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Article 2, paragraph 2, of the Convention. National policy concerning nursing services and nursing personnel. The Committee notes the Government’s indication that it intends to increase the night duty and vigil duty allowance for nursing personnel so as to avoid their dropping out from the public sector. It also notes that an implementing ministerial order is currently under preparation. The Committee requests the Government to keep the Office informed of any similar measures or initiatives aimed at improving the employment and working conditions of nursing personnel, including their pay conditions. The Committee would also appreciate receiving the Government’s views as to whether the remuneration levels of nursing personnel are commensurate with their socio-economic needs, qualifications and responsibilities and whether they sufficiently take into account the constraints and inherent hazards of the nursing profession.

With regard to the ongoing re-evaluation and classification of nursing jobs, which has been undertaken by the Nursing Department of the Ministry of Health in collaboration with the trade union of nursing personnel, the Committee notes the Government’s indication that the national project for the human resources development of nurses has now been finalized and has been disseminated to all regional health departments for guidance and information of nursing staff. The Committee requests the Government to provide additional explanations on the new classification system of nursing jobs and outline its objectives, priorities as well as proposed strategies.

Article 2, paragraph 3, and Article 5, paragraph 2. Consultation and negotiation with the social partners on the policy on nursing personnel. The Committee notes the Government’s reference to section 2 of Act No. 115 of 1976 establishing a Public Union of Nursing which provides that the union endeavours, among others, to contribute to the formulation of a policy for the education of nursing personnel, and to develop the means for the improvement of nursing services. The Committee considers that this provision may set out in general terms the mandate of the Public Union of Nursing, but says very little about the practical manner in which the union participates in consultations aiming at the adoption of a policy concerning nursing services or the determination of conditions of employment and work of nursing personnel. The Committee therefore requests the Government to provide more detailed information on the institutional framework within which the representative organizations of nursing personnel are consulted with respect to the elaboration and application of policies and principles regarding the nursing profession and the determination of conditions of employment and work of nursing personnel.

Article 3. Nursing education and training. The Committee notes the information provided by the Government regarding the reform of the nursing education from a three-level to a two-level system by gradually transforming secondary nursing schools, which currently account for 85 per cent of all graduates, to technical institutes for nursing and accordingly extending nursing studies from three to five years. It also notes the Government’s indications about the policy of continuous training for nursing personnel through collaboration with foreign universities. Noting that the final phase of the reform of the nursing education system is scheduled to be completed by 2010, the Committee requests the Government to provide all available information on the progress made so far as well as on the practical results of the existing collaborative arrangements with foreign academic institutions for the training of nursing personnel.

Article 5, paragraph 3. Settlement of disputes concerning employment conditions. Further to its previous comment on this point, the Committee notes that the Government refers to Act No. 47 of 1978 on the Statute of Public Employees as the legislation governing employment conditions of nursing personnel employed in the public sector. Noting that this Act does not appear to contain any provisions on the settlement of collective disputes concerning conditions of employment of public employees, the Committee asks the Government to clarify how the Convention is given effect with respect to nursing personnel in the public sector.

Article 7. Special regulations on occupational health and safety for nursing personnel. The Committee notes the Government’s reference to the Order of the Ministry of Manpower and Emigration No. 211 of 2003 concerning the limits of safety, conditions and requirements to protect from biological, chemical, mechanical, physical and negative hazards in the work environment, which is an instrument of general nature in the field of occupational safety and health. In this respect, the Committee draws the Government’s attention to the Joint ILO/WHO guidelines on health services and HIV/AIDS, published in 2005, with a view to assisting health services in building their capacities to provide their workers with a safe, healthy and decent working environment as the most effective way both to reduce transmission of HIV and to improve the delivery of care to patients. The Committee wishes also to refer to the International Labour Conference discussion held in June 2009 on “HIV/AIDS and the world of work” with a view to adopting an international labour Recommendation, and in particular to paragraph 37 of the proposed conclusions (see ILC, 98th Session, 2009, Report IV(2), page 310) which provides that public health systems should be strengthened, where appropriate, in order to ensure greater access to prevention, treatment, care and support, and to reduce the additional strain on public services, particularly on health workers, caused by HIV/AIDS. The Committee would be grateful if the Government would indicate in its future reports any specific measures taken or envisaged with a view to adapting laws and regulations on occupational safety and health to the special nature of nursing work and of the environment in which it is carried out and to increase the protection afforded by them.

