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Article 2 of the Convention. National policy concerning nursing services and nursing personnel. The Committee understands that the Department of Health has developed a Human Resources for Health Master Plan 2005–30 to serve as a conceptual framework and road map to support human resources development and management in the health-care sector. In particular, it notes that the Master Plan contains measures such as the exploration of bilateral negotiations with destination countries for health workers, the forging of North–South, hospital-to-hospital partnerships, the introduction of a six-month leave period for hospital nurses hired by their foreign counterparts, during which they could return and train local hospital nurses, and the enactment of legislation which would require nursing school graduates to serve locally for a number of years equivalent to their years of study. The Committee also understands that following the adoption of the 25-year Master Plan, the Human Resources for Health Network (HRHN) was created in 2006 as a multisectoral organization composed of government and non-government bodies with the aim of addressing and responding to human resources issues and problems. The Network’s main objective is to review and harmonize policies among member organizations and to establish a database containing relevant information concerning human resources for health. The Committee requests the Government to provide a copy of the Human Resources for Health Master Plan, and to keep the Office informed of any progress made in the implementation of the measures and strategies set out in the Master Plan related to nursing personnel. It would also appreciate receiving up to date information concerning the activities of the HRHN and their outcomes. Moreover, the Committee would be interested in receiving a copy of the most recent report of the Congressional Commission on Health, set up under section 34 of the Magna Carta for Public Health Workers of 1992 (Republic Act No. 7305), to review on a five-yearly basis health human resource development and to formulate recommendations.
In addition, the Committee notes that section 37 of the Nursing Act of 2002 (Republic Act No. 9173) provides for implementing regulations for this Act to be issued by the Professional Regulation Commission. It would appreciate if the Government would provide a copy of these regulations once adopted.
Moreover, the Committee notes the observations made by the Public Services Labor Independent Confederation (PSLINK), dated 15 September 2008, concerning the application of the revised Nursing Act of 2002, section 32 of which provides for the increase of the entry pay of public health nurses from PHP10,000–15,000 (approximately US$316). According to PSLINK, not all government hospitals are in a position to implement this provision of the Nursing Act, in particular local government hospitals, where nurses are paid in some cases even at the minimum wage level. The Committee requests the Government to provide any comments it may wish to make in response to the observations of PSLINK.
As regards the persistent problem of health professionals’ migration, the Committee understands that the Philippines is the world’s leading exporter of nurses with 85 per cent of Filipino nurses working abroad in some 50 countries, that the number of nursing schools continues to rise (470 schools in 2006 as compared to 251 in 2003), and that the phenomenon of doctors becoming nurses in order to go abroad remains unchecked (an estimated 9,000 doctors having already left as nurses from 2002 to 2005). It also understands that the massive scale of migration is adversely affecting the quality of medical services with hundreds of hospitals having recently closed down, or partially closed, across the country because of lack of doctors and nurses. The Committee requests the Government to provide an updated assessment of the brain drain situation in the health sector and elaborate on any new measures or initiatives undertaken to contain the migration flow and to facilitate the retention and return of health professionals.
In this respect, the Committee wishes to refer to the draft WHO code of practice on the international recruitment of health personnel, currently under consideration, which urges member States to enter into bilateral and multilateral arrangements to promote cooperation and coordination on migrant health personnel recruitment processes in order to maximize the benefits and mitigate the potential negative impact of international recruitment of health personnel, and also calls for measures in order to retain and sustain a skilled domestic health workforce by improving their social and economic status, their living and working conditions, their opportunities for employment and their career prospects.
Article 3. Nursing education and training. The Committee notes that by virtue of section 9(d) of the Nursing Act, the Board of Nursing is responsible for ensuring quality nursing education. In this connection, it notes the course syllabus developed by the Board entitled, “Foundations of nursing practice including professional adjustment”. In addition, it understands that the Board is planning to develop a National Career Progression Program. It would appreciate if the Government would keep the Office informed of any progress made in the development of this programme.
Article 5, paragraph 1. Participation of nursing personnel in the planning of services. The Committee notes that the Board of Nursing has adopted a three-year strategic plan setting out its objectives, strategies and expected outcomes. It would appreciate receiving all available information, such as annual activity reports, showing the progress made in the implementation of the strategic plan.
