Nursing Personnel Convention, 1977 (No. 149) - Lithuania (Ratification: 2007)

Direct Request (CEACR) - adopted 2019, published 109th ILC session (2021)

Articles 2 and 5 of the Convention. National policy concerning nursing services and nursing personnel. Consultations. The Committee takes note of the Government’s report, much of which reiterates information provided in its previous report. The Committee understands that, according to the OECD Reviews of Health Systems: Lithuania 2018 (the 2018 OECD Review), Lithuania has achieved a profound transformation of its health system after declaring independence in the early 1990s. The 2018 OECD Review indicates that the organization and governance of the system is typical of many European countries and has remained stable over the past two decades, with an appropriate set of policy directions having been consistently pursued over time. Health is a prominent inter-sectoral priority that cuts across Lithuania’s main strategic planning documents; for example, the objective of “Health for All” is one of three horizontal priorities established in the country’s national development strategy: “Lithuania 2030”. Its implementation is governed by a specific inter-sectoral action plan coordinated by the Ministry of Health. In its previous comments, the Committee noted the establishment of a new Health Programme 2011–20 and requested the Government to provide information on its implementation and impact, particularly on the quality of nursing services and the employment conditions of nursing personnel. The Review notes that overall, no systematic tools are in place to assess future needs and gaps, or to evaluate the impact of future policies. The Government reports on indirect measures that, in its view, have had a positive impact on improving the quality of nursing care services. In this respect, the Government refers to the annex that forms part of the Collective Agreement of the National Health System of Lithuania, 31 August 2018, No. 2/S-133, which provides for the allocation of €100 million to increase wages for healthcare professionals as of May 2018. It adds that, depending on educational level, the fixed portion of the basic salary for nursing personnel may not be less than 60–70 per cent of the fixed portion of the basic salary for physicians. The Government also refers to the annex that forms part of the Collective Agreement of the National Health System of Lithuania, which entered into force in January 2019 and focuses on improving the working conditions of healthcare specialists. It takes note of the report on the State of Health in the EU Country Health Profile 2017 on Lithuania (2017 Health Status Profile), prepared by the OECD and the European Observatory on Health Systems and Policies, and available on the website of the European Commission. According to the 2017 Health Status Profile, despite the large emigration of health workers since it joined the EU in 2004, Lithuania has retained a higher number of physicians per capita than the EU average (4.3 per 1000 population compared to 3.6), mainly by increasing the number of graduates. On the other hand, the ratio of nurses to the population (7.7), is below the EU average of 8.4. Main health system challenges include the uneven distribution of physicians across the country, the aging of the health workforce and emigration. The 2017 Health Status Profile indicates that a number of new policies have been put in place to increase the number of nurses and strengthen their role in health services, especially in primary care. Specialist nurse training has been initiated, for example in diabetes and cardiology, where new positions for chronic patient groups have been introduced. The Government indicates that measures aimed at regulating the provision of personal healthcare services are designed to regulate the workload of healthcare professionals with the aim of achieving a 1:2 ratio of doctors to nurses. The Committee also notes that, according to the 2017 OECD Profile, since joining the EU in 2004, Lithuania has experienced large migration outflows of health workers, particularly of nursing personnel, who emigrate abroad in search of better pay and working conditions. It notes that this situation remains a challenge for the country and understands that according to the OECD STAT database, 26,078 nurses migrated abroad in 2018. The Committee requests the Government to provide up to-date information on the implementation and impact of the national Health Programme 2011–20, particularly with respect to improving the quality of nursing services and the employment conditions of nursing personnel. It also requests the Government to provide information on the content, status and impact of the inter-sectoral action plan coordinated by the Ministry of Health, as well as on the allocation of €100 million to increase wages for healthcare professionals pursuant to the Collective Agreement of the National Health System of Lithuania. It reiterates its request that the Government provide detailed, updated information concerning current trends in respect of nursing migration from Lithuania and any measures taken or envisaged to retain nursing personnel, measures in relation to education, vocational guidance and training, as well as in relation to working conditions, including career prospects and remuneration. The Committee also requests the Government to provide information on measures taken or envisaged to ensure the active participation of nursing personnel in the development, implementation and monitoring of policies and general principles regarding the nursing profession.

Part V of the Report Form. Application in practice. The Committee requests the Government to provide detailed updated information, disaggregated by age, sex and region, concerning the situation of nursing personnel in the country, the nurse-population ratio, the number of nursing personnel broken down by those working at public and private healthcare establishments, and the number of those who leave the profession each year and to provide copies of any recent reports or studies addressing nursing-related issues.

