Beyond Market Access – Domestic Regulation and Mutual Recognition

Beyond Market Access – Domestic Regulation and

Mutual Recognition

Mode 4 of the GATS –Taking Stock and Moving Forward

September 2008

David C. BentonChief Executive Officer Designate

International Council of Nurses

Three issues:Three issues:

MRAs their role and the challenges

Stakeholder involvement and contribution

Pragmatic Facilitation of Mode 4

The International The International Council of Nurses (ICN)Council of Nurses (ICN)

Is a federation of 131 National Nurses Associations

Strives to improve the standards of nursing care through better education and regulation of nursing

Believes the overriding purpose of statutory regulation is to serve and protect the public

The Context for Mode 4 and The Context for Mode 4 and NursingNursing

The global nursing shortage Practice environments Public demands/expectations Governments interest in changing roles

and frustration with the professions Money Professions’ interest in a global view Trade Entrepreneurship Migration

PolicyNet Sum & FearsTrade and SafetyDivergence in

Health Sector (Taskshifting)

Education Policy Disincentives

Immigration controls

Regulatory coherence (Private and State Sectors)

ProcessRegulatorsSystemsResourcesAdaptation

TechnicalLanguistic and

CulturalSpecialistRogue

Practitioners

Role and ChallengesRole and Challenges

Mode 4 as Part of a Complex Mode 4 as Part of a Complex Adaptive SystemAdaptive System

Failure to recognise the GATS and MODE 4 as part of a complex adaptive system is a real barrier to progess in reaching agreements and will lead to longer term practical problems

JapanJapan

CanadaCanada

Dealing with Complex Adaptive Dealing with Complex Adaptive systems (General Points)systems (General Points)

Increased transparency and accountability

Better communications

Better and timelier data collection and information generation

Involve, negotiate, think future as well as now, pragmatism and feedback.

Stakeholder Involvement And Stakeholder Involvement And ContributionContribution

More than Trade Ministries Health, Education, Immigration

(Government) Professionals and Regulatory Bodies

All on the Same Page Knowledge, Time-scales and

Vision/Outcomes Systems Impact and planning for success

Normative Approaches and Networking

Pragmatic Facilitation of Mode 4Pragmatic Facilitation of Mode 4

Support the concept of strengthening regulatory infrastructure before introducing disciplines

Where none exists introduce regulatory bodies and legislation that is flexible and facilitative

Update outdated and rigid legislationBe dynamic in adapting to the changing needs of

the health care environment and the evolving and expanding capabilities of nurses

Leave domestic regulation broad and generalEncourage countries with strong frameworks to

help othersEncourage international model frameworks

Pragmatic Facilitation of Mode 4Pragmatic Facilitation of Mode 4

Pragmatic Facilitation of Mode 4Pragmatic Facilitation of Mode 4

Facilitate normative working across countries and jurisdictionsE-based data exchange and

minimum data sets with shared data element definitions

Compatible systems of credential assessment

Calibration of Educational Credit and Qualification Frameworks

Domestic Disciplines for Nursing

Pragmatic Facilitation of Mode 4Pragmatic Facilitation of Mode 4• ICN and ICM Regulators Forum

• Support for developing country participation • Support for multi-lingual participation

• ICN Research into the Role and Identity of the Regulator

• Database of Jurisdictions• Comparative analysis of legislation• Compendium of legislation and regulatory best

practices• Lexicon of terms

Thank you

International Council of Nurses3, place Jean-Marteau

1201 GenevaTel.: +41 22 908 0100Fax: +41 22 908 0101Email: [email protected]: www.icn.ch