sudan health regulatory prsentation

8/2/2019 Sudan Health Regulatory Prsentation

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Insaf Hassan

Midwifery Regulation Globally


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What is regulation?

Midwifery regulation is the set of criteria andprocesses arising from the legislation thatidentifies who is a midwife and who is not,and describes the scope of midwifery

practice.The scope of practice is those activitieswhich midwives are educated, competentand authorised to perform.

Registration, sometimes called licensure, isthe legal right to practise and to use the titleof midwife. It also acts as a means of entry tothe profession. (International Confederation

of Midwives 2002 p. 1)


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Central purpose of midwiferyregulation

The primary reason for legislation andregulation is to protect the public fromthose who attempt to provide midwifery

services inappropriately (ICM, 2002)The health and safety of mothers and

their babies is protected throughregulatory mechanisms that ensure thatmidwives are competent to practise andprovide high standards of midwifery care.

Standards must be evidence based and

purposeful improve health care of


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Models of regulation

1. Specific legislation:

Midwives Act

Nursing & Midwifery Act

Nursing Act (midwifery not usually recognisedas a separate profession)Medical Act

It has become increasingly apparent that

nursing legislation is inadequate to regulatemidwifery practice (ICM, 2002)

. Legislation sets the powers of the RegulatoryAuthority (Eg. Midwifery Council/Board)


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2. Generic legislation/umbrellalegislation

Single Act for all regulated health

professions (Medicine, nursing, midwifery,physiotherapy, dentistry etc)

Each profession has its own RegulatoryAuthority to enact the legislation

Consistent approach to healthregulation/powers

Each profession, through its Regulatory

Authority, is empowered to managere ulation functions for itself


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Government-ledMinistry of Health

Limited involvement of profession

Limited regulatory functions

Midwifery associationsProvide aspects of regulation (eg. Setting

standards for practice)

No legislative power

Local standards

No regulatory structures


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Current regulatory directions

Recent legislation provides fullregulation powers; older

legislation limits powers toregistration, education standards& discipline

New legislation includes laymembers RAs

New legislation includes

mechanisms for continuing


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Principles of good regulation

NECESSITY

EFFECTIVENESS

FLEXIBILITYPROPORTIONALITY

TRANSPARENCY

ACCOUNTABILITYCONSISTENCY


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ICM Global standards formidwifery regulation

Purpose of regulation

Protect safety of mother & babyreceiving midwifery care through six

main regulatory functions:1. Setting the scope of midwifery practice

2. Setting/approving standards for pre-registration midwifery education

3. Registering midwives4. Relicensing midwives who remain

competent after registration

5. Disciplining midwives found to breach

standards


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Standards are a framework foreffective midwifery regulation

The framework defines the elements of regulationin order to:

Determine who may use the title of midwife;

Describe the scope of practice of a midwifeconsistent with the ICM definition of a midwife;

Ensure that midwives enter the register followingeducation consistent with the ICM Global

Standards for Midwifery Education (2011);Ensure that midwives enter the register able todemonstrate the ICM Essential Competencies forBasic Midwifery Practice (2011);

Ensure that midwives are able to practise

autonomously within their prescribed scope of


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Standards are a framework foreffective midwifery regulation

Ensure that midwives demonstratecontinuing competence to practise;

Ensure that midwives and women(as users of midwifery services) arepart of the governance of midwifery

regulatory bodies; andEnsure public safety through theprovision of a competent andautonomous midwifery workforce.


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The ICM standards cover

1. Model of regulation

2. Protection of title

3. Governance

4. Functions:

4.1 Scope of practice

4.2 Pre-registration midwifery

education4.3 Registration

4.4 Continuing competence

4.5 Complaints & discipline

4.6 Code of conduct & ethics


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Model of regulation

Midwifery specificMidwives Act or specific midwifery

recognition in umbrella legislation -Statutory powers for effective regulation

Midwifery-specific regulatoryauthority/processes

Autonomous profession

National levelUniformity

Where federal and state government need mechanism for collaboration &

communication


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Protection of title

Only those authorised under the legislationmay use title midwife

Identifies fully qualified midwives fromothers with midwifery skills

Responsible and accountable; adhere toprofessional codes & standards

Mothers & families can expect competentcare from educated & fully qualified

midwivesRegulatory authority can prosecute

someone holding themself out to be amidwife if not registered


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Governance

Transparent processes fornomination, selection &appointment of members of the

regulatory authority (RA)Majority members are midwives

reflecting diversity of midwifery

practiceLay members

Legislation sets out governancestructures


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Governance contd

Chairperson is a midwifeRA funded by fees paid by midwives

(any government support should notlimit autonomy of RA)

