Background
History of health professions regulation in Cambodia
The current reform agenda
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The current needs and circumstances of Cambodia’s health system;
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Contemporary approaches to health professional regulation (referred to in the study as “smart practices”);
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The Cambodian Government’s health system strategic priorities; and
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The government’s international obligations and in particular, its obligations as a member of the Association of South East Asian Nations (ASEAN).
A project to strengthen the regulatory system
Methods
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Examine the current regulatory system and legal environment for health professions in Cambodia against mandates described in current legislation and
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Identify, in consultation with stakeholders, areas where the current regulatory system is meeting the requirements of a well-performing regulatory system (and areas where it is not).
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Zero indicating that the desired attribute is not present;
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One indicating that the desired attribute is partially present; and
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Two indicating that the desired attribute is present.
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A desktop review of key laws, plans, reports and other documents relating to the regulation of the five health professions in Cambodia;
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Key informant interviews with stakeholders in Cambodia (at the national and provincial levels);2
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The completion of a self-assessment by members of the five regulatory Councils. The self-assessment was based on the work of Benton et al. [1] who have developed a series of key indicators of measuring the performance of high-performing regulatory bodies.
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The key functions of health profession regulation;
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The key issues affecting the Cambodian health sector (including relevant development in the wider ASEAN Region); and
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“Smart” health profession regulation practices of possible relevance to Cambodia. (We specifically looked for reviews and studies about health professional regulation from neighbouring countries to Cambodia to use as comparators for our review but were unable to find any studies.)
Results and discussion
Cambodia’s legal framework for regulation
The regulators
The self-assessment
Councils | ||||||
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1 | 2 | 3 | 4 | 5 | ||
Legislation advocacy and responsiveness | ||||||
Implementing legislation | The regulatory body interprets legislation to facilitate and accommodate changing public protection needs | 1 | 1 | 2 | 1 | 2 |
Advocacy | The regulatory body routinely provides comments on wide health system reform and change | 0 | 2 | 1 | 2 | 1 |
Promotes professional issues that are congruent with protecting the public | 1 | 2 | 2 | 2 | 1 | |
Responsiveness | The regulatory body has processes that are consistent with those of other disciplines | 1 | 1 | 2 | 2 | 2 |
The regulatory body keeps guidance, codes, standards, competencies and rules in step with changing expectations of the public | 1 | 0 | 2 | 2 | 2 | |
The regulatory body interprets legislation to facilitate and accommodate changing public protection needs | 0 | 0 | 2 | 2 | 2 | |
Organizational and internal governance | ||||||
Board governance | Board Members of the regulatory body are subject to regular performance appraisal | 1 | 0 | 1 | 0 | 0 |
Clear criteria and the necessary competences for the selection and appointment of senior officials and board members are available | 0 | 0 | 1 | 0 | 1 | |
Induction processes are in place for new Board Members | 0 | 2 | 3 | 0 | 2 | |
Business processes | The regulatory body collaborates with other regulatory agencies to minimize administrative burden and maximize the use and impact of data | 0 | 0 | 3 | 0 | 0 |
The regulatory body has mechanisms to align their accreditation systems with other agencies while continuing to fulfil their mandate | 0 | 0 | 2 | 0 | 0 | |
Develops guidance and rules that are supportive of health system change | 0 | 0 | 2 | 0 | 2 | |
The regulatory body uses new technology to streamline business and regulatory processes | 0 | 0 | 2 | 0 | 2 | |
The regulatory body has mechanisms in place to detect and deal with fraudulent applications and requests for verification | 0 | 0 | 3 | 0 | 1 | |
The regulatory body has in place disaster recovery procedures and processes | 0 | 0 | 0 | 0 | 0 | |
The regulatory body has adequate resources to enable all responsibilities to be fully discharged | 1 | 1 | 2 | 0 | 1 | |
Reporting lines are clear, and reports are comprehensive and timely | 1 | 0 | 0 | 2 | 1 | |
All committees have explicit, regularly reviewed terms of reference, and the activities of the committees are reported regularly to a full regulatory body | 0 | 0 | 2 | 2 | 0 | |
Quality Improvement | The regulatory body identifies and promotes best regulatory practice | 0 | 1 | 2 | 2 | 1 |
The regulatory body has access to relevant expert advice to support its decision-making processes | 1 | 0 | 2 | 0 | 2 | |
Emergent trends from the outcomes of the conduct and competence process are used to inform revisions of standards and requirements for continuing competence | 0 | 0 | 2 | 1 | 0 | |
The regulatory body routinely examines a sample of completed continuing competence returns | 0 | 0 | 1 | 1 | 0 | |
The regulatory body monitors its performance and seeks to continually improve the time taken to deal with fitness to practice allegations | 0 | 0 | 2 | 1 | 2 | |
External governance and public accountability | ||||||
Accountability | The regulatory body is held to account for its performance | 0 | 1 | 2 | 1 | 1 |