Article 5, paragraph 2. Negotiations on conditions of service of nursing personnel. Further to its previous comment on this point, the Committee notes sections 31 and 33 of the Magna Carta of Public Health Workers on the right of health workers to freely form or join unions as well as to participate in the formulation of national policies governing the social security system applicable to them. The Committee requests the Government to explain how it is ensured that tripartite consultations take place for other issues related to conditions of employment of nursing personnel than those concerning social security. It would also be grateful if the Government would provide information concerning the organization and functioning of the Management-Health Workers’ Consultative Councils at different levels.
Article 7. Occupational safety and health of nursing personnel. The Committee notes that the Philippines National AIDS Council has published a manual entitled “Taking Care of the Caregivers: Primer for Health Workers on AIDS Prevention and Control.” It requests the Government to provide up to date information concerning any new measures taken or envisaged in order to adapt the national legislation on occupational safety and health to the special nature of nursing work and of the environment in which it is carried out, as required under this Article of the Convention.
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 that under section 30 the Nursing Act, the Board of Nursing is to initiate studies on nursing manpower needs, production, utilization, and development. It would be grateful if the Government would supply a copy of any such study which may have already been completed, as well as information concerning the application of the Convention in practice, including, for instance, the number of students currently enrolled in nursing schools, the number of nurses registered with the Board of Nursing, the nurse-to-population ratio, any practical difficulties encountered in applying the Convention, etc.
The Committee notes the information contained in the Government’s report and the attached documentation, in particular the adoption of the new Nursing Act of 2002 (Republic Act No. 9173). The Committee requests the Government to forward a copy of the corresponding rules and regulations as soon as they are adopted, and wishes to draw the Government’s attention to the following points.
Article 2, paragraphs 1 and 2, of the Convention. Recalling the Government’s earlier statement that the Department of Health in coordination with other public health-related agencies and professional associations has been preparing a nationwide Nursing Development Plan, the Committee requests the Government to specify whether this Plan has been finalized, and if so, to provide detailed information on its contents and the measures taken for its implementation.
Moreover, the Committee notes the findings of the second part of the study on the problems of nursing employment, which was undertaken by the National Institute of Health of the University of the Philippines-Manila and published in 2000. According to the authors of this study, the growth of nurses in recent years has been astronomical; whereas in 1990 there were 125 schools which produced 173,659 registered nurses, in 2000 there were approximately 182 schools and 323,490 nurses. At the same time, the reported demand for nurses, both domestic and international, is estimated at nearly 180,000 nursing positions of which only 15 per cent represents the local demand, or 27,160 jobs. The Committee notes that among the various policy options formulated in the study, it is proposed that the Board of Nursing should implement stricter standards regarding the opening and closing of nursing colleges/universities and that it should publish a list of non-performing schools. It is also recommended that the nurse-patient ratios should be reviewed, that independent nursing practice/entrepreneurship should be encouraged, and that the salary levels and working conditions of nurses in private institutions should be improved to make nursing positions more attractive than non-nursing positions. The Committee requests the Government to indicate in its next report whether any follow-up action is taken or contemplated with respect to the above proposals and to provide detailed particulars on any other initiative designed to reduce the huge nursing surplus.
In addition, the Committee notes that under section 34 of the Magna Carta for Public Health Workers of 1992 (Republic Act No. 7305), a Congressional Commission on Health (HEALTHCOM) was set up to periodically review and assess health human resource development, particularly on continuing professional education and training, and that the report of this Commission to be rendered once every five years should serve as the basis for policy legislation in the field of health. The Committee requests therefore the Government to communicate the most recent report of the Congressional Commission on Health and to indicate any policy decisions taken or envisaged in the light of the Commission’s recommendations.
Article 5, paragraph 1. The Committee notes the information provided by the Government concerning the increased membership and broader powers and functions of the Board of Nursing under sections 3 and 9 of the new Nursing Act of 2002. It notes in particular that the members of the Board are appointed among persons representing the three major areas of nursing, namely nursing education, nursing and service and community health nursing. It also notes that the Board is engaged in joint projects such as the finalization and publication of the Implementing Rules and Regulations of Republic Act 9173, the promulgation of a revised Code of Ethics for the nursing profession, and the development of criteria and mechanism for the certification of nursing specialty organizations while its principal activities include the conduct of the Integrated Comprehensive Nursing Licensure Examination (ICNLE), the inspection of nursing schools and review centres and also the monitoring of hospitals for safe nursing practice. The Committee would be grateful to the Government for continuing to supply all available information on the responsibilities and work plan of the Board of Nursing. It would appreciate receiving a copy of its latest annual report, provided for in section 10 of the Nursing Act of 2002, including any recommendations for the adoption of measures aimed at upgrading and improving the nursing practice, as well as a copy of the revised Code of Ethics as soon as it is formally adopted.
