Background: The world is faced with a chronic shortage of health workers, and the World Health Organization (WHO) has estimated a global shortage of 7.2 million health workers resulting in large gaps in service provision for people with disability. The magnitude of the unmet needs, especially within musculoskeletal conditions, is not well established as global data on health work resources are scarce.
Methods: We conducted an international, cross-sectional survey of all 193 United Nation member countries and seven dependencies to describe the global chiropractic workforce in terms of the availability (numbers and where they are practising), quality (education and licensing), accessibility (entry and reimbursement), and acceptability (scope of practice and legal rights). An electronic survey was issued to contact persons of constituent member associations of the World Federation of Chiropractic (WFC). In addition, data were collected from government websites, personal communication and internet searches. Data were analysed using descriptive statistics. Worldwide density maps of the distribution of numbers of chiropractors and providers of chiropractic education were graphically presented.
Results: Information was available from 90 countries in which at least one chiropractor was present. The total number of chiropractors worldwide was 103,469. The number of chiropractors per country ranged from 1 to 77,000 (median = 10; IQR = [4–113]). Chiropractic education was offered in 48 institutions in 19 countries. Direct access to chiropractic services was available in 81 (90%) countries, and services were partially or fully covered by government and/or private health schemes in 46 (51.1%) countries. The practice of chiropractic was legally recognized in 68 (75.6%) of the 90 countries. It was explicitly illegal in 12 (13.3%) countries.
Conclusion: We have provided information about the global chiropractic workforce. The profession is represented in 90 countries, but the distribution of chiropractors and chiropractic educational institutions, and governing legislations and regulations largely favour high-income countries. There is a large under-representation in low- and middle-income countries in terms of provision of services, education and legislative and regulatory frameworks, and the available data from these countries are limited.
Author keywords: Chiropractic — Rehabilitation — Global Health — Health workforce — Survey — Cross-sectional — Education
Author affiliations: MJS: Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark; MJS: Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; MR,DS, PC: UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Oshawa, Ontario, Canada; PT: Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Providencia, Santiago, Chile; PT: Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, NSW, Australia; RB: World Federation of Chiropractic, Toronto, Ontario, Canada; PC: Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada; PC: Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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