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

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

Articles 2 and 5 of the Convention. National policy concerning nursing services and nursing personnel. Consultations. The Committee notes the information provided by the Government on the measures taken and envisaged to improve the quality of nursing care and to address human resource shortages in healthcare. The Government indicates in this regard that Seychelles has a revised Scheme of Service which proposes to increase nurses’ basic salary and other allowances with a view to attracting and retaining nursing personnel in the profession. The revised Scheme was submitted to the relevant authorities for approval on 4 May 2020. The Committee further notes the Government’s indication that the revision of the Nurses and Midwives Act, 1985 was validated by nurses’ representatives and is currently before the Office of the Attorney General for consideration. With regard to education and training, the Government reports that the National Institution for Health and Social Studies (NIHSS) is the only accredited institution in the Seychelles for providing pre-service and post-basic training in the health and social work fields. The Committee notes with interest the information provided by the Government regarding the different programmes and diplomas on nursing offered by the NIHSS and the number of students enrolled. The Government indicates that some programmes are still undergoing validation by the Seychelles Qualification Authority (SQA). It adds that the admission rate for nursing professional training is 65 per cent, 67 per cent for nursing with additional midwifery training and 65 per cent for social work. In 2018, it was estimated that only 48 per cent of those enrolled in the nursing programme graduated and 70 per cent of this group enrolled in the midwifery programme. The Committee nevertheless observes that the Government does not provide information on the current situation regarding the emigration of national nurses overseas and on measures taken to address this issue. In addition, the Government has not provided information on the participation of nursing personnel in the planning of nursing services and decisions concerning them. The Committee requests the Government to continue to provide detailed updated information, including statistical information disaggregated by sex and age, on the nature, scope and impact of measures taken or envisaged to improve the quality of nursing care and to address human resource shortages in healthcare, indicating the measures taken in relation to education and training, as well as in relation to employment and working conditions, with the aim of attracting men and women to the profession and retaining them in it. The Committee further requests the Government to provide updated information on the status of the adoption of the revised Scheme of Service and of the review of the Nurses and Midwives Act, 1985, as well as to provide copies of these documents once they become available. It also reiterates its request that the Government provide updated information concerning the current situation regarding the overseas migration of nurses and the measures undertaken to address this issue. The Committee also reiterates its request to the Government to provide detailed updated information on the participation of nursing personnel in the planning of nursing services and decisions concerning them.

Application in practice. The Government reports that, according to data from the Department of Health, there are 2,920 health professionals registered, of which 74.6 are actively practicing in either the public or the private sector. With regard to nursing personnel, the Government indicates that 67 per cent of registered professional nurses are practicing as well as nearly 100 per cent of allied health professionals. Moreover, the Government reports that there are 951 registered nurses, 640 nurses are practising in the country and 119 are expatriated. The Government adds that 91.6 per cent of nurses are women, compared to 99.4 per cent of midwives. The Government indicates that 27.40 per cent of nurses are aged between 35 and 44 and that, therefore, urgent measures are required to train and recruit nurses in a timely manner, so that they can be mentored by experienced nurses, 25 per cent of whom are expected to retire in the next decade. Finally, the Committee notes the Government’s indication that it received technical guidance and support from the World Health Organization (WHO) for the implementation of the National Health Workforce Account (NHWA) in the country. NHWA is a system by which countries progressively improve the quality, availability and use of health workforce data. The Government indicates that, according to the NHWA report of 2020, nursing data in the country is fragmented, and extensive efforts are required to have data stored in one source. The Committee requests the Government to continue to provide detailed updated information, disaggregated by age, sex and region, concerning the situation of nursing personnel in the country, including the number of students graduating from nursing colleges every year and the number of institutions offering nursing education and training, the number of nursing personnel by sectors of activity, levels of training and functions and their ratio to the population, as well as the number of those who leave the profession each year.

