Nursing Personnel Convention, 1977 (No. 149) - Kyrgyzstan (RATIFICATION: 1992)

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Articles 2, 3 and 5. National policy on nursing services and nursing personnel. Consultation. In its previous comments, initially made in 2017, the Committee requested the Government to provide updated information on the practical implementation of the national “Programme for the development of nursing 2012–16”, its impact and any follow-up action envisaged. It also requested the Government to clarify whether and how representative organizations of nursing personnel had been associated with the preparation of the programme and other measures giving effect to the provisions of the Convention. The Committee notes with interest the information provided in the Government’s report in relation to the adoption of the Nursing Development and Education Programme in Kyrgyzstan 2019–23 whose objective is to provide training to and strengthen the role of nursing specialists in providing health care to the population. The Programme contemplates, among other measures, the establishment of contemporary nursing practices, as well as the integration of nursing personnel, both in vocational training and in nursing education and practical healthcare. The Committee welcomes the Government’s indication that the representative organizations of nursing personnel participated in the development of the Programme as well as in the realization of studies on nursing. The Government adds that the monitoring and evaluation of the Programme’s implementation will be carried out by the Ministry of Health, the Ministry of Education and Science, the Association of Nursing Specialists of Kyrgyzstan, the Association of Groups of Family Doctors and Family Nurses, and the Association of Medical Colleges of Kyrgyzstan. In addition, the Committee notes the adoption in January 2019 of the Program of the Kyrgyz Republic Government on Public Health Protection and Health Care System Development for 2019–30 “Healthy Person – Prosperous Country”, developed through an inclusive process and with support from the World Health Organization (WHO). According to the Program, it is the fourth such strategic document developed and defines major lines for further healthcare system development and the protection of the public health, aligned with other national policies, such as the National Development Strategy (2018–40). The Program’s objectives include protecting health and strengthening primary healthcare, in pursuit of universal health coverage (UHC) by 2030. The Committee notes that the Program calls for the active participation of stakeholders at all levels of the health system and in all regions of the country, to better ensure ownership of the Program and its successful implementation. Key objectives include reforming nursing education in accordance with new requirements and needs in the healthcare sector. To this end, the Program provides for the development and implementation of a nursing education reform strategy, as well as for the development of the competencies of nursing specialists and those of all specialists with secondary medical education (such as midwives and paramedics). The Committee notes the persistent challenges faced by the public health system, described in the Program, which include insufficient material and financial resources, as well as the lack of required competencies. According to the Program document, while a sufficient number of public health specialists graduate annually from the universities, there is always a workforce shortage as young specialists are not interested in working in their area of specialization, while experienced specialists are in high demand in Commonwealth of Independent States (CIS) and non-CIS countries, particularly in the private health sector. In this respect, the Committee also notes that the Program’s goals include making the healthcare system attractive for nurses, as well as for other health sector professionals. The Committee requests the Government to provide detailed updated information on the nature and impact of the measures taken or envisaged to facilitate retention of the nursing workforce through provision of remuneration packages and career prospects designed to attract them to the profession and retain them in it. It also requests the Government to provide updated detailed information on the nature, implementation, monitoring and impact of the measures adopted, to ensure that nursing personnel, including midwives, are provided with quality education and training appropriate to the exercise of their functions as well as to their professional career development. The Committee further requests the Government to provide a copy of the Nursing Development and Education Programme in Kyrgyzstan 2019–23, as well as copies of new normative or policy documents that may be developed under the relevant health sector programmes in the near future.

