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Article 2, paragraph 1, of the Convention. National policy concerning nursing services and nursing personnel. The Committee notes the Government’s indication that the National Parliament is currently working on a package of acts regulating health-care issues and that these acts are expected to operate a reform of the health-care system and produce positive impact on all persons employed within the system, including nurses and midwives. While remaining concerned about the unresolved crisis experienced by the public health-care sector in recent years, the Committee requests the Government to provide in its next report full particulars on all legislative developments regarding the announced reform of the health-care system and to transmit copies of all relevant texts.

Article 2, paragraph 2. Employment and working conditions of nursing personnel. The Committee understands that there is an important migration flow of nurses towards other European countries such as Italy and the United Kingdom, the flow which is primarily connected with low wages, poor working conditions and the threat of unemployment. It also understands that some thought appears to be given to policies to encourage the return of emigrants, in particular medical professionals, as reflected for instance in the policy recommendations on this issue presented by the Institute of Public Affairs in September 2006. The Committee therefore requests the Government to provide specific information on the extent of the migration phenomenon in the health sector and on any programmes, campaigns or other measures taken or envisaged to address this issue.

Article 4. Requirements for practice of nursing profession. The Committee notes the Government’s reference to the Ordinance of the Minister of Science and Higher Education of 12 April 2007, concerning education standards for individual fields of study and levels of education. In particular, it notes the Government’s indication that each graduate of higher nursing and midwifery school must now be approved by the Minister of Science and Higher Education based on an opinion of the State Commission for Accreditation, and be accredited by the Minister of Heath, on the basis of an opinion of the National Council for Accreditation of Medical Education. Recalling that under section 12.2 of the Act of 5 July 1996 concerning the professions of nurse and midwife, the authorization to practise is to be granted by the district board of nurses and midwives, the Committee requests the Government to clarify whether the Ordinance of the Minister of Science and Higher Education of 12 April 2007 repealed or otherwise modified the provisions of the Act of 5 July 1996.

Article 5. Collective bargaining and dispute settlement. Further to its previous comments on the serious wage dispute which has been affecting the Polish health-care system for many years, the Committee notes the Government’s reference to the Act of 22 April 2006 on transfer of funds, which allocated the necessary resources to finance salary increases to health-care service providers that took place in 2006 and 2007. It also notes the Government’s indication that with respect to claims arising from the so-called “Act 203”, as of 31 January 2008, liabilities to employees had been satisfied in 99.99 per cent of the cases. While noting the Government’s explanations, the Committee understands that, since its last comment in 2005, the situation in the health sector has remained tense and occasionally escalated to protracted and even radical protest action (for instance, warning strikes in April–May 2006, the four-week strike movement of June 2007 known as the “white village protest”, etc.). In this connection, the Committee wishes to recall that Article 5(2) of the Convention calls for negotiations between employers’ and workers organizations for the determination of conditions of employment and work of nursing personnel while Article 5(3) requires recourse to negotiations or to independent and impartial machinery for the settlement of disputes with a view to making it unnecessary for the organizations representing nursing personnel to resort to such other protest action which might be potentially harmful to the well-being of patients and the operation of medical centres. While reiterating the importance of constant and open social dialogue, as required by this Article of the Convention, the Committee requests the Government to continue supplying detailed information on the evolution of the situation, particularly as regards any direct negotiations or recourse to such third-party settlement procedure as mediation, conciliation or arbitration and the results obtained.

Part V of the report form. Application in practice. The Committee notes the statistical information provided by the Government showing the yearly evolution of the number of nursing training places and of the amount of subsidy per training place. The Committee requests the Government to continue supplying up to date information concerning the application of the Convention in practice, including, in particular, the number of students currently enrolled in nursing schools, the nurse-to-population ratio, copies of official reports or studies analysing the situation in the nursing care sector, etc.

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The Committee notes the observations of the Polish Trade Union of Nurses and Midwives (OZZPiP) dated 20 May 2005 on the application of the Convention and the Government’s reply received on 9 November 2005. Following up on its previous comments, the OZZPiP alleges that the crisis experienced by the nursing personnel in the public health care sector since 1999 is deepening leading many nurses and midwives to either leave the profession or seek employment abroad. Noting that the number of nurses and midwives employed in public hospitals has decreased by one-fifth in the last six years, the OZZPiP considers that the Government still fails to apply the Act of 22 December 2000 amending the Act regarding the system of determining by negotiation the growth of average remuneration payable by certain employers (also known as the “203 Act” which guaranteed wage increases for nursing personnel), and the Order of the Minister of Health of 1999 concerning the minimum conditions of employment of nurses and midwives. It also states that the national parliament has discontinued its work on draft legislation which proposed the establishment of a minimum salary level for all nurses and midwives employed in public health-care institutions.

