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 Table of Contents  
EDITORIAL
Year : 2021  |  Volume : 15  |  Issue : 1  |  Page : 1-4

The National Commission for Allied and Healthcare Professions Act – A dawn of a new era of physiotherapy in India


1 Senior Physiotherapist, Neuro-Physiotherapy Unit, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
2 Professor and Head of Department, Neuro-Physiotherapy Department, DVVPF's College of Physiotherapy, Ahmednagar, Maharashtra, India
3 Professor of Physiotherapy and Vice Principal, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

Date of Submission23-Jul-2021
Date of Decision23-Jul-2021
Date of Acceptance23-Jul-2021
Date of Web Publication19-Aug-2021

Correspondence Address:
Prof. Rajeev Aggarwal
Senior Physiotherapist, Neuro-Physiotherapy Unit, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/pjiap.pjiap_19_21

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How to cite this article:
Aggarwal R, Ganvir S, Swaminathan N. The National Commission for Allied and Healthcare Professions Act – A dawn of a new era of physiotherapy in India. Physiother - J Indian Assoc Physiother 2021;15:1-4

How to cite this URL:
Aggarwal R, Ganvir S, Swaminathan N. The National Commission for Allied and Healthcare Professions Act – A dawn of a new era of physiotherapy in India. Physiother - J Indian Assoc Physiother [serial online] 2021 [cited 2021 Dec 3];15:1-4. Available from: https://www.pjiap.org/text.asp?2021/15/1/1/324125



Health-care professionals in a society have dual responsibilities of upgradation as well as delivery of services. The need of regulatory body can never be overemphasized in creating a framework within which health-care professionals upgrade themselves by acquiring new skills, innovating new approaches and technology, transfer knowledge as well as provide health-care services that are innocuous, effective, and patient centred.

India, home of 1.3 billion populations, envisages “Health for All” for holistic development of the country. This mission can be accomplished with good governance, people-friendly health policies, and regulation of health professionals. In the last 70 years, physiotherapy profession has become an integral and important component of health-care delivery system of India. The need and importance of physiotherapy is rising exponentially due to sedentary lifestyle, steady rise in geriatric population, noncommunicable diseases (NCDs), sports-related injuries, and rising disabilities due to trauma, diseases, and disorders. Despite eclectic growth in all dimensions including academics, clinical, research, and popularity among the people, physiotherapy profession still witnesses the agony of apathy by administrators, dominance by other medical professionals, lack of hierarchy/cadres in government organizations, neglect by scientific research funding agencies, and disparity in academic posts compared to other medical professions.[1] With multidimensional growth of the profession and discontent among physiotherapy professionals, a need for regulation was felt and the Government of India responded with many solutions in last many decades, but it could never get consensus of administrators and physiotherapy professionals. After a large number of meetings and negotiations, “The National Commission for Allied and Healthcare Professions Act” was enacted by the Government of India with the assent of the President of India on March 28, 2021, that provides a regulatory body for physiotherapists in India.[2] The aim of this Act is “to provide for regulation and maintenance of standards of education and services by allied and health-care professionals, assessment of institutions, maintenance of a Central Register and State Register and creation of a system to improve access, research and development and adoption of latest scientific advancement and for matters connected therewith or incidental thereto”.[2] This Act may turn out to be a panacea for physiotherapy profession.


  Physiotherapist as Health-care Professional Top


This Act incorporated physiotherapists as health-care professionals that is defined by the Act as “healthcare professional” includes a scientist, therapist, or other professionals who studies, advises, researches, supervises, or provides preventive, curative, rehabilitative, therapeutic, or promotional health services and who has obtained any qualification of degree under this Act, the duration of which shall not be <3600 h spread over a period of 3–6 years divided into specific semesters.[2]

Physiotherapists are often inadvertently termed as allied health person, paramedical, technician, or rehabilitation worker. There is no mention of paramedical category in the Act, whereas rehabilitation workers are included in the Rehabilitation Council of India. The Act recognizes allied health professionals as a group of professionals who will implement any health-care treatment on recommendation of health-care professionals. The Act defines “allied health professional” includes an associate, technician, or technologist who is trained to perform any technical and practical task to support diagnosis and treatment of illness, disease, injury, or impairment, and to support implementation of any health-care treatment and referral plan recommended by a medical, nursing, or any other health-care professional, and who has obtained any qualification of diploma or degree under this Act, the duration of which shall not be <2000 h spread over a period of 2–4 years divided into specific semesters.[2] With these definitions, the debate on inclusion of physiotherapists in paramedical/technicians/allied health professional/multiple rehabilitation workers has been culminated.