Article 7. Occupational safety and health. The Committee notes from the COVID-19 Health System Response Monitor developed jointly by the WHO, the European Commission and the European Observatory on Health Systems and Policies, that the Government has taken a range of measures to ensure that the country can count on a sufficient physical infrastructure and workforce capacity to support an effective response to the COVID-19 outbreak. In particular, the Committee notes measures taken to provide training to health workers on the basis of national clinical guidelines on COVID-19 (Order No. 173 to approve interim clinical guidelines on COVID-19 of 20 March 2020) as well as the establishment of premiums for healthcare workers, including nursing personnel, who are engaged in the treatment of coronavirus patients, paid in addition to their regular salaries. Against this backdrop, the Committee wishes to draw the attention of the Government to Paragraph 49 of the Nursing Personnel Recommendation, 1977 (No. 157), which provides that: “(1) all possible steps should be taken to ensure that nursing personnel are not exposed to special risks. Where exposure to special risks is unavoidable, measures should be taken to minimise it; (2) measures such as the provision and use of protective clothing, immunisation, shorter hours, more frequent rest breaks, temporary removal from the risk or longer annual holidays should be provided for in respect to nursing personnel regularly assigned to duties involving special risks so as to reduce their exposure to these risks; (3) In addition, nursing personnel who are exposed to special risks should receive financial compensation.” The Committee recalls that nursing personnel who, due to the specific characteristics of their work must be in close physical contact with their patients, are at high risk of being infected while treating patients with suspected or confirmed COVID-19, especially where infection control precautions, including the use of personal protective equipment (PPE), are not strictly practised. The Committee therefore requests the Government to provide detailed updated information on the nature and impact of safety measures taken or envisaged, including the provision of PPE and training in its correct use, as well as provision of adequate rest breaks during workers’ shifts and limitations on excessive hours wherever possible, with a view to protecting the health and well-being of nurses during the COVID-19 pandemic and in future crises.

Part V of the report form. Application in practice. The Committee 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 number of persons enrolled in nursing schools; the number of female and male nurses who enter and leave the profession each year; 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 Kyrgyzstani health sector.

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The Committee notes that the Government’s report has not been received. It hopes that the next report will contain full information on the matters raised in its previous comments initially made in 2017.

Repetition

Article 2 of the Convention. National policy concerning nursing services and nursing personnel. The Committee notes the information provided by the Government in its brief report, which reiterates information previously provided in 2012, including information on the “Programme for the development of nursing for 2012–16”. The Government indicates that the obligations and rights of nursing personnel have been reviewed and that their working conditions are equivalent to those of other employees. The Committee requests the Government to communicate updated information on the practical implementation of the “Programme for the development of nursing 2012–16”, its impact and any follow-up action taken or envisaged. It also requests the Government to clarify whether and how representative organizations of nursing personnel have been associated with the preparation of the programme and other measures giving effect to the provisions of the Convention. Referring to its previous comments, the Committee requests the Government to provide comprehensive information on the situation currently prevailing in the health-care sector in Kyrgyzstan, in particular any difficulties encountered in the implementation of the Convention, and to indicate any legislative measures or policy initiatives taken or envisaged to address the challenges identified.

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Article 2 of the Convention. National policy concerning nursing services and nursing personnel. The Committee notes the information provided by the Government in its brief report, which reiterates information previously provided in 2012, including information on the “Programme for the development of nursing for 2012–16”. The Government indicates that the obligations and rights of nursing personnel have been reviewed and that their working conditions are equivalent to those of other employees. The Committee requests the Government to communicate updated information on the practical implementation of the “Programme for the development of nursing 2012–16”, its impact and any follow-up action taken or envisaged. It also requests the Government to clarify whether and how representative organizations of nursing personnel have been associated with the preparation of the programme and other measures giving effect to the provisions of the Convention. Referring to its previous comments, the Committee requests the Government to provide comprehensive information on the situation currently prevailing in the health-care sector in Kyrgyzstan, in particular any difficulties encountered in the implementation of the Convention, and to indicate any legislative measures or policy initiatives taken or envisaged to address the challenges identified.

