Nursing Personnel Convention, 1977 (No. 149) - Ecuador (Ratification: 1978)

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

Articles 2, 4, 5 and 6 of the Convention. Employment and working conditions for nursing personnel. Consultations. Regulation of hours of work. Since 2012, the Committee has been referring to the comments of the Ecuadorian Medical Federation (FME) according to which the provisions of the Basic Public Service Act (LOSEP) of 2010, particularly section 47(k) governing compulsory redundancies with termination payments, and Executive Decree No. 813 of 2011 setting out the procedure for such redundancies, were contrary to the Convention since they were adopted without social dialogue, provided no opportunity for workers to intervene whether administratively or judicially, and permitted arbitrary dismissals of medical personnel. The FME also alleged that in 2011 some 5,000 workers in the public administration, including medical personnel, were dismissed under section 47(k) of the LOSEP. The Federation further alleged that the above-mentioned laws had increased working time to eight hours per day, which violated constitutionally protected rights of workers engaged in dangerous and unhealthy occupations. The FME stated that a Constitutional Court ruling was pending on the alleged unconstitutionality of section 8 of Executive Decree No. 813 amending the LOSEP regulations and that the Government was considering labour law reforms. The Committee asked the Government to keep it informed of developments regarding labour law reforms relating to the application of the Convention. The Committee notes the Government’s general reference in its report to the fact that the Ministry of Public Health, under sections 4 and 196 of the Basic Health Act (LOS), is the authority responsible for analysing various aspects of staff training in the health sector, taking account of national and local needs, with a view to promoting reforms in training and capacity-building plans and programmes for the various health personnel training institutions. The Government also refers to the conclusion of an inter-institutional cooperation agreement between the Ministry of Public Health, the General Council of Official Nursing Associations in Madrid (Spain) and the Ecuadorian Nursing Federation aimed at developing management training based on good official nursing practices in Spain for nurses working in establishments of the Ministry of Public Health in Ecuador. Lastly, the Government indicates that no rulings have been issued relating to the content of the present Convention during the period covered by the report. Recalling the existence of a Constitutional Court ruling on the alleged unconstitutionality of section 8 of Executive Decree No. 813 which was pending at the time of the Government’s last report in 2014, the Committee requests the Government to provide information on the follow-up to the case and its resolution. The Committee also requests the Government to send detailed, up-to-date information on the legislation in force relating to the application of the Convention, and also on any envisaged reforms, including with regard to the prerequisites for employment in the nursing profession.

Article 7. Occupational safety and health. In its 2009 comments, the Committee noted the Government’s indication that no measures had been taken to adapt occupational safety and health laws and regulations to the specific nature of nursing work. The Committee has therefore been asking the Government to keep the Office informed of any measures taken or contemplated to improve the protection of nursing personnel against infectious diseases, including HIV and AIDS. However, the Committee observes that the Government has not supplied any information on this matter. The Committee therefore once again requests the Government to provide detailed information on any measures taken or contemplated to improve the protection of nursing personnel against infectious diseases, including HIV and AIDS.

Application in practice. The Committee requests the Government to provide detailed, up-to-date information on the application of the Convention in practice, including statistics on the number of nursing personnel – disaggregated by sex, sector of activity and level of training and functions – and also statistics on the ratio of nursing personnel to population, the number of persons entering and leaving the profession each year, the measures taken to encourage individuals to work in the nursing profession, and copies of official reports or studies on nursing services. The Committee also requests the Government to provide information on any practical difficulties encountered in the application of the Convention, such as the shortage or migration of nursing personnel.

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

Articles 2, 5 and 6 of the Convention. Employment and working conditions for nursing personnel – Consultations – Regulation of hours of work. The Committee had previously noted the comments of the Ecuadorian Medical Federation (FME) according to which the provisions of the Organic Public Service Act (LOSEP) of 2010, particularly section 47(k) regulating compulsory redundancies with termination payments, and Executive Decree No. 813 of 2011 setting out the procedure for such redundancies, were contrary to Articles 2, 5 and 6 of the Convention since they were adopted without social dialogue, provided no opportunity for workers to intervene whether administratively or judicially, and permitted arbitrary dismissals of medical personnel. The Federation had also alleged that the new laws had increased the working hours to eight hours per day, which violated constitutionally protected rights of workers engaged in dangerous and unhealthy occupations. The Committee also noted that a Constitutional Court ruling was pending on the constitutionality of LOSEP and that the Government was considering labour law reforms based on the recommendations of an ILO technical assistance mission carried out in February 2011. The Committee notes the Government’s reply – dated 25 January 2013 – on the issues raised by the FME. The Government indicates that the reforms to the public service, including the public health service, fall within the legitimate authority of the Executive and are aimed at improving the efficiency of these services. The Government further indicates that compulsory redundancies with termination payments under section 47(k) of the LOSEP respond to the need of downsizing the public sector and are similar to the dismissal procedure under the Labour Code. It also points out that the workers affected by this procedure were compensated according to the law. Regarding the equality of treatment between nursing personnel and other workers with respect to working time, the Government indicates that the legislation complies with Article 6 of the Convention. The Committee requests the Government to keep it informed of developments regarding labour law reforms based on the recommendations of the ILO technical assistance mission that visited the country in 2011. Finally, it requests the Government to provide its response to the Committee’s last comment formulated in 2009 addressing a number of issues concerning national law and policy with respect to nursing services and nursing personnel.

