Daños por la mala postura

All the interviews, except the confirmatory interview with Adeeb, occurred during the lead up to the IAP elections. Minda's, Lalit's and Rani's interviews occurred two weeks before the IAP election result announcement. Adeeb's interview occurred after the latest 2011 regulatory bill had been rejected and as the Goa dual conference dispute was occurring.

Throughout the interviews participants identified that the IAP was only a professional advisory body that retained a register of members, and that it was not a regulatory or statutory body, therefore the IAP was powerless in many contexts and was often not listened to by the universities. The interviewees articulated different expectations of the effectiveness of the IAP role which were unanimously identified by participants as firstly, setting a common curriculum for bachelors and masters degrees for the universities to develop their courses upon; and secondly, monitoring the minimum requirements to run a

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physiotherapy course (infrastructure, staff to student ratios etc) and to inspect the colleges. Manish considered that the IAP were effective in these duties. Mindha and FG3 perceived the IAP was ineffective and not responsive to change. Adeeb reported perceptions of corruption that ranged from vote rigging to lucrative incentives associated with the approval of colleges.

Perceptions of the IAP that subsequently lost the disputed election differed and ranged from "the association has well meaning people who are kind of trying to

have a stringent quality control so that things won’t go awry" (Ashna) to a body

that "has not achieved anything in the last 50 years" (Adeeb) and "for making

some permanent change or for some making it brighter, even I think they are not doing much" (Srishri, FG2).

"...they are still stuck in trying to become something themselves

individually, that they don’t think of the entire profession really and they are very conservative in their views and are still stuck on the old concept

of what physiotherapy was around 20 years back and they don’t really want to move on."

Minda (studied in UK, returned to India)

Rani and Minda both identified that there were a lot of things that the IAP could be doing to change things, for example it should be the body that physiotherapists would look to for policies, guidelines, career pathways etc. It could bring together groups to discuss the issues and identify ways forward, but these things were not happening. Only Adeeb was interviewed after the IAP split and he was broadly supportive of the new IAP cast, as opposed to those who had lost the vote, but also stated that he had resigned his IAP membership several years previously.

There was an optimism expressed by all participants, except for Adeeb, that things were slowly changing despite frequent government reversals in

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establishing a regulatory council. All participants referred to the proposed regulatory council and suggested that everything would improve when it was in place. Throughout the interviews, participants referred to beliefs, hopes and expectations that once physiotherapy had a government recognised council in place the problems within Indian physiotherapy would be resolved. They believed that there would be increased respect, that pay would improve and that the practice scenario would improve, because as physiotherapists they would have clinical autonomy.

The understanding of the role and the scope of the proposed council was mixed and differed between participants but it was not timeframe dependent and so did not reflect the changing proposals. Expectations of the council were identified:

 To improve physiotherapy practice and help to retain physiotherapists.

 To regulate physiotherapy practice and to "protect it" from "quacks".

 To lead to increased pay.

 To increase the profile and awareness of physiotherapy, especially with other professions.

 To set the curriculum (the IAP would set the standards of practice and have a strong influence with the council, as IAP members would be on the council). Curriculum changes submissions would be expected to be time consuming and cumbersome due to the associated bureaucracy.

 To tell state governments how many physiotherapists should be employed in the public sector and the positions required to create a coherent career pathway.

 To establish mandatory, continuing professional development (CPD) to remain registered.

 To sponsor physiotherapists to study overseas and ensure they return to India post-study.

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However in the aftermath of the latest failed government bill, Adeeb was more sceptical, "a Council won't sort out anything really", he considered that if physiotherapists are grouped with technician level professions then it would not achieve autonomous status and in a regulated system he felt that it would mean that physiotherapists would not be able to set up independent practices, take self-referrals and that they would be "working under the thumb of a doctor" only able to give the modality that the doctor prescribed. All the clinical decision making and everything that he had studied for in the UK would be "gone". In the absence of a government level bill, Adeeb reported that the states appeared to be establishing councils of their own, with some inferring physiotherapists' autonomy (Maharashtra and Tamil Nadhu), and some not (Punjab).

An article in the Physiotimes by Sinha (2012) identified that the 2011 Health Bill would bring much needed reform to the Indian health sector and would be good for physiotherapy in the long term, as new regulatory councils (even though they are not specifically mentioned in the 2011 Health Bill) could be easily established. He suggested that the Health Bill's rejection reflected the doctors concerns that power would move away from doctors to bureaucrats. Issues associated with medical dominance and authority have featured extensively in the literature over the last two decades; specifically in the context of reorganised workforce requirements, changing health economics and systems of delivery, increased autonomy of the allied health professions and blurring of professional boundaries (Friedson 1985; Ovretveit 1985; Kenny and Adamson 1992; Nettleton 1995; Colyer 2004; Watts 2009).