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

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

Article 2(1), of the Convention. National policy concerning nursing services and nursing personnel. In its previous comments, the Committee had requested the Government to provide information on measures taken to address the nursing shortage, prevent health-worker migration and ensure satisfactory working conditions for nursing personnel. The Government provides information on the adoption of new regulations and amendments to various legislative provisions related to matters covered by the Convention. The Committee notes in particular the enactment of Regulation No. 1529 on the Procedure for organization and financing of healthcare (17 December 2013), the Order of the Cabinet of Ministers No. 633 on Changing the financing model of the Latvian healthcare system (1 November 2016), and the Order of the Cabinet of Ministers No. 394 on the Conceptual Report of the reform of the healthcare system (7 August 2017). The Government reports that multiple projects have been pursued by the Ministry of Health to improve the healthcare infrastructure, mainly with regard to inpatient health services, the National Health Service (NHS) and general practitioners. Additional programmes for the training and recruitment of healthcare staff have been implemented to ensure the provision of the public quality health services. The Committee notes the Government’s indication that the Operational Programme – Growth and Employment (OPGE) published in 2014, sets priorities for the OPGE’s contribution to the achievement of the Europe 2020 Strategy, which includes improving access to healthcare, particularly in regions with fewer services. Noting that the discrepancy in the availability of doctors and nurses between the capital city and the regions is one of the biggest among the EU countries, with the majority of physicians and nursing personnel employed in the capital city of Riga, the OPGE aims to improve accessibility to healthcare and healthcare support personnel who provide services in priority health sectors (such as cardiovascular, oncology, perinatal and neonatal care and mental healthcare) to persons residing outside of the capital. The OPGE calls for measures to be taken to attract doctors and nursing personnel to the regions, through the introduction of a “business trip” system, where personnel are assigned to regions for a specific period, covering moving allowances and providing opportunities for young health workers to begin and continue to practice in the regions. According to the statistics provided by the Government, between 2013 and 2018, the number of nurses in basic work has continued to decrease (from 9,501 in 2013 to 9,317 in 2018), an increase in the number of nurses in additional work (from 2,588 in 2013 to 3,428 in 2018) and the number of nursing institution graduates (from 285 in 2013 to 461 in 2017) is recorded. The Committee further notes that, according to the OPGE, the average availability of nurses in Latvia is considerably below the average in EU countries and there are more nurses per 10,000 inhabitants in Riga (71.7 per cent) and Latgale (48.7 per cent) than in the other regions of the country. The Committee requests the Government to provide detailed information, including statistical information disaggregated by sex, age and region, on the impact of measures taken in the process of implementing programmes and policies on the improvement of nursing services and on attracting and retaining nursing personnel, including midwives, particularly in rural and remote areas of the country. Taking account of the continued shortage of nursing personnel, the Committee requests the Government to supply information on measures taken or envisaged to ensure access to quality nursing care, particularly for groups in vulnerable situations, such as children, women, people with disabilities and people living in rural areas.

Article 2(2). Employment and working conditions of nursing personnel. The Committee notes the amendments made to the Labour Law of 2002, particularly those relating to the Organisation of Working Time (Chapter 32), Rest Time (Chapter 33) and Leave (Chapter 35). The Government indicates that amendments have also been made to the Medical Treatment Law of 12 June 1997, section 26, modifying the right of medical practitioners to qualify for a medical certificate (1 December 2016). Amendments were also introduced in 2017 to section 53.1, paragraph 7, of the Medical Treatment Law which was challenged on the basis that it discriminated against medical personnel by restricting their right to compensation for overtime hours. Subsequently, section 53.1, paragraph 7, was replaced by Transitional Provision 31. On 15 May 2018, the Latvian Constitutional Court held that both section 53.1, paragraph 7, and section 31 of Transitional Provision of the Medical Treatment Law were incompatible with the principle of equality in the Latvian Constitution and declared it null and void as of 1 January 2019 (Case No. 2017-15-01). The Government further reports that the remuneration of healthcare personnel is a priority, adding that problems in the state-funded healthcare institutions include low rates of remuneration, particularly for middle and lower level personnel. The Committee notes that, from 1 January 2017, the minimum monthly wage was increased and the lowest wage echelons were raised. The Committee notes that by 2018, wages for doctors and functional specialists will increase by 44 per cent, for medical and patient care persons and functional specialists’ assistants by 38 per cent, and for medical and patient care support persons by 24 per cent. Recalling that the Convention calls for measures to be taken to attract and retain people to the nursing profession, ensuring reasonable career prospects and levels of remuneration that take account of the constraints and hazards inherent in the profession, the Committee requests the Government to provide information on the impact of measures taken to improve the terms and conditions of employment, and particularly the remuneration, of nursing personnel.

