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Physiotherapy regulation in Nepal

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Physiotherapy
Regulation in Nepal
Saurab Sharma
Physiotherapy Member | Nepal Health Professional Council
Assistant Profess...

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Acknowledgement
SAURAB SHARMA, INPTRA 2017 2

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Content
• Brief history of physiotherapy in Nepal
• Physiotherapy regulating body
• Current Code of Ethics and revision
• ...

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Physiotherapy regulation in Nepal

This was a 15 minute presentation made to physiotherapy regulators from across the globe at the INPTRA conference in Cape Town on 30th June, 2017.

This was a 15 minute presentation made to physiotherapy regulators from across the globe at the INPTRA conference in Cape Town on 30th June, 2017.

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Physiotherapy regulation in Nepal

  1. 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 SAURAB SHARMA, INPTRA 2017 1
  2. 2. Acknowledgement SAURAB SHARMA, INPTRA 2017 2
  3. 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 SAURAB SHARMA, INPTRA 2017 3
  4. 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 SAURAB SHARMA, INPTRA 2017 4
  5. 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. SAURAB SHARMA, INPTRA 2017 5
  6. 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. SAURAB SHARMA, INPTRA 2017 6
  7. 7. Regulatory Board Ministry of Health and Population Nepal Health Professional Council Nepal Physiotherapy Association SAURAB SHARMA, INPTRA 2017 7 Physio- therapist
  8. 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). SAURAB SHARMA, INPTRA 2017 8
  9. 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). SAURAB SHARMA, INPTRA 2017 9
  10. 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. SAURAB SHARMA, INPTRA 2017 10
  11. 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? SAURAB SHARMA, INPTRA 2017 11
  12. 12. Upgrading to license exam: BPT SAURAB SHARMA, INPTRA 2017 12 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. 13. Upgrading to license exam: MPT SAURAB SHARMA, INPTRA 2017 13 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. 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. SAURAB SHARMA, INPTRA 2017 14
  15. 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 SAURAB SHARMA, INPTRA 2017 15
  16. 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 SAURAB SHARMA, INPTRA 2017 16
  17. 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 SAURAB SHARMA, INPTRA 2017 17 ◦ 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. 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. SAURAB SHARMA, INPTRA 2017 18
  19. 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 SAURAB SHARMA, INPTRA 2017 19
  20. 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 SAURAB SHARMA, INPTRA 2017 20
  21. 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 SAURAB SHARMA, INPTRA 2017 21
  22. 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 SAURAB SHARMA, INPTRA 2017 22
  23. 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 SAURAB SHARMA, INPTRA 2017 23
  24. 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. SAURAB SHARMA, INPTRA 2017 24
  25. 25. SAURAB SHARMA, INPTRA 2017 25 Thank you Contact: saurabsharma1@gmail.com Link_physio Linkphysio.com www.linkphysio.com

Editor's Notes

  • Bring regards from Nepal – the land of Mount Everest and Gautam Buddha.
    I am here representing Nepal Health Professional Council as a subject committee member for physiotherapy.
    Assistant Prof at KUSMS
  • I am very grateful to INPTRA for providing the scholarship to attend this prestigious conference. Here I will share experiences of physiotherapy regulation in Nepal and take home information to improve regulation of physiotherapy by listening to your experiences throughout the conference.
    Thank Mark Lane for helping with physiotherapy regulation planning in Nepal and encouraging me to apply for the scholarship.
  • I will discuss briefly about ……. .
    I will raise different professional issues which may have implications for other countries as well.
  • Nepal is ~53 times smaller than Australia and more than 4 million people live.
    2.5 million. people live in the capital and neighboring towns.
    Maximum PTs are concentration in the capital, many migrate to Canada to register as a PT and some go abroad for higher studies.



    Washington is approximately 172,348 sq km, while Nepal is approximately 147,181 sq km. Meanwhile, the population of Washington is ~7 million people (24 million more people live in Nepal)




  • CPT is the priority of Government for jobs and other opportunities, which reach to district hospitals.
    Comparable to health assistants.
    No job opportunities for BPT or MPT.
  • Physiotherapy is regulated by Nepal health professional council which works under Ministry of Health and Polulation.
  • Thus the NHPC is extremely busy in taking care of 29 specialties and may not really be efficient enough to be innovative to improvise the standards, regulate ethical practice, take initiatives on improvising the quality of the services being delivered to the consumers.
  • TU counts the number of hours/ years in a course and gives equivalence without evaluating the course itself.
  • Not all physios are trained equally.
    Internship:
    Unsupervised training or no training.
    Inadequate exposure to different areas of physiotherapy.

  • One exam regulation for all 29 specialties.
  • 2 -3 years time for reviewing certificates
    Pending certificates since 2008. Some pending decisions since 2000 AD
  • Huge debate whether to discourage Level B and Level C professionals. How to regulate the roles of each of these?
  • Revised and Reviewed by the chair of Asian West Pacific group of WCPT.
    Submitted to the council for approval in 2015.
  • Respect and dignity: to acknowledge, value and appreciate the worth of all clients.
    Respect for client autonomy: to respect a client’s or substitute decision maker’s right to make decisions for their health and treatment.
    Beneficence: to provide benefit to clients.
    Non-maleficence: to do no harm to clients.
    Justice: to treat and manage all the clients/ patients equally irrespective of race, cast, religion, social status etc.
    Responsibility: to be reliable and dependable.
    Trustworthiness and integrity: to be honest and to be trusted.
    Professionalism: to be a good citizen/ member in good standing (renew the membership status timely) of the regulatory body/ council.
  • Many PTs trained in India.
    Education in Nepal is important.
    better than India for Nepalese.
  • (No exposure to Sports Physiotherapy, animal physiotherapy yet)

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