Midwifery Regulation Globally

Click to edit Master subtitle style

Insaf Hassan

3/15/12

What is regulation?
Midwifery regulation is the set of criteria and processes arising from the legislation that identifies who is a midwife and who is not, and describes the scope of midwifery practice. The scope of practice is those activities which midwives are educated, competent and authorised to perform. Registration, sometimes called licensure, is the legal right to practise and to use the title of midwife. It also acts as a means of entry to the profession. (International Confederation 3/15/12 of Midwives 2002 p. 1)

Central purpose of midwifery regulation

The primary reason for legislation and

regulation is to protect the public from those who attempt to provide midwifery services inappropriately (ICM, 2002) The health and safety of mothers and their babies is protected through regulatory mechanisms that ensure that midwives are competent to practise and provide high standards of midwifery care. Standards must be evidence based and 3/15/12 purposeful improve health care of

Models of regulation
1. Specific legislation: Midwives Act Nursing & Midwifery Act Nursing Act (midwifery not usually recognised

as a separate profession) Medical Act It has become increasingly apparent that nursing legislation is inadequate to regulate midwifery practice (ICM, 2002)
.Legislation sets the powers of the Regulatory

Authority (Eg. Midwifery Council/Board)

3/15/12

Models of regulation
2. Generic legislation/umbrella legislation
Single Act for all regulated health

professions (Medicine, nursing, midwifery, physiotherapy, dentistry etc) Each profession has its own Regulatory Authority to enact the legislation Consistent approach to health regulation/powers Each profession, through its Regulatory Authority, is empowered to manage 3/15/12 regulation functions for itself

Models of regulation
Government-led Ministry of Health Limited involvement of profession Limited regulatory functions Midwifery associations Provide aspects of regulation (eg. Setting standards for practice) No legislative power Local standards No regulatory structures
3/15/12

Current regulatory directions

Recent legislation provides full

regulation powers; older legislation limits powers to registration, education standards & discipline
New legislation includes lay

members RAs New legislation includes 3/15/12 mechanisms for continuing

Principles of good regulation

NECESSITY EFFECTIVENESS FLEXIBILITY PROPORTIONALITY TRANSPARENCY ACCOUNTABILITY CONSISTENCY
3/15/12

ICM Global standards for midwifery regulation

Purpose of regulation Protect safety of mother & baby

receiving midwifery care through six main regulatory functions: 1. Setting the scope of midwifery practice 2. Setting/approving standards for preregistration midwifery education 3. Registering midwives 4. Relicensing midwives who remain competent after registration 5. Disciplining midwives found to breach 3/15/12 standards

Standards are a framework for effective midwifery regulation

The framework defines the elements of regulation

in order to: Determine who may use the title of midwife; Describe the scope of practice of a midwife consistent with the ICM definition of a midwife; Ensure that midwives enter the register following education consistent with the ICM Global Standards for Midwifery Education (2011); Ensure that midwives enter the register able to demonstrate the ICM Essential Competencies for Basic Midwifery Practice (2011); Ensure that midwives are able to practise 3/15/12 autonomously within their prescribed scope of

Standards are a framework for effective midwifery regulation

Ensure that midwives demonstrate

continuing competence to practise; Ensure that midwives and women (as users of midwifery services) are part of the governance of midwifery regulatory bodies; and Ensure public safety through the provision of a competent and autonomous midwifery workforce.
3/15/12

The ICM standards cover

1. 2. 3. 4. Model of regulation Protection of title Governance Functions: 4.1 Scope of practice 4.2 Pre-registration midwifery education 4.3 Registration 4.4 Continuing competence 4.5 Complaints & discipline 3/15/12 4.6 Code of conduct & ethics

