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Update outdated and rigid legislationBe dynamic in adapting to the changing needs of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