Part V of the report form. Application in practice. The Committee notes that, according to the statistical information provided by the Government the number of students enrolled at nursing schools is 21,207 while the number of nursing personnel registered with the Public Union of Nursing amounts to 204,000, 80 per cent of whom are working in the public sector. It would be grateful if the Government would continue supplying up to date information concerning the application of the Convention in practice, including, for instance, the nurse-to-population ratio, copies of official reports or studies addressing nursing-related issues, any practical difficulties encountered in applying the Convention, etc.

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The Committee notes the Government’s report.

Article 2, paragraph 2, of the Convention. The Committee notes the Government’s indication that the Central Authority for Administration and Management is considering the possibility of increasing by 30 per cent the bonuses to nursing graduates with a view to stemming the flow of nursing personnel leaving the public sector. While recalling that similar information was communicated by the Government in its previous reports, the Committee understands that, in the absence of any concrete measures to reverse the tendency, the phenomenon of nursing personnel leaving the public sector or the nursing profession altogether persists. It therefore requests the Government to provide detailed information, including all available statistics, on the current situation in both public and private medical institutions in so far as nursing staff is concerned, the number of licensed nurses recruited every year, their basic salary levels and range of allowances. The Committee would also appreciate receiving the Government’s views as to whether the pay conditions in the nursing sector adequately reflect the socio-economic needs, special responsibilities and inherent risks of the nursing profession and are likely to attract persons to the profession and retain them in it.

In addition, the Committee notes that the project for the re-evaluation and classification of nursing jobs, which is being developed by the Ministry of Health’s Nursing Department in collaboration with the trade union of nursing personnel, and to which the Government has been referring for the past ten years, is still under preparation. The Committee requests the Government to specify whether the project is still actively pursued, and if so, to indicate a possible timetable for its finalization. The Committee takes also this opportunity to ask the Government for up-to-date information on current policy and programmes on nursing education and training. The Committee understands that 94 per cent of practising nurses are diploma nurses, i.e. graduates of secondary nursing schools, and only 6 per cent are college or technical institute graduates, which may pose a problem of efficiency and quality of nursing care. In this connection, the Committee hopes that the Government will supply in its next report full particulars on the measures taken or envisaged to upgrade the standards of education and training of nursing personnel, as required under this Article of the Convention.

Article 5, paragraph 2. In some earlier comments, the Committee had raised the question of the participation of the trade union of nursing personnel in collective negotiations for the determination of conditions of employment and work in health-care establishments of the private sector. In the absence of clear reply, the Committee is bound to request once again the Government to provide full and documented information on the level, content and outcome of any such negotiations in which the nurses’ trade union has participated in recent years.

Article 5, paragraph 3. Further to its previous comments, the Committee notes the Government’s reference to the new Labour Code No. 12 of 2003 as covering the settlement of labour disputes in both the public and the private sectors. The Committee observes, however, that under section 4 of the new Labour Code, public servants of state agencies, including local government units and public authorities, are excluded from its scope of application. It is therefore obliged to renew its request for clarification on the legal provisions or regulations governing the settlement of conflicts arising in connection with the terms and conditions of employment of nursing personnel in the public sector. The Committee would also appreciate receiving copies of any relevant texts.

Article 7. The Committee notes the provisions of the new Labour Code No. 12 of 2003 on occupational safety and health and labour environment security. It notes, in particular, that section 210 requires protective measures when the nature of work involves infection risks for the workers while section 213 provides for a ministerial decree laying down the conditions for preventing such risks. The Committee would be grateful if the Government would indicate whether an executive decree has already been issued in this respect. It would also thank the Government for continuing to provide information on any measures taken or planned seeking to improve the occupational health and safety standards applicable to health-care workers, including any specific initiative undertaken with respect to protection of nursing personnel from HIV infection.

Part V of the report form. The Committee notes that according to news reports, Egypt experiences a severe shortage of qualified nurses with nursing staff totalling 140,000 persons which represents a ratio of approximately 20 nurses per 10,000 inhabitants. The Committee would be grateful to the Government for supplying additional information on any concrete efforts to address the problem of shortage of nurses, especially by instituting incentive measures to retain qualified professionals in the health sector. Moreover, the Committee would wish to receive all available information on the practical application of the Convention, including, for instance, the number of students attending nursing schools, copies of official reports or research studies examining the problems and prospects of the nursing profession, etc.

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The Committee notes the information supplied by the Government in its reports. It also notes the comments made by the Federation of Egyptian Industries on the subject of a plan concerning the protection of nursing staff against the transmission of diseases.

