Regulation

Strengthening Health Professional Regulation in Uganda and Kenya: A Foundational Study

Research Question: How does health professional regulation operate and affect healthcare in Low and Middle-Income Countries?

This is a 2-year pilot study on regulation in Kenya and Uganda that aimed to map the regulatory landscape for health professionals in both countries. Regulation of healthcare professionals is key to achieving good health and wellbeing and achieving Universal Health Coverage (UHC). A functional regulatory framework is critical to strengthening accountability systems for healthcare quality improvement, ensuring patient safety, improving population access to quality health services, supporting health professionals and strengthening health systems.

The Problem: Regulation is a key challenge for health policy and achieving UN sustainable development goals relating to good health and providing high quality universal health coverage in LMICs. While regulation can enhance healthcare quality and safety, the limited research on healthcare regulation in LMICs suggests it is often unenforced or ineffective due to inadequate regulatory resources, instruments or staff capacity, corruption and regulatory capture. At the same time, clinical mistakes and malpractice appear to be rife, threatening to undermine the sustainability of healthcare systems. Improving health regulation in LMICs can help address these problems, so there is urgent need to understand how to do so. A significant barrier to improving professional regulation in LMIC health care is lack of evidence about how it occurs. This study is therefore timely as it contributes to filling this gap – the limited evidence on how regulation works or affects clinical practice in LMICs like Uganda and Kenya. Our study sought to explore and document the current status and processes involved in health professional regulation including; the development of standards and how they are communicated to professionals; the granting of licences and their verification; constraints to regulation; perceptions and response to regulation by the professionals, compliance among other issues.

Research Strategy: We conducted empirical research using a mixed methods approach. We ‘mapped’ the regulatory territory in Uganda and Kenya, examining how regulation for doctors and nurses/midwives works in practice. For example, how are regulation and regulatory standards for doctors and nurses/midwives developed and their purpose communicated to these professionals? How are licenses granted, renewed, verified and which professionals are licensed (or not)? What are the risks within these processes and constraints for the regulators? What evidence is there of regulatory corruption? How do clinicians perceive and respond to professional regulation, regulatory bodies and standards? To what extent do they report compliance? How do they think regulation might be improved? Are there ways of developing user-friendly regulation processes (e.g. via information and communication technologies)?

We also considered how health professional regulation might address emerging challenges in the Ugandan and Kenyan health systems (such as upholding distinct professional standards while enabling inter-professional collaboration and service delivery, task-shifting and task-sharing, devolution of healthcare services, blurring public-private sectors, achieving SDGs and equal provision of high quality UHC). How might professional regulation provide an external quality assurance mechanism or support professional development and facility-driven quality improvement? We also analysed how local and national contexts support or undermine implementation of better regulation.

Study Outcomes: We provided, and continue to provide, evidence that can help regulators and policymakers to implement regulatory improvements, which would, in turn, enhance health systems and patient care. We seek to impact regulatory policy in Kenya and Uganda. We are doing this by closely engaging and sharing findings with regulatory stakeholders (including the members of our advisory board). Then, in collaboration with regulators and based on our findings, we aim to develop a larger research project piloting and evaluating regulatory interventions. While our empirical research is focused on Kenya and Uganda, regulators in other LMICs may also be able to learn from generalisable findings from this study.

About the Research Team

Project Contacts

       1. Catherine Nakidde Project Administrator

            kathy.lubowa@gmail.com | cnakidde@chasei.org

2. Gloria Seruwagi, Uganda Lead (Co-PI)

            gseruwagi@musph.ac.ug

Established in 2017, CHASE-i seeks to improve health and socioeconomic outcomes through multidisciplinary research, innovation, implementation and partnership. 

Address

  • P.O. Box 7062
    Kampala, Uganda
  • +256 (0) 772 073 703
    +256 (0) 708 778 557
  • inquiries@chasei.org

Useful Links

Focus Areas

CHASE-i © 2022

CHASE-i is an affiliate of Makerere University.

Innovate. Implement. Improve.

Dr Gloria Seruwagi

MPH | Taught Component - DrPH | PhD

Founder

Dr Gloria Seruwagi’s wide-ranging background includes extensive experience as a public health specialist, behavioural scientist, policy advisor, researcher and educator specialising in SRMNCAH+N, health systems, policy and issues affecting disadvantaged, marginalised or vulnerable populations. She has supported and led multidisciplinary teams (MDTs) in providing robust solutions to complex multisectoral challenges.

A versatile health systems and policy specialist, some of Gloria’s work spans implementation research and realist evaluation; reforming the healthcare regulatory system; improvement science (Quality Improvement/QI and in particular Quality of Care/QoC interventions in sexual, reproductive, maternal, newborn, child, adolescent health and nutrition (SRMNCAH+N); Community Engagement and Involvement (CEI) where she is a very strong advocate of community participation in health and wellbeing. She has undertaken extensive work addressing NCDs, forced migration, cross-border and multi-country dynamics in humanitarian and development contexts; development challenges in urban contexts; and supported several global initiatives on decolonisation of research, programming and enhancing equity between the Global North and South.

As the Centre’s founder, Gloria supports a multidisciplinary team from different fields including health, climate science, social science, education, engineering, law, economics, education, ICT and development as they join forces in partnership to provide impactful, sustainable solutions to the problems facing our nation, continent and world today. A strong believer in the power of partnership to bring about meaningful and lasting change, Gloria is particularly interested in bridging the longstanding gap between research, policy and practice (or the “the three worlds” as they are commonly known). She has championed a solid and impactful model at CHASE-i where its experts are drawn from different institutions and sectors within and outside of academia, stretching out to secure partnerships in research, policy and practice – within Uganda, the East African Community, Great Lakes Region and abroad.


Catherine Nakidde Nzesei

BSc. | MA | MPH | PhD ongoing

Associate Director of Programmes

Catherine Nakidde Nzesei is the Centre’s Associate Director of Programmes – providing leadership and support to the Programmes Unit across all projects, teams and associates.

Catherine is a public health specialist with graduate training in public health, health promotion and international development. A recipient of the 2022 Commonwealth Scholarship, she embarked on a PhD in public pealth at UCL which is driven by her passion for health system strengthening – and building on previous work around Strengthening Health Professional Regulation in Uganda and Kenya. Catherine’s PhD examines systems and processes for continuous quality improvement of healthcare professional training.

Catherine’s professional interests revolve around leveraging impact from effective systems and empowering vulnerable population categories to enable them to fulfil their potential – whether in a professional, community or personal setting. Some of her previous work has focused on understanding the experiences of refugees and slum dwellers in the COVID-19 pandemic as well as health system resilience. Since inception, Catherine has directly supported for several Centre projects including those on Reproductive Maternal Newborn Child and Adolescent Health (RMNCAH), refugee health and wellbeing, Quality Improvement (QI) and livelihoods.