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

Observation (CEACR) - adopted 2020, published 109th ILC session (2021)

Article 2 of the Convention. National policy concerning nursing services and nursing personnel. Consultation. The Committee notes with interest the range of policy initiatives adopted by the Government during the reporting period in relation to public health services and the health workforce, particularly with respect to nursing services and nursing personnel. These policies were developed following consultation with and through the active participation of the relevant stakeholders, including the private sector, health training institutions, relevant regulatory bodies and civil society organizations. The Committee notes the adoption of Malawi’s first National Health Policy (NHP) in July 2017, which establishes an overarching framework to guide the achievement of the country’s health sector. It includes among its priority areas: health service delivery; human resources for health; leadership and governance; and health financing. In relation to the health workforce, the 2017 NHP contemplates the adoption of measures to ensure that a sufficient number of adequately trained and motivated health workers, including nurses, are recruited, deployed and retained in line with the health needs of the population at all levels of healthcare service delivery. The Committee also notes the adoption of the medium-term Health Sector Strategic Plan II (HSSP II) in 2017, which outlines a range of objectives and activities and guides for the use of resources during 2017–22. The HSSP II a set of priority strategies, including: improving retention and recruitment of properly deployed and motivated health workers and strengthening the health workforce planning process. The Committee further notes the development, in alignment with the above-mentioned policies on health and health workers, of the Nursing and Midwifery Policy (NMP), adopted in June 2018. The 2018 NMP provides a framework for the provision of comprehensive, quality and equitable nursing and midwifery services that will contribute to achieving the country’s health-related goals. However, challenges noted in the 2018 NMP include a high disease burden in the country, as well as high rates of maternal mortality (439 per 100,000 births), neonatal mortality (27 per 1,000 live births) and an under-5 mortality rate of 64 per 1,000. It is noted that the maternal mortality ratio will need to be reduced by 84 per cent to meet Sustainable Development Goal targets. The main objectives of the 2018 NMP include: reducing nursing and midwifery vacancy rates from the current 63 per cent to 50 per cent by 2022; providing guidance to decision-makers, stakeholders and partners for the effective planning and implementation of nursing and midwifery services; facilitating delivery of quality nursing and midwifery services; supporting quality clinical mentorship and supervision of nursing students; and timely placement of new nursing and midwifery graduates. In addition, the 2018 NMP envisages the participation of a broad range of actors in its monitoring and implementation, including workers’ organizations, nurses’ associations, private sector organizations, development partners, and non-governmental organizations. In addition, the Committee notes the implementation of the Malawi German Health Programme (MGHP), which calls for the adoption of measures, in line with the 2017 NHP and the HSPP II, to ensure a better distribution and increased qualification of clinical and nursing staff in the area of maternal and newborn healthcare. The Committee requests the Government to provide detailed, up-to-date information on the measures taken in the context of the National Health Policy, the Health Sector Strategic Plan II 2017–22, the Nursing and Midwifery Policy and the Malawi German Health Programme, as well as on their impact in practice. 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.

Community health nursing. The Committee notes that, according to the HSSP II, a significant proportion of Malawi’s population (84 per cent) has no access to healthcare, especially those persons residing in rural and hard-to-reach areas of the country. In this context, the Committee notes the adoption of the country’s first National Community Health Strategy 2017–22 (NCHS) in November 2017, which is aligned with existing national health policies as well as with the HSSP II. The 2017 NCHS was developed following an intensive consultative process with relevant stakeholders in the health sector, which included local communities. The principal objective of the 2017 NCHS is to ensure quality, integrated community health services that are affordable, culturally acceptable, scientifically appropriate, and accessible to every household. In order to achieve this goal, the 2017 NCHS includes among its strategic objectives that of building a sufficient, equitably distributed, well-trained community health workforce that includes community nursing personnel. The Committee notes that, according to the 2017 NCHS, there is a shortage of community nurses. Moreover, the 2017 NCHS indicates that community nurses are being used to fill gaps at health facilities and are therefore spending less time on community work. They face challenges that include: lack of clarity regarding their roles and tasks; inadequate training and supervision; and poor incentives. To address the shortage of adequately trained and motivated community health workers (CHWs), the 2017 NCHS sets out a number of key interventions: recruitment of additional CHWs, including a minimum of two community health nurses (CHNs) per health centre and one community midwife assistant (CMA) per community health delivery structure; promoting equitable geographical distribution of CHWs; and providing high-quality, integrated pre-service and in-service training to all CHWs. The 2017 NCHS also envisages the launch of a more standardized package of financial, non-financial, social and performance-based incentives aimed at increasing the retention of CHWs and supporting their strong performance across the country. The Committee further notes that the 2018 NMP includes a policy priority area on community health nursing and midwifery. In this regard, the 2018 NMP includes the following strategies, among others: providing leadership for community health nursing and midwifery services and strengthening such services by integrating community health nursing interventions in all nursing and midwifery services. The Committee requests the Government to provide detailed updated information on the effective implementation, monitoring and impact of the measures adopted in the framework of the National Community Health Strategy 2017–22 and the 2018 Nursing and Midwifery Policy with regard to nursing services and nursing personnel, including nurses, midwives and community health workers.

Mental health nurses. The Committee notes that, according to the HSSP II, there are many people in Malawi with mental disorders, a majority of whom seek medical care at health facilities, but are misdiagnosed due to presenting with physical symptoms. Common disorders such as depression and anxiety, whose prevalence is estimated at 10–20 per cent are often missed or not treated. The Government indicates in the HSSP II that, although at least 20 psychiatric nurses and psychiatric clinical officers are trained every year, the number of psychiatric staff actively carrying out mental health-related activities is very low due to the general shortage of nurses in the health system. The Committee requests the Government to provide updated detailed information on the measures taken or envisaged to ensure the quantity and quality of mental health nursing care necessary for attaining the highest possible level of health for the population.

