Importance of strengthening nursing and midwifery regulation
Nurses, midwives and allied health personnel are critical to health service delivery and are frontline providers of health; nurses and midwives provide 70-80% of essential health care. As such they are a vital resource for attaining health and development targets. In resolution WHA64.7 24, the World Health Assembly in 2011 recognized and endorsed the need to strengthen nursing and midwifery in order to ensure the delivery of competent, accessible, effective and appropriate nursing care.
Within that context, nursing and midwifery regulation and evaluation are important components of strengthening health services and ensuring the safety and quality of health care services. While nurses should take the lead in their professional governance, regulatory systems should recognize and incorporate the valid roles and responsibilities of other relevant parties, including the public, the government and other professions.
During the regional forum on the future of nursing and midwifery, held in Amman, Jordan on 24 April 2015, nursing and midwifery regulation was the subject of considerable discussion and debate and was identified among the key challenges impeding the delivery of safe and competent nursing and midwifery care in the Region.
The WHO Regional Office for the Eastern Mediterranean therefore organized an expert group meeting in Cairo on 8–10 December 2015 to discuss practical steps to strengthen the regulation of nursing and midwifery in the Region. The meeting was attended by regional and international experts and representatives of nursing midwifery and allied health regulatory councils and accrediting bodies as well as ministries of health of countries of the Eastern Mediterranean Region. The objectives of the meeting were to:
describe the situation of nursing and midwifery regulation in the Eastern Mediterranean Region based on the findings of the Eastern Mediterranean regulation survey;
present successful experiences in regulation of the health workforce from within and outside the Region;
identify the priorities for strengthening the regulation of these three categories of professionals; and
identify and suggest actions to strengthen nursing and midwifery regulation in the three groups of countries; and to suggest options for implementing robust regulatory policies and practices that will protect the health of the public.
Issues and challenges
In order to identify appropriate ways to assist countries in their efforts to establish or strengthen national regulatory agencies, participants considered and discussed the results of two regional surveys conducted in 2014 and 2015 on the situation of nursing, midwifery and allied health professions regulation as well as the short-, medium- and long-term action points outlined in the regional framework for action on strengthening nursing and midwifery 2015–2025.
A number of important issues that needed to be considered in relation to developing nursing and midwifery regulation in the Region were identified including:
Enhancing the level of knowledge and understanding of health professionals, legislators, policy-makers and planners, about the importance of modern health professions regulation.
Educating the public to become better informed about regulation, and how it affects them directly.
Empowering regulatory bodies to use ICT technologies to communicate with various stakeholders and policy-makers about the roles and the benefits of the services which they provide.
Ensuring the visibility of regulation and regulatory bodies through allocating sufficient levels of authority, responsibility and accountability, as well as resources, to the regulatory system and its governing body.
Acknowledging and strengthening the link between professional regulation and quality improvement. This relationship needs to be understood by practitioners, managers, planners and policy-makers.
Promoting more professional and effective management of the regulatory processes.
Investing in regulators with the required skill sets, ensuring staff training and paying greater attention to preparing the governing body to carry out its role.
Understanding the situation of regulation in each country to be able to identify needs.
Developing, strengthening and institutionalizing regulation that is dynamic, flexible and transparent.
Identifying the essential characteristics of effective regulations, such as targets of effective regulations, who regulates, what should be regulated and the power of effective regulation.
Promoting collaborative efforts and partnerships to assess countries’ efforts to develop and improve their regulatory systems.
Recognizing the core functions for regulatory bodies which are applicable to all countries: representing the profession and collecting fees; registering and licensing of professionals; implementing a professional code of ethics and taking disciplinary actions; setting ethical standards for clinical research; and setting standards for education and practice.
The main challenges facing countries of the Region in their efforts to develop nursing and midwifery regulations are:
lack of political support and commitment
ineffective lobbying and advocacy
poor understanding of regulations
fragmentation of regulatory functions and
lack of knowledge on regulation and professionalism.
Broad strategies to address these challenges include: i) strengthening leadership of regulators, and other stakeholders including the health professionals themselves; ii) promoting collaboration and coordination among various stakeholders at the national and regional levels; iii) building capacity of regulators and advocacy among the political groups; and iv) developing a clear understanding of where each country stands with regard to regulation processes and developing a road map based on the priorities and the context of the country.
The way forward
A number of actions to move the process of nursing and midwifery regulation forward at country and regional levels were proposed (Box 1).
