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

Direct Request (CEACR) - adopted 2022, published 111st ILC session (2023)

Article 2 of the Convention. Formulation of a national policy concerning nursing services and nursing personnel. The Committee welcomes the adoption of the National Human Resource Policy and Strategies for Health (NHRPSH) in February 2020. The NHRPSH was developed with the support of the World Health Organization (WHO), and followed a participatory process, which included experts from different national institutions, regulatory bodies, the Christian Health Association of Ghana (CHAG), the private sector, non-governmental organizations (NGOs) and development partners. Its objective is to ensure the availability of a motivated health workforce that is equitably distributed and has the required knowledge, skills and competencies and attitude to provide the necessary quality health care at all levels. The Committee notes that, according to the NHRPSH, despite an increase in the number of categories of health workers, the country is facing challenges with regard to the distribution of the health workforce and ensuring that health workers reach the areas where their services are most needed. In this respect, the NHRPSH provides for the training and development of an adequate number and mix of health workers, as well as for the equitable distribution of such workers. The Committee further notes the Government’s indication that all health workers, including nursing personnel, have been placed on the single spine salary structure. The Committee requests the Government to provide detailed, up-to-date information, including disaggregated statistical data, on the nature and impact of specific measures taken in the context of the National Human Resource Policy and Strategies for Health (NHRPSH). In particular, the Committee requests the Government to provide detailed information on the implementation and impact of those measures designed to provide nursing personnel with employment and working conditions, including career prospects and remuneration, which are likely to attract persons to the profession and retain them in it, as well as to attract them to practice in rural and remote areas of the country. It further requests the Government to provide information regarding the consultations held with the social partners with respect to the formulation and implementation of the policy, as envisaged under Article 2 of the Convention.

Articles 2(2)(a) and 3. Nursing education and training. The Committee notes the Government’s indication that there are three levels of nursing education and training: pre-service training, which has been expanded to offer admission to more students; post-basic-training, where practicing nurses with diplomas or pre-diploma certificates may improve their skills; and post-graduate-training, where practicing degree nurses may enrol for specialized training. The Committee further notes that, according to the NHRPSH, certain challenges exist in relation to the education and training of health personnel. These include: a lack of alignment between the training provided and the needs of the various health delivery agencies, the limited number of avenues for the training of health personnel to enable them to practice in new and emerging service delivery areas, and an over-centralization of training at the postgraduate level. In addition, existing accreditation regimes have not been effectively enforced. In this context, the NHRPSH envisages the adoption of measures to develop education and training programmes aimed at: effectively addressing the projected training needs of health workers, developing appropriate skills for specific service areas, enhancing accessibility of postgraduate training to meet current and emerging health service delivery needs, as well as ensuring standardization and quality of training of health professionals. The Committee requests the Government to provide detailedupdated information on the nature, implementation, monitoring and impact of the measures adopted, including those adopted in the framework of the NHRPSH, to ensure that all categories of nursing personnel, including midwives, are provided with quality education and training appropriate to the exercise of their functions as well as to their professional career development.

Article 5(2).Negotiated determination of conditions of employment of nursing personnel. The Committee notes with interest the signing of a collective agreement between the health agencies and facilities under the Ministry of Health and the CHAG and the Ghana Registered Nurses and Midwives’ Association (GRNMA) in November 2020. The collective agreement sets out the conditions of employment for nurses and midwives in relation to salaries, allowances and benefits, hours of work and overtime, leave entitlements, training and other working conditions, with the aim of attracting, developing and maintaining an adequately trained and motivated nursing workforce. The collective agreement applies to all categories of workers covered by the collective bargaining certificate of the GRNMA and its allied associations. The Committee requests the Government to provide detailed updated information on the implementation in practice of the 2020 collective agreement regarding nursing personnel and its impact on attracting and keeping an adequate number of motivated qualified nursing personnel in the profession.

Article 7. Occupational safety and health (OSH). The Committee notes that one of the strategic objectives of the NHRPSH is to promote and maintain the highest degree of physical, mental, and social well-being among health workers. To this end, it envisages the adoption of measures to: ensure that all health agencies develop and implement comprehensive reinsurance systems to cater for the health needs of health workers and their families; harmonize all existing policies and guidelines on OSH and established systems to ensure the implementation of OSH regulations; and ensure the development and implementation of programmes to provide psychological support to health workers. The Committee further notes that section 21 of the 2020 collective agreement concerning nursing personnel includes a set of provisions aimed at ensuring the health, safety, and wellbeing of nurses, such as access to healthcare for nurses and their families (including treatment for nurses living with HIV) and the employer’s obligation to provide nurses with personal protective equipment (PPE) at no cost. Finally, the Government refers to the implementation of the revised workplace HIV and TB Policy and Technical Guidelines for the Health Sector 2020, which applies to all employees in the sector, including nurses, prospective health workers (both temporary and permanent workers), and patients in public, private and faith-based health institutions in Ghana. The Committee requests the Government to provide information on the nature and the impact of the measures taken to ensure the health, safety, and wellbeing of nursing personnel, including those adopted in the framework of the NHRPSH. It also requests the Government to provide detailed and up-to-date information on the number and results of the survey carried out to assess compliance with the 2020 collective agreement concerning nursing personnel.

Application in practice. The Committee notes that, according to statistical data made available by the WHO, in 2020 there were 95,789 nurses (1.70 per 10,000 population) and 16,700 midwives (5.37 per 10,000 population) practicing in Ghana. It further notes that in 2019, 73 per cent of nurses and 98.2 per cent of midwives were women. The Committee requests the Government to provide updated detailed information on the application of the Convention in practice, including statistical data disaggregated by sex, age and region concerning: the ratio of nursing personnel to the population; the number of persons enrolled in nursing schools; the number of female and male nurses who enter and leave the profession each year; the organization and the operation of all institutions which provide healthcare services; as well as official studies, surveys and reports addressing health workforce issues in the Ghanaian health sector.

