December 10, 2019


Line Dempsey: Welcome back to another episode of our podcast, Regulation Matters: a CLEAR conversation. My name is Line Dempsey, and I'm the Chief Compliance Officer with Riccobene Associates here North Carolina, and I'm your host here and happy to be with you. I'm also on the CLEAR board of directors as well as the current chair of the National Certified Investigator Training Committee with CLEAR. As you all are aware, the Council on Licensure, Enforcement and Regulation, or CLEAR, is an association of individuals, agencies, and organizations that comprise the international community of professional and occupational regulation. Our podcast is just another opportunity for you to hear about the latest and greatest in our community. Today I'm joined by Nick Lord, national director for government relations, and Kim Ayscough, executive director for regulatory operations. Both of them are with the Australian Health Practitioner Regulation Agency, or AHPRA. We're glad to have both of you with us today. Welcome.


Guest speakers: Thanks, Line. It's great to be with you.


Line: We really do appreciate you guys joining us today. What we'd like to talk about with you today is a major project that I know you both have been involved with. It's a collaborative network of health workforce regulators. Nick, let me start with you and ask, so what is a collaborating centre of the World Health Organization, or WHO? And what sort of work is a collaborating centre of the WHO typically involved in?


Nick Lord: Well thanks, Line. Collaborating centres of the World Health Organization are organizations that basically help carry out the programs of the WHO. They can be research centres, government agencies, health service providers and universities, depending on the type of work that they might carry out for the WHO. And they are often organizations of some sort of national significance. Typically collaborating centres work in areas such as public health programs, like disease prevention, health promotion, nutrition, etcetera; but they also cover other things that are related to the agenda of the World Health Organization, things such as health technology, education of the health workforce and also regulation, as well regulation of people, of products or services - all related to healthcare.


Line: So why did AHPRA seek to be a collaborating centre with the World Health Organization?


Nick: Well, AHPRA started its work as the national agency for health practitioner regulation in Australia in 2010. And since then, we've always had connections to international regulators and other partners, particularly in the United Kingdom and North America. We've had one-off connections and engagements with the WHO over this decade; for example, we've held collaborative meetings with regulators in our region about the status of regulation at the health workforce and other such engagements. But in 2016, our executive came to the view that a more organized, systematic approach to our engagement with the WHO would be very beneficial for a number of things. One of them was that it would make a meaningful contribution to building better and more contemporary regulation of the health workforce in our region. It would help us to build networks and share learning and expertise between regulators. And it also was recognizing that the health workforce that we deal with is a global and mobile workforce. And that's got implications for regulators such as AHPRA, particularly because Australia is a significant importer of health professionals every year. And it also helps us to engage with other Australian-based healthcare services, agencies, and other universities that act as collaborating centres as well. So we basically saw benefits not only for our work, but for other regulators in the region as well, by becoming a Collaborating Centre. I think there's hundreds of collaborating centres across the world with the WHO, and it's 50 of those here in Australia.


Line: Well, let me ask you, I guess looking at it from the WHO's perspective, why are they interested in regulation of the health workforce, and with that, what is the link between regulating health practitioners and the WHO’s goal of universal health coverage?


Nick: Look, it's a good question. It's well recognized that health systems and services only function if it has a workforce. It's an industry and a sector that is very reliant upon its workforce. And if universal health coverage is about ensuring that everybody has access to health services that are high quality, that are safe, that are affordable, then really, it's not too long before the issues about regulating the health workers in that workforce become important, in terms of the quality of their education and the standards of their practice particularly is what becomes significant. It's really not sufficient that a country has enough available health workers for universal health coverage to be achieved, but they've also got to be accessible and they've really gotta have sufficient competence to be able to provide those services as well. So that's been somewhat of a focus of the WHO over the last few years, and it certainly is becoming more apparent in a lot of their planning documents. And one document that I certainly point towards to our listeners if they want to look into this more deeply is the WHO's Global Strategy for Human Resources for Health 2030. It's an interesting read, and it's available from the WHO website.


Line: Great, thanks for sharing that, Nick. I guess, how would you describe the status or the current state of regulation of health workforce in countries like of the Asia Pacific region?


Nick: Well, it's an interesting mix, and I probably put the members’ types into one of three categories in this Asia-Pacific region. First, we have a number of what I guess most people would call first world countries - countries such as South Korea, Japan, Australia, New Zealand, Singapore – who, in terms of their regulation of the health workforce, all have well-established legislative arrangements to health practitioners. They all have somewhat different structures of regulating health practitioners and different degrees of independence in their regulation of health practitioners, but nevertheless, they're all relatively well-established and mature.


