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Article 2, paragraph 1, of the Convention. Formulation and implementation of a policy for nursing services and nursing personnel. The Committee notes the adoption of Decree No. 07-2007 of 20 February 2007 establishing an Act for the provision of nursing care and also its implementing regulations of 11 January 2008 (Acuerdo Gubernativo No. 56-2008), which establish the National Council for Nursing Care and the Nursing Services Development Unit. The Committee also notes the Government’s indication that the Ministry of Public Health is responsible for managing the implementation of policies in the area of health and for coordinating the various public, private and community bodies. It further notes the Government’s statement that efforts have been made to establish national policies for nursing services. These efforts have resulted in a national workplan drawn up in cooperation with the National Nursing School of Guatemala, the Guatemalan Association of Professional Nurses and also the chief nurses of public hospitals and health centres. The Committee notes that this plan – the “Integrated nursing care development plan 2008–12” – deals with the reinforcement of nursing care management capacity, professional competence, coordination of services, training and communication, and human resources.
The Committee understands that there are substantial disparities in the country regarding the distribution of human resources in the area of health care between rural and urban areas since 70 per cent of nursing personnel work exclusively in hospitals, leaving rural health centres with serious shortages of nursing staff. It notes that in 2005 a programme for the promotion of basic nursing care was launched by the National Nursing School of Cobán in five municipalities in the north of Guatemala to enable nursing personnel in rural districts to be trained by the most qualified personnel from urban areas.
Furthermore, the Committee notes that, according to a recent study by the Pan American Health Organization (PAHO), Guatemala is experiencing a shortage of nursing personnel since the ratio is only 3.6 per 10,000 inhabitants. It also notes, according to a study published in 2004, that 34 per cent of qualified nursing personnel have emigrated to the United States and auxiliary nursing staff represent 82 per cent of the workforce in this area. The Committee understands that the main causes of migration of qualified nursing personnel abroad are low wages, the economic situation, the low standard of living, family needs, poor career prospects and the lack of public policies in this area. It wishes to refer to the Code of practice currently being drafted by the WHO concerning the international recruitment of health personnel, which encourages member States to conclude bilateral and multilateral agreements to promote cooperation and coordination relating to migrant health personnel in the recruitment process, in order to optimize the advantages and reduce the potentially negative impact of the international recruitment of health personnel, and which also calls for measures to conserve and maintain a qualified national workforce of health personnel by improving their economic and social situation, living and working conditions, possibilities of employment and career prospects. While noting the efforts made by the Government and also the need to collect up to date information in this area, the Committee requests the Government to supply detailed information on (i) the application of the “Integrated nursing care development plan 2008–12” and the “Programme for the promotion of nursing care 2005” and also the results achieved, and (ii) any developments in the situation of nursing personnel and, if applicable, information on any additional measures taken or contemplated to contain the phenomenon of migration of qualified nursing personnel abroad.
Article 2, paragraphs 2(b) and 3. Pay for nursing personnel. Consultation with employers’ and workers’ organizations. Further to its previous comment, the Committee notes that the Government’s report does not contain any specific reply to the comments made by the Trade Union Confederation of Guatemala (UNSITRAGUA) dated 25 August 2003 and sent to the Government on 8 October 2003. Specifically, UNSITRAGUA indicated that: (i) overtime worked by nursing personnel was not paid and there was no adequate procedure for the compensation of hours worked in the event of changes in terms of duty; and (ii) there was no collective agreement concerning conditions of work which applied specifically to nursing personnel, the nursing trade unions not having being consulted. The Committee recalls that, in accordance with the provisions of the Convention, each Member must take the necessary measures 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. In addition, the policy concerning nursing services and nursing personnel must be formulated in consultation with the employers’ and workers’ organizations concerned. The Committee requests the Government to provide detailed information on the matters raised by UNSITRAGUA.
Article 5. Participation of nursing personnel in the planning of nursing services and consultation of personnel on decisions concerning them. The Committee recalls that UNSITRAGUA also indicated that nursing personnel did not participate in the planning of nursing services, decisions on this subject being taken unilaterally by the directors and heads of assistance centres. While recalling that Article 5 of the Convention requires the adoption of measures to promote the participation of nursing personnel in the planning of nursing services and consultation with such personnel on decisions concerning them, the Committee requests the Government to send its comments in reply to the allegations made by UNSITRAGUA.
Article 7. Occupational safety and health. With regard to the conditions of employment and protection of nursing personnel, the Committee recalls that UNSITRAGUA emphasized that there was no health and safety policy for nursing personnel, particularly as regards the risk of contamination by HIV/AIDS owing to the lack of suitable protective equipment in national hospitals, thus obliging nursing personnel to work under dangerous conditions. In this regard, the Committee wishes to draw the Government’s attention to the “Joint ILO/WHO guidelines on health services and HIV/AIDS”, published in 2005, with a view to helping health services to strengthen their capacity for providing workers with a healthy and decent working environment, this being the most effective means of reducing the transmission of HIV and improving the provision of care for patients. The Committee would also like to refer to the discussion held at the June 2009 session of the International Labour Conference on “HIV/AIDS and the world of work”, with a view to the adoption of an international labour Recommendation, in particular paragraph 37 of the draft conclusions (see ILC, 98th Session, 2009, Report IV(2), page 310), which states 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 new measure taken or contemplated in order to improve the protection of nursing personnel against infectious diseases, including HIV/AIDS.
