Nursing Personnel Convention, 1977 (No. 149) - Russian Federation (RATIFICATION: 1979)

CMNT_TITLE

Previous comment

Article 2(b) and 5 of the Convention. National policy concerning nursing services and nursing personnel. Working conditions. Working time and remuneration. The Government indicates that in order to eliminate staff imbalances in medical organizations and their units located in rural areas or in workers’ settlements, urban-type settlements and cities with a population of up to 50,000 persons, since 2018 the Government has co-financed the expenses of medical workers, including nursing staff (paramedics), posted from cities to rural areas, through one-off compensation payments with the aim of retaining these medical workers on a permanent basis. The Government further indicates that current legislation provides for the differentiation of five levels of remuneration for nursing staff based on the qualifications, complexity and specificity of the professional activity. Moreover, an assessment of the development of workers’ skills is carried out as part of their certification for qualification categories, with a corresponding increase in the level of salaries. The Government also reports that obtaining a qualification category or recognition of a high level of specialist training grants a slight increase in salary, but not greater clinical powers. At the federal level, the average salary for nursing staff in each healthcare organization must be at least 100 percent of the average monthly labour income in the region. According to the Government, specific remuneration agreements have been established at the medical organization level. Furthermore, the Government reports that all health care workers have a reduced working time of 39 hours per week (as opposed to 40 hours per week in other sectors). Depending on the complexity of the work, additional social benefits are granted in the form of reduced working hours by a percentage (36, 33, 30, 24 hours per week) and, in the case of employees working under harmful conditions, they are granted increased paid annual leave. As for shift work, it is regulated by collective agreement in a medical organization and is usually for periods of 12 or 24 hours. The Government further states that the health care system has a unified nomenclature of specialties, which provides for differentiation of nurses and other comparable staff in terms of qualification level in various areas of health care with limited access to employment based on educational background. According to the Government, consultations are currently underway between the federal health authority and the social partners, including the professional nursing association to decide whether this nomenclature needs updating. The Committee requests the Government to continue to provide detailed updated information on the nature and impact of the measures taken to provide nursing personnel with employment and working conditions, including career prospects and remuneration, which are likely to attract persons to the profession and retain them in it, particularly in rural and remote areas of the country. In addition, the Committee requests the Government to supply information regarding wages, benefits and career prospects for nurses as compared to other similar occupations in all regions. The Committee also requests the Government to provide up-to-date information on the consultations carried out with the employers’ and workers’ organizations concerned, with regard to such measures, including the results of the consultations on the updating of the unified nomenclature of specialties.

Article 2(2)(a) and (3). Education and training. The Government indicates that, under the 2018 Healthcare National Project, the Federal Project “Providing health system medical organizations with qualified personnel”, provides for the implementation of a set of measures in the area of education and training aimed at increasing the number of nurses, included those whose training is financed from the state and municipal budgets; and developing specific training to prepare a professional for a known job position in advance, with additional benefits and social support during the training period. The Government further indicates that there is a unique bachelor’s degree programme in nursing which offers the same conditions and the same programme to medical graduates and nursing graduates from medical schools, including those with specialized work experience. Moreover, in order to increase the number of doctors and nurses, Decree No. 1304 of 9 October 2019 on the “Principles of modernization” of primary health care was issued, which ordered the increase of the number of students in professional educational organizations by at least 30 percent annually due to the existing shortage of specialists (section 1.4.7), by training specialists with secondary medical education, starting 2020/21. In 2021–22, it was envisaged to increase the total number of admissions for specialty, bachelor’s and master’s degree programmes by 7.8 per cent compared to previous year. On the other hand, the Government indicates that in order to support the employment of nurses in rural areas and remote settlements it attracts school-leavers living in these places with accommodation and social support measures for the duration of their studies; and establish a network of college branches in isolated areas. The Committee requests the Government to provide information on the nature and the impact of the measures implemented in the framework of the Decree No. 1304 of 9 October 2019 on the “Principles of modernization” of primary health with regards to the increase of the number of nurses, as well as on any measures taken or envisaged to ensure that nursing personnel are provided with education and training appropriate to the exercise of their functions. It further requests the Government to continue to provide statistical information, disaggregated by sex, age and region, on the number of persons enrolled in nursing schools and the number of female and male nurses who enter and leave the profession each year, including in rural and remote areas of the country.

