A regulatory gap analysis of midwifery to deliver essential reproductive, maternal, newborn, child and adolescent health services in Lao People's Democratic Republic

Shogo Kubota; Moe Ando; John Murray; Sengmany Khambounheuang; Khampasong Theppanya; Phouvanh Nanthavong; Chankham Tengbriacheu; Malouny Sisavanh; Thongchan Khattiyod; Daisuke Asai; Howard Sobel; Masamine Jimba

doi:10.1016/j.lanwpc.2023.100960

A regulatory gap analysis of midwifery to deliver essential reproductive, maternal, newborn, child and adolescent health services in Lao People's Democratic Republic

Lancet Reg Health West Pac. 2023 Dec 5:43:100960. doi: 10.1016/j.lanwpc.2023.100960. eCollection 2024 Feb.

Affiliations

¹ WHO Laos, Vientiane, Lao PDR.
² WHO Western Pacific Region, Manilla, Philippines.
³ Department of Health Personnel, Ministry of Health, Vientiane, Lao PDR.
⁴ National Mother and Child Health Center, Department of Hygiene and Health Promotion, Ministry of Health, Vientiane, Lao PDR.
⁵ Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Abstract

Background: In Lao Peoples Democratic Republic, midwives are the main providers of primary reproductive, maternal, newborn, child and adolescent (RMNCAH) services. We analyzed to what extent practice regulations allow midwives to provide nationally defined essential RMNCAH services.

Methods: Stakeholder consultations and document reviews were conducted to identify the essential RMNCAH interventions and care tasks midwives are expected to provide without physicians. These were defined in: 1) the Essential Health Service Package (EHSP) and 2) 18 national standards and guidelines. We then mapped whether midwifery regulations, which provide the legal framework for clinical service provision, supported delivery of these standards to identify regulatory gaps. Data were used to update regulations.

Findings: Midwives were expected to provide 39 RMNCAH interventions without physicians, representing 1100 care tasks. Midwifery practice regulations allowed eight of 39 interventions (20.5%) and 705 of 1100 care tasks (64.1%) at baseline. Of the 31 interventions not allowed for provision by midwives, 83.9% (26) required prescribing and giving medicines, 51.6% (16) ordering and conducting diagnostics, 38.7% (12) making a clinical diagnosis, and 22.6% (7) use of non-pharmacological interventions. The Ministry of Health convened a multi-stakeholder group to revise the midwifery practice regulations, which increased the legally supported interventions and care tasks to 37 (94.9%) and 1081 (98.3%), respectively.

Interpretation: This novel methodology enabled systematic identification and quantification of regulatory gaps in midwifery practice and data-driven revisions. Consequently, regulatory support for delivery of primary RMNCAH interventions vastly improved. The approach can be applied to other clinical cadres, service areas and countries.

Funding: Korea Foundation for International Health Care (KOFIH) supported research operation.

Keywords: Child and adolescent health; Essential health service; Low-middle income country; Maternal and reproductive health; Midwifery; Newborn; Policy gap analysis; Regulation; Scope of practice.