Table 2 Key messages from this review categorized by structures, processes, and outcomes
From: Design, delivery and effectiveness of health practitioner regulation systems: an integrative review
Topic | Key messages |
|---|---|
Structures: Scope and governance | Governance reforms show a trend toward umbrella laws, multi-profession regulators, more diverse governing boards, and increasing accountability and oversight measures Increasing reliance on principles and tools of risk-based regulation signals a shift to more proactive strategies for harm prevention and mitigation |
Structures: Institutions | Most studies focused on statutory registration, a model increasingly being used across various jurisdictions and practitioner groups The lack of standardized HPR typology complicates comparisons and makes it difficult to draw conclusions about the effectiveness of various governance models |
Structures: System linkages | HPR can support government strategies for workforce planning, development, supply and distribution, particularly to address workforce shortages in rural areas and during emergencies Despite efforts in harmonization and mutual recognition, challenges remain with cross-border recognition of qualifications and portability of registration, impacting health worker migration and mobility |
Processes: Scopes of practice | Scope of practice regulation can adapt to health system demands for collaborative team-based practice and a more dynamic division of labor Scope of practice reforms, particularly around prescribing rights for non-physician clinicians, can improve healthcare access and quality |
Processes: Continuing competence | Outcomes-based CPD models can be effective continuing competence mechanisms if access, equity, delivery, and design are addressed Programs that support internationally educated health practitioners can aid recruitment and successful transition to practice |
Processes: Accreditation of health practitioner education programs | Core elements of accreditation are broadly consistent across jurisdictions and there is a growing presence of international accreditation agencies and standards Despite a lack of evidence on outcomes or cost-effectiveness, accreditation is considered important for assuring graduate competence in many jurisdictions and is a focus for regulatory strengthening initiatives in LMICs |
Processes: Complaints and discipline | Remediation programs to support safe return to practice and clear mandatory reporting obligations can be effective public protection mechanisms |
Processes: T&CM practitioners | Statutory registration can strengthen public protection for T&CM occupations based on risk profiles and is increasingly used to preserve indigenous medical knowledge and improve health service delivery to underserved populations |
Outcomes | Alternatives to statutory registration for lower-risk health occupations can improve health services and consumer protection A broader systems approach to evaluating regulatory failures and standardized evaluation frameworks can aid regulatory strengthening initiatives |