Nursing Personnel Convention, 1977 (No. 149) - Kenya (RATIFICATION: 1990)

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The Committee takes note of the supplementary information provided by the Government in light of the decision adopted by the Governing Body at its 338th Session (June 2020). The Committee proceeded with the examination of the application of the Convention on the basis of the supplementary information received from the Government this year, as well as on the basis of the information at its disposal in 2019

Articles 2(2) and 3(1) of the Convention. National policy concerning nursing services and nursing personnel. Nursing education and training. In its previous comments, the Committee noted the Government’s indication that nursing in Kenya was undergoing transformation, with the sector being reformed to align itself with the Constitution. The Committee noted the Government’s reference to the Nursing Strategic Direction towards Vision 2030, which aimed to: reorganize the Scheme of Service for Nurses, mainstream processes for improved quality of nursing services; and introduce new programmes. The Committee requested the Government to provide information on the implementation of these large-scale reforms and their impact, particularly in relation to the quality of nursing care. The Government reports that nursing in the country has undergone extensive transformation during the reporting period. It adds that the Scheme of Service for nursing personnel, established in 2015, is due for review, indicating that a Directorate in nursing was established with the support of the Scheme. With respect to measures to promote the retention of nurses, the Committee notes the Government’s indication that the promotion of nurses is being carried out using the current Scheme of Service, and there has been an increase in allowances. The Committee further notes the Government’s indication that nurses are being trained on processes, resulting in improved collaboration with other health workers and better patient care. The availability of specialized care has been increased through nurses who have completed the requisite courses. In addition, mobile clinics have enabled nurses and midwives to provide comprehensive care in communities, reducing healthcare disparities. The Government refers to the “Big Four” plan announced in December 2017, which will guide the development agenda of the country in the period 2018–22, and includes Universal Health Coverage (UHC). The Committee notes with  interest  the launch of Kenya’s Nursing Now campaign in 2018, which seeks to strengthen leadership in nursing as a central principle as well as to achieve UHC. The Government indicates that compiling data on the overseas migration of nurses remains a challenge given that many nurses migrate for other purposes, but start working overseas. Moreover, few nurses request a license from the national regulatory body before migrating. The Committee takes note of the detailed Annexes provided by the Government on the public and private institutions providing nursing education and training and the number of students who graduate from nursing colleges annually. It also notes the detailed information regarding the organization of nursing studies (requirements for entry, levels of education, duration). The Government indicates that there are currently 26 different training programmes (five at certificate level, 19 at diploma level and two at degree level) with different entry requirements and duration of study. Furthermore, post-basic diploma courses are offered in Kenya, providing specialized training in areas such as cardiac nursing and community nursing. With respect to the manner in which nursing education and training is monitored, the Government indicates that the Nursing Council of Kenya (NCK) is mandated to set standards related to the education and practice of nursing and midwifery and of health care through: regulation of nurses and midwives training syllabi and institutions; conducting of licensing examinations; compilation and maintenance of registers, rolls and records required to be kept under the Nurses Act; undertaking disciplinary measures as necessary to maintain a proper standard of conduct and nursing care; and advising the Cabinet Secretary on matters concerning all aspects of nursing. The Committee requests the Government to continue to provide updated information on measures taken or envisaged to promote the retention of nursing personnel and to provide information on the impact of new programmes to improve working conditions of nursing personnel and the quality of nursing care, including on the impact of the Nursing Now campaign. The Committee requests the Government to provide detailed information, including disaggregated statistical data concerning trends in the overseas migration of nurses and information on the impact of measures taken to address this issue. The Committee also requests the Government to continue to provide information on the number of students who graduate from nursing colleges annually and the number of institutions offering nursing education and training, and on the organization and monitoring of nursing education and training.

Article 5(2). Determination of conditions of employment and work. The Government indicates that, although the Kenya National Union of Nurses (KNUN) has concluded collective bargaining agreements with various private nursing institutions, it has not yet concluded a collective agreement to improve the terms and conditions of employment for nurses employed by county governments. The Committee reiterates its request that the Government provide a copy of the collective bargaining agreement between the KNUN and the Government once it has been concluded. In addition, the Committee once again requests the Government to provide copies of the collective bargaining agreements in force between the Government and the Union of Kenya Civil Servants and the Kenya Union of Domestic, Hotels, Educational Institutions, Hospitals and Allied Workers that contain provisions on the employment conditions of nursing personnel.

