Observation (CEACR) - adopted 2021, published 110th ILC session (2022)

Nursing Personnel Convention, 1977 (No. 149) - Guatemala (Ratification: 1995)

The Committee takes note of the supplementary information provided by the Government in light of the decision adopted by the Governing Body at its 338th Session (June 2020). The Committee is proceeding with the examination of the application of the Convention on the basis of the supplementary information received from the Government in 2020, as well as on the basis of the information at its disposal in 2019.

The Committee notes the observations made by the Autonomous Popular Trade Union Movement and the Global Unions of Guatemala, received on 16 October 2020, which denounce the recruitment of nursing personnel through temporary contracts for professional services to perform work of a permanent nature, and the precarious working conditions of these workers. In particular, they report that these workers do not have access to the rights established for nursing personnel in the labour legislation relating to aspects such as holidays, access to benefits of the Guatemalan Social Security Institute, healthcare, maternity leave or breastfeeding breaks. They also report that, in the context of the COVID-19 pandemic, the nursing personnel under the aforementioned contractual arrangements who were infected with the virus did not receive medical assistance, and were required to go to work despite presenting symptoms of COVID-19. In addition, they highlight that they were not provided with personal protective equipment (PPE) and were refused access to COVID-19 testing. The workers’ organizations indicate that on 25 May 2020, they submitted an application for protection (amparo) to the Constitutional Court, which ordered the Ministry of Health to immediately adopt the necessary measures to issue PPE to all workers and to protect those workers considered to be high risk. The workers’ organizations also indicate that they submitted an application for protection (amparo) for the misuse of temporary contracts, for health sector services to carry out labour activities, with a proven relationship of permanent dependence. The workers’ organizations also denounce the initiation of dismissal proceedings as a reprisal against the workers who promoted and supported the submission for the above remedies. In addition, they denounce the significant salary differences between nursing personnel who perform the same functions but who are hired under different contractual terms or in different regions. Lastly, the workers’ organizations report that in the last four years, graduates of the nursing schools in Quiche, Cobán and Guatemala Capital have not received their academic certificates, which prevents them from accessing employment. Furthermore, they report the absence of adequate and sufficient protection measures in the context of the COVID-19 pandemic, including the lack of PPE and measures to minimize the risks to which workers are exposed. The Committee requests the Government to provide its reply in this regard.

COVID-19 pandemic. Measures adopted concerning public health. The Committee notes the detailed information provided by the Government in its supplementary report on the various public health measures adopted to address the effects of the COVID-19 pandemic. The Government indicates that on 16 March 2020, it issued Governmental Decree No. 5-2020 declaring a state of public disaster throughout the national territory as a result of the COVID-19 pandemic, which has subsequently been extended on several occasions. The Government indicates in its supplementary report that, in March 2020, the Plan to prevent, contain and respond to COVID-19 cases in Guatemala, developed by the Ministry of Public Health and Social Assistance (MSPAS), was approved. The measures in the Plan to be adopted to address the epidemiological threat posed by COVID-19 include ongoing training and active participation of personnel from the different levels of healthcare in the various coordination forums of the health sector and emergency response system, as well as the National Coordinating Body for Disaster Reduction (CONRED). The Committee invites the Government to provide up-to-date information in its following report on the impact of the pandemic on the implementation of national policies and programmes relating to nursing services and nursing personnel with a view to ensuring the objectives of the Convention.