In its comments, the Federation alleges that the Ministry of Labour and the representatives of employers’ and workers’ organizations have prepared a clear and well-designed plan concerning the protection of nursing staff against transmission of diseases. It also indicates that periodical inspections are held in application of the protective measures and that the results of the inspections are sent to the competent authorities. The Committee requests the Government to send it a copy of the plan as well as information on its practical application, such as inspection reports and statistics.

In addition, the Committee requests the Government to provide further information on the following points.

Article 2, paragraph 2(b), of the Convention.  In its previous comments, the Committee noted that the project on the classification of nursing jobs in the regions, developed by the Department of Nursing Care of the Ministry of Health in collaboration with the trade union of nursing personnel was under final consideration by the Central Management and Administrative Body. The Committee notes again the information supplied by the Government to the effect that the final text of this instrument will be supplied as soon as adopted.

The Committee also noted that by virtue of decision No. 289 of 1995 taken by the president of the Central Management and Administrative Body in regard to reassessment of a number of posts in the Ministry of Health, the level of the post of General Director of Nursing Care has been raised to Head of Central Management of Nursing Care, with two administrative units. In relation to the Committee’s previous comments on whether there are any laws or regulations applicable to nursing personnel in both the public and private sectors which are likely to attract persons to the profession and retain them in it, the Committee noted the information supplied by the Government that:

-  by virtue of Order No. 534 of 1983 of the Minister of Health incentives are granted to nursing personnel for exceptional efforts;

-  a few private hospitals pay wages and bonuses representing 400 per cent to 600 per cent, on average, of a nurse’s wage in the public sector, and thus the General Administration of Nursing at the Ministry of Health is exerting efforts to increase the level of bonuses in this sector to reduce the number of nursing personnel leaving the profession. The Government also indicates that in the light of Order No. 2072, 1993, of the President of the Council of Ministers, it raised infection risk allowances to 180, 120 and 96 Egyptian pounds a year, according to professional grade;

-  a proposal has been submitted by the Minister of Health, and accepted to increase the allowance to graduates of the Institutes of Nursing in order to prevent 30 per cent of them from leaving their profession due to the initial starting salary prescribed in the public sector;

-  the infection risk allowance for nursing personnel was increased by 360 Egyptian pounds a year to a maximum of 40 per cent of the initial starting salary fixed for the job.

The Government also stated that the Central Management and Administrative Body was currently examining this issue with a view to stemming the flow of nursing personnel leaving the public sector. The Committee requests the Government again to keep it informed on the application of this provision of the Convention.

Article 5, paragraph 3.  In its previous comments, the Committee noted that sections 93 to 106 of the 1981 Labour Code cover the settlement of labour disputes. The Committee notes the information supplied by the Government to the effect that sections 93 to 106 of the Labour Code apply also to all workers in the public sector, in accordance with section 1 of Act No. 48 of 1978 on employees in the public sector. However, the Committee notes again that section 3(a) of the Labour Code provides that "the provisions of the present law shall not apply to: (a) persons working in the administrative bodies of the State, local government units and local public bodies, except for the provisions stipulated in Chapter 5 entitled ‘Occupational Health and Safety’ and provisions to be adopted by a Decree of the President". Consequently, the Committee would be grateful if the Government would take the necessary measures to bring national legislation into conformity with the Convention on this point.

Article 7.  In its previous comments, the Committee noted that, according to the information supplied by the Government, Chapter 5 of the Labour Code relating to occupational health and safety, has been amended by a new Labour Code. The Government stated that a copy of the new provisions would be supplied as soon as they were published. In the context of its 1990 general observation, reiterated in 1994, the Committee noted that the General Administration of Nursing Care of the Ministry of Health held a conference in 1994 on the role of nurses in limiting the spread of the HIV infection. The Government indicated that it had decided at that conference to ensure the participation of nursing personnel in symposia, to hold practical workshops and to prioritize the formulation of training plans in order to obtain the most recent information regarding HIV and to upgrade the level of knowledge and skills of nursing personnel in order to avoid situations of exposure to this virus while performing their duties.

The Committee notes the information supplied by the Government that it will provide information on this subject as soon as it is possible. The Committee therefore requests the Government again to inform it of measures taken or envisaged in regard to nursing personnel infected or considered to be infected by HIV (adaptation of employment conditions, etc.).

Part V of the report form.  The Committee notes with interest the statistical data supplied by the Government in its report. It requests the Government to continue to communicate such statistics and to provide data on the number of persons who abandoned the profession, particularly in the public sector.

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The Committee notes the information provided by the Government in reply to its previous comments.