Article 7. Occupational safety and health. The Government indicates that Federal Law No. 426-FZ of 28 December 2013 on the special assessment of working conditions provides that the assessment of risks in the workplace of nurses is carried out through a special procedure that takes into account the hazard class. In case of working in harmful and/or dangerous working conditions, medical workers, including nurses, receive additional salary and holidays. The Committee welcomes the information that negotiations between the federal health authority and professional nursing associations take place regularly to ensure effective protection of the occupational safety and health at work of nurses. Recalling the recent recognition of the right to a safe and healthy working environment as a fundamental principle and right at work, the Committee requests the Government to provide copies of collective agreements that have been concluded between the federal health authority and professional nursing associations regarding the occupational safety and health at work of nurses. It also requests the Government to provide information on any safety measures taken or envisaged to improve working conditions in respect of safety, health and security for nursing personnel.

Application in practice. The Committee notes that, according to the latest accessible OECD data, in 2019 there were 8.5 nurses per 1,000 inhabitants. The Committee requests the Government to provide information, including updated statistics, on how access to healthcare in both rural and urban areas has evolved over the last 10 years. The Government is also asked to supply copies ofreports by inspection services as regards compliance with the labour law framework in the healthcare sector. It also requests the Government to provide updated detailed information on the application of the Convention in practice, including statistical data disaggregated by sex, age and region concerning: the ratio of nursing personnel to the population; the organization and the operation of all institutions which provide healthcare services; as well as official studies, surveys and reports addressing health workforce issues in the health sector.

CMNT_TITLE

Article 2 of the Convention. National policy concerning nursing services and nursing personnel. The Committee notes that the Government has last provided substantive information on the implementation of the Convention in 2003. In its latest report, the Government fails to address any of the points that the Committee has been raising since 2004 (including the restructuring of health care, the pay system for nursing personnel, and the participation of representative bodies of nurses in the planning of nursing services) and limits itself to providing information concerning the employment of women, maternity protection and persons with family responsibilities.

The Committee understands, however, that there have been important developments in the past few years that may have an impact on the application of this Convention, for instance the establishment of the Commission on Health Care by Government Resolution No. 1018 of 8 October 2012, and the elaboration of the state programme on health-care development in pursuance of Presidential Executive Order No. 596 of 7 May 2012. The Committee also understands that, as announced by the Government in January 2013, the implementation of regional health-care modernization programmes for the period 2011–13 is under way and that approximately 700 billion roubles (RUB) (US$19.9 billion) had been allocated to these programmes. Apart from construction of health-care facilities and modernization of medical equipment, such initiatives entailed amendments to 57 federal laws and resulted in certain regions in salary increases and new remuneration systems for medical personnel.

Yet, the Committee notes that serious challenges persist, especially as regards the staffing of the health-care system with highly qualified and motivated personnel. The Committee notes, in particular, that as indicated in a Government meeting held in April 2013 and devoted to human resources development in the health-care system, at present the nurses per doctor ratio is two to one instead of five to one in most countries with modern health-care systems. In the same meeting, the Minister of Health Care stated that in the past ten years the number of nurses per 10,000 inhabitants declined from 97 to 90 whereas the country requires an estimated 117.5 nurses per 10,000 inhabitants. The Minister added that even though 59,000 nurses were trained per year, 90,000 nurses were leaving the profession annually, of whom only 15,000 due to retirement, and the remaining simply seeking better jobs.