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

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

Repetition

Article 2(1) of the Convention. Policy concerning nursing services and personnel. The Committee notes the indication by the Government in its report that a new Human Resource Strategic Plan for the Health Sector is under preparation. The Committee requests the Government to provide a copy of the latest version of the Human Resource Strategic Plan for the Health Sector.

Article 2(2)(b). Employment and working conditions of nursing personnel. In response to its previous request regarding the progress made under the Migration for Development in Africa (MIDA) Ghana Health Project, the Committee notes the Government’s report which states that the Fair Wages and Salaries Commission migrated 99 per cent of the public sector workers into the Single Spine Salary Structure, including nursing personnel, which has improved their conditions of service. The Government also states that it is addressing the migration issue by focusing on the nursing personnel’s wages and salary concerns through the introduction of the Public Sector Pay Policy (2009) and the MIDA Ghana Project. It adds that employers’ and workers’ organizations were involved in the process.

Article 3(1). Education and training of nursing personnel. In response to its previous comment concerning the decrease in the registration of nurses and midwifery personnel, the Committee notes the Government’s indication that it was a result of its own constant failure to implement the Single Spine Pay Policy but hopes that these concerns have now been addressed. The Committee requests the Government to indicate the concrete measures taken in this regard.

Article 5(2). Negotiated determination of conditions of employment of nursing personnel. The Committee notes the information provided by the Government in its report that a collective bargaining agreement has been issued to the Ghana Registered Nurses Association (GRNA) mandated to negotiate for better conditions of service on their behalf. The Committee requests the Government to provide a copy of the abovementioned collective bargaining agreement and any other collective bargaining agreements with other organizations representing nurses.

Article 7. Occupational safety and health of nursing personnel. In its previous comment, the Committee noted that the National Workplace HIV/AIDS Policy is of general applicability and covers nursing personnel. It recalls, however, that particular protection is required for nursing personnel who work directly with patients with HIV/AIDS. It notes that the Government’s report does not provide any information on this matter. The Committee once again requests the Government to provide additional information on any progress made with regard to the adoption of specific measures for the protection of nursing personnel who work directly with patients with HIV/AIDS.

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

The Committee notes with concern that the Government’s report has not been received. It expects that the next report will contain full information on the matters raised in its previous comments.

Repetition

Article 2(1) of the Convention. Policy concerning nursing services and personnel. The Committee notes the indication by the Government in its report that a new Human Resource Strategic Plan for the Health Sector is under preparation. The Committee requests the Government to provide a copy of the latest version of the Human Resource Strategic Plan for the Health Sector.

Article 2(2)(b). Employment and working conditions of nursing personnel. In response to its previous request regarding the progress made under the Migration for Development in Africa (MIDA) Ghana Health Project, the Committee notes the Government’s report which states that the Fair Wages and Salaries Commission migrated 99 per cent of the public sector workers into the Single Spine Salary Structure, including nursing personnel, which has improved their conditions of service. The Government also states that it is addressing the migration issue by focusing on the nursing personnel’s wages and salary concerns through the introduction of the Public Sector Pay Policy (2009) and the MIDA Ghana Project. It adds that employers’ and workers’ organizations were involved in the process.

Article 3(1). Education and training of nursing personnel. In response to its previous comment concerning the decrease in the registration of nurses and midwifery personnel, the Committee notes the Government’s indication that it was a result of its own constant failure to implement the Single Spine Pay Policy but hopes that these concerns have now been addressed. The Committee requests the Government to indicate the concrete measures taken in this regard.

Article 5(2). Negotiated determination of conditions of employment of nursing personnel. The Committee notes the information provided by the Government in its report that a collective bargaining agreement has been issued to the Ghana Registered Nurses Association (GRNA) mandated to negotiate for better conditions of service on their behalf. The Committee requests the Government to provide a copy of the abovementioned collective bargaining agreement and any other collective bargaining agreements with other organizations representing nurses.

Article 7. Occupational safety and health of nursing personnel. In its previous comment, the Committee noted that the National Workplace HIV/AIDS Policy is of general applicability and covers nursing personnel. It recalls, however, that particular protection is required for nursing personnel who work directly with patients with HIV/AIDS. It notes that the Government’s report does not provide any information on this matter. The Committee once again requests the Government to provide additional information on any progress made with regard to the adoption of specific measures for the protection of nursing personnel who work directly with patients with HIV/AIDS.

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

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

Repetition

Article 2(1) of the Convention. Policy concerning nursing services and personnel. The Committee notes the indication by the Government in its report that a new Human Resource Strategic Plan for the Health Sector is under preparation. The Committee requests the Government to provide a copy of the latest version of the Human Resource Strategic Plan for the Health Sector.

Article 2(2)(b). Employment and working conditions of nursing personnel. In response to its previous request regarding the progress made under the Migration for Development in Africa (MIDA) Ghana Health Project, the Committee notes the Government’s report which states that the Fair Wages and Salaries Commission migrated 99 per cent of the public sector workers into the Single Spine Salary Structure, including nursing personnel, which has improved their conditions of service. The Government also states that it is addressing the migration issue by focusing on the nursing personnel’s wages and salary concerns through the introduction of the Public Sector Pay Policy (2009) and the MIDA Ghana Project. It adds that employers’ and workers’ organizations were involved in the process.

Article 3(1). Education and training of nursing personnel. In response to its previous comment concerning the decrease in the registration of nurses and midwifery personnel, the Committee notes the Government’s indication that it was a result of its own constant failure to implement the Single Spine Pay Policy but hopes that these concerns have now been addressed. The Committee requests the Government to indicate the concrete measures taken in this regard.

