The regulation of healthcare professions and support workers in international context

Abstract

Background The objective of this paper is to outline and compare the regulation of paid healthcare professions and associated support workers in international context, bringing out the lessons to be learned as appropriate. Modern neo-liberal societies have sought to enhance healthcare through greater professional regulation, albeit in different ways and at variable pace. This general trend is illustrated with reference to medicine in the UK. However, although such reforms have helpfully cascaded to other health professions, government policy in high-income countries has not yet adequately regulated the interrelated group of non-professionalised health support workers who form the largest and least recognised part of the workforce. Nonetheless, in low- and middle-income (LMIC) countries—aside from the greater need for regulation of health professions—there is even more of an imperative to regulate the disparate, largely invisible support workforce. Methods With reference to existing studies of the medical and wider health professions in the UK and selected other higher income societies, the importance of health professional regulation to the public is underlined in the Global North. The larger gap in the regulation of support workers in modern neo-liberal countries is also emphasised on a similar basis, with an increasingly ageing population and advances in healthcare. It is argued from the very limited patchwork of secondary literature, though, that policy-makers may want to focus even more on enhancing regulation of both the professional and non-professional workforce in LMIC societies centred mainly in the Global South, drawing on lessons from the Global North. Results/conclusions Efforts to reform health professional regulatory approaches in more economically developed countries, while needing refinement, are likely to have had a positive effect. However, even in these societies there are still substantial shortfalls in the regulation of health support workers. There are even larger gaps in LMICs where there are fewer health professional staff and a greater dependence on support workers. With higher rates of morbidity and mortality, there is much more scope here for reforming health regulation in the public interest to extend standards and mitigate risk, following the pattern for healthcare professions in the Global North.

Adaptations in models of urological regulation and their application to sub‐Saharan Africa

“…These changes in governmental health policy culminated in the licensing of doctors for practice in the UK (2012) [24], and the evolution of a process of revalidation, or re-licensing (2016) to modernize governance, ensure patient safety and improve health service delivery [25,26]. Revalidation must take place every 5 years and is based on satisfactory annual appraisal documentation.…”

“…However, regulation is difficult in the region due to the local economics, legislative probity and most importantly the way in which healthcare is delivered to the population. Much care in resource‐poor environments is provided by clinical officers, nurses or support workers; whilst clinical officers and nurses are registered by professional councils in their respective countries, a large number of support workers fall outside of any form of regulatory umbrella [26]. There are precious few trained doctors, even fewer specialists, and little managerial infrastructure available to effectively regulate specialist practice as is done in HICs in north America, Europe, Asia and even the Middle‐East and North‐Africa region.…”

Protecting the public interest while regulating health professionals providing virtual care: A scoping review

“…Many health professions in high-income Anglophone jurisdictions with a common law history are governed by regulatory bodies mandated to protect the public. (13) The paramountcy of the public interest is often enshrined in the legislative framework empowering regulators (6), requiring regulators to protect the public against negligence, dishonesty, and incompetence by ensuring only those fit to practice safely are registered. (14) Professional regulators typically aim to meet this public protection mandate by setting entry-to-practice standards, maintaining a register of licensed practitioners, and monitoring and enforcing conduct, competency, and capacity in practice.…”

Assessing Capture Risks in the Regulatory Mechanism: Insights from Kenya’s Regulation of Professionals in the Construction Labour Market

“…Literature on regulation is preponderant in the field of health professions (Besançon, Rockey and van Zanten 2012; Carè, Steel and Wardle 2021; Clarke et al 2016; Dower and Finocchio 1999; Dower, Moore and Langelier 2013; Kidane 2012; McLaughlin, Leigh and Worsley 2016; Regan et al 2015; Saks 2014; Saks 2021; Samanta and Samanta 2004; Schaumans and Verboven 2008; Schepers and Casparie 1997; Squires and Dorsen 2018) and occasionally, the legal profession (Olgiati 1997) and accounting (Cooper and Robson 2006). Perhaps this may be so because the legal and medical professions compared to others happen to be highly regulated in the US and Europe (Garoupa 2004) and, also the oldest (Law and Kim 2004).…”