The current study demonstrated that there is a shortage of rehabilitation healthcare workforce and limited number of occupational therapy and physiotherapy training programs in SSA. The findings of this study is in agreement with previous studies that indicated shortage of rehabilitation healthcare workforce [
20,
23,
29,
34‐
36] and limited OT and PT training programs [
32,
33,
35‐
38] in some SSA countries. For the past 65 years, WFOT and WCPT have been strong advocates for their respective professions [
19,
36,
39,
40]. Both organizations have promoted international cooperation and collaboration and worked through their membership organizations in SSA to elevate/upgrade the level of training and education so that the practice and standards of services provided by practitioners can be advanced. The current study revealed that there are very few OT and PT educational programs and most of them are offered at or below bachelor’s level, resulting in a limited number of OT and PT healthcare providers who can be available to provide rehabilitation services [
23,
29,
34,
35]. This suggests that there is an urgent need to strengthen and professionalize the local branches of PT and OT professional associations and for an expanded role of international organizations and collaboration among higher education institutions in Anglophone SSA countries in order to address the challenge of educating a critical mass of occupational therapists and physiotherapists and meet the growing demand for rehabilitation services. These findings are consistent with the results obtained in previous health workforce studies conducted in SSA [
19,
36,
40]. For instance, Frantz reported in a study that lack of undergraduate training programs, limited number of therapists, need for upgrading knowledge base of physiotherapy educators, and recognizing physiotherapy as an essential service were some of the challenges facing physiotherapy education in Africa [
36]. Recent studies by Balogun et al. suggests that, compared to many other SSA countries, Nigeria is probably positioned to play an important role in West African SSA region, in building capacity to train more OT and PT healthcare workforce and for international collaboration and exchanges [
32,
33]. Similarly, results from the current study suggests that South Africa with the greatest number of OT and PT programs at academic master and doctorate degree levels is also better positioned as being a catalyst to build capacity for OT and PT healthcare workforce in the southern Africa region of SSA.
Unless a concerted effort is made to increase the number of OT and PT clinicians and educators with advanced degrees, the goal of developing and sustaining entry-level OT and PT educational programs at or above the bachelor entry-level will be difficult to achieve [
20,
40]. The WCPT Africa Region in 2014 adopted a Vision 2020, with goals to help the few SSA countries currently operating diploma PT programs in Africa and to upgrade to bachelor’s degree level, and a Vision 2030, which will see upgrade of most bachelors entry level to clinical doctorate entry level [
19]. The WCPT in various Guiding Policy documents has set international standards for entry-level education in physiotherapy as a minimum of Baccalaureate, Masters, or Doctoral entry-level education [
41,
42]. The WCPT also now conducts international accreditation of educational institutions worldwide that wish to attain, maintain, and be recognized as meeting these international standards [
43]. In addition, the WCPT has also been directly involved in taking steps to help upgrade education programs in some African countries. For example, through an international initiative to strengthen education programs in Africa, the WCPT in collaboration with Handicap International, and supported by funding from the United States Agency for International Development (USAID), will assist three African nations of Mali, Niger, and Senegal through the SUDA Project from 2016 through 2018 and beyond [
44,
45]. The goals of SUDA are (1) strengthening three national physical therapy associations, (2) using WCPT standards to support three countries in improving physical therapy entry-level education in order to advance towards WCPT accreditation, (3) developing a WCPT policy paper related to physical therapy assistants (PTAs), (4) augmenting wheelchair training within the physical therapy sector. SUDA acronym is derived from each of the first letter of the four program objectives: S, U, D, and A [
44,
45]. Through a similar international initiative, there are indications that Ethiopia will soon have its first occupational therapy training program, which will be established at the University of Gondar, Ethiopia. This will be made possible as part of a US$ 24.2 million grant to Queen’s University, Ontario, Canada (to be disbursed over a 10-year period), from The MasterCard Foundation [
46]. The MasterCard Foundation maintains a network of 27 universities that supports accessibility in education, specifically for students with disabilities across the African continent [
47]. Therefore, without similar international initiatives, cooperation, and partnerships among SSA country, these vision and goals may be difficult to achieve. Although extensive efforts were made to obtain OT and PT country data for SSA countries, the results of this study is limited by the inability of the authors to access current OT and PT country information for some SSA countries. Several SSA country data listed in Tables
1 and
2 were reported as “NA”, i.e., no data
available.
Recommendations for further studies
Given that the burden of injuries and non-communicable diseases (i.e., cardiovascular, cancers, diabetes and chronic lung diseases) is rising disproportionately among lower income countries and populations, the challenge of training individuals who can provide specialized rehabilitation (for example, post stroke and cardiac events) and activity of daily living services must be addressed. Nine suggestions are advanced for future research on OT and PT workforce in SSA. First, given that inadequate clinical fieldwork sites, lack of qualified faculty, and poor country-level awareness could potentially contribute to the low number of OT and PT educational programs and practitioners in SSA reported in this study, a future follow-up study should be expanded to include an assessment of the quality of the existing PT and OT educational programs. Studies similar to the recent report of Balogun et al. should be extended to other SSA countries [
32,
33]. Second, this study did not investigate admission requirements, number of student enrolled, job placement, perception of new graduates, and employment settings of OT and PT practitioners. This should be considered in future studies. Third, given that the WFOT and WCPT have been advocating to upgrade the entry level into the OT and PT professions to beyond bachelor degree levels in all countries [
36,
39], the feasibility of this initiative in developing countries should be assessed [
33]. Fourth, the delivery of health and rehabilitation services is increasingly team based [
48‐
50]. Research should be conducted to examine the extent to which the curriculum of existing PT and OT programs emphasize team-based and interdisciplinary education. Fifth, since physicians play a significant role in the delivery of healthcare and training of allied health professionals in SSA, an investigation of the views of physicians on the roles and contributions of PT and OT practitioners will provide critical information educators can use to design curriculum and strategies to establish OT and PT as integral members of the healthcare delivery team [
51,
52]. Sixth, OT practice is generally based on western perceptions and classifications of activities of daily living and human occupation. The extent to which African perspectives are considered in the framing of the entry-level OT competencies should be examined [
53]. Seventh, efforts should be made to identify and replicate effective models of international cooperation and partnership on the training and education of PT and OT [
38,
40]. Eight, in order to obtain an accurate number of native-born and expatriate practicing PT and OT, an effort should be made to obtain information directly from professional licensing and government agencies. Finally, given resource constraints, data availability, and language constraints, this investigation focused on Anglophone SSA countries. This study should be expanded with specific focus on examining (a) the availability of OT and PT educational programs, (b) general knowledge and awareness of PT and OT professions among students, (c) employment settings for PT and OT, and (d) physician acceptance of the roles PT and OT in Francophone SSA.