Article 2, paragraph 2(b), of the Convention. Further to its previous comments the Committee takes note of the information provided by the Government that the project on the classification of nursing jobs in the regions developed by the Department of Nursing Care of the Ministry of Health, in collaboration with the trade union of nursing personnel is under final consideration by the Central Management and Administrative Body. The Committee also takes note that the final text will be communicated when it is adopted. The Committee notes the information according to which due to decision No. 289 of 1985 taken by the President of the Central Management and Administrative Body concerning the re-evaluation of a number of jobs at the Ministry of Health, the level of the Director-General of Nursing was upgrading to the level of Head of the Central Management of Nursing with two administrative units. In relation to the Committee's previous comments on whether there are any laws or regulations applicable to nursing personnel in both the public and private sectors which are likely to attract persons to the profession and retain them in it, the Committee notes the information supplied by the Government that:

-- By virtue of Order No. 534 of 1983 of the Minister of Health incentives are granted to nursing personnel for exceptional efforts.

-- A few private hospitals pay wages and bonuses representing 400 per cent to 600 per cent, on average, of a nurse's wage in the public sector, and thus the General Administration of Nursing at the Ministry of Health is exerting efforts to increase the level of bonuses in this sector to reduce the number of nursing personnel leaving the profession. The Government also informs that in the light of Order No. 2072 of 1993 of the President of the Council of Ministers, it raised infection allowances to 180, 120 and 96 Egyptian pounds a year, according to the professional grade.

-- A proposal has been submitted to the Minister of Health, which was agreed upon, to increase the allowance in order to prevent 30 per cent of graduates of the Graduate Institutes of Nursing from leaving their profession due to the initial starting salary prescribed in the public sector.

-- Infection allowance for nursing personnel was increased by 360 Egyptian pounds a year to a maximum of 40 per cent of the initial starting salary fixed for the job.

The Government also states that the Central Management and Administrative Body currently examine this issue with a view to limiting the number of nursing personnel who leaves the public sector. The Committee requests the Government to continue to supply information in relation to the application of this provision of the Convention.

Article 5, paragraph 3. Further to its previous comments the Committee notes the information supplied by the Government that sections 93 to 106 of the Labour Code of 1981 provide also for the settlement of labour conflicts in the public sector. However, the Committee notes that section 3(a) of the Labour Code provides that "The provisions of the present law shall not apply to: (a) working people with the administrative organs of the State, local government units and public organisations except for the provisions stipulated in Chapter 5 entitled 'Occupational Health and Safety' and provisions to be adopted by a Decree by the President." The Committee therefore requests the Government to provide clarifications on this issue.

Article 7. The Committee takes note of the information provided by the Government that Chapter 5 of the Labour Code relating to occupational health and safety was amended by the draft of a new Labour Code. The Government also informs that a copy of the new provisions will be sent as soon as it is published. With reference to its general observation of 1990 which it repeated in 1994, the Committee notes the information that the General Administration of Nursing at the Ministry of Health organized a conference in 1994 on the role of nurses in limiting the spread of the human immunodeficiency virus (HIV) infection. The Government informs that decisions were taken at this conference to assure the participation of nursing personnel to symposia and to carry out practical workshops and to prioritize the formulation of training plans so as to obtain the most recent information regarding the human immunodeficiency virus (HIV) and to upgrade the level of knowledge and skills of nursing personnel in order to avoid situations of exposure to this virus whilst performing its duties. The Committee requests the Government to continue providing information on these issues and on the measures taken or contemplated with respect to nursing personnel who are infected or considered to be infected by HIV (e.g. adaptation of conditions of work, etc.).

Part V of the report form. The Committee takes note of the data provided by the Government in its report. The Committee notes with interest that the number of nursing personnel in proportion to the number of inhabitants, sick persons and doctors has increased during the last years in comparison to the data contained in the report of the Government received in January 1994. The Committee requests the Government to continue to provide information on the number of persons who are leaving the profession, in particular, in the public sector.

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The Committee notes the detailed information supplied by the Government in reply to its previous comments.

Article 2, paragraph 2(b), of the Convention. The Committee notes that the project developed by the Ministry's Department of Nursing Care, in collaboration with the trade union of nursing personnel and the delegate of the central management and administrative body, with a view to the re-evaluation and classification of nursing jobs covered by the Ministry of Health, is still being examined by the central management and administrative body. It hopes that the Government will supply the Office with a copy of the final text of the above project when it is adopted. Furthermore, the Committee notes that the wages of nursing personnel are governed by the Act respecting the civilian staff of the public administration. It requests the Government to state whether there are any laws or regulations applicable to nursing personnel in the public sector which are likely to attract persons to the profession and retain them in it, in accordance with this Article of the Convention. Please also state whether there are any provisions of the same type covering nursing personnel in the private sector.

