1. THE AIM OF PRESENTATION TO PRESENT FRAMEWORK OF TRAINING AND REGULATION OF HEALTH CARE PROFESSIONALS TO PRESENT FRAMEWORK OF TRAINING AND REGULATION OF HEALTH CARE PROFESSIONALS

2. UNDERGRADUATE TRAINING NURSES AND MIDWIVES TILL 01.05.2004. Legislation: The Law on Education, The Law on Professional Education Legislation: The Law on Education, The Law on Professional Education Requirements: licensing and accreditation of the programme Requirements: licensing and accreditation of the programme III professional qualification level III professional qualification level 6 nursing schools for nurses and 1- for midwives (The Ministry of Health) 6 nursing schools for nurses and 1- for midwives (The Ministry of Health) Average lenght of the nursing programme: 4400 hours, midwifery programme: 4600 hours Average lenght of the nursing programme: 4400 hours, midwifery programme: 4600 hours State board exam State board exam

3. UNDERGRADUATE TRAINING NURSES AND MIDWIVES From 01.05.2004. Legislation: The Law on Education, The Law on Highest Education, The Law on Regulated Professions and Recognition of Professional Qualification, Regulations No. 68 of the Cabinet of Ministers “Requirements of education programmes for acquirement of dentist, pharmacist, nurse un midwife qualification”, corresponding EU directives 77/453/EEC and 77/452/EEC (nurses), EU directives 80/155/EEC (midwives) Legislation: The Law on Education, The Law on Highest Education, The Law on Regulated Professions and Recognition of Professional Qualification, Regulations No. 68 of the Cabinet of Ministers “Requirements of education programmes for acquirement of dentist, pharmacist, nurse un midwife qualification”, corresponding EU directives 77/453/EEC and 77/452/EEC (nurses), EU directives 80/155/EEC (midwives) Requirements : licensing and accreditation of the programme Requirements : licensing and accreditation of the programme IV professional qualification level IV professional qualification level 5 nursing colleges for nurses and 1 nursing school for midwives: under reorganization process for being college (The Ministry of Education and Science) 5 nursing colleges for nurses and 1 nursing school for midwives: under reorganization process for being college (The Ministry of Education and Science) Lenght of the programmes - 4600 hours (3 years) Lenght of the programmes - 4600 hours (3 years)

4. PROBLEMS I POLICY FOR DEVELOPING OF HUMAN RESOURCES IN HEALTH CARE (ratify by the Cabinet of Ministers in 18.05.2005) Small amount of graduated nursing students, e.g., in 2004 were 204 nursing graduates from 453 admitted students. It means, that in 2004 were just 45% nursing graduates from admitted students Small amount of graduated nursing students, e.g., in 2004 were 204 nursing graduates from 453 admitted students. It means, that in 2004 were just 45% nursing graduates from admitted students Reasons: from one side there are hard working conditions, low salary, low prestige of profession, but from another side – the requirements for education are high, prolonged lenght of programme etc.

5. PROBLEMS II Small amount of graduated midwifery students, e.g., in 2004. were 23 midwifery graduates from admitted students 23. It means, that in 2004. were just 60,9% midwifery graduates from admitted students Small amount of graduated midwifery students, e.g., in 2004. were 23 midwifery graduates from admitted students 23. It means, that in 2004. were just 60,9% midwifery graduates from admitted students Reasons: from one side there are hard working conditions, low prestige of profession, but from another side - requirements for education are high, prolonged length of programme as well as correlation between demographic situation in Latvia etc.) Implementation of EU directive 80/155/EEC Article 4 what determines that midwife should be allowed to practice independently (Recommendations of TAIEX) Implementation of EU directive 80/155/EEC Article 4 what determines that midwife should be allowed to practice independently (Recommendations of TAIEX)

6. SOLUTIONS I POLICY FOR DEVELOPING OF HUMAN RESOURCES IN HEALTH CARE (ratify by the Cabinet of Ministers in 18.05.2005) Developing of long-term programme for increasing of nursing students as well as for improving of education process Developing of long-term programme for increasing of nursing students as well as for improving of education process Co-operation with educators, professional associations, employer for facilitation of motivation to study, to work in nursing profession and for facilitation prestige of nursing profession Co-operation with educators, professional associations, employer for facilitation of motivation to study, to work in nursing profession and for facilitation prestige of nursing profession Developing of long-term programme for increasing of salary for nurses Developing of long-term programme for increasing of salary for nurses

