Solicitud directa (CEACR) - Adopción: 2024, Publicación: 113ª reunión CIT (2025)

Convenio sobre el personal de enfermería, 1977 (núm. 149) - Letonia (Ratificación : 1993)

The Committee notes the observations of the Free Trade Union Confederation of Latvia (FTUCL) transmitted by the Government and the Government’s response thereto received in August 2023.

Application of the Convention in practice. In its comments the FTUCL draws attention to the conclusions of the European Commission provided in the Report for Latvia 2023 (Commission Staf Working Document 2023 Country Report – Latvia, Accompanying the document Recommendation for a Council Recommendation on the 2023 National Reform Programme of Latvia and delivering a Council opinion on the Stability Programme of Latvia, 24 of May 2023, SWD 2023 614 final) concerning the availability of health care and health care personnel, as well as its strong connection to the low remuneration of health care personnel. The FTUCL notes that the number of practising nurses per 1,000 inhabitants is one of the lowest in the EU and has declined in recent years and that the shortages of health workers are more acute in areas outside Riga and urgent measures are necessary. The Government indicates that in 2022 it had planned to start work on the development of a health workforce strategy in Latvia within the framework of the Technical Support Instrument (TSI) project of the Directorate General for Structural Reform Support of the EC (DG REFORM). The Government also indicates that until the end of the project in July 2023, the planned solutions included the following: (i) human resources mapping; (ii) a database on human resources; and (iii) a sustainability model of continuing education - the creation of a coordinating institution. The Government adds that as part of the reform of the health system in 2017, significant measures have been taken in relation to the provision of human resources, which include: (i) a salary increase, including for residents; (ii) a new remuneration model for medical personnel; (iii) hospital cooperation; and (iv) mobility of human resources (SRSS hospital cooperation project). The Government indicates that, in 2022, there were 8,096 practising nurses of working age, which is half less than the EU average, and 25 per cent of nurses were in pre-retirement and retirement age. The Committee notes in that regard from the statistical data provided by the Government that the number of enrolments, new entrants and graduates in higher education institutions and colleges 2018–2022 show an almost constant decrease. In response to the comment made by the FTUCL, the Government states that there are a few main reasons for the low number of nurses, such as the ageing of the health workforce (for instance, in 2021 around 50 per cent of nurses of general care were either close to retirement age or already in retirement age) and the competition for opportunities abroad. The Government notes, however, that the remuneration has almost doubled from 2018 to 2022, and that the remuneration component is still one of the priorities for health workforce planning. Other priorities include increasing the number of state-funded study positions for healthcare, especially for nurses of general care, to bolster the influx of skilled healthcare professionals into the field. In the Law on the State Budget for 2023 and the Budget Framework for 2023, 2024 and 2025, state budget funding was allocated in addition to study positions for general care nurses, which is 296 additional state budget study positions. Furthermore, efforts to improve access to medical treatment and support beyond the capital city, Riga, are noteworthy. The European Social Fund (ESF) supported Project No. 9.2.5.0/17/I/001 “Improving the Availability of Medical and Medical Support Persons Outside Riga” seeks to level the healthcare field by extending services to underserved areas. The Government further indicates that the Ministry of Health has concluded 1,575 compensation contracts with medical personnel to attract medical personnel to the regions of Latvia. The Government explains that the Ministry of Health is working on a report on the future outlook for nursing employment and professional development, which was expected to be released in fall 2023, seeking input from various stakeholders, including the Latvian Nurses Association, universities and hospitals. In view of the above, recalling the vital role played by nursing personnel, together with other workers in the field of health, in the protection and improvement of the health and welfare of the population, the Committee hopes that, in its future reports, the Government will be in a position to indicate progress made as regards the implementation of a policy concerning nursing services and nursing personnel designed to provide the quantity and quality of nursing care necessary for attaining the highest possible level of health for the population. The Committee requests the Government to continue to provide updated detailed information on the follow up to the report on the future outlook for nursing employment and professional development, which was expected to be released in fall 2023. It also requests the Government to continue to provide updated detailed information on the application of the Convention in practice, including statistics disaggregated by sex, age and region, on the ratio of nursing personnel to the population, the number of persons enrolled in nursing care schools, the number of men and women nurses who enter and leave the profession each year, the organization and the operation of all institutions which provide healthcare, as well as official studies, surveys and reports addressing human resources issues in the health sector.