Article 5(2). Negotiated determination of conditions of employment of nursing personnel. The Committee notes the information provided by the Government in its report that a collective bargaining agreement has been issued to the Ghana Registered Nurses Association (GRNA) mandated to negotiate for better conditions of service on their behalf. The Committee requests the Government to provide a copy of the abovementioned collective bargaining agreement and any other collective bargaining agreements with other organizations representing nurses.

Article 7. Occupational safety and health of nursing personnel. In its previous comment, the Committee noted that the National Workplace HIV/AIDS Policy is of general applicability and covers nursing personnel. It recalls, however, that particular protection is required for nursing personnel who work directly with patients with HIV/AIDS. It notes that the Government’s report does not provide any information on this matter. The Committee once again requests the Government to provide additional information on any progress made with regard to the adoption of specific measures for the protection of nursing personnel who work directly with patients with HIV/AIDS.

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

Article 2(1) of the Convention. Policy concerning nursing services and personnel. The Committee notes the indication by the Government in its report that a new Human Resource Strategic Plan for the Health Sector is under preparation. The Committee requests the Government to provide a copy of the latest version of the Human Resource Strategic Plan for the Health Sector.

Article 2(2)(b). Employment and working conditions of nursing personnel. In response to its previous request regarding the progress made under the Migration for Development in Africa (MIDA) Ghana Health Project, the Committee notes the Government’s report which states that the Fair Wages and Salaries Commission migrated 99 per cent of the public sector workers into the Single Spine Salary Structure, including nursing personnel, which has improved their conditions of service. The Government also states that it is addressing the migration issue by focusing on the nursing personnel’s wages and salary concerns through the introduction of the Public Sector Pay Policy (2009) and the MIDA Ghana Project. It adds that employers’ and workers’ organizations were involved in the process.

Article 3(1). Education and training of nursing personnel. In response to its previous comment concerning the decrease in the registration of nurses and midwifery personnel, the Committee notes the Government’s indication that it was a result of its own constant failure to implement the Single Spine Pay Policy but hopes that these concerns have now been addressed. The Committee requests the Government to indicate the concrete measures taken in this regard.

Article 5(2). Negotiated determination of conditions of employment of nursing personnel. The Committee notes the information provided by the Government in its report that a collective bargaining agreement has been issued to the Ghana Registered Nurses Association (GRNA) mandated to negotiate for better conditions of service on their behalf. The Committee requests the Government to provide a copy of the abovementioned collective bargaining agreement and any other collective bargaining agreements with other organizations representing nurses.

Article 7. Occupational safety and health of nursing personnel. In its previous comment, the Committee noted that the National Workplace HIV/AIDS Policy is of general applicability and covers nursing personnel. It recalls, however, that particular protection is required for nursing personnel who work directly with patients with HIV/AIDS. It notes that the Government’s report does not provide any information on this matter. The Committee once again requests the Government to provide additional information on any progress made with regard to the adoption of specific measures for the protection of nursing personnel who work directly with patients with HIV/AIDS.

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

The Committee notes that the Government’s report has not been received. It hopes that a report will be supplied for examination by the Committee at its next session and that it will contain full information on the matters raised in its previous direct request, which read as follows:

Repetition

Article 2(1) of the Convention. Policy concerning nursing services and personnel. The Committee understands that a Human Resources Strategic Plan for the Health Sector was adopted. It requests the Government to provide a copy of the latest version of this document, and to keep the Office informed of any progress made in the implementation of the policies and strategies set out therein.

Article 2(2)(b). Employment and working conditions of nursing personnel. The Committee notes the information provided by the Government concerning its efforts to address the issue of health workers’ migration through various initiatives, such as the MIDA Ghana Health Project, in collaboration with the International Organization for Migration (IOM), or the adoption of the Single Spine Salary Structure, a unified pay structure for different categories of public sector workers.

With respect to the MIDA Ghana Health Project, the Committee understands that its third phase was launched in June 2008 for a duration of four years, which aims at facilitating 150 temporary returns of health professionals working overseas, ten interns sent abroad and at facilitating long-term returns of health workers, with a view to taking advantage of the available skills, expertise and experience of migrant Ghanaian health professionals, contributing to the capacity building of health workers in Ghana and to building cooperation between Ghana and the recipient countries. It also notes the Government’s indication that the project, during its previous phase from January 2005 to March 2008, has achieved, among others, 66 temporary returns, 75 migrant professionals registered in Ghana, five interns sent to Europe and 7,264 health workers trained. The Committee requests the Government to explain the progress made during the MIDA Ghana Health Project.

With respect to the Single Spine Pay Policy, while understanding that the pay structure involves the increase in wages of 16.5 and 34 per cent, the Committee asks the Government to explain how organizations of health professionals, especially those of nursing personnel such as the Ghana Registered Nurses Association (GRNA) or the Ghana Registered Midwives Association (GRMA), or consultative bodies such as the Nurses and Midwives Council, were involved in the process of adoption of the Single Spine Salary Structure, and how it is ensured that the unification of pay structure under the Single Spine Salary Structure does not affect public sector workers, especially nursing personnel workers, to their disadvantage.

The Committee notes other efforts made with respect to controlling the brain drain of Ghanaian health professionals, such as those by the GRNA to restrict health workers who have not served for five years from being verified to work overseas. It requests the Government to continue monitoring the situation of health professionals migrating overseas and to keep the Office informed on this point, as well as any measures taken or envisaged to respond to this issue.

Article 3(1). Education and training of nursing personnel. The Committee notes the statistical information provided by the Government on the number of enrolments to the nursing and midwifery training schools, which indicates a constant increase during the period 2004–07. On the other hand, it notes that the total number of nurses and midwives registered by the Nurses and Midwives Council continue to decrease during the same period. It would appreciate if the Government could explain the reasons for this decrease.

Article 5(2). Negotiated determination of conditions of employment of nursing personnel. The Committee notes the indication by the Government that the GRNA currently registers no collective bargaining agreements. It requests the Government to provide a copy of collective bargaining agreements registered with the Health Service Workers’ Union under the Ghana Trades Union Congress, as it is not yet made available to the Office.

