KINGDOM OF CAMBODIA NATION RELIGION KING Health Profession Councils National Strategic Plan 2015 2020 JUNE 2015 Supported by
Health Profession Councils National Strategic Plan 2015 2020 DISCLAIMER This strategic plan was authored by the health profession Councils in partnership with the USAID ASSIST Project. The views expressed do not necessarily reflect the views of the United States Agency for International Development (USAID) or the United States Government.
Table of Contents Acronyms... ii Purpose of the Document...1 Introduction and Context...1 Health Profession Councils Strategic Intent...2 Vision, Mission and Core Values of the Five Councils...3 Vision...3 Mission...3 Core Values...3 Themes and Criteria for High-performing Regulatory Bodies...4 Stakeholders and Partners...6 Inputs...6 Evaluation and Expected Outcomes for Strategic Interventions...7 Health Profession Councils National Strategic Plan 2015-2020...8
Acronyms ASEAN ASSIST CPD MRA USAID Association of South East Asian Nations USAID Applying Science to Strengthen and Improve Systems Project Continuing Professional Development Mutual Recognition Agreement United States Agency for International Development vi Health Profession Councils National Strategic Plan
Purpose of the Document This document has been developed for the five health profession Councils in partnership with the Human Resource Development Department of the Ministry of Health and with the support from the United States Agency for International Development (USAID) and its Applying Science to Strengthen and Improve Systems (ASSIST) Project. The purpose of this document is to communicate the five Councils National Strategic Plan for 2015 2020 for strengthening the system of regulation for all health professionals in Cambodia. Introduction and Context The Royal Government of Cambodia progressively introduced Royal Decrees to establish the five health profession Councils as follows: Medical Council of Cambodia 2000 Dental Council of Cambodia 2005 Cambodian Midwives Council 2006 Cambodia Council of Nurses 2008 Pharmacy Council of Cambodia 2010 This legislation and other related legislative instruments, sub-decrees and prakas currently provide the framework for the establishment and delivery of health professional regulation. The increasing focus on the assurance of both quality and safety of the public and private health care systems in Cambodia has resulted in consideration of how best to strengthen the system of regulating all health professionals in ways that meet the needs, cultural context and resources of Cambodia. Another equally important driver for this reform is the Royal Government of Cambodia s membership in the Association of South East Asian Nations (ASEAN). One of the primary goals of ASEAN is to improve skill development for health professionals so they can work in many different countries in the region. Three Mutual Recognition Agreements (MRAs) covering Doctors, Nurses, Dentists are being progressed with the objectives being to: Facilitate mobility of doctors, nurses and dentists within the ASEAN region Exchange information and enhance cooperation in respect of mutual recognition of doctors, nurses and dentists Promote adoption of best practices on standards and qualifications Provide opportunities for capacity building and education of doctors, nurses and dentists Health Profession Councils National Strategic Plan 1
A rapid baseline assessment was conducted in 2014 by the USAID ASSIST Project using a mixed methods approach that included: 1. A desktop review of key laws, plans, reports and other documents relating to the regulation of the health professions 2. Key informant interviews with stakeholders in Cambodia (at the National, Regional and Provincial level) 3. Gathering data using survey instruments to assess stakeholder knowledge of regulation 4. The completion of self-assessments by members of the five regulatory Councils 5. A rapid literature review to identify: The key functions of health professional regulation The key issues affecting the Cambodian health sector (including relevant development in the wider ASEAN region; and Smart practices to health professional regulation of possible relevance to Cambodia. The baseline assessment findings along with international experiences and Cambodian stakeholder perspectives were presented by the Councils at a two-day National Consultative Workshop in October 2014. The decision to strengthen the regulatory system provides a systematic way for all the Councils to work in partnership with stakeholders and health development partners to address the identified issues of: 1. Weak and variable effectiveness of health profession regulation; 2. Limited authority, capacity, structure and powers of the health profession Councils to regulate health professionals in Cambodia; 3. Limited connections between health profession regulation with other quality and safety mechanisms in the Cambodian health system. The stepwise interactive process of the National Consultative Workshop provided the opportunity to facilitate stakeholders understanding of the regulatory issues and the regulatory situation and to develop the strategy content. Five key issues were prioritised from the 20 issues identified. This resulted in 10 key strategic objectives and 28 strategic interventions to achieve the strategic objectives. The health development partners and the Human Resource Development Department of the Ministry of Health assisted the Councils to prioritise and finalise the Councils National Strategic Plan 2015-2020. Health Profession Councils Strategic Intent The Councils strategic intent over the next five years is to strengthen the system for regulation of all health professionals in Cambodia and thereby protect the community of Cambodia by: Addressing issues that adversely impact on the effectiveness of regulation of health professionals; Improving the authority, powers, capacity and structure of the five health profession Councils to regulate the health professions: doctors, dentists, pharmacists, nurses and midwives; Working in partnership with the Ministry of Health, Ministry of Education, Youth and Sports, Ministry of Justice, health development partners and key stakeholders to regulate the health professions effectively; Enhancing the connections between health profession regulation and other quality improvement and safety mechanisms within the Cambodian public and private health care systems. 2 Health Profession Councils National Strategic Plan
