Introduction
Not all Naturopathic programs are created the same. There are many programs in Naturopathy being taught globally. Some are being run by recognized schools, while others are not.1 For Africans, there is so much difficulty in assessing such recognized and accredited Naturopathic schools. Anecdotal evidence suggests that for many Africans, it is so difficult to afford such schools. This, in turn, leaves many Africans to resort to substandard Naturopathic foreign schools and this further creates credibility and recognition challenges for practitioners in Africa and Ghana, specifically.
South Africa is the only country with a nationally accredited Naturopathic program in Africa. However, the full degree program had been placed on hold for some time.2, 3 The School offers 5-year training programs in four disciplines of natural medicine:
Chinese Medicine and Acupuncture
Naturopathy
Phytotherapy (Western Herbal Medicine)
Unani Tibb Medicine
The study of these disciplines is currently divided into two separate degrees. The first degree is a Bachelor of Science in Complementary Health Sciences, completed over three (3) years. This can be followed by a Bachelor of Complementary Medicine (BCM) within the student’s chosen discipline (listed above), completed over two (2) years.
After completing the program, students are eligible for registration with The Allied Health Professions Council of South Africa (AHPCSA) as a Doctor2 in their studied discipline (e.g. Doctor of Phytotherapy). They can also be registered with the Board of Healthcare Funders (BHF) to obtain a practice number.2 Both national registrations allow private practice with a well-defined scope of practice by the AHPCSA and Department of Health.2 The scope or tool of practice involved taking history taking, clinical examination, medical imaging procedures, laboratory investigations (e.g. blood tests; X-rays), diagnosis and advice, and treatment as aligned in the scope of practice in the private healthcare system. They also join the South African Naturopathy Association.3
Ghana has now developed two programs to be offered at the tertiary level under the Commission for Technical and Vocational Education and Training (CTVET).4 Ghana’s program was funded and supported by the Nyarkotey University College of Holistic Medicine and Technology (NUCHMT).5
The process for accreditation started in 2021. The first step was the development of the National occupation standard for Naturopathy and Holistic Medicine at the HND and Bachelor’s levels. A team of academics was put together to help develop the occupation standards. National Occupational Standards (NOS) are enshrined with statements about the skills, knowledge, and used in employment, education, and practice.6 They define the outcomes of competent performance.6 It has become necessary in Ghana as the law mandated the commission for TVET to embrace Competency Based Training (CBT) in 2020.7
NOS has many benefits in the workplace and the development of the individual. These include recruitment, staff development review, promotion, identifying training or Continuing Professional Development (CPD) needs, and staff planning.6
In the trade of Naturopathy, NOS helps the Naturopathic profession to define areas of expertise and common competencies, define the role of Naturopaths and create a consistent approach to developing and accrediting training and qualifications.6
National Occupational Standards are also updated and in the case of Ghana, the regulator mandates that they are updated after every five years. Hence, the next NOS is scheduled for 2027. This means that successful products from CTVET accredited Naturopathic schools are supposed to demonstrate some levels of competencies in Naturopathy.
It is trite that Naturopaths interpret presenting symptoms as the individual’s unique response to physical, emotional, environmental, or genetic stress factors. Hence, the practitioner’s role is to identify these underlying causes and to support the healing power of nature within the individual. Naturopathy is also a way of life and naturopath will help empower individuals through education about lifestyle, diet, and exercise.6
Ghana’s version of the Naturopathic Occupational standard is concerned with the practitioners working with individuals to provide naturopathic healthcare. It describes the minimum competence specific to naturopathy. In the case of Ghana’s version, naturopaths will have many competencies and specialties, and the standard reflects up-to-date information and policies in Naturopathy. Another area of competence embedded in the case of Ghana is training in African Naturopathy and wider knowledge of biomedical science.
