Beyond Market Access

1
Beyond Market Access Domestic Regulation and
Mutual Recognition

• Mode 4 of the GATS
• Taking Stock and Moving Forward September 2008
• David C. Benton
• Chief Executive Officer Designate
• International Council of Nurses

2
Three issues

• MRAs their role and the challenges
• Stakeholder involvement and contribution
• Pragmatic Facilitation of Mode 4

3
The International 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

4
The Context for Mode 4 and Nursing

• 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

5
Role and Challenges

• Policy
• Net Sum Fears
• Trade and Safety
• Divergence in Health Sector (Taskshifting)
• Education Policy Disincentives
• Immigration controls
• Regulatory coherence (Private and State Sectors)

• Process
• Regulators
• Systems
• Resources
• Adaptation
• Technical
• Languistic and Cultural
• Specialist
• Rogue Practitioners

6
Mode 4 as Part of a Complex Adaptive 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

7
Japan
8
Canada
9
Dealing with Complex Adaptive 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.

10
Stakeholder Involvement And Contribution

• 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

11
Pragmatic 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• Update outdated and rigid legislation
• Be 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 general
• Encourage countries with strong frameworks to
  help others
• Encourage international model frameworks

12
Pragmatic Facilitation of Mode 4
13
Pragmatic Facilitation of Mode 4

• Facilitate normative working across countries and
  jurisdictions
• E-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

14
Pragmatic 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

15
Thank you

• International Council of Nurses
• 3, place Jean-Marteau
• 1201 Geneva
• Tel. [phone]
• Fax [phone]
• Email benton_at_icn.ch
• Website www.icn.ch
•