Part V of the report form. Practical application. The Committee takes note of the registration data provided by the Government, according to which, for the fiscal year 2019-20, there were 366 nurses in private practice and 1,316 nurses registered with the Nursing Council of Kenya. The Committee requests the Government to provide detailed information, disaggregated by age, sex and region, concerning the situation of nursing personnel in the country, including the nurse-population ratio, the number of nursing personnel broken down by those working at public and private healthcare establishments, and the number of those who leave the profession each year and copies of any recent reports or studies addressing nursing-related issues.

Article 7. Occupational, safety and health. The Committee notes the establishment of a National Emergency Response Committee on Coronavirus on 28 February 2020 through Executive Order No. 2 of 2020 and the adoption of the “interim guidelines and protocols for SARS-CoV 2 and COVID-19”. The Committee notes that the guidelines include recommendations for comprehensive prevention and case management strategies, addressed to health care workers taking care of patients suspected or confirmed to have COVID-19. According to “ILO: Country policy responses, COVID-19 and the world of work”, the Government has established the COVID -19 Emergency Response fund in partnership with the private sector. The Committee draws the attention of the Government to Paragraph 49 of Recommendation 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 also draws the Government’s attention to the ILO Guidelines on decent work in public emergency services, 2018, which recognize the need to protect public emergency workers, including emergency health workers, from exposure to communicable diseases. In particular, paragraphs 50 and 51 of the Guidelines stress that suitable and sufficient personal protective equipment (PPE) should be provided as protection against exposure to hazardous conditions for public emergency services (PES) workers and that workers and/or their representatives should be consulted and participate in relation to the selection and correct use of PPE. Noting that nursing personnel, are at high risk of being infected while treating patients with suspected or confirmed COVID-19 when infection control precautions, including use of personal protective equipment (PPE) are not strictly practiced, the Committee requests the Government to provide detailed updated information on the safety measures being taken or that are envisaged, including the provision of PPE and training in its 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 wellbeing of nurses and limiting as much as possible their risk of contracting COVID-19.

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Articles 2(2) and 3(1) of the Convention. National policy concerning nursing services and nursing personnel. Nursing education and training. In its previous comments, the Committee noted the Government’s indication that nursing in Kenya was undergoing transformation, with the sector being reformed to align itself with the Constitution. The Committee noted the Government’s reference to the Nursing Strategic Direction towards Vision 2030, which aimed to: reorganize the Scheme of Service for Nurses, mainstream processes for improved quality of nursing services; and introduce new programmes. The Committee requested the Government to provide information on the implementation of these large-scale reforms and their impact, particularly in relation to the quality of nursing care. The Government reports that nursing in the country has undergone extensive transformation during the reporting period. It adds that the Scheme of Service for nursing personnel, established in 2015, is due for review, indicating that a Directorate in nursing was established with the support of the Scheme. With respect to measures to promote the retention of nurses, the Committee notes the Government’s indication that the promotion of nurses is being carried out using the current Scheme of Service, and there has been an increase in allowances. The Committee further notes the Government’s indication that nurses are being trained on process, resulting in improved collaboration with other health workers and better patient care. The availability of specialized care has been increased through nurses who have completed the requisite courses. In addition, mobile clinics have enabled nurses and midwives to provide comprehensive care in communities, reducing healthcare disparities. The Government refers to the “Big Four” plan announced in December 2017, which will guide the development agenda of the country in the period 2018–22, and includes Universal Health Coverage (UHC). The Committee notes with interest the launch of Kenya’s Nursing Now campaign in 2018, which seeks to strengthen leadership in nursing as a central principle as well as to achieve UHC. The Government indicates that compiling data on the overseas migration of nurses remains a challenge given that many nurses migrate for other purposes, but start working overseas. Moreover, few nurses request a license from the national regulatory body before migrating. The Committee requests the Government to continue to provide updated information on measures taken or envisaged to promote the retention of nursing personnel and to provide information on the impact of new programmes to improve working conditions of nursing personnel and the quality of nursing care, including on the impact of the Nursing Now campaign. The Committee requests the Government to provide detailed information, including disaggregated statistical data concerning trends in the overseas migration of nurses and information on the impact of measures taken to address this issue. With respect to nursing education and training, the Committee reiterates its request that the Government provide updated information on the activities of the Nursing Council of Kenya, including the accreditation of nursing education providers, and the issuance of private practice licenses to nurses. The Committee also requests the Government to provide information on the number of students who graduate from nursing colleges annually and the number of institutions offering nursing education and training, on the organization of nursing studies (requirements for entry, levels of education, duration), and the manner in which nursing education and training is monitored and supervised by the public authorities.