The NOS has a General Area of Competence, which specifies the subject areas students are supposed to exhibit or be taught in the curriculum. It also has the skills and sub-skills and the range statements. The skills and sub-skills are embedded in the Learning Outcomes (Los). Each LO has the knowledge area and sub-skills have the Performance Criteria (PCs). The Ghanaian team developed learning materials for each subject in the occupation standards. Assessment tools and marking scheme guidelines were all developed to enhance students learning.
The Naturopathy and holistic medicine competency-based curriculum are ideal for the current changing trend in Naturopathic practice and unique in naturopathic education. Understanding competency-based education is important in naturopathic education, CBT means that, unlike the traditional education system, is centered on competence in each subject, instead of focusing on writing and passing exams to get good grades in a formalized and structured yearly curriculum schedule. This means that students can only move forward when they can demonstrate mastery.7 Traditional education places emphasis on the semester and students just move to the next semester whether they performed well or not. Competency-based education scores are based on the performance levels of each student, without bias. It is either achieved or not achieved.7, 8, 9
Gitahi10 has explained that a Competency-based Curriculum (CBC) is an educational system that emphasizes a learner’s unique talents and abilities rather than focusing wholly on academics and exam performances. Hence, it is a curriculum that focuses on the acquisition of knowledge, skills, and attitudes to use in the future in society.
Some key features of CBC are:
CBC is outcome-based: The first step in competency-based learning is to define precise learning outcomes. All lessons are hence geared towards the achievement of the set skills/competencies.
Learner-Centered: First and foremost, CBC learning values the student as an individual. For this reason, CBC empowers learners to master valuable skills/knowledge at their own pace.
Differentiated: CBC learning practices are adjusted to meet the individual needs of specific learners. All the interventions are determined by the learning requirements of the student.
In the challenges, we found that it will take some time for facilitators to adjust themselves and fit into the new program. CBT is also expensive to operate. The development of the Naturopathic curriculum took so much time and huge resources had to go into it. In CBT, we used the term facilitators and not lecturers. CBT facilitators have to be trained and certified before facilitating, unlike the traditional system. The CBT facilitation certification or licensure is valid for five years but is subject to renewal every two years. The maximum class size in CBT accredited institutions is twenty-five. This gives the facilitator the time to engage and mentor students, unlike the traditional system where schools enroll any student size. This place more financial burden on schools especially private schools. In CBT, learning materials are readily made available to students before the module commences. Additionally, institutions can upload course materials on their websites for students to access. External assessors also make sure the schools are doing the right thing; this serves as a monitoring and quality assurance purposes.
Figure 4
Prof. Raphael Nyarkotey Obu delivered the presentation at the Ministry of Health on progress made in the development of National Occupational Standards in naturopathy and Holistic Medicine
At this point, Ghana is proud to say that there is the advancement of the first National Accreditation towards the Higher National Diploma (HND) and Bachelor of Technology Naturopathy and Holistic Medicine. The Country’s first National Naturopathic Medical School; Nyarkotey University College of Holistic Medicine & Technology has been registered and officially recognized as a Competency Based Training (CBT) Provider Tertiary institution by the Commission for Technical and Vocational Education and Training (CTVET).
As part of the program accreditation process, the college team met the Ministry of Health regulator, Traditional Medicine Practice Council Departmental Heads at the Ministry of Health Head Office in Accra to engage the regulator on the progress towards accreditation and integration of prospective graduands into the Mainstream Healthcare.
The regulator also discussed the Professional aspect of the training after the students received their academic education from the college and the proposed writing of the Ghana Naturopathic Physician Examination for recognition. This is the first of its kind in the West African sub-region and among the few on the African Continent.
Hence, Ghana’s Naturopathic program is structured into two sessions. The academic component at the tertiary level for 4 years for the bachelor’s and professional training for one year. The HND is 3 years at the tertiary level and one year at the professional level. The HND for Naturopaths and Bachelor’s for Naturopathic Physicians with a different scope of practice.
