Direct Request (CEACR) - adopted 2019, published 109th ILC session (2021)

Nursing Personnel Convention, 1977 (No. 149) - Azerbaijan (Ratification: 1992)

Other comments on C149

Direct Request

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Articles 2(a) and (3) of the Convention. National policy concerning nursing services and nursing personnel. Nursing education and training. The Government reports on the implementation of the Health Sector Reform Project from 2006 to 2014, with the financial support of the World Bank. The objective of the Project was to improve overall the health system stewardship and financing, as well as to enhance equitable access to health services. The Project also sought to improve the technical and perceived quality of essential healthcare services in the selected districts, in a fiscally responsible and sustainable manner, with a view to improving health outcomes. The Project included a component on human resources development, divided into two subcomponents: (i) health workforce policy and planning; and (ii) health workforce education and training. The Committee notes the information included in the Implementation Report of 3 June 2014 on the World Bank Project concerning the measures taken to improve human resources in the health sector, including nursing personnel. Measures included: the development of a National Strategy for Human Resources in Health; a strategy for post graduate education and training programs; a certification program for healthcare professionals; and a strategy for strengthening professional associations in the health sector. In addition, the Government reports that three additional medical colleges were established in 2014 in the regions, to provide remote areas with qualified medical professionals. The Government adds that, in 2011, the nursing training programme was extended from two-and-a-half to three years and a new state standard was developed which updated the relevant curricula and academic programme for nursing personnel. The Committee notes that the Government does not provide a copy of the state standard. It notes that, according to the report, 55,396 nurses participated in professional development courses during the reporting period, while 33,846 participated in a certification process (of which 3,775 were recertified). Moreover, 60 health workers, including nursing personnel, were awarded medals and honorary titles, as part of a motivation campaign. The Committee notes that, in its concluding observations of 12 March 2015, the Committee on the Elimination of Discrimination against Women (CEDAW) noted Azerbaijan’s efforts to improve access to affordable healthcare services for all citizens, but remained concerned regarding inadequate State expenditure on health … poor healthcare infrastructure, especially in rural areas, and the inadequate skills of service providers (CEDAW/C/AZE/CO/5, paragraph 32). The Committee requests the Government to provide updated detailed information on the impact of the measures adopted, including in the framework of the Health Sector Reform Project, to ensure that nursing personnel are provided with education and training appropriate to the exercise of their functions. It also requests the Government to provide a copy of the national Strategy for Human Resources in Health. The Committee also reiterates its request to the Government to provide a copy of the 2011 state standard.

Articles 2(2)(b) and 5(2). Employment and working conditions of nursing personnel. Consultation. The Committee notes the adoption of the Presidential Orders of 29 August 2013, 18 January 2016 and 1 March 2018, each of which in turn increased the remuneration of health workers by 10 per cent. The Government reports that, as of 2018, the average monthly wage of a nurse was 171 Azerbaijani manat (AZN). The Committee observes that, according to the 3 May 2013 Report of the UN Special Rapporteur on the right to health, while health services are legally required to be free of charge in public health facilities in Azerbaijan, out-of-pocket payments, or payments for health-related goods and services made at the point of service delivery, including informal or so-called “envelope” payments, are prevalent in the Azerbaijani health system. The Special Rapporteur points out that the prevalence of the out-of-pocket payment practice is due in part to extensive corruption in the health system, and is also a consequence of the low salaries paid to doctors and other health workers, noting that, in 2011, the average monthly salary for health workers was 164 manats, representing less than half the average monthly salary for all workers in the country (364 manats). In order to supplement their low salaries, doctors and health workers, as a matter of uniform practice, collect informal payments from patients in return for health-related goods and service, resulting in an informal, unregulated system of fee-for-services (A/HRC/23/41/Add.1, paragraphs 19–20). The Government once again refers to the signing of a sectoral collective agreement for 2014–16 between the Ministry of Health and the trade union of healthcare workers. The Committee requests the Government to provide detailed updated information on the measures taken to facilitate retention of the nursing workforce through provision of remuneration packages and career prospects designed to attract and retain healthcare workers, including those measures adopted to tackle the practice of out-of-pocket payments in the health sector. The Committee reiterates its request that the Government provide a copy of the above-referenced sectoral collective agreement.

Part V of the report form. Application in practice. The Committee notes the Government’s indication that the nursing workforce decreased from 57,506 employees at the beginning of 2013 to 52,807 at the beginning of 2018, due to ongoing healthcare sector reforms. The Committee requests the Government to provide updated detailed information on the application of the Convention in practice, including statistics disaggregated by sex, age and region, on the ratio of nursing personnel to the population, the number of persons enrolled in nursing schools, the number of men and women nurses who enter and leave the profession each year, the organization and the operation of all institutions which provide healthcare, as well as official studies, surveys and reports addressing human resources issues in the health sector.