RA works collaboratively with midwiferyassociation

Partnership; consultation; collaboration

RA works collaboratively with healthprofession RAs nationally &internationally

Consistency; economies of scale

(shared systems)


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Functions: Scope of Practice

RA defines scope consistent with ICMdefinition and scope of practice of a midwifeLegal definition of what a midwife may do on

her own responsibility

Incorporates ICM essential competencies forbasic midwifery practice regardless of setting

Should enable autonomous practice (mayrequire other legislative changes)

Prescribing rightsAccess to laboratory & screening services

Consultation & referral

Admitting and discharge rights


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Functions: pre-registrationmidwifery education

RA sets minimum standards forprogrammes & accreditation ofinstitutions consistent with ICM educationstandardsProfession defines standards

Consistent standard for education leadingto registration

Standardisation of quality betweenprogrammes

RA approves programmes

RA accredits educational institutions


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Functions: Registration

Legislation sets criteria for midwiferyregistration/licensure

RA develops standards & processes forregistration/licensureEG:

Has met competencies

Successfully completes approved pre-registration midwifery education programme

Passed a national examination

Met standards of fitness (good character;communicates effectively; no health issues;no criminal record)


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Functions: Registration contd

RA develops process to assessequivalence of midwives from othercountries seeking to be registered

Comparison of educationAssessment of competence

Certificate of good standing

Possible examination & clinical

assessmentAdaptation programme may be

required provisional registration

Ethically facilitate international mobility


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Functions: registration contd

Range of registration/licensure statusRegistration categories provisional,

temporary, conditional, suspended, full

Temporary limitation of midwifes practice

in various circumstances (Eg. Remedialprogrammes)

RA maintain register of midwives,publicly availablePublic accountability & transparency

Pathways to registration where overseasmidwives do not meet standards

Data gathering for workforce planning


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Functions: ContinuingcompetenceRecertification or re-licensing is the

mechanism through which midwivesregularly demonstrate continuingcompetence

Recertification programmes includerequirements for continuing education;practice requirements; professionalactivities; competence review

Initial registration and regular relicensingare separate processesRegistration for life

Practising certificate


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Functions: Complaints &disciplineRA defines standards of conduct;

unprofessional conduct; professionalmisconduct

Legislation authorises RA to impose, review

& remove penalties, sanctions & conditionson practice

Legislation sets out powers & processes forreceipt, investigation, determination &

resolution of complaintsNatural justice

RA has policy & processes to managecomplaints

Competence, conduct, health

Functions: Code of conduct &


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Functions: Code of conduct &

ethicsRA sets standards of conduct& ethicsConsistent with ICM Codeof Ethics


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Use of ICM global regulationstandards

Use as a model for newlegislation and new regulatoryauthorities

Use as a framework for reviewof existing legislation &regulatory processes

Use as a benchmark

Use as an advocacy tool


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Education, Regulation andAssociation (ERA): Interrelated

PillarsIf any of these pillars is weak, the entire profession is weakened.

ED

UCAT

ION

RE

GULA

TION

AS

SOCI

ATION

ICM ESSENTIAL COMPETENCIES


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SITUATION OF MIDWIFERYREGULATION IN SUDANThe regulatory body is together with otherAllied Health Professions.

Sudan National Council for Medical andHealth professions

Body was established in January 2011 andto date naming of cadres to be regulatedhas since been finalized.

Committees for examination, registration,

accreditation, inspection, complaints andappeals have been established


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Comparison

How do we compare as Sudan?

What are the gaps

How do we address the identified gaps

Thank You!!!

sudan health regulatory prsentation

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