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Physiotherapy education in Africa- The experience in Nigeria

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Abstract

The African Rehabilitation Institute, an arm of the Organisation of African Unity, recently designed a physiotherapy education programme for implementation in African countries. The West African sub-region, having one of the oldest physiotherapy education programmes in the continent, was not directly involved in the formulation of the programme. A review of physiotherapy education in Nigeria, the first African nation after South-Africa to be admitted into the membership of the World Confederation for Physical Therapy, shows that the programme recommended by the African Rehabilitation Institute is highly commendable.
PHYSIOTHERAPY EDUCATION IN AFRICA
THE EXPERIENCE IN NIGERIA
Seyi L Amosun, BSc Physiotherapy;
PhD Physiology
Department o f Physiotherapy
College of Medicine, University of
Ibadan, Nigeria
Member of the Governing Council
(1989-1993)
Nigeria Society of Physiotherapy
INTRODUCTION
The curricula of physiotherapy education
programmes vary from one country to an
other. The contents of the curricula are also
influenced by the socio-cul tural tenets of each
society1. In addition, because of the continu
ous developments in the area of health care,
there is a constant evaluation of the curricula
to reflect the many changes occurring in the
philosophy, knowledge and practice of
physiotherapy. However, a recent develop
ment affecting the physiotherapy profession
was the directive of the European Economic
Community Council of Ministers, a geopo
litical group. The directive was designed to
make it easier for professionals, including
physiotherapists, to practise in member
states other than their own "home" state by
19922. It therefore became necessary that the
education and training of physiotherapists in
one state be equivalent to that required for
membership of related professional bodies in
other states. An education subcommittee of
the Stan ding Liaison Com mittee of
Physiotherapists (SLCP) in the European
Economic Community (EEC) was estab
lished in 1989 to draw up a report on physio
therapy education within the European
Community3. All member states were repre
sented on the subcommittee, and the recom
mendations are expected to be implemented
by the nations in the EEC.
Due to the downward socio-economic
trends in Africa and the high cost of medical
care, Brew-Graves1 had recommended that
members of the Organisation of African
Unity (OAU) should pool their scarce re
sources to provide basic medical education
relevant to the needs of the continent. The
African Rehabilitation Institute (ARI), an arm
of the OAU, had similar objectives in organ
ising a series of workshops, between 1988 and
1989, to develop a curriculum for physio
therapy education in Africa4. Ten African na
tions, namely Egypt, Botswana, Malawi, Le
sotho, Swaziland, Zimbabwe, Ethiopia,
Kenya, Tanzania and Zambia, were invited to
these workshops. Apart from the curriculum
developed, it was also recommended that
physiotherapy education in Africa should be
a four year University degree. These recom
mendations have been passed to the govern
ments of African states for implementation5.
While the objectives of ARI in organising
the workshops are highly commendable, it
would appear that the geo-political spread of
the invited countries did not include West
Africa, a major economic sub-region. The re
port by ARI stated that two African states,
Egypt and Zimbabwe, offered physiotherapy
education as a university degree. However,
records show that in 1983, Nigeria had three
separate physiotherapy education pro
grammes at university level6. It is therefore
considered that information on physio
therapy education in Nigeria would be bene
ficial in assessing the recommendations in the
report of ARI.
The Physiotherapy profession came into
being in Nigeria in 1959 . In 1967, the Nigeria
Society of Physiotherapy (NSP) became a
member of the World Confederation for
Physical Therapy (WCPT), the second
physiotherapy association in Africa after
South Africa to be so registered. In order to
meet the growing demands for physiothera
pists, there was the need to begin a training
programme locally. The NSP expressed the
opinion that the knowledge, skills and capa
bilities expected of the graduates of the pro
posed programme would best be developed
through university education. Therefore,- the
first physiotherapy educational programme
in Nigeria started in 1966 at the University of
Ibadan, Nigeria. The number of the physio
therapy educational programmes has in
creased from one in 1966 to five at present.
Four of the programmes offer a university
degree, while one offers a diploma. One of the
degree awarding institutions also offers mas
ters and doctoral programmes in physio
therapy.