Article 2(2)(a) and (3). Nursing education and training. The Committee notes that the HSSP II places a priority on improving the quality of training through the expansion of training and education opportunities, including through continuing professional development (CPD). The HSSP II provides for the adoption of specific measures to promote quality nursing and midwifery pre-service education, such as measures to institutionalize periodic curriculum reviews for all training institutions, as well as institutionalizing student–tutor ratios for specified nursing and midwifery training programmes; and measures to promote continued collaboration between teaching and clinical/community staff. The HSSP II also calls for the implementation of measures that encourage all nurses and midwives to pursue CPD, by institutionalizing CPD and supporting nurses and midwives undergoing upgrading courses and in-service training. The Committee notes in this regard that mandatory CPD for nurse midwives was re-introduced by the Nurses and Midwives Council of Malawi with the assistance of the MGHP. The Committee requests the Government to provide updated detailed information on the nature, implementation, monitoring and impact of the measures adopted, to ensure that 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). Determination of conditions of employment and work. In response to the Committee’s previous comments, the Government indicates that the collective bargaining agreement for the nursing sector has still not been concluded. The Committee requests the Government to continue to provide information on the status of the collective bargaining process and progress made in this regard, as well as to transmit a copy of any collective agreements concluded for the nursing sector.

Article 7. Occupational safety and health. The Committee notes that the President of Malawi declared a state of national disaster in response to the COVID-19 pandemic on 19 March 2020. The National Covid-19 Preparedness and Response Plan was subsequently launched for the period March–June 2020. The Plan includes among its specific objectives building the capacity of healthcare workers on highly infectious diseases (such as COVID-19), as well as procuring and distributing supplies and equipment to all treatment centres. In this regard, the Committee draws the attention of the Government to paragraph 49 of the Nursing Personnel Recommendation, 1977 (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; and (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’ 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, as they are often in close contact with patients, 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 well-being of nurses and limiting as much as possible their risk of contracting COVID-19.

Part V of the report form. Application in practice. The Committee notes that, according to the WHO Global Health Observatory, the total number of nursing and midwifery personnel in Malawi increased from 4,573 in 2016 to 7,957 in 2018. Nevertheless, the HSSP II indicates that the overall vacancy rate for nursing officers is currently 66 per cent (63 per cent among assistant community health officers, 72 per cent for chief nurse technicians, 45 per cent for chief nursing officers and 31 per cent for community midwifery assistants). This personnel shortage places a heavy burden on those nursing and midwifery professionals who are in employment. 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 Malawi health sector.

Direct Request (CEACR) - adopted 2018, published 108th ILC session (2019)

The Committee notes that the Government’s report has not been received. It hopes that the next report will contain full information on the matters raised in its previous comments initially made in 2015.

Repetition

Article 2(1) of the Convention. National policy concerning nursing services and nursing personnel. Following its request for information on the results of the Emergency Human Resources Plan and the Health Sector Programme of Work (PoW) 2004–10, the Committee notes the analysis contained in the Health Sector Strategic Plan (HSSP), which is the successor to the PoW and covers the period 2011–16. It notes in particular that the HSSP indicates that the country continues to experience critical shortages of key health workers, including nurses and midwives. In this respect, one objective, which is identified, is to provide human resources that are adequate, properly trained and remunerated, well-motivated and capable of effectively delivering the Essential Health Package (EHP) to the Malawi population. The Committee invites the Government to provide information concerning the results of the implementation of the HSSP in this regard.

Article 2(3). Consultation with the employers’ and workers’ organizations concerned. The Committee notes that the HSSP indicates that the National Health Policy is in its final draft and the National Public Health Act is in the process of being reviewed. Recalling that the national policy concerning nursing services and nursing personnel shall be formulated in consultation with the employers’ and workers’ organizations concerned, where such organizations exist, the Committee hopes that such consultations will be duly undertaken, including with the National Organization of Nurses and Midwives of Malawi (NONM), when finalizing the National Health Policy, as long as this policy concerns nursing services and nursing personnel. It requests the Government to provide information in this regard.

Article 5(2). Determination of conditions of employment and work. The Committee notes the Government’s indication that a draft collective bargaining agreement for the nursing sector is in the process of being finalized. It requests the Government to provide up-to-date information on the collective bargaining process and to transmit a copy of any collective agreement for the nursing sector as soon as it is concluded.

Direct Request (CEACR) - adopted 2015, published 105th ILC session (2016)

Article 2(1) of the Convention. National policy concerning nursing services and nursing personnel. Following its request for information on the results of the Emergency Human Resources Plan and the Health Sector Programme of Work (PoW) 2004–10, the Committee notes the analysis contained in the Health Sector Strategic Plan (HSSP), which is the successor to the PoW and covers the period 2011–16. It notes in particular that the HSSP indicates that the country continues to experience critical shortages of key health workers, including nurses and midwives. In this respect, one objective, which is identified, is to provide human resources that are adequate, properly trained and remunerated, well-motivated and capable of effectively delivering the Essential Health Package (EHP) to the Malawi population. The Committee invites the Government to provide information concerning the results of the implementation of the HSSP in this regard.

Article 2(3). Consultation with the employers’ and workers’ organizations concerned. The Committee notes that the HSSP indicates that the National Health Policy is in its final draft and the National Public Health Act is in the process of being reviewed. Recalling that the national policy concerning nursing services and nursing personnel shall be formulated in consultation with the employers’ and workers’ organizations concerned, where such organizations exist, the Committee hopes that such consultations will be duly undertaken, including with the National Organization of Nurses and Midwives of Malawi (NONM), when finalizing the National Health Policy, as long as this policy concerns nursing services and nursing personnel. It requests the Government to provide information in this regard.