Article 7. Occupational safety and health of nursing personnel. The Committee notes a copy of the National Workplace HIV/AIDS Policy and the Annual Programme of Work 2008 of the Ghana AIDS Commission. In particular, it notes that these documents do not appear to contain policies or programmes specifically targeting nursing personnel. While noting the Government’s explanation that the policy is of general applicability, thereby covering nursing personnel as well, the Committee ventures to request the Government to consider having specific policies or programmes as part of the abovementioned policy and programme, since particular protection is required for nursing personnel, who work directly with patients with HIV/AIDS.

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

Article 2, paragraph 1, of the Convention. Policy concerning nursing services and personnel. The Committee understands that a new Human Resources Strategic Plan for the Health Sector was adopted covering the period 2007–11. It requests the Government to provide a copy of this document, and to keep the Office informed of any progress made in the implementation of the policies and strategies set out therein.

Article 2, paragraph 2(b). Employment and working conditions of nursing personnel. The Committee notes the information provided by the Government concerning its efforts to address the issue of health workers’ migration through various initiatives, such as the MIDA Ghana Health Project, in collaboration with the International Organization for Migration (IOM), or the adoption of the Single Spine Salary Structure, a unified pay structure for different categories of public sector workers.

With respect to the MIDA Ghana Health Project, the Committee understands that its third phase was launched in June 2008 for a duration of four years, which aims at facilitating 150 temporary returns of health professionals working overseas, ten interns sent abroad and at facilitating long-term returns of health workers, with a view to taking advantage of the available skills, expertise and experience of migrant Ghanaian health professionals, contributing to the capacity building of health workers in Ghana and to building cooperation between Ghana and the recipient countries. It also notes the Government’s indication that the project, during its previous phase from January 2005 to March 2008, has achieved, among others, 66 temporary returns, 75 migrant professionals registered in Ghana, five interns sent to Europe and 7,264 health workers trained. The Committee requests the Government to keep the Office informed of the progress made during the third phase of the MIDA Ghana Health Project.

With respect to the Single Spine Pay Policy, while understanding that the pay structure involves the increase in wages of 16.5 and 34 per cent, the Committee asks the Government to explain how organizations of health professionals, especially those of nursing personnel such as the Ghana Registered Nurses Association (GRNA) or the Ghana Registered Midwives Association (GRMA), or consultative bodies such as the Nurses and Midwives Council, were involved in the process of adoption of the Single Spine Salary Structure, and how it is ensured that the unification of pay structure under the Single Spine Salary Structure does not affect public sector workers, especially nursing personnel workers, to their disadvantage.

The Committee notes other efforts made with respect to controlling the brain drain of Ghanaian health professionals, such as those by the GRNA to restrict health workers who have not served for five years from being verified to work overseas. It requests the Government to continue monitoring the situation of health professionals migrating overseas and to keep the Office informed on this point, as well as any measures taken or envisaged to respond to this issue.

Article 3, paragraph 1. Education and training of nursing personnel. The Committee notes the statistical information provided by the Government on the number of enrolments to the nursing and midwifery training schools, which indicates a constant increase during the period 2004–07. On the other hand, it notes that the total number of nurses and midwives registered by the Nurses and Midwives Council continue to decrease during the same period. It would appreciate if the Government could explain the reasons for this decrease.

Article 5, paragraph 2. Negotiated determination of conditions of employment of nursing personnel. The Committee notes the indication by the Government that the GRNA currently registers no collective bargaining agreements. It requests the Government to provide a copy of collective bargaining agreements registered with the Health Service Workers’ Union under the Ghana Trades Union Congress, as it is not yet made available to the Office.

Article 7. Occupational safety and health of nursing personnel. The Committee notes a copy of the National Workplace HIV/AIDS Policy and the Annual Programme of Work 2008 of the Ghana AIDS Commission. In particular, it notes that these documents do not appear to contain policies or programmes specifically targeting nursing personnel. While noting the Government’s explanation that the policy is of general applicability, thereby covering nursing personnel as well, the Committee ventures to request the Government to consider having specific policies or programmes as part of the abovementioned policy and programme, since particular protection is required for nursing personnel, who work directly with patients with HIV/AIDS.

Part V of the report form. Application in practice. The Committee notes the statistical information provided by the Government concerning the number of nurses and their ratio to the population and the evolution in the number of female nursing personnel who have applied for the verification of their registration, which is normally considered as the manifestation of their intent to work abroad. The Committee would be grateful if the Government would continue supplying up to date information and documents concerning the practical application of the Convention.

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. The Committee notes the Government’s explanations on the Additional Duty Hours Allowance and its method of calculation. The Committee understands that this allowance permits to increase the basic wage of a nurse from about 800,000 cedis (US$90) to 1.5 million cedis (US$170) and accordingly helps to retain many staff who would otherwise not resist calls from recruitment agencies to accept salaries up to 20 times higher abroad. At the same time, recent studies show that annual figures on Ghanaian nurses’ intention to migrate almost double the replacement rates from training while Ghanaian health workers in general (including doctors, pharmacists and laboratory technicians) show one of the highest levels of intention to migrate (61.6 per cent) in sub-Saharan Africa. Under the circumstances, the Committee considers that preserving its nursing workforce should be the Government’s primary goal in the field of health-care policy and therefore every possible step should be taken to address the concerns of nursing personnel, especially as regards adequate remuneration levels and motivating working conditions. The Committee asks the Government to closely monitor the evolution of the situation regarding health worker migration and to report on the impact any further incentive schemes may have on stemming the migration flow.

Article 3, paragraph 1. The Committee notes the information on the introduction of direct midwifery training and asks the Government to continue to provide information on measures relating to nursing education and training as may be taken in consultation with the Nurses and Midwives Council.

