Nursing Personnel Convention, 1977 (No. 149) - Azerbaijan (Ratification: 1992)

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

Articles 2(a) and (3) of the Convention. National policy concerning nursing services and nursing personnel. Nursing education and training. The Government reports on the implementation of the Health Sector Reform Project from 2006 to 2014, with the financial support of the World Bank. The objective of the Project was to improve overall the health system stewardship and financing, as well as to enhance equitable access to health services. The Project also sought to improve the technical and perceived quality of essential healthcare services in the selected districts, in a fiscally responsible and sustainable manner, with a view to improving health outcomes. The Project included a component on human resources development, divided into two subcomponents: (i) health workforce policy and planning; and (ii) health workforce education and training. The Committee notes the information included in the Implementation Report of 3 June 2014 on the World Bank Project concerning the measures taken to improve human resources in the health sector, including nursing personnel. Measures included: the development of a National Strategy for Human Resources in Health; a strategy for post graduate education and training programs; a certification program for healthcare professionals; and a strategy for strengthening professional associations in the health sector. In addition, the Government reports that three additional medical colleges were established in 2014 in the regions, to provide remote areas with qualified medical professionals. The Government adds that, in 2011, the nursing training programme was extended from two-and-a-half to three years and a new state standard was developed which updated the relevant curricula and academic programme for nursing personnel. The Committee notes that the Government does not provide a copy of the state standard. It notes that, according to the report, 55,396 nurses participated in professional development courses during the reporting period, while 33,846 participated in a certification process (of which 3,775 were recertified). Moreover, 60 health workers, including nursing personnel, were awarded medals and honorary titles, as part of a motivation campaign. The Committee notes that, in its concluding observations of 12 March 2015, the Committee on the Elimination of Discrimination against Women (CEDAW) noted Azerbaijan’s efforts to improve access to affordable healthcare services for all citizens, but remained concerned regarding inadequate State expenditure on health … poor healthcare infrastructure, especially in rural areas, and the inadequate skills of service providers (CEDAW/C/AZE/CO/5, paragraph 32). The Committee requests the Government to provide updated detailed information on the impact of the measures adopted, including in the framework of the Health Sector Reform Project, to ensure that nursing personnel are provided with education and training appropriate to the exercise of their functions. It also requests the Government to provide a copy of the national Strategy for Human Resources in Health. The Committee also reiterates its request to the Government to provide a copy of the 2011 state standard.

Articles 2(2)(b) and 5(2). Employment and working conditions of nursing personnel. Consultation. The Committee notes the adoption of the Presidential Orders of 29 August 2013, 18 January 2016 and 1 March 2018, each of which in turn increased the remuneration of health workers by 10 per cent. The Government reports that, as of 2018, the average monthly wage of a nurse was 171 Azerbaijani manat (AZN). The Committee observes that, according to the 3 May 2013 Report of the UN Special Rapporteur on the right to health, while health services are legally required to be free of charge in public health facilities in Azerbaijan, out-of-pocket payments, or payments for health-related goods and services made at the point of service delivery, including informal or so-called “envelope” payments, are prevalent in the Azerbaijani health system. The Special Rapporteur points out that the prevalence of the out-of-pocket payment practice is due in part to extensive corruption in the health system, and is also a consequence of the low salaries paid to doctors and other health workers, noting that, in 2011, the average monthly salary for health workers was 164 manats, representing less than half the average monthly salary for all workers in the country (364 manats). In order to supplement their low salaries, doctors and health workers, as a matter of uniform practice, collect informal payments from patients in return for health-related goods and service, resulting in an informal, unregulated system of fee-for-services (A/HRC/23/41/Add.1, paragraphs 19–20). The Government once again refers to the signing of a sectoral collective agreement for 2014–16 between the Ministry of Health and the trade union of healthcare workers. The Committee requests the Government to provide detailed updated information on the measures taken to facilitate retention of the nursing workforce through provision of remuneration packages and career prospects designed to attract and retain healthcare workers, including those measures adopted to tackle the practice of out-of-pocket payments in the health sector. The Committee reiterates its request that the Government provide a copy of the above-referenced sectoral collective agreement.

