1. Beyond Market Access – Domestic Regulation and Mutual Recognition Mode 4 of the GATS – Taking Stock and Moving Forward September 2008 David C. Benton Chief Executive Officer Designate International Council of Nurses

2. Three issues: MRAs their role and the challenges Stakeholder involvement and contribution Pragmatic Facilitation of Mode 4

3. The International Council of Nurses (ICN) Is a federation of 131 National Nurses Associations Strives to improve the standards of nursing care through better education and regulation of nursing Believes the overriding purpose of statutory regulation is to serve and protect the public

4. The Context for Mode 4 and Nursing The global nursing shortage Practice environments Public demands/expectations Governments interest in changing roles and frustration with the professions Money Professions interest in a global view Trade Entrepreneurship Migration

5. Policy Net Sum & Fears Trade and Safety Divergence in Health Sector (Taskshifting) Education Policy Disincentives Immigration controls Regulatory coherence (Private and State Sectors) Process Regulators Systems Resources Adaptation Technical Languistic and Cultural Specialist Rogue Practitioners Role and Challenges

6. Mode 4 as Part of a Complex Adaptive System Failure to recognise the GATS and MODE 4 as part of a complex adaptive system is a real barrier to progess in reaching agreements and will lead to longer term practical problems

7. Japan

8. Canada

9. Dealing with Complex Adaptive systems (General Points) Increased transparency and accountability Better communications Better and timelier data collection and information generation Involve, negotiate, think future as well as now, pragmatism and feedback.

10. Stakeholder Involvement And Contribution More than Trade Ministries Health, Education, Immigration (Government) Professionals and Regulatory Bodies All on the Same Page Knowledge, Time-scales and Vision/Outcomes Systems Impact and planning for success Normative Approaches and Networking

11. Pragmatic Facilitation of Mode 4 Support the concept of strengthening regulatory infrastructure before introducing disciplines Where none exists introduce regulatory bodies and legislation that is flexible and facilitative Update outdated and rigid legislation Be dynamic in adapting to the changing needs of the health care environment and the evolving and expanding capabilities of nurses Leave domestic regulation broad and general Encourage countries with strong frameworks to help others Encourage international model frameworks

12. Pragmatic Facilitation of Mode 4

13. Facilitate normative working across countries and jurisdictions E-based data exchange and minimum data sets with shared data element definitions Compatible systems of credential assessment Calibration of Educational Credit and Qualification Frameworks Domestic Disciplines for Nursing

14. Pragmatic Facilitation of Mode 4 ICN and ICM Regulators Forum Support for developing country participation Support for multi-lingual participation ICN Research into the Role and Identity of the Regulator Database of Jurisdictions Comparative analysis of legislation Compendium of legislation and regulatory best practices Lexicon of terms

15. Thank you International Council of Nurses 3, place Jean-Marteau 1201 Geneva Tel.: +41 22 908 0100 Fax: +41 22 908 0101 Email: benton@icn.chbenton@icn.ch Website: www.icn.ch