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

Nursing Personnel Convention, 1977 (No. 149) - Iraq (Ratification: 1980)

Article 2(2) of the Convention. National policy concerning nursing services and nursing personnel. The Committee notes with interest the adoption of the first Iraqi National Health Policy (NHP), developed in collaboration with the World Health Organization (WHO), relevant ministries and key health stakeholders. The NHP covers the period from 2014 to 2023 and seeks to achieve universal health coverage for all citizens while ensuring equity, quality and cost effectiveness. The Committee notes that the NHP contemplates the adoption of measures to review health workers’ conditions of service (salary, housing, professional advancement, contractual obligations, involvement in decision making, recognition of staff contributions and other incentives) and develop appropriate recruitment and retention strategies both for national and expatriate health workers within the public sector. The Committee also notes the adoption of a national nursing and midwifery strategy, whose development was informed by the WHO regional framework for strengthening nursing and midwifery in the Eastern Mediterranean Region 2016–2025. The Committee further notes that, according to WHO’s Global Health Workforce Statistics, the number of nurses per 1000 persons increased from 1.7 in 2016 to 2 in 2018. The Committee requests the Government to provide detailed updated information on the nature, content and impacts of the policies, programmes, incentives or other measures adopted, including in the framework of the National Health Policy for the period 2014-23 and the nursing and midwifery strategy, to: (i) offer attractive employment and working conditions and reasonable career prospects to all nurses; and (ii) to ensure that foreign nursing personnel working in the country enjoy equality of treatment with national personnel. It further requests the Government to provide a copy of the national nursing and midwifery strategy.

Article 3. Nursing education and training. The Committee notes the information provided by the Government regarding measures adopted to improve the quality of nursing education. The Government indicates that, pursuant to the national strategy for the development of the nursing and midwifery profession, new higher health institutes have been established in Baghdad and all of the governorates in coordination with the Ministry of Higher Education and Scientific Research (MoHESR). These institutes facilitate access to higher education for nursing personnel who hold a preparatory nursing, midwifery and obstetrics certificate and increase the number of nursing personnel by accepting secondary school graduates who have taken the science option. The new higher education institutes include sections for nursing, midwifery and obstetrics. The Government adds that preparatory nursing, midwife and obstetrics certificates are no longer accepted and the ministry schools that provided them have been closed in order to improve educational levels and the quality of nursing services nationwide. The Government indicates that the educational process in higher health institutes has been regulated by the Institutes of Health Professions Regulation No. 3 of 2011 and the organization of nursing, midwifery and obstetrics preparatory schools by the Nursing, Midwifery and Obstetrics Preparatory Schools Regulation No. 1 of 2013. The Government also refers to the implementation of development and educational programmes for nursing and midwifery (Registered Nurse Programme and Successful Nurse Programme). The Committee requests the Government to provide detailed updated information on the nature, the content and the impact of the measures adopted with a view to ensuring that nursing personnel are provided with education and training appropriate to the exercise of their functions, including those adopted in the framework of the National Health Policy for the period 2014-2023 and the national nursing and midwifery strategy. The Committee reiterates its requests to the Government to provide updated detailed information on the study curricula and statistics on the number of persons enrolled in, or graduating from, nursing schools per year – if possible disaggregated by sex and educational level.

Article 4. Practice of the nursing profession. In reply to the Committee’s previous comments, the Government reiterates that, in accordance with Act No. 96 of 2012, authorization to practice nursing in Iraq is granted by the nursing union. The Committee notes that the NHP provides for the adoption of measures to enhance the quality of health care services through accreditation and licensing in a systemic and sustainable approach. The Committee also notes the Government’s indication that the work of nursing personnel is in the process of being regulated by the adoption of the Iraqi Nursing Council Act and the Nursing Personnel Act. The Government reports that approval is also being sought for enactment of the Nursing Trade Union Act, although it refers to obstacles to its adoption. Lastly, the Government refers to the development of manuals on the application of nursing procedures for nursing and midwifery personnel in the public health sector. The Committee therefore reiterates its requests to the Government to transmit a copy of Act No. 96 of 2012 on the practice of the nursing profession and midwifery and all relevant information of a practical nature following the implementation of the new legislation (e.g. number of authorized nurses, registered membership of Nurses’ Association and nationality and number of foreign nurses authorized to practice in the country). The Committee further requests the Government to provide information on any progress made towards the adoption of the Iraqi Nursing Council Act and the Nursing Personnel Support Act and to provide a copy once adopted.

Article 5. Participation and consultation. The Committee notes that the NHP provides for the development and implementation of measures to build the capacity of and strengthen professional associations and unions to ensure their informed involvement in decision-making and promote the amicable settling of disputes. In this regard, the Committee requests the Government to provide updated detailed information on the specific measures taken or envisaged to promote the participation of nursing personnel in the planning of nursing services and consultation on decisions concerning them, as required under Article 5.

Article 7. Occupational safety and health. The Government reports that a draft law has been developed to ensure occupational safety and health and to provide a secure working environment for nursing and midwifery personnel. In the context of the COVID-19 pandemic, the Committee notes that, on 26 March 2020, the Government established a Higher Committee for Health and National Safety to direct the country’s effort to combat COVID-19. The national Higher Committee is mandated with setting out policies and adopting the necessary measures to contain COVID-19. With respect to ensuring occupational safety and health for front line health workers, the Committee recalls that nursing personnel who, due to the specific characteristics of their work, must be in close physical contact with their patients, are at high risk of being infected while treating patients with suspected or confirmed COVID-19, especially where infection control precautions, including the use of personal protective equipment (PPE), are not strictly practiced. The Committee wishes to draw the attention of the Government to Paragraph 49 of the Nursing Personnel Recommendation, 1977 (No. 157), which provides that: “(1) all possible steps should be taken to ensure that nursing personnel are not exposed to special risks. Where exposure to special risks is unavoidable, measures should be taken to minimise it; (2) measures such as the provision and use of protective clothing, immunisation, shorter hours, more frequent rest breaks, temporary removal from the risk or longer annual holidays should be provided for in respect to nursing personnel regularly assigned to duties involving special risks so as to reduce their exposure to these risks; and (3) in addition, nursing personnel who are exposed to special risks should receive financial compensation.” The Committee requests the Government to provide detailed updated information on the nature and impact of safety measures taken or envisaged, including the provision of personal protective equipment (PPE) and training in its correct use, as well as provision of adequate rest breaks during workers’ shifts and limitations on excessive hours wherever possible, with a view to protecting the health and well-being of nurses and midwives to limit to the extent possible their risk of contracting COVID-19. The Committee also requests the Government to provide updated information on progress made towards the adoption of the draft law concerning occupational safety and health for nursing personnel, and to provide a copy once adopted.