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Article 2, paragraphs 1 and 3, of the Convention. National policy concerning nursing services and nursing personnel. The Committee notes that the National Health Policy was adopted in 2000. In particular, it notes that the National Health Policy provides for strategies for priority-based human resource development, and recommends, among others: (i) the maximization of the knowledge and skills of health personnel; (ii) the restructuring and strengthening of the Bangladesh Nursing Council (BNC); and (iii) the provision of more need-based medical education and continuous training for nursing professionals. In addition, it notes that, in the process of the formulation of the National Health Policy, a subcommittee for Designing Strategies to Develop, Manage and Implement Human Resource Development Plans was created in order to prepare specific recommendations concerning, among others, necessary steps for human resource development and appropriate staffing in the health sector. This subcommittee consisted of representatives from governmental bodies, NGOs and an international organization. In this connection, the Committee notes that a draft update of the National Health Policy was completed in August 2008. The Committee would appreciate if the Government would provide additional information on the implementation of the National Health Policy and the results obtained. It would also be grateful if the Government would specify whether and how the employers’ and workers’ organizations concerned were associated with the formulation of this policy and its update.

Article 3, paragraph 1. Nursing education and training. The Committee notes the Government’s indication that the regulations provided for under section 19 of the Bangladesh Nursing Council Ordinance, 1983, concerning the basic requirements for nursing education and training have not yet been adopted. The Committee also notes the information provided by the Government that the new structure of nursing education came into force in January 2008, which consists of a four-year bachelor programme in nursing and midwifery science, a two-year post-bachelor programme in nursing and public health and a master degree programme in nursing and relevant fields. It requests the Government to keep the Office informed of any progress made in the revision process of the Bangladesh Nursing Council Ordinance, and to transmit a copy of the amended Ordinance and its regulations once they have been issued.

In addition, according to the report of the Bangladesh Health Watch entitled “The State of Health in Bangladesh 2007”, to which the draft updated National Health Policy refers, the Committee notes that while the aim of these educational reforms is to address the domestic shortage of nursing personnel, the same report estimates that many of the graduates will find employment overseas. It understands that numerous nurses migrated to foreign countries, particularly in the Middle East, even though numbers appear to be declining in recent years. According to a study published in June 2007, during the period 1991–2004, a total of 20,825 female workers migrated from Bangladesh through formal channels. Approximately 6 per cent of the emigrant female workers were nurses, of which 87 per cent went to Middle Eastern countries (mainly Saudi Arabia) and the rest to the Far East (mostly Malaysia). The Committee requests the Government to provide information on any measures taken or envisaged in order to maintain a sustainable domestic nursing workforce. In this respect, the Committee wishes to refer to the draft WHO Code of Practice on the International Recruitment of Health Personnel, currently under preparation, which urges member States to enter into bilateral and multilateral arrangements to promote cooperation and coordination on migrant health personnel recruitment processes in order to maximize the benefits and mitigate the potential negative impact of international recruitment of health personnel, and also calls for measures in order to retain and sustain a skilled domestic health workforce by improving their social and economic status, their living and working conditions, their opportunities for employment and their career prospects.

Article 6. Working conditions of nursing personnel. Further to its previous comments on this point, the Committee notes the Government’s renewed reference to the proposal sent to the Ministry of Health and Family Welfare regarding the improvement of the present status and pay scale of nursing officers and the creation of new posts. In the absence of any new information, the Committee requests the Government to provide information on the contents of the proposal made and to keep the Office informed of any progress made in this regard.

Article 7. Occupational safety and health of nursing personnel. The Committee notes the Government’s indication that efforts are currently made in order to adapt existing laws and regulations on occupational health and safety to the special nature of nursing work, as provided for in this Article of the Convention. The Government also refers to awareness-raising campaigns on prevention and protection from various infectious diseases. Moreover, the Government refers to the Hospital Improvement Initiative (HII) which aims at creating a safe working environment for hospital team including nurses. In this connection, 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 to both reduce transmission of HIV and to improve the delivery of care to patients. The Committee also wishes 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 requests the Government to keep the Office informed of any measures that might be taken or envisaged with a view to improving the protection of nursing personnel from infectious diseases, including HIV/AIDS.

Part V of the report form. Application in practice. The Committee notes that, according to the statistical information provided by the Government, there are currently 22,000 registered nurses, of whom approximately 15,000 work in hospitals or health-care institutions in the public sector. It also notes that the doctor–nurse ratio is 2:1, while the nurse–population ratio is 1:8,000. 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 number of students attending and graduating from nursing schools every year, the number of registered practising nurses, specific activities undertaken and results obtained through various programmes, such as the HII and the Divisional Nursing Education and Practice Network Programme, copies of official reports or studies addressing nursing-related issues, such as various studies undertaken by the Human Resources Development Unit of the Ministry of Health and Family Welfare, etc.

