Strengthening health professional regulation in Kenya and Uganda

加强肯尼亚和乌干达的卫生专业监管

• 批准号: MR/S013172/1
• 负责人: Gerald McGivern
• 金额: $ 23.06万
• 依托单位: University of Warwick
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2019
• 资助国家: 英国
• 起止时间: 2019 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FS013172%2F1
• 关键词: Strengthening; health; professional; regulation; Kenya

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.

监管可以提高医疗保健的质量和安全性，但对中低收入国家医疗保健监管的有限研究表明，监管往往是无效的，临床医疗事故可能部分因此而普遍存在。因此，我们需要更好地了解中低收入国家的医疗保健监管是如何运作的，以及为什么会运作，并可能得到改善。一些研究表明，发展“响应性监管”（Ayres和Braithwaite，1992年），包括监管者与受监管者的对话，以制定和商定监管的合法监管标准，说服专业人员遵守，并发现和制裁不遵守，可能会提高低收入国家卫生保健系统的监管效力。使用响应监管作为我们的“变革理论”，因此，我们建议在肯尼亚和乌干达的医生和护士/助产士的健康专业监管研究提供证据支持监管机构，以改善卫生监管，反过来，提高卫生系统和病人护理的质量和安全。正如我们所指出的，关于LMIC卫生系统监管的研究很少，也没有证据表明其对卫生保健实践的影响。因此，我们提出了混合方法的研究，研究小组的成员以前曾用于研究专业监管，发展这个证据基础。这项研究将涉及：对肯尼亚和乌干达的国家监管利益攸关方的文件和访谈进行分析;与肯尼亚和乌干达的医生和护士/助产士进行重点小组讨论，了解他们对监管的经验/看法;对州/区一级卫生专业人员监管的四个案例研究;以及对肯尼亚和乌干达医生和护士的在线调查，乌干达和肯尼亚卫生系统的专业人员由不同的专业人员管理，这两个国家都在建立单一的监督机构，以监测所有卫生专业的监管情况。这些重大的政策变化，加上项目组成员与两国监管机构和卫生政策制定者的联系，使这项研究特别有用和及时。该基础项目旨在提供证据，帮助监管机构改善监管和发展研究能力，并为更大的研究提案提供基础，试点监管改进并评估其影响。我们的国际跨学科研究团队包含来自乌干达，肯尼亚和英国的监管，卫生系统改善和卫生政策专家，具有开展卫生系统和监管研究的经验，这对卫生和监管政策产生了影响。我们将在整个项目中与肯尼亚和乌干达的监管机构密切合作，以确保我们研究他们认为重要的问题，并将研究结果报告给肯尼亚和乌干达的监管利益相关者（在两国的讲习班上）和其他低收入国家（通过国际监管政策和学术会议，出版物和在线），以帮助他们改善卫生监管，肯尼亚、乌干达和其他中低收入国家的病人护理质量和安全。