Part V of the report form. Application in practice. The Committee requests the Government to provide updated detailed information on the application of the Convention in practice, including statistics disaggregated by sex, age and region, on the ratio of nursing personnel to the population, the number of persons enrolled in nursing care schools, the number of men and women nurses who enter and leave the profession each year, the organization and the operation of all institutions which provide healthcare, as well as official studies, surveys and reports addressing human resources issues in the health sector.

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

Article 2 of the Convention. National policy concerning nursing services and nursing personnel. The Committee notes the Government’s indications about the various austerity measures that have been adopted as a result of the global economic crisis, and which have inevitably affected the implementation of the Development of Human Resources in the Health-care Sector 2006–15 (Order of the Cabinet of Ministers No. 870 of 6 November 2006). The Government explains that facing a drop of 25 per cent in GDP and a rise of unemployment to 20.5 per cent, it had to drastically reduce the national budget expenditure, including the health-sector budget. As a result, the Ministry of Health was unable to either schedule any salary increase for the health-care workers or plan any future increases. A new model for the financing of the public health-care system through compulsory health insurance was developed, however, which aims to gradually increase the national health-care budget to 4.5 per cent of GDP. Further to the Government’s explanations, the Committee understands that in recent years several hospitals have been closed and the salaries of health professionals cut down by up to 30 per cent. It also understands that an unknown number of nurses and doctors have emigrated mostly to the United Kingdom, Germany and Sweden. The Committee requests the Government to continue to provide up-to-date information on any measures, programmes or initiatives undertaken with a view to improving the quality of nursing care, offering satisfactory working conditions to nursing personnel, remedying the current shortage of nurses and preventing health worker migration.

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

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.

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

The Committee notes the Government’s report and wishes to draw its attention to the following points.

Article 2, paragraph 2(b), of the Convention. Further to its previous comments concerning the poor pay conditions in the nursing care sector which are mainly responsible for the sharp decrease of the nursing workforce in recent years, the Committee notes that the Government envisaged to increase the monthly average earnings of medical nurses from 125 to 178 lats (US$335) by December 2003. The Committee would be grateful if the Government would provide up-to-date information on the remuneration levels currently practised both in the public and the private sectors and to indicate any additional incentives, financial or other, designed to retain qualified nurses in the profession. In this connection, the Committee notes with concern recent press reports according to which nursing personnel consider joining the strike movement for higher pay and shorter working hours launched by anaesthetists in September 2004. According to some accounts, the current monthly wage for a nurse working a full shift is 173 euros before tax, while some 50 to 60 per cent of nurses perform extra work outside the normal working hours without receiving 100 per cent pay premium for overtime as laid down in section 68(1) of the new Labour Law. Moreover, the non-competitive working conditions in the Latvian health-care sector seem to promote the migration of medical specialists to Western Europe and concerns are being expressed that workers in poorly funded public service sectors, such as health care, education and science, might be particularly affected by this "brain drain". The Committee wishes to receive the Government’s views on the situation and the measures it intends to take in the short term to reverse this trend.

Articles 3 and 4. The Committee notes the information on the basic requirements of nursing education, the number of medical schools offering secondary medical education, the functions of the coordinating agency at the Ministry of Health and the procedures for registration and certification of medical practitioners. In this respect, the Committee would appreciate receiving copies of Cabinet Regulation No. 337 of 6 August 2002 and Ministry of Health Order No. 150 of 10 June 2003 which were not appended to the Government’s report and are not available at the Office. In addition, the Committee notes that the Government intends to reorganize public medical schools into higher vocational educational institutions in an effort to render the programmes of higher nursing education more attractive and consequently improve the status and reputation of the nursing profession as a whole. The Committee asks the Government to keep it informed of any concrete steps taken to this end in consultation with the Latvian Nurses Association, the Latvian Midwives Association and other interested professional organizations.

