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

Nursing Personnel Convention, 1977 (No. 149) - El Salvador (Ratification: 2013)

The Committee notes the observations of the Trade Union of Nursing Professionals, Technicians and Auxiliaries of El Salvador (SIGPTEES), received on 8 February and 12 September 2016. The Committee also notes the Government’s reply to these observations, received on 9 February 2017.

Article 2 of the Convention. Policy concerning nursing services and nursing personnel. The Committee notes with interest the adoption of the national policy on nursing care by means of Order No. 273 of 5 February 2016. The Government states that this policy was formulated with the participation of various bodies, including: the Nursing Unit at the Ministry of Health; SIGPTEES; the Nursing Supervisory Board (JVPE); and the National Association of Salvadoran Nurses. The Government indicates that the policy has eight areas, each with a set of goals, strategies and lines of action. The goals include: (i) developing actions in planning, organization, management and evaluation aimed at improving results in nursing care; (ii) promoting evidence-based nursing care which is comprehensive, ongoing, of high technical quality, safe and humane; (iii) providing nursing personnel with possibilities and conditions for acquiring new health knowledge and up-to-date approaches to the discipline; and (iv) establishing a system of information and computerization which makes visible the outcomes of nursing care for public health and the development of nursing as a science. The Committee observes that the policy also includes the following lines of action: updating and monitoring the application of the legislation in force in order to regulate nursing practice (1.3.1); ensuring that the complexity of duties assigned to nursing personnel are consistent with their level of training, position and professional competence (1.3.3); and promoting the professionalization of nursing instruction (3.1.3). The Committee also notes the adoption in December 2016 of the “National nursing care action plan”, which sets out the specific actions to be undertaken to promote the professionalization of nursing in its various areas of implementation in order to respond to the demand for high-quality public healthcare. The action plan also establishes a set of indicators to measure and evaluate the results achieved, response times, and the various entities responsible for implementation. The Committee requests the Government to send detailed, up-to-date information on the measures taken in the context of the “National nursing care action plan” and its impact in practice, particularly measures designed to provide nursing personnel with education and training appropriate to the exercise of their functions; and employment and working conditions, including career prospects and remuneration, which are likely to attract persons to the profession and retain them in it.

Article 4. Requirements for the practice of nursing. In reply to the Committee’s previous comments, the Government indicates that on 10 September 2012 the Health Commission was notified of the draft Bill on nursing practice, which was drawn up at the initiative of the JVPE. The Government reports on the various actions implemented by the Health Commission with a view to considering the adoption of the draft Bill, such as meetings with JVPE representatives and the request for technical reports. The Government states that the draft Bill is still being studied by the Health Commission. The Committee requests the Government to take the necessary steps to ensure the adoption of the draft Bill of January 2012 on nursing practice, to report on progress made towards that end, and to send a copy of the legislation once it has been enacted.

