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Article 2, paragraph 1, and Article 3 of the Convention. Policy concerning nursing services and personnel. The Committee notes the Government’s statement that at present workers’ organizations are not consulted on policy issues, but in future certain health policies could be formulated in conjunction with the employers’ and workers’ organizations concerned. Recalling similar assurances given by the Government in its previous report, the Committee hopes that the Government will make every effort to associate the social partners in designing and implementing all future policies concerning nursing services and personnel, as prescribed by this Article of the Convention.

Moreover, the Committee notes the Government’s statement that there is regular attrition of nurses who leave the country in the search of better employment opportunities abroad. While noting that the statistical data provided by the Government show that the number of nurses and midwives has remained stable in public institutions in the period 2002–07, the Committee would appreciate receiving fuller information on the situation concerning nurse migration and the efforts of the Government to maintain a sustainable domestic nurse workforce.

In this respect, the Committee wishes to refer to the commonwealth code of practice for the international recruitment of health workers and its companion document, adopted in 2003. In particular, it notes that the code provides that the international recruitment of health workers must be transparent and fair as regards its process, and that the right of health workers to migrate must not be undermined. At the same time, such recruitment must be mutually beneficial to both recruiting and source countries considering the difference in the capacities of these countries, which may be addressed through technical assistance. In the same vein, the Committee notes the draft WHO code of practice on the international recruitment of health personnel, currently under consideration, 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.

Articles 3 and 4. Nursing education and training. The Committee notes the Government’s indication that a new nursing curriculum has been prepared taking into consideration regional and international nursing standards. The Committee requests the Government to provide more detailed information on the new programme.

Article 7. Regulations on occupational health and safety for nursing personnel. Further to its previous comment on this point, the Committee understands that the National AIDS Council adopted in 2007 the “Seychelles Policy on HIV/AIDS in the Workplace”. In particular, it notes that the policy emphasizes the importance of the principles of tripartism and social dialogue in approaching matters related to HIV/AIDS as workplace issues, and the shared responsibility of employers and workers for ensuring a healthy work environment, including safety from HIV contamination. The Committee requests the Government to provide additional information on any specific policies or measures for nursing personnel, given the particular risk they face due to the nature of their work, as well as the implementation of the “Management of health-care worker exposures to HIV and recommendations for post-exposure prophylaxis”, and the results obtained.

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.

Finally, the Committee notes that the Government’s report does not contain replies to certain points raised in its previous direct request. It is therefore bound to ask the Government to respond to the comments concerning the application of Article 2(2) (adoption of regulations on education and training requirements in nursing and midwifery under the Nurses and Midwives Act); Article 2(3) (consultations with the social partners in formulation of health care policy); and Article 5 (representation of nursing personnel at the Central Management Committee of the Ministry of Health, collective bargaining in the nursing sector and settlement procedures for collective disputes).

Part V of the report form. Application in practice. The Committee notes the statistical information provided by the Government showing the number of nursing personnel registered with the Seychelles Nurses and Midwives Council and the evolution of number of health personnel employed at government establishments. 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, statistics on the number of nurses entering and leaving the profession per year, the nurse–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 detailed report and the attached documentation.

Article 2, paragraphs 1 and 3, of the Convention. Further to its previous comment on this point, the Committee notes that the Government admits that the employers’ and workers’ organizations were not involved in the formulation of the National Health Policy but undertakes to consult the social partners in any future policy formulation. The Committee recalls that the Convention places particular importance on the requirement for full consultations with the employers’ and workers’ organizations concerned not only in the design and implementation of a specific policy for nursing services and nursing personnel but also in the coordination of this policy with broader policies relating to health-care planning. The Committee hopes that the Government will take concrete steps to ensure that the social partners have some influence on the policy decisions affecting nursing services and asks the Government to keep it informed of any practical developments in this regard.

Article 2, paragraph 2. The Committee notes the Government’s indication that no regulations have as yet been issued under section 15(c) of the Nurses and Midwives Act (Revised 1991) concerning the vocational training, examinations and the conduct of examinations in nursing and midwifery. The Government adds, however, that the Seychelles Nurses and Midwives Council (SNMC), which is a statutory body established under section 3(1) of the Nurses and Midwives Act, has recently proposed some new regulations relating to the minimum education and training requirements for registration of nurses and midwives. The Committee would appreciate receiving additional information on any follow-up action in respect of the proposed regulations and requests the Government to transmit a copy of any relevant text as soon as it is adopted. As regards the revised Scheme of Service for the Nursing Cadre, which sets out the classification of nursing posts and outlines the corresponding job summary, minimum entry requirements, salary scales and allowances, the Committee notes that this Scheme applies exclusively to nursing staff employed in the public sector. Recalling that the Convention applies to all nursing personnel, wherever they work, the Committee requests the Government to specify the measures taken or envisaged to ensure that the nursing personnel engaged in the private sector enjoy employment and working conditions including career prospects and remuneration which are likely to attract persons to the profession and retain them in it.