Since the development of the curricula of
the physiotherapy education programmes
started after 1966 were influenced by the cur
riculum developed for the programme at the
University of Ibadan, it is assumed that a
review of the oldest programme will give a
reflection of physiotherapy education in Ni
geria. Therefore, the aim of this paper is to
review the physiotherapy education pro
gramme of the University of Ibadan, in order
to assess the value of the recommendations
of ARI on physiotherapy education in Africa.
PHYSIOTHERAPY EDUCATION AT
THE UNIVER SITY OF IBADAN
The major course objectives of the pro
gramme have been:
1. To produce physiotherapists with knowl
edge and clinical skills, who will contrib
ute significantly, as members of the health
care team, to the health and welfare of the
sick and physically disabled, as well as
preventing such health problems that may
lead to disabilities.
2. To produce physiotherapists who will not
only practice in hospitals but also work in
rehabilitation centres, sports medicine
centres, industries and as academicians in
the universities.
' Pre-entry Requirements
The candidates were required to be at least
18 years old on admission to the programme, -
with credit pass in the West African School
Certificate (WASC) examination in five com
pulsory subjects, namely English, Mathemat
ics, Physics, Chemistry and Biology.
From 1978, admission into any degree
programme in Nigerian universities was con
trolled by the Joint Admission Matriculation
Board (JAMB). The JAMB annually conducts
a national examination for all candidates'
seeking admission into the universities. From
the results, the admission committee in each
programme then determines the "cut-off"
points for selecting students.
The Curriculum
The curriculum is divided into three
phases, which cover four academic years.
Phase 1: The first year is referred to as the
pre-professional or preliminary year. In
itially, the year had been devoted exclusively
to basic science courses. Later, courses in hu
manities were added to the curriculum.
Phase 2: The second year is the pre-clinical
year, in which the main subjects were anat
omy, physiology, biochemistry and electro
physics. Additional courses in humanities
Bladsy 60 . Fisioterapie, Augustus 1994 Dee150 no 3
t
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and statistics have been included.
Phase 3: The third and fourth years are the
clinical years in which students receive in
structions in all facets of physiotherapy. The
fourth year focused on the principles of
physiotherapy in various medical and surgi
cal conditions. In addition, there were speci
ality lectures in anaesthesia, psychiatry, pa
thology, radiology, occupational therapy and
medical social work. The student was also
required to carry out a research project under
staff supervision. Lastly, the curriculum al
lotted much time for clinical practice. Experi
ence in general nursing was a prerequisite
before the students commenced with clinical
practice. The major objective for the nursing
experience was that the student would be
able to perform simple nursing tasks in the
general care of the patient.
The curriculum was later modified to in
clude statistics and research methodology be
cause it was believed that research training is
invaluable for our students and for the
physiotherapy profession.
The resolution by the World Health Or
ganisation (WHO) that by the year 2000, all
peoples of all countries should attain a level
of health that will permit them to lead so
cially and economically productive lives8, led
to the establishment of the primary health
care programme. This resulted in the modifi
cation of the physiotherapy education cur
riculum, with greater focus on community
based physiotherapy. Courses in humanities
were included in the curriculum for the pre
liminary and preclinical years. Also, courses
in Physiotherapy administration and man
agement were included in the clinical years.
Deficiencies
Increasing pressure is put on different
physiotherapy education programmes to
transform their curricula to focus on the
needs of the majority of the people in their
countries9. Much of our training has been
hospital based and clinically oriented, with
little emphasis on the culture and socioeco
nomic background of the society. Our stu
dents are most competent and able to work
in well equipped hospitals, which give them
a licence to practice outside the country. It is
necessary to modify the clinical training fur
ther to orientate the students to the health
needs and problems in the community, as
well as provide the skills attuned to manage
ment within the limited available resources.
There is the need to allocate more time for
community based physiotherapy, as was rec
ommended by Amosun10, and it should in
clude a period for rural attachment. Introduc
tion of clinical elective posting into the cur
riculum could be also helpful too.