Article 5(2). Determination of conditions of employment and work. The Committee notes the Government’s indication that a draft collective bargaining agreement for the nursing sector is in the process of being finalized. It requests the Government to provide up-to-date information on the collective bargaining process and to transmit a copy of any collective agreement for the nursing sector as soon as it is concluded.

Direct Request (CEACR) - adopted 2014, published 104th ILC session (2015)

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 comments.

Repetition

Articles 2(2)(b) and 5(2) of the Convention. National policy concerning employment and working conditions of nursing personnel. The Committee notes the Government’s explanations concerning the pay and other incentives enjoyed by nurses employed in public hospitals and hospitals run by the Christian Health Association of Malawi (CHAM). It understands that the Ministry of Health provides approximately 60 per cent and the CHAM, 37 per cent, of all formal health-care services, while private practitioners and commercial companies provide 2 per cent of such services. The Committee notes that according to a recent report of the Public Services International entitled “PSI HIV/AIDS southern Africa project report: The health sector in Malawi”, the shortage of nurses remains critical with a nurse–population ratio of 1:3,500, compared with the average of 1 to 1,000 for Africa as a whole. Up to 65 per cent of the public sector nursing posts are unfilled. Ninety-five per cent of registered nurses are urban based leaving significantly higher vacancy rates in rural areas. In some cases, hospital wards that normally require 10–12 nurses are staffed with just one nurse who is regularly required to carry out 16-hour shifts. Overall, the current number of nursing posts is 4,717 as compared to the estimated target of 8,440 nursing posts needed.

The Committee understands that, in 2004, faced with a health sector in near collapse, the Government received a six-year Human Resources Emergency Relief Plan 2004–10 from the UK Department for International Development and the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has enabled the Government to improve retention and re-engagement of nurses with 52 per cent salary supplement, staff housing incentives, etc. In this connection, the Committee notes that this Emergency Relief Plan was to provide emergency assistance to address acute problems the health sector is currently facing with respect to its workers, mainly by maintaining operation of critical posts, improving retention of the nursing personnel and by providing support in human resources management. In order to train and maintain a sustainable nursing workforce, it would be necessary to formulate and implement policies concerning employment and working conditions, including career prospects and remuneration, within the framework of a general health programme, as provided in Article 2 of the Convention. In this regard, the Committee would appreciate if the Government would provide information concerning the results of the Human Resources Emergency Relief Plan and the Health Sector Programme of Work 2004–10, or of any follow-up programme already elaborated, including the progress made in securing trained nursing personnel necessary for the implementation of the Essential Health Package (EHP).

With respect to the process of unionization of nursing staff, the Committee notes the information provided by the Government that the National Organization of Nurses and Midwives in Malawi (NONM) has been registered as a trade union since 2007. While noting the Government’s concern regarding the role and attitude of certain union leaders, the Committee recalls that the Convention requires full consultations with the workers’ organizations concerned for the formulation of the nursing policy (Article 2(3) of the Convention), and meaningful negotiations for the determination of conditions of employment (Article 5(2)). It therefore expresses the hope that the Government will engage in fruitful social dialogue with the newly established nurses and midwives organization with a view to devising common strategies and answers to the persisting problems of the health sector. It also requests the Government to provide up to date information on the collective bargaining process and to transmit a copy of any collective agreement for the nursing sector as soon as it is concluded.

Article 3(1). Education and training of nursing personnel. The Committee notes the detailed information provided by the Government concerning the activities of the Nurses and Midwives Council of Malawi and its Education and Examination Committee. It notes in particular that the number of students enrolled in nursing studies increased from 48 in 2004 to 154 in 2008, while the number of licensed and registered nurses passed from 24 in 2004 to 87 in 2008. It would appreciate if the Government would continue providing up to date information in this regard.

Direct Request (CEACR) - adopted 2013, published 103rd ILC session (2014)

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:

Repetition

Articles 2(2)(b) and 5(2) of the Convention. National policy concerning employment and working conditions of nursing personnel. The Committee notes the Government’s explanations concerning the pay and other incentives enjoyed by nurses employed in public hospitals and hospitals run by the Christian Health Association of Malawi (CHAM). It understands that the Ministry of Health provides approximately 60 per cent and the CHAM, 37 per cent, of all formal health-care services, while private practitioners and commercial companies provide 2 per cent of such services. The Committee notes that according to a recent report of the Public Services International entitled “PSI HIV/AIDS southern Africa project report: The health sector in Malawi”, the shortage of nurses remains critical with a nurse–population ratio of 1:3,500, compared with the average of 1 to 1,000 for Africa as a whole. Up to 65 per cent of the public sector nursing posts are unfilled. Ninty-five per cent of registered nurses are urban based leaving significantly higher vacancy rates in rural areas. In some cases, hospital wards that normally require 10–12 nurses are staffed with just one nurse who is regularly required to carry out 16-hour shifts. Overall, the current number of nursing posts is 4,717 as compared to the estimated target of 8,440 nursing posts needed.

The Committee understands that, in 2004, faced with a health sector in near collapse, the Government received a six-year Human Resources Emergency Relief Plan 2004–10 from the UK Department for International Development and the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has enabled the Government to improve retention and re-engagement of nurses with 52 per cent salary supplement, staff housing incentives, etc. In this connection, the Committee notes that this Emergency Relief Plan was to provide emergency assistance to address acute problems the health sector is currently facing with respect to its workers, mainly by maintaining operation of critical posts, improving retention of the nursing personnel and by providing support in human resources management. In order to train and maintain a sustainable nursing workforce, it would be necessary to formulate and implement policies concerning employment and working conditions, including career prospects and remuneration, within the framework of a general health programme, as provided in Article 2 of the Convention. In this regard, the Committee would appreciate if the Government would provide information concerning the results of the Human Resources Emergency Relief Plan and the Health Sector Programme of Work 2004–10, or of any follow-up programme already elaborated, including the progress made in securing trained nursing personnel necessary for the implementation of the Essential Health Package (EHP).

