Assessment of Physiotharapy Services in Nablus Governorate in the north of the West bank in Palestine, 2018
Dr.Nasser Abu Khader, PHD in Physical Therapy
The purpose of this study was to assess the physiotherapy services in Nablus Governorate in the North of the West Bank in Palestine.
The study population consisted of (31) providers who represented the institutions providing physiotherapy services. Exploratory descriptive design utilizing a structured questionnaire designed by the researcher and reviewed by advisor with a research background was utilized. The questionnaire consisted of (10) sections: The first section was related to socio demographic variables (age, gender, education and experience.) Sections two, quality and quantity, size of physiotherapy services, financial matters, human resources, relation with administrative system, patient referring system, cooperation and coordination, national policies and physiotherapy policies. Section nine covered priority physiotherapy needs. Section ten covered suggestions to develop physiotherapy policies, covered measures to improve quality of physiotherapy services.
Data were collected through face-to-face interviews. The analysis of the data revealed that the majority of providers of physiotherapy services were young less than 35 years (58.1%). the majority (62.8%) had a Bachelor degree; with more than 10 years of experience (53.3%).
This study focuses on a sector long neglected by the Palestinian society "the disabled" or as more recently called persons with special needs. During the first two years of the first Palestinian people's uprising, "Intifada" (1987-1989), at least 40,000 people, mostly young adults and children, were injured by the Israeli army's violence .(Palestine Central Bureau of Statistics (PCBS), 1997). Disability prevalence (2.7%) of the Palestinians were disabled, of (2.9%) in the West Bank and (2.4%) in Gaza strip. By gender (2.9%) are males and (2.5%) are females (PCBS), 2011).WHO estimates that about one billion people worldwide nearly 200 million experience considerable difficulties in functioning (about 130000 of them are living in Palestine).(WHO),2017.
A. Statement of the problem:
Many studies suggested that adequate utilization of Physiotherapy services affects the health status of the disabled. The utilization of these services can be affected by several factors. Although there are several studies focusing on disabilities and PT worldwide, yet relatively very few were conducted in Palestine. This study is a step forward in that respect and is essential for developing physiotherapy services in Palestine.
B. Significance of the study:
This study aims at collecting and describing basic information regarding physiotherapy services in Nablus districts of Palestine. Results of this study will help policy makers as well as physiotherapy care providers to improve the quantity and quality of care given to the disabled in order to meet their needs and to promote cooperation and coordination among the various institutions dealing with the disabled without undue cost to society. Such cooperation involves a division of labor based on experience in the field, technical expertise and ability to reach and involve communities in planned action.
The importance of conducting this study also lies in the fact that comprehensive physiotherapy must be based on realistic approaches rooted in low cost and appropriate services to the community As a result, the physiotherapy status of the disabled will improve, as an outcome of an effective and efficient physiotherapy care services. The most important challenge is to understand the future, to plan for it, and to act to make the future what we want it to be. This research will contribute to the modification of the national physiotherapy policy and to suggest services in a system characterized by cooperation and coordination.
This study may also help in coordinating capabilities of a body of people representing institutions working in the field of physiotherapy to guide research activities, collectively formulating strategy, planning for implementation and evaluation of physiotherapy projects at the country level.
C. Purpose and Objectives.
The general purpose of this study was to assess and describe the physiotherapy services in the Nablus districts.
The objectives include:
-Reviewing operational physiotherapy services at the different
- Assessing human resources in physiotherapy settings.
- Suggesting issues for consideration by policy makers in
Physiotherapy services in Palestine.
- Suggesting training in physiotherapy related areas. - Describing physiotherapy services in the Nablus districts.
- Contributing and promoting policy formulation in the physiotherapy fields.
D. Research Questions:
The following were the guiding questions for this study.
1-Who is providing physiotherapy?
2-How can quality and quantity of physiotherapy services be
3-What is the size of physiotherapy services?
4-What are the financial matters in the institutions of physiotherapy
5-What human resources are available for such services?
6-How is the administrative system in this physiotherapy
7-What is the condition of the patient-referring system, and
coordination and cooperation between the sectors of physiotherapy?
8-What are the top service priorities in the field of physiotherapy?
9-How should physiotherapy policies in Palestine be developed?
10-What can be done in order to improve physiotherapy services?
This study was based on the following assumptions:
1- Physiotherapy settings will participate in this study.
2-Administrators targeted to respond to the study questionnaire will
respond and freely express their opinion.