Article 5, paragraph 2. Recalling that the last time the Government provided copies of collective agreements applicable to nursing personnel was in 1992, the Committee requests the Government to transmit together with its next report copies of all collective bargaining agreements currently in effect and to specify the approximate number of health-care workers covered by those instruments.

Article 7. The Committee notes with interest the establishment by Act No. 613 of 2002, of the Ghana AIDS Commission (GAC) as a supra-ministerial and multi-sectoral body to coordinate programmes and activities of all stakeholders (ministries, departments, agencies, the private sector, development partners, NGOs, community-based organizations and civil society) in the fight against HIV/AIDS. It also notes that the heads of the Ghana Registered Nurses Association (GRNA) and the Ghana Registered Midwives Association (GRMA) are members of the Commission. The Committee requests the Government to supply additional information on the programmes and objectives of the GAC, including any specific initiative undertaken with respect to protection of nursing personnel from HIV infection.

Part V of the report form. The Committee notes that according to some accounts, nursing migration is intensifying and as a result more than 60 per cent of nursing positions remain unfilled even though nursing schools train about 600 nurses per year. As a 2002 report on the state of the Ghanaian economy indicated, 3,157 health workers left the country between 1993 and 2002, which represented over 31 per cent of health professionals trained in Ghana in the same period. The Committee is led to understand that at present there are only 10,000 nurses (as compared to over 20,000 nurses some 15 years ago) taking care of a population of about 19 million. The Committee would be grateful to the Government for supplying additional information on any concrete efforts to address the problem of a shortage of nurses, especially by adopting incentive measures to retain qualified professionals in the health sector. 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 2004, published 93rd ILC session (2005)

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:

Article 2, paragraphs 1 and 2(b), of the Convention. The Committee notes with interest the measures taken by the Government to train nursing personnel at higher levels of education, including university, and asks it to continue to provide information in this regard. It also notes the information that graduates are more attracted to work in the private sector or abroad than in the public sector and that the Government’s response has been to initiate an incentives scheme called "Additional duty hours allowance" designed to motivate nurses in the public sector. The Committee asks the Government to provide particulars of the content of this incentive scheme.

Article 2, paragraph 4. The Committee notes that, following the structural reform of the health service, nursing care services are coordinated with other aspects of health care and other workers in the field of health. It also notes the information that consultations in this respect were carried out with the employers’ and workers’ organizations concerned. The Committee asks the Government to provide further information on the arrangements for the abovementioned coordination and the procedures and framework in which the consultations provided for by this Article of the Convention are conducted.

Article 7. The Committee notes the information supplied by the Government concerning the code of practice regulating protection against ionizing radiations, and asks the Government to provide a copy of it. In its previous direct request, the Committee noted that new measures were still envisaged, in the context of negotiations for a collective agreement, to improve occupational safety and health of nursing personnel. The Committee therefore asks the Government to provide information on developments in this area. With regard to measures designed to take account of the particular risk for nursing personnel of accidental exposure to the human immunodeficiency virus (HIV), the Committee notes the draft Labour Code, currently before Parliament, provides for special protection of nursing personnel against HIV infection. The Committee asks the Government to provide the International Labour Office with a copy of the new Code as soon as it has been adopted. The Government is also asked to indicate whether the employers’ and workers’ organizations concerned have been consulted, in accordance with this provision of the Convention.

Part V of the report form. The Committee asks the Government to continue to provide general information on the manner in which the Convention is applied in practice, together with statistics on the strength of nursing personnel. It also asks the Government to provide a copy of all relevant documents not yet sent, such as laws, regulations, collective agreements or reports of the Nurses and Midwives Council, etc.

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

The Committee notes that the Government’s report has not been received. It hopes that a report will be supplied for examination by the Committee at its next session and that it will contain full information on the matters raised in its previous direct request, which read as follows:

Article 2, paragraphs 1 and 2(b), of the Convention. The Committee notes with interest the measures taken by the Government to train nursing personnel at higher levels of education, including university, and asks it to continue to provide information in this regard. It also notes the information that graduates are more attracted to work in the private sector or abroad than in the public sector and that the Government’s response has been to initiate an incentives scheme called "Additional duty hours allowance" designed to motivate nurses in the public sector. The Committee asks the Government to provide particulars of the content of this incentive scheme.

Article 2, paragraph 4. The Committee notes that, following the structural reform of the health service, nursing care services are coordinated with other aspects of health care and other workers in the field of health. It also notes the information that consultations in this respect were carried out with the employers’ and workers’ organizations concerned. The Committee asks the Government to provide further information on the arrangements for the abovementioned coordination and the procedures and framework in which the consultations provided for by this Article of the Convention are conducted.

Article 7. The Committee notes the information supplied by the Government concerning the code of practice regulating protection against ionizing radiations, and asks the Government to provide a copy of it. In its previous direct request, the Committee noted that new measures were still envisaged, in the context of negotiations for a collective agreement, to improve occupational safety and health of nursing personnel. The Committee therefore asks the Government to provide information on developments in this area. With regard to measures designed to take account of the particular risk for nursing personnel of accidental exposure to the human immunodeficiency virus (HIV), the Committee notes the draft Labour Code, currently before Parliament, provides for special protection of nursing personnel against HIV infection. The Committee asks the Government to provide the International Labour Office with a copy of the new Code as soon as it has been adopted. The Government is also asked to indicate whether the employers’ and workers’ organizations concerned have been consulted, in accordance with this provision of the Convention.

Part V of the report form. The Committee asks the Government to continue to provide general information on the manner in which the Convention is applied in practice, together with statistics on the strength of nursing personnel. It also asks the Government to provide a copy of all relevant documents not yet sent, such as laws, regulations, collective agreements or reports of the Nurses and Midwives Council, etc.

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

The Committee notes the information supplied by the Government in its reports. It asks the Government to provide further particulars on the following points.