With respect to the process of unionization of nursing staff, the Committee notes the information provided by the Government that the National Organization of Nurses and Midwives in Malawi (NONM) has been registered as a trade union since 2007. While noting the Government’s concern regarding the role and attitude of certain union leaders, the Committee recalls that the Convention requires full consultations with the workers’ organizations concerned for the formulation of the nursing policy (Article 2(3) of the Convention), and meaningful negotiations for the determination of conditions of employment (Article 5(2)). It therefore expresses the hope that the Government will engage in fruitful social dialogue with the newly established nurses and midwives organization with a view to devising common strategies and answers to the persisting problems of the health sector. It also requests the Government to provide up to date information on the collective bargaining process and to transmit a copy of any collective agreement for the nursing sector as soon as it is concluded.

Article 3(1). Education and training of nursing personnel. The Committee notes the detailed information provided by the Government concerning the activities of the Nurses and Midwives Council of Malawi and its Education and Examination Committee. It notes in particular that the number of students enrolled in nursing studies increased from 48 in 2004 to 154 in 2008, while the number of licensed and registered nurses passed from 24 in 2004 to 87 in 2008. It would appreciate if the Government would continue providing up to date information in this regard.

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

Article 2, paragraph 2(b), and Article 5, paragraph 2, of the Convention. National policy concerning employment and working conditions of nursing personnel. The Committee notes the Government’s explanations concerning the pay and other incentives enjoyed by nurses employed in public hospitals and hospitals run by the Christian Health Association of Malawi (CHAM). It understands that the Ministry of Health provides approximately 60 per cent and the CHAM, 37 per cent, of all formal health-care services, while private practitioners and commercial companies provide 2 per cent of such services. The Committee notes that according to a recent report of the Public Services International entitled “PSI HIV/AIDS southern Africa project report: The health sector in Malawi”, the shortage of nurses remains critical with a nurse–population ratio of 1:3,500, compared with the average of 1 to 1,000 for Africa as a whole. Up to 65 per cent of the public sector nursing posts are unfilled. Ninty-five per cent of registered nurses are urban based leaving significantly higher vacancy rates in rural areas. In some cases, hospital wards that normally require
10–12 nurses are staffed with just one nurse who is regularly required to carry out 16‑hour shifts. Overall, the current number of nursing posts is 4,717 as compared to the estimated target of 8,440 nursing posts needed.

The Committee understands that, in 2004, faced with a health sector in near collapse, the Government received a six-year Human Resources Emergency Relief Plan 2004–10 from the UK Department for International Development and the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has enabled the Government to improve retention and re-engagement of nurses with 52 per cent salary supplement, staff housing incentives, etc. In this connection, the Committee notes that this Emergency Relief Plan is to provide emergency assistance to address acute problems the health sector is currently facing with respect to its workers, mainly by maintaining operation of critical posts, improving retention of the nursing personnel and by providing support in human resources management. In order to train and maintain a sustainable nursing workforce, it would be necessary to formulate and implement policies concerning employment and working conditions, including career prospects and remuneration, within the framework of a general health programme, as provided in Article 2 of the Convention. In this regard, the Committee would appreciate if the Government would provide up to date information concerning the implementation of the Human Resources Emergency Relief Plan and the Health Sector Programme of Work 2004–10, or of any follow-up programme already elaborated, including the progress made in securing trained nursing personnel necessary for the implementation of the Essential Health Package (EHP).

With respect to the process of unionization of nursing staff, the Committee notes the information provided by the Government that the National Organization of Nurses and Midwives in Malawi (NONM) has been registered as a trade union since 2007. While noting the Government’s concern regarding the role and attitude of certain union leaders, the Committee recalls that the Convention requires full consultations with the workers’ organizations concerned for the formulation of the nursing policy (Article 2(3) of the Convention), and meaningful negotiations for the determination of conditions of employment (Article 5(2)). It therefore expresses the hope that the Government will engage in fruitful social dialogue with the newly established nurses and midwives organization with a view to devising common strategies and answers to the persisting problems of the health sector. It also requests the Government to provide up to date information on the collective bargaining process and to transmit a copy of any collective agreement for the nursing sector as soon as it is concluded.

Article 3, paragraph 1. Education and training of nursing personnel. The Committee notes the detailed information provided by the Government concerning the activities of the Nurses and Midwives Council of Malawi and its Education and Examination Committee. It notes in particular that the number of students enrolled in nursing studies increased from 48 in 2004 to 154 in 2008, while the number of licensed and registered nurses passed from 24 in 2004 to 87 in 2008. It would appreciate if the Government would continue providing up to date information in this regard.

Part V of the report form. Application in practice. The Committee notes the statistical information provided by the Government showing that the number of nurses who migrated is steadily decreasing in recent years from 85 in 2004 to 11 in 2008. It would be grateful if the Government would continue supplying detailed information concerning the application of the Convention in practice, including, for instance, the number of students currently enrolled in nursing schools, the nurse-to-population ratio, trends in the migration of nurses, copies of official reports or studies addressing nursing-related issues, etc.

