Physical Therapy has its roots in Afghanistan in the early 1980′s, through the establishment of the Physical Therapy Institute (PTI), and from its start to the present, the physical therapy profession has undergone considerable changes, most recently through the upgrading of the two-year curriculum to three years.The Afghan Association for Physical Therapy (AAPT) was established in 1998 as a step toward supporting the needs of the Afghan people, through promoting the physical therapy profession and quality physical therapy services.

In 2007 the Association became a member of the World Confederation of Physical Therapy (WCPT), whereby AAPT now strives to follow international standards in the aim of supporting the physical therapists in Afghanistan, and promoting the profession as part of general health-care services available to all Afghans who will benefit from physical therapy expertise. Since the establishment of AAPT particular emphasis has been placed on strengthening the profession and with the support and dedication of Afghan physical therapists, the Association can continue to strive towards the important goal of improving the physical therapy profession in Afghanistan. AAPT has registered as a professional association by MoPH in 2008 currently AAPT has 322 members through the 22 province of the country.

Executive Summary

To be included later (at the end)

Review of the Needs

No nationwide exact statistical data exists on disease or physical disability in Afghanistan. At present time the population of Afghanistan is approximately 30 million, and it has been estimated that approximately 2-3% of Afghans are disabled (physical disabilities, deafness, visual impairment and mental illness).

Out of the 3% of the total population of Afghanistan (900,000), disabilities that benefit from physiotherapy can be estimated to be at least 30-50%, i.e. 360,000 persons. However, if we include all such diseases that at some stage of the course of the disease or trauma benefit from physiotherapy (Orthopaedic, Neurology and Cardio-Respiratory diseases, etc.), the number of persons benefitting from physiotherapy will be between 1.5 – 2 million Afghans.

There are approximately 350 physical therapists who have been trained in Afghanistan; of these about 242 are at work within their profession. The majority (72.6 %) of physiotherapists work with non-governmental organisations (NGOs) in centre of major cities as rehabilitation services have been included in the Basic Package of Health Services (BPHS), the number of physical therapists is far from adequate. Only MoPH Disability Task Force has estimated that there will be a need for a minimum of 775 physical therapists within the coming 10 years, to fill the needs of the BPHS and EPHS of MoPH and if we consider International standards in which for every 100,000 people there is need of 47 physiotherapist therefore approximately 1410 physiotherapists needed for the people around the country.

Another challenge is that many are keen to work only in centres, and not in the communities. Some of the physiotherapists left their profession due to many reasons. Some of the PTs have changed their profession as they don’t have opportunity for higher education in Physiotherapy field.

Non-professional people are practicing physiotherapy in private practice in the country and the government is not paying attention to this issue resulting in low employment opportunities for professional physiotherapists and low quality of physiotherapy services.

Government has approved new law for private physiotherapy practice and created some barriers for opening and running physiotherapy clinics.

Current physiotherapy education level in Afghanistan is three year diploma however other countries have physiotherapy education at Master and PhD levels therefore resulting low quality of physiotherapy services around the country. Low level of awareness of physiotherapy among the people and even among medical staff is another challenge.low governmental support in physical rehab.

Addressing the Needs

AAPT strives to serve, improve and develop the physical therapy profession for benefit of the Afghan people, up to the international standards.

AAPT plays an important role in creating, maintaining and improving cooperation and coordination among the government, NGOs and other organizations, who are involved in physical rehabilitation services.

AAPT has a lot to offer to the people of Afghanistan, in hospitals, clinics and community based work through:

Providing capacity development programs for physiotherapists according to their needs and the needs of the Afghan people.
Working with the government and related organizations in order to promote physiotherapy education at least to bachelor degree level.
Providing awareness rising programs to the public especially for 12 grade high school students in rural area to select PT in KANCOR exam which help to increase the number of Physiotherapist in the country, and awareness program for medical staff regarding physiotherapy services and its role in health sector to increase the number of patients referral for physiotherapy.
Conducting professional advocacy for maintaining and development of the physiotherapy position in health sector.
Lobby for financial and technical support from local and foreign organizations to improve AAPT.
Adhere to and promote WCPT standards of practice for a professional associations
Communicate with WCPT and other associations, organizations and institutions for the further development of physical therapy in Afghanistan
Conducting, promoting and supporting physical therapy research in Afghanistan
Working with the governmental institutions to support the physical therapy profession including the establishment and maintenance of a registration system for physical therapists and physical therapy clinics in order to keep high quality PT services.

