Improvements in the performance of health personnel are being sought in an effort to achieve universal health coverage (UHC). Emphasis has thus been placed on the development of health personnel as part of a national UHC strategy throughout the world. In light of this, we planned the present symposium as a means of reviewing the current nursing trends in Southeast Asia and to investigate the issues facing the practical development of nursing personnel, as well as the future directions of nursing support, with a deliberate focus on UHC.
  At the symposium, changes in health issues in Japan, the contributions of nursing professionals in achieving UHC, and the educational programs required by Japanese nursing personnel for international cooperation were first presented. Next, the status of health personnel in Southeast Asia was reviewed. In particular, the status of the regulatory frameworks regarding nursing personnel and the measures for enhancing the practical ability of nurses through legal means were introduced separately for Laos, Cambodia, Vietnam, and Myanmar. Subsequently, as case examples of emerging countries in Southeast Asia, the nursing policies of Thailand and Indonesia were reviewed, measures for improving the practical ability of nurses through legal means in Indonesia were introduced, and support for enhancing networks within autonomous regions was proposed.
  International cooperation in the field of nursing requires strategic and comprehensive support for the development of nursing personnel in healthcare systems variable to economic growth and the means by which to achieve this are diversifying. Indeed, the symposium indicated the importance of responding to the diversity of support by enhancing networks of Japanese individuals involved in international cooperation and providing support for the enhancement of independent networks in Southeast Asia.

Purpose

  The training for “Strengthening Human Resource Development for Nursing and Midwifery in Southeast Asia” was implemented in order to strengthen the nursing education system in Cambodia, Laos, Myanmar and Vietnam. The purpose of this study was to evaluate the training using the training evaluation guide suggested by WHO; and to explore factors for training program to be effective, issues, and lessons.

Methods

  The WHO training evaluation guide which has five evaluation levels was modified as a tool to evaluate the training. Data were collected from training evaluations questionnaire, meeting records during training, and records of interviews conducted during follow-up visits. The factors for training to be effective, issues, and lessons were inductively identified by methodological triangulation from the results of training evaluations, the summary of training feedback from participants and the results of action plan progress.

Results and Discussion

  The training was evaluated as effective that not only achieved “Level 1: Reaction and Satisfaction” and “Level 2: Learning”, but also “Level 3: Behavior”. The factors for training to be effective were (1) practical content through sharing experiences amongmulti-country participants in neighboring countries, (2) selection of suitable trainees by setting the training language as the native language of each participating country, (3)lecture documents in native language facilitated sharing of the learning with relevant people in one’s own country, (4) maintain trainees’ motivation to implement action plans following an agreement with trainees during the training to confirm action plan progress through follow-up visits, and (5) pre-visitingeach participating country to explain the training outline makes relevant people’s much understanding of the training and interest in the action plan. Lessons learned were the importance of the definitions of technical terminology in each country’s native language and the efficacy of follow-up visits. Future issues are: “Level 4: Results”, support for each participant’s needs and “Level 5: Impact”, the development of mechanisms for continued sharing of experiences.

Conclusions

  Our evaluation confirmed the effective factors　for training, issues, and lessons. These are needed to be considered for the future training.

Background
  The Millennium Development Goals were put forth to strengthen maternal and child health, and because infectious disease has become a trend in the world, ensuring the quality and quantity of nursing is important. We report on a survey detailing the current status of legal frameworks and qualification systems in nursing in four countries: Cambodia, Lao People’s Democratic Republic (PDR), Myanmar, and Vietnam.
Method
  We conducted a semi-structured interview with nursing administrative officers, and then we confirmed those information in their countries in 2012 and 2013. We categorized the existing nursing legal framework, nursing qualification systems, professional association and council.
Results
  The King of Cambodia stipulated to a royal decree, which was established by the nursing council. In Lao PDR, following the Law on Health Care, two nursing and midwifery related regulations were developed. The Union of Myanmar enacted the Nurse and Midwife Law. In Vietnam following the Law on Medical Examination and Treatment, two Circulars were issued by the Ministry of Health to regulate the scope of practices and norms. We report on the current situation of the qualification and registration systems for nursing of each country. In addition, the development of qualifications and regulations should be reported based on the ASEAN Mutual Recognition Agreement (MRA).
Conclusion
  We conducted a comparison of four countries to ensure the quality of nursing. A challenge for the future is compliance and dissemination of the laws and regulations that have been developed. ASEAN MRA has become a driving force for improvement of these legal systems.

  One of the characteristics of nursing in Southeast Asia is the ASEAN Mutual Recognition Arrangements on Nursing Services, which strengthens professional capabilities through four objectives include facilitating mobility of nursing professionals within ASEAN.  The Japanese government supports human resources for health in the ASEAN region, as a member country of ASEAN+3. A meeting was held at the Annual Meeting of the Japan Association for International Health 2017. The meeting objectives were as follows: (1) to share three nursing research findings regarding nursing migration, regulatory framework, and in-service training that may affect quality of nursing and (2) to discuss Japan’s role in improving the quality of nursing in the ASEAN region. This report aims to summarize the presentations and points of that meeting.   The academic level of nursing education and nursing regulations have improved in ASEAN member countries. All member countries have university nursing education, and some have master’s and doctoral degree nursing programs. In lower middle income ASEAN countries, such as Cambodia, Laos, and Vietnam, the nursing education system is in the process of transition, from the technical to professional level of nursing. The next step for these countries is to strengthen the capabilities of nursing teachers who are responsible for professional nursing education at universities. The ASEAN University Network and universities in neighboring Thailand could also contribute to this end. In-service training is also needed because the guidance of more experienced nurses is crucial in nursing service as well as nursing practicums. Japan’s experience of developing an in-service training system could be useful for some ASEAN countries.   The objective of mobility among nursing professionals within the ASEAN has yet to be accomplished. However, there are pull and push factors of nurse migration due to economic conditions within the ASEAN. It is predicted that nurse migration will occur with mixed-skill caregivers to high income countries out of the ASEAN countries, because of the lack of caregivers for the aging population. In order to ensure quality nursing in the ASEAN region, it is not only necessary to share country-level experiences to improve nursing education and regulations but also crucial to develop systems that promote the circulation of nursing professionals through wide regional cooperation.