Direct Request (CEACR) - adopted 2008, published 98th ILC session (2009)

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(b), and Article 5, paragraph 2, of the Convention. The Committee wishes to receive the Government’s views as to whether the wages practised in the nursing sector adequately reflect the socio-economic needs, special responsibilities and inherent risks of the nursing profession and also whether current pay conditions are likely to ensure sufficient recruitment of qualified health professionals. Moreover, the Committee has been requesting the Government, for a number of years, to transmit a copy of the revised terms and conditions of employment applicable to members of the Christian Hospitals’ Association of Malawi (CHAM). Despite the Government’s assurances that this document would be made available through the UNDP, no such copy has ever been received by the Office. The Committee therefore requests the Government to provide, together with its next report, fully documented information on the working conditions (including working time, occupational health protection and social security) of nurses in the private sector. Furthermore, while noting the Government’s statement that the nurses and midwives associations of Malawi are the two organizations which look into the working conditions of nursing personnel, the Committee asks the Government to provide more specific information on the process of unionization of nursing staff and to indicate any progress made towards the determination of conditions of employment and work through collective bargaining.

Article 3, paragraph 1. The Committee notes that, in accordance with sections 3 and 11 of the Nurses and Midwives Act, 1995, the Nurses and Midwives Council of Malawi (NMCM) is charged with overseeing nursing and midwifery education, professional practice and conduct. The Committee would appreciate receiving additional information on all the policies and programmes recently initiated by the NMCM, such as the electronic nursing registry which is now in place within the registration section of the NMCM and which has the capacity to monitor nurse and midwife registration, licensure and deployment. The Committee would also be interested in obtaining up-to-date information on the activities of the NMCM, through its Education and Examination Committee, in matters of approval of nursing schools, curricula and qualifications pursuant to section 47(1) of the Nurses and Midwives Act.

Part V of the report form. The Committee notes that, according to a communication of the Malawi Congress of Trade Unions (MCTU) received on 5 April 2005, there is a brain drain in the nursing profession because of lack of motivation, and the Government has not put in place measures to stop this trend. In its reply dated 16 September 2005, the Government indicates that it has been working very hard to motivate employees in the health profession, in particular by raising their salaries by 52 per cent as from April 2005, and regrets not having received any concrete suggestions from the MCTU on the issue of brain drain. The Committee understands that the Ministry of Health and Population has been working since 2002 on an Essential Health Package (EHP) to address current inefficiencies in the public health sector and improve the quality of publicly funded health services. In this connection, the Committee notes that under the EHP Implementation Plan, an estimated 8,273 additional nursing personnel are required at the community, health centre and hospital levels. With regard to the problem of brain drain, the Committee understands that nurses who wish to leave the country must register with the Nurses and Midwives Council of Malawi. According to the information available to the Committee, 614 nurses, 95 per cent of whom have a university degree, have registered for this purpose since 2000. It notes, however, that the number of registrations per year is falling, from 111 in 2001 to 98 in 2005 and 23 in 2007.

The Committee would be grateful if the Government would supply in its next report detailed information on any progress made towards the implementation of the EHP proposals, especially as regards the shortage of nursing staff, as well as all other available information on the practical application of the Convention, including, for instance, statistics on the nurse-to-population ratio, the number of students attending nursing schools, the number of nurses leaving or joining the profession per year, copies of official reports or research studies examining the employment and working conditions of nursing personnel, etc.

Direct Request (CEACR) - adopted 2005, published 95th ILC session (2006)

The Committee notes the Government’s report.

Article 2, paragraph 2(b), and Article 5, paragraph 2, of the Convention. The Committee wishes to receive the Government’s views as to whether the wages practised in the nursing sector adequately reflect the socio-economic needs, special responsibilities and inherent risks of the nursing profession and also whether current pay conditions are likely to ensure sufficient recruitment of qualified health professionals. Moreover, the Committee has been requesting the Government, for a number of years, to transmit a copy of the revised terms and conditions of employment applicable to members of the Christian Hospitals’ Association of Malawi (CHAM). Despite the Government’s assurances that this document would be made available through the UNDP, no such copy has ever been received by the Office. The Committee therefore requests the Government to provide, together with its next report, fully documented information on the working conditions (including working time, occupational health protection and social security) of nurses in the private sector. Furthermore, while noting the Government’s statement that the nurses and midwives associations of Malawi are the two organizations which look into the working conditions of nursing personnel, the Committee asks the Government to provide more specific information on the process of unionization of nursing staff and to indicate any progress made towards the determination of conditions of employment and work through collective bargaining.

Article 3, paragraph 1. The Committee notes that, in accordance with sections 3 and 11 of the Nurses and Midwives Act, 1995, the Nurses and Midwives Council of Malawi (NMCM) is charged with overseeing nursing and midwifery education, professional practice and conduct. The Committee would appreciate receiving additional information on all the policies and programmes recently initiated by the NMCM, such as the electronic nursing registry which is now in place within the registration section of the NMCM and which has the capacity to monitor nurse and midwife registration, licensure and deployment. The Committee would also be interested in obtaining up-to-date information on the activities of the NMCM, through its Education and Examination Committee, in matters of approval of nursing schools, curricula and qualifications pursuant to section 47(1) of the Nurses and Midwives Act.