Stakeholder and Alliances

Ministry of Public Health (MoPH)
Disability and Rehabilitation Department (DRD)
The Ministry of Labor, Social Affairs, Martyrs and Disability (MoLSAMD)
Swedish Committee for Afghanistan (SCA)
Physical Therapy Institute (PTI)
Handicap International (HI)
International Committee of the Red Cross (ICRC)
Ghazanfar Institute of Health Sciences (GIHS)
World Confederation of Physical Therapy (WCPT)

Justification for Approach

The rationale for the choosing the approach is based on the decision made by the Ministry of Public Health as following:

Afghanistan is in great need of medical personnel who are practicing physiotherapists, i.e. are able to;

a) Do valid and reliable evaluation of physically disabled
b) Perform treatment in its various forms
c) Think in terms of functional goals for disabled
d) Teach disability prevention
e) Decide and plan good use of resources

Therefore AAPT has chosen to provide awareness programs for 12^th grade graduates, advocate for PT profession, facilitate and provide continuing education programs and upgrading courses. The rationale is to educate people who then are capable of addressing the above-mentioned needs of the disabled.

Strategic Focus

AAPT strategy is directly supporting the national physiotherapy and physical rehabilitation strategy of the Ministry of Public Health. AAPT strategy is also directly supporting the physical service provision identified in the national disability law and national disability policy and AAPT strategy supports the development of PT profession through capacity building programs for its members.

Vision

AAPT’s vision is to be a leading association in enhancing and promoting of physiotherapy profession in Afghanistan and enhancing welfare of its members and deliverance of quality physiotherapy services to the all people of Afghanistan.

Our Mission

AAPT works towards the development of national health by: representing the physiotherapy profession nationally and internationally promoting high standards of physiotherapy education, practice and research; supporting communication and exchanges of information among its members and general public and collaborating with national and international professional organizations.

Core Organizational Competencies:

The only Physiotherapy professional association in the country
Officially registered and recognized by the government of Afghanistan
Active member of WCPT and AWP.
Clear and sound structure of organization and having 322 members with branches in 7 regions.
AAPT currently has good relationships with various donors, international organisations and government institutions.
With regards to issues of representation and participation, various rules are in place about elections, and representation of groups from non-central areas in the governing body and executive committee.

Organizational Values:

Trusting in Allah

In accordance with the AAPT Core Values we will endeavor to promote ‘excellence’ and demonstrate to our members expectations of high service standards, integrity, honesty, responsibility, transparency and accountability by our behavior, our attitude.

We will endeavor to promote a ‘learning attitude’, and be learners ourselves.

Encourage best practices

Evidence based practice

Ethics based practice

To promote good PT practices, integrity, honesty and accountability
To work with PT service providers who are potential leaders in their community to be responsible, respected and law abiding citizens.
To encourage increased self-esteem and confidence in beneficiaries
The ethos of charging fees for our services will reflect their value to the community.

Objectives:

Supporting physiotherapy profession in finding its identity
Promoting the physiotherapy profession and increasing the awareness level about physiotherapy profession.
Strengthening the physiotherapy profession to provide the best service to the disabled and needy people.
To maintain list of person qualified to practice physiotherapy in Afghanistan.
To promote physiotherapy research& development.
To make AAPT sustainable.
Staff and members development and support.
To have sufficient number of physiotherapists in the country.
To support the promotion of physiotherapy profession from Diploma to degree level.
Building the capacity of physiotherapists to provide quality training programs.
To have police and procedure manual for AAPT

Outputs:

