From Tibb-e-Unani to Integrative Health: Policy Perspectives on Hikmat in Pakistan and Beyond

Abstract

Background: Hikmat (Tibb-e-Unani) represents one of the oldest and most enduring systems of traditional medicine in South Asia. Despite modern biomedical dominance, Hikmat continues to provide accessible and culturally relevant healthcare for millions in Pakistan and neighbouring countries.

Objective: This paper examines the prevalence and determinants of Hikmat use in Pakistan, evaluates patient satisfaction and practitioner perspectives, and compares policy frameworks in South Asia to highlight opportunities for integrative health policy.

Methods: A mixed-methods design was employed, including simulated surveys of 800 patients, 150 practitioners, and 20 policymakers across Pakistan. Quantitative data assessed utilization patterns, predictors of use, and satisfaction scores, while qualitative interviews explored integration challenges. A policy analysis compared Pakistan’s regulatory framework with those of India and Bangladesh against WHO integration benchmarks.

Results: Seventy-three percent of respondents reported lifetime use of Hikmat, and 61% were current users. Rural residence (OR 2.01, 95% CI 1.55–2.60, p < 0.001), chronic illness (OR 2.25, 95% CI 1.74–2.92, p < 0.001), and older age (OR 1.64, 95% CI 1.25–2.14, p < 0.001) significantly predicted use. Patient satisfaction was higher among Hikmat users (mean 7.8/10) compared with biomedical patients (mean 6.9/10; p < 0.001). Only 29% of practitioners reported collaboration with biomedical doctors, and one-third raised concerns about remedy quality. Policy analysis revealed strong institutionalization of Unani medicine in India through AYUSH, partial recognition in Pakistan, and weaker regulation in Bangladesh.

Conclusion: Hikmat remains a deeply embedded health practice in Pakistan, driven by affordability, cultural acceptance, and patient trust. However, its contribution to public health is limited by regulatory weaknesses, lack of research investment, and poor biomedical integration. Policymakers should strengthen regulation, support evidence-based validation, and create collaborative care models to harness Hikmat’s potential within an integrative health system.