The program is based on CBT which is different from the traditional system of education. In principle, such a curriculum is learner-centered and adaptive to the changing needs of students, teachers, and society in the Naturopathic community. Competency-based curricula are usually designed around a set of key competencies/competencies that can be cross-curricular and/or subject-bound.
There is a prospect for trained Naturopaths in Ghana from accredited CTVET schools. A naturopath is a natural health practitioner who specializes in nutritional therapy, osteopathy, homeopathy, acupuncture, or herbal medicine.9 A naturopath uses an approach to healthcare that blends modern scientific knowledge with traditional, natural forms of treatment.
Naturopathy provides self-employment. in the UK for instance, a practitioner could charge in the region of £65 to £90 for an initial consultation (lasting one to one and half hours) and £45 to £65 for follow-up appointments. The higher fees are typically charged by more experienced or specialized practitioners so expect to start at the lower end. 9
Practitioners often offer packages such as a six to eight-week program of an initial consultation and one follow-up, or a 12-week program with an initial consultation and two follow-up appointments.9
Practitioners require indemnity insurance cover and could generate annual salary rangers £18,700.9 The General Naturopathic Council (GNC)9 is the regulator for naturopathy in the UK. Along with the government agency Skills for Health, the GNC has developed the National Occupational Standards for naturopathy in the UK, which describes the minimum competencies for naturopaths. A practitioner must have completed a standard level and amount of training. The GNC sets the curriculum for UK courses, so it is prudent for prospective student seeks out training from a GNC accredited provider.
The qualifying course in the UK is to take a diploma in naturopathy, or one of the fields within naturopathy: nutrition, acupuncture, or homeopathy. Each provider will specify their course entry requirements. Practitioners do not need a degree, foundation degree, or HND to apply. There are two main professional bodies for naturopathic practitioners, and the courses they support include supervised clinical practice.9, 12
Hence, Ghana’s Competency Standards are in line with the Philippines Naturopathy standards13 which defines the MINIMUM required stock of knowledge, skills, and attitude for medical and non-medical health care professionals and workers in the area of Naturopathy. The competency also defines the proper roles and orientation needed for practice relevant and appropriate to the Philippine setting. In Ghana, the HND and Bachelor are awarded by the Commission for Technical and Vocational Education and Training(CTVET) after students complete each unit of competencies that have been achieved. Before the development of the occupational standards, there was a social dialogue for the Complementary Medicine community in Ghana14 to be abreast with the development.
Conclusion
The Competency Standard in Ghana has been developed to ensure that Naturopathy practice meets the minimum levels of adequate knowledge, skills, and awareness of indications and contraindications. Specifically, the purpose of this benchmark document is as follows:
To upgrade the level of professional education and training of Naturopaths in Complementary and Alternative Medicine with the end view of quality patient care, setting and maintaining standards of competence and integrity
To provide the foundation for the establishment of a competency assessment and certification system, for training modern Ghanaian Naturopaths on the African continent to improve primary healthcare delivery to meet international standards.
To provide a foundational guide for the Traditional Medicine Practice Council of the Ministry of Health and the various policymakers in the accreditation of the practice of Naturopathy;
To provide the framework for the development of training programs in Naturopathy for community health workers and other health professionals interested in taking Naturopathy and Holistic Medicine as a specialty or for integrative practice.
To provide for the development of training programs for the full range of training modalities including those of technical institutions, vocational institutions, apprenticeships, and community-based programs in Naturopathy and Holistic Medicine;
To pursue the Traditional Medicine Practice Council Standard Committee’s goal of formulating policies, standards, guidelines, and practices towards improving the quality and delivery of health services through the comprehensive (preventive, curative, rehabilitative, and promotive) development of traditional, complementary and alternative medicine, and its eventual integration into the national health care delivery system.
To contribute to bringing about a paradigm shift towards value formation, and ethical and social transformation using the holistic philosophy of traditional, complementary, and alternative systems of medicine through integrated multi-disciplinary and developmental approaches to TCAHC training.
Article DOI