Part V of the report form. Application in practice. The Committee notes the Government’s indication that the nursing workforce decreased from 57,506 employees at the beginning of 2013 to 52,807 at the beginning of 2018, due to ongoing healthcare sector reforms. 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 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)

Articles 2 and 3 of the Convention. National policy concerning nursing services and nursing personnel – Nursing education and training. The Committee notes the information provided by the Government concerning the ongoing reform of the health-care sector, in particular the increase of the health-care budget by 15 times since independence in 1991, the reconstruction of 160 medical facilities in the last five years and the recent wage increases of health workers which were implemented by presidential orders of 2009, 2010 and 2011, and which raised the average monthly wage of a nurse from 113 Azerbaijani new manat (AZN) (approximately US$144) in 2009 to AZN142 (approximately US$181) in 2011. In this connection, the Committee also notes the Government’s reference to medals and honorary titles, such as the title of “distinguished medical worker” established by Presidential Decree of 13 June 2013, awarded to nursing personnel with a view to stimulating their work. The Committee further notes the Government’s reference to the sectoral collective agreement, concluded between the Ministry of Health and the trade union of health-care workers. The Committee requests the Government to continue to provide information on any practical measures designed to improve the employment and working conditions of nursing personnel, especially in terms of career prospects and remuneration, and to render the nursing profession more attractive. In addition, the Committee would appreciate receiving a copy of the above-referenced sectoral collective agreement.

Moreover, the Committee notes the Government’s indication that the nursing workforce decreased from 62,509 employees in 2009 to 57,506 in 2013 as a result of the health-care sector reform, and as a result the Government is now implementing a development programme for 2010–14 to address staff shortage in health-care institutions. The Committee understands that the development programme aims at encouraging young health professionals to work in rural areas and that special commissions have been established to oversee the recruitment of personnel under the programme. The Committee requests the Government to provide additional information on the implementation of the development programme and the results achieved.

With regard to nursing education and training, the Committee notes that there are currently eight public medical colleges operating in the country and that the duration of the nursing training programme was extended in 2011 from two-and-a-half to three years. It also notes that in 2011 a new state standard was adopted updating the relevant curricula and academic programmes. The Committee requests the Government to transmit a copy of the 2011 state standard, as well as a copy of Order No. 58 of 13 June 2013 on model instruction on labour protection for nurses working at state institutions, to which reference was made in its report.

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

Article 2, paragraphs 1 and 3, of the Convention. National policy on nursing services and nursing personnel. With regard to the Government’s earlier indication that a new national health-care policy was expected to be formulated in the context of the ongoing health-care sector reform, the Committee notes that the Government’s last report does not provide any further details on the reform process and its outcome. The Committee would be grateful if the Government would provide in its next report full particulars on the implementation of the health-care sector reform, especially as regards the adoption of a national health-care policy, and describe how this policy is designed to impact on the quality of nursing services and the employment and working conditions of nursing staff. It also requests the Government to specify whether and how the employers’ and workers’ organizations concerned have been associated with the formulation of the new national health-care policy, as required by this Article of the Convention.

Articles 3 and 4. Nursing education and training. The Committee notes the general information provided by the Government on secondary medical schools, the duration of nursing studies and the five-year cycle of nurses’ certification. It understands that there are currently eight nursing schools as well as one school for postgraduate nursing education. While noting this information, the Committee would appreciate if the Government would provide detailed and documented information – including copies of any relevant laws or regulations, administrative orders or circulars – on basic and higher nursing education, study curricula, types of specialization in nursing care, training and skills-development programmes, qualification requirements for the practice of the nursing profession or the renewal of an authorization to practise as well as any other particulars bearing on the system and standards of nursing education.

Article 2, paragraph 2(b), and Article 5, paragraph 2. Employment and working conditions of nursing personnel. Further to its previous comment, the Committee notes that remuneration levels for nursing personnel are now fixed by the Cabinet of Ministers Decree No. 2 of 9 January 2004 on the approval of the scheme, types and amounts of the salaries of the employees working in public health institutions financed from the State budget. The Committee requests the Government to transmit a copy of this Decree and to provide similar information on the remuneration levels currently practised in the private sector as well as an indication on the number of health-care establishments and the number of nursing personnel employed in the private sector. In addition, the Committee notes that according to a study of the World Health Organization (WHO), Health-care Systems in Transition – Azerbaijan, published in 2004, the average salary for health-care workers is the lowest of any economic sector. For instance, in 2001 the average monthly salary of a graduate nurse was about 52,000 manat (approximately US$65), or 25.4 per cent of the national average (205,000 manat, approximately US$255) and that of a junior nurse was 42,000 manat (approximately US$52), or 20.5 per cent of the national average. The Committee requests the Government to express its views in this regard and elaborate on any incentive schemes which may have been developed with a view to attracting persons to the profession and retaining them in it.