Vision, Mission and Core Values of the Five Councils The five health profession Councils continue to remain independent entities responsible under the law for regulating their respective health profession. However, the Councils have made a commitment to work in partnership together with the Ministry of Health to achieve the following Vision and Mission and apply the Core Values to their actions and decisions in implementing the National Strategic Plan. Vision A strong and responsive system of health profession regulation that supports safe, quality health care services delivered by competent and registered health professionals in Cambodia. Core Values The core values underpinning the Councils actions and decisions are: Collaboration Consistency Quality and safety Fairness Integrity Transparency Accountability Mission Provide the leadership and collective voice in strengthening the system of regulation for all health professionals (medical practitioners, dentists, pharmacists, nurses and midwives) in accordance with the legislation and contemporary regulatory practices and in partnership with stakeholders. Health Profession Councils National Strategic Plan 3
Themes and Criteria for High-performing Regulatory Bodies The National Strategic Plan for 2015 2020 is based on four features or themes identified as necessary for Councils to become high-performing health professional regulatory bodies to assure the safety and quality of registered health professionals and their practice. These themes are: 1. Legislation, advocacy and responsiveness 2. Organisational and internal governance 3. Responsibilities and functions 4. External governance and public accountability Aspects of each of these four themes have been identified as the focus of this five-year Strategic Plan. They are Legislation, Organisational, Responsibilities and functions and Public accountability. A number of key criteria related to these themes will allow for the continuous assessment of the Councils performance in implementing the strategic interventions over the next five years to address the shortcomings of the current regulatory system. The five-year Strategic Plan focuses on some of the key criteria relating to aspects of the four themes that are considered to be a priority in the next five years. The aspects of the four themes are underlined and the related key criteria are identified by an asterisk (*) in the table below. Legislation, Advocacy and Responsiveness Implementing Legislation Advocacy The regulatory body interprets legislation to facilitate and accommodate changing public protection needs* The regulatory body routinely provides comments on wide health systems reform and change Promotes professional issues that are congruent with protecting the public Responsiveness The regulatory body has processes that are consistent with those of other disciplines* The regulatory body keeps guidance, codes, standards, competencies and rules in-step with changing expectations of the public* The regulatory body interprets legislation to facilitate and accommodate changing public protection needs Organisational and Internal Governance Board Governance Board members of the regulatory body are subject to regular performance appraisal Clear criteria and the necessary competences for the selection and appointment of senior officials and board members are available Induction processes are in place for new board members Business Processes The regulatory body collaborates with other regulatory agencies to minimise administrative burden and maximise the use and impact of data* The regulatory body has mechanisms to align their accreditation systems with other agencies while continuing to fulfil their mandate The regulatory body develops guidance and rules that are supportive of health systems change* The regulatory body uses new technology to streamline business and regulatory processes* The regulatory body has mechanisms in place to detect and deal with fraudulent applications and requests for verification* The regulatory body has in place disaster recovery procedures and processes The regulatory body has adequate resources to enable all responsibilities to be fully discharged* Reporting lines are clear and reports are comprehensive and timely All committees have explicit, regularly reviewed terms of reference, and the activities of the committees are reported regularly to the full regulatory body 4 Health Profession Councils National Strategic Plan