  Protection of Physiotherapist Title Top


This Act defines “Physiotherapy Professional is a person who practices physiotherapy by undertaking comprehensive examination and appropriate investigation, provides treatment and advice to any persons preparatory to or for the purpose of or in connection with movement or functional dysfunction, malfunction, disorder, disability, healing, and pain from trauma and disease, using physical modalities including exercise, mobilization, manipulations, electrical and thermal agents and other electro therapeutics for prevention, screening, diagnosis, treatment, health promotion and fitness. The physiotherapist can practice independently or as a part of a multidisciplinary team and has a minimum qualification of a baccalaureate degree.”[2] In the absence of any regulatory/licensing body, many unqualified people claimed themselves as physiotherapists and have been treating the patients. This Act prohibits any person to use physiotherapist title and practice physiotherapy without appropriate qualification in physiotherapy and being registered in the commission as a physiotherapist. This Act recognizes physiotherapists as an independent practitioner and supersedes all previous laws pertaining to physiotherapy practice including clinical establishment act. It is expected that all other legislations where physiotherapists are stakeholders will consider the definition and scope of physiotherapy in the commission as a reference point.


  Our Expectations from the National Commission for Allied and Healthcare Professions Top


Scope of physiotherapy

There are many reports and recommendations by various committees of Government of India that need to be implemented for the welfare of the Indian population. The 23rd report of Committee on Estimates (2017–2018) on Medical Education and Health Care in India by the Department of Health and Family Welfare reported that the “Committee are of the view that there is a huge potential and opportunities for delivering physiotherapy services under primary health care system which can be achieved by integrating the physiotherapy services at all levels of public health care delivery system. The Committee, therefore, recommends that the general public should be made aware of physiotherapeutic intervention as a system of first contact in place of medical intervention so as to improve quality of life and decrease dependency on medicines and drugs.”[3] The committee also emphasized need for making physiotherapy an important and mandatory discipline in the existing and upcoming medical colleges.

As per the report of the World Economic Forum on NCDs in India, the economic burden of NCD for India will be close to US$6.2 trillion for the period of 2012–2030.[4] This is further escalated by the side effects of the drugs. Preventing NCD through nonpharmacological means, i.e., physiotherapeutic system, will be a boon for the national economy. Third-party payers should consider paying for physical therapy by direct access to decrease health-care costs and incentivize optimal patient outcomes. Findings suggest that a physician's diagnosis and referral may not be required to direct care for patients seeking physiotherapy (PT) services. Third-party payers that require a physician referral for physiotherapy services may be delaying access to health care and increasing costs.[5]

Physiotherapy and rehabilitative services in India are largely ignored by the government. Combined physiotherapy, occupational therapy, and speech therapy expenditure constituted only 0.04% in comparison to whooping pharmaceutical expenditure of 35.4% of total health expenditure in 2015–2016.[6] It is imperative to add lives to the years to improve happiness index of our country while we are adding more years to the lives with life-saving measures. We, thereby, expect from the commission to define the scope and formulate the policies for physiotherapy profession to strengthen health-care delivery system of India and reduce the dependency on pharmaceuticals.

