Direct Request (CEACR) - adopted 2024, published 113rd ILC session (2025)

Nursing Personnel Convention, 1977 (No. 149) - Azerbaijan (Ratification: 1992)

Articles 2 and 3(1) of the Convention. National policy concerning nursing services and nursing personnel. Nursing education and training. The Committee notes with interest the information provided by the Government on the ongoing reform (transformation) in the health system of Azerbaijan aiming to improve healthcare services and to support the nursing workforce. In this regard, the Government indicates the entry into force of the Law on Health Insurance on 1 January 2020 and the establishment of the State Agency for Compulsory Health Insurance (TABIB), transformed from a government body into a public legal entity by the Presidential Directive No 1125 of 24 November 2016. The Agency’s main objectives include adopting measures to improve the quality of healthcare services and ensure they are accessible to the population. The Committee further notes the establishment of the Association for the Administration of Healthcare Territorial Units pursuant to Presidential Decree No 418 of 20 December 2018. To implement the latter, the Cabinet of Ministers has adopted a decision with a list of healthcare facilities to be managed by the Association as of 1 January 2020. According to the information provided by the Government, one the Association’s main objectives is the organization of healthcare services in healthcare facilities and the control of the quality of the services to comply with modern requirements.

The Committee further notes that according to the information from the World Health Organization (WHO), the health workforce development is a key component of the Government’s strategy to prioritize “human capital”. The Committee also notes the reform and progress in the healthcare education system of Azerbaijan. In this context, the Government refers in its report to changes in the legal status of the nursing institutions (medical colleges) operated by the Ministry of Health of Azerbaijan and the Ministry of Health of the Nakhchivan Autonomous Republic. According to the information provided, the medical colleges were transformed into public legal entities under Resolution No. 35 of the Cabinet of Ministers of 29 January 2022, which created the possibility of self-financing. In addition, the Committee notes the information about projects and courses in the last five years in collaboration with other international organizations (United Nations Children’s Fund (UNICEF), WHO and European Union (EU)) aiming to address challenges such as inadequate infrastructure, outdated curricula, and a shortage of nursing personnel. In this context, the Committee further notes the significant increase in the number of registered and graduated students for the period 2018-2022 (1,655 registered students and 1,594 graduated in the academic year 2018–2019 and 2,246 registered and 1,762 graduated in the academic year 2021–2022), a clear indication of the positive impact of the education reform in the country. The Committee further observes that mid-level healthcare workers must undergo certification every five years to verify their professionalism and suitability to practice in line with the Rules for the certification of persons (workers) engaged in practical medicine or pharmacy, approved by Resolution No. 108 of the Cabinet of Ministers of 8 June 2010. Furthermore, according to the information provided by the Government, 25,030 mid-level healthcare workers have been certified in the reporting period. The Government also indicates that, as of January 2022, the total number of mid-level healthcare workers in Azerbaijan was 44,246. In this context, the Committee notes a decrease in the density of nursing and midwifery personnel in the country from 6.4 per 1,000 population in 2018 according to the WHO Global Health Observatory to 4.4 mid-level health workers per 1,000 population in the country in January 2022 according to the information provided by the Government. The Government also informs about a draft of a Sectorial Collective Agreement for 2022–24 between the Ministry of Health and the National Committee of the Trade Union of Healthcare Workers of Azerbaijan. Regarding the latter, the Committee requests the Government to provide information about the entry into force of the Sectorial Collective Agreement for 2022–24 and its impact on the national policy concerning nursing personnel. It also requests the Government to continue to provide information on the specific measures taken or envisaged to invest in the education and training of nursing personnel. The Committee further reiterates its requests to the Government to provide a copy of the 2011 state standard with its next report.

Articles 2(2)(b) and 5(2). Employment and working conditions of nursing personnel. Consultation. The Committee notes the information provided regarding the efforts to increase the remuneration of health workers. The Committee further observes that, on 14 January 2022, the Government approved a Unified Wage Scale for workers employed in areas financed from the national budget. As a result, the mid-level healthcare workers received an average monthly pay of 442 Azerbaijani manats (approximately US$260), which represents an increase of almost 160 per cent in comparison with the average monthly wage of a nurse in 2018 (171 Azerbaijani manats). The Committee also notes that the Government refers to awards in the form of medals, honorary titles and certificates given to mid-level health workers to evaluate their work. The Committee, however, observes that in the context of the shortage of nursing personnel in the country, the Government does not provide further information on the measures taken to facilitate retention of the nursing workforce by not only bettering the remuneration packages but also by offering better career prospects designed to attract and retain healthcare workers. The report also does not contain information on the measures taken to address including those measures adopted to tackle the practice of out-of-pocket payments (OOPs) in the health sector. The Committee observes that OOPs in the health sector negatively impact nursing personnel by increasing their workload and stress due to delayed patient care. This can often lead to job dissatisfaction and burnout as nurses deal with more severe cases. Additionally, nurses may face ethical dilemmas when balancing patient care with financial limitations. Consequently, the Committee considers it important to address these issues requires by reducing the burden of OOPs payments and supporting nursing staff adequately. The Committee therefore reiterates its request to the Government to provide further information as regards the above issues.

Application in practice. The Committee notes the detailed information provided by the Government about the nursing personnel disaggregated by region, age and sex which shows that Baku has the highest number of nursing personnel – 17,209 nurses and midwives (16,914 women and 295 men), followed by Nakhchivan region – 2,433 nurses and midwives (2,357 women and 76 men) and Sumgait – 1,997 nurses and midwifes (1,980 women and 17 men). The region with the least number of nursing personnel is Zangilan - only 9 nurses and midwives. The Committee also notes that the nursing workforce continues to decrease from 52,807 employees at the beginning of 2018 to 44,246 in September 2022. The Committee further observes that the Government does not provide information on the number of nurses working in the public and private sector. It does not provide either information on the number of those who leave the profession each year. The Committee requests the Government to continue to provide detailed updated information, disaggregated by age and sex, concerning the situation of nursing personnel – including midwives, the nurse-population ratio, the number of nursing personnel broken down by those working at public and private healthcare establishments, and the number of those who leave the profession each year. It also requests the Government to provide copies of any recent reports, studies, or surveys relevant to the matters covered under the Convention.