Article 2 of the Convention. National policy for nursing services and nursing personnel. The Committee notes the detailed information provided by the Government regarding the regulations on the nursing profession and the various studies conducted on the situation of health workers in the country, including nursing personnel. In particular, the Committee notes the reports provided by the Government regarding the evaluations carried out in 2005 and 2013 on achievement of the targets established in the National Plan for the development of human resources in health 2007–2015. The Committee also notes that the Government refers to the development of the Regional Plan of the nursing professionals’ group of Central America and the Caribbean 2018–2022. Its lines of action include: building the human resources of nursing personnel, improving the working conditions of nursing personnel and strengthening continuous and lifelong education for these workers. The Government indicates that such lines of action would be agreed upon by representatives of nursing associations and colleges affiliated with the International Council of Nurses (ICN) at a meeting to be held in Singapore in 2019. The Committee also notes the Government’s indication that, within the framework of the II Central American and Caribbean Summit on “the development of nursing in Central America, a collective project to improve health” organized in October 2017, a declaration was signed by nursing personnel representatives of the participating countries. The Government indicates that the declaration includes pillars of work relating to governance, vocational internships and training for human resources, working conditions of nursing personnel, technical cooperation projects between national nursing associations, professional nursing colleges and the International Council of Nurses, the implementation of strategies to strengthen work within nursing networks, and the regulation of national policy and law on nursing. The Government adds that participants in the II Regional Summit undertook to disseminate the declaration at the national level, follow up on the agreements, strengthen union organization and carry out studies on the situation of nursing personnel. In this connection, the Government reports the development of a study by the Nursing Services Development Unit of the MSPAS on the working conditions of nursing personnel in Guatemala. This study highlights that obstacles to improving the working conditions of nursing personnel comprise the insufficient number of nursing personnel in the country owing to the lack of funding for recruitment, the heavy workload of nursing personnel who perform functions that are not part of their jobs, the lack of unified salaries for nursing personnel, the absence of ongoing occupational safety and health programmes, and salaries that are not commensurate with the qualifications and responsibilities of the position. With respect to the activities of the Interinstitutional Council, the Government refers to the establishment of the National Observatory of Human Resources in Health in 2012 and the coordination of interinstitutional actions with a view to developing proposals on plans for the training for human resources in health. Furthermore, the Committee notes the approval in 2019 of the regulations for the nursing staff of the hospital network of the MSPAS. The objectives of the regulations include standardizing the nursing staff functions according to position and academic degree, strengthening the quality of nursing care in the country’s hospital network, and systematizing discussion forums for nurses for the comprehensive analysis of the development of the profession at the different levels of care. The Committee requests the Government to provide detailed and up-to-date information on the impact on nursing services and nursing personnel of the measures adopted within the framework of the 2018–2022 Regional Plan and the declaration adopted at the II Central American and Caribbean Summit on the development of nursing, as well as the new regulations for the nursing staff of the hospital network of the MSPAS. The Committee also requests the Government to provide up-to-date information on the consultations carried out with the employers’ and workers’ organizations concerned, where such organizations exist, with regard to the abovementioned measures (Article 2(3)).

Article 7. Occupational safety and health. The Committee notes the Government’s indication that, in May 2015, measures were adopted with a view to implementing safety and health policies for health workers in compliance with the goals set out in the Regional Plan for human resources in health. The Committee notes, however, that according to the assessment on achievement of this goal conducted by the interinstitutional committee for joint actions of the academic and health sectors, the level of achievement reached only 25 per cent. The Committee also notes the detailed information provided by the Government in its supplementary report on the safety and health measures taken in the context of the COVID-19 pandemic. The Government refers, inter alia, to the approval on 14 June 2020 of Governmental Agreement No. 79 of 2020, which complements the 2014 regulations on occupational safety and health, relating to the prevention and control of the spread of COVID-19 in all workplaces in the public or private sector in the country. The Agreement sets out the implementation of occupational safety and health measures that allow for safe working conditions to minimize the risk of infection. In this connection, it establishes a series of obligations for the employer, such as providing PPE for the prevention and control of the spread of COVID-19 in the workplace. The Government reports that in August 2020, the Department of Occupational Safety and Health carried out an initial operation in 18 private sector hospitals to monitor compliance with the obligations established in the Agreement.

In this context, the Committee recalls that nursing personnel who, given the specific characteristics of their work must be in close physical contact with their patients, are at high risk of becoming infected while treating patients with suspected or confirmed COVID-19, particularly when precautions to control the spread, including the use of PPE, are not strictly applied. In this respect, the Committee wishes to draw the Government’s attention to paragraph 49 of the Nursing Personnel Recommendation, 1977 (No. 157), which sets out 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 minimize it; (2) Measures such as the provision and use of protective clothing, immunization, 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 indicate whether the abovementioned measures adopted in 2015 and Governmental Agreement No. 79 of 2020 have been effective in the prevention and control of COVID in the workplace, and to provide detailed and up-to-date information on the continued application of safety measures, including: the provision of PPE and training on its proper use;, the provision of adequate breaks during shifts and limitation of excessive hours wherever possible, with a view to protecting the health and well-being of nursing personnel; and limiting, as far as possible, their risk of contracting COVID-19. In addition, it requests the Government to provide detailed and up-to-date information on the number and result of the checks carried out on compliance with Governmental Agreement No. 79 of 2020 concerning nursing personnel.

The Committee is raising other matters in a request addressed directly to the Government.