Article 5(2). Determination of conditions of employment and work. The Government indicates that, although the Kenya National Union of Nurses (KNUN) has concluded collective bargaining agreements with various private nursing institutions, it has not yet concluded a collective agreement to improve the terms and conditions of employment for nurses employed by country governments. The Committee reiterates its request that the Government provide a copy of the collective bargaining agreement between the KNUN and the Government once it has been concluded. In addition, the Committee once again requests the Government to provide copies of the collective bargaining agreements in force between the Government and the Union of Kenya Civil Servants and the Kenya Union of Domestic, Hotels, Educational Institutions, Hospitals and Allied Workers that contain provisions on the employment conditions of nursing personnel.

Part V of the report form. Practical application. The Committee requests the Government to provide detailed information, disaggregated by age, sex and region, concerning the situation of nursing personnel in the country, including the number of practicing nurses registered with the Nursing Council of Kenya, the nurse-population ratio, the number of nursing personnel broken down by those working at public and private healthcare establishments, and the number of those who leave the profession each year and copies of any recent reports or studies addressing nursing-related issues.

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Article 2(2) of the Convention. National policy concerning nursing services and nursing personnel. The Committee notes the Government’s statement that nursing in Kenya is undergoing serious transformation and that nursing is being reformed to align itself with the letter and spirit of the Constitution. The Government also indicates that the Nursing Strategic Direction towards Vision 2030, which will soon be submitted to the Constitutional Implementation Commission for approval, aims at the reorganization of the Scheme of Service for Nurses, the mainstreaming of nursing processes for improved quality of nursing services and the introduction of new programmes. Moreover, the Committee understands that the new Kenya Health Sector Strategic and Investment Plan (2012–18), as well as the hospital reform programme are being developed. The Committee requests the Government to provide, together with its next report, detailed particulars on the implementation of these large-scale reforms, and how they are expected to impact on the quality of nursing care.

As regards the problem of continued migration of qualified nurses, the Committee recalls that the World Health Organization (WHO) has adopted in 2010, the Global Code of Practice on the International Recruitment of Health Personnel, which provides among other guiding principles, that the international recruitment of health personnel should be conducted based on the principles of transparency, fairness and promotion of sustainability of health systems in developing countries. The Committee understands that in accordance with article 7.3 of the Code, the Government has designated a national authority responsible for the exchange of information regarding health personnel migration and the implementation of the Code. The Committee requests the Government to submit up-to-date information concerning the current situation of overseas migration of nurses and any targeted measures or initiatives undertaken to address this issue.

With respect to remuneration levels of nursing personnel, the Committee notes the Government’s indication that salaries of nurses have remained unchanged since 2008, and that pending a salary increase through the Salaries and Remuneration Commission, nurses have been awarded an allowance to motivate and retain them especially those working in hardship areas. The Committee requests the Government to continue to provide information on measures to facilitate retention of the nursing workforce through attractive remuneration packages and career prospects.

Article 3(1). Nursing education and training. The Committee notes the adoption of the Nurses (Amendment) Act No. 27 of 2011, which basically revises the composition of the Nursing Council of Kenya, and the Nurses (Accreditation of Training Courses) Regulations, 2013 (Legal Notice No. 72). It also notes the information provided by the Government regarding the number of training institutions and nursing schools that increased from 68 in 2010 to 91 in 2013. The Committee requests the Government to provide more detailed information on the activities of the revised Nursing Council of Kenya, including the accreditation of nursing education providers, and the issue of private practice licenses to nurses, as well as up-to-date statistics on the number of students attending or graduating nursing colleges every year.

Article 5(2). Determination of conditions of employment and work. The Committee notes the Government’s indication that the process of discussing a collective bargaining agreement between the Kenya National Union of Nurses (KNUN) and the Government is currently in progress. The Committee requests the Government to provide a copy of the collective bargaining agreement once it has been concluded. The Government is also requested to provide copies of collective agreements currently in force between the Government and the Union of Kenya Civil Servants (UKSC) and the Kenya Union of Domestic, Hotels, Educational Institutions and Health Associations (KUDHEIHA), which contain provisions on employment conditions of nursing personnel.