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

Articles 2 and 5 of the Convention. National policy concerning nursing services and nursing personnel. Consultations. The Committee notes with interest the detailed information supplied in the Government’s report and annexes. The Government indicates that the National Health Policy 2016-2020 adopted in 2015, positions health at the centre of national development. The National Health Strategic Plan 2016–20 establishes milestones and sets appropriate goals to guide and optimize investment in health. The Committee notes the new Policy on Employment of Part-Time for Nursing and Midwifery Staff launched in August 2017 which, according to the Government, is guided by the Nursing Personnel Convention, 1977 (No. 149), and its Recommendation. In response to the Committee’s previous comments, the Government refers to a series of measures taken to improve the quality of nursing care. It indicates that the Consultative Forum of the Nurses Association of the Republic of Seychelles (NARS), held in February 2017, focused on the quality of nursing care, opportunities for nurses in the twenty-first century, the image of nursing and the socio-economic welfare of nurses and midwives. The Government adds that the Nursing and Midwifery Practise Committee was established in 2017 to develop and review standard operating procedures and guidelines for nursing practises. The nursing administration has established nursing and program performance indicators to assist in assessing the quality of nursing practices. The Committee notes that exit interviews on patient satisfaction with nursing care in hospitals were undertaken in June 2018 and that the surveys will be conducted every two years to assess progress made and identify gaps. The Government also reports on a wide range of measures taken to address human resource shortages in healthcare. In this respect, the Committee notes that the revised Scheme of Service for Nurses delivered in May 2017 after consultation with the relevant stakeholders including the NARS, has not yet been validated by the Ministry of Health. In 2017, intensive discussions were also held regarding the basic salary and related allowances and a series of regulations on Nurses Gratuity was approved by the Department of Public Administration for the nurses. The Committee takes note of the ongoing review of the Nurses and Midwives Act, 1985, which aims, inter alia, to reflect changes in the nursing and midwifery professions in the Seychelles. It also notes that, although the Employment Act does not set out specific provisions concerning the employment of nurses, the Nurses and Midwives Act, 1985, refers to the Code of Practice for general nurses which specifies the requirements for practicing nursing. Despite the fact that the number of health workers in relation to the population is high, more specialization and research is needed to achieve better health outcomes with the human resources already available. The Committee notes the Government’s indication that the nursing education and training has improved following training and professional development initiatives. In this context, it notes the Nursing Programme of the nursing faculty, as well as the National Institute of Health and Social Studies’ (NIHSS) Quality Assurance Policy and the Access Programme for Health Care, implemented in 2017 by the NIHSS to address issues such as the preparedness of learners applying for admission and the demand for health professionals. The Government refers to the main challenges, which include task shifting at all levels of the health system, the brunt of which was borne by the nurses, the lack of a database collection system and a national workforce database which makes planning for nurses and midwives more difficult, and the absence of an overall health research agenda on national health needs. The Committee also notes the lack of financial and human resources of the Nurses and Midwives Council which has consequences for its management, as well as the Government’s request for the ILO’s legal assistance in implementing the Council’s mandate. The Committee requests the Government to continue to provide information on measures taken or envisaged to improve the quality of nursing care and to address human resource shortages in healthcare indicating the measures taken in relation to education and training, as well as in relation to employment and working conditions, with the aim of attracting men and women to the profession and retaining them in it. It also requests the Government to provide up-to date information on the validation and implementation of the revised Scheme of Service and the outcome of the review of the Nurses and Midwives Act, 1985. It also requests the Government to submit up-to-date information concerning the current situation regarding overseas migration of nurses and any measures undertaken to address this issue. In addition, the Committee requests the Government to continue to provide information on nursing personnel in the planning of nursing services and decisions concerning them.

Part V of the report form. Application in practice. The Committee takes note of the statistics regarding the nursing personnel provided by the Government. The Committee requests the Government to continue to provide detailed information, disaggregated by age, sex and region, concerning the situation of nursing personnel in the country, including the number of students graduating nursing colleges every year and the number of institutions offering nursing education and training, the number of nursing personnel by sectors of activity, levels of training and functions and their ratio to the population, as well as the number of those who leave the profession each year.