Observation (CEACR) - adopted 2012, published 102nd ILC session (2013)

Articles 2, 5 and 6 of the Convention. Employment and working conditions for nursing personnel – Consultations – Regulation of hours of work. The Committee notes the comments of the Ecuadorian Medical Federation, which were received on 29 June 2012 and transmitted to the Government on 29 August 2012, concerning the application of the Convention. According to the Federation, the provisions of the Organic Public Service Act (LOSEP) of 2010, particularly section 47(k) regulating compulsory redundancies, and Executive Decree No. 813 of 2011 setting out the procedure for such redundancies, run contrary to Articles 2, 5 and 6 of the Convention since they were adopted without social dialogue, provide no opportunity for workers to intervene whether administratively or judicially, and permit arbitrary dismissals of medical personnel. The Federation indicates that in 2011, approximately 5,000 public service workers, including medical personnel, were dismissed pursuant to the new legislation. In addition, the Federation alleges that the new laws have increased the working hours to eight hours per day, which violates constitutionally protected rights of workers engaged in dangerous and unhealthy occupations. The Committee also notes the report of the technical assistance mission undertaken by the Office from 15 to 18 February 2011, which noted possible discrepancies between the Labour Code and LOSEP and ratified ILO Conventions. The Committee requests the Government to transmit any comments it may wish to make in reply to the observations of the Ecuadorian Medical Federation. Moreover, noting that a Constitutional Court ruling is pending on the constitutionality of LOSEP and also that the Government is considering labour law reforms based on the recommendations of the ILO technical assistance mission, the Committee requests the Government to keep the Office informed of further developments on these matters. Finally, the Committee requests the Government to provide its response to the Committee’s last comment formulated in 2009 addressing a number of issues concerning national law and policy with respect to nursing services and nursing personnel.

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

Article 2, paragraphs 1 and 2, of the Convention. National policy for nursing services and nursing personnel. The Committee recalls its previous comment in which it asked the Government to supply further information concerning the activities of a new unit set up to coordinate national policies for nursing personnel. In the absence of a reply from the Government on this point, the Committee wishes to repeat its request to the Government to provide full and detailed information on the formulation and implementation of a national policy aimed at providing the quantity and quality of nursing care necessary for attaining the highest possible level of health for the population.

Furthermore, the Committee notes the statistics supplied by the Government according to which the country has 21,500 nurses, which represent, on average, five to six nurses for 10,000 inhabitants. It understands that the country, like most Latin American countries, is experiencing a shortage of nursing personnel, with a consequent reduction in the quality of care provided for patients. Migration to Chile is particularly evident and this is facilitated by the existence of a reciprocal agreement which recognizes the diplomas of health professionals trained in both countries. Another source of concern in addition to the migration of qualified nursing personnel is that the latter are often replaced by less qualified auxiliary nurses (who already account for almost 70 per cent of all nursing staff). The Committee wishes to refer to the draft WHO code of practice concerning the international recruitment of health personnel, currently under consideration, which encourages member States to conclude bilateral and multilateral agreements to promote cooperation and coordination relating to migrant health personnel in the recruitment process, in order to optimize the advantages and reduce the potentially negative impact of the international recruitment of health personnel, and also calls for measures to conserve and maintain a qualified national workforce of health personnel by improving their economic and social situation, living and working conditions, possibilities of employment and career prospects. The Committee therefore requests the Government to supply detailed information on any developments in the situation and, if appropriate, on additional measures taken or contemplated to contain the phenomenon of the migration of qualified nurses abroad.

Article 4. Legislation concerning the requirements for the provision of nursing care and nursing services. The Committee notes that the Health Code has been amended to become a higher ranked organic law. It also notes the Act concerning assistant nurses which regulates, inter alia, the requirements for practicing as an assistant nurse. The Committee understands that this Act is still at the draft stage. The Committee therefore requests the Government to indicate whether the Act concerning assistant nurses has been adopted and to supply a copy of the Organic Health Act.