Article 2, paragraphs 1 and 2(b), of the Convention. The Committee notes with interest the measures taken by the Government to train nursing personnel at higher levels of education, including university, and asks it to continue to provide information in this regard. It also notes the information that graduates are more attracted to work in the private sector or abroad than in the public sector and that the Government’s response has been to initiate an incentives scheme called "Additional duty hours allowance" designed to motivate nurses in the public sector. The Committee asks the Government to provide particulars of the content of this incentive scheme.

Article 2, paragraph 4. The Committee notes that, following the structural reform of the health service, nursing care services are coordinated with other aspects of health care and other workers in the field of health. It also notes the information that consultations in this respect were carried out with the employers’ and workers’ organizations concerned. The Committee asks the Government to provide further information on the arrangements for the abovementioned coordination and the procedures and framework in which the consultations provided for by this Article of the Convention are conducted.

Article 7. The Committee notes the information supplied by the Government concerning the code of practice regulating protection against ionizing radiations, and asks the Government to provide a copy of it. In its previous direct request, the Committee noted that new measures were still envisaged, in the context of negotiations for a collective agreement, to improve occupational safety and health of nursing personnel. The Committee therefore asks the Government to provide information on developments in this area. With regard to measures designed to take account of the particular risk for nursing personnel of accidental exposure to the human immunodeficiency virus (HIV), the Committee notes the draft Labour Code, currently before Parliament, provides for special protection of nursing personnel against HIV infection. The Committee asks the Government to provide the International Labour Office with a copy of the new Code as soon as it has been adopted. The Government is also asked to indicate whether the employers’ and workers’ organizations concerned have been consulted, in accordance with this provision of the Convention.

Part V of the report form. The Committee asks the Government to continue to provide general information on the manner in which the Convention is applied in practice, together with statistics on the strength of nursing personnel. It also asks the Government to provide a copy of all relevant documents not yet sent, such as laws, regulations, collective agreements or reports of the Nurses and Midwives Council, etc.

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:

Article 2, paragraphs 1 and 2(b), of the Convention.  The Committee notes with interest the measures taken by the Government in improving nursing training. Until December 1986, 515 nurses had benefited from various nursing training geared to attainment of a higher level of nursing care. It requests the Government to continue to supply information on any developments in this respect.

Article 2, paragraph 4.  The Committee notes from the Government’s report that although appropriate consultations are being made in respect of policies affecting nursing services and nursing personnel, these policies are not coordinated with policies relating to other aspects of health care and to other workers in the field of health. It requests the Government to indicate, in accordance with the provisions of the Convention, the measures which have been taken or contemplated to ensure that the policy concerning nursing services and nursing personnel be coordinated with policies relating to other aspects of health care and to other workers in the field of health, in consultation with the employers’ and workers’ organizations concerned.

Article 7.  The Committee notes that new measures, in the context of negotiating a collective agreement to improve occupational health and safety of nursing personnel, are still under consideration. It requests the Government to provide information on any progress achieved in this respect. Furthermore, with reference to its general observation of 1990, which was reiterated in 1994, the Committee requests the Government to indicate the measures which have been taken or envisaged, in consultation with the employers’ and workers’ organizations concerned, to take into account the particular risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel: for example, by the arrangement of working conditions, confidentiality of test results, recognition that the cause of infection was occupational, etc.

Part V of the report form.  The Committee requests the Government to supply, if possible, data on the number of persons leaving the profession and to indicate any practical difficulties encountered in the implementation of the Convention.

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 takes note of the information supplied in the Government's report in reply to its previous comments.

Article 2, paragraphs 1 and 2(b), of the Convention. The Committee notes with interest the measures taken by the Government in improving nursing training. Until December 1986, 515 nurses had benefited from various nursing training geared to attainment of a higher level of nursing care. It requests the Government to continue to supply information on any developments in this respect.

Article 2, paragraph 4. The Committee notes from the Government's report that although appropriate consultations are being made in respect of policies affecting nursing services and nursing personnel, these policies are not coordinated with policies relating to other aspects of health care and to other workers in the field of health. It requests the Government to indicate, in accordance with the provisions of the Convention, the measures which have been taken or contemplated to ensure that the policy concerning nursing services and nursing personnel be coordinated with policies relating to other aspects of health care and to other workers in the field of health, in consultation with the employers' and workers' organizations concerned.

Article 7. The Committee notes that new measures, in the context of negotiating a collective agreement to improve occupational health and safety of nursing personnel, are still under consideration. It requests the Government to provide information on any progress achieved in this respect. Furthermore, with reference to its general observation of 1990, which was reiterated in 1994, the Committee requests the Government to indicate the measures which have been taken or envisaged, in consultation with the employers' and workers' organizations concerned, to take into account the particular risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel: for example, by the arrangement of working conditions, confidentiality of test results, recognition that the cause of infection was occupational, etc.

Part V of the report form. The Committee requests the Government to supply, if possible, data on the number of persons leaving the profession and to indicate any practical difficulties encountered in the implementation of the Convention.

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

The Committee takes note of the information supplied in the Government's report in reply to its previous comments.

Article 2, paragraphs 1 and 2(b) of the Convention. The Committee notes with interest the measures taken by the Government in improving nursing training. Until December 1986, 515 nurses had benefited from various nursing training geared to attainment of a higher level of nursing care. It requests the Government to continue to supply information on any developments in this respect.

Article 2, paragraph 4. The Committee notes from the Government's report that although appropriate consultations are being made in respect of policies affecting nursing services and nursing personnel, these policies are not coordinated with policies relating to other aspects of health care and to other workers in the field of health. It requests the Government to indicate, in accordance with the provisions of the Convention, the measures which have been taken or contemplated to ensure that the policy concerning nursing services and nursing personnel be coordinated with policies relating to other aspects of health care and to other workers in the field of health, in consultation with the employers' and workers' organizations concerned.