Article 7. Occupational health and safety of nursing personnel. The Committee recalls its previous comment in which it noted that special standards were being prepared for nursing personnel by the Ministry of Health in the form of occupational safety regulations and ministerial orders. It once again requests the Government to provide a brief overview of those standards and supply copies of the most relevant texts.

Part V of the report form. Application in practice. The Committee notes that according to the Government’s report, in 2007, the number of nursing personnel amounted to 33,400 persons. It also notes that according to the abovementioned WHO study, the number of nurses and support staff is declining gradually and the number of nurses per 1,000 population has diminished from ten in 1990 to seven in 2002. The Committee requests the Government to supply up to date information on the practical application of the Convention, including, for instance, statistical data and characteristics of the composition of the nursing workforce (e.g. age, gender), the number of nurses exiting or joining the profession every year, the nurse-to-population ratio, copies of official reports or studies addressing nursing-related issues, any practical difficulties experienced in the application of the Convention, such as shortage or migration of qualified nurses, etc.

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

The Committee notes the Government’s report which replies only partially to the points raised in previous comments.

Article 2, paragraphs 1 and 3, of the Convention. With reference to the Government’s earlier statement that the health sector is undergoing reform with a view to laying down the foundations of a national health-care policy, the Committee once again requests the Government to supply full particulars on any progress made to this end and to specify how it is ensured that the employers’ and workers’ organizations concerned are fully associated with the formulation of the new health-care policy. The Committee would be particularly interested in any measures designed to improve the quality of nursing services, especially in terms of increased motivation and productivity of nursing personnel.

Article 2, paragraph 2(a), and Article 3, paragraph 1. Further to its previous comment on nursing education and training, the Committee would appreciate receiving more detailed information on the levels, content and duration of nursing education, including copies of any legislative or administrative text regulating the operation of secondary medical schools, the list of nursing occupations and the certification of nursing personnel.

Article 2, paragraph 2(b), and Article 5, paragraph 2. The Committee recalls its previous comment in which it had requested the Government to provide a copy of the sectoral wage agreement concluded between the Ministry of Health and the Health Workers’ Union in May 1999. As this document has not been received, the Committee asks the Government to indicate whether the above agreement is still in force or has been replaced by another prescribing new pay scales for nursing personnel and to transmit a copy as appropriate. In this connection, the Committee would be grateful to the Government for providing 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 addition, the Committee requests the Government to report on any new developments concerning the expansion of the private health sector and to specify whether any collective agreement has already been concluded for determining the conditions of employment and work of nursing staff in private health-care institutions.

Article 7. With reference to the Government’s statement that special standards and regulations are being established for nursing personnel by means of occupational safety regulations and ministerial orders, the Committee would be grateful if the Government would provide a concise overview of those standards and supply copies of the most relevant texts.

Part V of the report form. The Committee requests the Government to continue providing general information on the manner in which the Convention is applied in practise, including statistics on the number of nursing staff by sectors of activity and by levels of training, and also to indicate any practical difficulties encountered in the implementation of the Convention. Furthermore, the Committee hopes that the Government will supply in its next report copies of all the texts which have not been transmitted previously to the Office, such as Order No. 219 of 25 November 1993 respecting the remuneration of health-care personnel financed out of the state budget and Order No. 10-1 of 25 March 1999 on compulsory arbitration.

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

The Committee notes the information provided by the Government in its reports.

Article 1, paragraph 3, of the Convention. The Committee notes that nursing services provided on a voluntary basis are not widespread in the country. It requests the Government to indicate any measure that is taken in future respecting nursing personnel working on a voluntary basis.

Article 2, paragraphs 1 and 3. The Committee notes from the information provided by the Government that the national policy respecting nursing services and personnel is based on the Constitution, the Labour Code and laws and regulations in the field of health. It also notes that the health sector is currently being reformed in Azerbaijan. The Committee therefore requests the Government to provide information on any national policy on nursing services which is implemented in this context, with an indication of the bodies responsible for its formulation and implementation. It also requests the Government to indicate the manner in which the employers’ and workers’ organizations concerned have been consulted in the context of the above policy.

