Observation (CEACR) - adopted 2009, published 99th ILC session (2010)

Nursing Personnel Convention, 1977 (No. 149) - Guatemala (Ratification: 1995)

Article 2, paragraph 1, of the Convention. Formulation and implementation of a policy for nursing services and nursing personnel. The Committee notes the adoption of Decree No. 07-2007 of 20 February 2007 establishing an Act for the provision of nursing care and also its implementing regulations of 11 January 2008 (Acuerdo Gubernativo No. 56-2008), which establish the National Council for Nursing Care and the Nursing Services Development Unit. The Committee also notes the Government’s indication that the Ministry of Public Health is responsible for managing the implementation of policies in the area of health and for coordinating the various public, private and community bodies. It further notes the Government’s statement that efforts have been made to establish national policies for nursing services. These efforts have resulted in a national workplan drawn up in cooperation with the National Nursing School of Guatemala, the Guatemalan Association of Professional Nurses and also the chief nurses of public hospitals and health centres. The Committee notes that this plan – the “Integrated nursing care development plan 2008–12” – deals with the reinforcement of nursing care management capacity, professional competence, coordination of services, training and communication, and human resources.

The Committee understands that there are substantial disparities in the country regarding the distribution of human resources in the area of health care between rural and urban areas since 70 per cent of nursing personnel work exclusively in hospitals, leaving rural health centres with serious shortages of nursing staff. It notes that in 2005 a programme for the promotion of basic nursing care was launched by the National Nursing School of Cobán in five municipalities in the north of Guatemala to enable nursing personnel in rural districts to be trained by the most qualified personnel from urban areas.

Furthermore, the Committee notes that, according to a recent study by the Pan American Health Organization (PAHO), Guatemala is experiencing a shortage of nursing personnel since the ratio is only 3.6 per 10,000 inhabitants. It also notes, according to a study published in 2004, that 34 per cent of qualified nursing personnel have emigrated to the United States and auxiliary nursing staff represent 82 per cent of the workforce in this area. The Committee understands that the main causes of migration of qualified nursing personnel abroad are low wages, the economic situation, the low standard of living, family needs, poor career prospects and the lack of public policies in this area. It wishes to refer to the Code of practice currently being drafted by the WHO concerning the international recruitment of health personnel, which encourages member States to conclude bilateral and multilateral agreements to promote cooperation and coordination relating to migrant health personnel in the recruitment process, in order to optimize the advantages and reduce the potentially negative impact of the international recruitment of health personnel, and which also calls for measures to conserve and maintain a qualified national workforce of health personnel by improving their economic and social situation, living and working conditions, possibilities of employment and career prospects. While noting the efforts made by the Government and also the need to collect up to date information in this area, the Committee requests the Government to supply detailed information on (i) the application of the “Integrated nursing care development plan
2008–12” and the “Programme for the promotion of nursing care 2005” and also the results achieved, and (ii) any developments in the situation of nursing personnel and, if applicable, information on any additional measures taken or contemplated to contain the phenomenon of migration of qualified nursing personnel abroad.

Article 2, paragraphs 2(b) and 3. Pay for nursing personnel. Consultation with employers’ and workers’ organizations. Further to its previous comment, the Committee notes that the Government’s report does not contain any specific reply to the comments made by the Trade Union Confederation of Guatemala (UNSITRAGUA) dated 25 August 2003 and sent to the Government on 8 October 2003. Specifically, UNSITRAGUA indicated that: (i) overtime worked by nursing personnel was not paid and there was no adequate procedure for the compensation of hours worked in the event of changes in terms of duty; and (ii) there was no collective agreement concerning conditions of work which applied specifically to nursing personnel, the nursing trade unions not having being consulted. The Committee recalls that, in accordance with the provisions of the Convention, each Member must take the necessary measures 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. In addition, the policy concerning nursing services and nursing personnel must be formulated in consultation with the employers’ and workers’ organizations concerned. The Committee requests the Government to provide detailed information on the matters raised by UNSITRAGUA.

Article 5. Participation of nursing personnel in the planning of nursing services and consultation of personnel on decisions concerning them. The Committee recalls that UNSITRAGUA also indicated that nursing personnel did not participate in the planning of nursing services, decisions on this subject being taken unilaterally by the directors and heads of assistance centres. While recalling that Article 5 of the Convention requires the adoption of measures to promote the participation of nursing personnel in the planning of nursing services and consultation with such personnel on decisions concerning them, the Committee requests the Government to send its comments in reply to the allegations made by UNSITRAGUA.

Article 7. Occupational safety and health. With regard to the conditions of employment and protection of nursing personnel, the Committee recalls that UNSITRAGUA emphasized that there was no health and safety policy for nursing personnel, particularly as regards the risk of contamination by HIV/AIDS owing to the lack of suitable protective equipment in national hospitals, thus obliging nursing personnel to work under dangerous conditions. In this regard, the Committee wishes to draw the Government’s attention to the “Joint ILO/WHO guidelines on health services and HIV/AIDS”, published in 2005, with a view to helping health services to strengthen their capacity for providing workers with a healthy and decent working environment, this being the most effective means of reducing the transmission of HIV and improving the provision of care for patients. The Committee would also like to refer to the discussion held at the June 2009 session of the International Labour Conference on “HIV/AIDS and the world of work”, with a view to the adoption of an international labour Recommendation, in particular paragraph 37 of the draft conclusions (see ILC, 98th Session, 2009, Report IV(2), page 310), which states that public health systems should be strengthened, where appropriate, in order to ensure greater access to prevention, treatment, care and support and to reduce the additional strain on public services, particularly on health workers, caused by HIV/AIDS. The Committee requests the Government to keep the Office informed of any new measure taken or contemplated in order to improve the protection of nursing personnel against infectious diseases, including HIV/AIDS.