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

Article 2 of the Convention. National policy concerning nursing services and nursing personnel. The Committee notes the Government’s indications that the Nurses and Midwives Act, 1985 (Cap 150), is undergoing revision for the possible adoption of a new act. The Government also indicates that a revised Scheme of Service, which has been the product of wide consultations with the regulatory body of nurses and the national nurses association (NARS), is now being implemented. In this connection, the Government explains that a retention allowance has been considered but not adopted for budgetary reasons, and also that there is an ongoing exercise for the revision of working hours and the adoption of more flexible schedules. With respect to nurse migration, the Committee notes the Government’s estimate that an additional 60 nurses and midwives would be required to fully cover the needs of hospitals and health centres. As regards nursing education, the Committee notes that according to the National Institute for Health Sciences (NIHSS), there are several challenges in the delivery of training programmes and courses, including a shortage of quality lecturers, lack of clinical laboratories and low-performing students. In this respect, the Government indicates that the nursing curriculum for the three-year diploma is being reviewed. The Committee requests the Government to continue to provide up-to-date information on any measures, programmes or initiatives aimed at addressing matters such as the quality of nursing care, human resource shortages in health care, the implementation of the revised Scheme of Service for nurses and the improvement of nursing education and training. The Committee also requests the Government to forward a copy of the Nurses and Midwives Act, 1985, once amended, as well as the new regulations on working time of nursing personnel as soon as they become available.

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

Article 2, paragraph 1, and Article 3 of the Convention. Policy concerning nursing services and personnel. The Committee notes the Government’s statement that at present workers’ organizations are not consulted on policy issues, but in future certain health policies could be formulated in conjunction with the employers’ and workers’ organizations concerned. Recalling similar assurances given by the Government in its previous report, the Committee hopes that the Government will make every effort to associate the social partners in designing and implementing all future policies concerning nursing services and personnel, as prescribed by this Article of the Convention.

Moreover, the Committee notes the Government’s statement that there is regular attrition of nurses who leave the country in the search of better employment opportunities abroad. While noting that the statistical data provided by the Government show that the number of nurses and midwives has remained stable in public institutions in the period 2002–07, the Committee would appreciate receiving fuller information on the situation concerning nurse migration and the efforts of the Government to maintain a sustainable domestic nurse workforce.

In this respect, the Committee wishes to refer to the commonwealth code of practice for the international recruitment of health workers and its companion document, adopted in 2003. In particular, it notes that the code provides that the international recruitment of health workers must be transparent and fair as regards its process, and that the right of health workers to migrate must not be undermined. At the same time, such recruitment must be mutually beneficial to both recruiting and source countries considering the difference in the capacities of these countries, which may be addressed through technical assistance. In the same vein, the Committee notes the draft WHO code of practice on the international recruitment of health personnel, currently under consideration, which urges member States to enter into bilateral and multilateral arrangements to promote cooperation and coordination on migrant health personnel recruitment processes in order to maximize the benefits and mitigate the potential negative impact of international recruitment of health personnel, and also calls for measures in order to retain and sustain a skilled domestic health workforce by improving their social and economic status, their living and working conditions, their opportunities for employment and their career prospects.

Articles 3 and 4. Nursing education and training. The Committee notes the Government’s indication that a new nursing curriculum has been prepared taking into consideration regional and international nursing standards. The Committee requests the Government to provide more detailed information on the new programme.

Article 7. Regulations on occupational health and safety for nursing personnel. Further to its previous comment on this point, the Committee understands that the National AIDS Council adopted in 2007 the “Seychelles Policy on HIV/AIDS in the Workplace”. In particular, it notes that the policy emphasizes the importance of the principles of tripartism and social dialogue in approaching matters related to HIV/AIDS as workplace issues, and the shared responsibility of employers and workers for ensuring a healthy work environment, including safety from HIV contamination. The Committee requests the Government to provide additional information on any specific policies or measures for nursing personnel, given the particular risk they face due to the nature of their work, as well as the implementation of the “Management of health-care worker exposures to HIV and recommendations for post-exposure prophylaxis”, and the results obtained.

In this respect, the Committee draws the Government’s attention to the Joint ILO/WHO guidelines on health services and HIV/AIDS, published in 2005, with a view to assisting health services in building their capacities to provide their workers with a safe, healthy and decent working environment as the most effective way both to reduce transmission of HIV and to improve the delivery of care to patients. The Committee wishes also to refer to the International Labour Conference discussion held in June 2009 on “HIV/AIDS and the world of work” with a view to adopting an international labour Recommendation, and in particular to paragraph 37 of the proposed conclusions (see ILC, 98th Session, 2009, Report IV(2), page 310) which provides that public health systems should be strengthened, where appropriate, in order to ensure greater access to prevention, treatment, care and support, and to reduce the additional strain on public services, particularly on health workers, caused by HIV/AIDS.