Clinical practice

It is a virtuous model to adopt a uniform exit and license exam for professional practice and entrance into postgraduate or doctoral level. The regulation of imparting education and employment of professionals should be coordinated well. At present, the Ministry of Social Justice and Empowerment, Government of India (MSJE), is the nodal department of national institutes for physiotherapy education and the Ministry of Health and Family Welfare, Government of India (MHFW), is the main employer. In spite of postgraduate qualification in physiotherapy imparted by MSJE for the last 20 years, no post has been created for their employment in the clinical sector by MHFW. It has led to underutilization of physiotherapy professionals. We expect from the commission to define the need and role of specialist physiotherapist in various disciplines such as cardiopulmonary, neurology, osteomyology, sports health, geriatric, women health, paediatrics, community care, accident, and emergency and critical care. Therapist–patient ratio needs to be defined in different clinical setups to provide a guideline for optimal delivery of care. In addition, cost-effective and efficient physiotherapeutic guidelines of various clinical conditions need to be developed in context of the Indian population like the stroke guidelines developed by MHFW.[7]

Service conditions

It is a matter of serious concern that Indian society grooms up and spends huge money to create a physiotherapy professional who later opts to serve people of other nations. Pay, respect, and professional developments are the main attractions for Indian physiotherapists to study and work abroad.[8] These factors need to be strived upon to attract scholarly students in physiotherapy and restrain the brain drain of skilled physiotherapists from India. Cadre structure of physiotherapy should be defined for smooth functioning of physiotherapy delivery system. Duties and responsibilities of each position in the cadre should be delineated. Pay scales and recruitment rules for physiotherapists are in abysmal state as these have not changed since many decades. The 31st Parliamentary Standing Committee on Health and Family Welfare and Seventh Central Pay Commission in their reports categorically mentioned that legitimate interests of physiotherapists regarding their pay scales and cadre should be taken care of and their existing pay structure may be revised according to their qualifications and duration of the course they have to put in before entering into a government job.[9],[10] We expect the commission under “career development pathways” to advise the concerned ministries and departments to commensurate the scope, skills, responsibilities, status, and pay scales of physiotherapy professionals.


  Physiotherapy Council Top


The Act has recommended the constitution of Professional Council for each recognized category. Under the National Commission for Allied and Healthcare Professions Rules, 2021, notified on May 27, 2021, there is no mention of duties, responsibilities, and powers of the professional council. The physiotherapy council should be provided with statutory powers to regulate the physiotherapy profession within the ambit of the commission. The liaising among physiotherapy council, state councils, autonomous boards, and advisory bodies is crucial for achieving the goals of the commission.

The constitution of physiotherapy council should encompass representation of each stakeholder. The head of physiotherapy department in national institutes, representatives of institutes of national excellence like All India Institute of Medical Sciences, New Delhi, employee state insurance hospitals, railways hospitals, defense hospitals, central government run hospitals, state-run hospitals, physiotherapists with outstanding scientific research, representative of Indian Association of Physiotherapists, and at least half of the total strength as elected members of physiotherapy profession should constitute the physiotherapy council.


  Academics in Physiotherapy Top


It would be a delight to find uniform basic standards of education, curricula, physical and instructional facilities, staff pattern, staff qualifications, quality instructions, assessment, examination, training, research, and continuing professional education for physiotherapy. The model curriculum prescribed by MHFW may be adopted by the commission as a ready reference.[11] The commission has empowered state councils through autonomous “undergraduate” and “postgraduate” Allied and Health Care Education Boards to determine the standards of health professionals education at graduate, postgraduate, and super specialty levels. Allied and Healthcare Profession Assessment and Rating Board shall determine the procedure for the assessment and rating of allied and health-care institutions by creating benchmarks. Self-evaluation of the institutes against predetermined benchmarks followed by peer team visits to the institutes as followed by the National Assessment and Accreditation Council (NAAC) may be adapted to ensure maintenance of minimum essential standards.

The scheme for opening of new institutions will be set by the central government probably with inputs from experts from all over the country. This will improve the minimum standard essentials of health-care institutions as the inputs from these experts will be incorporated. This Commission has created the opportunity of devising uniform curriculum throughout the country for better communication among the academicians throughout the country. Furthermore, as relevant boards, i.e. Undergraduate, postgraduate, and profession ethics and regulation boards, are being formed at the state level with specific areas of functioning, it will allow rapid communication with concerned authorities and quicker dissemination of issues. However, the constitution of these boards is not clearly described, and hence, there are chances that each state may structure it differently, but hopefully, the function will be the same. However, these are the assumptions at this point as these issues are not clearly spelled out in the act document.