3-Administrstors will help and allow the researcher to conduct the
study in their facilities.
F. Limitations of the Study:
The following were the presumed limitations of the study:
1-There are limited resources in the field of Physiotherapy research in Palestine.
2-Lack of co-operations by some of the services administrators.
3-Political daily instability in the country.
G. Major Research Concepts and Variables:
1-Physiotherapy care provider’s variables.
2- Physiotherapy care services variables.
3-Quality and quantity of the physiotherapy service’s variables.
4-Size of the Physiotherapy service’s variables.
6-Human resource’s variables.
7-Administrative system variables.
8-Patient-referring system, coordination and cooperation variables.
9-Physiotharpy policy variables.
10-physiotherapy priority variables.
The researcher utilized a descriptive quantitative design utilizing a structured questionnaire in a face to face interviewing to describe the Physiotherapy services in the Nablus district in Nablus. The face-to-face technique was most appropriate in order to include all providers of services with different service levels and to achieve high response rate. The study covered all operating Physiotherapy centers at the primary, secondary, and tertiary levels.
The targeted population included all the providers of Physiotherapy services in the northern districts of Palestine in Nablus. Responses were provided by the manager of each centers contacted.
This descriptive study was conducted to provide basic information about Physiotherapy services in the northern districts of Palestine in Nablus focusing on different aspect of Physiotherapy services including models, administration, facilities, rehabilitation policy, development of services, funds etc of different centers belonging to the Private, NGOs, Government, and UNRWA. It aims at helping the planners, decision makers and physiotherapy providers to better meet the Physiotherapy needs, to improve the quality of care, and to better formulate Physiotherapy policy.
This part of the study is designed to shed light on the West Bank in general and the northern Palestinian districts, in Nablus the targeted study area, in particular.
Characteristics of the study area:
Location: (Nablus) districts, which located in the northern area of the West Bank. Nablus district is the center of the northern area.
Description of the settings:
In this study, the researcher selected all settings. The Major part of the Physiotherapy care/services in north districts in Nablus is delivered by the NGOS, and private sectors. Services offered in these centers.
The Physiotherapy services are distributed in three refugee camps (Balata, Asqar, and Alain) camps. The centers provide their preventive & curative rehabilitation services to the Palestinian refugees who live in Nablus districts.
2- Public/ Government:
The public /government physiotherapy therapy services are operated by the Palestinian Ministry of Health, and Ministry of Social Affairs. The center provides its curative physiotherapy services to the insured Palestinians who live in the north districts.
The NGO’s Physiotherapy services are distributed in all north districts .The major part of the services is in Nablus district. These centers often physiotherapy, Services provided at minimal cost and free of charge for the social cases.
The private physiotherapy services are distributed in Nablus in the north districts .The major part of the services is also in Nablus district. Most services are located in the center of the cities. Physiotherapy is the major part of the services in this sector.
A. Research Design:
In this study the researcher has utilized a descriptive quantitative design utilizing a structured questionnaire with face-to-face interviewing to technique to describe the Physiotherapy services in the in Nablus district. The face-to-face technique will be most appropriate in order to include all providers of services with different service levels and to achieve high response rate.
The study will cover all operating Physiotherapy centers at the primary, secondary, and tertiary levels.
B. Identification of Population and Sample:
The target population includes all the providers of Physiotherapy services in the north districts of Palestine in Nablus district. Responses will be provided by each centers manger or responsible.
The researcher by them self made the interview and collected the survey from the centers.
The researcher had chosen four sectors, (Government, UNRWA, NGOS, Private) which provided Physiotherapy services to conduct the study. These clinics and centers were selected according to specific criteria, which had located in the north districts in Nablus district.
D. Ethical Consideration:
A formal Letter: Not used, because the cooperation of the administrator of Physiotherapy department.
Explanatory Form: Every eligible manger or responsible in the study was given a full explanation about the research. Including the purpose, nature of study, importance of participation in addition to assuring of confidentiality of information and voluntary participation and that the providers was given the total freedom or accept or reject participate in the research .
For the purpose of conducting face-to-face interview, the researcher designed a semi-structured questionnaire. The
Questionnaire aimed at exploring to evaluate the Physiotherapy services. The questionnaire was written in Arabic language to be easily understood by providers. The instrument was divided into (10) questions; each question consisted of several items (Appendix1). It was designed to collect information falling under the categories of: -
Question1: Related to the quality and quantity of the physiotherapy
services in the centers.