An essential aspect of the physiotherapy
education programme at the University of
Ibadan, is the lack of adequate funding for
development. Any increase in the intake of
students, from the present estimated average
of 20 students per academic year, is limited
by the need for support personnel. Funds are
needed to train the academic staff, to update
the library with current reading materials,
and to equip the research laboratory. Com
puters with appropriate software, equipment
and other teaching aids are needed for teach
ing, research and secretarial uses. Space is
also a critical factor as the present physical
layout may not be able to accommodate the
needed development.
The main objectives of the recommended
programme by ARI are to produce
physiotherapists who:
are capable of performing therapeutic
skills in varying capacities in solving
health problem s of individuals and
groups.
are capable of relevant scientific research,
administration and participation in con
tinuing education to improve perform
ance.
have a wider concept of rehabilitation in
Africa.
Similarities are observed, when compar
ing the ARI programme with that of the Uni
versity of Ibadan, regarding programme ob
jectives, pre-entry requirements, length of
course, subjects essential for theoretical and
clinical education, and clinical practice. One
major difference is the fact that ARI has pre
pared different and distinct programmes for
physiotherapy and occupational therapy
education. However, Nigeria has no occupa
tional therapy education programme, and
the physiotherapy students are trained to as
sume some of the responsibilities of the occu
pational therapist.
Another difference is that the University
of Ibadan programme has focused on geron
tology, which is in line with the recommen
dation of the WCPT that gerontology be
stressed throughout the training11. The ARI
curriculum has focused only on diseases of
old age in the psychiatry course. The care of
the elderly is of particular importance in Af
rican culture. The elderly person is not insti
tutionalised but rather occupies a respected
position in the community. It is also impor
tant that the ARI should be emphatic on
whether the physiotherapy educational pro
gramme should be an integral part of the
Faculty of Medicine of the university or be
run by schools of physiotherapy outside the
Faculties of Medicine, as in some schools in
Britain12.
Two of the conclusions from the SLCP
report13 are that: '
1. The SLCP supports four year educational
programmes for the profession of physio
therapy in order to meet the develop
ments of the society.
2. The professional education should include
elements of self and corporate analysis for
the objective assessment of effectiveness
of the individual and the efficiency of
physiotherapy services.
On comparison, it would seem that the
physiotherapy education programme of the
University of Ibadan has many similarities
with the programmes offered in most coun
tries of the European Community, especially
in the subjects included in their curricula3.
CONCLUSIONS
Physiotherapy has evolved over the years
from the initial role of providing technical
care, to providing primary care. Thus the
curriculum has moved from focusing solely
on technical skills to incorporating elements
of thought and rationalisation for actions
taken. The trend today is to supplement the
curative approach with that of prevention.
While physiotherapy education in Africa
may not be as developed as in some countries
like Canada and the United States of Amer-
ica6'14, there is evidence to show that a uni
versity degree in physiotherapy education
had been started in Africa many decades ago.
The first BSc Physiotherapy degrees in South
Africa were awarded in the late nineteen-for
ties15, while the BSc Physiotherapy degree
programme was started in Nigeria in 19667.
However, global socioeconomic changes
have made it necessary for some geo-political
blocks to pool resources in the training of
physiotherapists. With similar aims in mind,
the physiotherapy education programme
recommended by ARI for African countries,
compares favourably with that of the Univer
sity of Ibadan, although Nigeria was not rep
resented at the planning workshops. The
aims of ARI are highly commendable, and
the benefits in the physiotherapy education
programme designed for Africa, if given the
necessary support, will soon be manifested.
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physiotherapy training in Africa. Sebri Printers,
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5. Irwin-Carruthers SH. Report on the first gen
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vant? South African Journal of Physiotherapy
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Physiotherapy, August 1994 Vol 50 No 3 Page 61
Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2013.)
... Bedside teaching was the most popular workplace teaching style received by physiotherapists in our study. This is the same in most African countries (Amosun 1994). A general lack of frequency and structure for teaching was also highlighted, which had a lot to do with a lack of guidelines and support. ...
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Report on the first gen eral meeting of the African regional organi sation of the World Confederation for Physi cal Therapy
  • S H Irwin-Carruthers
Irwin-Carruthers SH. Report on the first gen eral meeting of the African regional organi sation of the World Confederation for Physi cal Therapy. South African Journal o f Physio therapy 1992;48:27-28.