Article 5, paragraph 2, and Article 6. The Committee notes the Government’s statement to the effect that nursing personnel enjoy the same protection as other workers covered by the Labour Law of 20 June 2001 in matters of hours of work (sections 130 to 140), weekly rest (sections 141 to 144), paid holidays (sections 149 to 152), educational leave (section 157), maternity leave (section 154), sick leave and social security. The Committee also notes that a general agreement was concluded on 6 March 2002 between the Ministry of Welfare and the Health and Social Care Workers’ Trade Union in respect of the working conditions of nursing personnel employed in social care institutions under the supervision of the Ministry of Welfare. The Committee requests the Government to provide a copy of the above agreement and to report on any progress made with regard to collective bargaining in all other public health-care establishments as well as in private medical centres.

Article 7. The Committee notes the Government’s reference to Cabinet Regulation No. 328 of 23 September 1997 which prescribes measures to limit HIV-infection risk among medical practitioners. As this text is unavailable at the Office, the Committee requests the Government to forward a copy.

Part V of the report form. The Committee notes the statistical information provided by the Government in its report concerning the number of medical practitioners, including nurses and midwives, in the period 2000-01. It also notes the Government’s statement that within the last ten years the nursing workforce has decreased almost by half due to low pay, difficult socio-economic conditions and the depreciation of the nursing profession. The Committee would be grateful to the Government for supplying additional information on any concrete efforts to address the problem of the shortage of nurses. Moreover, the Committee would appreciate receiving all 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 and the number of nurses leaving or joining the profession, copies of official reports or research studies examining the employment and working conditions of nursing personnel, etc.

Direct Request (CEACR) - adopted 2002, published 91st ILC session (2003)

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 direct request, which read as follows:

1. In order to enable it to examine the application of the Convention, the Committee requests the Government to provide a copy of the following legislation and regulations referred to in its report: (i) "Medical Law", 20 August 1994; (ii) Certification Regulations for Registered Nurses, Midwives, Physicians’ Assistants and Laboratory Technicians", 4 July 1995; (iii) the "Regulations of Registration of Nurses"; and (iv) any collective agreement applicable to nursing personnel.

2. Nevertheless, the Committee already notes from the Government’s report and the information forwarded by the World Health Organization (WHO) a major problem of general application of the Convention, in particular with respect to the following provisions:

Article 2, paragraphs 1 and 2(b), of the Convention, read in conjunction with Article 5, paragraph 2, Article 6, paragraph (a), Article 7 and Part V of the report form. The Committee notes that according to the Government the number of nurses in 1995 in comparison with 1994 has decreased for 2,364 persons for the following reasons: (i) low salaries; (ii) low socio-economic situation; and (iii) low prestige of the profession. Meanwhile, 393 nurses were formally unemployed as of 1 June 1995.

Moreover, the Committee notes the great concern expressed by the World Health Organization (WHO) concerning the decline of nursing care in the country due to low salaries, the low socio-economic situation and the low prestige of the profession. According to the WHO, the trend is especially worrisome since the needs of the population for nursing care are increasing. With the growing number of elderly, a rise in chronic diseases, and a growing need for health promotion and disease prevention in the communities far more nurses are needed to meet national health targets.

As concerns overtime remuneration, the Committee notes that the Labour Code provisions which envisage a payment of not less than a double amount are, in practice, often not taken into account by employers. It also notes that no collective agreement has been concluded in respect of nurses’ working conditions.

In addition, the Committee notes the Government’s indication that nurses’ occupational safety and health conditions are bad, with a lack of adequate protection against some occupational risks such as contagious diseases or radiations.