Article 5. Consultations with nursing personnel. The Committee notes that the SIGPTEES reports in its observations that it has not received any reply to its repeated requests made in 2015 for a meeting with the Minister of Health with a view to presenting a set of demands regarding regulation of the conditions of work of nursing personnel. In this regard, the Committee notes that the SIGPTEES attaches to its observations the set of demands, in which, inter alia, it requests: (i) a meeting with the Minister of Health; (ii) the formulation of a nursing services and personnel policy, in accordance with Article 2 of the Convention; (iii) standardization of conditions for processing, review and resources relating to leave, free days and deductions for nursing personnel; and (iv) measures to revise procedures for the recruitment, transfer and reassignment of nursing personnel in order to ensure transparency in all stages (start, processing and conclusion). In its reply to these observations, the Government indicates that: (i) bilateral and working meetings have been held with the SIGPTEES, including monthly meetings in the context of the Inter-Institutional Commission for the National Health System (SNS); (ii) the national nursing policy was adopted in 2016, with the SIGPTEES involved in its formulation; (iii) the conditions governing leave, free days and deductions of nursing personnel are the same as those established for other public employees in the legislation (Act concerning rest days, vacations and leave of public employees); and (iv) the system for the recruitment and transfer of nursing personnel is governed by the procedures set forth in sections 20–28 and 37 of the Civil Service Act and the internal regulations and manuals of the Ministry of Health and other health sector institutions relating to human resources. With regard to the latter, the Government also indicates that the management of nursing posts is undertaken each year at the time of drawing up the budget, on the basis of needs forecasts for the different national hospitals and health regions. The Government adds that it has not received any complaints regarding flaws in nursing recruitment or in the management of nursing posts. The Committee also notes that the SIGPTEES claims that on 26 November 2015 the SNS Inter-Institutional Commission, composed of institutions and workers’ organizations in the sector, held a meeting recording the closure of the business process which had been under way since 18 February 2015 with the purpose of ensuring compliance with the Convention. The SIGPTEES objects to the fact that this record was adopted without being signed or notified according to the legally established procedure. The Government indicates that a copy of the closure instrument was given to all participants in the process, including the SIGPTEES. The Government also states that during the above-mentioned meeting a comparative chart of the national legislation was adopted, specifying the various national provisions guaranteeing the rights of nursing personnel, in accordance with Article 6 of the Convention. Lastly, the SIGPTEES indicates that nursing personnel do not have the same rights of freedom of association as other workers, regarding aspects such as the granting of leave for representatives of workers’ organizations. In addition, it refers to the decision of 13 November 2015 of the Fourth Labour Court (ref. NUE 12394-15-DV-4LB1/MY (851/2015)), declaring that the demonstration held by nursing personnel during their free time constituted an illegal strike. In this regard, the Committee indicates that such matters will be examined in the context of the Freedom of Association and Protection of the Right to Organise Convention, 1948 (No. 87). The Committee requests the Government to provide detailed information on the measures taken or contemplated to ensure the participation of nursing personnel in the planning of nursing services and consultation with such personnel on decisions concerning them.

Article 6. Conditions of work. The Committee notes that the SIGPTEES reports that nursing personnel do not receive any extra pay for overtime, for dangerous or unhealthy tasks, night work or public holidays on which they work. The SIGPTEES claims that the Ministry of Health does not provide nursing personnel recruits with uniforms or food. It also indicates that nursing personnel are entitled to only three days’ paternity leave. However, the Committee notes that the SIGPTEES does not specify whether the right to three days’ paternity leave for nursing personnel is per year or per month, and whether this is equivalent to what is established for other workers. The Committee requests the Government to send detailed, up-to-date information on the manner in which it is ensured in practice that nursing personnel enjoy conditions of work at least equivalent to those of other workers, including with regard to extra pay for overtime, dangerous or unhealthy tasks, night work and work on public holidays, and with regard to paternity leave.

Article 7. Occupational safety and health. The Committee observes that the goals of the national nursing care policy include improving working conditions for nursing personnel to ensure that they can perform their tasks without physical, psychological or social risks. In this regard, the policy establishes the following lines of action: promoting compliance with, and the application of, the laws and regulations concerning occupational safety and health (7.2.1); and modernizing systems and measures for protection against risks and harm to health (7.2.2). The Committee requests the Government to send up-to-date information on the nature and impact of the measures taken in the context of the “National nursing care plan” to guarantee the occupational safety and health of nursing personnel, including their protection against infectious diseases, such as HIV and AIDS.

Application in practice. The Committee notes that, according to the information available in the draft of the “National nursing care plan”, in February 2015 there were 29,622 persons enrolled in the JVPE register (18.40 per cent were graduates, 22.75 per cent were “technologists” (advanced diploma), 37.37 per cent were “technicians” (intermediate diploma) and 21.48 per cent were nursing auxiliaries. The SIGPTEES reports that in many hospitals there is a ratio of one nurse for 50 to 60 patients. The Committee requests the Government to provide detailed, up-to-date information on the application of the Convention in practice, including statistics on the numbers of nursing personnel – disaggregated by sex, age, sector of activity, level of training and functions – and statistics on the ratio of nursing personnel to population, the number of persons entering and leaving the profession each year, the measures taken to attract persons to the profession, and copies of official reports and studies relating to nursing services. The Committee also requests the Government to provide information on any practical difficulties encountered in the application of the Convention, such as the shortage or migration of nursing personnel.