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:
MRAs their role and the challenges
Stakeholder involvement and
contribution
Pragmatic Facilitation of Mode 4
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
The Context for Mode 4 and
Nursing
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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
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
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
Japan
Canada
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.
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
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 Update outdated and rigid legislation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
Pragmatic Facilitation of Mode 4
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
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
Thank you
International Council of Nurses
3, place Jean-Marteau
1201 Geneva
Tel.: +41 22 908 0100
Fax: +41 22 908 0101
Email: [email protected]
Website: www.icn.ch