Article 7. The Committee notes that new measures, in the context of negotiating a collective agreement to improve occupational health and safety of nursing personnel, are still under consideration. It requests the Government to provide information on any progress achieved in this respect. Furthermore, with reference to its General Observation of 1990, which was reiterated in 1994, the Committee requests the Government to indicate the measures which have been taken or envisaged, in consultation with the employers' and workers' organizations concerned, to take into account the particular risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel: for example, by the arrangement of working conditions, confidentiality of test results, recognition that the cause of infection was occupational, etc.

Point V of the report form. The Committee requests the Government to supply, if possible, data on the number of persons leaving the profession and to indicate any practical difficulties encountered in the implementation of the Convention.

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

The Committee noted 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:

The Committee requests the Government to provide additional information on the following points:

Article 2, paragraph 1, of the Convention. According to the report, the Government's policy and its efforts aim at improving the quality of nursing care, by adjusting nursing training to the country's needs. The Committee would appreciate receiving information on the results achieved so far, including statistics on the number of nursing personnel trained and on the impact of this increased training on the number of nursing posts in the country.

Article 2, paragraph 2(b). Please indicate whether any measures have been taken to ensure that the classification of nursing personnel for remuneration purposes may attract persons to the profession and retain them in it.

Article 2, paragraph 4. The Committee would appreciate receiving information on the manner in which the policy concerning nursing services and nursing personnel is coordinated with policies relating to other aspects of health care and to other workers in the field of health.

Article 6(d). The Committee requests the Government to supply information and the texts applicable to educational leave for nursing personnel, since the Labour Regulations 1969 referred to in the report contain no provision on this point.

Article 7. The Committee noted that new measures are under consideration, in the context of negotiating a collective agreement, to improve occupational health and safety of nursing personnel. It requests the Government to keep it informed of any progress achieved in this respect.

Direct Request (CEACR) - adopted 1995, published 83rd ILC session (1996)

The Committee noted with regret that the Government's report has not been received. It hopes again that a report will be supplied for examination by the Committee at its next session and that it will contain full information on the following matters raised in its previous direct request:

Article 2, paragraph 1, of the Convention. According to the report, the Government's policy and its efforts aim at improving the quality of nursing care, by adjusting nursing training to the country's needs. The Committee would appreciate receiving information on the results achieved so far, including statistics on the number of nursing personnel trained and on the impact of this increased training on the number of nursing posts in the country.

Article 2, paragraph 2(b). Please indicate whether any measures have been taken to ensure that the classification of nursing personnel for remuneration purposes may attract persons to the profession and retain them in it.

Article 2, paragraph 4. The Committee would appreciate receiving information on the manner in which the policy concerning nursing services and nursing personnel is coordinated with policies relating to other aspects of health care and to other workers in the field of health.

Article 6(d). The Committee requests the Government to supply information and the texts applicable to educational leave for nursing personnel, since the Labour Regulations 1969 referred to in the report contain no provision on this point.

Article 7. The Committee noted that new measures are under consideration, in the context of negotiating a collective agreement, to improve occupational health and safety of nursing personnel. It requests the Government to keep it informed of any progress achieved in this respect.

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

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:

The Committee requests the Government to provide additional information on the following points:

Article 2, paragraph 1, of the Convention. According to the report, the Government's policy and its efforts aim at improving the quality of nursing care, by adjusting nursing training to the country's needs. The Committee would appreciate receiving information on the results achieved so far, including statistics on the number of nursing personnel trained and on the impact of this increased training on the number of nursing posts in the country.

Article 2, paragraph 2(b). Please indicate whether any measures have been taken to ensure that the classification of nursing personnel for remuneration purposes may attract persons to the profession and retain them in it.

Article 2, paragraph 4. The Committee would appreciate receiving information on the manner in which the policy concerning nursing services and nursing personnel is coordinated with policies relating to other aspects of health care and to other workers in the field of health.

Article 6(d). The Committee requests the Government to supply information and the texts applicable to educational leave for nursing personnel, since the Labour Regulations 1969 referred to in the report contain no provision on this point.

Article 7. The Committee noted that new measures are under consideration, in the context of negotiating a collective agreement, to improve occupational health and safety of nursing personnel. It requests the Government to keep it informed of any progress achieved in this respect.

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

The Committee notes the report of the Government and its reply to the Committee's previous comments concerning Article 1, paragraph 2, Article 5, paragraphs 2 and 3, of the Convention. It requests the Government to provide additional information on the following points:

Article 2, paragraph 1, of the Convention. According to the report, the Government's policy and its efforts aim at improving the quality of nursing care, by adjusting nursing training to the country's needs. The Committee would appreciate receiving information on the results achieved so far, including statistics on the number of nursing personnel trained and on the impact of this increased training on the number of nursing posts in the country.

Article 2, paragraph 2(b). Please indicate whether any measures have been taken to ensure that the classification of nursing personnel for remuneration purposes may attract persons to the profession and retain them in it.

Article 2, paragraph 4. The Committee would appreciate receiving information on the manner in which the policy concerning nursing services and nursing personnel is coordinated with policies relating to other aspects of health care and to other workers in the field of health.

Article 6(d). The Committee requests the Government to supply information and the texts applicable to educational leave for nursing personnel, since the Labour Regulations 1969 referred to in the report contain no provision on this point.

Article 7. The Committee notes with interest that new measures are under consideration, in the context of negotiating a collective agreement, to improve occupational health and safety of nursing personnel. It requests the Government to keep it informed of any progress achieved in this respect.

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

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 has taken note of the Government's first report and would appreciate further information on the following points:

Article 1, paragraph 2, of the Convention. The Committee notes that the information supplied by the Government refers to nursing personnel in the public sector. Bearing in mind that the Convention covers "all nursing personnel wherever they work", please specify in what manner and under what legal or conventional provisions the Convention is applied in the private sector. Please provide a copy of these provisions and the text of the Nurses Ordinance (Cap. 71).