Article 5, paragraph 3. The Committee notes that the dispute settlement procedure applicable to nursing personnel in the private sector includes an optional arbitration system. The parties may choose either amicable settlement or conciliation and arbitration, in accordance with sections 93 to 106 of the Labour Code of 1981. It also notes that nursing personnel in the public administration are covered by the dispute settlement procedures governing personnel in the public administration. The Committee would be grateful if the Government would indicate the legal provisions or regulations governing the settlement of conflicts in the public sector and if it would supply a copy of them.

Article 7. The Committee requests the Government to indicate the measures which have been taken or are envisaged to improve existing laws and regulations on occupational health and safety by adapting them to the special nature of nursing work and of the environment in which it is carried out. Furthermore, with reference to its general observation of 1990, which was reiterated in 1994, the Committee requests the Government to indicate the measures which have been taken or are envisaged, in consultation with the employers' and workers' organizations concerned, to take into account the particular risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel, for example, by the arrangement of working conditions, confidentiality of test results, recognition that the cause of infection was occupational, etc.

Point V of the report form. The Committee notes the statistics supplied by the Government in its last report. It hopes that the Government will continue to supply such statistics and that it will provide information on the number of persons who are leaving the profession, as soon as it is available.

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The Committee notes the information supplied by the Government in its reports received in 1985 and 1989 in reply to its previous comments. It would be grateful if the Government would supply additional information on the following points:

Article 2, paragraphs 1 and 2(a), of the Convention. The Committee notes with interest the recommendations resulting from the study evaluating the effectiveness of the education programme for nursing care. It requests the Government to supply information on any measures taken to give effect to these recommendations. In particular, it requests the Government to provide information on the progress made on its four-year plan to up-date the education programme for nursing care, which is being elaborated with the help of the United Nations.

Article 2, paragraph 2(b). The Committee notes from the Government's report that the study undertaken to establish a grading structure for posts occupied by nursing personnel is still being prepared. It requests the Government to provide information, in its next report, of any progress made in this regard as well as any measures taken as a result so as to ensure that nursing personnel enjoy career prospects and remuneration commensurate with their level of responsibilities and likely to attract persons to the profession and retain them in it, in accordance with this provision of the Convention.

Article 5, paragraph 1. In reply to the Committee's comments regarding the participation of nursing personnel in the planning of nursing services and consultation with such personnel on decisions concerning them, in conformity with the above provisions of the Convention, the Government indicates that such participation is ensured by virtue of Acts Nos. 47 and 48 of 1978 concerning, respectively, personnel in the public administration and personnel in the public sector and that, in practice, the system of participation set out in this legislation is also applicable to nursing personnel in the private sector. It adds that nursing personnel are also associated with decisions concerning them at the level of their establishments. The Committee notes this information and requests the Government to indicate whether the participation and consultation of nursing personnel in the private sector in decisions concerning them, which is assured in practice, is also guaranteed by legal provisions or regulations. If so, please indicate which provisions.

Article 5, paragraph 2. The Committee requests the Government to indicate whether the trade union for nursing personnel set up by Act No. 115 of 1976 continues to be in operation and, if so, whether it participates in negotiations on the terms and conditions of employment of this personnel, in accordance with the provisions of the Convention.

Article 5, paragraph 3: (a) In its previous comments, the Committee noted, from information supplied by the Government, that the procedure for settling disputes that occur as regards determining the terms and conditions of employment, as set out in the Labour Code, is applicable to nursing personnel not only in the private sector, but also in the public sector by virtue of Act No. 33 of 1982, which amended the Labour Code. The Committee once again requests the Government to supply a copy of this Act, and fuller information on the settlement of labour disputes affecting nursing personnel in the public administration who, according to the Government's report, have the right of appeal to the courts.

(b) The Committee has also noted that the Labour Code sets up a system of compulsory arbitration for the settlement of disputes. It recalls, however, that this Article of the Convention provides that disputes be settled in such a manner as to ensure the confidence of the parties involved through independent and impartial machinery such as mediation, conciliation and voluntary arbitration. It requests once again the Government to indicate the way by which the guarantees provided for in the Convention are provided under the system of compulsory arbitration set up by the Labour Code.

Point V of the report form. The Committee has noted the statistical data supplied with the 1988 report and hopes that the Government will continue to supply such statistics and will also be able to provide data relating to the number of persons leaving the profession.