Strengthening health professional regulation in Kenya and Uganda

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Regulation can enhance quality and safety in health care, yet the limited research on health care regulation in LMICs suggests it is often ineffective and clinical malpractice, perhaps partly consequently, widespread. We therefore need to better understand how and why health care regulation in LMICs operates and might be improved. Some research has suggested that developing, 'responsive regulation' (Ayres and Braithwaite, 1992) involving regulator-regulatee dialogue to develop and agree regulatory legitimate regulatory standards, persuade professionals to comply, and detect and sanction noncompliance, may improve regulatory effectiveness in LMICs' health care systems. Using responsive regulation as our 'theory of change', we therefore propose to research health professional regulation for doctors and nurses/midwives in Kenya and Uganda to provide evidence supporting regulators to improve health regulation and, in turn, enhance health systems and the quality and safety of patient care. As we noted, there is very little research on regulation in LMIC health systems or evidence about its impact on health care practices. We therefore propose mixed methods research, which members of the research team have previously used to research professional regulation, to develop this evidence base. This research would involve: Analysis of documentation and interviews with national regulatory stakeholders in Kenya and Uganda; focus groups with doctors and nurses/midwives in Kenya and Uganda about their experiences/perceptions of regulation; four case studies of health professional regulation at county/district level; and an online survey of Kenyan and Ugandan doctors and nurses/midwives at national level.Professionals in the Ugandan and Kenyan health systems are regulated by different profession-specific bodies but both countries are establishing single oversight bodies to monitor regulation across all health professions. These major policy changes, coupled with members of the project team's connections to regulators and health policy-makers in both countries, make this research particularly useful and timely. This foundational project aims to provide evidence to help regulators improve regulation and develop research capacity and provide a foundation for a larger research proposal, piloting regulatory improvements and evaluating their impact. Our international interdisciplinary research team contains experts on regulation, health systems improvement and health policy from Uganda, Kenya and the UK, with experience of conducting research on health systems and regulation, which has had impacted health and regulatory policy. We will collaborate closely with regulatory bodies in Kenya and Uganda throughout the project to ensure that we research issues and questions they believe are important and report findings back to regulatory stakeholders in Kenya and Uganda (at workshops in both countries) and other LMICs (via international regulatory policy and academic conferences, in publications and online) to help them improve health regulation and, in turn, the quality and safety of patient care in Kenya, Uganda and LMICs beyond.