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The role of health practitioner regulation in ensuring patient safety is well recognized. Less recognized is the role of regulation in addressing broader health system priorities. These goals include managing the costs, capacities and distribution of health professional education institutions; ensuring the competence and equitable distribution of health workers; informing workforce planning and mobilization; enabling the use of digital technologies; and addressing challenges related to the international mobility of health workers. Even where health practitioner regulation is designed to advance these goals, important gaps exist between the potential of regulatory systems and their performance. The response to the coronavirus disease 2019 (COVID-19) pandemic led many countries to introduce regulatory changes to allow more flexibility and innovations in the mobilization of health practitioners. Building on this experience, we need to critically re-examine health practitioner regulatory systems to ensure that these systems support rather than impede progress towards national health goals. We discuss the role of health practitioner regulation in contemporary health systems, highlighting recent regulatory reforms in selected countries, including during the COVID-19 pandemic. We identify the importance of dynamic, effective and flexible health practitioner regulatory systems in progress towards universal health coverage and health security.

The formation of health professionals is critical for the health system to function and achieve its universal health coverage (UHC) goals. This is well recognized by the majority of governments that plan for the training and regulations necessary to ensure quality. But the importance of market forces is often overlooked, resulting in interventions and regulations that often fail to achieve their intended effects. The Economics of Health Professional Education and Careers aims to inform the design of health professionals' education policies to better manage health labor market forces toward UHC. It documents what is known about the influence of market forces on the health professional formation process. The contexts of the market for health professional training have been subject to important changes in recent decades, in particular: the growing extent of employment of mid-level cadres of health professionals; changes in technology and the associated growth of high-skilled occupations; the increasing interconnectedness of national health systems through globalization, with its implications for international health professional mobility; and the greater complexity of the public-private mix in employment options. There is a need to ensure that market forces align with the intentions of planning and regulation and the UHC goals. This study provides recommendations to support the design of policies that help to achieve these goals.

Health workforce challenges hinder progress towards universal health coverage, improved health outcomes1 and health security. The global health workforce shortage is declining,2 but progress is slower in the African and Eastern Mediterranean regions and Small Island Developing States. International migration of health workers, when not adequately managed, can exacerbate pre-existing inequalities, further depleting the availability of health workers in countries already affected by shortages.To mitigate these challenges, the World Health Assembly adopted in 2010 the WHO Global Code of Practice on the International Recruitment of Health Personnel. The code has two major objectives: first, to guide international cooperation in the ethical management of health worker migration; second, to catalyse action and investment in the health systems of developing countries facing health workforce shortages.3 One of the core provisions of the code is to discourage active international recruitment from low- and middle-income countries affected by workforce challenges.In 2020, an independent review of the relevance and effectiveness of the code documented its continued relevance, as international migration of health personnel has continued to rise.4 As to effectiveness, examples of successful implementation exist, but also areas where the code's impact could be increased. For example, one of the review's recommendations was to regularly update the list of countries facing severe health workforce challenges.

The role of health practitioner regulation in ensuring patient safety is well recognized. Less recognized is the role of regulation in addressing broader health system priorities. These goals include managing the costs, capacities and distribution of health professional education institutions; ensuring the competence and equitable distribution of health workers; informing workforce planning and mobilization; enabling the use of digital technologies; and addressing challenges related to the international mobility of health workers. Even where health practitioner regulation is designed to advance these goals, important gaps exist between the potential of regulatory systems and their performance. The response to the coronavirus disease 2019 (COVID-19) pandemic led many countries to introduce regulatory changes to allow more flexibility and innovations in the mobilization of health practitioners. Building on this experience, we need to critically re-examine health practitioner regulatory systems to ensure that these systems support rather than impede progress towards national health goals. We discuss the role of health practitioner regulation in contemporary health systems, highlighting recent regulatory reforms in selected countries, including during the COVID-19 pandemic. We identify the importance of dynamic, effective and flexible health practitioner regulatory systems in progress towards universal health coverage and health security.

Background Despite the large body of evidence suggesting that effective public health infrastructure is vital to improving the health status of populations, many universities in developing countries offer minimal opportunities for graduate training in public health. In Nepal, for example, only two institutions currently offer a graduate public health degree. Both institutions confer only a general Masters in Public Health (MPH), and together produce 30 graduates per year. The objective of this assessment was to identify challenges in graduate public health education in Nepal, and explore ways to address these challenges. Methods The assessment included in-person school visits and data collection through semi-structured in-depth interviews with primary stakeholders of Nepal’s public health academic sector. The 72 participants included faculty, students, alumni, and leaders of institutions that offered MPH programs, and the leadership of one government-funded institution that is currently developing an MPH program. Data were analyzed through content analysis to identify major themes. Results Six themes characterizing the challenges of expanding and improving graduate public health training were identified: 1) a shortage of trained public health faculty, with consequent reliance on the internet to compensate for inadequate teaching resources; 2) teaching/learning cultures and bureaucratic traditions that are not optimal for graduate education; 3) within-institution dominance of clinical medicine over public health; 4) a desire for practice–oriented, contextually relevant training opportunities; 5) a demand for degree options in public health specialties (for example, epidemiology); and 6) a strong interest in international academic collaboration. Conclusion Despite an enormous need for trained public health professionals, Nepal’s educational institutions face barriers to developing effective graduate programs. Overcoming these barriers will require: 1) increasing the investment in public health education and 2) improving the academic environment of educational institutions. Long term, committed academic collaborations with international universities may be a realistic way to: 1) redress immediate inadequacies in resources, including teachers; 2) encourage learning environments that promote inquiry, creativity, problem-solving, and critical thinking; and 3) support development of the in-country capacity of local institutions to produce a cadre of competent, well-trained public health practitioners, researchers, teachers, and leaders.

The health sector is shaped by its professionals. The processes by which they are selected for training, trained, and then deployed are therefore critical for the functioning of any health system. The market for health professional education is wide ranging, encompassing multiple types of health professionals with different lengths and depths of training, from community health workers to specialist physicians. The objective of this paper is to inform the design of policies to better manage health labor market forces by documenting what is known about the influence of market forces on the health professional formation process. It aims to address issues from a global perspective, seeking out patterns of difference between low, middle, and high income countries and across regions of the world. It also aims to understand the evolution of the health professions and of health labor markets over the last 30 years, and to cover all types of health professional, although the constraints of the literature engendered a focus on physicians and nurses. This study focuses on the market influences on the formation stages of a health professional's career considered as those stages that involve formal, accredited education. A scoping review of the literature was undertaken seeking evidence on the following questions: what have been the large global and regional trends in the development of health professions?; how have these trends affected the career decisions of current and potential health professionals?; what is the evidence base on the value and effectiveness of health professional education of different types?; and how has the market for health professional education evolved, and with what interrelationships with the health labor and health care markets? Chapter one gives introduction. The evidence collected from the literature review to answer the four questions is discussed in chapter's two to five. Chapter six draws conclusions, including the policy implications of the existing evidence base and the areas where gaps suggest the need for further research.