Moreover, the Committee notes the information contained in the 2013 United Nations Development Programme (UNDP) report, entitled National Human Development Report for the Russian Federation – Sustainable Development: Rio Challenges, which concludes that despite considerable improvements in the health-care system in recent years, further changes are needed over a period of eight to ten years to meet present challenges, including greater efficiency in the use of financial, material and human resources and special focus on priorities such as the skills and motivation of staff. The report also puts forward a series of recommendations, including the introduction of more efficient work contracts for health-care workers (higher wages and linkage to specific levels of service quality and quantity), introduction of a new system for certification of personnel, reform in the system of professional medical education and training and a greater role for professional communities in the management of health care. The Committee requests the Government to provide detailed information on measures, initiatives or campaigns implemented under the various health-care development programmes as well as the regional health-care modernization programmes (2011–13), aimed at promoting the attractiveness of the nursing profession and improving the employment conditions of nursing personnel. The Committee also requests the Government to specify whether and how representative workers’ organizations, such as the Russian Nurses Association, are effectively consulted in the formulation of new policies, or the setting up of new structures or programmes which might impact on the employment and working conditions of nursing personnel.

CMNT_TITLE

Article 2(1) of the Convention. Development and implementation of a policy concerning nursing services and nursing personnel. The Committee notes the Government’s very brief report. It notes with regret that it does not provide any new information concerning the follow-up to the Sectorial Development Programme for Nursing (2001–05) and the Sectorial Employment Assistance Programme for Medical and Pharmaceutical Workers (2001–03), to which it referred in a previous report. The Committee understands that several cooperation activities have been undertaken with development agencies from countries such as Canada and the United States with a view to assisting the Ministry of Health and the Russian Nursing Association to establish a strategy for the restructuring of health care, among other measures, through the establishment of new standards for training, standardized clinical procedures and new organizational models. The Committee requests the Government to provide further information on these activities, whether they are undertaken at the national or regional level, and particularly on their impact on the working conditions of nursing personnel. The Committee also reiterates its previous request on the implementation, results and follow-up action of the Sectorial Development Programme for Nursing (2001–05).

Article 2(2)(b). Remuneration of nursing personnel. Further to its previous comments on this point, the Committee notes that the Government has not provided any further information on the envisaged reform of the pay system for nursing personnel which is reported to be based on flexible systems of performance bonuses allowing health care institutions to reward good performance, retain high-quality specialists and encourage the personnel to achieve specific targets. The Committee therefore once again requests the Government to provide detailed information on the current pay system and the level of remuneration of nursing personnel, taking into account the special characteristics of the profession, and to indicate whether employment conditions, including remuneration, are likely to attract persons to the profession and retain them in it.

Article 5. Participation of nursing personnel in the planning of nursing services. The Committee notes that the Government has not provided any further information concerning bodies which would allow nursing personnel to participate in the planning of nursing services, namely nursing councils, the Institute of Nursing Specialists and the Nursing Council. The Committee once again requests the Government to provide a copy of the text establishing the Nursing Council and regulating its composition and mandate, and to provide further information on the operation and principal activities undertaken by these bodies.

Article 7. Occupational health and safety. Further to its previous comments, the Committee notes that the Government has not provided any information concerning the Programme for the Improvement of Working Conditions and the Health and Safety of Health Workers (2002–05), to which it referred in its last report. The Committee therefore requests the Government to provide updated information on this Programme, including its results, its impact on the working conditions of nursing personnel and on any other programme implemented since 2005 in this field.

The Committee also wishes to draw the Government’s attention to the Joint ILO/WHO guidelines on health services and HIV/AIDS, published in 2005, with a view to helping health services reinforce their capacity to provide their workers with a healthy and decent working environment as the most effective means of both reducing HIV transmission and improving the provision of care to patients. The Committee also wishes to refer to the discussion at the International Labour Conference in June 2009 on the theme “HIV/AIDS and the world of work” with a view to the adoption of an international labour Recommendation, and in particular to Paragraph 37 of the draft conclusions (see ILC, 98th Session, 2009, Report IV(2), page 300), which indicates 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. The Committee requests the Government to keep the Office informed of any measure that may be adopted or envisaged with a view to improving the protection of nursing personnel against infectious diseases, including HIV/AIDS.

