A Closer Look at the Developing Profession of Speech and Language Pathology (SLP) in Turkey

SEYHUN TOPBAS

Introduction

Speech and language pathology (SLP) in Turkey is a young profession but is growing rapidly. Bleile et al. (2007: 1) has stated that 'the amount of attention a country gives to communication disorders depends on its history, cultural ties on language and disability, economics and availability of services; and that the impact of a communication disorder varies depending on where a person is born and lives'. Thus, a glance at the whole system is necessary to visualize the developmental status of SLP within this country. In this chapter, I will first simplify the complicated nature of the Turkish health, education and special education systems and the financing of services, followed by a closer look at the history of the profession and education of speech and language pathologists (SLPs). Finally, I will present the current developments in lieu of my previous report (Topbas, 2006a), and will articulate the problematic issues in service delivery within this system.

An Overview of the Turkish Health and Education Systems

Turkish health system

The Turkish health care system has a complex structure. To simplify the matter only the basic structure and service delivery will be summarized. Several old laws, although subjected to various changes, still constitute the basis of the practice system. Health policies implemented until 1980 were formed within the Socialization of Health Services Law (1961, No: 224), which attempted to establish a national health service free of charge although this was not achieved until recently. Currently, the health system, including the social insurance system, is undergoing the effects of a reform package, by the Health Transformation Program (Akdag? et al., 2007).

Health services in Turkey are supplied by a multitude of public and private providers. The Turkish Ministry of Health (MoH) is the main government body responsible for health sector policy making, implementation of national health strategies and direct provision of primary and secondary health care, maternal health services, children and family planning services and preventive health services. The two key public providers are the MoH and the University hospitals. The MoH operates an extensive network of health facilities through several affiliated public, quasi-public, private and philanthropic organizations, depending on the advocates' concern with policy formulation, provision of health care, finance of health care and whether they have administrative jurisdiction over the delivery of health care (MoH, 2004). Apart from policy making, the provision of health services is supplied by public and private hospitals, outpatient polyclinics, laboratories and diagnostic and rehabilitation centers, providing primary, secondary and specialized inpatient and outpatient care. University (state and foundation) hospitals are under the responsibility of The Council of Higher Education of Turkey (CoHE) as they support medical training. Each medical school has its own university hospital, acting as a main referral hospital as well as providing comprehensive and modern health care.

The MoH also focuses on school health services organized jointly with the Turkish Ministry of National Education (MoNE), which includes vaccination, screening programs (eye, oral and general physical examinations that check height and weight) and primary care services. A recent attempt has been made to implement a health-promoting schools project, in collaboration with the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF), as well as mother and child health centers and family planning centers. Services for those with special needs and necessary rehabilitation services after treatment are also rendered in collaboration with MoNE (MoH, 2004).

Turkish education system

The Turkish National Education System (Act No: 1739) is highly centralized. The MoNE is responsible for all formal and non-formal educational services in the country excluding higher education. Formal regular education includes preschool education, basic education (primary), secondary education and higher education. Both private and public state educational institutions are prominent. Education is free at every level in state institutions. Preschool education is optional for children aged 0–6. These may be infant or nursery schools, or preprimary classes within a primary school. An important step carried out by the MoNE is the mobile kindergarten project for 36–72-month-old children who live in villages and cannot attend preschool and/or for those with a low socioeconomic backgrounds. Primary education, being compulsory, involves the education and training of children in the age group of 6–14 (in total, eight years of education). A national curriculum is implemented across the country. Secondary education, which is not compulsory, consists of four years of education following primary education and includes general, vocational and technical high school training for the 14–16 age group (MoNE, 2007).

In accordance with Law No. 2547 of 1981, the CoHE is the planning, coordinating and policymaking body...