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Article 2(2) of the Convention. Measures to promote attractive employment and working conditions for nursing personnel. The Committee notes the revised Scheme of Service for Nursing Officers, issued in August 2002, which provides for a well-defined career structure (establishing eight grades of nursing officers) for qualified nursing personnel in the public sector. With respect to the remuneration levels, the Committee notes the Government’s indication that wages for nursing personnel have gone up by between 90 and 116 per cent during the period from 2000 to 2008. The Committee also notes the general information provided by the Government concerning measures to monitor the nursing workforce and facilitate retention, for instance the setting up of a comprehensive electronic database of nurses, doctors, clinical officers and laboratory staff deployed in various health facilities, and the increase of the retirement age from 55 to 60 years that resulted in the retention of 2,500 nurses who could otherwise have been retired between 2009 and 2013. Moreover, the Committee notes the Second National Health Sector Strategic Plan (NHSSP II) of the Ministry of Health for the period 2005–10 which identifies human resource management issues such as insufficient staffing at most health centres and dispensaries and the need for redeployment of nurses. The Committee understands that a first Strategic Plan for the nursing sector has been drafted and also that new draft legislation on nursing personnel is currently before the Parliament. The Committee requests the Government to keep the Office informed of any progress made in the adoption of these legislative and policy measures and to transmit copies of all relevant texts once they have been adopted.

As regards the issue of ongoing migration of nursing personnel, the Committee notes the Government’s indication that strategies are being discussed to address the issue, including measures such as the payment of an extra allowance, salary increment and constant dialogue. In this connection, the Committee draws the Government’s attention to the draft WHO Code of Practice on the International Recruitment of Health Personnel, currently under preparation, 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. The Committee requests the Government to keep the Office informed of any specific measures taken or envisaged with a view to controlling or mitigating the consequences of the continued migration of qualified nurses.

Article 3(1). Nursing education and training. The Committee notes the Government’s indication that training opportunities for nurses have considerably expanded with only two universities offering degree programmes in nursing in 2002, as compared to ten universities delivering first and second degree programmes today. The Government adds that, in total, there are 68 training institutions for nurses at the certificate, diploma and degree levels. In view of the rapid growth in the number of institutions offering nursing education and training, the Committee requests the Government to provide more detailed information on the organization of nursing studies (requirements for entry, levels of education, duration), the coordination with educational programmes designed for other health workers, and the supervision of nursing education and training by the public authorities.

Article 5(2). Determination of conditions of employment and work. The Committee recalls its previous comments in which it requested the Government to provide copies of all collective agreements currently in effect regulating the conditions of employment and work of health-care personnel in the private sector. In the absence of the Government’s reply on this point, the Committee again requests the Government to: (i) specify how it is ensured that the terms and conditions of employment applicable to nurses in the private sector are determined through negotiation between employers’ and workers’ organizations; and (ii) transmit copies of relevant collective agreements.

Article 7. Occupational health and safety. The Committee notes the Government’s indication that efforts are being made to improve safety at workplace with specific focus on infection prevention and needle stick injuries. The Government also indicates that nurses continue to receive on-the-job training in modern infection prevention and post-exposure prophylaxis while infection prevention guidelines are under preparation. Moreover, the Government has transmitted a copy of the revised Public Sector Workplace Policy on HIV and AIDS, which was published by the Ministry for Public Service in May 2010 with a view to addressing new challenges and emerging issues in the management of HIV and AIDS. In this connection, 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 draw the Government’s attention to the new HIV and AIDS Recommendation, 2010 (No. 200), paragraph 45 of which provides that public health systems should be strengthened to help ensure greater access to prevention, treatment, care and support, and reduce the additional strain on public services, particularly on health workers, caused by HIV and AIDS. The Committee requests the Government to transmit a copy of the infection prevention guidelines once published. It also requests the Government to keep the Office informed of any initiatives or programmes to improve the occupational safety and health of nursing personnel, especially the protection against infectious diseases such as HIV/AIDS, in view of the specific risks and hazards inherent in the profession.

Part V of the report form. Practical application. The Committee notes the statistical information provided by the Government showing that the nursing personnel represents over 47 per cent of the workforce in the health sector. The Committee requests the Government to continue to provide the information concerning the application of the Convention in practice, including, for instance, the number of students attending or graduating nursing schools every year, the number of practising nurses registered with the Nursing Council of Kenya, the nurse-population ratio, and copies of any recent reports or studies addressing nursing-related issues.

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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 2, of the Convention. Employment and working conditions of nursing personnel. The Committee notes the Government’s statement in its last report that nursing personnel in the public sector have now a different scheme of service from other civil servants and that they are entitled due to the nature of their work to a uniform allowance, a risk allowance and a responsibility/administrative allowance. The Committee requests the Government to communicate in its next report supplementary information on the new conditions of service of nurses in government service and to forward copies of all relevant texts. In addition, the Committee wishes to receive the Government’s views as regards the remuneration levels practised in the health sector in the light of reported strike movements of nurses over low pay and, in some cases, unpaid wages.