Meetings with DRD,(MoPH), DCSG(Molsamad) Hospital, GIHS , MOHE and other related organizations.
Prints of volume 13, 14, 15, 16 and 17, TV and Radio interviews and World Physiotherapy Day celebrations.
A number of 20 continuing education training conducted.
Having the whole list of PTs in country.
Three physiotherapy researches and survey being done.
Training and membership fees collected.
AAPT staff and 500 PT received continuing education course and 10 physiotherapists provided with exposer visits and 150 physiotherapists are being placed.
Approximately 3000 students of 12^th grade received physiotherapy awareness programs.
Approved bachelor curriculum, official recognition letter and commencement of the program.
Teacher Training Programs started with a number 15 physiotherapists
Police and procedure Manual

Activities:

Conducting Professional advocacy programs.
Conducting professional awareness programs for medical staff.
Conducting continuing education trainings
Collecting physiotherapist list in the country.
Conducting and supporting physiotherapy research.
Collecting trainings, membership and admission fee.
Supporting staff and members in exposure visits and coordinating job placements for members.
Conducting awareness programs for 12^th grade students.
Encouraging MoHE to start physiotherapy department and supporting the creation of curriculum development committee and to be involved in the committee.
Conducting teacher training programs.
Formulating policy and procedure.

Indicators:

Meetings with related authorities, seminars for medical staff, recognitions of PT diploma, lobby for decrease in government tax of private clinics.
Printing of leaflets, magazine, brochures, other programs through Medias, celebrations and other gathering.
Conducting continuing education courses.
Physiotherapists information in AAPT database.
Conducted research and surveys.
Increase in AAPTs property and operational income.
Trainings, exposure visits and relationship with employing organisations.
Number of physiotherapists.
Meeting minutes, existence of bachelor curriculum.
Teacher training program class, attendance and material.
Meeting and workshop

Strategy in Terms of Location

AAPT seeks to help provide a sufficient number of male and female PT’s for provincial centers throughout Afghanistan. Seven regions have been selected for AAPT operational activities including central region which Kabul.

These regions have been selected because of their geographical importance and ease of accessibility for AAPT members.

AAPT tries to implement its awareness programs for 12^th grade high school students in the area where there are no or less number physiotherapists and continuing education programs are rendered in the central region Kabul and in provinces according to the need and resources.

Stability and Security: These are perhaps the two most important factors, because without stability one cannot carry on an any operations.

Strategy in Terms of Personnel or HR

We currently have 12 male 1 female as EC committee members including President, Vice President, Secretary, Treasurer, Information & Publication Officer, Continuing Education Program Officer, 7 Regional Representatives. There is also one admin/translator and 7 advisors.

We require one admin officer in order to take care of all financial and administration activities. There is an urgent need for capacity development of key executive’s members of the AAPT for better leadership and management.

Currently AAPT has 322 members including 173 Male and 110 Female.

Strategy in Terms of Sustainability

Our sustainability strategy comprises the following focus areas which help AAPT build its sustainability:

Reducing level of dependency to donations
Building, maintaining and improving trust among beneficiaries through diversity and inclusion
Generating incomes through publication of training materials, through accepting advertisement for the magazine and providing and facilitating trainings
Strong focus on organizational developments
Encouraging volunteerism among members it
Building small sources of income and funds such as clinic etc.

Strategy in Terms of Communication and Relationship

It is considered critically important for AAPT to have close relationships with its stakeholders. So, AAPT is always trying to improve relationships with stakeholders through regular and ad hoc meetings especially the stakeholders who are both highly important and has high impact.