Article 5, paragraph 2. The Committee has been requesting the Government for years to indicate whether the enabling laws governing collective bargaining in the public sector have been enacted and also to report on the revision of the Civil Service Code which contains provisions on this subject. In the absence of any clear reply on this point, the Committee once again asks the Government to specify the steps it intends to take to give effect to this Article of the Convention which provides that the determination of conditions of employment and work of nursing personnel should preferably be made by negotiation between employers’ and workers’ organizations concerned.
Article 7. Further to its previous comments concerning the need to take measures to adapt the legislation on health and safety at work to the particular risk of accidental exposure to HIV/AIDS, the Committee requests the Government to report on any new developments or initiatives on these matters. The Committee recalls, in this connection, that the Government has not reported on the outcome of the Senate Bill No. 1674 concerning regulations to minimize the risk of needle-stick injury to health-care workers, to which it had made reference in its 1999 report, and therefore asks the Government to provide up-to-date information on legal and other measures taken to protect nursing personnel from HIV infection.
Part V of the report form. The Committee would be grateful if the Government could continue to supply information on the application of the Convention in practice, including for instance statistics on the number of nurses currently employed in both the public and private sectors, the number of students attending nursing schools and the number of nurses leaving the country or the profession, copies of official reports examining the employment and working conditions of nursing personnel, as well as any practical difficulties encountered in the implementation of the Convention.
The Committee recalls its previous comments and notes the information provided by the Government in its report. It requests the Government to provide information on the following points.
Article 2, paragraphs 1 and 2, of the Convention. The Committee notes the information that the Department of Health, under the chairmanship of the Director of the Health Human Resource Development Bureau and the Nursing Adviser, in coordination with the Board of Nursing, the National League of Government Nurses Inc., the Philippine Nurses Association, the Association of Nursing Service Administrators of the Philippines and the Association of Deans of the Philippine Colleges of Nursing, has been preparing the Nursing Development Plan for the country for the past two years. The Committee requests the Government to provide detailed information on the contents of this plan and the measures taken for its application.
With particular regard to the training of nursing personnel, the Committee notes that the Health Human Resource Development Bureau of the Department of Health and 16 regional health offices are conducting training of trainers and a management course for multidisciplinary health workers, which include nurses and midwives in both hospitals and public health centres. It also notes that the various organizations of nursing personnel have developed training activities in the field of health. In addition, the Committee notes that nurses who intend to apply for work abroad take short training courses at the Philippine Heart Centre for Asia, the National Kidney and Transplant Institute and other speciality teaching training hospitals.
In addition, the Committee notes the information that a study on the situation of nursing care in the Philippines has been undertaken by a professor at the National Institute of Health of the University of Philippines, Manila, with a view to determining the magnitude of the problem of unemployment among nurses registered in the Philippines, determining the trends in the supply and demand for nurses and identifying the factors at both the local and international levels which have contributed to the problems, with a view to helping policy-makers find a solution. The Committee notes that the domestic and international demand for nursing personnel was 178,045 positions in 1998 and that, at the same time, there was an estimated surplus of 128,065 nurses. The Committee requests the Government to report on the conclusions of this study, with an indication of the solutions that have been found or are envisaged to the problem of the apparent saturation of the profession.
Article 5, paragraph 1. The Committee notes the information provided by the Government concerning the Board of Nursing, which has the mandate to regulate the practice of nursing and ensure the maintenance of efficient technical, professional, ethical and moral standards, taking into account the health needs of the nation. It notes that the Board of Nursing and nurses have initiated a series of meetings and a nursing summit to develop immediate goals and a plan of action designed, among other matters, to unite the nursing sector to ensure that there is a sufficient number of nurses in decision-making positions and to develop a strong relationship with policy-makers, to integrate the nursing service and education, to open opportunities to strengthen the independent functions of nurses and to decrease supply and increase demand. The Committee requests the Government to continue providing information on the activities of the Board of Nursing.