Quality Improvement The regulatory body identifies and promotes best regulatory practice The regulatory body has access to relevant expert advice to support its decision-making processes* Emergent trends from the outcomes of the conduct and competence process are used to inform revisions of standards and requirements for continuing competence The regulatory body routinely examines a sample of completed continuing competence evidence from health professionals The regulatory body monitors its performance and seeks to continually improve the time taken to deal with fitness to practice allegations External Governance and Public Accountability Accountability The regulatory body is held to account for its performance The regulatory body has clear set of performance measures that are reported regularly While there may be multi-stakeholder input to development of standards, codes, scopes of practice policies and procedures, their application is free of inappropriate influence by government, the profession or other interested parties* The regulatory body acts in a manner that maintains the confidence of the public, professionals, employers and other key stakeholders The regulatory body has a strategic plan with linked operation objectives that are regularly reviewed and updated* Transparency The regulatory body has a set of clearly defined and publically available operating procedures The regulatory body has a balance between lay and professional members The regulatory body provides clear and succinct information on their responsibilities and process to registrants and the public* There are clear appeals processes that can be pursued if the decisions or the actions of the regulatory body are thought to be unsound All decision making is transparent, documented and accessible to the profession and the public Collaboration The regulatory body engages and consults key stakeholders in the development of policy and standards.* Responsibilities and Functions Competence Continuing competence procedures are in place that use data from multiple sources* and Conduct The regulatory body maintains independence in resolving allegations and complaints* Clear, accessible and well-publicised complaints procedures are readily available The regulatory body has standards of performance in relation to dealing with the receipt, acknowledgement, Investigation and resolution of fitness to practice complaints and allegations* The regulatory body has an impartial approach in dealing with allegation both with regard to complaints and registrants* An adequate range of meaningful sanctions for non-observance of the standards and non-compliance with codes of conduct is available* Registry Integrity Ethics and Professional Behaviour Standards and Education Mobility The register is accurate, comprehensive and readily accessible by the public, the registrants, employers and any other interesting parties* The regulatory body ensures that only persons who meet stipulated criteria for licensure can practice as a health professional Registration renewal procedures are efficient and effective* Promotes registrant behaviour that is reflective and self-regulatory* The regulatory body develops and promotes sound ethical and conduct codes* The regulatory body ensures educational programs are aligned with the competencies required by registrants for fitness to practice Professional standards and competencies are developed and set in collaboration with educational providers, employers, professional organisation and the public Processes relating to health professionals wishing to migrate into or emigrate from the jurisdiction are efficient and effective* Health Profession Councils National Strategic Plan 5
Stakeholders and Partners These include: Ministry of Health Ministry of Education, Youth and Sport Ministry of Justice Education providers (public and private) Employers public and non-government organisations (not-for-profit and for-profit) Professional associations Health professionals Representative community organisations The people of Cambodia International health development partners Inputs The inputs for each strategic intervention will vary; however, they will be drawn from the following: Financial, human and physical resources: Royal Government of Cambodia; health development partners; health professional fees Relevant departments of the Ministry of Health, Ministry of Education, Youth and Sport and Ministry of Justice Technical experts - local and international USAID ASSIST Project 6 Health Profession Councils National Strategic Plan
Evaluation and Expected Outcomes for Strategic Interventions Both quantitative and qualitative key performance indicators will be identified for each strategic intervention to measure the progress and success of each strategic intervention in achieving the strategic goal. It is envisaged that many of these key performance indicators will be developed in partnership with stakeholders for each of the regulatory and business functions. It will also provide a mechanism for ongoing assessment of the performance of the Councils in the delivery of a cost effective, efficient and quality regulatory service for all health professions. The Strategic Plan and associated work will be reviewed regularly by the Councils to: Assess the progress of the action plan for each strategic intervention and to reflect changing needs and priorities; Ensure continued alignment with the five health profession Councils shared vision, mission and values; Ensure it complements each Council s existing legislative mandate to effectively regulate their respective health profession and thereby protect the people of Cambodia. Health Profession Councils National Strategic Plan 7
Health Profession Councils National Strategic Plan 2015-2020 THEME STRATEGIC GOAL STRATEGIES Legislative Review and Reform Organisational Redesign Responsibilities and Functions Goal 1: Review the existing laws for all Councils and prepare amendments or develop a new law for all health profession Councils to meet the current and future needs of Cambodia Goal 2: Fully implement the amendments or a new health professions law Goal 3: Review and redesign the Councils structure to build capacity to establish and maintain effective and efficient regulatory systems and processes Goal 4: Achieve full compliance with registration requirements and full awareness amongst stakeholders and health professionals of registration requirements and obligations Review of existing laws and preparation of a legislation plan to guide development of amendments and/or a new health profession law for all Councils that ensures all the required regulatory provisions are addressed at the appropriate level of the law Design and prepare legislation