We then have a number of countries in the region that we would generally describe as transitioning economies - these are countries such as Vietnam, Cambodia, Malaysia for example. They're relatively fast growing economies, and as such, their health systems and services are rapidly evolving. And typically, their health workforce is also rapidly growing in number. This is one of the challenges for their regulators particularly - to keep pace with this growth and to make sure that there is sufficient regulation in place for safe and quality services. These countries often have established legislative arrangements for their regulation, but the capacity and resourcing for those regulators may be quite variable. And these regulators are often looking to tap into expertise and resources that AHPRA has to help them out.


And then the third category we have in our region, particularly in the countries of the South Pacific, are the small countries like Fiji, Samoa, Tonga, etc, who may also have some regulatory structures in place but they often don't have the size and the capacity to be managing some of the regulatory issues that are arising because the health workforce is changing. And some of those issues are to do with, for example, an increasing fly-in, fly-out workforce that they're experiencing in healthcare coming from countries as diverse as South Africa or India or some of the South American countries. And they're also having to deal with a workforce that is more specialized where more specialists are involved, and that in itself, of course, poses more regulation challenges. So in summary, Line, I say it's a bit of a mix, and that's what makes this work quite interesting.


Line: I would imagine so. Well I guess, looking at member states of the WHO, what has been their initial level of interest for AHPRA's Collaborating Centre?


Nick: Well, it has taken us a little time to establish some of the relationships with the WHO member states. Typically we've gone through and started the engagements at a government level to try to find focal points within the different governments and health departments that are within governments to try to establish links. But we now have, I think, a number of member states (and I've mentioned some of those already, but I'll say them again- particularly Vietnam, Malaysia, and some of the South Pacific countries) that have been interested from the start. And they've been quite engaging and looking to share information, share expertise, and learn from our experience. And we've also more recently been starting to grow a healthy level of interest in a range of other countries, particularly Cambodia, Laos, Brunei, and Hong Kong as recently as well.


Line: Wow, that's great! I guess, how is AHPRA establishing the Collaborating Centre? What are the elements and priorities that they're putting forth?


Nick: Yeah, so when you become a collaborating centre with the WHO, there's basically an agreed number of deliverables or areas that the collaborating centre will work in and towards. And so the first one was really in supporting of building information or building relationships and information. The most important part of that work has been to establish a regional collaborative network of health workforce regulators. And we are now having quarterly webinars, plus other out-of-session engagements, to help discuss topics of mutual significance in regulation and share information and expertise.


That's certainly been our priority for 2019, but a second priority that we're building on now is to contribute towards building the capacity of other regulators in the region. And at the first level, this has been particularly about receiving quite a number of delegations from member states from a range of countries, and also importantly this month we’ll be sending our first AHPRA staff member into one of these countries on a short-term visit to act as a consultant in another country. And from there, once we establish those things, our next priority is then to work specifically toward enhancing the capacity of other regulatory staff in other regulators through opportunities such as work exchange programs or other strategies that will help directly build the capacity of other staff.


Line: Well, you might have answered my next question in that, but I guess, this network of regulators that you guys are establishing, what do you ultimately hope to achieve from the network?


Nick: First of all is particularly information sharing. Our chief executive officer, Martin Fletcher, really believes that everybody who's involved in regulation has got something both to share and to learn from other regulators.


And in terms of this network, I think there's two sort of ways we see that working. One is around the sharing of expertise in regulatory challenges such as enforcement, standard setting, compliance, particularly regulatory issues around continuing professional development, and so forth. But another way or another important part of this discussion is really about workforce issues that are of interest in the region. And just by way of example, at our next webinar we're hoping to have a joint discussion on the impact of free trade agreements that arise in the Asian region and the potential issues that are associated with the free movement of the health workforce between countries that often arises through such free trade agreements.


And then the other thing we're looking at the possibility of is the joint work between regulators between the region. So an interesting example on this is how we might be able to develop mechanisms for sharing information about practitioners of concern, who sometimes move between countries to avoid regulatory scrutiny. This is something that we would be looking forward to trying to establish some dialogue or other topics where sharing of information would be of great value.


Line: They can run, but they can't hide. That's great.


Nick: That's it.


Line: Well, let me shift over to Kym now and, basically, to CLEAR’s involvement in the network of health workforce regulators, in particular in the Western Pacific region. I guess, what attracted our board of CLEAR to be involved in a network of health regulators in the Asia Pacific area?