Article 5, paragraph 2. Determination of conditions of employment and work by negotiation. With reference to the various memoranda of agreement annexed to the Government’s previous report, most of which were concluded in 1999 for a two-year period, the Committee would be grateful to the Government for supplying copies of all collective agreements in force determining the conditions of work of health-care personnel in the private sector.

Article 7. Occupational health and safety. Further to its previous comment on this point, the Committee notes the Government’s indication that the Federation of Kenya Employers (FKE) has drawn up a Code of Conduct on HIV/AIDS in the workplace which covers all its members, including those employing nursing personnel. The Committee asks the Government to provide a copy of this Code of Conduct. It also notes that, according to the Government’s last report, the Ministry of Health, in consultation with the Nursing Council of Kenya, was in the process of formulating rules to supplement the existing infection prevention and control guidelines. The Committee requests the Government to transmit the text of these rules once they are issued and to keep the Office informed of any further measures or initiatives aiming at minimizing the risk of HIV infection for health‑care providers. Bearing in mind that HIV-positive persons are estimated to occupy up to 40 per cent of beds in most hospitals, the Committee considers that sustained efforts are necessary to effectively contain the risk of patient-to-nursing staff HIV transmission.

Part V of the report form. Application in practice. The Committee notes that according to the statistics provided by the Government in its last report, there are 40,000 nurses, of whom 18,200 are employed in public medical institutions accounting for 34 per cent of the total Ministry of Health workforce. The Committee understands that a National Nursing Workforce Analysis project, scheduled to be completed in 2005, is currently under way with a view to computerizing and analysing existing supply and demand data on the nursing workforce and student nurses. 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 nurse-to-population ratio, the number of students attending nursing schools and the number of nurses leaving or joining the profession, copies of official reports or research studies examining the employment and working conditions of nursing personnel, as well as any practical difficulties encountered in the implementation of the Convention.

Moreover, the Committee understands that Kenya is facing a problem of brain drain in the health sector. According to the information available to the Committee, between 2001 and 2006, more than 3,000 nurses left the country to work in countries offering substantially higher salaries and a number of them had to pay for this purpose fees equal to ten months’ wages to private employment agencies. The Committee asks the Government to provide information regarding measures taken concerning, in particular, the plan for the improvement of working conditions of nursing personnel, including remuneration, in order to fight against the problem of brain drain.

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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 2, of the Convention. The Committee notes the Government’s statement in its last report that nursing personnel in the public sector have now a different scheme of service from other civil servants and that they are entitled due to the nature of their work to a uniform allowance, a risk allowance and a responsibility/administrative allowance. The Committee requests the Government to communicate in its next report supplementary information on the new conditions of service of nurses in government service and to forward copies of all relevant texts. In addition, the Committee wishes to receive the Government’s views as regards the remuneration levels practised in the health sector in the light of reported strike movements of nurses over low pay and, in some cases, unpaid wages.

Article 5, paragraph 2. With reference to the various memoranda of agreement annexed to the Government’s previous report, most of which were concluded in 1999 for a two-year period, the Committee would be grateful to the Government for supplying copies of all collective agreements in force determining the conditions of work of health-care personnel in the private sector.

Article 7. Further to its previous comment on this point, the Committee notes the Government’s indication that the Federation of Kenya Employers (FKE) has drawn up a Code of Conduct on HIV/AIDS in the workplace which covers all its members, including those employing nursing personnel. The Committee asks the Government to provide a copy of this Code of Conduct. It also notes that, according to the Government’s last report, the Ministry of Health, in consultation with the Nursing Council of Kenya, was in the process of formulating rules to supplement the existing infection prevention and control guidelines. The Committee requests the Government to transmit the text of these rules once they are issued and to keep the Office informed of any further measures or initiatives aiming at minimizing the risk of HIV infection for health‑care providers. Bearing in mind that HIV-positive persons are estimated to occupy up to 40 per cent of beds in most hospitals, the Committee considers that sustained efforts are necessary to effectively contain the risk of patient-to-nursing staff HIV transmission.

Part V of the report form. The Committee notes that according to the statistics provided by the Government in its last report, there are 40,000 nurses, of whom 18,200 are employed in public medical institutions accounting for 34 per cent of the total Ministry of Health workforce. The Committee understands that a National Nursing Workforce Analysis project, scheduled to be completed in 2005, is currently under way with a view to computerizing and analysing existing supply and demand data on the nursing workforce and student nurses. 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 nurse-to-population ratio, the number of students attending nursing schools and the number of nurses leaving or joining the profession, copies of official reports or research studies examining the employment and working conditions of nursing personnel, as well as any practical difficulties encountered in the implementation of the Convention.

