April 11, 2017

It takes a village

Written by Alyson Smith and Silvia Holschneider

This article originally appeared on USAID ASSIST. Reposted with permission.

April 2 – 8, 2017 marks World Health Worker Week. We’re honoring health workers in this blog series. Today’s theme is “Partnerships.”  

In Cambodia, each health profession is regulated by their respective independent Council—the Medical Council of Cambodia, the Dental Council of Cambodia, the Cambodian Midwives Council, the Cambodian Council of Nurses, and the Pharmacy Council of Cambodia. Since 2000, these councils have played an important quality and safety role through registration of qualified health professionals, making sure that they maintain registration, establish the codes and standards of professional practice and investigate complaints about matters relating to a health professional’s health, performance or professional conduct.

Starting in July 2014, with funding support from the United States Agency for International Development (USAID), the USAID ASSIST Project has been working in partnership with the existing five health professional Councils along with the Ministry of Health (MOH), and other key stakeholders to strengthen the system of health profession regulation in the country. To date only about half (53.5%) of all health professionals are registered with their Councils. This is due in part to Councils’ having: very limited human and physical resources to build capacity and implement the requirements of legislation; no authority to enforce the mandatory legal requirements including mandatory registration and payment of an annual fee to maintain registration for all public and private health care professionals; and limited recognition of the importance of the Councils’ roles and connections with other quality and safety mechanisms in the Cambodian public and private health sectors.

ASSIST, the Councils, and the MOH quickly realized that addressing these complex challenges could not be done by one group alone—but instead would involve partnerships among various stakeholders, at national and sub-national levels, to increase the likelihood of success and sustainability. Here are some of the ways these partnerships are evolving:

Established a clear purpose and a set of agreed upon goals through the creation of a shared five-year national Strategic Plan 2015 – 2020 for all five health profession Councils.

Launched by the Minister for Health in June 2015, the Strategic Plan provides a shared understanding between the Councils, the MOH and stakeholders of the key priorities required to strengthen health profession regulation in Cambodia; guides the implementation and evaluation of priority improvements to health profession regulation in Cambodia; and facilitates the opportunity for health development partners to understand the approach and contribute to strengthening health profession regulation that meets the needs of Cambodia.

Collaborative effort between the MOH and Councils along with JICA Office of the WHO Representative in Cambodia and ASSIST. 

To develop a new law on Regulation of Health Practitioners that provides the authority for health profession Councils to carry out regulatory functions including registration and license to practice; management of complaints received against health professionals’ health, performance and/or conduct including sanctions; codes and standards of professional practice; controls on health profession pre-service education (e.g., scopes of practice and graduate competencies); and monitoring and compliance of health professionals’ continuing competence to practice. This involved technical assistance from ASSIST, commitment and participation of all health profession Councils at national and sub-national levels, the MOH, and health partners. The collaborative effort continues to help make the necessary consequential amendments to the existing Royal Decrees, Sub-decrees and Prakas and other relevant legislation as well as develop the policy and procedures for the new or amended regulatory functions for all Councils.

Supported the ongoing partnership between the health professional Councils and the MOH.

Providing technical advice and guidance to the health profession Councils to develop a comprehensive business plan for organizational redesign of the Councils. The business plan provides clear financial requirements and identifies potential sources of funds to establish the Councils’ approved Joint Secretariat, including an office and employment of a sufficient number and quality of staff to deliver efficient and effective business and regulatory systems and processes for the five Councils. The goal is for the Councils to be self-funded from registrant fees within five years.

Working closely with health professionals across Cambodia to achieve greater compliance with mandatory registration and in the future, a renewable license to practice to ensure continuing competence.

In-depth interviews with health practitioners helped us identify challenges and barriers to registration in some parts of the country. We are working to raise awareness about health professionals’ registration and license to practice requirements. This requires a comprehensive approach that involves numerous partnerships:

  1. Collaborating with the five Councils and the MOH at national, regional, and provincial levels to seek support and an enabling environment to implement and disseminate messages regarding the new Law on Regulation of Health Practitioners.
  2. Working with health professional education institutions to disseminate information about their professional obligations and the new law to graduating students;
  3. Working with registered health professionals as “peer mentors” to influence awareness, knowledge, and behaviors among non-registered health professionals in both the public and private health sectors and motivate them to register;
  4. Targeting health professionals as well as the general public with key messages provided through different communication channels about the importance of health professionals registering and being treated by registered health professionals; and
  5. Working in partnership with a local IT development company to develop and test a web-based registration management system that provides for an on-line application process, access by all to up-to-date information on health professionals’ registration and health practitioners’ license to practice status and a range of reports on health professional workforce data.

The Royal Government of Cambodia has embarked on an important journey to strengthen the quality of its health profession workforce and to ensure the safety of the public receiving health care services. USAID ASSIST is honored to support this work.