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

Nursing Personnel Convention, 1977 (No. 149) - Latvia (Ratification: 1993)

Article 2 of the Convention. National policy concerning nursing services and nursing personnel. The Committee recalls its previous comments in which it noted the persistent problems experienced in the health-care sector, principally poor pay conditions, sharp decrease of workforce, and low prestige for health-care professionals. The Committee notes that according to the “Public Health Analysis in Latvia, 2006”, published by the Health Statistics and Medical Technologies State Agency, the average wage of health and social care workers was lower than the average gross wage in the country which was LVL302 (approximately €430) per month in 2006. In this connection, it understands that in November 2006 the Government adopted the Action Strategy 2007–09 aiming at tripling the wages of nurses and physicians by 2010. The Committee also notes other documents and programmes defining national policy concerning staffing of the health-care system, such as the programme “Development of Human Resources in the Health-care Sector” (Order of the Cabinet of Ministers No. 326 of 18 May 2005) and the Programme “Development of Human Resources in the Health-care Sector
2006–15” (Order of the Cabinet of Ministers No. 870 of 6 November 2006), which sought among others to raise the number of qualified medical professionals, improve the quality of university education and offer competitive remuneration levels. The Committee requests the Government to elaborate on the implementation of these programmes, their follow-up and the results obtained, especially in terms of improving the quality of nursing care and offering satisfactory working conditions to nursing personnel. It also asks the Government to provide a copy of Regulations of the Cabinet of Ministers No. 980 of 30 November 2006 concerning wages of medical personnel.

In this connection, the Committee notes that according to the Government’s report, the Free Trade Union Confederation of Latvia alleges that the Government is not in compliance with the Convention – principally because of low wage levels and poor working conditions – which led to yet another strike movement in September 2008. In this connection, it understands that the Health and Social Care Workers’ Trade Union (LVSADA), not being able to reach agreement with the Ministry of Health on funding of the sector, undertook similar action also in autumn 2008. The Committee would appreciate if the Government would provide additional explanations in this respect, in particular as regards any negotiations that may have taken place or any agreement that may have been concluded in the aftermath of the latest protest action.

Articles 3 and 4. Nursing education and training. The Committee notes the Government’s indication that all nursing schools have been reorganized as university colleges offering both basic diplomas, or first degrees, and postgraduate decrees. The Committee notes, however, that according to the abovementioned report “Public Health Analysis in Latvia, 2006”, even though 450 students are enrolled in medical colleges every year, only 44.2 per cent of them graduate, and only 51.9 per cent of the graduates actually start to work in the health-care sector, which represents a mere 22.8 per cent of the total enrolled students. The Committee also notes that at present there is an estimated shortage of approximately 3,000 nurses. The Committee requests the Government to provide information on any concrete measures, initiatives or campaigns undertaken or envisaged in consultation with the organizations of nursing personnel concerned with a view to remedying the current shortage of nurses and improving the planning of human resources in the health sector.

Article 5, paragraph 2, and Article 6. Collective bargaining in the health-care sector. The Committee notes the Government’s reference to the latest general collective agreement concluded between the Ministry of Welfare and the LVSADA on 6 February 2008. It would appreciate if the Government would outline the essential provisions of the new collective agreement, in particular any pay increments, special allowances or other incentives and benefits offered in light of the constraints and hazards inherent in the nursing profession and designed to attract and retain persons in it. The Committee would also appreciate receiving a copy of this collective agreement.

Article 7. Occupational safety and health of nursing personnel. The Committee notes that the Regulations of the Cabinet of Ministers No. 628 of 4 November 2003 concerning the organizational procedures for restriction of the spread of HIV/AIDS and the treatment of HIV-infected persons and of AIDS patients do not provide for any specific preventive measures for the protection of nursing personnel. 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 refer to the International Labour Conference discussion held in June 2009 on “HIV/AIDS and the world of work” with a view to adopting an international labour Recommendation, and in particular to paragraph 37 of the proposed conclusions (see ILC, 98th Session, 2009, Report IV(2), page 310) which provides 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.

Part V of the report form. Application in practice. The Committee notes the statistical data provided by the Government showing the evolution of the number of registered and practising nurses, nursing school graduates and the nurse-to-population ratio in the period 2003–07. The Committee would be grateful if the Government would continue supplying up to date information concerning the application of the Convention in practice.