Moreover, the Committee understands that Kenya is facing a problem of brain drain in the health sector.  According to the information available to the Committee, between 2001 and 2006, more than 3,000 nurses left the country to work in countries offering substantially higher salaries and a number of them had to pay for this purpose fees equal to ten months’ wages to private employment agencies. The Committee asks the Government to provide information regarding measures taken concerning, in particular, the plan for the improvement of working conditions of nursing personnel, including remuneration, in order to fight against the problem of brain drain.

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The Committee notes the information supplied by the Government in its last report.

Article 2, paragraph 2, of the Convention. The Committee notes the Government’s statement that nursing personnel in the public sector have now a different scheme of service from other civil servants and that they are entitled due to the nature of their work to a uniform allowance, a risk allowance and a responsibility/administrative allowance. The Committee requests the Government to communicate in its next report supplementary information on the new conditions of service of nurses in government service and to forward copies of all relevant texts. In addition, the Committee wishes to receive the Government’s views as regards the remuneration levels practised in the health sector in the light of reported strike movements of nurses over low pay and, in some cases, unpaid wages.

Article 5, paragraph 2. With reference to the various memoranda of agreement annexed to the Government’s previous report, most of which were concluded in 1999 for a two-year period, the Committee would be grateful to the Government for supplying copies of all collective agreements in force determining the conditions of work of health-care personnel in the private sector.

Article 7. Further to its previous comment on this point, the Committee notes the Government’s indication that the Federation of Kenya Employers (FKE) has drawn up a Code of Conduct on HIV/AIDS in the workplace which covers all its members, including those employing nursing personnel. The FKE Code of Conduct (Revised 2002) having not been appended in the Government’s report, the Committee would appreciate receiving a copy. The Committee also notes that the Ministry of Health, in consultation with the Nursing Council of Kenya, is in the process of formulating rules to supplement the existing infection prevention and control guidelines. The Committee requests the Government to transmit the text of these rules once they are issued and to keep it informed of any further measures or initiatives aiming at minimizing the risk of HIV infection for health-care providers. Bearing in mind that HIV-positive persons are estimated to occupy up to 40 per cent of beds in most hospitals, the Committee considers that sustained efforts are necessary to effectively contain the risk of patient-to-nursing staff HIV transmission.

Part V of the report form. The Committee notes that according to the latest statistics provided by the Government in its report, there are 40,000 nurses, of whom 18,200 are employed in public medical institutions accounting for 34 per cent of the total Ministry of Health workforce. The Committee understands that a National Nursing Workforce Analysis project, scheduled to be completed in 2005, is currently under way with a view to computerizing and analysing existing supply and demand data on the nursing workforce and student nurses. 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 nurse-to-population ratio, the number of students attending nursing schools and the number of nurses leaving or joining the profession, copies of official reports or research studies examining the employment and working conditions of nursing personnel, as well as any practical difficulties encountered in the implementation of the Convention.

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Further to its previous comments, the Committee notes with interest the information supplied by the Government concerning Articles 2, paragraph 2(b), 5, paragraphs 2 and 3, and 6 and would be grateful if it would provide further information on the following points.

Article 7. The Committee notes the Government’s statement in its report that no law has as yet been enacted to protect nurses against accidental exposure to HIV/AIDS infection. It also notes that the Ministry of Health, in conjunction with the Nursing Council of Kenya, has issued guidelines on infection prevention and control for use by nurses in all health facilities. While noting the indication that no cases of nurses infected in the course of duty have been recorded, the Committee reminds the Government of the need to take steps to improve occupational safety and health legislation in order to protect nursing personnel against accidental exposure to HIV. In this connection, it draws the Government’s attention to the ILO code of practice on HIV/AIDS in the world of work, published in June 2001. It hopes that in its next report the Government will be able to indicate that, besides publications to ensure that the personnel concerned are better informed, other practical measures have been taken in consultation with the employers’ and workers’ organizations concerned in respect of the accidental exposure of nursing personnel to HIV, as well as measures envisaged for nursing personnel infected or deemed to be infected by HIV (for example, adjustment of working conditions, confidentiality of test results, recognition of the disease as service-incurred, etc.).

Part V of the report form. The Committee notes the information supplied by the Government in its report that about 30,000 nurses are working in Kenya, of whom 17,000 are in government services. Furthermore, every year about 400 nurses leave the profession whereas 2,000 others are trained. It asks the Government to continue to provide statistics on nursing personnel, together with general information on how the Convention is applied in practice.

