Factors influencing the strengthening of nursing regulatory systems: A comparative study of Lao PDR and Mongolia

Abstract

Access to high-quality healthcare requires a qualified health workforce supported by a robust regulatory framework, an overarching legal structure governing regulation of health professionals. Its effectiveness depends on how well its regulatory functions are carried out. Implementing these functions requires regulatory systems that provide organizational arrangements for each health profession. This study focuses on the nursing regulatory systems in Lao PDR and Mongolia to identify key factors influencing their strengthening and extract policy insights to inform efforts to strengthen nursing regulation in low- and middle-income countries. A qualitative research design was employed, integrating literature reviews and semi-structured interviews with 24 stakeholders from ministries of health, nursing associations, nursing education institutions, clinical nursing administrators, and development partners. The development stages of the nursing regulatory systems were analyzed using Walt and Gilson's Health Policy Analysis Model and the five progressive stages. While governance, capacity building, and health workforce information systems (HWIS) are recognized as important factors in health workforce regulation, this study demonstrates how they interact across stages of development. Three key factors were identified: i) Strengthening governance with nursing engagement in policymaking, ii) Capacity building of internal stakeholders through collaboration with external partners, and iii) Establishing interoperable HWIS for sustainable regulatory implementation. These factors operate in a cumulative and phased process, reflecting regulatory system maturity. The findings underscore the importance of tailoring regulatory strategies to the context—with early-stage countries focusing on governance and capacity building, and more mature systems advancing toward digital integration and institutional sustainability.