The Committee reminds the Government of the general obligation of ratifying States, under this Convention, to provide, within the resources available for health care as a whole, the quantity and the quality of nursing care necessary for attaining the highest possible level of health for the population. It requests the Government to indicate the measures which have been taken or are contemplated in order to meet this obligation and to comply with the aforementioned provisions of the Convention, in particular with regard to: (i) the formulation, adoption and application - in consultation with the employers’ and workers’ organizations concerned - of a coordinated general health programme aimed at improving the level of health of the population; and (ii) the general improvement - including by means of legislation, collective bargaining or other practical measures - of the nurses’ working and safety and health conditions, so as to attract persons to the profession and retain them in it.

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

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 direct request, which read as follows:

        1. In order to enable it to examine the application of the Convention, the Committee requests the Government to provide a copy of the following legislation and regulations referred to in its report: (i) "Medical Law", 20 August 1994; (ii) Certification Regulations for Registered Nurses, Midwives, Physicians’ Assistants and Laboratory Technicians", 4 July 1995; (iii) the "Regulations of Registration of Nurses"; and (iv) any collective agreement applicable to nursing personnel.

        2. Nevertheless, the Committee already notes from the Government’s report and the information forwarded by the World Health Organization (WHO) a major problem of general application of the Convention, in particular with respect to the following provisions:

        Article 2, paragraphs 1 and 2(b), of the Convention, read in conjunction with Article 5, paragraph 2, Article 6, paragraph (a), Article 7 and Part V of the report form. The Committee notes that according to the Government the number of nurses in 1995 in comparison with 1994 has decreased for 2,364 persons for the following reasons: (i) low salaries; (ii) low socio-economic situation; and (iii) low prestige of the profession. Meanwhile, 393 nurses were formally unemployed as of 1 June 1995.

        Moreover, the Committee notes the great concern expressed by the World Health Organization (WHO) concerning the decline of nursing care in the country due to low salaries, the low socio-economic situation and the low prestige of the profession. According to the WHO, the trend is especially worrisome since the needs of the population for nursing care are increasing. With the growing number of elderly, a rise in chronic diseases, and a growing need for health promotion and disease prevention in the communities far more nurses are needed to meet national health targets.

        As concerns overtime remuneration, the Committee notes that the Labour Code provisions which envisage a payment of not less than a double amount are, in practice, often not taken into account by employers. It also notes that no collective agreement has been concluded in respect of nurses’ working conditions.

        In addition, the Committee notes the Government’s indication that nurses’ occupational safety and health conditions are bad, with a lack of adequate protection against some occupational risks such as contagious diseases or radiations.

        The Committee reminds the Government of the general obligation of ratifying States, under this Convention, to provide, within the resources available for health care as a whole, the quantity and the quality of nursing care necessary for attaining the highest possible level of health for the population. It requests the Government to indicate the measures which have been taken or are contemplated in order to meet this obligation and to comply with the aforementioned provisions of the Convention, in particular with regard to: (i) the formulation, adoption and application - in consultation with the employers’ and workers’ organizations concerned - of a coordinated general health programme aimed at improving the level of health of the population; and (ii) the general improvement - including by means of legislation, collective bargaining or other practical measures - of the nurses’ working and safety and health conditions, so as to attract persons to the profession and retain them in it.

Direct Request (CEACR) - adopted 2000, published 89th ILC session (2001)

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 direct request, which reads as follows:

1.  In order to enable it to examine the application of the Convention, the Committee requests the Government to provide a copy of the following legislation and regulations referred to in its report: (i) "Medical Law", 20 August 1994; (ii) Certification Regulations for Registered Nurses, Midwives, Physicians’ Assistants and Laboratory Technicians", 4 July 1995; (iii) the "Regulations of Registration of Nurses"; and (iv) any collective agreement applicable to nursing personnel.

2.  Nevertheless, the Committee already notes from the Government’s report and the information forwarded by the World Health Organization (WHO) a major problem of general application of the Convention, in particular with respect to the following provisions:

Article 2, paragraphs 1 and 2(b), of the Convention, read in conjunction with Article 5, paragraph 2, Article 6, paragraph (a), Article 7 and Part V of the report form.  The Committee notes that according to the Government the number of nurses in 1995 in comparison with 1994 has decreased for 2,364 persons for the following reasons: (i) low salaries; (ii) low socio-economic situation; and (iii) low prestige of the profession. Meanwhile, 393 nurses were formally unemployed as of 1 June 1995.