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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:

The Committee notes the information supplied by the Government in reply to its previous direct request.

Article 2, paragraph 2(b), and Article 5, paragraph 2. The Government's report states that nursing personnel in the public service are regulated by the conditions of service of health care personnel and that their conditions of work in the private sector are determined by collective bargaining which takes the conditions of the public sector as its guideline. Please supply copies of any legal provision or regulation, as well as of any collective agreement concerning health care personnel. Please also supply copies of collective agreements, other than the agreement covering the Aga Khan Hospital in Kisumu, which determine the conditions of work in the private sector.

Article 5, paragraph 3. According to the Government's report, the settlement of collective labour disputes in the private sector follows the procedure set out in the Trade Disputes Act, Cap. 234. The Committee requests the Government to supply information on the practical application of this procedure. It also requests the Government to state the manner in which the guarantees set out in the Convention, requiring disputes to be settled through negotiations or in such a manner as to ensure the confidence of the parties involved, through independent and impartial machinery, are given effect in the context of the above Trade Disputes Act.

Article 6(a), (d), (e) and (g). The Committee notes with interest that in the collective agreement supplied by the Government (respecting the Aga Khan Hospital, Kisumu) the provisions applicable to private sector personnel in respect of hours of work, educational leave, maternity leave and social security, are at least equivalent to those of other workers established under the Employment Act of 12 April 1976. It would be grateful if the Government would supply copies of other collective agreements applicable to nursing personnel in the private sector. With regard to the public sector, the Committee notes that the Code of Regulation for Civil Servants determines the conditions of work of nursing personnel in the public sector. It requests the Government to supply a copy of the above Code.

Article 7. The Committee notes the Government's statement that no measures have been taken to improve laws and regulations on occupational health to protect nursing personnel against accidental exposure to the human immunodeficiency virus (HIV). The Committee hopes that in its next report the Government will be able to indicate the measures which have been taken, in consultation with the employers' and workers' organizations concerned, to take into account the specific risk of accidental exposure to HIV for nursing personnel, as well as the measures envisaged for nursing personnel who have been infected or are considered to have been infected by HIV (for example, by the arrangement of conditions of work, confidentiality of the results of examinations, recognition of the occupational nature of the disease, etc.).

Part V of the report form. The Committee notes with interest the information concerning the practical application of the Convention and the number of nursing personnel in relation to the population, as well as the negligible number of persons leaving the profession. It requests the Government to provide information on any developments in the situation.

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The Committee notes the information supplied by the Government in reply to its previous direct request.

Article 2, paragraph 2(b), and Article 5, paragraph 2. The Government's report states that nursing personnel in the public service are regulated by the conditions of service of health care personnel and that their conditions of work in the private sector are determined by collective bargaining which takes the conditions of the public sector as its guideline. Please supply copies of any legal provision or regulation, as well as of any collective agreement concerning health care personnel. Please also supply copies of collective agreements, other than the agreement covering the Aga Khan Hospital in Kisumu, which determine the conditions of work in the private sector.

Article 5, paragraph 3. According to the Government's report, the settlement of collective labour disputes in the private sector follows the procedure set out in the Trade Disputes Act, Cap. 234. The Committee requests the Government to supply information on the practical application of this procedure. It also requests the Government to state the manner in which the guarantees set out in the Convention, requiring disputes to be settled through negotiations or in such a manner as to ensure the confidence of the parties involved, through independent and impartial machinery, are given effect in the context of the above Trade Disputes Act.

Article 6(a), (d), (e) and (g). The Committee notes with interest that in the collective agreement supplied by the Government (respecting the Aga Khan Hospital, Kisumu) the provisions applicable to private sector personnel in respect of hours of work, educational leave, maternity leave and social security, are at least equivalent to those of other workers established under the Employment Act of 12 April 1976. It would be grateful if the Government would supply copies of other collective agreements applicable to nursing personnel in the private sector. With regard to the public sector, the Committee notes that the Code of Regulation for Civil Servants determines the conditions of work of nursing personnel in the public sector. It requests the Government to supply a copy of the above Code.

Article 7. The Committee notes the Government's statement that no measures have been taken to improve laws and regulations on occupational health to protect nursing personnel against accidental exposure to the human immunodeficiency virus (HIV). The Committee hopes that in its next report the Government will be able to indicate the measures which have been taken, in consultation with the employers' and workers' organizations concerned, to take into account the specific risk of accidental exposure to HIV for nursing personnel, as well as the measures envisaged for nursing personnel who have been infected or are considered to have been infected by HIV (for example, by the arrangement of conditions of work, confidentiality of the results of examinations, recognition of the occupational nature of the disease, etc.).

