Direct Request (CEACR) - adopted 2023, published 112nd ILC session (2024)

Nursing Personnel Convention, 1977 (No. 149) - Philippines (Ratification: 1979)

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Article 2 of the Convention. National policy for nursing services and nursing personnel. The Committee notes from the National Human Resources for Health Master Plan (NHRHMP) 2020–40 that the Philippines has become one of the world’s major sources of migrant health workers, particularly nurses. The Government indicates in its report that, according to statistical information of the Department of Labour and Employment (DOLE), as of April 2021, there were 601,796 professionally active nurses, of which 174,849 were practicing in national health facilities. The Government estimates that more than 50 per cent of the supply of nurses are working temporarily or have permanently migrated to other countries (approximately 328,851). The Committee notes that the NHRHMP emphasizes that the temporary and permanent outmigration of health workers has adversely affected both the quantity and quality of workers left in the country. The NHRHMP points out that this is aggravated by the increasing number of health workers, particularly nurses, working in non-health sectors, where pay is higher and working conditions are better than jobs offered in some health facilities. According to information available in the DOLE website, the Philippines faces a shortage of 127,000 nurses. The Committee notes that the NHRHMP highlights that the shortage of health workers is partly caused by the limited number of well-paying jobs in the health sector; unclear career paths; inadequate support for health workers’ health, safety, and well-being; and the increasing demand for Filipino health workers in other countries. The NHRHMP stresses out that there are also substantial health worker gaps at the community level, especially in high-risk or geographically isolated and disadvantaged areas. The NHRHMP points out that it is estimated that 25 per cent of all barangays do not have health workers serving their population. Factors affecting the maldistribution of health workers include disparities in pay between private and public sectors, and within the public sector, between national and local levels; limited capacity of local government units to hire health workers; and poor working conditions in the place of assignment.

The Committee notes with interest the adoption of the NHRHMP 2020–40 with support from the World Health Organization (WHO) and the United States Agency for International Development (USAID). The NHRHMP sets out policies and strategies for the appropriate generation, recruitment, retraining, regulation, retention, and reassessment of the health workforce, including nursing personnel, based on population health needs. The NHRHMP envisages the implementation of measures to raise health workers’ productivity and responsiveness and promote their retention by ensuring job satisfaction and motivation, such as increasing permanent positions, adopting standardized compensation, benefits and incentives, enhancing competencies and career opportunities, and establishing occupational safety and health (OSH) policies. The NHRHMP is regularly updated every five years to consider significant events that might occur, such as changes in health situation, public health emergencies, and technology advancement. Lastly, the Committee observes that, on 8 July 2019, Bill No. 260 “Comprehensive Nursing Law” was filed before the Senate and its consideration is still pending. The Committee requests the Government to provide detailed information, including statistical data, on the impact on nursing services and nursing personnel of the measures adopted within the framework of theNational Human Resources for Health Master Plan (NHRHMP) 2020–40. 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 practicein high-risk or geographically isolated and disadvantaged 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. In addition, please also supply with the next report a copy of Bill No. 260 “Comprehensive Nursing Law” if enacted, indicating the manner in which it impacts the application of the Convention.

Article 2(2)(b). Remuneration of nursing personnel. The Government refers to the Salary Standardization Law of 2019 (RA No. 11466), which provides for salary scales and increase in base pay through step increments for civilian personnel, which includes public health workers. The Committee observes that the NHRHMP emphasizes that, while the Government has implemented salary standardization in the public sector, no similar scheme was prescribed for the private health sector. There are no laws that mandate the provision of benefits to health workers in private healthcare and benefits are not standardized as they are for public sector health workers. The NHRHMP emphasizes that there are substantial disparities between the wages of health workers, including nurses, hired by the national and the local governments, and among those working in the public sector and the private sector. According to the NHRHMP, the entry level premium for health workers in the public sector is roughly 50 per cent higher than in the private sector. The NHRHMP points out that this situation incentives qualified health workers to seek jobs in the public healthcare, other industries or overseas. The Committee notes from the NHRHMP that a House Bill No. 7569 “Minimum Wage for Nurses in the Private Sector Act” was filed in 2020 and its consideration is still pending. The Committee commends the fact that the NHRHMP clearly identifies the issues above and wishes to stress that the obligation to aim at providing 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, applies regardless of whether they work for public or private health establishments. It therefore requests the Government to provide information on the impact of the measures taken to facilitate retention of the nursing workforce through the provision of remuneration packages designed to attract and retain healthcare workers, including those measures adopted to tackle the disparities in the wages of nursing personnel hired by the national and the local governments, and among those working in the public and private sectors. It also requests the Government to provide a copy of theHouse Bill No. 7569 “Minimum Wage for Nurses in the Private Sector Act”, if enacted, indicating how it addresses the issue of the wage gap between public and private sector health workers.

Articles 5 and 6. Conditions of employment and work of nursing personnel. The Government indicates the adoption of the Department of Labour and Employment (DOLE) Department Order No. 182, series of 2017 (DO 182-17), which provides the guidelines governing the employment and working conditions of health personnel, including nurses and midwives, in the private healthcare sector. The Government indicates that workers’ and employers’ representatives were consulted at the National Tripartite Industrial Peace Council (NTIPC) on the adoption of the guidelines. The DO 182-17 establishes minimum benefits at least equivalent to those of other workers with regard to, inter alia, hours of work, weekly rest, paid annual holidays, paid maternity and paternity leave, and social security benefits. It further provides that the minimum benefits established are without prejudice to any company policy, contract or collective agreement providing for better terms and conditions of employment (section 3, second paragraph), and social welfare benefits (section 12). The Committee observes, however, that section 4 of the DO 182-17 and section 83 of the Labour Code provide that health personnel in cities and municipalities with a population of at least one million or in hospitals and clinics with a bed capacity of at least 100 shall hold regular office hours for eight hours per day, for five days, except where the exigencies of the service require that such personnel work for six days or 48 hours. In such cases, they are entitled to an additional compensation of at least 30 per cent of their regular wage for work on the sixth day.

The Committee would like the Government to provide further details as to the manner in which these “exigencies of the service” are understood and applied in practice. In the Committee’s understanding situations in which regular recourse to overtime is made to compensate for persistent nursing workforce shortages are not compatible with the protection afforded by the nursing personnel instruments. In this respect, paragraph 33(3) of Recommendation No. 157 indicates that temporary exceptions to the provisions on “normal” and “actual” working hours should only be authorized in case of special emergency necessitating to derogate temporarily to the normal hours of work of nursing personnel. The Committee also recalls that, in such cases, the competent authority or body should determine the circumstances and limits in which exceptions to the normal hours of work may be permitted. These circumstances should be defined in agreement or in consultation with the representatives of nursing personnel (see 2022 General Survey, Securing decent work for nursing personnel and domestic workers, key actors in the care economy, paragraphs 420–422). The Committee therefore requests the Government to provide information on which circumstances are considered in the national legal practice to constitute “exigencies of the services” under section 4 of the Department Order No. 182, series of 2017 (DO 182-17) andsection 83 of the Labour Code. The Government is also invited to indicate how it is ensured that these circumstances are defined in agreement or in consultation with the representatives of nursing personnel. Please also provide copies of pertinent collective agreements currently in force concerning the employment and working conditions of nursing personnel in the public and private sectors.