Model of regulation
Midwifery specific
Midwives Act or specific midwifery

recognition in umbrella legislation Statutory powers for effective regulation Midwifery-specific regulatory authority/processes Autonomous profession
National level
Uniformity Where federal and state government

need mechanism for collaboration & communication 3/15/12

Protection of title
Only those authorised under the legislation

may use title midwife Identifies fully qualified midwives from others with midwifery skills Responsible and accountable; adhere to professional codes & standards Mothers & families can expect competent care from educated & fully qualified midwives Regulatory authority can prosecute someone holding themself out to be a midwife if not registered
3/15/12

Governance
Transparent processes for

nomination, selection & appointment of members of the regulatory authority (RA) Majority members are midwives reflecting diversity of midwifery practice Lay members Legislation sets out governance structures 3/15/12

Governance contd
Chairperson is a midwife RA funded by fees paid by midwives

(any government support should not limit autonomy of RA) RA works collaboratively with midwifery association Partnership; consultation; collaboration RA works collaboratively with health profession RAs nationally & internationally Consistency; economies of scale 3/15/12 (shared systems)

Functions: Scope of Practice

RA defines scope consistent with ICM

definition and scope of practice of a midwife

Legal definition of what a midwife may do on

her own responsibility Incorporates ICM essential competencies for basic midwifery practice regardless of setting Should enable autonomous practice (may require other legislative changes) Prescribing rights Access to laboratory & screening services Consultation & referral Admitting and discharge rights
3/15/12

Functions: pre-registration midwifery education

RA sets minimum standards for

programmes & accreditation of institutions consistent with ICM education standards

Profession defines standards Consistent standard for education leading

to registration Standardisation of quality between programmes

RA approves programmes

3/15/12 RA accredits educational institutions

Functions: Registration
Legislation sets criteria for midwifery

registration/licensure RA develops standards & processes for registration/licensure

EG: 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)
3/15/12

Functions: Registration contd

RA develops process to assess

equivalence of midwives from other countries seeking to be registered

Comparison of education Assessment of competence Certificate of good standing Possible examination & clinical

assessment Adaptation programme may be required provisional registration Ethically facilitate international mobility 3/15/12

Functions: registration contd

Range of registration/licensure status
Registration categories provisional,

temporary, conditional, suspended, full Temporary limitation of midwifes practice in various circumstances (Eg. Remedial programmes)
RA maintain register of midwives,

publicly available
Public accountability & transparency

Pathways to registration where overseas

midwives do not meet standards 3/15/12 Data gathering for workforce planning

Functions: Continuing competence

Recertification or re-licensing is the

mechanism through which midwives regularly demonstrate continuing competence Recertification programmes include requirements for continuing education; practice requirements; professional activities; competence review Initial registration and regular relicensing are separate processes
Registration for life Practising certificate
3/15/12

Functions: Complaints & discipline

RA defines standards of conduct;

unprofessional conduct; professional misconduct Legislation authorises RA to impose, review & remove penalties, sanctions & conditions on practice Legislation sets out powers & processes for receipt, investigation, determination & resolution of complaints Natural justice RA has policy & processes to manage complaints 3/15/12 Competence, conduct, health

Functions: Code of conduct & ethics

RA sets standards of conduct

& ethics Consistent with ICM Code of Ethics

3/15/12

Use of ICM global regulation standards

Use as a model for new

legislation and new regulatory authorities Use as a framework for review of existing legislation & regulatory processes Use as a benchmark Use as an advocacy tool
3/15/12

Education, Regulation and Association (ERA): Interrelated Pillars pillars is weak, the entire profession is weakened. If any of these
A S S O C I A T I O N ICM ESSENTIAL COMPETENCIES E D U C A T I O N R E G U L A T I O N

3/15/12

27 27

3/15/12

28 28

3/15/12

SITUATION OF MIDWIFERY REGULATION IN SUDAN

The regulatory body is together with other

Allied Health Professions. Sudan National Council for Medical and Health professions Body was established in January 2011 and to date naming of cadres to be regulated has since been finalized. Committees for examination, registration, accreditation, inspection, complaints and appeals have been established
3/15/12

Comparison
How do we compare as Sudan? What are the gaps How do we address the identified gaps

Thank You!!!

3/15/12