TY - JOUR
T1 - Regulating recognition and training for new medical specialties in India
T2 - The case of emergency medicine
AU - Sriram, Veena
AU - Baru, Rama
AU - Bennett, Sara
N1 - Funding Information:
Fieldwork for this study conducted by VS was supported by the American Institute of Indian Studies and the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. VS is currently supported by the Agency for Healthcare Research and Quality under grant award T32 HS000087 (PI: Jane Holl, MD, MPH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of AHRQ.
Publisher Copyright:
© 2018 The Author(s). Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved.
PY - 2018/9/1
Y1 - 2018/9/1
N2 - Regulation is essential to health systems and is central to advancing equity-oriented policy objectives in health. Regulating new medical specialties is an emerging, yet underexplored, aspect of health sector governance in low- and middle-income countries (LMICs), such as India. Limited research exists regarding how regulatory institutions in India decide what specialties should be formally recognized and how training programmes for these specialties should be organized. Understanding these regulatory functions provides a lens into how policymakers envision the role of these specialties in the broader health system and how they view the linkages between medical education, health system needs and equity. Drawing upon the recent development of emergency medicine in India, the goal of this study was to understand how recognition and training for new medical specialties are regulated in India. Building on previous frameworks, we examined the institutions, functions, enforcement, mechanisms and institutional relationships that make up the regulatory architecture, and situated our analysis in historical context. Two data sources were iteratively utilized: document review (n=93) and in-depth interviews (n=87). Our analysis reveals a plurality of institutions involved in regulating recognition and training for new medical specialties in India, characterized by a lack of coordination, limited collaboration and weak accountability. We also found an absence of clear responsibility for the systematic, planned development of specialties, particularly in terms of health system in strengthening and achieving health equity. As medical specialization continues to shape health systems in LMICs, further streamlining and coordination in the regulatory system will enable policymakers, researchers, practitioners and civil society to proactively plan for how these specialties can better integrate with health systems, and to advance their contribution to improving health outcomes.
AB - Regulation is essential to health systems and is central to advancing equity-oriented policy objectives in health. Regulating new medical specialties is an emerging, yet underexplored, aspect of health sector governance in low- and middle-income countries (LMICs), such as India. Limited research exists regarding how regulatory institutions in India decide what specialties should be formally recognized and how training programmes for these specialties should be organized. Understanding these regulatory functions provides a lens into how policymakers envision the role of these specialties in the broader health system and how they view the linkages between medical education, health system needs and equity. Drawing upon the recent development of emergency medicine in India, the goal of this study was to understand how recognition and training for new medical specialties are regulated in India. Building on previous frameworks, we examined the institutions, functions, enforcement, mechanisms and institutional relationships that make up the regulatory architecture, and situated our analysis in historical context. Two data sources were iteratively utilized: document review (n=93) and in-depth interviews (n=87). Our analysis reveals a plurality of institutions involved in regulating recognition and training for new medical specialties in India, characterized by a lack of coordination, limited collaboration and weak accountability. We also found an absence of clear responsibility for the systematic, planned development of specialties, particularly in terms of health system in strengthening and achieving health equity. As medical specialization continues to shape health systems in LMICs, further streamlining and coordination in the regulatory system will enable policymakers, researchers, practitioners and civil society to proactively plan for how these specialties can better integrate with health systems, and to advance their contribution to improving health outcomes.
KW - Education
KW - Mapping
KW - Policy analysis
KW - Qualitative research
KW - Regulation
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U2 - 10.1093/heapol/czy055
DO - 10.1093/heapol/czy055
M3 - Article
C2 - 30052974
AN - SCOPUS:85053308347
SN - 0268-1080
VL - 33
SP - 840
EP - 852
JO - Health policy and planning
JF - Health policy and planning
IS - 7
ER -