Part V of the report form. The Committee notes that, according to a communication of the Malawi Congress of Trade Unions (MCTU) received on 5 April 2005, there is a brain drain in the nursing profession because of lack of motivation, and the Government has not put in place measures to stop this trend. In its reply dated 16 September 2005, the Government indicates that it has been working very hard to motivate employees in the health profession, in particular by raising their salaries by 52 per cent as from April 2005, and regrets not having received any concrete suggestions from the MCTU on the issue of brain drain. Moreover, the Committee notes that according to news reports, Malawi is facing a health crisis as trained nurses leave to seek better wages abroad. It is estimated that the country has lost 9 per cent of all its nurses in the past two years, and that 2,200 nurses serving in all of Malawi’s public hospitals represent barely one-third of the established number. The Committee understands that the Ministry of Health and Population has been working since 2002 on an Essential Health Package (EHP) to address current inefficiencies in the public health sector and improve the quality of publicly funded health services. In this connection, the Committee notes that under the EHP Implementation Plan, an estimated 8,273 additional nursing personnel are required at the community, health centre and hospital levels. The Committee would be grateful if the Government would supply in its next report detailed information on any progress made towards the implementation of the EHP proposals, especially as regards the shortage of nursing staff, as well as all other available information on the practical application of the Convention, including, for instance, statistics on the nurse-to-population ratio, the number of students attending nursing schools, the number of nurses leaving or joining the profession per year, copies of official reports or research studies examining the employment and working conditions of nursing personnel, etc.

Direct Request (CEACR) - adopted 2003, published 92nd ILC session (2004)

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:

Articles 2, paragraph 2(b) and 5, paragraph 2, of the Convention. Referring to its previous comments regarding the Government’s statement on its policy allowing employees in both the private and public sectors to freely organize in trade unions and engage in collective bargaining, the Committee recalls that the Government referred to this statement in its report received in 1994. In the report received in 1999, the Government indicated that it would send a copy of this declaration, published in June 1997, through the United Nations Development Programme. However, as the Committee indicated in its 1999 direct request, no such copy has been received. While reiterating its request that the Government send a copy of this declaration, it requests the Government to provide clarification as to whether the declaration adopted in 1997 is an adaptation of the one mentioned in the report received in 1994. It also requests the Government to supply information on any factor concerning nursing personnel in the context of this declaration. It also hopes that the revision of the general terms and conditions of employment applicable to members of the Christian Hospitals’ Association of Malawi (CHAM) will shortly be completed and that the Government will supply a copy.

Article 6. While noting the information supplied by the Government concerning the duration of day and night work, weekly leave, paid annual leave, sick leave, maternity leave and social security, the Committee requests the Government to specify whether the new scale relating to hours of work and weekly rest in the public sector has been established and, if so, requests the Government to supply a copy with its next report.

Article 7 and Part V of the report form. In the absence of any information on this matter, the Committee requests the Government to indicate the progress made in the occupational safety and hygiene field after consultation with the employers’ organizations and the nursing personnel concerned, and to supply available statistical data. Referring, furthermore, to its 1990 general observation, repeated in 1994, the Committee noted in its previous comments the progress made in protection against accidental exposure of nursing staff to the human immunodeficiency virus (HIV), and requests the Government to indicate the measures taken or contemplated in regard to nursing staff who are infected or considered to be infected by HIV (adaptation of working conditions, recognition that the cause of infection was occupational, etc.).

Direct Request (CEACR) - adopted 2001, published 90th ILC session (2002)

The Committee notes the information supplied by the Government concerning working conditions of nursing personnel in the public sector. Further to its previous comments, it hopes that the Government will supply in its next report information on the following points.

Articles 2, paragraph 2(b) and 5, paragraph 2, of the Convention. Referring to its previous comments regarding the Government’s statement on its policy allowing employees in both the private and public sectors to freely organize in trade unions and engage in collective bargaining, the Committee recalls that the Government referred to this statement in its report received in 1994. In the report received in 1999, the Government indicated that it would send a copy of this declaration, published in June 1997, through the United Nations Development Programme. However, as the Committee indicated in its 1999 direct request, no such copy has been received. While reiterating its request that the Government send a copy of this declaration, it requests the Government to provide clarification as to whether the declaration adopted in 1997 is an adaptation of the one mentioned in the report received in 1994. It also requests the Government to supply information on any factor concerning nursing personnel in the context of this declaration. It also hopes that the revision of the general terms and conditions of employment applicable to members of the Christian Hospitals’ Association of Malawi (CHAM) will shortly be completed and that the Government will supply a copy.

Article 6. While noting the information supplied by the Government concerning the duration of day and night work, weekly leave, paid annual leave, sick leave, maternity leave and social security, the Committee requests the Government to specify whether the new scale relating to hours of work and weekly rest in the public sector has been established and, if so, requests the Government to supply a copy with its next report.

Article 7 and Part V of the report form. In the absence of any information on this matter, the Committee requests the Government to indicate the progress made in the occupational safety and hygiene field after consultation with the employers’ organizations and the nursing personnel concerned, and to supply available statistical data. Referring, furthermore, to its 1990 general observation, repeated in 1994, the Committee noted in its previous comments the progress made in protection against accidental exposure of nursing staff to the human immunodeficiency virus (HIV), and requests the Government to indicate the measures taken or contemplated in regard to nursing staff who are infected or considered to be infected by HIV (adaptation of working conditions, recognition that the cause of infection was occupational, etc.).

Direct Request (CEACR) - adopted 1999, published 88th ILC session (2000)

Article 2, paragraph 2(b), and Article 5, paragraph 2, of the Convention. The Committee recalls that it has requested the Government in its previous report to provide information on any developments in relation to nursing personnel with regard to the governmental policy statement allowing employees in both the private and public sectors to freely organize in trade unions and engage in collective bargaining. The Committee notes that the report does not contain any information on that matter and it hopes that the Government will supply it with its next report. The Committee informed the Government that no copy of the referred governmental statement has been received from the UNDP, and thus the Committee would be grateful if the Government would communicate this copy directly to the Office. The Committee takes note of the information that the Government is not able to provide a copy of the general terms and conditions of employment applying to members of the Christian Hospitals' Association of Malawi (CHAM) at this juncture because they have engaged a consultant who is currently working on the new conditions. The Committee hopes the Government will communicate a copy of the general terms and conditions once the mentioned exercise is finished.