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The Committee notes the Government’s report and wishes to draw attention to the following points.

Article 3, paragraph 1, of the Convention. The Committee has been requesting the Government for some time past to specify whether regulations have been issued under section 19(2) of the Bangladesh Nursing Council Ordinance, 1983 to lay down the basic requirements for nursing education and training. In successive reports, the Government has referred to the basic nursing syllabus, course outlines and training curriculum used by public and private nursing institutions and has indicated that all relevant texts have been communicated to the Office. Regrettably, the Committee notes that no such texts have ever been appended to the reports received and therefore asks the Government to include in its next report fully documented information on the requirements regarding nursing education and training prescribed under the Nursing Council Ordinance, 1983.

Article 6. The Committee recalls its previous comment in which it expressed concern about the information that most private clinics do not comply with the conditions of employment of nurses applicable in the public sector. In the absence of any further information in the Government’s report on this point, the Committee is obliged to refer to Article 1, paragraph 2, of the Convention which provides that the Convention applies to all nursing personnel, wherever they work, and asks the Government to provide specific information on the working conditions and entitlements of nurses employed in the private sector in respect of pay, working time and social security, as compared to those enjoyed by the nursing personnel working in public institutions.

In addition, the Committee notes the Government’s statement that the Ministry of Health and Family Welfare is taking steps for increasing the pay scale of nursing officers and creating new posts, while a Human Resource Management Programme is under way to revise the job description of all categories of health personnel. The Committee would appreciate receiving additional information on the outcome of these measures including the new remuneration levels for health-care workers once they are established.

Article 7. Further to its previous comment concerning the need to upgrade the occupational health and safety standards in the working environment of nursing personnel, the Committee notes the Government’s indication that a programme has been developed on prevention and protection of nurses from various infectious diseases and that awareness has been raised among nurses with regard to precautionary measures and personal safety. The Government also refers to Hospital Improvement Initiative (HII) programmes carried out in selected hospitals with the aim of creating safe working environment for hospital personnel including proper disposal of hospital waste. The Committee requests the Government to provide more detailed information on the implementation of these programmes and the practical results obtained so far and also to report on any new developments or initiatives on these matters.

Part V of the report form. The Committee notes that according to the Government’s report there are at present approximately 19,800 registered nurses, of whom 12,689 are employed in public hospitals and health-care institutes. The Government further indicates that there are almost twice as many doctors as nurses in the health sector, the ratio being 1.8 to 1, while the ratio of nurses in relation to the overall population is 1 to 8,000. As regards the situation prevailing among the Directorate of Nursing Services (DNS), which is responsible for enforcing and implementing the provisions of the Convention, and nursing personnel employed in the private sector, the Committee notes that some contact has been established in a limited scale through the Nursing Education and Practice Network Programme at the divisional level which offers the opportunity for periodical meetings and exchange of views. While expressing the hope that such constructive dialogue will continue, the Committee requests the Government to provide additional information on the abovementioned programme. It also requests the Government to continue to supply information on the application of the Convention in practice, including for instance statistics on the number of nurses currently employed in both the public and private sectors or the number of students attending nursing schools, measures to remedy the shortage of nursing personnel and also the imbalance in the nurse to physicians ratio, official reports (e.g. annual reports of the DNS) addressing labour and employment issues related to the nursing profession, as well as any practical difficulties encountered in the implementation of the Convention.

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The Committee notes the succinct information provided by the Government in its report.

Article 3, paragraph 1, of the Convention. Further to its previous comments the Committee observes that no copies of the regulations issued under section 19(2)(i) to (m) of the Bangladesh Nursing Council Ordinance, 1983, have ever been enclosed with the Government's reports. The only legal texts which have been sent with this Ordinance were its three schedules referring to nursing qualifications granted by the nursing institutions in Bangladesh which are related to the application of section 9 but not to section 19(2) of the Ordinance. In this respect, the Committee observes that the Government in its report of 1994 stated in relation to the application of Article 3, paragraph 1, that these regulations had been sent with the report of 1993. However, in the report of 1993 the Government stated as follows: "The text of the course outlines for senior registered nurse syllabus prescribed under section 19, paragraph 2(i), of the Bangladesh Nursing Council Ordinance, 1983, is to be sent separately ...". The Committee is therefore bound to request the Government once more to communicate copies of the regulations issued under section 19(2)(i) to (m) of the Bangladesh Nursing Council Ordinance, 1983.

