From Acupuncture to Chiropractic: What India’s Regulatory Experience Can Teach Africa

When Africans hear about acupuncture, chiropractic and osteopathy, these disciplines are often placed together under the broad umbrella of “alternative medicine.” My continuing study of India’s healthcare regulatory system, however, has convinced me that this description is legally inadequate.

A therapy can be recognized without the practitioner necessarily becoming a statutorily recognized healthcare professional. A practitioner may also be permitted to perform a particular technique without acquiring ownership of an entire professional title.

India provides an interesting contemporary example. The country has developed a statutory framework for allied and healthcare professions under the National Commission for Allied and Healthcare Professions Act, 2021. But acupuncture, chiropractic and osteopathy do not presently occupy identical positions within that framework. Understanding the differences offers important lessons for Ghana and Africa.

Acupuncture has taken a major regulatory step

Perhaps the most interesting development concerns acupuncture. Acupuncture has been practised in India for many years, but questions surrounding education, registration and regulation persisted.

A significant change occurred on 26 September 2024, when the Government of India issued Notification S.O. 4238(E), bringing acupuncture professionals expressly into the Schedule of the National Commission for Allied and Healthcare Professions Act. Acupuncture professionals were placed under the category of “Other Care Professionals.”

This means acupuncture in India has moved beyond simply being a therapeutic technique practised by individuals. Its practitioners now have an express pathway within a national statutory regulatory architecture.

What is the NCAHP?
The National Commission for Allied and Healthcare Professions, or NCAHP, is an important component of India’s healthcare regulatory system. The 2021 legislation provides a framework covering professional standards, education, recognition of qualifications, professional registers, institutions and professional conduct.

The Act contains a Schedule identifying professions falling within its regulatory architecture and a mechanism for amending that Schedule. India therefore does not necessarily need an entirely new Act of Parliament whenever an emerging allied healthcare profession requires statutory inclusion. Acupuncture demonstrates how this mechanism can work.

Recognition does not finish the work
Putting a profession into legislation does not complete its professionalization. Government and regulators must still determine who qualifies as an acupuncturist, what education and clinical training are required, who registers practitioners, what procedures they may perform, what ethical standards apply, when patients should be referred, how competency is maintained and how misconduct is addressed.

Legislation creates regulatory authority; implementation makes regulation meaningful.

Chiropractic presents a different picture
Chiropractic is internationally recognized as a distinct healthcare profession in several countries and is particularly associated with musculoskeletal healthcare and manual interventions, including spinal manipulation.

India’s contemporary statutory position is different from that of acupuncture. In the current Schedule of the NCAHP Act, chiropractic is not expressly identified as an autonomous professional category comparable to acupuncture.

This does not mean that every technique associated with chiropractic is necessarily prohibited in India. Some manual techniques associated with chiropractic are also used by other recognized healthcare professions, including physiotherapy.

Physiotherapists can also use manipulation

Physiotherapy is expressly recognized within India’s allied and healthcare professions framework. Importantly, India’s statutory description of physiotherapy includes interventions involving mobilization and manipulation.

But manipulation is also strongly associated with chiropractic. If two professions use the same technique, does one profession own that technique? The answer should not automatically be yes.

Healthcare professions frequently overlap. The fact that two professions use manipulation does not necessarily make them the same profession.

A therapy is not necessarily a profession
From my analysis, I propose the Therapy–Profession Distinction Principle: legal recognition of a therapeutic technique should not automatically be interpreted as legal recognition of an autonomous healthcare profession.

Manipulation is a technique. Physiotherapy is a profession. Chiropractic is a profession in countries that recognize it as such. Osteopathy is also a profession in jurisdictions that regulate it as such.

What differentiates professions is not merely the technique performed. Education, philosophy, competency, clinical authority, scope of practice and regulatory accountability also matter.

What about osteopathy?
Osteopathy makes the discussion more complicated because its meaning differs internationally. In the United States, Doctors of Osteopathic Medicine are fully licensed physicians. In several other countries, osteopathy exists as a distinct manual healthcare profession.

Merely importing the title “osteopath” into another country without defining what it means creates regulatory confusion. Like chiropractic, osteopathy is not expressly identified as an autonomous profession in the current NCAHP Schedule examined in my research.

Questions therefore arise concerning qualifications, training duration, diagnostic authority, permitted manipulative procedures, registration and complaints. These questions cannot safely be left entirely to practitioners themselves.

Can a short course make someone a chiropractor?