Article 2, paragraph 2(a). The Committee notes that the training of nursing personnel is provided by specialized medical schools and through in-depth training courses, in accordance with the programmes approved with the Ministry of Health. It also notes that, in addition to specialized basic training, nursing personnel receive appropriate practical training. Finally, it notes that 3,008 intermediary-level nurses followed further training courses in 1999, or 5.3 per cent of the personnel in this category. It requests the Government to provide additional information on the content and duration of these programmes.

Article 2, paragraph 2(b). The Committee notes the information provided by the Government to the effect that Order No. 219 of 25 November 1993 issued by the Ministry of Health, respecting the remuneration of health-care personnel financed by the state budget, sets out the duties and wage scale of nursing personnel. It notes that there are different categories of nurses with different wage levels. The Committee notes the brief information provided concerning the careers of nursing personnel and requests the Government to provide fuller information on the career prospects of nursing personnel in the public and private sectors. Furthermore, it requests the Government to provide a copy of Order No. 219 of 25 November 1993.

Article 3, paragraph 2. The Committee notes that the training of nursing personnel is provided within the context of a unified education system, under the authority of the Ministry of Education. It notes the list of nursing occupations, the duration of training and the curricula are established by the Ministry of Health and approved by the Ministry of Education. The Committee requests the Government to indicate the manner in which nursing education and training are coordinated with the education and training of other workers in the field of health, in accordance with this paragraph of the Convention.

Article 4. The Committee notes that, according to the Government, the level of knowledge and experience required to provide medical care is determined by the national legislation. The Committee requests the Government to indicate the provisions of laws or regulations which determine the requirements for the provision of nursing care and services, and to provide copies of the relevant texts.

Article 5, paragraph 2. The Committee notes that the conditions respecting the remuneration of health-care personnel are covered by the sectoral wage agreement concluded by the Ministry of Health and the Republic Committee of Health Workers’ Unions in May 1999. It requests the Government to provide a copy of the above agreement. It also requests it to indicate the progress achieved in the development of the private health sector and to provide, where appropriate, copies of collective agreements determining the working conditions of nursing personnel in the private sector.

Article 5, paragraph 3. The Committee notes the information that the Labour Code includes strikes as one of the means of settling labour disputes, but that section 281 prescribes a number of service sectors that are vital to human health and safety, including the hospital sector, in which strikes are prohibited. It notes that, where the parties are unable to settle a dispute arising in one of these sectors by means of conciliation, they are referred to compulsory arbitration. It also notes that, on the basis of section 281 above, regulations respecting compulsory arbitration have been approved by Order No. 10-1 of the Ministry of Labour and Social Protection, dated 25 March 1999. The Committee therefore requests the Government to supply a copy of the above Order.

Article 6. The Committee notes that the conditions of work of nursing personnel in the areas of daily rest, educational leave, maternity leave, sickness leave and social security are governed by the general labour legislation. The Committee also requests the Government to provide a copy of the collective agreements, other than the above wage agreement (Article 5, paragraph 2), which are applicable in this respect to nursing personnel.

Article 7. The Committee notes the information provided by the Government on the measures taken to combat the spread of HIV. It requests the Government to provide a copy of the Act of 16 April 1996 and its regulations, as well as Instruction No. 210 of the Cabinet of Ministers, dated 20 October 1997, establishing a national programme for the prevention of the spread of HIV. The Committee also notes that special standards and regulations are currently being prepared for nursing personnel in view of the increasing number of regulations respecting occupational safety issued by the Ministry of Health. The Committee therefore requests the Government to continue providing information on the measures taken in this field and to provide copies of any relevant texts.

Part V of the report form. The Committee notes the information provided by the Government to the effect that there were 57,223 workers in the intermediary medical personnel category as of 1 January 2000, of whom 28,774 were nurses, corresponding to 713.8 and 358.9 employees in the respective categories for each 100,000 inhabitants. The Committee requests the Government to continue providing general information on the manner in which the Convention is applied in practice, including statistical data on the numbers of nursing personnel, the number of persons leaving the profession and the reasons given for their departure, any difficulties which may have been encountered in the implementation of the Convention, etc.

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

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:

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

Article 1, paragraph 3, of the Convention. Please supply a copy of the legal provisions relating to medical activities, including nursing care and services. Please also indicate any special measures that have been adopted respecting nursing personnel who give nursing care and services on a voluntary basis.

Article 2, paragraphs 1 and 3. Please provide information on the national policy concerning nursing services, with an indication of the bodies responsible for formulating and implementing the policy. Please also indicate the manner in which the employers' and workers' organizations concerned were consulted regarding the above policy.

