Action in the Asia Western Pacific Region of the World Confederation for Physical Therapy.
The Asia Western Pacific (AWP) Region is one of five designated regions established by the World Confederation for Physical Therapy (WCPT) to enhance closer co-operation amongst member organisations. The current growth in membership is one of the most exciting developments for the profession and signals the fact that increasing numbers of the region's population are likely to be the recipients of physiotherapy services. The paper discusses key objectives for the region and ways in which the AWP group is fulfilling its role to facilitate improved health through physical therapy. The links between WCPT--AWP and the work of the World Health Organization in the region are also discussed, in the context of potential limitations to meeting health targets established for the population. Limitations include health workforce shortages; population health issues such as diabetes, cardiovascular disease, respiratory disease and obesity as well as the region's vulnerability to natural disasters and the consequences for populations affected. Rehabilitation for victims of natural disasters is often neglected and physiotherapy services are non-existent. Furthermore physiotherapy as a profession still does not exist in a number of countries in the region. The physiotherapy profession needs to take up the challenge to ensure that physical rehabilitation is available to all. Skinner MA (2006): Action in the Asia Western Pacific Region of the World Confederation for Physical Therapy. New Zealand Journal of Physiotherapy 34(2): 47-49.
Key Words: World Confederation for Physical Therapy (WCPT); WCPT Asia Western Pacific (AWP) Region, World Health Organization (WHO).
Closer co-operation between members is a key role of WCPT-AWP Region.
Member Organisations aim to facilitate improved health through physical therapy.
WCPT has an official relationship with WHO--a key focus in the AWP Region is the role of physiotherapy in improving outcomes from disaster management.
The Asia Western Pacific (AWP) Region is one of five designated regions established by the World Confederation for Physical Therapy (WCPT) to enhance closer co-operation amongst member organisations in the geographic locality. The Region is bound by the WCPT's Declarations of Principle and Position Statements but at the same time has the liberty to develop its own strategic plan relevant to the needs of the populations and physiotherapy professional organisations it serves.
The AWP Region is the most diverse both geographically and socio-economically. It covers nations separated by vast areas of the Indian and Pacific Oceans; land locked countries that boast the highest and most famous mountains in the world yet whose people are amongst the poorest; and a mix of countries with low population density and high urbanisation such as Australia, contrasted with those of relatively high population density and low urbanization such as Fiji (WHO, 2006a). Over 53% of the world's population live in the region; however 1.3 billion of these people, from the Peoples' Republic of China, do not currently have a health profession called "physiotherapy" and thus are denied the benefits that membership of the WCPT and the AWP provide.
Membership of the AWP Region is not stagnant though. Besides the 18 organisations that are already formal members, physiotherapy professional groups in the region including Afghanistan, United Arab Emirates, Pakistan, Bangladesh, Vietnam, Cambodia and Myanmar have either begun the formal process of applying for membership of the WCPT or are developing their own constitutions and standards as part of the work required to be eligible for membership. This potential growth in membership is one of the most exciting developments for our profession and signals the fact that increasing numbers of the region's population are likely to be the recipients of physiotherapy services.
Improving access to physiotherapy services is an inherent part of the AWP regional group's role to facilitate improved health in the region through physical therapy. The AWP Region through the WCPT has a formal association with the WHO and thus AWP's role fits comfortably within the domain of the WHO whose mission is "to support all countries and their people to achieve the highest attainable level of health" (WHO, 2006b).
In order to fulfill its role the AWP has to know more about its members and the population it serves as well as adopting strategies and relationships that can be applied to each of the countries and the various cultural groups they represent. The following objectives were ratified by the member organisations at the AWP's Biennial Regional
Meeting held in Seoul, in November 2005.
1. Develop closer co-operation with member organisations.
2. Have observers present at the WHO South East Asia and Western Pacific regional meetings.
3. Improve data collection for WCPT.
4. Develop a draft Disaster Management Plan to be considered for adoption by WCPT.
5. Foster professional activities within the Region.
6. Foster communication and liaison with non-WCPT countries bound by the Region.
Information sharing is one of the greatest benefits of closer co-operation with member organisations. One of the best examples of learning through information sharing was illustrated through the lessons learned from the 2004 severe acute respiratory syndrome (SARS) epidemic. The WHO (WHO, 2005) has described the SARS epidemic as a turning point for international public health as it revealed weaknesses in the public health structure and demonstrated how such biological disasters cannot be contained by geographic borders and can pose a huge threat to international health. As a result of lessons learned and subsequent research, the WHO in South East Asia and the Western Pacific regions has now developed a strategy to confront the challenges of emerging diseases (WHO, 2005). This plan required close communication and co-operation amongst all the countries and for physiotherapists has resulted in the sharing of experiences of working with patients affected by the SARS crisis as well as improvements in and/or the implementation of pandemic management plans.
Having observer status at WHO regional meetings means that the AWP receives reports and copies of the meeting agendas and is given the opportunity to provide comment on matters relevant to physiotherapy. The AWP sends an observer to the WHO regional meetings when budget allows. The next WHO Western Pacific meeting will be held in New Zealand in September 2006. It is nearly 40 years since the group last met in New Zealand.
