University of Southampton, Southampton, United Kingdom.
PLoS One. 2021 May 14;16(5):e0251331. doi: 10.1371/journal.pone.0251331. eCollection 2021.
In India, nursing regulation is generally weak, midwifery coexists with nursing, and 88% of nursing and midwifery education is provided by the private health sector. The Indian health system faces major challenges for health care provision due to poor quality, indeterminate regulatory functions and lack of reforms.
We undertook a qualitative investigation to understand midwifery and nursing education, and regulatory systems in India, through a review of the regulatory Acts, and an investigation of the perceptions and experiences of senior midwifery and nursing leaders representing administration, advocacy, education, regulation, research and service provision in India with an international perspective.
There is a lack of importance accorded to midwifery roles within the nursing system. The councils and Acts do not adequately reflect midwifery practice, and remain a barrier to good quality care provision. The lack of required amendment of Acts, lack of representation of midwives and nurses in key governance positions in councils and committees have restrained and undermined leadership positions, which have also impaired the growth of the professions. A lack of opportunities for professional practice and unfair assessment practices are critical concerns affecting the quality of nursing and midwifery education in private institutions across India. Midwifery and nursing students are generally more vulnerable to discrimination and have less opportunities compared to medical students exacerbated by the gender-based challenges.
India is on the verge of a major regulatory reform with the National Nursing and Midwifery Commission Bill, 2020 being drafted, which makes this study a crucial and timely contribution. Our findings present the challenges that need to be addressed with regulatory reforms to enable opportunities for direct-entry into the midwifery profession, improving nursing education and practice by empowering midwives and nurses with decision-making powers for nursing and midwifery workforce governance.
在印度，护理监管通常较为薄弱，助产学与护理并存，并且 88%的护理和助产教育由私营卫生部门提供。由于质量差、监管职能不确定以及缺乏改革，印度卫生系统在提供医疗保健方面面临重大挑战。
我们通过审查监管法案，并调查代表印度行政、宣传、教育、监管、研究和服务提供的具有国际视角的高级助产士和护士领导者的看法和经验，进行了一项定性研究，以了解印度的助产士和护理教育以及监管系统。
在护理系统中，助产士的角色没有得到应有的重视。委员会和法案没有充分反映助产实践，仍然是提供高质量护理的障碍。法案没有进行必要的修订，助产士和护士在理事会和委员会的关键治理职位中没有代表，这限制和破坏了领导地位，也阻碍了这些专业的发展。缺乏专业实践机会和不公平的评估实践是影响印度私立机构护理和助产教育质量的关键问题。助产士和护士学生普遍比医学生更容易受到歧视，机会也更少，而性别方面的挑战则加剧了这种情况。
印度即将进行重大监管改革，正在起草 2020 年国家护理和助产委员会法案，这使得本研究具有至关重要和及时的意义。我们的研究结果提出了需要通过监管改革来解决的挑战，以便为直接进入助产士职业提供机会，通过赋予助产士和护士决策权来增强其权力，从而改善护理教育和实践，为护理和助产劳动力治理提供支持。