The Committee also recalls that, under the terms of section 33 of the Magna Carta and Rule XVIII of its Implementing Rules, a mechanism is to be set up for continuing dialogue with health workers’ organizations at the national, regional and local levels. It once again requests the Government to provide information on this subject, with an indication, where appropriate, of the functioning of this mechanism.
Article 5, paragraph 2. In the absence of a reply from the Government on this point, the Committee is bound to reiterate its previous request, in which it asked the Government to indicate whether the enabling texts governing collective bargaining in the public sector, as revised, have been enacted and, if so, to provide a copy of them with its next report.
Article 7. The Committee refers to its general observation of 1990, repeated in 1994, in which it stressed the need to take measures to adapt the legislation on health and safety at work to the particular risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel. In this respect, the Committee also suggested to consult with nursing personnel on such measures. Having not received lately any information from the Government on this matter, the Committee asks the Government to provide detailed information on the measures taken in pursuance of its recommendations, based on Article 7 of the Convention.
Part V of the report form. The Committee requests the Government to continue providing information on the manner in which the Convention is applied in practice, including statistical data on the numbers of nursing personnel, the numbers of students registered with nursing schools, the numbers of graduate male and female nurses who have not found employment and who leave the country or the profession, etc.
The Committee notes with regret that the Government’s report contains no reply to previous comments. It hopes that the next report will include full information on the matters raised in its previous direct request, which reads as follows:
Article 2, paragraph 2, of the Convention. The Committee notes that the "Magna Carta for Public Health Workers" (Act No. 7305) has been passed into law, and the Implementing Rules and Regulations which were sent with the Government report. It notes that under section 34 of the "Magna Carta", the Department of Health and a Congressional Commission of Health (HEALTHCOM) are to establish and review, within the framework of a general health programme, policies concerning nursing services and personnel.
It further notes from the report on "The Status of Nursing Education - Update for 1993" provided with the Government's report that, due to foreign demand which led to qualified nursing personnel seeking employment abroad, and at the same time to an accelerated opening of nursing schools in the country throughout the last ten years, the enrolment of nursing students increased from 35,245 in 1989-90 to 172,545 in 1992-93, an increase of 389 per cent. At the same time, the quality of nursing education has dropped, due to a lack of qualified teaching staff. This has caused the percentage of those who graduated to drop from 30 to 11 per cent in the same period. However, with recent recruitment freezes abroad, especially in the United States, there was an imminent risk for newly graduated nursing personnel that they could not find adequate employment in the foreseeable future.
The Committee asks the Government to indicate any measures envisaged or taken to provide nursing personnel with education and training appropriate to the exercise of their functions, and employment and working conditions, including career prospects and remuneration, which are likely to attract persons to the profession and retain them in it.
Article 5, paragraph 1. The Committee notes the Philippine Nursing Act (No. 7164) of 1991, to establish a Board of Nursing, to supervise and regulate the practice of the nursing profession. The Committee further notes that under section 29 of the Act, the Nursing Board shall undertake studies and initiate and/or cooperate with government or private agencies in the conduct of studies for health human resource production, utilization and development. The Committee asks the Government to provide information on any such studies undertaken.
At the same time, the Committee notes that section 33 of the "Magna Carta for Public Health Workers" and Rule XVIII of the Implementing Rules and Regulations provide for the establishment of a mechanism for a continuing dialogue with health workers’ organizations at the national, regional and local level. It hopes that this mechanism will be implemented soon and asks the Government to communicate information on its functioning.
Article 5, paragraph 2. The Committee notes that, while freedom of association in the public sector is recognized by both the Constitution and pertinent laws (inter alia by section 31 of the "Magna Carta"), the appropriate enabling laws governing collective bargaining in the public sector have yet to be enacted. It further notes that the Civil Service Code which contains provisions on this subject is still under review and has not yet been promulgated. The Committee hopes that all necessary steps to this end will be taken in the near future and requests the Government to provide information on any progress made.
Part V of the report form. The Committee has noted the statistical data provided with the report and would be grateful if the Government would continue to communicate such data, including information on the application of the Convention in practice, and on any difficulties encountered.
