Formulation of the Bangladesh Rehabilitation Council Act 2018: the prime activities and advocacy of Bangladesh Physiotherapy Association (BPA)
Bangladesh is a developing country in south East Asia constituting more than 10 percent of person with disability and disease paradigm across the globe including Bangladesh has been transformed from infectious to non-infectious. At this moment, the country have been facing challenges to deal with injuries in spine & extremities, autism, cerebral palsy, road traffic accident, spinal mechanical pain, stroke related health problem and so on. Therefore, there is a necessity of Physiotherapy, occupational therapy, speech and language therapy, psychology and other rehabilitation services. It has been observed that the profound growth of professionals in medicine and surgery over last decade. Comparing to these, despite transformation of disease pattern, Physiotherapists and other health professionals are yet to be integrated into the mainstream health professionals due to health policy gap and research gap.
Physiotherapy & rehabilitation education and services has been inaugurated by direct influence of the Father of the Nation Bongobondhu Sheikh MujiburRahman, shortly after Independence for the war wounded freedom fighters in 1972. The course stopped after 2 years and it took 30 years to inaugurate the first stone of government Physiotherapy College initiated his daughter by Sheikh Hasina, the prime minister of Bangladesh& daughter of the Father of the Nation though the college is yet to be inaugurated. Subsequently, with the direct initiative of Sheikh Hasina rehabilitation services have been implementing through so far 103 Integrated Disability Service Centre & 32 Mobile Therapy Rehabilitation van under Ministry of Social Welfare since 2010.
Challenges of providing Physiotherapy & Rehabilitation Service
The first challenge was meet up the upraising demand of the service in Bangladesh. There were discrepancies in quality and eligibility criteria of entering Physiotherapy and rehabilitation profession. There were a lot of quack service centers serving throughout the country and no-definite guideline or standard of practice. Day by day the credit of the graduation and diploma courses were demotion by several group working inside the government. They changed the name of “Physiotherapy Department” in established government hospitals, omitted the qualification and title protection of “Physiotherapist”, and stopped the creation of posts in all stages of health care delivery system. An strange system were being developed where the autonomous physiotherapy and rehabilitation professionals were forced to work under direct order of other professionals. There was no room to grow for Physiotherapy and Rehabilitation professionals in Bangladesh. There were no government regulations existing to license and regulate a rehabilitation centre in Bangladesh.
The initiatives by BPA
BPA has been working to establish regulatory body for Physiotherapy and rehabilitation professionals since establishment in 2001. There were several initiatives by Ministry of health so far. In 2010, BPA applied a writ petition to the supreme court of Bangladesh in the matter of registering Physiotherapy and rehabilitation professionals by BMDC. Further when BMDC regulations have been changed in 2010, BPA file another petition mentioning the “independent practice” of the professionals and formulation of independent professionals. At 2013 in response to BPA’s appeal Bangladesh Medical & Dental Council led by Valerie Ann Taylor, the regulatory body of physician and dentists; informed that they are unable to regulate the physiotherapy professionals due to scarcity of manpower and suggested to form another independent Council. Since then BPA concentrated on creating a positive appeal to the government through civil society, beneficiaries, stakeholders and policy makers.
Bangladesh Rehabilitation Council Act
The act is a direct initiative of the government. In 2016, the National steering committee for Autism & Neuro-developmental disorder chaired by Saima Wazed Hossain; the WHO goodwill ambassador of Autism and granddaughter of the Father of the Nation. The committee was formed by five ministries including Ministry of Health and decided to give responsibility to Ministry of Social welfare to initiate the council process. In the stakeholder meeting, BPA focused on professional autonomy, standard education and opportunity to serve the nation through government sector.
1st international Conference for Rehabilitation Professional
To ensure this basic component, Bangladesh physiotherapy Association (BPA) arranged an international conference in 22nd December 2017 in Dhaka. Delegates from 12 countries attended the conference and key note speech has been presented by Saima Wazed Hossain. As a professional Psychologist, she demanded professional autonomy, equal status, and equal salary for physiotherapy & rehabilitation professionals’ equivalent to medical and health care professionals. This was a turning point of formation of BRC act 2018.
Meetings, Seminar, Human Chain and Advocacy
To establish the council BPA conducted more than 100 meetings with Prime Minister’s Office, Ministry of Social Welfare, Ministry of Health, National Parliament, Bangladesh Medical Association, Political organizations, Suchona Foundation, many NGO’s, District commissioners, figured autonomous personality, lawyers, foreign delegates and experts. To overcome the situation, BPA called human chain in front of the National Press Club for several times to ensure the smoother establishment of the Council. BPA arranged more than 48 community camps, 12 dialogues and more than 1270 letters and paperwork’s in 2 years of establishment period of the council. BPA executive committee held 46 extra meeting apart from their schedule and 6 annual general meeting in the matter of council in 2 years. The council has been formed with the outmost collaboration of BPA and CRP to the government. In the crucial time when the council draft was about to place in Cabinet meeting for approval, CRP’s founder co-coordinator Valerie Ann Taylor and executive director Md. Shafiq- ul Islam played a vital role in advocacy to the government. Also, on the occasion of world physiotherapy day 2018, department of Physiotherapy, CRP in collaboration with BPA arranged a scientific session where the key person of the council were present and committed to outmost hard working regarding establishment of BRC act.
The Establishment of BRC
On 25th October, 9 months after BPA’s conference the Bangladesh Rehabilitation Council Act 2018 has been passed unanimously by national parliament of Bangladesh. In the parliamentary discussion, several MP’s praised on the contribution of Bangladesh Physiotherapy Association and professional role of Physiotherapists in Bangladesh. Comrade Rashed Khan Menon said, this council is a revolutionary attempt of the government to ensure proper physiotherapy and rehabilitation services of Bangladesh; and the country is working as a role model to promote, rehabilitate and prevent disability, he added.
The act has 37 sections, 7 schedule mentioning physiotherapist having 5 years graduate program as “Practitioner”, 3 years diploma degree as “Medical technologists (Physiotherapy) and 18 months short course as “Technician”. Each professional will be registered and practitioners will practice by registration form the council. The rehabilitation service units or hospitals and centers also require BRC registration and the educational institute will also be authorized by the council. The council will ensure standard care and service for the persons with disabilities and the person who are prone to disability in every stage of service delivery system in Bangladesh, stated by Rashed Khan Menon.
BPA is trying to contribute in bylaws of council regarding practice guide, status and details that is under processed to gazette. BPA expects, the council will contribute significantly on education, Services and creating a positive environment where physiotherapist will work and contribute the society with outmost honor, autonomy and dignity. BPA is now the member of the council and working on the full functioning of the council.