7. SOLUTIONS II Developing of regulations (based on The Law on the Medical Treatment) what will provide independent practice of midwives Developing of regulations (based on The Law on the Medical Treatment) what will provide independent practice of midwives Implementation of EU directive 80/155/EEC what determines possibility for nurses to acquire qualification of midwife (length of programme - 18 months) Implementation of EU directive 80/155/EEC what determines possibility for nurses to acquire qualification of midwife (length of programme - 18 months)

8. POSTGRADUATE TRAINING NURSES AND MIDWIVES Legislation: The Law on Medical Treatment, The Law on Education, The Law on Professional Education, The Law on Highest Education, The Law on Regulated Professions and Recognition of Professional Qualification, Regulations No. 68 (29.02.2002.) of the Cabinet of Ministers “Requirements of education programmes for acquirement of dentist, pharmacist, nurse un midwife qualification”, Regulations No. 431 (23.12.1997.) of the Cabinet of Ministers “Procedures for the Certification of Medical Persons”, Professional standards, Statutes of Specialities, Order of the Ministry of Health Nr.250 (24.09.2003.) “Regulations of Register for Medical Persons” Legislation: The Law on Medical Treatment, The Law on Education, The Law on Professional Education, The Law on Highest Education, The Law on Regulated Professions and Recognition of Professional Qualification, Regulations No. 68 (29.02.2002.) of the Cabinet of Ministers “Requirements of education programmes for acquirement of dentist, pharmacist, nurse un midwife qualification”, Regulations No. 431 (23.12.1997.) of the Cabinet of Ministers “Procedures for the Certification of Medical Persons”, Professional standards, Statutes of Specialities, Order of the Ministry of Health Nr.250 (24.09.2003.) “Regulations of Register for Medical Persons”

9. THE AIM OF POSTGRADUATE TRAINING To improve professional skills, knowledge, competencies by formal or informal education system (The Law on Education)

10. FORMAL EDUCATION I Specialization (The Law on Medical Treatment) – the part of postgraduate training, what proceed in accordance with accreditate education programme and considering the professional standards and statutes of specialities. Specialization (The Law on Medical Treatment) – the part of postgraduate training, what proceed in accordance with accreditate education programme and considering the professional standards and statutes of specialities. Confirmation of acquired specialization – document of professional qualification (diploma, certificate etc.) approved by state. Confirmation of acquired specialization – document of professional qualification (diploma, certificate etc.) approved by state.

11. FORMAL EDUCATION II 9 nursing specialization programmes financed by state 9 nursing specialization programmes financed by state Requirements: licensing and accreditation of the programmes, minimum length of programmes - 960 hours, carry out by nursing colleges, professional standards, statutes of specialities Requirements: licensing and accreditation of the programmes, minimum length of programmes - 960 hours, carry out by nursing colleges, professional standards, statutes of specialities There is no formal postgraduate training for midwives, but there is informal postgraduate training organized by Professional Association of Midwives There is no formal postgraduate training for midwives, but there is informal postgraduate training organized by Professional Association of Midwives

12. BASIC PROBLEM Lack of profession standards for developing of new specialization programmes for nurses in accordance with requirements of legislation Lack of profession standards for developing of new specialization programmes for nurses in accordance with requirements of legislation

13. SOLUTIONS To develop profession standards for specialities To develop profession standards for specialities To define those specialities what should be financed by state, to predict how many those nursing specialists are needed etc. To define those specialities what should be financed by state, to predict how many those nursing specialists are needed etc. To improve education programmes for acquiring specialization in accordance with profession standards To improve education programmes for acquiring specialization in accordance with profession standards To realize nursing specialization programmes in accordance with legislation To realize nursing specialization programmes in accordance with legislation

14. INFORMAL EDUCATION I Activities of education what are organized out of formal education towards interests of participants and related to requirements (The Law on Education) Activities of education what are organized out of formal education towards interests of participants and related to requirements (The Law on Education) Part of postgraduate training-developing of professional qualification what realizes according to free choice education programme. There is no reglamentation for length and content of the programme. Compulsory requirement: regularly maintaining of professional qualification in emergency care (The Law on Medical Treatement) Part of postgraduate training-developing of professional qualification what realizes according to free choice education programme. There is no reglamentation for length and content of the programme. Compulsory requirement: regularly maintaining of professional qualification in emergency care (The Law on Medical Treatement)

15. INFORMAL EDUCATION II FORMS OF OBTAINING:  Courses, seminars, conferences, congresses, having in- service training, e-learning, distance learning, self- learning, etc. CONTENT:  Demands of labour market, demands of situation, professional competencies (requirements for re- certification), common demands (pedagogy, legislation, etc.) EXECUTORS:  Nursing colleges, universities, health care institutions, professional associations, persons, etc.