Article 6. The Committee recalls that, from its first previous comments, after the first report was examined, the Committee has been requesting the Government to inform on the specific regulations ruling the working conditions (paragraphs (a) to (g) of this provision of the Convention) in relation to nursing personnel. The Government provided some information, e.g., on hours of work, holidays, etc. Although the Committee has formulated several requests the Government has not supplied concrete information on the legal texts providing such working conditions (with the exception of the Prescribed Leave Rules, 1959, for holidays) nor has it sent copies of the relevant texts. The Committee therefore requests the Government once more to communicate the relevant information and copies with its next report.

In addition, the Committee notes with concern the information provided by the Government that most private clinics do not comply with the standard of employment of nurses in the public sector. The Committee requests the Government to provide information on the measures taken or envisaged to ensure the application of these provisions of the Convention to the totality of the nursing personnel employed in the private sector.

Article 7. The Committee notes with concern the information provided by the Government according to which: precautions are not complied with as regards the application of this provision due to the non-availability of necessary equipment; no effective mechanism to reduce the hazard to nursing personnel of HIV/AIDS/hepatitis and other infectious diseases is operational; waste disposal is not properly functional and the sale of used equipment is a common practice. The Committee trusts that the Government will make every effort to take the necessary action to adapt the existing laws and regulations on occupational health and safety to the special nature of nursing work and the environment in which it is carried out. Referring to its general observation of 1990, which it repeated in 1994, the Committee hopes that the Government will take measures, in consultation with the employers' and workers' organizations concerned, with regard to the adjustment of working conditions of the nursing personnel infected or considered to be infected with HIV/AIDS (e.g. hours of work, rest time, recognition that the cause of infection was occupational, compensations, etc.).

Part V of the report form (read in conjunction with Article 2, paragraph 2). The Committee notes the information supplied by the Government that contact between the Directorate of Nursing Services and nurses employed in the private sector has not improved. The Committee trusts that the Government will take the necessary measures to improve this situation and that it will supply information on any progress achieved in this matter. The Committee suggests that the Government might wish to make use of the technical assistance of the International Labour Office to resolve the matter. In addition, the Committee requests the Government to continue to provide statistical information on the number of nursing personnel in the public and private sectors, in relation to the population and other people employed in the health sector, and the number of people leaving the profession.

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

Article 3, paragraph 1, of the Convention. The Committee notes that under section 19(2)(i) to (m) of the Bangladesh Nursing Council Ordinance of 1983, the above Council is responsible for issuing regulations on the basic requirements for the training and education of nursing personnel. However, the Committee has not yet received copies of the basic nursing syllabus and curriculum used by private nursing centres, nor copies of the training programme for State nurses. It hopes that the Government will provide these documents in the near future.

Article 6. The Government does not indicate whether there are any specific regulations on hours of work of nursing personnel in the public and private sectors, including compensation for overtime and inconvenient hours, as provided for in this Article of the Convention (paragraph (a)) and in the 1965 Shops and Establishments Act. Nor does the Government indicate whether the provisions of the law concerning paid annual leave (paragraph (c)), educational leave (paragraph d)), sick leave (paragraph (f)) and social security (paragraph (g)) are applied specifically to nursing personnel in the public and private sectors. The Committee again expresses the hope that the Government will provide specific information on the above points, together with a copy of the provisions guaranteeing the above-mentioned entitlements. Please also provide a copy of the provisions ensuring weekly rest for nursing personnel in the public and private sectors, as required in paragraph (b) of the present Article.

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

Point V of the report form (read in conjunction with Article 2, paragraph 2). The Committee noted that the basic nursing syllabus is regularly adapted to developments in medical and nursing sciences and technology. It also noted that nursing personnel whose performance was excellent had access to international study scholarships. The Committee again asks the Government to keep it informed of progress made in contacts between the Directorate of Nursing Services and nurses employed in the private sector and to provide general information on how the Convention is applied in practice. It asks the Government to continue to provide statistical information on the number of nursing personnel in the public and the private sectors, in relation to the population and other people employed in the health sector, and the number of people leaving the profession.

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The Committee notes the observations made by the Bangladesh Employers Association. It also notes that the Government's report contains no reply to its comments and that the legislation mentioned which was supposed to be sent to the Office (Prescribed Leave Rules, 1959 and the Course Outlines for Senior Registered Nurse Syllabus prescribed under section 19, paragraph 2(i) of the Bangladesh Nursing Council Ordinance) has not been received. It hopes that the next report will include full information on the matters raised in its previous direct request which read as follows:

(a) Article 3, paragraph 1 of the Convention. The Government stated in its report that regulations have been issued under section 19, paragraph 2 of the Bangladesh Nursing Ordinance of 1983 to lay down minimum standards for nursing education and training. The Committee would therefore appreciate it if the Government would communicate the text of the above regulations. Please also send copies of basic nursing syllabus and curriculum used by the private nursing centres.

