Minimum core competencies to standards of practice: regulation in the Asia-Pacific region: ICM Deputy Director Judi Brown reports on the 4th Meeting of Regulatory Authorities from the W Pacific and SE Asian Regions, held in Hong Kong, November 25-26, 2002

International Midwifery, Jan-Feb, 2003 by Judi Brown

The 4th Meeting of Regulatory Authorities from the Western Pacific and South East Asian Regions was held in Hong Kong, 25 and 26 November, 2002, at the Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China.

My involvement with the Conference came from a request from the Australian Nursing Council to facilitate a session on `Evaluation of Midwifery Legislation' as part of a preconference workshop to be held 23 November.

The Conference steering group comprised the Australian Nursing Council, the Nursing Council of New Zealand, and a representative of the host country planning group, Professor Thomas Wong, Chairman of the Nursing Council of Hong Kong. Ms Manbo Man, past President of the Hong Kong Midwives Association and now Chairperson of the Midwives Council of Hong Kong also attended. In all there were approximately 80 international delegates.

Building on earlier work

The theme `From Minimum Core Competencies to Standards of Practice--Issues and Challenges' was a continuation of the work that regulatory authority representatives had started at the last meeting held in Bangkok in 2000. At that time many of the core competencies for nurses in the Western Pacific and Asian Regions were identified and associated issues explored. The outcome of these deliberations was presented at the 5th International Conference on the Regulation of Nursing and Midwifery in June 2001 in Copenhagen, Denmark (a report on this was published in International Midwifery 14(6): 10-11). The pre-conference workshop was designed to assist those countries who are still struggling to set up a regulatory authority.

Competencies and life long learning: evidence to policy

Dr. Naeema Al-Gasseer, Senior Nursing Scientist at WHO, Geneva delivered the keynote presentation `Competencies and Life Long Learning: Evidence to Policy'. Dr Al-Gasseer identified issues for nursing and midwifery that had formed part of an address by the WHO Director-General, Dr. Brundtland to the Global Advisory Group on Nursing and Midwifery in Geneva in 2002. The essence of the presentation was for midwives and nurses to:

* use a human fights based approach to the development of services

* forecast the need for future models of care without losing sight of the need to be dynamic and competent

* work in partnership with other health professionals.

Dr Al-Gasseer stated that the `responsibility to build a culture that supports competence for life-long learning lies with several stakeholders such as a civil society, policy makers, legislators, health care providers, professional associations and employers. The need to forecast the potential competencies required to deliver health services calls for involvement at individual, institutional and societal levels'. The recent document Nursing and Midwifery Services Strategic Directions 2002-2008, she said, provides a framework for collaborative action to support countries in improving midwifery and nursing services at global, regional and national levels.

Key challenges for the 21st century within a health context, Dr Al-Gasseer suggested, would include:

* Impact of health care reform and cost containment on the workforce and services, with emphasis on the efficiency of services and equitable access to those services

* Provision for mobility and consumer demand as well as shortages and migration of the health workforce

* Knowledge explosion and access to solutions with a need for evidence to inform health practices

* Epidemiology changes and service responses

* Poverty

* Human rights and gender issues.

Participants were reminded that `individuals worldwide have the human right to be treated by a competent person'. Dr Al-Gasseer stressed that current evidence of direct or indirect impact of midwifery and nursing services on the population is still limited. The evidence needs expanding to show if these services are truly responsive to health needs. Dr Al-Gasseer called for a paradigm shift for midwifery and nursing, and a need for more accountability from its leaders.

The ICM contribution

As Deputy Director of the ICM Board of Management, I was involved in the pre-conference workshop for invited participants from countries where attempts are being made to develop their own regulatory authorities. Approximately 40 participants aimed to achieve the objectives of:

* understanding the steps needed to establish an authority

* demonstrating an ability to use a framework to identify requirements for effective regulation of midwives and nurses

* demonstrating an ability to develop regulatory policy derived from an Act regulating midwives and nurses.

I worked with 15 participants in evaluating a tool, developed by WHO. The tool is entitled `Framework for assessing situational analysis and identifying needs to strengthen midwifery in-country' (details of the tool are available from ICM, info@internationalmidwives.org). Outcomes of the work will be forwarded to the Midwifery Adviser to WHO, Geneva, to be considered for inclusion in the WHO Making Pregnancy Safer-Strengthening Midwifery Toolkit.