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

Article 2(1) of the Convention. National policy concerning nursing services and nursing personnel. The Committee understands that a new Health Programme 2011–20 has been established and that Lithuania has entered into a biennial collaborative agreement 2012–13 with the WHO/Europe, which aims to raise the level of health. The Committee requests the Government to provide up to-date information on the implementation of these programmes, particularly as regards their impact on the quality of nursing services and the employment conditions of nursing personnel. Moreover, the Committee recalls its previous comment in which it noted the persistent challenges of nursing migration and requested the Government to indicate any measures or initiatives to reverse the emigration trend. The Committee understands that the emigration of nurses and doctors – basically in the search of better pay conditions – continues unabated, mainly towards European countries such as Denmark, the United Kingdom, Norway, Germany and Sweden. It also understands that, in some cases, nurses do not formally emigrate but travel to neighbouring countries to work for four weeks before returning home for two weeks off. The Committee further understands that there are serious limitations regarding migration statistics and that the use of the number of certificates of competency as an indication of the scale of the outflow is not a reliable tool. Realizing that in the long run migration of qualified nurses puts the national health care system at risk, and that this question calls for coordinated action both by countries of origin and host countries, the Committee requests the Government to provide up-to-date information – including all available statistics – on the situation of nursing migration and any policies or projects implemented in this area.

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

The Committee notes the Government’s first report on the application of the Convention and wishes to draw its attention to the following points.

Article 2, paragraph 1, of the Convention. National policy concerning nursing services and nursing personnel. The Committee notes that under sections 67 and 68 of the Law amending the Law on the health system (Act No. VIII-946 of 1 December 1998), the formulation of national health policies is carried out primarily by two bodies, namely, the National Health Board, which acts as an advisory body for the Parliament and the Government, and the State Health Commission, which acts as a coordinating body among government entities for the formulation of policy measures and the implementation of relevant legislation. It understands that the Parliament has adopted the Lithuanian Health Programme 1997–2010 while the Government has adopted the Implementation Strategy of Health Care Reform’s Aims and Objectives. This strategy, however, does not appear to contain any policies, programmes or activities specifically targeted to nursing personnel. The Committee therefore requests the Government to provide a copy of the Health Programme 1997–2010 and to elaborate on its implementation and the results achieved with respect to nursing personnel. It also asks the Government to explain how the ongoing health-care reform is expected to affect the quality and quantity of nursing care.

Article 2, paragraph 2. Employment and working conditions of nursing personnel. The Committee notes the Government’s indication that working hours, working conditions, remuneration levels, job descriptions and internal procedures for nurses are regulated by internal rules approved by the heads of health-care institutions in consultation with the employers’ and workers’ organizations concerned, such as the Union of Lithuanian Nursing Managers (ULNM) and the Lithuanian Nursing Specialists Organization (LNSO). Recalling that the Convention calls for measures designed to render the nursing profession attractive, including reasonable career prospects and levels of remuneration that take account of the constraints and hazards inherent in the profession, the Committee would appreciate receiving the Government’s views as to whether nursing personnel is currently offered employment and working conditions (including possibilities of professional advancement and financial benefits) that are likely to incite young persons to join the profession or retain qualified nurses in it. It would also request the Government to provide sample copies of internal rules regulating the working conditions in health establishments.

Article 2, paragraph 3. Consultations with social partners. The Committee notes the Government’s indication that representatives of the ULNM and the LNSO are included in the panel of the Ministry of Health and a standing working group on nursing issues, both set up in 2009, for the examination of questions such as the draft Law on nursing practice, licensing, skill development, safe working environment, workload and trade union representation. It would be grateful if the Government would provide more detailed information on the organization and activities of the panel as well as on the operation of the standing working group and any practical results obtained so far.

Article 5, paragraph 1. Participation of nursing personnel in planning. The Committee notes the Government’s reference to section 47 of the Labour Code (Act No. IX-926 of 4 June 2002) generally providing for the employee’s right to information and consultation. According to the Government’s explanations, the information and consultation processes deal with issues related to the internal administration of an enterprise, including, for instance, its current and future activities and important decisions concerning financial and labour matters. Recalling that the Convention requires that nursing personnel be not merely kept informed but rather actively involved in the elaboration and application of policies and general principles regarding the nursing profession, the Committee requests the Government to provide additional information on any specific measures to this effect.

Part V of the report form. Application in practice. The Committee understands that the country experiences a serious problem of nurse migration with 45 per cent of all licensed nurses being reportedly registered in other countries, mainly in Western Europe. The Committee would be grateful if the Government would provide in its next report up to date information on the manner in which the Convention is applied in practice, including for instance statistics on the number of students entering or graduating from nursing schools, the number of nurses registered with the State Health-care Accreditation Agency (VASPVT), the nurse–population ratio, copies of any relevant collective agreements, measures or initiatives to contain or reverse the nurse migration trend, etc.