Article 7. Occupational safety and health. The Committee notes the Government’s indication to the effect that no particular measure has been adopted with a view to adapting occupational safety and health laws and regulations to the specific nature of nursing work, in accordance with this Article of the Convention. In this regard, the Committee wishes to draw the Government’s attention to the Joint ILO/WHO guidelines on health services and HIV/AIDS, published in 2005, with a view to helping health services to strengthen their capacity for providing workers with a healthy and decent working environment, this being the most effective means of reducing the transmission of HIV and improving the provision of care for patients. The Committee would also like to refer to the discussion held at the June 2009 session of the International Labour Conference on “HIV/AIDS and the world of work”, with a view to the adoption of an international labour recommendation, in particular paragraph 37 of the draft conclusions (see ILC, 98th Session, 2009, Report IV(2), page 310), which states 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. The Committee requests the Government to keep the Office informed of any new measures taken or contemplated in order to improve the protection of nursing personnel against infectious diseases, including HIV/AIDS.

Part V of the report form. Application in practice. The Committee requests the Government to continue supplying information on the application of the Convention in practice, including, for example, statistics on the numbers of nursing personnel – by sectors of activity and by levels of training and functions, if possible – the number of persons entering and leaving the profession each year, copies of reports or official studies on nursing services, information on any practical difficulties encountered in the implementation of the Convention, etc.

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

The Committee notes the information contained in the Government’s last report. The Committee would be grateful if the Government would continue to provide, in accordance with Part V of the report form, all available information concerning the application of the Convention in practice, including, for instance, statistics on the evolution of the nursing workforce both in urban and rural areas, the number of students enrolled in nursing schools as well as the number of nurses leaving the profession every year, copies of official reports or studies examining the employment and working conditions of nursing personnel, etc.

The Committee would be particularly interested in receiving up to date information on the work of the newly created unit for the coordination of national policies regarding nursing personnel and would also wish to have the Government’s views on whether global phenomena such as the shortage of qualified nurses, nursing migration, the intensification of workload of health workers in general and the privatization or redesigning of the work organization of health-care institutions affect the quality of nursing services at the national level.

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

The Committee notes with satisfaction the information communicated by the Government on the adoption of the Act respecting the professional exercise of the duties of nursing personnel of 19 February 1998 and Decree No. 492 establishing a new regulation to implement the above Act. The Committee also notes that the Ministry of Labour has formed a unit to coordinate national policies governing nursing personnel. In addition, the Committee notes with interest the Government's statement to the effect that special measures have been adopted to address the potential risks faced by nursing personnel of accidental contamination by the HIV virus and the documentation appended to the Government's report in this regard.

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

The Committee notes the Government's report and would request further information on the following points.

Article 2, paragraph 4 and Article 5, paragraph 1, of the Convention. The Committee notes that due to the Government's present policy of decentralizing the health services, an important number of nurses have been installed as area coordinators. It asks the Government to inform it about the details of this policy and about any improvements of the quantity and quality of nursing care available for the population. Please also indicate how this policy is coordinated with those relating to other workers in the health-care fields. Please also indicate how the consultation of nursing personnel in the re-established National Division of Nursing Personnel is functioning in practice.

Article 7. The Committee notes that the Collective Agreement of the Ecuadorian Institute of Social Security (IESS) is no longer in force. It asks the Government to indicate any measures taken to improve existing laws and regulations on occupational health and safety by adapting them to the special nature of nursing work and of the environment in which it is carried out.

Point V of the report form. The Committee notes the statistics provided with the Government's report. It requests the Government to continue to communicate such statistics and information on the practical application of the Convention, and on any difficulties encountered in its implementation.

Direct Request (CEACR) - adopted 1991, published 78th ILC session (1991)

Article 2, paragraph 4, and Article 5, paragraph 1, of the Convention. The Committee notes with interest from the Government's report and reply to its previous comments, that the National Division of Nursing Personnel has been re-established in the Ministry of Public Health, to promote the co-ordination of the national policy concerning nursing services and nursing personnel with other health policies of interest to such personnel, and to allow nurses to participate in the planning of nursing services. The Committee requests the Government to keep it informed of any new developments in this respect.

Article 7. Further to its previous comments, the Committee requests the Government to supply copies of the instructions foreseen under section 33 of the second collective agreement of the Ecuadorian Institute of Social Security (IESS), and of any other texts that may be issued on occupational health and safety of nursing personnel under Chapters V and VI of the Regulations respecting occupational health and safety.

The Committee takes note of the new Regulations on the organic structure of the Ministry of Public Health of 1986, and the statistics supplied under Point V of the Report Form. It requests the Government to continue to communicate such statistics and information on the practical application of the Convention and on any difficulties encountered.