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Article 2 of the Convention. National policy concerning nursing services and nursing personnel. The Committee notes the Government’s reference to the Decree of the Ministry of Health No. 61 of 9 February 2012 approving a “Programme for the development of nursing for 2012–16” as well as the Decree of the Ministry of Health No. 319 of 24 June 2008 on improving hospital nursing. The Government explains that the new measures have been adopted in order to improve the organization of the management and operation of nursing services, develop nursing education, and enhance the role of nurses in the health system. The Government also indicates that the working conditions of nursing personnel are equivalent to those of other employees and refers, in this respect, to Order No. 246 of 26 May 2012 and Decree No. 308 of 23 July 2002, which provide for wage supplements for nursing personnel working in infectious disease units, X ray units, laboratories and surgical units. The Committee requests the Government to provide in its next report full information on the practical implementation of the abovementioned “Programme for the development of nursing 2012–16”, its concrete results and any follow-up action. It also requests the Government to clarify whether and how representative organizations of nursing personnel have been associated with the preparation of the programme. Furthermore, the Committee requests the Government to submit a copy of Decree No. 319 of 24 June 2008 on improving hospital nursing.

Moreover, the Committee notes the statistical data on the evolution of the number of medical specialists provided by the Government in its latest report. The Committee also notes the Government’s indications according to which, in the period 2010–13, owing to an improvement of working conditions and a salary raise, there has been an influx of nursing specialists into health-care organizations in the country. However, the Committee notes that according to the “Kyrgyzstan health system review” published in 2011 by the European Observatory on health systems and policies, health-care personnel is faced with a number of challenges, for instance the significant decline of the number of health workers per population since the early 1990s, the increased rate of both internal and external migration among health workers, and the low salaries that lead to poor motivation making the profession unattractive for young graduates. According to the same study, the wages of nursing and auxiliary medical personnel reaches slightly more than 50 per cent of the minimum consumer basket. In 2009, there were 517 nurses per 100,000 population which is far below the averages for the Central Asian Republics and the Commonwealth of Independent States (CIS) while almost 50 per cent of nurses are at or close to retirement age. The Committee accordingly requests the Government to provide more detailed information on the situation currently prevailing in the health-care sector, in particular any difficulties encountered in the implementation of the Convention, and to indicate any legislative measures or policy initiatives it intends to take in order to address these challenges.

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The Committee notes with regret that the Government’s report has not been received. It must therefore repeat its previous observation, which read as follows:

Repetition

Article 2 of the Convention. Policy concerning nursing services and personnel. Noting that the Government has not communicated a report on the application of the Convention for more than ten years, the Committee requests the Government to provide detailed information concerning the application of all the provisions of the Convention, especially in the light of the Labour Code (Act No. 106 of 4 August 2004) and of Act No. 6 of 9 January 2005 on the protection of citizens’ health.

The Committee hopes that the Government will make every effort to take the necessary action in the near future.

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The Committee notes that the Government’s report has not been received. It must therefore repeat its previous observation which read as follows:

Article 2 of the Convention. Policy concerning nursing services and personnel. The Committee notes with regret that the Government has not communicated a report on the application of the Convention for more than ten years. It once again requests the Government to provide detailed information concerning the application of all the provisions of the Convention, especially in the light of the new Labour Code (Act No. 106 of 4 August 2004) and of Act No. 6 of 9 January 2005 on the protection of citizens’ health.

The Committee hopes that the Government will make every effort to take the necessary action in the near future.

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Article 2 of the Convention. Policy concerning nursing services and personnel. The Committee notes with regret that the Government has not communicated a report on the application of the Convention for more than ten years. It once again requests the Government to provide detailed information concerning the application of all the provisions of the Convention, especially in the light of the new Labour Code (Act No. 106 of 4 August 2004) and of Act No. 6 of 9 January 2005 on the protection of citizens’ health.

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The Committee notes with regret that the Government’s report has not been received for the tenth consecutive year. It asks the Government to supply for examination by the Committee at its next session detailed information on the application of all the provisions of the Convention, in the light of the new Labour Code of 2004 and of Act No. 6 of 9 January 2005 on the protection of the citizens’ health.

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The Committee notes with regret that the Government’s report has not been received for the ninth consecutive year. It also notes the adoption of Text No. 106 of 4 August 2004 issuing the Labour Code, and of Act No. 6 of 9 January 2005 on the protection of the health of citizens, which it will examine at its next session. The Committee trusts that the Government will provide full information on the application of all the provisions of the Convention in its next report.