Suppose a physiotherapist undertakes a short course in spinal manipulation. The practitioner may legitimately acquire additional competency. But does that automatically make the physiotherapist a chiropractor? I argue that it should not.

Likewise, completing several courses in osteopathic techniques should not automatically permit someone to represent himself or herself as an osteopath where that title ordinarily represents a distinct professional education.

What does “chiropractor” tell the patient?

When a patient sees “Dr X — Chiropractor,” the patient may reasonably believe that the practitioner has completed professional chiropractic education. Similarly, the title osteopath should communicate something meaningful about education and competency.

I therefore propose the Professional Title Integrity Principle: a healthcare professional title should communicate a verifiable educational, competency and regulatory status to the public. This is not simply about protecting professions. It is about protecting patients.

The law must address overlapping professions

The Overlapping Professions Regulatory Principle provides that where different healthcare professions use similar techniques, regulators should not ask only who owns the technique. They should examine education, competency, clinical authority, scope, risk, referral obligations and accountability.

The central concern should remain patient safety.

Not every profession needs its own Act
India’s NCAHP framework presents an interesting possibility for Africa. If Ghana eventually decides to regulate acupuncture, chiropractic, osteopathy, naturopathy, homeopathy, clinical nutrition, massage therapy, yoga therapy and other emerging professions, Parliament may not necessarily need a separate Act for every profession.

An umbrella regulatory statute could establish a national commission for complementary, integrative and allied healthcare professions and place recognized professions into a statutory Schedule. Additional professions could later be added through a legally controlled process.

Risk should determine the strength of regulation

Not every healthcare activity presents the same level of risk. Someone teaching general wellness principles may not require the same regulatory controls as someone inserting needles or performing high-velocity spinal manipulation.

The greater the clinical risk and independent professional authority, the stronger the regulatory safeguards should be. I describe this as the Risk-Proportionality Principle.

Regulating the practitioner is not enough
There is also a difference between asking whether a practitioner is qualified and whether a facility is appropriate for treating patients. A competent practitioner may still operate from an unsuitable clinical environment.

Professional regulation concerns the person. Facility regulation concerns the place in which healthcare is delivered. A modern regulatory framework should address both where appropriate.

What Ghana and Africa can learn
African governments should first map emerging healthcare professions before regulating them. They should determine how many practitioners exist, where they were trained, what qualifications they possess and what services they provide.

Only after answering these questions can regulators intelligently determine whether a profession should be integrated into an existing profession, recognized as a specialty or regulated autonomously.

Regulation does not mean every treatment works

Government recognition of acupuncture, chiropractic, osteopathy, naturopathy or any other healthcare profession should never be interpreted as government certification that every therapeutic claim made by practitioners is scientifically proven.

Professional regulation and scientific efficacy are different questions. Scientific claims must remain subject to research and evidence. Professional recognition should increase scientific responsibility, not diminish it.

Africa should regulate intelligently
India’s evolving experience with acupuncture, chiropractic and osteopathy teaches us that healthcare regulation should move beyond simplistic categories of “orthodox” and “alternative.”

Acupuncture’s movement into India’s statutory allied-health framework demonstrates how an emerging profession can progress toward formal professionalization. Chiropractic and osteopathy demonstrate another regulatory reality: a profession may exist in practice before its precise statutory identity is settled.

Africa should neither rush to recognize every emerging healthcare occupation as an autonomous profession nor leave established clinical practices indefinitely within regulatory uncertainty. The objective should be proportionate, evidence-informed and patient-centred regulation.

Ultimately, the lesson is simple: a therapy is not automatically a profession. A technique does not automatically confer a professional title. Recognition does not automatically establish competence. Regulation must ultimately exist not merely to protect professions, but to protect the public.

About the Author
Prof. Raphael Nyarkotey Obu is a Ghanaian naturopathic academic, researcher and lawyer whose scholarly interests include health law, naturopathic medicine, traditional and complementary medicine regulation, professional education and health policy. He is President of Nyarkotey College of Holistic Medicine and Founding President of the African Naturopathic Federation.

Three ways Africa could regulate emerging professions

Source: Constructed by the Author (2026).

A possible African regulatory pathway

Identify the emerging profession
Map practitioners and qualifications
Determine educational and competency standards

Assess clinical risks
Examine overlap with existing professions
Select the appropriate regulatory model
Establish registration and title requirements

Define scope and referral boundaries
Establish ethics and disciplinary procedures
Protect the patient
Source: Constructed by the Author (2026).

   Comments0