Article 2, paragraph 4. The Committee once again requests the Government to describe how the policy on nursing profession is integrated into a coherent policy framework on health care in general and to specify whether provision is made for consultations with employers’ and workers’ organizations to this effect.

Articles 3 and 4. The Committee notes the information provided by the Government concerning the National Institute of Health and Social Studies and the various programmes it offers in paramedical, biomedical, dental, environmental health, and pharmaceutical sciences, including a three-year course on nursing and an 18-month course on midwifery. The Committee would appreciate receiving additional information on the functioning of the National Institute of Health and Social Studies and the organization of nursing and midwifery studies, including the number of students enrolled to each course and the rate of graduates who are offered salaried employment at the end of their studies.

Article 5, paragraph 1. The Committee notes that according to the information provided by the Government with respect to the composition and mandate of the 13-member Central Management Committee of the Ministry of Health, no representative of the nursing personnel appears to participate in the Committee’s discussions relating to the planning of nursing services. Noting, however, that the Government had previously indicated that the nurses are represented to the Central Management Committee by the Director of Nurses, the Committee requests the Government to provide further clarifications on this point.

Article 5, paragraph 2. The Committee notes the Government’s indication that there have been to date no collective agreements concluded in either the public or private sector in respect of nursing personnel. The Committee would be grateful if the Government could continue to provide in future reports information concerning any collective bargaining effort with a view to determining higher employment and working standards for nursing personnel especially in the private sector.

Article 5, paragraph 3. The Committee notes the Government’s explanations concerning the internal dispute settlement procedure provided for under the Public Service Orders in respect of disciplinary offences. However, the Committee is bound to recall that this Article of the Convention does not refer to disciplinary matters or other individual labour disputes involving nursing staff but to collective disputes arising in connection with the determination of terms and conditions of employment of the nursing profession as such. The Committee requests therefore the Government to provide in its next report more precise information regarding any institutionalized arrangements, as may be available, for the purpose of settling collective disputes through independent and impartial proceedings in a manner that makes it unnecessary for the organizations representing nursing personnel to resort to such other forms of industrial action which may be disruptive to the health services system.

Article 7. Further to its previous comment on this point, the Committee notes the document entitled "Management of health-care worker exposures to HIV and recommendations for post-exposure prophylaxis" which establishes a protocol for effective risk assessment and preventive action with respect to occupational transmission of HIV. The Committee requests the Government to report on the measures taken or contemplated with respect to health-care workers who are infected or considered to be infected by HIV, for instance regarding the confidentiality of test results, the arrangement of working conditions, etc.

Part V of the report form. The Committee notes with interest the statistical information concerning the total number of registered nurses and midwives as at September 2003 as well as the number of persons who have left the profession in the course of that year. It asks the Government to continue to supply the information requested under this point, particularly as regards the number of nursing personnel, by sectors of activity and by levels of training and functions, and their relation to population, to the number of patients and to other manpower in the health field, and also to indicate any practical difficulties encountered in the implementation of the Convention.

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The Committee notes the information provided by the Government in its report. It notes that the Government refers to the Nurses and Midwives Act (Revised 1991), the text of which is not available in the Office, and requests it to provide a copy. The Committee also requests the Government to provide information on the following points.

Article 2, paragraphs 1 and 3, of the Convention. The Committee notes the information that the Ministry of Health is responsible for the formulation and implementation of the National Health Policy. This policy applies to all "nursing personnel", that is to say to both female and male nurses. The Committee notes that there are certain policy guidelines (for example, health is recognized as a fundamental human right; determination of access to health care, not by health or position but by need; and the commitment of the Government to provide a free national health system to all Seychellois). The Committee also notes that national health priorities have been defined. The Committee requests the Government to indicate, firstly, whether the employers’ and workers’ organizations concerned were consulted in the formation of this policy and, secondly, to provide information on its application in practice and the results achieved.

Article 2, paragraph 2. The Committee notes that section 15 of the Nurses and Midwives Act provides that the minister responsible for the administration of the Act may make regulations concerning vocational training, examinations and the conduct of examinations concerning nursing care. However, it notes that no regulations have been provided by the Government giving effect to section 15 above. The Committee therefore requests the Government to indicate whether such regulations have been adopted by the minister concerned and, if so, to provide a copy. The Committee also notes that a Scheme of Service of the Nursing Cadre determines the conditions of employment and career prospects and remuneration of nursing personnel. It requests the Government to provide a copy of the above Scheme of Service and to indicate any other measures taken to secure for nursing personnel engaged in the public and private sectors employment and working conditions, including career prospects and remuneration, which are likely to attract persons to the profession and retain them in it.