Article 6. The Committee notes the indication of the Government that it is not possible to provide a copy of administrative arrangements concerning points (a) hours of work; and (b) weekly rest, applicable to public sector since a new schedule is on elaboration at this moment. The Committee hopes that the Government will provide the text when the schedule is ready. The Committee takes note of the information provided by the Government in relation to the working conditions applicable to the members of the CHAM. It requests the Government to communicate copies of the relevant texts.

Article 7 and Part V of the report form. The Committee notes that consultation with the organization of employers and nursing personnel concerned still takes place to improve the practical application of the provisions of the Convention. However, the Committee takes note with regret that due to budgetary constraints nothing has been done in the application of these provisions of the Convention. The Committee requests the Government to report on any progress achieved in this respect. With reference to its general observation of 1990 which it repeated in 1994, the Committee notes the information that there is progress though discussions are still under way in order to find ways and means of protecting the nursing personnel from accidental exposure to the human immunodeficiency virus (HIV). The Committee requests the Government to continue providing information on this issue and to report on the measures taken or contemplated with respect to nursing personnel who are infected or considered to be infected by HIV (adaptation of conditions of work, recognition that the cause of infection was occupational, etc.).

Direct Request (CEACR) - adopted 1995, published 82nd ILC session (1995)

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, of the Convention. The Committee notes the Government's information concerning determination of the employment and working conditions of nursing personnel. It asks the Government to provide a copy of the general terms and conditions of employment applying to members of the Christian Hospitals' Association of Malawi (CHAM). In addition, the Committee notes that the Government has recently published a policy statement for employees in both the private and public sectors to freely organize in trade unions and engage in collective bargaining. It asks the Government to provide a copy of the above statement and to provide information on any developments in this area that affect nursing personnel.

Article 5, paragraph 3. The Committee notes with interest the Government's information concerning the practical application of the procedure for the settlement of disputes arising out of the determination of working conditions, and particularly the manner in which the guarantees of independence and impartiality of the procedure, provided for in the Convention, are preserved.

Article 6. Please provide a copy of the administrative arrangements concerning (a) hours of work and (b) weekly rest, applicable to public sector nursing personnel. Please also provide a copy of the general provisions applying to members of CHAM, in respect of: (a) hours of work; (b) weekly rest; (c) paid annual leave; (d) maternity leave; (e) sick leave; and (f) social security.

Article 7 and point V of the report form. The Government's report - particularly the information on occupational safety and health and the statistics on the numbers of nursing personnel - reveals that the practical application of the Convention is difficult owing to budgetary constraints. The Committee asks the Government to provide information on developments in the situation (statistics, etc.), and in particular to indicate the measures taken or contemplated, in consultation with the organizations of employers and nursing personnel concerned, to improve the practical application of the provisions of the Convention in the area of occupational safety and health. In addition, with reference to its general observation of 1990 which it repeated in 1994, the Committee asks the Government to indicate the measures taken or contemplated, in consultation with the organizations of employers and nursing personnel concerned, to take account of the particular risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel: for example, by the arrangement of conditions of work, confidentiality of test results, recognition that the cause of infection was occupational, etc.

Direct Request (CEACR) - adopted 1994, published 81st ILC session (1994)

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 following matters raised in its previous direct request:

Article 2, paragraph 2(b), and Article 5, paragraph 2, of the Convention. The Government's last report indicated that the employment and working conditions including career prospects and remuneration of nursing personnel in the public sector were assured by the Malawi Public Service Regulations whereas the Private Hospitals Association of Malawi (PHAM) coordinated the condition of service and remuneration for those nurses working in private hospitals, although it appeared from the report that there are no collective agreements applying to nursing personnel. The Committee requests the Government to indicate the methods by which in the absence of collective agreements conditions of employment and work of nursing personnel in the private sector are determined. Please also supply detailed information on any measures taken 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.

Article 5, paragraph 3. The Committee noted that the settlement of disputes procedure under the Trade Disputes (Arbitration and Settlement) Act (Cap. 54:02) seemed to apply to nursing personnel in both the public and private sectors. The Committee requests the Government to supply detailed information on the practical application of this procedure. It requests the Government to indicate, in particular, how the guarantees provided for in the Convention, which requires that disputes be settled through negotiations or in such manner as to ensure the confidence of the parties involved through independent and impartial machinery, are provided under the above Trade Disputes Act.

Article 6. 1. Please indicate the specific conditions enjoyed by nursing personnel in the fields covered by paragraphs (a) hours of work, (b) weekly rest, and (d) educational leave, of this Article, and the legal provisions or regulations establishing such conditions.

2. Please specify the provisions applicable to nursing personnel in the private sector in the fields covered by paragraphs (c), (e), (f) and (g) of this Article and concerning, respectively, paid annual leave, maternity leave, sick leave and social security.

Article 7. Please indicate the measures that have been taken to give effect to this Article (measures to adapt the occupational health and safety provisions to the special nature of nursing work).

Point V of the report form. Please supply the statistics requested under this point of the report form on the number of nursing personnel in relation to population, the number of patients and other health workes, data on the number of persons leaving the nursing profession, and a general appreciation of the manner in which the Convention is applied in the country, including any practical difficulties encountered.

Direct Request (CEACR) - adopted 1993, published 80th ILC session (1993)

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 following matters raised in its previous direct request:

Article 2, paragraph 2(b), and Article 5, paragraph 2, of the Convention. The Government's last report indicated that the employment and working conditions including career prospects and remuneration of nursing personnel in the public sector were assured by the Malawi Public Service Regulations whereas the Private Hospitals Association of Malawi (PHAM) coordinated the condition of service and remuneration for those nurses working in private hospitals, although it appeared from the report that there are no collective agreements applying to nursing personnel. The Committee requests the Government to indicate the methods by which in the absence of collective agreements conditions of employment and work of nursing personnel in the private sector are determined. Please also supply detailed information on any measures taken 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.