Part V of the report form. Application in practice. The Committee notes the detailed statistical information provided by the Government concerning the numbers of nursing personnel at the intermediary level. The Committee would be grateful if the Government would continue providing general indications on the manner in which the Convention is applied in practice, including, for example, statistics on the numbers of nursing personnel, disaggregated, where possible, by level of training and function, sex and age, their relation to the population, the numbers entering and leaving the profession each year, copies of official reports or studies covering nursing services, information on any practical difficulties encountered in the implementation of the Convention, such as the shortage or migration of nursing personnel.

CMNT_TITLE

The Committee notes that the Government’s report has not been received. It hopes that a report will be supplied for examination by the Committee at its next session and that it will contain full information on the matters raised in its previous direct request, which read as follows:

Article 2, paragraph 1, of the Convention. The Committee notes the information that a new sectoral development programme for nursing (2001–05) has been drawn up by the Ministry of Health in consultation with the Inter-Regional Nursing Association. The programme, which is part of the plan for the development of health and medical science approved by the Government in 1997, aims at improving all aspects (legislative, material, technical) of the organization of the work of nursing personnel, refining systems for training and management of nursing staff, raising the professional and social status of nurses, guaranteeing social protection for nursing specialists and assisting the development of professional nursing associations. The Committee would be grateful if the Government would provide in its next report full information on the practical implementation of the programme, its concrete results and any follow-up action.

Article 2, paragraph 2(a). As regards education and training, the Committee notes the Government’s indication that the second sectoral employment assistance programme for medical and pharmaceutical workers (2001–03) has now been completed. The programme, which was drawn up by the Ministry of Health in consultation with the Health Workers’ Union, aimed at promoting employment opportunities for nursing personnel by refining training courses, study programmes and curriculum, improving professional mobility and developing educational standards for specific fields or institutions. While noting with interest the general description of the scope and aims of the programme, the Committee would appreciate receiving documented information on the practical results achieved, including for instance statistics on the number of training courses delivered and health workers trained.

Article 2, paragraph 2(b). The Committee notes the Government’s indication that the nurses’ current system of pay, which is based on the unified wage scale, offers little incentive and therefore consideration is given to the possibility of introducing flexible pay incentive systems which would allow health‑care institutions to reward good performance, retain high-quality specialists and stimulate personnel to achieve specific targets. The Committee would be interested in receiving additional information on the evolution of the system and level of remuneration of nursing personnel in light of the difficulty and special characteristics of their profession.

Article 5. The Committee notes from the Government’s last report that the participation of nursing personnel in the planning of nursing services is ensured through nurses’ councils traditionally functioning within medical institutions, the institute of nursing specialists which coordinates the work with representatives of the Ministry of Health and health authorities in all federal districts and regions, and the Nursing Council which has been set up within the Ministry of Health. These are all public bodies playing a consultative role in drawing up recommendations on training and employment issues, and in making proposals for laws and regulations relating to the organization of nursing and the introduction of new nursing technology. The Committee would be grateful if the Government would transmit a copy of the text establishing the Nursing Council and regulating its composition and mandate.

Article 7. The Committee notes the Government’s reference to a new programme for the improvement of working conditions and safety and health of health workers (2002–05) set up by the Ministry of Health in consultation with the Health Workers’ Union. The programme is designed to safeguard the occupational safety and health of health workers through legal, organizational, technical and scientific means, assess working conditions in workplaces, provide training, and help to reduce occupational injuries and diseases among health workers. The Committee would welcome all additional information that the Government could provide on the specific steps taken for the realization of the programme and the progress made in this respect.

