Physiotherapy should be a vital domain in Public Health Framework: Dr Nalinikanta Mishra
Despite the urgent need for physiotherapy services for underprivileged communities, Community Physiotherapy is not a sought-after specialisation in India. Physiotherapists tend to serve in institutions rather than at community level, as a result of which this field of healthcare has stagnated.The need for community physiotherapy has always been on the rise, especially with the shifting paradigm from chronic diseases to lifestyle diseases. Role of prevention of lifestyle diseases, epidemics and harnessing a better lifestyle are of prime importance in the health intervention. Community Physiotherapists are going to be the right personnel to do this job rather than any other medical professionals, as they can bridge the gap between medical knowledge and counseling skills. Rampant urban life leads to physical stress, which in turn is responsible for the psychological stress. This is the first cause for cardiovascular and various psychosomatic dysfunctions. These changing trends need to be dealt with, using physiotherapeutic skills for a larger population in the community. Increased medical treatment costs are also forcing the health planners, health insurance sector and general masses to turn to preventive measures and maintain a healthy state of the mind and body. Community Physiotherapists shall be in great need to fill the gap between increasing number of clients and the trained healthcare workers available in the world. Although the conventional picture of community physiotherapy is slowly changing in the country, the lacunae in the health system still need to be filled. Community rehabilitation projects are run mainly by NGOs in India. However, very few of them work in the health segment, mainly due to lack of motivated health professionals willing to work in the communities. A huge opportunity is presented by treatment of acute or sub acute conditions leading to the necessary fame and monetary gains to physiotherapists. Musculoskeletal, Neurosciences, Cardiovascular Physiotherapy specialisations offer faster results for the improvement and normalisation of dysfunctions of individuals. Secondly, most physiotherapists consider themselves as an integral part of the hospital healthcare set-up and staff. It becomes very difficult for them to imagine working in any other setup where they may have to work with a different set of colleagues. Many are reluctant to shoulder the responsibility all by themselves or as a leader of a mixed professional group which has an integration of experts from medical, allied health, paramedical, non-health related backgrounds and society at large. It is not easy for many physiotherapists to play a multi-professional role in the community set-up.
Firstly, we still have to enrich the role of physiotherapists in various health and social programmes which are established either by government or non-governmental organisations. We have to include subjects like Management and Leadership skills along with an update of Socio-Cultural-Economical issues of the country. This will help the physiotherapists to be more capable and inclined to take the jobs in the administration of the organisations and explore beyond their healthcare knowledge and skills.
Secondly, in situations where resources are limited, we would be in charge of taking care of every aspect of physiotherapy treatment. There could be little or no availability of a graduate physiotherapist in such situations. Our clinical judgement about the health condition plays a pivotal role for the outcome for the needy, especially in a remote situation. We have to work towards being accepted as multi-role professionals who can balance both health and social issues with equal ease and expertise.
Thirdly no doubt, many of us are doing a great job, but we still have a great capability. We must aspire to reach the lead position in different organisations to be able to do justice to our knowledge and capacity. Involvement of a NGO in general or specialised aspects of healthcare projects may ensure limited good as against those organisations who are focused on health issues and are exclusively working for improvement in the scenario. It has been noted that in few NGOs where the physiotherapist is the decision maker and the one responsible for the implementation, this has resulted in distinctly better results in quantity and quality of ongoing programmes in addition to programmes like post-disaster rehabilitation of the survivors. Unless we voice our concerns openly and boldly, we will not be able to receive acceptance from the professionals, planners, government organisations or non-government organisations around the world.
Lastly Afro-Asian continent has a diverse population in terms of socio-cultural, educational, and economical purview. A uniform system is a big problem for effective implementation of any preventive, curative and rehabilitative health programme. We have to make a special needs-based programme for each part of the continent or country, which should have availability of trained personnel, logistics by good governmental or non-governmental agency. It should be cost-effective, such that the success and continuity of the programme can be assured. Physiotherapists can definitely take a lead role in feasibility surveys, designing the community health programmes and their implementation. They will have to create tie-ups with governmental or nongovernmental agencies for financial assistance as well as managing logistics for the ongoing programme.
Community physiotherapy can be a useful addition to the public health system in India. Given the challenging situation of community rehabilitation in the country, the scenario of community physiotherapy has undergone certain positive changes over time. Nevertheless, there seem to be certain lacunae that continue to persist in the system. These need to be duly addressed so that Indian communities get the benefit of physiotherapy services.
Dr Nalinikanta Mishra
Master in Public Health (Health Management), BPT
CHARM(Centre for Health Activities Research and Management)