Regulate health workers

To provide quality healthcare, doctors, medical laboratory professionals and other healthcare professionals are regulated by the Medical Council of Malawi (MCM), from training institutions to their practice.

The council reviews the curricula of all medical training programmes in Malawi and approves external examiners for healthcare professionals.

When individuals satisfy MCM requirements, they are registered to practice. Their registration is renewed through ongoing demonstration of competence so that the healthcare workforce is fit for purpose and fit for practice.

The process ensures that services are up to standard, but some patients are harmed despite the existing regulatory regimes and demands for accountability from health workers.

This calls for regulatory reforms in the governance of health systems.

In Malawi, there were limited regulations for health workers, including medical laboratory professions before 1987.

Still, the weak healthcare professional regulation remains an area of concern.

In 2001, a study by Manyozo-Phiri  and colleagues  revealed that MCM roles are not always understood by both health workers and the public.

This sometimes results in conflicts, discouraging some practitioners from getting registered, thus operating without the necessary recognition.

The regulations prescribe continuing professional development for improved service delivery.

The council is mandated to ensure continuous profession development is available to all health professionals.

However, registered professions doubt whether enrolment in such programmes provides sufficient evidence of continuing competence since it is not a requirement for the annual renewal of MCM registration.

Regulation of the discipline requires that practitioners always demonstrate professionalism, including high standards of probity and ethical behaviour.

Unprofessional behaviour calls for disciplinary action from the regulators such as MCM and professional organisations such as the Malawi Association of Medical Laboratory Scientists.

Frequently, the MCM receives cases involving illegal possession of medicines, operating unregistered premises, professional negligence and practitioners providing health services that they are not competent to do.

The scope of practice defines tasks various healthcare professionals may need to undertake in their role.

Health workers ought to demonstrate unquestionable competence to carry out their role in an independent, safe and effective manner for the benefit of the community.

But the status of other medical training programmes needs to be defined.

On May 13, the Physician’s Assistant Union lamented lack of scope of practice documentation by the regulatory body.

A week later, pathologist Charles Dzamalala also lamented the same in his press statement.

The medical council was established under the Medical Practitioners and Dentists Act of 1987 which indicates that allied health professions are also regulated by MCM. However, there is no definition for the said allied health professions.

I expect the allied professions include physiotherapists and chiropodists.

Perhaps, there is another document somewhere that defines allied workers. If yes, the Act should specify the involvement of allied health proffessions in the council and executive.

There is a link between regulation, education and workforce skilling.

The scope of practice should be defined for all health workwers based on educational curricula.

Nonetheless, those with post-graduate qualifications in laboratory medicine are unregulated where significant clinical and research elements are part of their role. There should be evidence of clinical competence and research achievement as part of the regulatory process. 

I do not believe that there are any shortcuts to an effective system of professional regulation.

For the healthcare professionals to have an obligation to act professionally and ethically throughout their career, MCM, training institutions and healthcare professional bodies should clarify, by activity and level of authority, the role definitions for each healthcare profession grade to prevent compromising the healthcare services delivery in Malawi.