Moreover, the Committee notes that according to the Government’s 39 new documents relating to the occupational safety and health of health-care personnel currently existed in draft form. The Committee requests the Government to give a detailed account in its next report of any new legislative or administrative instruments which may have entered into effect in these matters, including provisions or measures relating to the protection of nursing personnel against HIV infection.

Part V of the report form. The Committee notes the statistical information provided by the Government according to which in 2003 there were 1,388,349 medical personnel, including 923,560 nurses, while 150,000 to 200,000 of those health-care workers (or 13 to 15 per cent) leave the nursing profession every year. The Committee would be grateful if the Government could continue supplying information on the application of the Convention in practice, including for instance statistics on the number of students attending nursing schools and the number of nurses leaving the profession, copies of official reports or research studies examining the evolution of the socio-economic status of nursing personnel, as well as any practical difficulties encountered in the implementation of the Convention (e.g. delays in paying wages in the health sector, increase of occupational diseases among medical workers, etc.).

CMNT_TITLE

The Committee notes the Government’s detailed report and attached documentation.

Article 2, paragraph 1, of the Convention. The Committee notes the information that a new sectoral development programme for nursing (2001-05) has been drawn up by the Ministry of Health in consultation with the Inter-Regional Nursing Association. The programme, which is part of the plan for the development of health and medical science approved by the Government in 1997, aims at improving all aspects (legislative, material, technical) of the organization of the work of nursing personnel, refining systems for training and management of nursing staff, raising the professional and social status of nurses, guaranteeing social protection for nursing specialists and assisting the development of professional nursing associations. The Committee would be grateful if the Government would provide in its next report full information on the practical implementation of the programme, its concrete results and any follow-up action.

Article 2, paragraph 2(a). As regards education and training, the Committee notes the Government’s indication that the second sectoral employment assistance programme for medical and pharmaceutical workers (2001-03) has now been completed. The programme, which was drawn up by the Ministry of Health in consultation with the Health Workers’ Union, aimed at promoting employment opportunities for nursing personnel by refining training courses, study programmes and curriculum, improving professional mobility and developing educational standards for specific fields or institutions. While noting with interest the general description of the scope and aims of the programme, the Committee would appreciate receiving documented information on the practical results achieved, including for instance statistics on the number of training courses delivered and health workers trained.

Article 2, paragraph 2(b). The Committee notes the Government’s indication that the nurses’ current system of pay, which is based on the unified wage scale, offers little incentive and therefore consideration is given to the possibility of introducing flexible pay incentive systems which would allow health-care institutions to reward good performance, retain high-quality specialists and stimulate personnel to achieve specific targets. The Committee would be interested in receiving additional information on the evolution of the system and level of remuneration of nursing personnel in light of the difficulty and special characteristics of their profession.

Article 5. The Committee notes from the Government’s report that the participation of nursing personnel in the planning of nursing services is ensured through nurses’ councils traditionally functioning within medical institutions, the institute of nursing specialists which coordinates the work with representatives of the Ministry of Health and health authorities in all federal districts and regions, and the Nursing Council which has been set up within the Ministry of Health. These are all public bodies playing a consultative role in drawing up recommendations on training and employment issues, and in making proposals for laws and regulations relating to the organization of nursing and the introduction of new nursing technology. The Committee would be grateful if the Government would transmit a copy of the text establishing the Nursing Council and regulating its composition and mandate.

Article 7. The Committee notes the Government’s reference to a new programme for the improvement of working conditions and safety and health of health workers (2002-05) set up by the Ministry of Health in consultation with the Health Workers’ Union. The programme is designed to safeguard the occupational safety and health of health workers through legal, organizational, technical and scientific means, assess working conditions in workplaces, provide training, and help to reduce occupational injuries and diseases among health workers. The Committee would welcome all additional information that the Government could provide on the specific steps taken for the realization of the programme and the progress made in this respect.

