This document discusses the history and current state of physiotherapy regulation in Nepal. It outlines the regulatory bodies overseeing physiotherapy, including the Nepal Health Professional Council and Nepal Physiotherapy Association. The document also examines challenges such as the lack of a license exam and proliferation of unaccredited physiotherapy programs. However, it notes recent positive developments like revisions to the code of ethics and plans to improve education standards through a license exam and master's program. Overall, the document presents an overview of physiotherapy regulation in Nepal and both current issues and planned reforms to strengthen the profession.

1. Physiotherapy
Regulation in Nepal
Saurab Sharma
Physiotherapy Member | Nepal Health Professional Council
Assistant Professor |Kathmandu University School Of Medical Sciences, Nepal
PhD Student | School of Medicine, University Of Otago, New Zealand
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2. Acknowledgement
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3. Content
• Brief history of physiotherapy in Nepal
• Physiotherapy regulating body
• Current Code of Ethics and revision
• Physiotherapy education
• Minimum requirement for BPT
• Challenges of physiotherapy profession
• Positive steps
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4. Nepal and physiotherapists
•Area = 885 X 193 km.
•Population ~ 29 million.
•14 zones, 75 districts.
•1,500 Registered PTs.
•1 PT per 20,000 people
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5. Physiotherapy (PT) in Nepal –
Brief History
• Nurses and health professional were trained in a Government
Hospital of Nepal.
• Certificate/ Diploma course (CPT)
• 1983 – 1990 (Tribhuvan University)
• 2003 – 2010 (Kathmandu University- KU).
• CPT upgraded to Bachelor of Physiotherapy in 2010 in KU.
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6. Physiotherapy (PT) in Nepal –
Brief History
• Increased awareness of physiotherapy after the 2015
earthquake.
• More job positions in Government hospitals.
• Many proposals to start CPT and BPT courses.
• KU planning to start Master of Physiotherapy.
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7. Regulatory Board
Ministry of Health and
Population
Nepal Health
Professional Council
Nepal Physiotherapy
Association
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Physio-
therapist

8. Nepal Health Professional Council
(NHPC)
• 1 Chairman, 1 Registrar, 9 Board members (1 PT representative).
• Part time / Extra time work (except registrar = secretary).
• 29 different subjects/ professions including physiotherapy.
• 29 sub-committees for every discipline.
• Total 70 000+ registered members (www.nhpc.org.np).
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9. How are physios registered in Nepal?
• Tribhuvan University equivalence for BPT, MPT.
• Completion of online form.
• 20 – 40 US Dollars registration charge for different levels of
registration.
• Document review.
• Review duration ~ 1 month.
• Reviewed by 4 Physiotherapists independently and the registrar.
• Certificate issue time ~ 1 month (varies).
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10. Challenges in registration process
• Fake universities –> distance education= no clinical placements.
• One university has 100 affiliated PT schools.
• Internship training that cannot be trusted.
• Solution: assessment of knowledge and skills.
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11. Upgrading to license exam
• One examination for 29 specialties under NHPC.
• Separate exams for Certificate/ Diploma level, Bachelor and
Master of Physiotherapy.
• Skills/ practical examination?
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12. Upgrading to license exam: BPT
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Topics Marks Weightage
Musculoskeletal physiotherapy 30
60%Neurology (Including mental health) 15
Cardiopulmonary and multisystem disorder 15
Ethics, management and evidence based practice 15
40%
Physiotherapy across life span and across genders
(Geriatrics, pediatrics, women’s/ men’s health)
15
Community Based Rehabilitation and Health
Promotion (Including Exercise prescription)
10
Total 100 100%

13. Upgrading to license exam: MPT
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Sub-topics Marks
Part 1
(50 Marks)
Elective: Specialty subject 50
Part 2
(50 Marks)
Evidence based practice and Research 30
Ethics and management 10
General Topics in Physiotherapy 10
Total 100

14. Current Code of Ethics for
Physiotherapy
• A brief document developed in 2005.
• Mentions the roles of different levels of physiotherapy
professional.
• Level A – Bachelor of Physiotherapy and above (12 + 4.5 years)
• Level B – Certificate level / Diploma (10 + 3 years)
• Level C – Physiotherapy Aid (10 + 1 year)
• No significant difference between the level A and B.
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15. Code of Ethics
Proposed Revision
• Role of the council
• Definitions of physiotherapy professionals
• Core competencies
• Code of ethics
• Distinct scopes of practice: Level A, B and C
• Registration process and re-registration
• License examination
• Continuing Professional Development activities
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16. Ethical Principles: Revision
1. Respect and dignity
2. Respect for client autonomy
3. Beneficence
4. Non-maleficence
5. Justice
6. Responsibility
7. Trustworthiness and integrity
8. Professionalism
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17. Ethical Principles: Revision
◦ Ethical versus unethical practice
◦ Providing good care
◦ Autonomy of client and client-centred
approach
◦ Informed consent
◦ Standards of physiotherapy practice
◦ Record keeping and confidentiality
◦ Involvement in research
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◦ Minimizing risk and ensuring
practitioner’s health
◦ Maintaining professional
performance and ongoing
learning
◦ Professional behavior and
practice
◦ Teaching, supervising and
assessing
◦ Pre-information about service

18. Physiotherapy Education in Nepal
• Kathmandu University runs the only course - 4.5 years BPT.
• Focus on Research and Evidence Based Practice.
• PT students can learn cultural traits of Nepalese that may
contribute to health problems.
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19. Physiotherapy Education:
Clinical Placements and Internship
• Outpatient physiotherapy department
• Cardiac, pulmonary rehabilitation
• Intensive care units: CCU, NICU, PICU
• Neuro-rehabilitation including Spinal cord injury
• Surgery: Orthopedic, Cardiac, Neuro and General
• Community based rehabilitation
• Women’s health and pediatrics
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20. Minimum requirement to start
Bachelor of Physiotherapy
• Revised in 2016 and sent for approval to the council
• Hard to keep balance between high standards and feasibility to
start a course
• Unavailability of Professors, Assistant/ assistant professors
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21. Current challenges
• Getting physiotherapists’ voice to the board
• Keeping physiotherapy as a priority at the council
• Approving documents of physiotherapy; e.g., code of ethics
• Controlling malpractices
• PT’s working beyond the scope of physiotherapy practice
• Conducting license exam
• Controlling students enrollment in fake universities/ institution
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22. Current challenges
• Title – Physiotherapist versus Doctor
• Questions – independent council versus a separate council
• Continuing Professional Development (CPD) activities
• Collaborating with other experts (high cost associated)
• Decentralizing PT’s outside of Kathmandu
• Retaining PTs within the country
• Pay  $60 – 350 dollars per month
• Not enough Government jobs
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23. Positive steps so far….
• Review of the current code of ethics
• Review of minimum standards for starting BPT
• Planned License exam
• Plans for starting Master of Physiotherapy
• More job positions facilitated after Nepal Earthquake 2015
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24. Summary
• Good progress in physiotherapy education and physiotherapy
regulation plans.
• Long way to go.
• Dangers of exponential rise in number of physiotherapists.
• Revision of code of ethics, minimum requirement.
• License examination should start soon.
• Need strong implementation plans.
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25. SAURAB SHARMA, INPTRA 2017 25
Thank you
Contact:
saurabsharma1@gmail.com
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