The regulatory body has a clear set of performance measures that are reported regularly | 0 | 0 | 1 | 0 | 0 | |
While there may be multi-stakeholder input to the 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 | 2 | 0 | 2 | 0 | 0 | |
The regulatory body acts in a manner that maintains the confidence of the public, professionals, employers and other key stakeholders | 1 | 0 | 2 | 2 | 1 | |
The regulatory body has a strategic plan with linked operation objectives that are regularly reviewed and updated | 2 | 0 | 1 | 2 | 0 | |
Transparency | The regulatory body has a set of clearly defined and publically available operating procedures | 1 | 0 | 2 | 3 | 1 |
The regulatory body has a balance between lay and professional members | 2 | 0 | 0 | 2 | 0 | |
The regulatory body provides clear and succinct information on their responsibilities and process to registrants and the public | 1 | 0 | 3 | 2 | 1 | |
There are clear appeals processes that can be pursued if the decisions or the actions of the regulatory body are thought to be unsound | 0 | 0 | 1 | 2 | 2 | |
All decision-making is transparent, documented and accessible to the profession and the public | 0 | 0 | 3 | 3 | 1 | |
Collaboration | The regulatory body engages and consults key stakeholders in the development of policy and standards | 0 | 0 | 3 | 2 | 2 |
Responsibilities and functions | ||||||
Competence and conduct | Continuing competence procedures are in place that uses data from multiple sources | 0 | 0 | 2 | 2 | 0 |
The regulatory body maintains independence in resolving allegations and complaints | 0 | 0 | 3 | 2 | 0 | |
Clear, accessible and well-publicized complaint procedures are readily available | 0 | 0 | 2 | 0 | 0 | |
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 | 0 | 0 | 2 | 0 | 2 | |
The regulatory body has an impartial approach in dealing with an allegation both with regard to complaints and registrants | 0 | 0 | 2 | 2 | 0 | |
An adequate range of meaningful sanctions for non-observance of the standards and non-compliance with codes of conduct is available | 0 | 0 | 3 | 1 | 0 | |
Registry integrity | The register is accurate, comprehensive and readily accessible by the public, the registrants, employers and any other interested parties | 1 | 0 | 2 | 2 | 1 |
The regulatory body ensures that only persons who meet stipulated criteria for licensure can practice as a health professional | 2 | 0 | 3 | 2 | 1 | |
Registration renewal procedures are efficient and effective | 0 | 0 | 3 | 2 | 0 | |
Ethics and professional behaviour | Promotes registrant behaviour that is reflective and self-regulatory | 0 | 0 | 3 | 2 | 2 |
The regulatory body develops and promotes sound ethical and conduct codes | 1 | 0 | 3 | 2 | 3 | |
Standards and education | The regulatory body ensures educational programmes are aligned with the competences required by registrants for fitness to practice | 0 | 0 | 3 | 0 | 1 |
Professional standards and competencies are developed and set in collaboration with educational providers, employers, professional organization and the public | 1 | 0 | 3 | 0 | 2 | |
Mobility | Processes relating to health professionals wishing to migrate into or emigrate from the jurisdiction are efficient and effective | 0 | 0 | 3 | 2 | 0 |
Clarity
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Some health professionals perceive registration with Councils to be voluntary when in fact it is compulsory (75 % respondents, Kampot);
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Some health professionals believe practice is possible without registration (25 % respondents, Kampot); and
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Most health professionals felt that only registered health professionals should be allowed to provide services (77 % respondents, Kampot).
Essential regulatory functions
Cambodia’s specific needs
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The mobility of medical practitioners, nurses and dentists within the ASEAN Region;
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Information exchange and enhanced cooperation in respect of mutual recognition of medical practitioners, dentists and nurses;
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The promotion and adoption of best practices on standards and qualifications; and
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Opportunities for capacity building and training of medical practitioners, dentists and nurses.
A regulatory score card
Does Cambodia have a legal/regulatory system for health professionals that assures safety and quality? | Sub total | ||
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1. Laws—maximum possible score: 4 | |||
Are there existing laws for regulating health professionals? | 1/2 | 1/4 | |
Are the existing laws less than 10 years old? | 0/2 | ||
2. Regulatory institutions—maximum possible score: 6 | |||
Is there an existing regulator(s) for health professionals? | 1/2 | 3/6 | |
Is the regulator(s) well resourced? | 1/2 | ||
Is the regulator running effective regulatory systems and processes? | 1/2 | ||
3. Clarity—maximum possible score: 8 | |||
Are regulatory roles clear? | 1/2 | 2/6 | |
Do professionals understand their obligations? | 1/2 | ||
Is there a clear overarching strategy/policy for health professional regulation? | 0/2 | ||
4. Scope—maximum possible score: 8 | |||
Are all health professional groups regulated? | 1/2 | 2/8 | |
Of the groups that are regulated, are all members regulated? | Private sector? | 1/2 | |
Public sector? | 0/2 | ||
Non-governmental organization? | 0/2 | ||
5. Essential functions—maximum possible score: 10 | |||
Are all essential health professional regulatory functions in place? | Registration requirements | 1/2 | 4/10 |
Licensing requirements | 0/2 | ||
Standards | 1/2 | ||
Controls on health professional education | 1/2 | ||
Monitoring and compliance | 1/2 | ||
6. Cambodia’s needs—maximum possible score: 6 | |||
Does the regulatory scheme address Cambodia’s current needs? | 1/2 | 3/6 | |
Is the current regulatory scheme contributing to the government’s broader health system objectives? | 1/2 | ||
Does the current system meet ASEAN requirements for mutual recognition of health professional qualifications? | 1/2 | ||
15/40 |