Legislation, Registration, and Standards (LRS) Toolkit

WCO describes the concept of Optometry as:

Optometry is a healthcare profession that is autonomous, educated, and regulated (licensed/registered), and optometrists are the primary healthcare practitioners of the eye and visual system who provide comprehensive eye and vision care, which includes refraction and dispensing, detection/ diagnosis and management of disease in the eye, and the rehabilitation of conditions of the visual system.

Optometry, despite the first professional education dating back to 1872, still remains unregulated in many countries across the world. These unregulated environments have enabled unregistered persons to engage in professional acts without the necessary training or oversight. This can lead to the provision of poor quality optometric services and unethical acts being conducted, with no recourse to the members of the public. The lack of regulations and legislation can also negatively impact professional advocacy initiatives, preventing the development of optometry in the respective country.

The World Health Organization, on the issue of law and the workforce, acknowledges that health systems and services are dependent on the performance of the healthcare workforce. It further recognizes the contribution of law to the performance of the workforce by formalizing the definition of the scopes of the professions, ensuring high standards for entry and practice and promoting ongoing competency and ethics (World Health Organization, 2019). Professional laws and regulations should be underpinned by professionalism as well as inclusivity and accountability to the populations that professions serve as promoted by Goal 16 of the Sustainable Development Goals (United Nations, 2019). Defining the laws, rules and regulations will provide the governance framework that ensures ethical practice, quality education and practice standards, professionalism and accountability within the specific health sector and system in the country.

The Legislation, Registration and Standards (LRS) committee of the WCO,  has been mandated to assist countries with developing legislation and regulation. The TOOLKIT is aimed to serve as a LRS resource to guide optometrists in their respective country to develop professional associations, legislative framework, and regulatory bodies. It must be noted that as Constitutions, Health Acts and other sovereign rules differ globally, the optometric profession’s leadership needs to be familiar with the relevant country laws within which Optometry legislation will be located, review analogous regulations and most importantly, remain acutely aware of the eye care needs of their respective country. It is also important to differentiate between policy, legislation, regulations and rules.

Policy outlines what a body hopes to achieve and the methods and principles it will use to achieve them. It states the goals of the body.  A policy document is not a rule or a law, but it will often identify new laws that are required to achieve its goals.

Legislation is comprised of laws that set out standards, procedures and principles that must be followed. If a law is not followed, those responsible for breaking them can be prosecuted in court (Education Training Unit for Democracy and Development, 2019). The legislative framework is set out as regulations and rules.

Regulations are orders issued by an executive authority or regulatory body. As they form part of the legal statute, they cannot be amended without going through the required legal steps. Regulations have the force of the law and are enforced by the regulatory body.

Rules are sets of prescribed guidelines for conduct and actions or regulating principles. These can be introduced or amended by the oversight body without having to go through legal processes. They can be enforced. e.g. by a disciplinary committee of the regulatory body.

The Toolkit has been structured to deal with the processes for legislation, regulations, rules, and professional guidelines. Existing examples, from various developed and developing countries, have been sourced by the task team and an attempt has been made to provide a general approach which could serve as a guide. Organizations wishing to promote legislative change in a country or region will need to examine the external and internal factors that will affect their success.

The task team understands that countries are at different stages of development in relation to their legislative process. Therefore, the TOOLKIT has been structured in a stepped approach to guide countries according to the stage of development as follows:

Stage 1: Countries where optometry is not recognized by the government and therefore with no professional association and/or legislation, regulations or rules.

Stage 2: Countries where optometry is recognized and/or legislated by the government but no independent optometry regulatory body.

Stage 3: Countries where optometry is fully recognized as a regulated profession with optometric legislation, regulations, but are looking to expand scope of practice and/or develop additional clinical guidelines in various areas.