There are three key issues that have the potential to interrupt the WHO's plans to reach its health targets (WHO, 2000) in the region. The first is a growing international workforce crisis (WHO, 2006b). Whether it is in a well developed nation such as New Zealand or an emerging nation such as Nepal the health workforce shortages in the region are most acute in rural and/or remote areas and amongst the lower socioeconomic locations in urban areas. There is also an aging health workforce and a general lack of experienced health workers, professional autonomy, professional regulation and job satisfaction. In addition issues such as poor working conditions and migration add to the negative effect on workforce retention and participation (WHO, 2006b). In the AWP Region member organisations, special interest groups and others need to work together to ensure that physiotherapy is represented at policy and planning levels; that physiotherapy is recognised by governments and other agencies as a core health service, that it is a regulated health profession, and that the profession optimises the benefits of strategic partnership and collaboration.
From an education perspective, the Schools of Physiotherapy need to ensure that their programmes meet the guidelines for entry level qualifications set down by WCPT (WCPT, 2006).
".... That physical therapist entry level educational programmes be based on university or university level studies, of a minimum of four years, independently validated and accredited as being at a standard that accords graduates full statutory and professional recognition ..."
A further requirement is to ensure that Schools are graduating physiotherapists to meet the workforce and population health needs and also that Schools ensure that pre-registration curriculum provide the scope of education sufficient to meet the WHO's purpose i.e. for the population to achieve the highest attainable level of health.
The second threat to the WHO achieving its health targets (WHO, 2000) is population health issues. Leading causes of mortality and morbidity in this region and globally are heart disease; hypertension and stroke; smoking related lung conditions including cancer and emphysema; and diabetes (WHO, 2006b). The obesity epidemic is a further factor which is contributing to the rise in life-threatening illness, reduction in quality of life and use of valuable health care resources (WHO, 2003). Physiotherapists have a key role as non-invasive practitioners to address these health issues (Dean et. al 2000). Again in carrying out its role the profession needs to ensure that it is represented at policy and planning levels; that it develops liaisons with groups such as WHO, and that physiotherapy pre-entry level education programmes include content that enables assessment of the knowledge, skills and attitudes required to achieve competence in cardiopulmonary physiotherapy. More specifically in response to the obesity epidemic physiotherapists should use their skill as educators in disease prevention to promote and oversee physical activity programmes, reinforce positive behaviours for healthy living through physical activity and provide effective and efficient physiotherapy management of medical and surgical interventions resultant from conditions that are likely to have attributed at least in part to the obesity problem (WHO, 2003).
The third risk to WHO's achievement of its health goals (WHO, 2000) is the high risk of natural disasters and emerging infectious diseases in the region. The WHO Collaborating Centre for Research on the Epidemiology of Disasters (CRED) has been maintaining an Emergency Events Database since 1988 (WHO CRED, 2006). The database distinguishes two types of disasters: 1) natural including floods, earthquakes and biological disasters and 2) technological including industrial and transport accidents. The Western Pacific is known to be the region most affected by natural disasters. Two of the most devastating disasters in the past 25 years occurred in the region; in 2004, the Asian tsunami, and in 2005, the earthquake in Northern Pakistan and India (Brennan and Waldman, 2006). One of the gains that is emerging from the implementation of knowledge from research outcomes in the area of disaster management is that the statistics are favouring a reduction in mortality in favour of morbidity (WHO CRED, 2006). With the emergence of the extended care practitioner role for physiotherapists it may be argued that physiotherapists should be included amongst the leaders in rescue teams providing emergency care for victims of physical trauma. A more compelling argument is for physiotherapists to be included amongst planners and policy makers for disaster management particularly in regard to the role they should be taking in the physical rehabilitation of the victims of disasters. Rehabilitation following a natural disaster is an ongoing process, which stretches far beyond the initial period of emergency care and media attention. However rehabilitation does not always receive recognition by way of funding and other key resources such as health professionals to lead the programmes. Thus the objectives and goals for health as set out roles for WCPT-AWP and WHO become difficult to achieve.
One of the key objectives established by the AWP has been to develop a draft position statement on a Disaster Management Plan that will potentially be put forward for adoption by WCPT at its next General Meeting to be held in Vancouver in 2007. The draft plan is currently being revised as part of the preliminary consultation process. A position statement on disaster management adopted by the WCPT would strengthen the profession's position in promoting the role of physiotherapy in rehabilitation of victims of disaster to both the policy makers and planners and would provide direction for the profession to ensure that populations have access to physical rehabilitation.
Another of the challenges that faces the profession in the AWP Region is the process that will enable the people of the world's most populated country, China, to have access to physiotherapy services and for the local people who are interested in working in a health profession to have the opportunity to be educated as physiotherapists. To date there are no health professionals in China whose training would meet the WCPT's requirements to use the title "physiotherapist" or "physical therapist". However a few programmes are being established under the guidance of Schools of Physiotherapy in two AWP member organisations, Hong Kong and Japan. The AWP is looking at ways to ensure that professional programmes established in China in the future continue to meet the WCPT guidelines for entry-level education programmes (WCPT, 1995) and that a physiotherapy professional association that meets WCPT's and the Region's objectives will ultimately be established in China.
The WCPT Asia Western Pacific Region is an active and dynamic one. Its member organisations range from centenarians (Australian Physiotherapy Association) to those in conception (Afghanistan) but the principle of facilitating improved health in the region through physical therapy is the same amongst all member organisations. We can develop our role best by working together in the areas such as education, research, policy and planning.
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Margot A skinner, PhD, MPhEd, Dip Phty Chairman, WCPT Asia Western Pacific Region
ADDRESS FOR CORRESPONDENCE:
Dr Margot A Skinner, School of Physiotherapy, University of Otago, P O Box 56, Dunedin, New Zealand. Email: margot. email@example.com