PHYSIOTHERAPY EDUCATION IN AFRICA THE EXPERIENCE IN NIGERIA Seyi L Amosun, BSc Physiotherapy; PhD Physiology Department o f Physiotherapy College o f Medicine, University o f Ibadan, Nigeria Member o f the Governing Council (1989-1993) Nigeria Society o f Physiotherapy IN TRO D U CTIO N 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 d in g L iaiso n C om m ittee 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, Sw aziland, 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 (W CPT), 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. PH YSIOTHERAPY EDUCATION AT THE U N IV ER 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 Requirem ents 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. T h e 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_________________________________________________ '_________ R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) 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. D eficiencies 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 program m e 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. REFER EN C ES 1. Brew-Graves SH. Medical education, health care and development in Africa. African Jour­ nal o f Medicine and Medical Sciences 1992;21:9- 15. 2. Allchurch P. European Community Directive -1992. Physiotherapy 1989;75:261. 3. Cooney M. Physiotherapy education in the European Community. Physiotherapy Ireland 1991;12:12-16. 4. African Rehabilitation Institute. Syllabus fo r physiotherapy training in Africa. Sebri Printers, Zimbabwe 1993. 5. 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. 6. Walker JM, Everette LE, Evan P R Profile of physical therapy educators in five countries. Physical Therapy 1983;63:1127-1133. 7. Ajao CA. The Nigeria Society of Physio­ therapy: The first decade. Journal o f Nigeria Society o f Physiotherapy 1969;1:1-10. 8. World Health Organisation. Evaluation of the strategies for health for all by the year 2000. Seventh report on the World health situ­ ation, volume 2: African region. WHO, Braz­ zaville 1987. 9. Cornielje H. Transforming physiotherapy training: Some thoughts. Physio Forum 1992;7:15. 10. Amosun SL. Curriculum for community physiotherapy: A proposal. Journal o f Nigeria Society o f Physiotherapy 1990;9:31. 11. Beenhakker JC. Are our curricula still rele­ vant? South African Journal o f Physiotherapy 1991;47:8-9. 12. Kerr KM. Pre-entry requirements and aca­ dem ic perform ance in primary degree courses in physiotherapy at the Ulster Poly­ technic. Physiotherapy 1985;71:468-471. 13. Haase E. Physiotherapy in the European Community. Physiotherapy Ireland 1991;12:6- 11. 14. Kimmel D. A comparison of physiotherapy in Canada and the United States. Physio­ therapy Canada 1992;44:9-14. 15. Irwin-Carruthers SH. An investigation into post-graduate physiotherapy education in South Africa. South African Journal o f Physio­ therapy 1991;47:3-9. Physiotherapy, August 1994 Vol 50 No 3 Page 61 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )