Society for Advances in Learning Disabilities

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Press Release on the proposed NCHRH Bill of 2009

Posted on June 1, 2011 at 12:43 PM

For Immediate Release

New Delhi- June 1, 2011


Occupational therapists in India are greatly disappointed by the discriminatory policies exhibited by the Government of India toward them over many years, and most recently in the form of the proposed draft of the National Council of Human Resources in Health (NCHRH) Bill of 2009. The Bill scheduled for passage in September by the parliament greatly undermines the contribution of occupational therapy, an independent healthcare profession practiced in more than 65 countries worldwide. Occupational therapy interestingly is not mentioned in the titles of the proposed departments namely the departments of Medicine, Nursing, Pharmacy, Dentistry, Rehabilitation and Physiotherapy, Public Health and Hospital Management, and Allied Health Sciences, thus severely undermining its scope of practice and subjecting it to future detriment.

Government Promises Made and Broken Over the Years

Currently with no government regulatory body, the profession has been self-regulated by and large under the standards of education and practice prescribed by the All India Occupational Therapists’ Association (AIOTA), the national association of occupational therapists, and the World Federation of Occupational Therapy (WFOT), of which it is a charter member. In a press release on July 28th, 2010, Dr. Madan Warhade, the president of AIOTA, reflected on the many years of deception by the Government of India despite their repeated assurances to create an independent central council.

It is noteworthy that the central government had recognized and sanctioned the need to regulate the profession as early as 1983. In 1988, Ku. Saroj Kharpade, the then honorable Minister of State for Health and Family Welfare, announced a decision to set up an independent cell under an umbrella council meant just for occupational therapy and physiotherapy, two closely related but completely separate professions. Monies were also allocated for the same by the Ministry of Health and Family Welfare in 1989 and 1990. Interestingly in 1998, disregarding all previous work, occupational therapy and physical therapy were clubbed with a heterogeneous group of trades/ professions under the Rehabilitation Council of India Act of 1992 under the auspices of the Ministry of Social Justice & Empowerment which was later rescinded after objections raised by the respective national associations representing occupational therapists and physiotherapists. Once again, despite consultation provided by AIOTA, yet another poorly informed bill was proposed in 2001 with occupational therapists and physiotherapists named under a new council this time under the Paramedical Council Bill. However, in 2008, the 31st Report of the Parliamentary Standing Committee on Health and Family Welfare categorically recommended an independent central council for occupational therapy under the “Allied Health Central Councils Act of 2007. Once again not following through with decisions made over a span of nearly three decades, legislators have now decided to undo all the work done in the past in favor of their newest project -the NCHRH Bill of 2009. In keeping with its inglorious past, the Bill promises to again deprive the profession of occupational therapy its due place under the Bill, and intensifies the step-motherly treatment toward it by the government.

About Occupational Therapy

Occupational Therapy, abbreviated as "OT", is at times, also called "Ergo Medicine", a term based on the philosophy that "work (ergo) is medicine". It is also called Ergotherapeutics, Ergotherapy, or Ergotherapie in certain parts of the world. However, "Occupational Therapy" is the accepted English translation and the most commonly used term to describe the profession globally.

The practice of occupational therapy includes therapeutic use of “occupations” that includes everyday life activities for the purpose of participation in roles and situations in every facet of life. It may be viewed in simpler terms as treatment by “occupying” the mind and body in scientifically-based goal-oriented tasks that aid in optimizing health and wellness. The word “occupational” in the nomenclature of the profession, indicates anything that humans do to occupy themselves mentally, physically, emotionally, or socio-economically.

Occupational therapists use a variety of tools in their treatments that include but are not limited to exercises, specially designed activities including everyday tasks, prescription and designing of environmental adaptations/ adaptive devices/ orthoses, training in the use of orthotics and prosthetics, use of modalities that incorporate heat, water or ice, electricity, sound, etc. as therapeutic media, manual techniques, ergonomic consultation and designing, behavioral adaptations, etc. in order to facilitate optimal performance in human “occupations”, that is life’s tasks.

Medicine (physicians/ surgeons) and Occupational Therapy are Separate and Independent Healthcare Professions

In its zeal to expand its scope of practice and/ or limit that of occupational therapy and physiotherapy, the Medical Council of India and the Indian Medical Association (organizations that respectively regulate and represent practitioners of modern or western medicine, also called allopathy) has repeatedly wrongly claimed and classified them as paramedical fields. Being in a position to do so, they have used their influence to falsely advise the Ministry of Health and Family Welfare and other bodies to include these professions as paramedicine. Contrary to such ill-advised claims and misinformation, the recognition of occupational therapy and physiotherapy as independent healthcare professions is well established globally.

Paramedical fields have supportive roles to the discipline of western medicine. These fields have developed directly from areas of western medicine, with members of these trades/ professions requiring supervision by physicians or surgeons, and do not have independent roles in the assessment of consumers’ conditions and delivery of healthcare services.

Occupational therapists work independently, with many having their own successful private practices worldwide. Practitioners of western medicine and occupational therapy often refer to each other to complement their therapies for the benefit of their mutual consumers. One type of practitioner cannot provide the services of the other since their scopes and focii on health are completely different. Physicians/ surgeons focus on treating the pathology, that is correcting/ reducing dysfunctions at the cellular, tissue, organ, or organ system level. Occupational therapists address functional limitations, and treat to correct/ reduce issues or barriers that limit human performance in life activities that may or may not be caused by a pathological condition. While practitioners of modern medicine use pharmaceutical agents (pharmacotherapy) and surgical interventions, occupational therapists treat by non-pharmaceutical means, and do not provide invasive procedures. Physicians/ surgeons and occupational therapists have many overlapping areas in their syllabii as both must study basic human sciences in their undergraduate curricula to gain knowledge of the human body. However, physicians/ surgeons train specifically in their therapeutic domain of prescribing medicine and performing surgery, while occupational therapists are trained in occupational science and specialize in the prescription of “occupations” and other non-invasive pre-occupational interventions in order to optimize function. Postgraduate studies in both fields involve specialization in particular areas of human pathology and corresponding areas of human function respectively.

The histories of modern or western medicine and occupational therapy also indicate the differences in their origins and philosophical bases. Occupations in the form of human diversions and expressions with therapeutic value can be appreciated since the very existence of cavemen. The earliest evidence of "occupations" used as method of treatment were documented around c. 100 BCE, where Asclepiades, a Greek practitioner, initiated humane treatment of patients with mental illness using therapeutic baths, massage, exercise, and music. Later, Celsus, a Roman, prescribed music, travel, conversation and exercise to his patients. These “occupations” are still part of the much technologically and scientifically advanced modern day occupational therapy practice. A more recent development of the field involved the pioneering works of European healthcare revolutionaries such as Phillip Pinel and Johann Reil in the 18th century, and American psychiatrist, Adolf Meyer, in the late 19th century. The aftermath of World War I and World War II requiring rehabilitation of soldiers lead to the establishment, and rapid growth of the profession with a formal and unique professional identity separate from other medical fields in the United States of America. The field evolved almost simultaneously in Great Britain. Although it has its origin in very ancient times, it is one of the newest healthcare disciplines re-organized in modern times under the name of “Occupational Therapy”. It was formally started in India with its first school in 1950. In 1951, the world body, WFOT was founded which currently is comprised of over 65 national member organizations. AIOTA, the national association, was founded in 1952. Similarly, the practice of medicine and surgery in some form or the other has its roots in very ancient times although allopathy (the front-runner term used for ‘Modern Medicine’ or ‘Western Medicine’;) was coined in 1810 by Samuel Hahnemann.

Occupational therapy’s contribution to healthcare is unduplicated by any other independent medical field through its focus and expertise in identifying/ diagnosing and treating dysfunctions/ maladaptations in occupational performance, that is, the ability to perform life’s different activities. This includes ability to breastfeed or roll in a newborn to the ability to use a computer without causing health issues and staying productive at work in a young adult to being able to take care of self-care needs such as dressing, grooming and bathing in the elderly to maintaining the dignity of life in one’s end days. Occupational therapy views life as comprising of different “occupations” that occupy time and energy, and believe that disease is but one factor of health and therefore, treating just pathology doesn’t automatically result in optimal health. The state of good health is achieved by optimal human functioning.

Implications of the Bill if Passed in its Current State

“If passed ‘as-is’, the Bill will be a devastating blow to the practice of occupational therapy in India”, says Dr. Joseph Wells, a US-based healthcare executive, and an advisor to the Board of Directors of the Association of Asian-Pacific Occupational Therapists in America. Without an independent central council for occupational therapy, he asserts that the standards of practice will deteriorate, and severely limit professional development in India. Ironically countries such as United States of America (US) have repeatedly placed it as one of the best careers (US News and World Report, 2009) with a projected 26% job growth between 2008 and 2018 (US Department of Labor) despite the economic slowdown.

“The Bill in its current state will allow undue encroachment by inadequately trained professionals from other medical fields and breed quackery into the domain of occupational therapy since the need of these services are established but a lack of proper regulation will not be able to control who provides it”, warns Wells.

According to Dr. Madan Warhade of AIOTA (press release of July 28th, 2010), there are 28 programmes including bachelor’s, master’s and doctoral degrees in occupational therapy recognized by AIOTA/ WFOT in India, and the minimal educational requirement to practice as an entry-level occupational therapist is a 4.5 year professional bachelor’s degree similar to undergraduate education in other medical streams in India. However, due to the lack of a central council, in states other than Delhi and Maharashtra, the only two states that have state councils, little can be done to prevent universities/ institutions starting programmes in occupational therapy that do not meet AIOTA/ WFOT set standards. Though unrecognized by AIOTA/ WFOT, graduates of these programmes are allowed to practice freely in India. The danger to the public through substandard training of these self-styled “occupational therapists” in India continues with little protection granted through the proposed Bill. Dr. Madan Warhade points out that due to poor domestic policies, more than 50% of occupational therapists trained in India from educational programmes recognized by AIOTA/ WFOT (a mandate to practice outside India) have migrated to other countries such as the U.S., United Kingdom, Canada, Australia, New Zealand, Ireland, Singapore, United Arab Emirates, and other countries where these professionals are in high demand with placements in every healthcare setting such as hospitals, nursing homes, home health , private clinics, industrial wellness clinics, etc.. The so-called ‘brain-drain’ certainly burdens the care provided to the citizens of India, who by mere numbers have lesser access to qualified occupational therapists which will be further jeopardized by the proposed NCHRH Bill, if uncorrected. “With India’s advancing economy, expatriate professionals such as software engineers are returning to India in considerable numbers”, says Dr. Wells. “However, the same cannot be expected from occupational therapists who enjoy high job satisfaction and status in other countries as compared to rather hostile situations in India”, he adds. He, however, is optimistic that this trend may be reversed in the future if the policies are made more favorable to occupational therapists.

The Bill especially does not take into consideration the global shift (as endorsed by the World Health Organization) in health policies to allow greater autonomy to consumers to choose their healthcare providers/ systems versus the age old institutional and paternal control in deciding the healthcare needs for them. The paradigm shift calls to empower consumers to have greater choices and access to healthcare providers of all kinds. The policies in India currently suggest otherwise with power being skewed to favor only certain types of healthcare providers at the expense of limiting consumer access to optimal and comprehensive healthcare, and unduly restricting the scopes of disciplines such as occupational therapy.

Dr. Wells also hopes that the Bill would develop foresight on India’s growing health tourism industry. Occupational therapy plays an essential role in all conditions, physical and mental, that disrupts function. It is a covered service under practically all health insurance programs in the U.S., a major consumer of health tourism. In Wells’ opinion, the Bill currently limits the prospects of occupational therapy as a viable avenue of global health tourism, and must be rectified at the earliest.

Summing up the implications of the proposed Bill, Dr. Wells states that the Bill, in its current form, is high unfavorable to the estimated 5000 qualified occupational therapists nationally and will certainly affect the practice negatively. “Although, the number of practitioners are insignificant in terms of the number of votes they transcribe to, policymakers must weigh-in on the contributions this unique group of healthcare providers can make to ensure many of the over 1 billion citizens of India are at their productive best”, he suggested. He further added that “Occupational therapists and the general public alike have many reasons to protest against this Bill, and should charge the government to ensure cost-saving direct access to and equitable regulation of all independent health professions including occupational therapy”.

Categories: Government/ Policy Issues

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Reply titiksh varma
12:57 PM on July 31, 2011 
i m gone through this press note and it is really humiliating................. its hard but now we should understand that this government will not going to accept our profession as it opinion regarding this situation will be to have our OT representatives in every political party, like there are doctor cell n lawyer cell why should not a O.T CELL. than only our voice have some impact on this politicians. we have to start 4rm grass root.......................
Reply hetal tripathi
2:58 PM on July 31, 2011 
@ titiksh: u r extremely right.......
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