Finally, the Committee notes that the Government’s report does not contain replies to certain points raised in its previous direct request. It is therefore bound to ask the Government to respond to the comments concerning the application of Article 2(2) (adoption of regulations on education and training requirements in nursing and midwifery under the Nurses and Midwives Act); Article 2(3) (consultations with the social partners in formulation of health care policy); and Article 5 (representation of nursing personnel at the Central Management Committee of the Ministry of Health, collective bargaining in the nursing sector and settlement procedures for collective disputes).

Part V of the report form. Application in practice. The Committee notes the statistical information provided by the Government showing the number of nursing personnel registered with the Seychelles Nurses and Midwives Council and the evolution of number of health personnel employed at government establishments. It would be grateful if the Government would continue supplying up to date information concerning the application of the Convention in practice, including, for instance, statistics on the number of nurses entering and leaving the profession per year, the nurse–population ratio, copies of official reports or studies addressing nursing-related issues, any practical difficulties encountered in applying the Convention, etc.

Direct Request (CEACR) - adopted 2004, published 93rd ILC session (2005)

The Committee notes the Government’s detailed report and the attached documentation.

Article 2, paragraphs 1 and 3, of the Convention. Further to its previous comment on this point, the Committee notes that the Government admits that the employers’ and workers’ organizations were not involved in the formulation of the National Health Policy but undertakes to consult the social partners in any future policy formulation. The Committee recalls that the Convention places particular importance on the requirement for full consultations with the employers’ and workers’ organizations concerned not only in the design and implementation of a specific policy for nursing services and nursing personnel but also in the coordination of this policy with broader policies relating to health-care planning. The Committee hopes that the Government will take concrete steps to ensure that the social partners have some influence on the policy decisions affecting nursing services and asks the Government to keep it informed of any practical developments in this regard.

Article 2, paragraph 2. The Committee notes the Government’s indication that no regulations have as yet been issued under section 15(c) of the Nurses and Midwives Act (Revised 1991) concerning the vocational training, examinations and the conduct of examinations in nursing and midwifery. The Government adds, however, that the Seychelles Nurses and Midwives Council (SNMC), which is a statutory body established under section 3(1) of the Nurses and Midwives Act, has recently proposed some new regulations relating to the minimum education and training requirements for registration of nurses and midwives. The Committee would appreciate receiving additional information on any follow-up action in respect of the proposed regulations and requests the Government to transmit a copy of any relevant text as soon as it is adopted. As regards the revised Scheme of Service for the Nursing Cadre, which sets out the classification of nursing posts and outlines the corresponding job summary, minimum entry requirements, salary scales and allowances, the Committee notes that this Scheme applies exclusively to nursing staff employed in the public sector. Recalling that the Convention applies to all nursing personnel, wherever they work, the Committee requests the Government to specify the measures taken or envisaged to ensure that the nursing personnel engaged in the private sector enjoy employment and working conditions including career prospects and remuneration which are likely to attract persons to the profession and retain them in it.

Article 2, paragraph 4. The Committee once again requests the Government to describe how the policy on nursing profession is integrated into a coherent policy framework on health care in general and to specify whether provision is made for consultations with employers’ and workers’ organizations to this effect.

Articles 3 and 4. The Committee notes the information provided by the Government concerning the National Institute of Health and Social Studies and the various programmes it offers in paramedical, biomedical, dental, environmental health, and pharmaceutical sciences, including a three-year course on nursing and an 18-month course on midwifery. The Committee would appreciate receiving additional information on the functioning of the National Institute of Health and Social Studies and the organization of nursing and midwifery studies, including the number of students enrolled to each course and the rate of graduates who are offered salaried employment at the end of their studies.

Article 5, paragraph 1. The Committee notes that according to the information provided by the Government with respect to the composition and mandate of the 13-member Central Management Committee of the Ministry of Health, no representative of the nursing personnel appears to participate in the Committee’s discussions relating to the planning of nursing services. Noting, however, that the Government had previously indicated that the nurses are represented to the Central Management Committee by the Director of Nurses, the Committee requests the Government to provide further clarifications on this point.