(b) Article 6. The Committee noted the information supplied by the Government on hours of work of nursing personnel. It also noted that there are no specific regulations in this regard and that no compensation is granted for overtime and inconvenient hours of work, as is provided for in the Convention and in the Shops and Establishments Act, 1965 for workers employed in such types of establishments. The Committee hopes that the Government will be able to take the necessary measures to give effect to the requirements of paragraph (a) of the above Article of the Convention. The Government also stated that nurses in the public sector are entitled to paid annual holidays, educational leave, sick leave and social security benefits as other government employees in conformity with paragraphs (c), (d), (f) and (g) of this Article. Please indicate under what legislative or other provisions nursing personnel in the public sector enjoy the above-mentioned conditions as well as whether the above provisions are also applicable to nursing personnel in the private sector. (Please supply copies of the provisions guaranteeing these rights.)

The Committee also noted the information on the provisions applicable to other workers in the country - especially under the Shops and Establishments Act, 1965 in respect of benefits specified under paragraphs (d), (e) and (f) of this Article concerning educational leave, maternity leave and sick leave, respectively. Please indicate whether nursing personnel are also entitled to weekly rest as provided for in subparagraph (b) of Article 6 of the Convention.

(c) Point V of the report form (in conjunction with Article 2, paragraph 2). The Committee noted that nurses employed in the private health sector are not supervised by the Directorate of Nursing Services or by the Bangladesh Nursing Council. It also noted that the above Directorate is initiating efforts to work more closely with the privately employed nurses. The Committee requests the Government to keep it informed on the progress made in that respect and to provide general information on the manner in which the Convention is applied in practice (including, for example, statistics on the number of nursing personnel in the public and the private sector, and their relation to population and to other persons employed in the health field). Please also supply, if possible, data on the number of persons leaving the profession.

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I. Further to its previous comments, the Committee notes the information supplied by the Government on the application of Article 5, paragraphs 1 and 2, of the Convention concerning the participation of nursing personnel in the planning of nursing services and the consultation of such personnel on decisions concerning their conditions of work and the determination of conditions of employment by negotiation between employers' and workers' organisations concerned.

II. The Committee requests the Government to supply further information on the following points:

(a) Article 3, paragraph 1 of the Convention. The Government states in its report that regulations have been issued under section 19, paragraph 2 of the Bangladesh Nursing Ordinance of 1983 to lay down minimum standards for nursing education and training. The Committee would therefore appreciate it if the Government would communicate the text of the above regulations (as it was not appended to the report). Please send also copies of basic nursing syllabus and curriculum used by the private nursing centres.

(b) Article 6. The Committee notes the information supplied by the Government on hours of work of nursing personnel. It also notes that there are no specific regulations in this regard and that no compensation is granted for overtime and inconvenient hours of work as it is provided for in the Convention and in the Shops and Establishments Act, 1965 for workers employed in those establishments. The Committee hopes that the Government will be able to take the necessary measures to give effect to the requirements of paragraph (a) of the above Article of the Convention. The Government also states that nurses in the public sector are entitled to paid annual holidays, educational leave, sick leave and social security benefits as other government employees in conformity with paragraphs (c), (d), (f) and (g) of this Article. Please indicate by virtue of what legislative or other provisions nursing personnel in the public sector enjoy the above-mentioned conditions as well as whether the above provisions are also applicable to nursing personnel in the private sector. (Please supply copies of the provisions guaranteeing these rights.)

The Committee also notes the information on the provisions applicable to other workers in the country - especially under the Shops and Establishments Act, 1965 in respect of benefits specified under paragraphs (d), (e), (f) of this Article concerning educational leave, maternity leave and sick leave, respectively. Please indicate whether nursing personnel is also entitled to weekly rest as provided for in subparagraph (b) of Article 6 of the Convention.

(c) Point V of the report form (in conjunction with Article 2, paragraph 2). The Committee notes that nurses employed in the private health sector are not controlled by the Directorate of Nursing Services or by the Bangladesh Nursing Council. It also notes that the above Directorate are initiating efforts to work more closely with the privately employed nurses. The Committee requests the Government to keep it informed on the progress made in that respect and to provide general information on the manner in which the Convention is applied in practice (including, for example, statistics on the number of nursing personnel in the public and the private sector, and their relation to population and to other persons employed in the health field). Please also supply, if possible, data on the number of persons leaving the profession.