing institutions and by setting up new institutions for siddha education. It must be complemented by rigorous certification mechanisms to identify traditionally trained experts, a model that has been recently attempted with Yoga. For students to enroll, there is a need to develop a comprehensive ecosystem with appropriate forward linkages from education to careers. In preventive healthcare, a siddha inspired understanding of fundamental health principles and simple remedies disseminated through primary education and media outreach can minimise primary healthcare burden and reduce out of pocket expenditure.

Overall, this is a welcome signal of intent from the government. National recognition can indeed act as a boost. But it is crucial to look beyond and work towards institutionalisation, capacity building and creating a holistic ecosystem with appropriate forward linkages – measures that can lead to concrete public good. It is high time that an Indic knowledge systems like siddha receives concrete policy attention it deserves to realise its potential for human wellbeing. This could be Tamil Nadu’s gift to India and the world's wellbeing. That would indeed be an appropriate universalism.

Shyam Krishnakumar and Varalakshmi Lakshminarayanan

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