Article 2, paragraph 1. Please indicate whether measures have been taken in practice with a view to drawing up and implementing a policy on nursing services and personnel within the framework of a general health programme to improve nursing care both as to quantity and quality and to raise the standard of health among the population.

Article 2, paragraph 2(b). Please indicate whether measures have been taken in conformity with the above-mentioned provision of the Convention to provide nursing personnel in both the public and the private sectors with employment and working conditions including career prospects and remuneration likely to attract persons to the profession and retain them in it. Please specify in particular the measures taken to ensure that the classification of nursing personnel for remuneration purposes corresponds to that of worker categories whose work while of a different nature in practice is of equal value.

Article 2, paragraphs 3 and 4. Please indicate whether there are trade union organisations for nursing personnel in the public and private sectors and if so specify: (a) whether these organisations are consulted when the national policy concerning nursing services and personnel is being formulated; and (b) how is this policy co-ordinated with policies relating to other aspects of health care and to other workers in the field of health.

Article 5, paragraph 1. Please indicate whether nursing personnel both in the public and the private sector can participate in the planning of nursing services and whether they are consulted on decisions concerning them in the hospital establishments where they work.

Article 5, paragraph 2. Please indicate whether there are collective agreements which determine conditions of employment and work for nursing personnel and if so please supply a copy.

Article 5, paragraph 3. The Government indicates in its report that there is no procedure for the settlement of disputes arising in connection with the determination of working conditions for nursing personnel in the public sector and it adds that the Civil Servants' Association of Ghana represents the interests of nursing personnel in such cases. The Committee would be grateful if the Government would provide more comprehensive information on the bargaining machinery for public servants to which it refers and to indicate also whether the procedure for settling disputes provided for in the Labour Decree of 1967, amended in 1969, applies also to nursing personnel in the private sector.

Article 6. The Government indicates in its report that nursing personnel in the public sector enjoy the same working conditions as other public servants. Please specify the regulations which apply in respect of (a) hours of work; (b) weekly rest; (c) paid annual holidays; (d) educational leave; (e) maternity leave; (f) sick leave; (g) social security; and provide a copy of the appropriate texts. Please indicate also whether the provisions of the Labour Decree of 1967, amended in 1969, which regulates the above matters, apply also to nursing personnel in the private sector and if this personnel is covered by the social security scheme laid down by Act No. 279 of 1965.

Article 7. Please indicate whether measures have been taken apart from those contained in the Code of Practice on protection against radiation with a view to improving 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. Please supply information on the application of the Convention in practice and state the number of persons working in the nursing profession in the public and private sectors as well as their relation to the population of the country and the other workers in the field of health.

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

The Committee has taken note of the Government's first report and would appreciate further information on the following points:

Article 1, paragraph 2, of the Convention. The Committee notes that the information supplied by the Government refers to nursing personnel in the public sector. Bearing in mind that the Convention covers "all nursing personnel wherever they work", please specify in what manner and under what legal or conventional provisions the Convention in applied in the private sector. Please provide a copy of these provisions and the text of the Nurses Ordinance (Cap. 71).

Article 2, paragraph 1. Please indicate whether measures have been taken in practice with a view to drawing up and implementing a policy on nursing services and personnel within the framework of a general health programme to improve nursing care both as to quantity and quality and to raise the standard of health among the population.

Article 2, paragraph 2(b). Please indicate whether measures have been taken in conformity with the above-mentioned provision of the Convention to provide nursing personnel in both the public and the private sectors with employment and working conditions including career prospects and remuneration likely to attract persons to the profession and retain them in it. Please specify in particular the measures taken to ensure that the classification of nursing personnel for remuneration purposes corresponds to that of worker categories whose work while of a different nature in practice is of equal value.

Article 2, paragraphs 3 and 4. Please indicate whether there are trade union organisations for nursing personnel in the public and private sectors and if so specify: (a) whether these organisations are consulted when the national policy concerning nursing services and personnel is being formulated; and (b) how is this policy co-ordinated with policies relating to other aspects of health care and to other workers in the field of health.

Article 5, paragraph 1. Please indicate whether nursing personnel both in the public and the private sector can participate in the planning of nursing services and whether they are consulted on decisions concerning them in the hospital establishments where they work.

Article 5, paragraph 2. Please indicate whether there are collective agreements which determine conditions of employment and work for nursing personnel and if so please supply a copy.

Article 5, paragraph 3. The Government indicates in its report that there is no procedure for the settlement of disputes arising in connection with the determination of working conditions for nursing personnel in the public sector and it adds that the Civil Servants' Association of Ghana represents the interests of nursing personnel in such cases. The Committee would be grateful if the Government would provide more comprehensive information on the bargaining machinery for public servants to which it refers and to indicate also whether the procedure for settling disputes provided for in the Labour Decree of 1967, amended in 1969, applies also to nursing personnel in the private sector.

Article 6. The Government indicates in its report that nursing personnel in the public sector enjoys the same working conditions as other public servants. Please specify the regulations which apply in respect of (a) hours of work; (b) weekly rest; (c) paid annual holidays; (d) educational leave; (e) maternity leave; (f) sick leave; (g) social security; and provide a copy of the appropriate texts. Please indicate also whether the provisions of the Labour Decree of 1967, amended in 1969, which regulates the above matters, apply also to nursing personnel in the private sector and if this personnel is covered by the social security scheme laid down by Act No. 279 of 1965.

Article 7. Please indicate whether measures have been taken apart from those contained in the Code of Practice on protection against radiation with a view to improving 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. Please supply information on the application of the Convention in practice and state the number of persons working in the nursing profession in the public and private sectors as well as their relation to the population of the country and the other workers in the field of health.