Direct Request (CEACR) - adopted 2022, published 111st ILC session (2023)

Nursing Personnel Convention, 1977 (No. 149) - Ghana (Ratification: 1986)

Article 2 of the Convention. Formulation of a national policy concerning nursing services and nursing personnel. The Committee welcomes the adoption of the National Human Resource Policy and Strategies for Health (NHRPSH) in February 2020. The NHRPSH was developed with the support of the World Health Organization (WHO), and followed a participatory process, which included experts from different national institutions, regulatory bodies, the Christian Health Association of Ghana (CHAG), the private sector, non-governmental organizations (NGOs) and development partners. Its objective is to ensure the availability of a motivated health workforce that is equitably distributed and has the required knowledge, skills and competencies and attitude to provide the necessary quality health care at all levels. The Committee notes that, according to the NHRPSH, despite an increase in the number of categories of health workers, the country is facing challenges with regard to the distribution of the health workforce and ensuring that health workers reach the areas where their services are most needed. In this respect, the NHRPSH provides for the training and development of an adequate number and mix of health workers, as well as for the equitable distribution of such workers. The Committee further notes the Government’s indication that all health workers, including nursing personnel, have been placed on the single spine salary structure. The Committee requests the Government to provide detailed, up-to-date information, including disaggregated statistical data, on the nature and impact of specific measures taken in the context of the National Human Resource Policy and Strategies for Health (NHRPSH). In particular, the Committee requests the Government to provide detailed information on the implementation and impact of those measures designed 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, as well as to attract them to practice in rural and remote areas of the country. It further requests the Government to provide information regarding the consultations held with the social partners with respect to the formulation and implementation of the policy, as envisaged under Article 2 of the Convention.

Articles 2(2)(a) and 3. Nursing education and training. The Committee notes the Government’s indication that there are three levels of nursing education and training: pre-service training, which has been expanded to offer admission to more students; post-basic-training, where practicing nurses with diplomas or pre-diploma certificates may improve their skills; and post-graduate-training, where practicing degree nurses may enrol for specialized training. The Committee further notes that, according to the NHRPSH, certain challenges exist in relation to the education and training of health personnel. These include: a lack of alignment between the training provided and the needs of the various health delivery agencies, the limited number of avenues for the training of health personnel to enable them to practice in new and emerging service delivery areas, and an over-centralization of training at the postgraduate level. In addition, existing accreditation regimes have not been effectively enforced. In this context, the NHRPSH envisages the adoption of measures to develop education and training programmes aimed at: effectively addressing the projected training needs of health workers, developing appropriate skills for specific service areas, enhancing accessibility of postgraduate training to meet current and emerging health service delivery needs, as well as ensuring standardization and quality of training of health professionals. The Committee requests the Government to provide detailedupdated information on the nature, implementation, monitoring and impact of the measures adopted, including those adopted in the framework of the NHRPSH, to ensure that all categories of 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.

Article 5(2).Negotiated determination of conditions of employment of nursing personnel. The Committee notes with interest the signing of a collective agreement between the health agencies and facilities under the Ministry of Health and the CHAG and the Ghana Registered Nurses and Midwives’ Association (GRNMA) in November 2020. The collective agreement sets out the conditions of employment for nurses and midwives in relation to salaries, allowances and benefits, hours of work and overtime, leave entitlements, training and other working conditions, with the aim of attracting, developing and maintaining an adequately trained and motivated nursing workforce. The collective agreement applies to all categories of workers covered by the collective bargaining certificate of the GRNMA and its allied associations. The Committee requests the Government to provide detailed updated information on the implementation in practice of the 2020 collective agreement regarding nursing personnel and its impact on attracting and keeping an adequate number of motivated qualified nursing personnel in the profession.

Article 7. Occupational safety and health (OSH). The Committee notes that one of the strategic objectives of the NHRPSH is to promote and maintain the highest degree of physical, mental, and social well-being among health workers. To this end, it envisages the adoption of measures to: ensure that all health agencies develop and implement comprehensive reinsurance systems to cater for the health needs of health workers and their families; harmonize all existing policies and guidelines on OSH and established systems to ensure the implementation of OSH regulations; and ensure the development and implementation of programmes to provide psychological support to health workers. The Committee further notes that section 21 of the 2020 collective agreement concerning nursing personnel includes a set of provisions aimed at ensuring the health, safety, and wellbeing of nurses, such as access to healthcare for nurses and their families (including treatment for nurses living with HIV) and the employer’s obligation to provide nurses with personal protective equipment (PPE) at no cost. Finally, the Government refers to the implementation of the revised workplace HIV and TB Policy and Technical Guidelines for the Health Sector 2020, which applies to all employees in the sector, including nurses, prospective health workers (both temporary and permanent workers), and patients in public, private and faith-based health institutions in Ghana. The Committee requests the Government to provide information on the nature and the impact of the measures taken to ensure the health, safety, and wellbeing of nursing personnel, including those adopted in the framework of the NHRPSH. It also requests the Government to provide detailed and up-to-date information on the number and results of the survey carried out to assess compliance with the 2020 collective agreement concerning nursing personnel.

Application in practice. The Committee notes that, according to statistical data made available by the WHO, in 2020 there were 95,789 nurses (1.70 per 10,000 population) and 16,700 midwives (5.37 per 10,000 population) practicing in Ghana. It further notes that in 2019, 73 per cent of nurses and 98.2 per cent of midwives were women. 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 Ghanaian health sector.