[The Government is asked to report in detail in 2008.]

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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. Please provide the text of the national plan for nursing personnel, including the measures taken concerning training, employment and conditions of work, which are referred to in the report.

Article 2, paragraph 2(a), and Article 3. Please supply the text of the Health Act of the Republic of Kyrgyzstan, to which reference is made in the report.

Article 4. Please indicate and supply copies of the subsidiary legislative texts of the ex-USSR which are still in force in Kyrgyzstan, to which reference is made in the report.

Article 5. Please supply copies of any legislative provisions or regulations on the Nursing Council and other regional nursing councils, to which reference is made in the report.

Article 6. Please supply copies of the legislation respecting social insurance and labour matters, to which reference is made in the report.

Article 7. Please supply copies of the legislation and regulations which are in force respecting occupational health and safety, to which reference is made in the report.

CMNT_TITLE

The Committee notes with regret 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. Please provide the text of the national plan for nursing personnel, including the measures taken concerning training, employment and conditions of work, which are referred to in the report.

Article 2, paragraph 2(a), and Article 3. Please supply the text of the Health Act of the Republic of Kyrgyzstan, to which reference is made in the report.

Article 4. Please indicate and supply copies of the subsidiary legislative texts of the ex-USSR which are still in force in Kyrgyzstan, to which reference is made in the report.

Article 5. Please supply copies of any legislative provisions or regulations on the Nursing Council and other regional nursing councils, to which reference is made in the report.

Article 6. Please supply copies of the legislation respecting social insurance and labour matters, to which reference is made in the report.

Article 7. Please supply copies of the legislation and regulations which are in force respecting occupational health and safety, to which reference is made in the report.

CMNT_TITLE

The Committee notes with regret 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. Please provide the text of the national plan for nursing personnel, including the measures taken concerning training, employment and conditions of work, which are referred to in the report.

Article 2, paragraph 2(a), and Article 3. Please supply the text of the Health Act of the Republic of Kyrgyzstan, to which reference is made in the report.

Article 4. Please indicate and supply copies of the subsidiary legislative texts of the ex-USSR which are still in force in Kyrgyzstan, to which reference is made in the report.

Article 5. Please supply copies of any legislative provisions or regulations on the Nursing Council and other regional nursing councils, to which reference is made in the report.

Article 6. Please supply copies of the legislation respecting social insurance and labour matters, to which reference is made in the report.

Article 7. Please supply copies of the legislation and regulations which are in force respecting occupational health and safety, to which reference is made in the report.

CMNT_TITLE

The Committee notes with regret 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. Please provide the text of the national plan for nursing personnel, including the measures taken concerning training, employment and conditions of work, which are referred to in the report.

Article 2, paragraph 2(a), and Article 3. Please supply the text of the Health Act of the Republic of Kyrgyzstan, to which reference is made in the report.

Article 4. Please indicate and supply copies of the subsidiary legislative texts of the ex-USSR which are still in force in Kyrgyzstan, to which reference is made in the report.

Article 5. Please supply copies of any legislative provisions or regulations on the Nursing Council and other regional nursing councils, to which reference is made in the report.

Article 6. Please supply copies of the legislation respecting social insurance and labour matters, to which reference is made in the report.

Article 7. Please supply copies of the legislation and regulations which are in force respecting occupational health and safety, to which reference is made in the report.

CMNT_TITLE

The Committee notes with regret 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. Please provide the text of the national plan for nursing personnel, including the measures taken concerning training, employment and conditions of work, which are referred to in the report.

Article 2, paragraph 2(a), and Article 3. Please supply the text of the Health Act of the Republic of Kyrgyzstan, to which reference is made in the report.

Article 4. Please indicate and supply copies of the subsidiary legislative texts of the ex-USSR which are still in force in Kyrgyzstan, to which reference is made in the report.