Moreover, the Committee notes the great concern expressed by the World Health Organization (WHO) concerning the decline of nursing care in the country due to low salaries, the low socio-economic situation and the low prestige of the profession. According to the WHO, the trend is especially worrisome since the needs of the population for nursing care are increasing. With the growing number of elderly, a rise in chronic diseases, and a growing need for health promotion and disease prevention in the communities far more nurses are needed to meet national health targets.

As concerns overtime remuneration, the Committee notes that the Labour Code provisions which envisage a payment of not less than a double amount are, in practice, often not taken into account by employers. It also notes that no collective agreement has been concluded in respect of nurses’ working conditions.

In addition, the Committee notes the Government’s indication that nurses’ occupational safety and health conditions are bad, with a lack of adequate protection against some occupational risks such as contagious diseases or radiations.

The Committee reminds the Government of the general obligation of ratifying States, under this Convention, to provide, within the resources available for health care as a whole, the quantity and the quality of nursing care necessary for attaining the highest possible level of health for the population. It requests the Government to indicate the measures which have been taken or are contemplated in order to meet this obligation and to comply with the aforementioned provisions of the Convention, in particular with regard to: (i) the formulation, adoption and application - in consultation with the employers’ and workers’ organizations concerned - of a coordinated general health programme aimed at improving the level of health of the population; and (ii) the general improvement - including by means of legislation, collective bargaining or other practical measures - of the nurses’ working and safety and health conditions, so as to attract persons to the profession and retain them in it.

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

The Committee notes with regret that the Government's report contains no reply to previous comments. It hopes that the next report will include full information on the matters raised in its previous direct request, which deals with the following questions:

1. In order to enable it to examine the application of the Convention, the Committee requests the Government to provide a copy of the following legislation and regulations referred to in its report: (i) "Medical Law", 20 August 1994; (ii) Certification Regulations for Registered Nurses, Midwives, Physicians' Assistants and Laboratory Technicians", 4 July 1995; (iii) the "Regulations of Registration of Nurses"; and (iv) any collective agreement applicable to nursing personnel.

2. Nevertheless, the Committee already notes from the Government's report and the information forwarded by the World Health Organization (WHO) a major problem of general application of the Convention, in particular with respect to the following provisions: Article 2, paragraphs 1 and 2(b), of the Convention, read in conjunction with Article 5, paragraph 2, Article 6, paragraph (a), Article 7 and Part V of the report form. The Committee notes that according to the Government the number of nurses in 1995 in comparison with 1994 has decreased for 2,364 persons for the following reasons: (i) low salaries; (ii) low socio-economic situation; and (iii) low prestige of the profession. Meanwhile, 393 nurses were formally unemployed as of 1 June 1995.

Moreover, the Committee notes the great concern expressed by the World Health Organization (WHO) concerning the decline of nursing care in the country due to low salaries, the low socio-economic situation and the low prestige of the profession. According to the WHO, the trend is especially worrisome since the needs of the population for nursing care are increasing. With the growing number of elderly, a rise in chronic diseases, and a growing need for health promotion and disease prevention in the communities far more nurses are needed to meet national health targets.

As concerns overtime remuneration, the Committee notes that the Labour Code provisions which envisage a payment of not less than a double amount are, in practice, often not taken into account by employers. It also notes that no collective agreement has been concluded in respect of nurses' working conditions.

In addition, the Committee notes the Government's indication that nurses' occupational safety and health conditions are bad, with a lack of adequate protection against some occupational risks such as contagious diseases or radiations.

The Committee reminds the Government of the general obligation of ratifying States, under this Convention, to provide, within the resources available for health care as a whole, the quantity and the quality of nursing care necessary for attaining the highest possible level of health for the population. It requests the Government to indicate the measures which have been taken or are contemplated in order to meet this obligation and to comply with the aforementioned provisions of the Convention, in particular with regard to: (i) the formulation, adoption and application -- in consultation with the employers' and workers' organizations concerned -- of a coordinated general health programme aimed at improving the level of health of the population; and (ii) the general improvement -- including by means of legislation, collective bargaining or other practical measures -- of the nurses' working and safety and health conditions, so as to attract persons to the profession and retain them in it.