For a student of physiotherapy profession, communication with any other student in the country will be easier as each one will speak the same academic language. The national academic or co-curricular programs such as research conventions, innovation schemes, and academic or research grants can be designed with better ease as there will be uniformity in course content and evaluation timelines.


  Research in Physiotherapy Top


Research is an inevitable and integral part of any health-care profession. The aim of the National Commission for Allied and Healthcare Professions Act is regulation and maintenance of standards of education and services of allied and health-care professions. Promoting allied and health-care professional research should be one of the priorities of the commission. Being a country of multiple cultures and linguistics, India requires a strong research base of its own in any health-care field. The commission should provide provisions to promote research as it improves the quality of care. Physiotherapy profession in India needs to focus more on quality research to build the knowledge base. Physiotherapists employed in academic institutions should be encouraged and supported to carry out quality to research to build the knowledge base. There should be avenues to provide appropriate research support in the form of major grants to promote physiotherapy research. The commission may recommend the government to create structures such as Indian Council of Medical Research and AYUSH department to promote allied and health sciences research including physiotherapy.

At the same time, we should also understand that it may not be possible to physiotherapists involved in clinical care at the gross root level to carry out research. One of the proven solutions to cater the need of practicing therapists is to develop national guidelines.[12] Evidence-based practice improves the quality of health care by providing scientifically proven and transparent care.[13] As observed in developed countries, most of the therapists are the consumers of research findings. Physiotherapy practice should be informed by quality research, and the culture of evidence-based practice can be effectively promoted through continuing professional development (CPD) programs. One of the functions of this commission is to provide guidelines for CPDs. By promoting CPDs, this commission will facilitate the practicing therapists to improve their knowledge and skills lifelong. We believe that the new commission will provide adequate importance to promote physiotherapy research in India.



 
  References Top

1.
Raja K. Physiotherapy - The state of the profession in India: An analysis. Physiother 2017;11:34-6.  Back to cited text no. 1
    
2.
Available from: https://egazette.nic.in/WriteReadData /2021/226213.pdf. [Last accessed on 2021 Jun 25].  Back to cited text no. 2
    
3.
Available from: http://164.100.47.193/lsscommittee/Estimates/16_Estimates_23.pdf page 91-92 [Last accessed on 2021 Jul 16].  Back to cited text no. 3
    
4.
Available from: http://www3.weforum.org/docs/WEF_EconomicNonCommunicableDiseasesIndia_Report_2014.pdf. [Last accessed on 2021 Jul 17].  Back to cited text no. 4
    
5.
Ojha HA, Snyder RS, Davenport TE. Direct access compared with referred physical therapy episodes of care: A systematic review. Phys Ther 2014;94:14-30.  Back to cited text no. 5
    
6.
Available from: https://main.mohfw.gov.in/sites/default/files/NHA_Estimates_Report_2015-16_0.pdf. [Last accessed on 2021 Jul 15].  Back to cited text no. 6
    
7.
8.
Grafton K, Gordon F. The motivations and aspirations of Indian physiotherapists who migrate overseas to study and work: A grounded theory study. Physiotherapy 2019;105:385-95.  Back to cited text no. 8
    
9.
10.
Available from: https://doe.gov.in/sites/default/files/7cpc_report_eng.pdf. [Last accessed on 2021 Jul 17].  Back to cited text no. 10
    
11.
12.
Kumar S. Building research capacity in allied health: New decade, new challenges and new opportunities. Int J Allied Health Sci Pract 2010;8:3.  Back to cited text no. 12
    
13.
Kumar S, Swaminathan N. Evidence-based practice and allied health professions: A modern take on ancient India. Int J Allied Health Sci Pract 2014;12:3.  Back to cited text no. 13
    




 

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