Article 5, paragraph 3. The Committee noted that the settlement of disputes procedure under the Trade Disputes (Arbitration and Settlement) Act (Cap. 54:02) seemed to apply to nursing personnel in both the public and private sectors. The Committee requests the Government to supply detailed information on the practical application of this procedure. It requests the Government to indicate, in particular, how the guarantees provided for in the Convention, which requires that disputes be settled through negotiations or in such manner as to ensure the confidence of the parties involved through independent and impartial machinery, are provided under the above Trade Disputes Act.

Article 6. 1. Please indicate the specific conditions enjoyed by nursing personnel in the fields covered by paragraphs (a) hours of work, (b) weekly rest, and (d) educational leave, of this Article, and the legal provisions or regulations establishing such conditions.

2. Please specify the provisions applicable to nursing personnel in the private sector in the fields covered by paragraphs (c), (e), (f) and (g) of this Article and concerning, respectively, paid annual leave, maternity leave, sick leave and social security.

Article 7. Please indicate the measures that have been taken to give effect to this Article (measures to adapt the occupational health and safety provisions to the special nature of nursing work).

Point V of the report form. Please supply the statistics requested under this point of the report form on the number of nursing personnel in relation to population, the number of patients and other health workes, data on the number of persons leaving the nursing profession, and a general appreciation of the manner in which the Convention is applied in the country, including any practical difficulties encountered.

Direct Request (CEACR) - adopted 1992, published 79th ILC session (1992)

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 following matters raised in its previous direct request, which read as follows:

Article 2, paragraph 2(b), and Article 5, paragraph 2, of the Convention. The report indicates that the employment and working conditions including career prospects and remuneration of nursing personnel in the public sector are assured by the Malawi Public Service Regulations whereas the Private Hospitals Association of Malawi (PHAM) co-ordinates the condition of service and remuneration for those nurses working in private hospitals, although it appears from the report that there are no collective agreements applying to nursing personnel. The Committee requests the Government to indicate the methods by which in the absence of collective agreements conditions of employment and work of nursing personnel in the private sector are determined. Please also supply detailed information on any measures taken 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.

Article 5, paragraph 3. The Committee notes that the settlement of disputes procedure under the Trade Disputes (Arbitration and Settlement) Act (Cap. 54:02) seems to apply to nursing personnel in both the public and private sectors. The Committee requests the Government to supply detailed information on the practical application of this procedure. It requests the Government to indicate, in particular, how the guarantees provided for in the Convention, which requires that disputes be settled through negotiations or in such manner as to ensure the confidence of the parties involved through independent and impartial machinery, are provided under the above Trade Disputes Act.

Article 6. 1. Please indicate the specific conditions enjoyed by nursing personnel in the fields covered by paragraphs (a) hours of work, (b) weekly rest, and (d) educational leave, of this Article, and the legal provisions or regulations establishing such conditions.

2. Please specify the provisions applicable to nursing personnel in the private sector in the fields covered by paragraphs (c), (e), (f) and (g) of this Article and concerning, respectively, paid annual leave, maternity leave, sick leave and social security.

Article 7. Please indicate the measures that have been taken to give effect to this Article (measures to adapt the occupational health and safety provisions to the special nature of nursing work).

Point V of the report form. Please supply the statistics requested under this point of the report form on the number of nursing personnel in relation to population, the number of patients and other health workes, data on the number of persons leaving the nursing profession, and a general appreciation of the manner in which the Convention is applied in the country, including any practical difficulties encountered.

Direct Request (CEACR) - adopted 1990, published 77th ILC session (1990)

The Committee notes the Government's first report. It requests the Government to supply additional information on the following points:

Article 2, paragraph 2(b), and Article 5, paragraph 2, of the Convention. The report indicates that the employment and working conditions including career prospects and remuneration of nursing personnel in the public sector are assured by the Malawi Public Service Regulations whereas the Private Hospitals Association of Malawi (PHAM) co-ordinates the condition of service and remuneration for those nurses working in private hospitals, although it appears from the report that there are no collective agreements applying to nursing personnel. The Committee requests the Government to indicate the methods by which in the absence of collective agreements conditions of employment and work of nursing personnel in the private sector are determined. Please also supply detailed information on any measures taken 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.

Article 5, paragraph 3. The Committee notes that the settlement of disputes procedure under the Trade Disputes (Arbitration and Settlement) Act (Cap. 54:02) seems to apply to nursing personnel in both the public and private sectors. The Committee requests the Government to supply detailed information on the practical application of this procedure. It requests the Government to indicate, in particular, how the guarantees provided for in the Convention, which requires that disputes be settled through negotiations or in such manner as to ensure the confidence of the parties involved through independent and impartial machinery, are provided under the above Trade Disputes Act.

Article 6. 1. Please indicate the specific conditions enjoyed by nursing personnel in the fields covered by paragraphs (a) hours of work, (b) weekly rest, and (d) educational leave, of this Article, and the legal provisions or regulations establishing such conditions.

2. Please specify the provisions applicable to nursing personnel in the private sector in the fields covered by paragraphs (c), (e), (f) and (g) of this Article and concerning, respectively, paid annual leave, maternity leave, sick leave and social security.

Article 7. Please indicate the measures that have been taken to give effect to this Article (measures to adapt the occupational health and safety provisions to the special nature of nursing work).

Point V of the report form. Please supply the statistics requested under this point of the report form on the number of nursing personnel in relation to population, the number of patients and other health workers, data on the number of persons leaving the nursing profession, and a general appreciation of the manner in which the Convention is applied in the country, including any practical difficulties encountered.