16. INFORMAL EDUCATION III Correlation between informal education and regulation system Correlation between informal education and regulation system Monitoring: state (requirements for register) and professional associations (requirements for certificate) Monitoring: state (requirements for register) and professional associations (requirements for certificate)

17. PROBLEMS Quality insurance and evaluation of informal postgraduate training Quality insurance and evaluation of informal postgraduate training Reason: decentralization of realization Low motivation of nurses, midwives Low motivation of nurses, midwives Reasons: nurse, midwife should pay by her/him-self, during working time etc.)

18. SOLUTIONS To improve evaluation model of informal postgraduate training To improve evaluation model of informal postgraduate training To co-operate with employers in relation to increase their motivation to have well educated health personal To co-operate with employers in relation to increase their motivation to have well educated health personal To increase amount of correspondence courses (like e-learning, distance learning etc.) To increase amount of correspondence courses (like e-learning, distance learning etc.)

19. REGULATION NURSES AND MIDWIVES There are 2 models of regulation:  Registration system  Certification system

20. THE SYSTEM OF REGISTRATION Legislation: The Law on Medical Treatment, Order of the Ministry of Health Nr.250 (24.09.2003.) “Regulations of Register for Medical Persons” (Project of the Cabinet of Ministers) Legislation: The Law on Medical Treatment, Order of the Ministry of Health Nr.250 (24.09.2003.) “Regulations of Register for Medical Persons” (Project of the Cabinet of Ministers) The aim of register: to get the rights of practice and to ensure quality and quantity of the nurses, midwives The aim of register: to get the rights of practice and to ensure quality and quantity of the nurses, midwives Requirements: graduated nursing school (state board exam) or college, renewing of register each 5 years by postgraduate training (nurse, midwife should attend courses for 150 hours; compulsory course of emergency care), obligatory for all nurses, midwives Requirements: graduated nursing school (state board exam) or college, renewing of register each 5 years by postgraduate training (nurse, midwife should attend courses for 150 hours; compulsory course of emergency care), obligatory for all nurses, midwives Register exam: for nurses, midwives who should re-establish the rights of practice (breaking of practising more then 5 years) Register exam: for nurses, midwives who should re-establish the rights of practice (breaking of practising more then 5 years)

21. THE SYSTEM OF CERTIFICATION Legislation: The Law on Medical Treatment, Regulations No. 431 (23.12.1997.) of the Cabinet of Ministers “Procedures for the Certification of Medical Persons”, Statutes of Specialities, Legislation: The Law on Medical Treatment, Regulations No. 431 (23.12.1997.) of the Cabinet of Ministers “Procedures for the Certification of Medical Persons”, Statutes of Specialities, Aim of certification: to get the rights of specialists practice in the speciality for 5 years Aim of certification: to get the rights of specialists practice in the speciality for 5 years Requirements: ~3 years of practice in chosen speciality, register, postgraduate course ~100 – 200 hours, certification exam Requirements: ~3 years of practice in chosen speciality, register, postgraduate course ~100 – 200 hours, certification exam At the present in 29 nursing specialities At the present in 29 nursing specialities

22. PROBLEMS OF REGULATION Requirements for register and certification are not clearly determined, e.g., for both models are needed postgraduate training courses Requirements for register and certification are not clearly determined, e.g., for both models are needed postgraduate training courses Fragmentation of nursing specialities restricts movement of the nurse in labour market Fragmentation of nursing specialities restricts movement of the nurse in labour market Lack of unified information system for applicants (there are several certification institutions) Lack of unified information system for applicants (there are several certification institutions) Possibility of the conflict of interests and lack of objectivity, because the same persons who realise postgraduate training are involved in certification as well Possibility of the conflict of interests and lack of objectivity, because the same persons who realise postgraduate training are involved in certification as well

23. SOLUTIONS Develop model of basic nursing specialities and sub-specialities Develop model of basic nursing specialities and sub-specialities Develop unified information system for certification Develop unified information system for certification Establish coordination system between register and certification systems Establish coordination system between register and certification systems