Article 5, paragraph 2. The Committee notes the Government’s indication that there have been to date no collective agreements concluded in either the public or private sector in respect of nursing personnel. The Committee would be grateful if the Government could continue to provide in future reports information concerning any collective bargaining effort with a view to determining higher employment and working standards for nursing personnel especially in the private sector.

Article 5, paragraph 3. The Committee notes the Government’s explanations concerning the internal dispute settlement procedure provided for under the Public Service Orders in respect of disciplinary offences. However, the Committee is bound to recall that this Article of the Convention does not refer to disciplinary matters or other individual labour disputes involving nursing staff but to collective disputes arising in connection with the determination of terms and conditions of employment of the nursing profession as such. The Committee requests therefore the Government to provide in its next report more precise information regarding any institutionalized arrangements, as may be available, for the purpose of settling collective disputes through independent and impartial proceedings in a manner that makes it unnecessary for the organizations representing nursing personnel to resort to such other forms of industrial action which may be disruptive to the health services system.

Article 7. Further to its previous comment on this point, the Committee notes the document entitled "Management of health-care worker exposures to HIV and recommendations for post-exposure prophylaxis" which establishes a protocol for effective risk assessment and preventive action with respect to occupational transmission of HIV. The Committee requests the Government to report on the measures taken or contemplated with respect to health-care workers who are infected or considered to be infected by HIV, for instance regarding the confidentiality of test results, the arrangement of working conditions, etc.

Part V of the report form. The Committee notes with interest the statistical information concerning the total number of registered nurses and midwives as at September 2003 as well as the number of persons who have left the profession in the course of that year. It asks the Government to continue to supply the information requested under this point, particularly as regards the number of nursing personnel, by sectors of activity and by levels of training and functions, and their relation to population, to the number of patients and to other manpower in the health field, and also to indicate any practical difficulties encountered in the implementation of the Convention.

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

The Committee notes the information provided by the Government in its report. It notes that the Government refers to the Nurses and Midwives Act (Revised 1991), the text of which is not available in the Office, and requests it to provide a copy. The Committee also requests the Government to provide information on the following points.

Article 2, paragraphs 1 and 3, of the Convention. The Committee notes the information that the Ministry of Health is responsible for the formulation and implementation of the National Health Policy. This policy applies to all "nursing personnel", that is to say to both female and male nurses. The Committee notes that there are certain policy guidelines (for example, health is recognized as a fundamental human right; determination of access to health care, not by health or position but by need; and the commitment of the Government to provide a free national health system to all Seychellois). The Committee also notes that national health priorities have been defined. The Committee requests the Government to indicate, firstly, whether the employers’ and workers’ organizations concerned were consulted in the formation of this policy and, secondly, to provide information on its application in practice and the results achieved.

Article 2, paragraph 2. The Committee notes that section 15 of the Nurses and Midwives Act provides that the minister responsible for the administration of the Act may make regulations concerning vocational training, examinations and the conduct of examinations concerning nursing care. However, it notes that no regulations have been provided by the Government giving effect to section 15 above. The Committee therefore requests the Government to indicate whether such regulations have been adopted by the minister concerned and, if so, to provide a copy. The Committee also notes that a Scheme of Service of the Nursing Cadre determines the conditions of employment and career prospects and remuneration of nursing personnel. It requests the Government to provide a copy of the above Scheme of Service and to indicate any other measures taken to secure for nursing personnel engaged in the public and private sectors employment and working conditions, including career prospects and remuneration, which are likely to attract persons to the profession and retain them in it.

Article 2, paragraph 4. The Committee notes the information that inter sectoral action for the attainment of health for all is a priority objective. It notes that the ministries and institutions concerned with health matters have to add a health dimension to their sectoral policies to achieve this coordination. The Government concludes that all stakeholders are therefore involved in the coordination of the National Health Policy. The Committee therefore requests the Government to indicate the machinery of this coordination, and the manner and framework in which the consultations envisaged by these provisions of the Convention are held.

Articles 3 and 4. The Committee notes that section 8 of the Nurses and Midwives Act establishes the requirements for the inclusion of nurses and midwives on the respective register. It notes that this section makes the Nurses and Midwives Council of Seychelles responsible for determining the basic requirements in terms of education and training of nursing personnel and for supervising such education and training. It therefore requests the Government to provide detailed information on the content of the education and training provided to nursing personnel and the examinations which they have to take. The Committee also requests the Government to indicate whether nursing education and training is coordinated with the education and training of other workers in the field of health, in accordance with Article 3, paragraph 2, of the Convention.