Moreover, the Committee notes that according to the Government’s report 39 new documents relating to the occupational safety and health of health-care personnel currently exist in draft form. The Committee requests the Government to give a detailed account in its next report of any new legislative or administrative instruments which may have entered into effect in these matters, including provisions or measures relating to the protection of nursing personnel against HIV infection.

Part V of the report form. The Committee notes the statistical information provided by the Government according to which in 2003 there were 1,388,349 medical personnel, including 923,560 nurses, while 150,000 to 200,000 of those health-care workers (or 13 to 15 per cent) leave the nursing profession every year. The Committee would be grateful if the Government could continue supplying information on the application of the Convention in practice, including for instance statistics on the number of students attending nursing schools and the number of nurses leaving the profession, copies of official reports or research studies examining the evolution of the socio-economic status of nursing personnel, as well as any practical difficulties encountered in the implementation of the Convention (e.g. delays in paying wages in the health sector, increase of occupational diseases among medical workers, etc.).

CMNT_TITLE

The Committee notes the detailed information supplied in the Government's report.

Article 2 of the Convention. The Committee notes the information that a draft of basic principles for the development of the nursing profession has been drawn up with the participation of professional associations of nurses, to continue to improve the professional activity of nursing personnel and promote their participation in the implementation of state policy in this sphere. It also notes the information the Government provides on the elaboration, with the participation of the Trade Union of Public Health Workers, of the "Employment Aid Programme for Workers in the Field of Medicine and Pharmaceutics for 1998-2000", and the public health organizations' fee agreement to resolve the problems in nursing personnel's employment. It requests the Government to supply information on all progress achieved in this respect and also to transmit a copy of the text after its adoption, and to transmit information on the implementation of the programme mentioned above.

Article 5. The Committee notes from the Government's report that the participation of nursing personnel in decisions regarding the development of nursing services is ensured through professional associations of doctors' assistants, midwives and nurses. It also notes that the conditions of work and activities of medical workers, including nursing personnel, are governed by collective agreements. It requests the Government to provide copies of these collective agreements.

Article 7. The Committee notes with interest the adoption of the Federal Law "on the propagation in the Russian Federation of diseases caused by the AIDS virus (HIV infection)" by the State Douma (parliament) on 24 February 1995, which provides that the personnel responsible for diagnosing HIV infections and for treating seropositive persons, as well as the personnel working with equipment containing the AIDS virus, are entitled to wages increased by 20 per cent (of the standard fee), a reduction in working hours (36 hours in the week), paid leave of 36 working days, and the right to state compensation in the event of death resulting from diseases related to development of HIV infection. It also notes the adoption of Decree No. 1017 of 13 October 1995 issuing "rules of conduct for medical examinations to detect HIV infection", which ensures that such examinations are free and the results thereof confidential.

Part V of the report form. The Committee requests the Government to continue to supply general information on the manner in which the Convention is applied in practice and also to transmit, if possible, data on the number of persons leaving the profession.

CMNT_TITLE

The Committee notes the detailed information supplied in the Government's report.

Article 7 of the Convention. The Committee notes that guarantees of safe working conditions and the prevention of employment injuries are laid down in the Fundamentals of Labour Legislation. It also notes that the application of the laws and regulations respecting the protection of workers' safety and health is supervised by the labour protection and safety techniques service in the public sector and by supervisory bodies at the state and municipal level and trade union organizations responsible for technical and legal labour inspection. Furthermore, with reference to its general observation of 1990, which was reiterated in 1994, the Committee requests the Government to indicate the measures which have been taken or are envisaged, in consultation with the employers' and workers' organizations concerned, to take into account the particular risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel: for example, through the arrangement of working conditions, the confidentiality of test results, recognition that the cause of infection was occupational, etc.

Point V of the report form. Please continue to supply general information on the manner in which the Convention is applied in practice and also provide, where possible, information on the number of persons who are leaving the profession.