Expected Results

If financed fully and implemented the strategy will ensure:

Increased coordination, monitoring and reporting and quality management of Physiotherapy training and services which in turn has helped physiotherapy profession increase its recognition and identity in the health sector.
Increased understanding of the needs and realities of physiotherapy profession throughout the MoPH to ensure physiotherapy is included in all policy, planning and implementation activities of the GIHS and also in the health system.
Policies to guide and enhance training of physiotherapy, physiotherapy services in the healthcare system and private sector in the Country
Awareness package developed and health staff trained in the physiotherapy profession to enhance the relation and understanding from the physiotherapy professions.
Printed materials: 5000 leaflets, 5 volumes of magazine, 10000 brochures, 20 issues of newsletters and other programs through Medias and celebrations.
Physiotherapist records available in AAPT database.
Three physiotherapy research being conducted and published.
Number of professional physiotherapists increased to 500.
A number of 10 physiotherapists gone for exposure visits.
A number of 150 physiotherapists being placed.
Physiotherapy bachelor degree curriculum developed and approved.
AAPT being able in providing approximately 25 percent of its yearly budget through membership and training fee other operational incomes sources.
Members are more committed and therefore ready for volunteerism.
Graduates from teacher training programs (Post-Graduate): 15 physiotherapists will be graduated from Teacher Training Program by 2020.
Upgrading 2 year to 3 Year Diploma: There is an apparent need during the coming 5 years to do at least one upgrading course.
Upgrading to bachelor degree: Starting a fresh bachelor degree program within Kabul Medical University (KMU) and another upgrading of 3year diploma to bachelor degree during the coming 5 years.
Continuing Education Programs: In order to maintain physiotherapy services in Afghanistan at an appropriate level, and in order to encourage further professional development of graduate physiotherapists, at least 15 continuing education training will be implemented.

Financials Resources

AAPT mains financial resources include the followings:

Grant and Donations
Training fee and training materials sales (Handout, CDs etc.).
Membership fee
Publications

Constrain and Challenges

Insufficient employee in AAPT
Approximately 150 physiotherapist who have completed the one year upgrading physiotherapy program are still waiting receive their 3 Year equivalent Diploma.
Membership fee issues
Members and even EC members are not so commitment to AAPT priorities.
Difficulty of finding expatriate for conducting professional training.
Insufficient budget for AAPT operations
Low understanding of the MoPH authorities and other relevant personnel from the Physiotherapy profession
Limited professional and technical staff in the country is a big barriers for disability and physical rehabilitation services
Low salary of the physiotherapy professional staff in the health system
Lack of security in the rural communities is an obstacle in the implementation of rehabilitation services
The only national training center called Physiotherapy Training Institute (PTI) with low capacity in terms of technical and support staff is not able to fulfill the requirements.
Limited attention from the government line Ministries (MoPH, MoLSMAD and MoHE) to the physiotherapy profession
Difficulties in the provision of diplomas to the upgraded physiotherapist in the country which had negative impact on the profession
There is no unified national strategy for physiotherapy profession in the country
There is no department for physiotherapy in the Kabul Medical University under the Ministry of Higher Education.
Lack of availability of bachelor degree in physiotherapy in the Country
Nonprofessionals are working as physiotherapists in the private physiotherapy clinics and in the health facilities within MoPH in the Country.
Limited number of professional physiotherapists in the Country.
Limited information of the health staff from the physiotherapy profession and role of physiotherapist in the healthcare services
Lack of awareness and interest of the newly 12 grade graduate students from provinces to select the profession of physiotherapy in the concur exam
The people are not well aware of physiotherapy profession therefore call it with non-acceptable terms.

Most of the government hospitals don’t have physiotherapy department and physiotherapy staff in their structures.

Evaluation Processes

Regular evaluation processes have included the following:

Continuous evaluation is performed during the year in some areas of work through weekly Admin Committee Meetings, Quarterly EC Meetings and General Assembly at end of the year.
The AAPT General Assembly Meeting, which discusses activities such as evaluating the Strategic Long Range Plans and evaluating the activities of the program.
The AC evaluates the program work when annual reports are presented.
The Executive Committee Members evaluate the program work in broad terms twice a year
Another important form of evaluation is the use of external evaluators, who would concentrate on specific areas of work, such as evaluation of the AAPT members, as they are the main result/output of the program.
The area of evaluation of program work should be developed to become more systematic and covering.
High reliability and validity will be important for evaluation to be useful and development orientated. The next external evaluation is recommended for 2015.

Strategy 2015-2020

Introduction