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

Nursing Personnel Convention, 1977 (No. 149) - Philippines (Ratification: 1979)

Article 2 of the Convention. National policy concerning nursing services and nursing personnel. The Committee understands that the Department of Health has developed a Human Resources for Health Master Plan 2005–30 to serve as a conceptual framework and road map to support human resources development and management in the health-care sector. In particular, it notes that the Master Plan contains measures such as the exploration of bilateral negotiations with destination countries for health workers, the forging of North–South, hospital-to-hospital partnerships, the introduction of a six-month leave period for hospital nurses hired by their foreign counterparts, during which they could return and train local hospital nurses, and the enactment of legislation which would require nursing school graduates to serve locally for a number of years equivalent to their years of study. The Committee also understands that following the adoption of the 25-year Master Plan, the Human Resources for Health Network (HRHN) was created in 2006 as a multisectoral organization composed of government and non-government bodies with the aim of addressing and responding to human resources issues and problems. The Network’s main objective is to review and harmonize policies among member organizations and to establish a database containing relevant information concerning human resources for health. The Committee requests the Government to provide a copy of the Human Resources for Health Master Plan, and to keep the Office informed of any progress made in the implementation of the measures and strategies set out in the Master Plan related to nursing personnel. It would also appreciate receiving up to date information concerning the activities of the HRHN and their outcomes. Moreover, the Committee would be interested in receiving a copy of the most recent report of the Congressional Commission on Health, set up under section 34 of the Magna Carta for Public Health Workers of 1992 (Republic Act No. 7305), to review on a five-yearly basis health human resource development and to formulate recommendations.

In addition, the Committee notes that section 37 of the Nursing Act of 2002 (Republic Act No. 9173) provides for implementing regulations for this Act to be issued by the Professional Regulation Commission. It would appreciate if the Government would provide a copy of these regulations once adopted.

Moreover, the Committee notes the observations made by the Public Services Labor Independent Confederation (PSLINK), dated 15 September 2008, concerning the application of the revised Nursing Act of 2002, section 32 of which provides for the increase of the entry pay of public health nurses from PHP10,000–15,000 (approximately US$316). According to PSLINK, not all government hospitals are in a position to implement this provision of the Nursing Act, in particular local government hospitals, where nurses are paid in some cases even at the minimum wage level. The Committee requests the Government to provide any comments it may wish to make in response to the observations of PSLINK.

As regards the persistent problem of health professionals’ migration, the Committee understands that the Philippines is the world’s leading exporter of nurses with 85 per cent of Filipino nurses working abroad in some 50 countries, that the number of nursing schools continues to rise (470 schools in 2006 as compared to 251 in 2003), and that the phenomenon of doctors becoming nurses in order to go abroad remains unchecked (an estimated 9,000 doctors having already left as nurses from 2002 to 2005). It also understands that the massive scale of migration is adversely affecting the quality of medical services with hundreds of hospitals having recently closed down, or partially closed, across the country because of lack of doctors and nurses. The Committee requests the Government to provide an updated assessment of the brain drain situation in the health sector and elaborate on any new measures or initiatives undertaken to contain the migration flow and to facilitate the retention and return of health professionals.

In this respect, the Committee wishes to refer to the draft WHO code of practice on the international recruitment of health personnel, currently under consideration, 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.

Article 3. Nursing education and training. The Committee notes that by virtue of section 9(d) of the Nursing Act, the Board of Nursing is responsible for ensuring quality nursing education. In this connection, it notes the course syllabus developed by the Board entitled, “Foundations of nursing practice including professional adjustment”. In addition, it understands that the Board is planning to develop a National Career Progression Program. It would appreciate if the Government would keep the Office informed of any progress made in the development of this programme.

Article 5, paragraph 1. Participation of nursing personnel in the planning of services. The Committee notes that the Board of Nursing has adopted a three-year strategic plan setting out its objectives, strategies and expected outcomes. It would appreciate receiving all available information, such as annual activity reports, showing the progress made in the implementation of the strategic plan.

Article 5, paragraph 2. Negotiations on conditions of service of nursing personnel. Further to its previous comment on this point, the Committee notes sections 31 and 33 of the Magna Carta of Public Health Workers on the right of health workers to freely form or join unions as well as to participate in the formulation of national policies governing the social security system applicable to them. The Committee requests the Government to explain how it is ensured that tripartite consultations take place for other issues related to conditions of employment of nursing personnel than those concerning social security. It would also be grateful if the Government would provide information concerning the organization and functioning of the Management-Health Workers’ Consultative Councils at different levels.

Article 7. Occupational safety and health of nursing personnel. The Committee notes that the Philippines National AIDS Council has published a manual entitled “Taking Care of the Caregivers: Primer for Health Workers on AIDS Prevention and Control.” It requests the Government to provide up to date information concerning any new measures taken or envisaged in order to adapt the national legislation on occupational safety and health to the special nature of nursing work and of the environment in which it is carried out, as required under this Article of the Convention.

In this respect, 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 that under section 30 the Nursing Act, the Board of Nursing is to initiate studies on nursing manpower needs, production, utilization, and development. It would be grateful if the Government would supply a copy of any such study which may have already been completed, as well as information concerning the application of the Convention in practice, including, for instance, the number of students currently enrolled in nursing schools, the number of nurses registered with the Board of Nursing, the nurse-to-population ratio, any practical difficulties encountered in applying the Convention, etc.