The Committee notes the Government’s report. The Committee also takes note of the observations made by the Trade Union Confederation of Guatemala (UNSITRAGUA) which were transmitted to the Government on 8 October 2003. The Committee will examine the Government’s report and the comments of the organization in detail at its next session and welcomes any additional information that the Government may wish to provide.
The Committee notes with interest the information provided by the Government that a Bill respecting the exercise of the profession of nursing was transmitted to Congress for approval in 1997. The Committee trusts that the Government will provide with its next report the text of the above Act as approved.
Article 1, paragraph 3, of the Convention. The Committee notes that, according to the Government, as under the terms of the national Constitution all work has to be remunerated, there is no nursing personnel giving nursing care and services on a voluntary basis. Nevertheless, the Committee requests the Government to state whether in practice, as often happens, there are personnel who occasionally provide nursing services on a voluntary basis in dispensaries or health posts. If such is the case, it would be grateful if the Government provides information on the measures which have been adopted or are envisaged to protect such personnel.
Article 5, paragraph 2. The Committee notes the information provided by the Government in its report that the conditions of employment and work of nursing personnel employed in the private sector are not regulated. According to the Government's report, the employers impose their own conditions. The Committee also notes the information to the effect that the Government is not aware of the existence of collective agreements concerning nursing personnel employed in the private sector. The Committee recalls that, in accordance with this provision, their conditions of employment and work shall be determined preferably by negotiation between employers' and workers' organizations. The Committee requests the Government to provide information on the methods that exist in the country for the determination of the conditions of employment and work of nursing personnel employed in the private sector.
Article 5, paragraph 3. With reference to its previous comments, the Committee notes that the Government has not provided a detailed and precise answer concerning the procedures used for the settlement of disputes arising in connection with the determination of terms and conditions of employment of nursing personnel employed in the public sector. The Committee trusts that the Government will provide the information requested in its next report.
Article 6. The Committee notes that the Government's report does not indicate, as requested by the report form, the legislation, collective agreements or other methods under which the application of each of the conditions of work set out in points (a), (b), (c), (d), (e), (f) and (g) of this Article are applied. The Committee hopes that the Government will provide detailed information on this subject in its next report.
Article 7. The Committee trusts that, when the Bill to regulate the exercise of the nursing profession is adopted, the bodies to which reference is made in the Bill will endeavour to improve 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. With reference to its general observation of 1990, which was repeated in 1994, the Committee requests the Government to indicate the measures taken or contemplated, in consultation with the employers' and workers' organizations concerned, to take into account the particular risk of accidental exposure to HIV among nursing personnel. It also requests the Government to indicate the measures taken or contemplated with respect to nursing personnel who are infected or considered to be infected by HIV (for example, conditions of work, confidentiality of test results, recognition that the cause of infection was occupational, etc.).
Part V of the report form. The Committee requests the Government to provide general information on the manner in which the Convention is applied in practice.
The Committee notes the information provided by the Government in its first report. The Committee requests the Government to provide additional information on the following points:
Article 1, paragraph 3, of the Convention. The Committee notes the Government's statement to the effect that there are no special rules established concerning nursing personnel who give nursing care and services on a voluntary basis, since in accordance with the Constitution, all work should be remunerated. The Committee requests the Government to indicate whether, in practice, nursing personnel in Guatemala occasionally offer nursing care and service on a voluntary basis.
Article 2, paragraph 2(b). The Committee requests the Government to provide information in respect of the employment and working conditions of nursing personnel employed in the private sector, also indicating the career prospects and remuneration which are likely to attract persons to the profession and to retain them in it.
Article 4. The Committee requests the Government to indicate whether the regulation of the National Nursing School remains in force or whether it has been repealed and, if so, the Committee requests the Government to provide a copy of the text.
Article 5, paragraph 2. The Committee requests the Government to provide information and copies of texts relative to the collective agreements concluded which concern nursing personnel employed in the private sector.
Article 5, paragraph 3. The Committee requests the Government to provide information relative to the procedures adopted for the settlement of disputes arising in connection with the determination of the terms and conditions of employment of nursing personnel employed in the public sector.
Article 6. With regard to the conditions of work referred to in Article 6(a), (b), (c), (d), (e), (f) and (g) of the Convention, the Committee requests the Government to indicate: (i) whether these conditions are regulated by the provisions of the Labour Code as well as the provisions of the Act respecting the civil service; and (ii) whether there are also collective and other agreements which regulate these conditions of work.
Article 7. The Committee requests the Government to provide additional information on the measures adopted 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.
Point V of the report form. The Committee notes the statistical information provided by the Government relative to the number of nursing personnel employed in the public and private sectors. It also notes that the number of persons who are entering the profession is estimated at approximately 10 per cent of the number of persons who are leaving the profession.
The Committee requests the Government to continue to provide general information in respect of the application of the Convention in conformity with the provisions of the Convention.