Quation2: Items related to the size of physiotherapy services in the
Question3: Items related to the funding of the physiotherapy services in the Centers.
Question4: Items related to the human resources in the physiotherapy centers.
Question5: Items related to the administration systems in the
Question6: Items related to the referral system and cooperation and
Coordination Between centers.
Question7: Items related to the general policies of the physiotherapy.
Question8: Items related to the priorities of the physiotherapy.
Question9: Items related to the believes, that we needs to develop
the physiotherapy policies.
Question10: Items related to the improvement the quality of the
F. Pilot Testing:
These items in the questionnaire were evaluated by advisors who had research back ground and by two qualified Physiotherapy for validity purposes.
G. Data Collection:
The researcher had planned to spend five days in the field in Nablus district for interview and collect data from the providers. The providers was first given a complete explanation about the purpose, nature of the study in addition to assure her/his confidentiality and that providers was free to accept or reject to participate in the study, the interview was conducted.
Before starting the interview, the questionnaire forms were prepared and serial by numbers. That was to secure the availability of all forms all the time. At the end of each interview, the researcher scanned the questionnaire to ensure adequate completion of all information.
Limitation of this study were related to
1-A relatively small size from one district where by the finding can only represent the situation in the district.
2-The responses of institution in some topics are too high, because the Presented institution wants to give a good picture about institution in this Study.
I. Method of Data Analysis:
The data was entered into the computer, while utilizing the statistical program SPSS. Descriptive statistics such as mean, percentage, frequency distribution, and ranks.
This chapter gave an overview of the methodology that was used to answer the research questions, which included the research design, the target population, sampling, setting, instrument and methods of data collection and analysis.
Table (3) Distributions of Physiotherapy Institutions as follows Palestinian physiotherapy Association, 2018)
Table (3) Distributions of Physiotherapy Institutions as follows CNCFR In Nablus, 2018)
Table (3) Distributions of Physiotherapy Institutions as follows CNCFR In Nablus, 2018)
A. Data Analysis Procedure:
Data collection was carried out in the period in March 2018. The population of the study different subjects. The subjects were from Government centers and clinic, Non Government centers, UNRWA centers, and Private centers in the Nablus district. Face to face interview technique was carried out, and all questionnaires were completed ensuring 100% response rate.
Descriptive statistics for closed-ended questions was carried out using the (SPSS) program indicating Mean, Frequencies, and percentages.
For data analysis, the researcher used the following percentages:
(80%) as above was considered very high degree of strong agree.
(70-79.9%) as above was considered high degree of agree.
(60-69.9%) as above was considered moderate degree of
(50-59.9%) as above was considered low degree of disagree.
(Less than 50%) as above was considered very low degree of
B. Presentation of Results:
The presentation of data covered the 10 parts of the questionnaire. The part one presents descriptive analysis of types of PT services. The third part presents descriptive analysis of respondents assessment of PT services in relation to several aspects of quality and quantity of services, size of services, financial, human resources, administrative system, referral system, cooperation and coordination between the institutions, PT policies, priority of PT, serious, development of PT policies, and suggestions needed to develop PT policies to improve PT services quality. The findings are presented in a tabular form.
1. Classification Variables:
For this part, frequency distributions were developed for each of the descriptive variables of the population.
This chapter has presented an overview of the results of 31 providers from 31 PT services institutions and centers. The purpose was to describe PT services. Data collected in the period January 2018, and was analyzed using percentages, Frequencies distribution, and rank.
Results were presented in the thirteen parts: the descriptive responses related to the types of PT services, quality and quantity of PT services, size of PT services, financial matters, human resources, administrative system, patient-referring system, cooperation and coordination between institutions.
This study aimed at describing the PT services in districts in Nablus district.
Information in this regard was collected, and pointed out important aspects that need be considered by various PT care providers in the Nablus districts were pointed out can be summarized as follows:
C. Recommendations for Further Research.
This study was descriptive in its nature to collect information regarding the characteristics of PT services in the north districts in Nablus district. It serves as base line data for further studies related to PT services. Based on this study, it is recommended that the future studies in this area use other variables in addition to those in this study, which would be of great advantage to PT planning programmers. The population size can be increased in order to cover all West Bank as well as Palestine as a whole, to allow for the general is ability of the findings.
The areas recommended to be tacked include: -
beneficiaries in evaluating of PT services provided at
The institution continually.