Nepal

Original Editor - Manisha Shrestha Top Contributors - Manisha Shrestha and Kim Jackson

Introduction

Nepal is one of the countries located in the Asia Western Pacific Region.

It has a three-level federal system of government which includes federal, provincial, and local so the health system has also been federalized.[1] Along with government health facilities, there are various private, community, and international non-governmental organizations which are providing health services to the public. Government health insurance policy has recently been started here in Nepal and not in all provinces it has reached out. Physiotherapy service has been incorporated in government health insurance.

Physiotherapists in Nepal are working in an in-patient setting, out-patient, rehab, community and as a part of different sports teams.

A brief history of Physiotherapy in Nepal

  • Earlier in the 1980s, Nurses and other health professionals were trained in Government hospitals.[2]
  • Nepalese students went to foreign countries mainly India to gain a degree in Physiotherapy.
  • Certificate/Diploma of Physiotherapy (CPT) was started from 1883-1990 in Tribhuvan university whereas from 2003-2010 in Kathmandu University. Later CPT course upgraded to Bachelor of Physiotherapy (BPT) in 2010. [2]
  • Recently, in 2018 BPT has been started at Pokhara University as well.
  • Kathmandu University is planning to start a Master of Physiotherapy.
  • Increased level of awareness about the need and role of physiotherapy in Government and public level since the massive earthquake in 2015.
  • More job positions are being created at the Government level.[2]
  • Now,

Practicing physiotherapists in Nepal: 2,053

Member of Nepal Physiotherapy Association (NEPTA): 455[3]

Regulating Bodies of Physiotherapy in Nepal

Nepal Health Professional Council (NHPC)

It is a national governing body that comes under the Ministry of Health and Population (MOHP) of Nepal. Under this council, there are about 29 different professions registered including Physiotherapy.

Nepal Physiotherapy Association (NEPTA)

  • It is a national organization of professional Nepalese physiotherapists.[4]
  • NEPTA is recognized by the Government of Nepal and registered as a national umbrella organization of professional physiotherapists.
  • It becomes a member of the World Confederation for Physical Therapy (WCPT) in 2003.
  • It is the 11th smallest member organization in the Asia Western Pacific Region of WCPT.
  • There are 455 physiotherapist members in this member organization (MO).[3]
  • The Nepal Physiotherapy Association has experienced a 9% increase in membership numbers in the past year. (Survey from 2018).

Therapist Preparation

Entry Requirement to BPT for Students

  • Intermediate in Science (ISc) or Higher Secondary Level (10+2 Science streams) in biology stream or equivalent Proficiency Certificate level of Physiotherapy (CPT) (registered in NHPC) as recognized by concern University with at least 50% marks or equivalent.
  • A written entrance examination will be held for all applicants and should secure 50% marks to be eligible for admission which is followed by interview.[5]

Institutes for Physiotherapy degree

  • Kathmandu University School of Medical Sciences (KUSMS) was the only place where formal undergraduate (4.5 years) physiotherapy course is delivered in Nepal. But since 2018/19, Pokhara university has also started Bachelor of Physiotherapy.
  • Currently, student intake is increased to 30 students every year.
  • Bachelor of Physiotherapy is a 4 and half year course (4 academic years and 6 months of an internship). [5]
  • Whereas, Diploma of Physiotherapy affiliated under CTEVT which is a 3-year course done immediately after secondary level of education is still being run in School of Health Sciences, Chitwan, and in Nepalese Army Institute of Health Sciences.

To work as a Physiotherapist in Nepal

To work as a Physiotherapist in Nepal, one needs to be registered under Nepal Health Professional Council and obtain a license to practice. The physiotherapist need not need to undergo an examination of his/her knowledge, in order to get the license till now but in upcoming days she/he may need to. NHPC is currently making an exam format for licensing purposes.

 Specialization

  • Physiotherapists with a postgraduate degree in different fields of Physiotherapy such as sports medicine, musculoskeletal, pediatrics, neurology, geriatric, etc. are available in Nepal. Some of them have already completed and some are doing a doctorate in different specific fields. Physiotherapists are involved in clinical, academic, and research aspects.

Patient Access to Physiotherapy or Physical Therapy Services / Entry Point

  • A physiotherapist can act as a first contact practitioner. A patient can have direct access to physiotherapy. Direct access means a person can refer themselves to a physiotherapist without a referral from another health professional.
  • People can refer themselves but they do not know where to go at first. This is a lack of awareness regarding health education in Nepal. There is no rule that the patients are to be first directed to medical doctors and then to physiotherapy by referral but this has been the general practice, unfortunately.
  • If a patient is aware of the need for physiotherapy for his/her problem, she/he can go directly to the physiotherapist in both private and public practice.[6]

Information about the Patient Community

Nepal's 2020 population is estimated as 29,136,808 people at mid-year according to UN data. Nepal's population is equivalent to 0.37% of the total world population. Between 1990 and 2017, Nepal experienced a shift in the burden of disease from communicable, maternal, neonatal, and nutritional (CMNN) diseases to non-communicable diseases (NCDs). Chronic low back pain and knee osteoarthritis are common in the rural part of Nepal.[7] The patient-therapist ratio is 0.73 per 10,000 population. [6] 

Social/Cultural Influences

The Nepalese population mainly follows Hinduism and is religious in beliefs. Still, in most of the suburban, rural, and remote areas, people prefer traditional doctors for treatment purposes. Most of the family are joint family and father is the head of the family.

References

  1. Thapa R, Bam K, Tiwari P, Sinha TK, Dahal S. Implementing federalism in the health system of Nepal: opportunities and challenges. International journal of health policy and management. 2019 Apr;8(4):195.
  2. 2.0 2.1 2.2 Saurab Sharma. Physiotherapy regulation in Nepal. [PowerPoint presentation].  Kathmandu University School of Medical Sciences, Nepal. [Jul 14, 2017; Feb 6, 2021]. Available from: https://www.slideshare.net/saurabsharma/physiotherapy-regulation-in-nepal?qid=c5ab0775-ca94-4fbe-95a5-733397961ebe&v=&b=&from_search=9.
  3. 3.0 3.1 World Physiotherapy. Nepal: a profile of the profession in 2020. Available from: https://world.physio/membership/nepal [30 June 2020, 6 Feb 2020].
  4. Nepal Physiotherapy Association (NEPTA). Available from: http://nepalphysio.org.np/ [6 Feb 2020].
  5. 5.0 5.1 Minimum Requirements For the recognition of Bachelor in Physiotherapy. Nepal Health Professional Council. 2076. Available from: https://nhpc.org.np/backend/web/uploads/formuploads/BPT%20Minimum%20Requirement.pdf Lasted accessed: 27th March, 2021.
  6. 6.0 6.1 World Physiotherapy. Nepal Physiotherapy Association. Available from:https://world.physio/membership/nepal lasted accessed: 21st March, 2021.
  7. Pandey AR, Chalise B, Shrestha N, Ojha B, Maskey J, Sharma D, Godwin P, Aryal KK. Mortality and risk factors of disease in Nepal: Trend and projections from 1990 to 2040. Plos one. 2020 Dec 3;15(12):e0243055.