Kym Ayscough: Thanks, Line. So I think it's fairly clear from what Nick's outlined about the purpose of the Collaborating Centre and the work of the network so far that the goals of the network are very much aligned with CLEAR's intent and its mission. So, obviously across CLEAR we aim to provide a forum for improving the quality and understanding of regulation with all of us focused on enhancing our public protection mission. So, when AHPRA reached out to the CLEAR Board of Directors with an invitation to become part of the network, the directors were very excited about the possibility of taking the experience that CLEAR has of bringing regulators together across professions and across countries and sharing information, being able to make that similar contribution to this emerging networking in a different part of the world.


Line: And I know I'm fairly familiar with it but I guess for our listeners, tell us more about the involvement that CLEAR has had with the network to-date.


Kym: So our involvement with the network has been relatively new, but having been invited to join the network, the first thing that we've been able to do is to share with the network members, who have a variety of different status in terms of the maturity of their regulatory systems, as Nick explained. So our participation in the network to-date has been to explain to members in the region what CLEAR's purpose is, the kinds of events that CLEAR is able to organize, the communities of CLEAR that enable this continuing conversation about issues of interest in regulation more broadly, and just to really start to build awareness among the member states about CLEAR and its role in enabling conversations around regulation.


Line: From the CLEAR perspective, what do you see as the opportunities from being involved with the network?


Kym: I think the opportunities are in a number of different kind of domains. So, of course, one of the things we aim to foster through CLEAR is that we learn from others, and there are certainly opportunities for those of us who've been involved with CLEAR for a while to continue to learn about the establishment of emerging regulatory models and the operation of regulation in the Asia-Pacific region. We see the opportunity to continue to share what we know with those in the region for the purpose of enhancing the regulatory system.


And whilst Nick spoke about the movement of practitioners within the region, we know of course that there's also a movement of practitioners across the world. So the more we're all engaged in the same conversation about our expectations of registered practitioners, the stronger our overall ability to continue our public protection missions. Of course, part of the intention would be to encourage member states to think about the value of joining CLEAR, joining its communities of practice, its communities of conversation, so that these discussions about regulations spread beyond the region and into the rest of the CLEAR membership. And I think an ultimate goal, one of CLEAR's strategic directions, is to continue to grow the membership and grow the participation of regulators in the Asia-Pacific region.


That'd be great if we got opportunities to continue to extend things like our education offerings into the region. We've dipped our toe in the water, so to speak, by holding a symposium in New Zealand in late 2018, which was also supported by a number of our regular training programs, both for board members and for executives of regulatory agencies. So continuing this close cooperation with the WHO Collaborating Centre and the member states give us opportunities also to look at continuing to expand that reach.


Line: That's always quite exciting when I get updated on things. Well, what ways can our CLEAR members get involved?


Kym: That's a really good question, Line. I think what I would respond to is Nick's comments about the challenges, I guess- that's making sure that we reach, or the Collaborating Centre reaches, all of the right people within the member states. So my call-out would be for CLEAR members, many of whom belong to profession-specific international associations of regulators, if you've got contacts in the region who you think might benefit or be able to offer a benefit to the Collaborating Centre and its regional network, I would encourage you to share those details, because the more participation there is in this collaborative network, the [greater the] reach of the discussion will be and the more opportunity for a base of learning from each other.


Line: Perfect, well thank you. Well, I think this has been great to hear about this project. So I wanna take a moment just to thank both Nick and Kym for your time and being part of this CLEAR podcast. I think it's tremendously exciting and wonderful to have the opportunity to share and learn from each other, especially at this level. I think this is very important for the future. So thank you for speaking with us today.


And thank you, our listeners, for returning and checking out our podcast again. We'll be back with another episode of Regulation Matters: a CLEAR conversation very soon. Please subscribe to our Podcast. It's available in a lot of different avenues. It's available on Podbean, iTunes, Apple Podcast Google podcast and Google Play, Stitcher, Spotify or TuneIn. If you've enjoyed this podcast episode, please leave a rating or comments in the app. This is very helpful for us to improve our ranking and make it easier for new listeners to find us. Feel free to visit our website at www.clearhq.org for additional resources as well as a calendar of upcoming training programs and events. Finally, I'd like to thank our CLEAR staff, specifically Stephanie Thompson, our content coordinator and editor for this program. Once again I’m Line Dempsey, and I hope to be speaking with you again very soon.



The audio version of this podcast episode is available at https://podcast.clearhq.org/e/WHO_collaborating_centre/



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