Article 5. Please supply copies of any legislative provisions or regulations on the Nursing Council and other regional nursing councils, to which reference is made in the report.

Article 6. Please supply copies of the legislation respecting social insurance and labour matters, to which reference is made in the report.

Article 7. Please supply copies of the legislation and regulations which are in force respecting occupational health and safety, to which reference is made in the report.

CMNT_TITLE

The Committee notes with regret 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. Please provide the text of the national plan for nursing personnel, including the measures taken concerning training, employment and conditions of work, which are referred to in the report.

        Article 2, paragraph 2(a), and Article 3. Please supply the text of the Health Act of the Republic of Kyrgyzstan, to which reference is made in the report.

        Article 4. Please indicate and supply copies of the subsidiary legislative texts of the ex-USSR which are still in force in Kyrgyzstan, to which reference is made in the report.

        Article 5. Please supply copies of any legislative provisions or regulations on the Nursing Council and other regional nursing councils, to which reference is made in the report.

        Article 6. Please supply copies of the legislation respecting social insurance and labour matters, to which reference is made in the report.

        Article 7. Please supply copies of the legislation and regulations which are in force respecting occupational health and safety, to which reference is made in the report.

CMNT_TITLE

The Committee notes with regret 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 reads as follows:

Article 2, paragraph 1, of the Convention.  Please provide the text of the national plan for nursing personnel, including the measures taken concerning training, employment and conditions of work, which are referred to in the report.

Article 2, paragraph 2(a), and Article 3.  Please supply the text of the Health Act of the Republic of Kyrgyzstan, to which reference is made in the report.

Article 4.  Please indicate and supply copies of the subsidiary legislative texts of the ex-USSR which are still in force in Kyrgyzstan, to which reference is made in the report.

Article 5.  Please supply copies of any legislative provisions or regulations on the Nursing Council and other regional nursing councils, to which reference is made in the report.

Article 6.  Please supply copies of the legislation respecting social insurance and labour matters, to which reference is made in the report.

Article 7.  Please supply copies of the legislation and regulations which are in force respecting occupational health and safety, to which reference is made in the report.

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:

The Committee notes the Government's first report on the application of the Convention. It requests the Government to supply additional information on the following points.

Article 2, paragraph 1, of the Convention. Please provide the text of the national plan for nursing personnel, including the measures taken concerning training, employment and conditions of work, which are referred to in the report.

Articles 2, paragraph 2(a), and 3. Please supply the text of the Health Act of the Republic of Kyrgyzstan, to which reference is made in the report.

Article 4. Please indicate and supply copies of the subsidiary legislative texts of the ex-USSR which are still in force in Kyrgyzstan, to which reference is made in the report.

Article 5. Please supply copies of any legislative provisions or regulations on the Nursing Council and other regional nursing councils, to which reference is made in the report.

Article 6. Please supply copies of the legislation respecting social insurance and labour matters, to which reference is made in the report.

Article 7. Please supply copies of the legislation and regulations which are in force respecting occupational health and safety, to which reference is made in the report.

CMNT_TITLE

The Committee notes the Government's first report on the application of the Convention. It requests the Government to supply additional information on the following points.

Article 2, paragraph 1, of the Convention. Please provide the text of the national plan for nursing personnel, including the measures taken concerning training, employment and conditions of work, which are referred to in the report.

Articles 2, paragraph 2(a), and 3. Please supply the text of the Health Act of the Republic of Kyrgyzstan, to which reference is made in the report.

Article 4. Please indicate and supply copies of the subsidiary legislative texts of the ex-USSR which are still in force in Kyrgyzstan, to which reference is made in the report.

Article 5. Please supply copies of any legislative provisions or regulations on the Nursing Council and other regional nursing councils, to which reference is made in the report.

Article 6. Please supply copies of the legislation respecting social insurance and labour matters, to which reference is made in the report.

Article 7. Please supply copies of the legislation and regulations which are in force respecting occupational health and safety, to which reference is made in the report.