National nursing and midwifery legislation in countries of South-East Asia with high HIV burdens
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World Health Organization. Regional Office for South-East Asia
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This paper analyses nursing and midwifery legislation in high HIV-burdencountries of the World Health Organization (WHO) South-East Asia Region, withrespect to global standards, and suggests areas that could be further examinedto strengthen the nursing and midwifery professions and HIV service delivery. Toprovide universal access to HIV/AIDS prevention, care and treatment, sufficientnumbers of competent human resources for health are required. Competence inthis context means possession and use of requisite knowledge and skills to fulfilthe role delineated in scopes of practice. Traditionally, the purpose of professionalregulation has been to set standards that ensure the competence of practisinghealth workers, such as nurses and midwives. One particularly powerful form ofprofessional regulation is assessed here: national legislation in the form of nursingand midwifery acts. Five countries of the WHO South-East Asia Region accountfor more than 99% of the region’s HIV burden: India, Indonesia, Myanmar, Nepaland Thailand. Online legislative archives were searched to obtain the most recentnational nursing and midwifery legislation from these five countries. Indonesia wasthe only country included in this review without a national nursing and midwiferyact. The national nursing and midwifery acts of India, Myanmar, Nepal and Thailandwere all fairly comprehensive, containing between 15 and 20 of the 21 elements inthe International Council of Nurses Model Nursing Act. Legislation in Myanmar andThailand partially delineates nursing scopes of practice, thereby providing greaterclarity concerning professional expectations. Continuing education was the onlyelement not included in any of these four countries’ legislation. Countries withouta nursing and midwifery act may consider developing one, in order to facilitateprofessional regulation of training and practice. Countries considering reform totheir existing nursing acts may benefit from comparing their legislation with that ofother similarly situated countries and with global standards. Countries interested inimproving the sustainability of scale-up for HIV services may benefit from a greaterunderstanding of the manner in which nursing and midwifery is regulated, be itthrough continuing education, scopes of practice or other relevant requirementsfor training, registration and licensing
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