Article 2, paragraph 4. The Committee notes the information that inter sectoral action for the attainment of health for all is a priority objective. It notes that the ministries and institutions concerned with health matters have to add a health dimension to their sectoral policies to achieve this coordination. The Government concludes that all stakeholders are therefore involved in the coordination of the National Health Policy. The Committee therefore requests the Government to indicate the machinery of this coordination, and the manner and framework in which the consultations envisaged by these provisions of the Convention are held.

Articles 3 and 4. The Committee notes that section 8 of the Nurses and Midwives Act establishes the requirements for the inclusion of nurses and midwives on the respective register. It notes that this section makes the Nurses and Midwives Council of Seychelles responsible for determining the basic requirements in terms of education and training of nursing personnel and for supervising such education and training. It therefore requests the Government to provide detailed information on the content of the education and training provided to nursing personnel and the examinations which they have to take. The Committee also requests the Government to indicate whether nursing education and training is coordinated with the education and training of other workers in the field of health, in accordance with Article 3, paragraph 2, of the Convention.

Article 5, paragraph 1. The Committee notes that, according to the Government’s report, the objective of the Nurses and Midwives Council consists of involving nursing personnel through active participation in the planning of nursing services, through discussions with the management of nursing personnel and the Nursing Association. It notes that a Central Management Committee of the Ministry of Health also discusses major issues related to the planning of nursing personnel, and that the nurses are represented by the Director of Nurses. The Committee requests the Government to indicate whether there is also participation by nursing personnel at the local level, which would make it possible to take into account the individual or specific claims of certain units, or whether such participation is secured at a higher level through the Council. It also requests the Government to provide further particulars concerning the operation of the Central Management Committee of the Ministry of Health.

Articles 5, paragraph 2, and 6. The Committee notes the information contained in the Government’s report to the effect that the conditions of employment and work of nursing personnel in the public sector are determined, on the one hand, by public services orders and, on the other hand, by collective agreements which may be negotiated on the basis of the collective bargaining agreement concluded between the Ministry of Administration and Manpower of the Seychelles and workers’ unions. The Committee requests the Government to indicate whether collective agreements have in practice been negotiated within this framework and, if so, to provide copies. The Committee understands that the conditions of work of nurses in the private sector are determined by the Employment Act, 1995. It requests the Government to indicate whether there are collective agreements applicable to nursing personnel in the private sector and, if so, to provide copies. If there are no such agreements, the Committee requests the Government to indicate whether collective bargaining is envisaged by the laws and regulations with a view to the determination of the conditions of employment and work of nursing personnel in the private sector. The Committee also notes that nurses are covered by conditions of service establishing criteria and procedures for promotion and the payment of allowances and bonuses. It notes that the information provided by the Government concerning the conditions of work in the fields mentioned in Article 6 shows that nursing personnel benefit from conditions which are at least equivalent to those of other workers in the country, as set out in the Conditions of Employment Regulations, 1991. The Committee requests the Government to provide a copy of the conditions of service of nurses and of the Public Service Orders.

Article 5, paragraph 3. The Committee notes that the Government’s report refers to the existence of an Investigation Committee established under the Nurses and Midwives Regulations, 1989. However, it notes that under sections 17 and 18 of these Regulations, the role of the Investigation Committee is to conduct investigations in order to allow the Council to make decisions on disciplinary matters. The information provided by the Government does not relate to the settlement of disputes arising in connection with the determination of terms and conditions of employment. The Committee therefore requests the Government to provide information on this subject in its next report.

Article 7. In its general observation of 1990, which was repeated in 1994, the Committee emphasized the need to take measures to adapt the legislation on health and safety at work to the particular risk of accidental exposure of nursing personnel to the human immunodeficiency virus (HIV). In this respect, it also draws the Government’s attention to the Code of practice on HIV/AIDS and the world of work published in June 2001. The Committee notes the information that there is no special legislation in the Seychelles regulating the occupational health and safety of nursing work and of the environment in which the work is carried out, but that occasional workshops are held in this field, which also cover HIV/AIDS measures. It also notes that an Occupational Health Unit has been established in the Ministry of Health to guide and sensitize nurses to the potential risks and dangers that exist in their working environment, and that all necessary protection is provided to nurses to protect others against communicable diseases. 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 adapt the national legislation in this field and to take into account the particular risk of accidental exposure to HIV among nursing personnel, for example through the arrangement of conditions of work, the confidentiality of test results and recognition that the cause of infection was occupational, etc.

Part III of the report form. The Committee requests the Government to indicate the manner in which the application of the relevant laws, regulations and collective agreements is assured.

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, including, in so far as possible, statistics on the numbers of nursing personnel, by sector of activity and by level of training and functions, and their relation to the population, to the number of patients and to other workers in the health field, and on the number of persons leaving the profession.