Point V of the report form. The Committee notes with interest the information concerning the practical application of the Convention and the number of nursing personnel in relation to the population, as well as the negligible number of persons leaving the profession. It requests the Government to provide information on any developments in the situation.

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The Committee notes that the Government's report contains no reply to its comments. It hopes that the next report will include full information on the following matters raised in its previous direct request:

Article 1, paragraph 3, of the Convention. The Committee noted that no information has been provided on nursing personnel who gives nursing care and services on a voluntary basis. The Committee therefore requests the Government to indicate whether such personnel exists in Kenya and, if so, whether special rules have been adopted concerning this personnel which, according to the Convention, should not derogate from the provisions of Article 2, paragraph 2(a) and Articles 3, 4 and 7 of the Convention. It also asks the Government to supply copies of the existing texts in this respect.

Article 2, paragraph 2(a), and Article 3. Please provide copies of the provisions that are currently in force concerning the training of the various categories of nursing personnel; and the basic requirements as regards the education and training of nursing personnel. Please supply information on the coordination of the education and training of nursing personnel with the education and training provided for other workers in the field of health.

Article 2, paragraph 2(b). Please provide particulars on the measures taken with regard to employment and working conditions of nursing personnel, including career prospects and remuneration which are likely to attract persons to the profession and retain them in it.

Article 5, paragraph 2. Please indicate whether the conditions of employment and work of nursing personnel in the private sector are also determined by negotiation and, if so, supply copies of collective agreements that determine these conditions.

Article 5, paragraph 3. The Committee noted that the National Nurses Association of Kenya and the Kenya Nurses Association participate in the settlement of disputes concerning personnel in the public sector. The Committee requests the Government to indicate the procedure used for the settlement of collective disputes for nursing personnel in the private sector.

Article 6(a), (d), (e) and (g). The Committee requests the Government to supply copies of provisions which apply to nursing personnel as regards hours of work, educational leave, maternity leave and social security.

Article 7. The Committee noted the information supplied by the Government on this point of the Convention. Please indicate whether any special measures have been taken or are envisaged to improve laws and regulations on occupational health and safety by adapting them to the special nature of nursing work, inter alia, to protect nursing personnel against occupational exposure to the AIDS virus.

Point V of the report form. Please provide information on the practical application of the Convention and indicate the number of nursing personnel in the public and private sectors in relation to the population. Please provide information on the number of persons leaving the profession.

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The Committee notes the first report of the Government. It requests the Government to provide additional information on the following points:

Article 1, paragraph 3, of the Convention. The Committee notes that no information has been provided on nursing personnel who gives nursing care and services on a voluntary basis. The Committee therefore requests the Government to indicate whether such personnel exists in Kenya and, if so, whether special rules have been adopted concerning this personnel which, according to the Convention, should not derogate from the provisions of Article 2, paragraph 2(a) and Articles 3, 4 and 7 of the Convention. It also asks the Government to supply copies of the existing texts in this respect.

Article 2, paragraph 2(a), and Article 3. Please provide copies of the provisions that are currently in force concerning the training of the various categories of nursing personnel; and the basic requirements as regards the education and training of nursing personnel. Please supply information on the coordination of the education and training of nursing personnel with the education and training provided for other workers in the field of health.

Article 2, paragraph 2(b). Please provide particulars on the measures taken with regard to employment and working conditions of nursing personnel, including career prospects and remuneration which are likely to attract persons to the profession and retain them in it.

Article 5, paragraph 2. Please indicate whether the conditions of employment and work of nursing personnel in the private sector are also determined by negotiation and, if so, supply copies of collective agreements that determine these conditions.

Article 5, paragraph 3. The Committee notes that the National Nurses Association of Kenya and the Kenya Nurses Association participate in the settlement of disputes concerning personnel in the public sector. The Committee requests the Government to indicate the procedure used for the settlement of collective disputes for nursing personnel in the private sector.

Article 6(a), (d), (e) and (g). The Committee requests the Government to supply copies of provisions which apply to nursing personnel as regards hours of work, educational leave, maternity leave and social security.

Article 7. The Committee notes the information supplied by the Government on this point of the Convention. Please indicate whether any special measures have been taken or are envisaged to improve laws and regulations on occupational health and safety by adapting them to the special nature of nursing work, inter alia, to protect nursing personnel against occupational exposure to the AIDS virus.

Point V of the report form. Please provide information on the practical application of the Convention and indicate the number of nursing personnel in the public and private sectors in relation to the population. Please provide information on the number of persons leaving the profession.