Direct Request (CEACR) - adopted 1998, published 87th ILC session (1999)

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:

1. In order to enable it to examine the application of the Convention, the Committee requests the Government to provide a copy of the following legislation and regulations referred to in its report: (i) "Medical Law", 20 August 1994; (ii) "Certification Regulations for Registered Nurses, Midwives, Physicians' Assistants and Laboratory Technicians", 4 July 1995; (iii) the "Regulations of Registration of Nurses"; and (iv) any collective agreement applicable to nursing personnel.

2. Nevertheless, the Committee already notes from the Government's report and the information forwarded by the World Health Organization (WHO) a major problem of general application of the Convention, in particular with respect to the following provisions:

Article 2, paragraphs 1 and 2(b), of the Convention, read in conjunction with Article 5, paragraph 2, Article 6, paragraph (a), Article 7 and point V of the report form. The Committee notes that according to the Government the number of nurses in 1995 in comparison with 1994 has decreased for 2,364 persons for the following reasons: (i) low salaries; (ii) low socio-economic situation; and (iii) low prestige of the profession. Meanwhile, 393 nurses were formally unemployed as of 1 June 1995.

Moreover, the Committee notes the great concern expressed by the World Health Organization (WHO) concerning the decline of nursing care in the country due to low salaries, the low socio-economic situation and the low prestige of the profession. According to the WHO, the trend is especially worrisome since the needs of the population for nursing care are increasing. With the growing number of elderly, a rise in chronic diseases, and a growing need for health promotion and disease prevention in the communities far more nurses are needed to meet national health targets.

As concerns overtime remuneration, the Committee notes that the Labour Code provisions which envisage a payment of not less than a double amount are, in practice, often not taken into account by employers. It also notes that no collective agreement has been concluded in respect of nurses' working conditions.

In addition, the Committee notes the Government's indication that nurses' occupational safety and health conditions are bad, with a lack of adequate protection against some occupational risks such as contagious diseases or radiations.

The Committee reminds the Government of the general obligation of ratifying States, under this Convention, to provide, within the resources available for health care as a whole, the quantity and the quality of nursing care necessary for attaining the highest possible level of health for the population. It requests the Government to indicate the measures which have been taken or are contemplated in order to meet this obligation and to comply with the aforementioned provisions of the Convention, in particular with regard to: (i) the formulation, adoption and application -- in consultation with the employers' and workers' organizations concerned -- of a coordinated general health programme aimed at improving the level of health of the population; and (ii) the general improvement -- including by means of legislation, collective bargaining or other practical measures -- of the nurses' working and safety and health conditions, so as to attract persons to the profession and retain them in it.

Direct Request (CEACR) - adopted 1997, published 86th ILC session (1998)

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:

1. In order to enable it to examine the application of the Convention, the Committee requests the Government to provide a copy of the following legislation and regulations referred to in its report: (i) "Medical Law", 20 August 1994; (ii) "Certification Regulations for Registered Nurses, Midwives, Physicians' Assistants and Laboratory Technicians", 4 July 1995; (iii) the "Regulations of Registration of Nurses"; and (iv) any collective agreement applicable to nursing personnel.

2. Nevertheless, the Committee already notes from the Government's report and the information forwarded by the World Health Organization (WHO) a major problem of general application of the Convention, in particular with respect to the following provisions:

Article 2, paragraphs 1 and 2(b), of the Convention, read in conjunction with Article 5, paragraph 2, Article 6, paragraph (a), Article 7 and point V of the report form. The Committee notes that according to the Government the number of nurses in 1995 in comparison with 1994 has decreased for 2,364 persons for the following reasons: (i) low salaries; (ii) low socio-economic situation; and (iii) low prestige of the profession. Meanwhile, 393 nurses were formally unemployed as of 1 June 1995.