Article 2, paragraph 2(a). Please indicate the measures taken to provide nursing personnel with education and training appropriate to the exercise of their functions.

Article 2, paragraph 2(b). Please indicate the legal provisions or regulations governing the working conditions of nursing personnel. Please also supply information on the career prospects of nursing personnel in the public and private sectors.

Article 2, paragraph 4. Please indicate the manner in which the coordination and consultation laid down in this paragraph are ensured.

Article 3, paragraph 2. Please indicate how the coordination called for in this paragraph is ensured.

Article 4. Please provide information on any laws or regulations specifying the requirements governing the practice of nursing and the provision of nursing care and services.

Article 5, paragraphs 1, 2 and 3. Please indicate the measures taken to promote the participation of nursing personnel in the planning of nursing services and the consultation with such personnel on decisions concerning them.

Article 5, paragraph 2. Please indicate the methods by which the conditions of employment and work of nursing personnel are determined and their results in the public and private sectors. Please also provide copies of any collective agreements establishing the conditions of work of nursing personnel in the private sector.

Article 5, paragraph 3. Please describe the procedures for the settlement of disputes applicable to nursing personnel in the public and private sectors, as well as the laws and/or regulations applicable in this context.

Article 6(a), (b), (c), (d) and (f). Please indicate whether, and by virtue of which measures, nursing personnel enjoy conditions that are at least equivalent to those of other workers in respect of: (a) hours of work; (b) weekly rest; (c) paid annual leave; (d) educational leave; and (f) sick leave. Please also provide copies of collective agreements applicable in this respect to nursing personnel.

Article 7. Please indicate all the measures which have been taken or are envisaged, particularly in consultation with employers' and workers' organizations, to take into account the special risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel.

Part V of the report form. Please provide general information on the manner in which the Convention is applied in practice, including, for example: statistics on the numbers of nursing personnel in relation to the population; the number of persons leaving the profession; any practical difficulties which may have been encountered in the implementation of the Convention, etc.

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

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

Article 1, paragraph 3, of the Convention. Please supply a copy of the legal provisions relating to medical activities, including nursing care and services. Please also indicate any special measures that have been adopted respecting nursing personnel who give nursing care and services on a voluntary basis.

Article 2, paragraphs 1 and 3. Please provide information on the national policy concerning nursing services, with an indication of the bodies responsible for formulating and implementing the policy. Please also indicate the manner in which the employers' and workers' organizations concerned were consulted regarding the above policy.

Article 2, paragraph 2(a). Please indicate the measures taken to provide nursing personnel with education and training appropriate to the exercise of their functions.

Article 2, paragraph 2(b). Please indicate the legal provisions or regulations governing the working conditions of nursing personnel. Please also supply information on the career prospects of nursing personnel in the public and private sectors.

Article 2, paragraph 4. Please indicate the manner in which the coordination and consultation laid down in this paragraph are ensured.

Article 3, paragraph 2. Please indicate how the coordination called for in this paragraph is ensured.

Article 4. Please provide information on any laws or regulations specifying the requirements governing the practice of nursing and the provision of nursing care and services.

Article 5, paragraphs 1, 2 and 3. Please indicate the measures taken to promote the participation of nursing personnel in the planning of nursing services and the consultation with such personnel on decisions concerning them.

Article 5, paragraph 2. Please indicate the methods by which the conditions of employment and work of nursing personnel are determined and their results in the public and private sectors. Please also provide copies of any collective agreements establishing the conditions of work of nursing personnel in the private sector.

Article 5, paragraph 3. Please describe the procedures for the settlement of disputes applicable to nursing personnel in the public and private sectors, as well as the laws and/or regulations applicable in this context.

Article 6(a), (b), (c), (d) and (f). Please indicate whether, and by virtue of which measures, nursing personnel enjoy conditions that are at least equivalent to those of other workers in respect of: (a) hours of work; (b) weekly rest; (c) paid annual leave; (d) educational leave; and (f) sick leave. Please also provide copies of collective agreements applicable in this respect to nursing personnel.

Article 7. Please indicate all the measures which have been taken or are envisaged, particularly in consultation with employers' and workers' organizations, to take into account the special risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel.

Point V of the report form. Please provide general information on the manner in which the Convention is applied in practice, including, for example: statistics on the numbers of nursing personnel in relation to the population; the number of persons leaving the profession; any practical difficulties which may have been encountered in the implementation of the Convention, etc.