Article 2(1) of the Convention. National policy concerning nursing services and nursing personnel. In its previous comments, the Committee had requested the Government to provide information on the impact of measures taken in the process of implementing programmes and policies on the improvement of nursing services and on attracting and retaining nursing personnel. The Government indicates that in 2019 it initiated the reform of the education of the nursing profession with the Order of the Cabinet of Ministers No. 537 of 29 October 2019. The reform envisages expanding the nurse’s competence by abandoning narrow specializations, which would contribute to the accessibility of nursing care services to the population, including in the regions. The Government reports that under the operational program of the ESF project “Growth and Employment” 9.2.6. co-financed project No. 9.2.6.0/17/I/001, “Increasing the qualifications of medical and medical support personnel”, the training of nurses and midwives is provided in 14 different professional development programs in the regions as well. The Government adds that in 2022, the nursing reform was completed and, in that framework, the general care nursing profession was introduced. The Committee notes that various amendments to the legislation were made as part of the reform, which included amendments to the Medical Treatment Law of 12 June 1997 and regulations concerning the Register of Medical Personnel and Medical Support Persons (Regulation of the Cabinet of Ministers No.317 of 24 May 2016), Professions Regulated (Regulation of the Cabinet of Ministers No.460 of 6 June 2006), Rules for the Operation of the Medical Risk Fund (Cabinet of Ministers No.1268 of 5 November 2013) and Minimum Requirements of Educational Programmes for the Acquisition of the Professional Qualification of Dentist, Pharmacist, Nurse and Midwife (Cabinet of Ministers No.68 of 19 February 2002). The Government indicates that with the support of the ESF, the Ministry of Health is implementing a project to improve access to treatment and support for people in priority health areas (cardiovascular, oncology, perinatal and neonatal, and mental health), for residents outside Riga. The Committee notes, from the statistical information provided by the Government on the number of nurses and midwives by statistical region 2018–22, that there is a continuous decrease of nurses and midwives per 10,000 inhabitants and that the lack of nurses and midwives is even higher in other areas of the country outside Riga. The Committee also notes that, from the data on the number of nurses and midwives by age group from 2018–22, there is a continuous decrease in nurses and midwives by age, which could have a serious impact on the total number of workers in this sector in the forthcoming years. The Committee requests the Government to continue to provide detailed information, including statistical information disaggregated by sex, age and region, on the impact of measures taken in the process of implementing programmes and policies on the improvement of nursing services and on attracting and retaining nursing personnel, including midwives, particularly in rural and remote areas of the country. The Committee requests the Government to continue to supply information on measures taken or envisaged to ensure access to quality nursing care, particularly for groups in vulnerable situations, such as children, women, people with disabilities and people living in rural areas, taking account of the continued shortage of nursing personnel.

Article 2(2). Employment and working conditions of nursing personnel. The Committee notes that to improve the availability of medical treatment and medical treatment support for persons who provide services in the priority areas of health (cardiovascular, oncology, childcare and mental health) for residents living outside of Riga, the Government modified Regulation of the Cabinet of Ministers No.158 of 21 March 2017 to improve access to medical treatment support for residents outside Riga. This new scheme is aimed at attracting new forces to medical institutions and grants medical practitioners’ monetary compensation if they provide health care services paid for by the state and undertake to work in the region for five years full-time, as well as meet other conditions. Under this scheme, nurses and midwives outside Riga are provided additional compensation for each family member and for living expenses. The Government indicates that the budget framework for 2023, 2024 and 2025 stipulates an increase in the salary for nurses of 10.14 per cent and for nursing assistants of 16.11 per cent and that, in order to combat the insufficient number of nurses in the country, additional funding is expected to be directed to the introduction of the general care nursing profession, including promoting the employment of nurses. The Government adds that according to the Regulation of the Cabinet of Ministers No. 317 of 24 May 2016, “Procedure for Creating, Supplementing and Maintaining the Register of Medical Personnel and Medical Support Persons”, professional nurses and midwives are considered medical personnel. The Government indicates that taking into account the above, the increase in the average salary and monthly salary of medical personnel, which is applicable to nurses and midwives, increased from €974 in 2018 to €1,813 in 2022. The Committee takes note of this information with interest and requests the Government to continue to provide information on the impact of measures taken to improve the terms and conditions of employment, and particularly the remuneration, of nursing personnel.