Direct Request (CEACR) - adopted 2009, published 99th ILC session (2010)

Article 2, paragraphs 1 and 2, of the Convention. National policy for nursing services and nursing personnel. The Committee notes the detailed information provided by the Government regarding the new National Health Care Plan 2008–2013 entitled “Satisfied Users and Performers of Healthcare Services”, which was adopted on 26 June 2008 to follow up on the previous National Health Care Programme that had expired in 2004. It notes in particular that the Plan provides for improved training of health care staff in order to fill the skills and knowledge gap and envisages greater powers for nurses. The Committee also notes the reform of the salary system and the system of career progression in the nursing sector which were undertaken following the introduction of the new salary system in the public sector in 2002. According to the Government’s explanations, the new salary system is transparent, permitting the uniform evaluation of the work of nursing staff and has resulted in a major increase of approximately 20 per cent in the salaries of health-care workers. Available statistics for the period 2003–06 show an increasing trend in the number of health‑care workers in the public sector which may well be a reflection of the policy reforms. The Committee would appreciate if the Government would provide in future reports up to date information on the implementation of the National Health Care Plan, in particular as regards any measures designed to improve the quality of nursing care or measures likely to affect the employment and working conditions of nursing personnel.

Article 2, paragraph 3. Consultations with the social partners. The Committee notes the Government’s indications concerning the participation of professional associations and trade unions in the drafting of the Resolution on the National Health Care Plan 2008–2013 and the broad public debate that preceded the adoption of the Resolution by the National Assembly. It requests the Government to elaborate on the nursing-specific policy objectives and priorities as may be defined in the five-year health-care action plan, and also to clarify whether any nurses associations have participated in the formulation of that policy.

Article 3. Nursing education and training. The Committee notes the information about the new secondary school educational programmes for the area of health care following the adoption of the 2006 Vocational and Technical Education Act as well as the preparations for the implementation of a new post-secondary professional education programme for senior staff nurses. It also notes that according to the National Health Care Plan, the number of nurses is expected to rise by 17 per cent in the period 2008–13 and that in anticipation of growing needs two new nursing colleges have recently been established. The Committee requests the Government to continue to transmit all available information on the organization of nursing studies, including basic education and practical training, and the evolution of the nursing workforce.

Article 6. Employment conditions of nursing personnel. Hours of work. Further to its previous comment on this point, the Committee notes the Government’s explanations that under the revised Health Services Act, overtime work may exceed the limitation of eight hours per week provided that there is the worker’s written consent and an agreement between the employer and the employee on overtime work. It also notes that working time which exceeds 16 continuous hours requires written consent of the medical professional. In this connection, the Committee notes that section 143(3) of the Employment Act limits overtime work to eight hours a week, 20 hours a month and 180 hours a year, while section 145(2) prohibits an employer to impose overtime work to certain categories of workers such as workers with special health or family needs. The Committee is therefore obliged to once again ask the Government to explain how it is ensured that nursing personnel enjoy conditions at least equivalent to those of other workers with respect to hours of work, overtime work and on-call work.

Annual holidays with pay. The Committee notes the Government’s explanations concerning the discrepancy between the statutory minimum annual leave entitlement of four weeks provided for in section 159 of the Employment Act and the basic annual leave of 18 days provided for in section 47 of the Collective Agreement for Nursing Personnel. It notes in particular that following the recommendations of a tripartite working group, which was set up in 2003 to examine that incongruity, it was decided not to abrogate the provisions of collective agreements which provide for annual leave lower than the legal minimum but to ensure that the combined total of basic and any additional leave may never be lower than the legal minimum. Moreover, even when the worker is not entitled to any additional leave, he/she should nevertheless be granted the minimum period of four weeks prescribed by the Employment Act. The Committee requests the Government to confirm the understanding that, as a matter of established practice, nursing personnel are never granted less than four weeks of annual holidays with pay. It also asks the Government to keep the Office informed of any new measure that might be taken to ensure that nursing personnel enjoy not only in practice but also in law paid annual holidays at least equivalent to those of other workers.

Article 7. Occupational health and safety of nursing personnel. The Committee notes the Government’s statement that apart from the generally applicable Occupational Health and Safety Act and its implementing regulations, there are no specific instruments to regulate health and safety at work for medical professionals. It also notes the information on a newly designed online application entitled “Ergonomics in Healthcare” which is about to be launched by the Ministry of Labour, Family and Social Affairs. The Committee requests the Government to continue providing full particulars on any measures, legislative, administrative or others, seeking to improve the occupational health and safety standards applicable to health care workers.

In this respect, the Committee draws the Government’s attention to the Joint ILO/WHO guidelines on health services and HIV/AIDS, published in 2005, with a view to assisting health services in building their capacities to provide their workers with a safe, healthy and decent working environment as the most effective way both to reduce transmission of HIV and to improve the delivery of care to patients. The Committee wishes also to refer to the International Labour Conference discussion held in June 2009 on “HIV/AIDS and the world of work” with a view to adopting an international labour Recommendation, and in particular to paragraph 37 of the proposed conclusions (see ILC, 98th Session, 2009, Report IV(2), page 310) which provides that public health systems should be strengthened, where appropriate, in order to ensure greater access to prevention, treatment, care and support, and to reduce the additional strain on public services, particularly on health workers, caused by HIV/AIDS.

Part V of the report form. Application in practice. The Committee notes the statistical information concerning labour inspection results in the healthcare sector for the period 2005–08. The Committee would be grateful if the Government would supply information concerning the application of the Convention in practice, including, for instance, statistical data and characteristics of the composition of the nursing workforce (e.g. age, gender), the number of nurses exiting or joining the profession every year, the nurse-to-population ratio, copies of official reports or studies addressing nursing-related issues, any practical difficulties such as shortage of qualified nurses, etc.