Moreover, the Committee notes the great concern expressed by the World Health Organization (WHO) concerning the decline of nursing care in the country due to low salaries, the low socio-economic situation and the low prestige of the profession. According to the WHO, the trend is especially worrisome since the needs of the population for nursing care are increasing. With the growing number of elderly, a rise in chronic diseases, and a growing need for health promotion and disease prevention in the communities far more nurses are needed to meet national health targets.

As concerns overtime remuneration, the Committee notes that the Labour Code provisions which envisage a payment of not less than a double amount are, in practice, often not taken into account by employers. It also notes that no collective agreement has been concluded in respect of nurses' working conditions.

In addition, the Committee notes the Government's indication that nurses' occupational safety and health conditions are bad, with a lack of adequate protection against some occupational risks such as contagious diseases or radiations.

The Committee reminds the Government of the general obligation of ratifying States, under this Convention, to provide, within the resources available for health care as a whole, the quantity and the quality of nursing care necessary for attaining the highest possible level of health for the population. It requests the Government to indicate the measures which have been taken or are contemplated in order to meet this obligation and to comply with the aforementioned provisions of the Convention, in particular with regard to: (i) the formulation, adoption and application -- in consultation with the employers' and workers' organizations concerned -- of a coordinated general health programme aimed at improving the level of health of the population; and (ii) the general improvement -- including by means of legislation, collective bargaining or other practical measures -- of the nurses' working and safety and health conditions, so as to attract persons to the profession and retain them in it.

Direct Request (CEACR) - adopted 1996, published 85th ILC session (1997)

The Committee notes the information supplied in the Government's first report.

1. In order to enable it to examine the application of the Convention, the Committee requests the Government to provide a copy of the following legislation and regulations referred to in its report: (i) "Medical Law", 20 August 1994; (ii) "Certification Regulations for Registered Nurses, Midwives, Physicians' Assistants and Laboratory Technicians", 4 July 1995; (iii) the "Regulations of Registration of Nurses"; and (iv) any collective agreement applicable to nursing personnel.

2. Nevertheless, the Committee already notes from the Government's report and the information forwarded by the World Health Organization (WHO) a major problem of general application of the Convention, in particular with respect to the following provisions:

Article 2, paragraphs 1 and 2(b), of the Convention, read in conjunction with Article 5, paragraph 2, Article 6, paragraph (a), Article 7 and point V of the report form. The Committee notes that according to the Government the number of nurses in 1995 in comparison with 1994 has decreased for 2,364 persons for the following reasons: (i) low salaries; (ii) low socio-economic situation; and (iii) low prestige of the profession. Meanwhile, 393 nurses were formally unemployed as of 1 June 1995.

Moreover, the Committee notes the great concern expressed by the WorldHealth Organization (WHO) concerning the decline of nursing care in the country due to low salaries, the low socio-economic situation and the low prestige of the profession. According to the WHO, the trend is especially worrisome since the needs of the population for nursing care are increasing. With the growing number of elderly, a rise in chronic diseases, and a growing need for health promotion and disease prevention in the communities far more nurses are needed to meet national health targets.

As concerns overtime remuneration, the Committee notes that the Labour Code provisions which envisage a payment of not less than a double amount are, in practice, often not taken into account by employers. It also notes that no collective agreement has been concluded in respect of nurses' working conditions.

In addition, the Committee notes the Government's indication that nurses' occupational safety and health conditions are bad, with a lack of adequate protection against some occupational risks such as contagious diseases or radiations.

The Committee reminds the Government of the general obligation of ratifying States, under this Convention, to provide, within the resources available for health care as a whole, the quantity and the quality of nursing care necessary for attaining the highest possible level of health for the population. It requests the Government to indicate the measures which have been taken or are contemplated in order to meet this obligation and to comply with the aforementioned provisions of the Convention, in particular with regard to: (i) the formulation, adoption and application - in consultation with the employers' and workers' organizations concerned - of a coordinated general health programme aimed at improving the level of health of the population; and (ii) the general improvement - including by means of legislation, collective bargaining or other practical measures - of the nurses' working and safety and health conditions, so as to attract persons to the profession and retain them in it.

[The Government is asked to report in detail in 1997.]