Demande directe (CEACR) - adoptée 2009, publiée 99ème session CIT (2010)

Article 2, paragraph 2(b), and Article 5, paragraph 2, of the Convention. National policy concerning employment and working conditions of nursing personnel. The Committee notes the Government’s explanations concerning the pay and other incentives enjoyed by nurses employed in public hospitals and hospitals run by the Christian Health Association of Malawi (CHAM). It understands that the Ministry of Health provides approximately 60 per cent and the CHAM, 37 per cent, of all formal health-care services, while private practitioners and commercial companies provide 2 per cent of such services. The Committee notes that according to a recent report of the Public Services International entitled “PSI HIV/AIDS southern Africa project report: The health sector in Malawi”, the shortage of nurses remains critical with a nurse–population ratio of 1:3,500, compared with the average of 1 to 1,000 for Africa as a whole. Up to 65 per cent of the public sector nursing posts are unfilled. Ninty-five per cent of registered nurses are urban based leaving significantly higher vacancy rates in rural areas. In some cases, hospital wards that normally require
10–12 nurses are staffed with just one nurse who is regularly required to carry out 16‑hour shifts. Overall, the current number of nursing posts is 4,717 as compared to the estimated target of 8,440 nursing posts needed.

The Committee understands that, in 2004, faced with a health sector in near collapse, the Government received a six-year Human Resources Emergency Relief Plan 2004–10 from the UK Department for International Development and the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has enabled the Government to improve retention and re-engagement of nurses with 52 per cent salary supplement, staff housing incentives, etc. In this connection, the Committee notes that this Emergency Relief Plan is to provide emergency assistance to address acute problems the health sector is currently facing with respect to its workers, mainly by maintaining operation of critical posts, improving retention of the nursing personnel and by providing support in human resources management. In order to train and maintain a sustainable nursing workforce, it would be necessary to formulate and implement policies concerning employment and working conditions, including career prospects and remuneration, within the framework of a general health programme, as provided in Article 2 of the Convention. In this regard, the Committee would appreciate if the Government would provide up to date information concerning the implementation of the Human Resources Emergency Relief Plan and the Health Sector Programme of Work 2004–10, or of any follow-up programme already elaborated, including the progress made in securing trained nursing personnel necessary for the implementation of the Essential Health Package (EHP).

With respect to the process of unionization of nursing staff, the Committee notes the information provided by the Government that the National Organization of Nurses and Midwives in Malawi (NONM) has been registered as a trade union since 2007. While noting the Government’s concern regarding the role and attitude of certain union leaders, the Committee recalls that the Convention requires full consultations with the workers’ organizations concerned for the formulation of the nursing policy (Article 2(3) of the Convention), and meaningful negotiations for the determination of conditions of employment (Article 5(2)). It therefore expresses the hope that the Government will engage in fruitful social dialogue with the newly established nurses and midwives organization with a view to devising common strategies and answers to the persisting problems of the health sector. It also requests the Government to provide up to date information on the collective bargaining process and to transmit a copy of any collective agreement for the nursing sector as soon as it is concluded.

Article 3, paragraph 1. Education and training of nursing personnel. The Committee notes the detailed information provided by the Government concerning the activities of the Nurses and Midwives Council of Malawi and its Education and Examination Committee. It notes in particular that the number of students enrolled in nursing studies increased from 48 in 2004 to 154 in 2008, while the number of licensed and registered nurses passed from 24 in 2004 to 87 in 2008. It would appreciate if the Government would continue providing up to date information in this regard.

Part V of the report form. Application in practice. The Committee notes the statistical information provided by the Government showing that the number of nurses who migrated is steadily decreasing in recent years from 85 in 2004 to 11 in 2008. It would be grateful if the Government would continue supplying detailed information concerning the application of the Convention in practice, including, for instance, the number of students currently enrolled in nursing schools, the nurse-to-population ratio, trends in the migration of nurses, copies of official reports or studies addressing nursing-related issues, etc.