Policy analysis of legislative frameworks relating to physiotherapy in Belgium and South Africa

Nemeth, Tim
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Introduction From a physiotherapy service provider point of view, the outlines and the content of the legislative framework in which to operate differ from country to country. The revelation of differences and similarities should contribute to recommendations for improvement in physiotherapy policy for practice, education and future policy changes. A preliminary search on PubMed showed that although studies have been conducted on health policy, no policy was found pertaining to physiotherapy in particular. Conducting research was justified to be able to produce a first analysis on the topic. Aim The aim of the study was to analyse the current rehabilitation policies underpinning physiotherapy service delivery in Belgium and South Africa. Method This study is a qualitative content analysis with three components: a) literature scoping review, b) analysis of current policies and legislation pertaining to physiotherapy and c) interviews with physiotherapists that are key stakeholders in the policy development process. The data was analysed using the Walt and Gilson (1994) policy analysis triangle framework. Results Literature review showed a paucity of available research addressing the topic of this study. The analysis of current policies outlined that in both countries physiotherapy is embedded in a regulated health care system, providing a framework for policy. An important outlined gap is the outdated regulation governing physiotherapy in both countries. The physiotherapy key stakeholders expressed that physiotherapists in Belgium and South Africa have an opportunity to engage in policy development as stakeholders through their professional associations. Strong elements addressed for Belgium were the accessible physiotherapy services and a secured budget for physiotherapy services. South African key stakeholders outlined the importance of vi being a self-regulating profession. The lengthy policy development process and the inadequate budget were outlined as important gaps in both systems. Conclusion Important gaps such as disempowerment of Belgian physiotherapists and the lack of knowledge on physiotherapy policy development by South African regulators were revealed. These gaps point to the need of well targeted advocacy to showcase the value of physiotherapy to other involved stakeholders. The outlined strength of being a part of a regulated health care system enables physiotherapists to influence policy development. Knowledge on how policy development is organised will allow more physiotherapists to engage and participate in legislative processes.
A dissertation submitted in fulfilment of the requirements for the degree Master of Science in Physiotherapy to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2020