24. UNDERGRADUATE TRAINING PSHYSICIANS Legislation: The Law on Education, The Law on Highest Education, The Law on Regulated Professions and Recognition of Professional Qualification, Regulations No. 315 (30.07.2002.) of the Cabinet of Ministers “Requirements of education programmes for acquirement of physicians qualification” Legislation: The Law on Education, The Law on Highest Education, The Law on Regulated Professions and Recognition of Professional Qualification, Regulations No. 315 (30.07.2002.) of the Cabinet of Ministers “Requirements of education programmes for acquirement of physicians qualification” Requirements: licensing and accreditation of the programme Requirements: licensing and accreditation of the programme 2 universities: (Riga Stradins University, University of Latvia) 2 universities: (Riga Stradins University, University of Latvia) Length of the programme - 5500 hours (6 years) Length of the programme - 5500 hours (6 years)

25. PROBLEMS POLICY FOR DEVELOPING OF HUMAN RESOURCES IN HEALTH CARE (ratify by the Cabinet of Ministers in 18.05.2005) Short supply of clinics for realizing of education programmes (e.g. technologies, pedagogues etc.) Short supply of clinics for realizing of education programmes (e.g. technologies, pedagogues etc.) Shortage of dormitories Shortage of dormitories State guarantied grants (for now state guarants grant just for each 5 student) State guarantied grants (for now state guarants grant just for each 5 student)

26. SOLUTIONS POLICY FOR DEVELOPING OF HUMAN RESOURCES IN HEALTH CARE (ratify by the Cabinet of Ministers in 18.05.2005) Developing of long-term programme for increasing of studying physicians as well as for improving of education process Developing of long-term programme for increasing of studying physicians as well as for improving of education process Co-operation with educators, professional associations, employers for facilitation of motivation to study in physicians profession Co-operation with educators, professional associations, employers for facilitation of motivation to study in physicians profession Developing of long-term programme to increase the grants for students as well as salaries for physicians Developing of long-term programme to increase the grants for students as well as salaries for physicians Developing of supplies for clinics and to facilitate co- operation between universities and clinics Developing of supplies for clinics and to facilitate co- operation between universities and clinics

27. POSTGRADUATE TRAINING PHYSICIANS Legislation: The Law on Medical Treatment, The Law on Education, The Law on Professional Education, The Law on Highest Education, The Law on Regulated Professions and Recognition of Professional Qualification, Regulations No. 315 (30.07.2002.) of the Cabinet of Ministers “Requirements of education programmes for acquirement of physicians qualification”, Regulations No. 120 (13.03.2001.) of the Cabinet of Ministers “Regulations of financing of residency and planning of residents”, Regulations No. 431 (23.12.1997.) of the Cabinet of Ministers “Procedures for the Certification of Medical Persons”, Statutes of Specialities, Order of the Ministry of Health Nr.250 (24.09.2003.) “Regulations of Register for Medical Persons”, EU directives 93/16/EEC Legislation: The Law on Medical Treatment, The Law on Education, The Law on Professional Education, The Law on Highest Education, The Law on Regulated Professions and Recognition of Professional Qualification, Regulations No. 315 (30.07.2002.) of the Cabinet of Ministers “Requirements of education programmes for acquirement of physicians qualification”, Regulations No. 120 (13.03.2001.) of the Cabinet of Ministers “Regulations of financing of residency and planning of residents”, Regulations No. 431 (23.12.1997.) of the Cabinet of Ministers “Procedures for the Certification of Medical Persons”, Statutes of Specialities, Order of the Ministry of Health Nr.250 (24.09.2003.) “Regulations of Register for Medical Persons”, EU directives 93/16/EEC

28. FORMAL EDUCATION I Residency ( The Law on Medical Treatment ) – education of physicians for acquire speciality in accordance with accreditate education programme (considering statutes of specialities). Residency ( The Law on Medical Treatment ) – education of physicians for acquire speciality in accordance with accreditate education programme (considering statutes of specialities). Confirmation of acquired specialization – diploma of highest medical education or other equal conformation ( The Law on Regulated Professions and Recognition of Professional Qualification) Confirmation of acquired specialization – diploma of highest medical education or other equal conformation ( The Law on Regulated Professions and Recognition of Professional Qualification)

29. FORMAL EDUCATION II 37 specialities; 29 sub-specialities (including dentistry specialists) 37 specialities; 29 sub-specialities (including dentistry specialists) Demands: licensing and accreditation of residency programmes, length of programmes are regulated by Regulations No. 315 (30.07.2002.) of the Cabinet of Ministers “Requirements of education programmes for acquirement of physicians qualification”, process of residency are regulated by Regulations No. 120 (13.03.2001.) of the Cabinet of Ministers “Regulations of financing of residency and planning of residents”, EU directives 93/16/EEC Demands: licensing and accreditation of residency programmes, length of programmes are regulated by Regulations No. 315 (30.07.2002.) of the Cabinet of Ministers “Requirements of education programmes for acquirement of physicians qualification”, process of residency are regulated by Regulations No. 120 (13.03.2001.) of the Cabinet of Ministers “Regulations of financing of residency and planning of residents”, EU directives 93/16/EEC Executors: Health care institutions with rights of educator and universities (GP) Executors: Health care institutions with rights of educator and universities (GP) Financing: State or self-financing Financing: State or self-financing