The Committee notes that the Government's report contains no reply to previous comments. It hopes that the next report will include full information on the matters raised in its previous direct request, which reads as follows:
It further notes from the report on "The Status of Nursing Education Update for 1993" provided with the Government's report that, due to foreign demand which led to qualified nursing personnel seeking employment abroad, and at the same time to an accelerated opening of nursing schools in the country throughout the last ten years, the enrolment of nursing students increased from 35,245 in 1989-90 to 172,545 in 1992-93, an increase of 389 per cent. At the same time, the quality of nursing education has dropped, due to a lack of qualified teaching staff. This has caused the percentage of those who graduated to drop from 30 to 11 per cent in the same period. However, with recent recruitment freezes abroad, especially in the United States, there was an imminent risk for newly graduated nursing personnel that they could not find adequate employment in the foreseeable future.
At the same time, the Committee notes that section 33 of the "Magna Carta for Public Health Workers" and Rule XVIII of the Implementing Rules and Regulations provide for the establishment of a mechanism for a continuing dialogue with health workers' organizations at the national, regional and local level. It hopes that this mechanism will be implemented soon and asks the Government to communicate information on its functioning.
Point V of the report form. The Committee has noted the statistical data provided with the report and would be grateful if the Government would continue to communicate such data, including information on the application of the Convention in practice, and on any difficulties encountered.
1. Referring to its previous comments, the Committee has noted with interest the detailed information supplied by the Government in its report and the documentation attached to this report. The Committee has examined the various legal texts on public servants and other employees of the public sector and has noted that, according to the indications of the Government, this legislation also applies to military nursing personnel, and that therefore all the nursing personnel are covered by the national regulations as stipulated in Article 1, paragraph 2, of the Convention. The Committee has also taken note of the information on Article 5, paragraph 3 concerning procedures for the settlement of disputes.
2. With regard to the other points in its comments, the Committee would like to draw attention to the following:
Article 2, paragraph 2. (a) The Government indicates that the Parliamentary Bill which was intended to revise the Act of 1953 on the practice of the nursing profession has been withdrawn, but that a new Bill (Senate Bill No. 102) containing codification and revision of the entire body of former legislation in this matter is under discussion in the National Congress. The Committee hopes that this Bill, which is designed primarily to improve the training of nursing personnel within the framework of a general programme for the health services, will be adopted in the near future, and that the Government will indicate all progress made in this respect.
(b) The Committee also notes with interest the Senate Bill No. 536 communicated by the Government which aims at adopting a "Magna Carta" for workers in the health services and in hospitals in general, and which contains provision for working conditions, including wages, which will be advantageous to the workers. The Committee would be grateful if the Government would keep it informed of developments regarding this Bill. The Committee also notes the measures adopted to create new jobs for nursing personnel and to raise their wage rates. It also notes with interest the increased numbers in the nursing profession. It would be grateful if the Government would continue to communicate such information, as well as information on all other measures taken to attract persons to this profession and to retain them in it.
Article 5, paragraph 1. The Committee has examined the text of Executive Order No. 895 of 1983 (communicated by the Government), which provides for the creation in public and state-controlled enterprises, including hospitals, of joint committees composed of personnel and management representatives, and it has noted that the principle task of these committees will be to deal with grievances arising from certain working conditions such as work distribution, transfers to another post, productivity, etc. The Committee would be grateful if the Government would indicate whether the committees created by virtue of this Decree in the public hospitals also participate in the planning of nursing services, and whether nursing personnel are consulted through these joint committees on decisions concerning them, in conformity with the above provision of the Convention.
Article 5, paragraph 2. The Committee notes with interest the various legal provisions introduced by the Government to encourage collective bargaining in the public sector, in particular Executive Order No. 180 of 1987 and the Public Service Commission's resolution of 24 May 1989. The Committee notes, however, that according to a leaflet entitled "Primer on Public Sector Unionism" published by the Ministry of Labour and Employment, certain questions relating to working conditions (such as, for example, wage increases, improvements in medical and dental care, retirement benefits increases, etc.) cannot be the subject of collective bargaining. The Committee hopes that the Government will be able to take the necessary measures to ensure that the above questions may also be decided by means of collective bargaining.
Point V of the report form. The Committee has noted the statistical data provided with the report and would be grateful if the Government would continue to communicate such data, including information on the application of the Convention in practice and on any difficulties encountered.