for health professions regulation at the appropriate level of the law through a consultative process with key stakeholders Guide the passage of the new law through the legislative process including the Ministry of Health, Council of Ministers and the National Assembly Establish and monitor the implementation plan for the amendments or a new health profession law Disseminate the new health professions law through workshops and other communications to health professionals and relevant stakeholders Review the structure and operations of all Councils and design appropriate structures and systems that are transparent and meet the needs of Cambodia Review possible models of international regulatory bodies and work through a consultative process to consider options and develop an appropriate workable model Councils to have in place a sustainable business model that can mobilise resources for efficient and effective health profession regulation by 2016 Creation of a joint secretariat or executive committee that comprises representatives from all Councils to provide a single voice for health profession regulation in Cambodia; resolve problems; and support the Councils regulatory work and business requirements, including a shared office and staff Development of guidelines to review and define the roles and responsibilities of each health profession Council at every level (national, regional and provincial) and for implementation Development of annual action plans with review of progress and achievements at 6 monthly intervals Development of effective tools for monitoring and evaluation Review level of compliance with existing laws; identify and prioritise gaps and any immediate changes required to the laws and interim administrative solutions to manage gaps in registration Develop a system and process for dissemination and implementation of the existing laws at all levels throughout the country to all health professionals, health care facilities (national, regional, provincial) and other stakeholders 8 Health Profession Councils National Strategic Plan
THEME STRATEGIC GOAL STRATEGIES Responsibilities and Functions (Cont.) Public Accountability Goal 5: Review and further strengthen the level of health professionals ethical behaviour in the delivery of patient care Goal 6: Review and further strengthen health professionals meeting the minimum requirements for professional competence to practice, including continuing professional development. Goal 7: Disciplinary action to be taken against all registered health professionals that do not comply with the laws, regulatory policy, or codes and standards of professional practice Goal 8: Monitor health professionals practice to ensure quality of health care Goal 9: At least 90% of the public know they need to seek care from registered health professionals and how to make a complaint against a health professional Goal 10: 100% of health professionals, and all relevant organisations delivering health care services (international, non-government, Associations and private and public employers) are aware that health professionals need to be registered to practise and their professional obligations once registered Conduct investigation and research to evaluate (1) client satisfaction with health professionals and service providers and (2) whether there is compliance of health professionals with the legislation and code of ethics Conduct dissemination forums to health professionals on the code of ethics for their health profession Develop tools to assess the competence of health professionals registered with Councils and assess when the health professionals apply for renewal of registration Health profession Councils provide de-identified data to the Ministry of Health to inform the national health workforce development plan Councils work with the Ministry of Health, Ministry of Education, Youth and Sport and education providers to set standards for preservice education to ensure graduates achieve minimum competence Establish a framework and guidance for continuing professional development and ensure that every health professional completes continuing professional development (CPD) to maintain the minimum standard of competence Establish disciplinary categories and process for investigations and non-compliance (e.g., warnings, fines for delays in payments and infractions, legal action, removal from register for a designated period of time or cancellation of registration) Establish and implement complaint and disciplinary procedures including disciplinary committee to assess and determine misconduct behaviours Develop reporting and follow-up systems to monitor and evaluate the improvement progress Ensure the clear separation of roles and responsibilities for the health profession Councils and the professional associations, particularly in relation to the complaints and disciplinary function Develop and implement a mechanism for the regular monitoring of registered health professionals to ensure the quality and effectiveness of their professional practice Disseminate information to the public about: - The importance of registered health professionals in providing quality and safe health care - How to identify a registered health professional - How to make a complaint against a health professional Disseminate information to health professionals and all relevant organisations delivering health care services (international, nongovernment, associations and private and public employers) about their obligations and: - The importance of registered health professionals in providing quality and safe health care - How to identify a registered health professional - The professional obligations of health professionals - How to make a complaint against a health professional Integrate information into pre-service education for students of the health professions Health Profession Councils National Strategic Plan 9