30. FORMAL EDUCATION III PROCESS of RESIDENCY: Determine the amount of specialities financing by state (MH) Determine the amount of specialities financing by state (MH) Competition for Health care institutions with rights of educator and universities for allowance to educate residents Competition for Health care institutions with rights of educator and universities for allowance to educate residents Competition for applicants of residency Competition for applicants of residency After graduating of residency – for 3 years work in health care institutions of state or municipality After graduating of residency – for 3 years work in health care institutions of state or municipality

31. PROBLEMS I EDUCATION PROCESS: Collision between Regulations No. 315 (30.07.2002.) of the Cabinet of Ministers “Requirements of education programmes for acquirement of physicians qualification” and Statutes of Specialities about length of programmes Collision between Regulations No. 315 (30.07.2002.) of the Cabinet of Ministers “Requirements of education programmes for acquirement of physicians qualification” and Statutes of Specialities about length of programmes In statutes of Specialities there are not defined requirements for educators (related to content) in several cases In statutes of Specialities there are not defined requirements for educators (related to content) in several cases Shortage of students exchange Shortage of students exchange

32. PROBLEMS II ORGANIZATION PROCESS: No clearly defined status of resident (status of studios and employee) No clearly defined status of resident (status of studios and employee) Requirement of state for 3 years work in health care institutions of state or municipality Requirement of state for 3 years work in health care institutions of state or municipality Insufficiency of research based long-term human resource planning for labour market Insufficiency of research based long-term human resource planning for labour market

33. SOLUTIONS I To finalize implementation of Regulations No. 315 (30.07.2002.) of the Cabinet of Ministers “Requirements of education programmes for acquirement of physicians qualification” (based on 93/16/EEC) what determines minimal length of residency programmes To finalize implementation of Regulations No. 315 (30.07.2002.) of the Cabinet of Ministers “Requirements of education programmes for acquirement of physicians qualification” (based on 93/16/EEC) what determines minimal length of residency programmes To make amendments of Statutes of Specialities (detailed description of content) or to develope Profession standards To make amendments of Statutes of Specialities (detailed description of content) or to develope Profession standards To develop model of State granted students exchange To develop model of State granted students exchange

34. SOLUTIONS II To develop an amendments of Regulations No. 120 (13.03.2001.) of the Cabinet of Ministers “Regulations of financing of residency and planning of residents” To develop an amendments of Regulations No. 120 (13.03.2001.) of the Cabinet of Ministers “Regulations of financing of residency and planning of residents” To analyse present and necessary human resources and to work out model for developing of human resources (quality and quantity) To analyse present and necessary human resources and to work out model for developing of human resources (quality and quantity)

35. INFORMAL EDUCATION I Requirements for forms of obtaining, content, executors the same like nurses, midwives Requirements for forms of obtaining, content, executors the same like nurses, midwives Correlation between informal education and certification Correlation between informal education and certification Monitoring: state and professional associations (requirements for certificate) Monitoring: state and professional associations (requirements for certificate)

36. BASIC PROBLEM No common model of informal postgraduate training system for physicians No common model of informal postgraduate training system for physicians

37. SOLUTIONS To develop research based model (who?, what?, for whom?, how? etc.) of informal education for physicians (assistance: development of register system for physicians informal education) To develop research based model (who?, what?, for whom?, how? etc.) of informal education for physicians (assistance: development of register system for physicians informal education)

38. CONCLUSIONS Overall undergraduate training system and postgraduate training for nurses and pshysicians is realized in accordance with Latvian legislation and EU directives Overall undergraduate training system and postgraduate training for nurses and pshysicians is realized in accordance with Latvian legislation and EU directives Postgraduate training divides into 2 branches: formal and informal Postgraduate training divides into 2 branches: formal and informal Informal postgraduate training is organized towards interests of participants and related to requirements and correlates with regulation system Informal postgraduate training is organized towards interests of participants and related to requirements and correlates with regulation system Regulation system is an instrument for human resources planning, because it proceeds quality and quantity of health care persons Regulation system is an instrument for human resources planning, because it proceeds quality and quantity of health care persons