Article 5, paragraph 1. The Committee notes that, according to the Government’s report, the objective of the Nurses and Midwives Council consists of involving nursing personnel through active participation in the planning of nursing services, through discussions with the management of nursing personnel and the Nursing Association. It notes that a Central Management Committee of the Ministry of Health also discusses major issues related to the planning of nursing personnel, and that the nurses are represented by the Director of Nurses. The Committee requests the Government to indicate whether there is also participation by nursing personnel at the local level, which would make it possible to take into account the individual or specific claims of certain units, or whether such participation is secured at a higher level through the Council. It also requests the Government to provide further particulars concerning the operation of the Central Management Committee of the Ministry of Health.

Articles 5, paragraph 2, and 6. The Committee notes the information contained in the Government’s report to the effect that the conditions of employment and work of nursing personnel in the public sector are determined, on the one hand, by public services orders and, on the other hand, by collective agreements which may be negotiated on the basis of the collective bargaining agreement concluded between the Ministry of Administration and Manpower of the Seychelles and workers’ unions. The Committee requests the Government to indicate whether collective agreements have in practice been negotiated within this framework and, if so, to provide copies. The Committee understands that the conditions of work of nurses in the private sector are determined by the Employment Act, 1995. It requests the Government to indicate whether there are collective agreements applicable to nursing personnel in the private sector and, if so, to provide copies. If there are no such agreements, the Committee requests the Government to indicate whether collective bargaining is envisaged by the laws and regulations with a view to the determination of the conditions of employment and work of nursing personnel in the private sector. The Committee also notes that nurses are covered by conditions of service establishing criteria and procedures for promotion and the payment of allowances and bonuses. It notes that the information provided by the Government concerning the conditions of work in the fields mentioned in Article 6 shows that nursing personnel benefit from conditions which are at least equivalent to those of other workers in the country, as set out in the Conditions of Employment Regulations, 1991. The Committee requests the Government to provide a copy of the conditions of service of nurses and of the Public Service Orders.

Article 5, paragraph 3. The Committee notes that the Government’s report refers to the existence of an Investigation Committee established under the Nurses and Midwives Regulations, 1989. However, it notes that under sections 17 and 18 of these Regulations, the role of the Investigation Committee is to conduct investigations in order to allow the Council to make decisions on disciplinary matters. The information provided by the Government does not relate to the settlement of disputes arising in connection with the determination of terms and conditions of employment. The Committee therefore requests the Government to provide information on this subject in its next report.

Article 7. In its general observation of 1990, which was repeated in 1994, the Committee emphasized the need to take measures to adapt the legislation on health and safety at work to the particular risk of accidental exposure of nursing personnel to the human immunodeficiency virus (HIV). In this respect, it also draws the Government’s attention to the Code of practice on HIV/AIDS and the world of work published in June 2001. The Committee notes the information that there is no special legislation in the Seychelles regulating the occupational health and safety of nursing work and of the environment in which the work is carried out, but that occasional workshops are held in this field, which also cover HIV/AIDS measures. It also notes that an Occupational Health Unit has been established in the Ministry of Health to guide and sensitize nurses to the potential risks and dangers that exist in their working environment, and that all necessary protection is provided to nurses to protect others against communicable diseases. The Committee requests the Government to indicate the measures which have been taken or are envisaged, in consultation with the employers’ and workers’ organizations concerned, to adapt the national legislation in this field and to take into account the particular risk of accidental exposure to HIV among nursing personnel, for example through the arrangement of conditions of work, the confidentiality of test results and recognition that the cause of infection was occupational, etc.

Part III of the report form. The Committee requests the Government to indicate the manner in which the application of the relevant laws, regulations and collective agreements is assured.

Part V of the report form. The Committee requests the Government to provide general information on the manner in which the Convention is applied in practice, including, in so far as possible, statistics on the numbers of nursing personnel, by sector of activity and by level of training and functions, and their relation to the population, to the number of patients and to other workers in the health field, and on the number of persons leaving the profession.