In its reply, the Government contents itself to stating that because the majority of nurses and midwives are employed by independent non-public health-care establishments, it is not empowered to directly enforce compliance with any of the above laws or regulations. As regards public health-care establishments, the Government states that they are not subject to government administration but operate as independent entities. In any event, the Government considers that the head of each health-care institution, whether private or public, is responsible for the financial and human resources management of such institution, while settling individual labour law claims or monitoring compliance with applicable standards falls with the jurisdiction of courts of law.

With regard to accumulated claims under the so-called “203 Act”, the Government refers to the recent adoption and entry into force of the Act on public aid and restructuring of public health-care establishments (Dz. U. No. 78, Text 684) which is meant to help health-care units solve the problem of the growing indebtedness in the health services sector. The Act provides for the possibility of settling individual employees’ claims through loans from the state budget. In fact, under section 35(4) of the Act, loans should be primarily intended for the repayment of liabilities arising from the “203 Act” for the period 2001-04. In this connection, the Government indicates that the state budget for 2005 provides for a loan reserve of 2.2 billion PLN and that 551 health-care establishments are expected to apply to the State Treasury for loans amounting to 1.7 billion PLN.

With reference to the question of adequate pre- and post-diploma training for nurses and midwives raised by the OZZPiP, the Government states that the system of professional training for nurses and midwives takes into account the teaching standards set forth in the European Union’s sector directives, while the National Committee of Accreditation of Medical Schools is responsible for monitoring the nursing schools’ compliance with the binding education and training standards. The Government adds that the number and value of training positions subsidized by the Ministry of Health has been increasing systematically each year.

The Committee notes the Government’s explanations. It recalls that the problems of deferred payment of wages and wage arrears in the health-care sector have been the subject of recent observations addressed to the Government under the Protection of Wages Convention, 1949 (No. 95), and have also been examined by the Committee on the Application of Standards at the 92nd Session of the International Labour Conference (June 2004). The Committee asks the Government to continue supplying detailed information on the evolution of the situation, particularly with regard to ongoing reforms in the field of health care and their implications for the practice of the nursing profession.

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The Committee notes the information supplied in the Government’s report and the attached documentation. It also notes the observations communicated by the Polish Trade Union of Nurses and Midwives on 27 January 2003 concerning the application of the Convention and the Government’s reply dated 1 October 2003.

Article 2, paragraph 2(a), of the Convention. The Committee recalls its previous observation in which it requested the Government to supply additional information on the new educational and training programmes introduced for the nursing profession and also to indicate whether the ongoing reforms and restructuring policy in the field of health care have been formulated in consultation with the employers and workers concerned, as required under Article 2, paragraph 3, of the Convention. In its reply, the Government reports that the new system of nurses’ and midwives’ education consists of higher vocational studies organized by medical academies and higher vocational schools and that at present 29 centres, including 11 medical academies and 18 higher vocational schools, provide such education. The Government also indicates that, under the 2001 Act regarding the nursing profession, the National Accreditation Board of Medical Schooling was set up for the purpose of monitoring the education standards of the faculties offering nursing and midwifery studies. As regards social dialogue in the health-care sector, the Government refers to the first meeting of a "round table" conference held in April 2003 which brought together representatives of more than 90 organizations such as autonomous governments and territories, medical academies, employers’ organizations, the pharmaceutical industry and trade unions, including representatives of nurses and midwives, to discuss the problems in the health-care system which require legislative changes. The Committee stresses the importance of open and continuous dialogue with the social partners since negotiated solutions have a much better chance of succeeding in a context where social consensus is the only solid basis for the continuation of painful structural reforms.

In addition, the Committee notes the Government’s detailed explanations concerning the group nursing and midwifery practice which was introduced by virtue of the 1998 Act concerning the amendment of the laws on health-care establishments and medical professions. The Committee requests the Government once again to indicate whether the employers’ and workers’ organizations concerned were consulted in this respect.

Article 2, paragraph 2(b). Further to its previous request for detailed information with regard to the working conditions and remuneration levels of nursing personnel, the Committee notes that the Government refers to insufficient financial resources in the health-care system and the resulting necessity of ongoing adjustment of the employment level and pay conditions of nurses and midwives. The Government reiterates that the main objective of the restructuring process launched in 1999 was to adjust the level of medical personnel employment to the real needs of the health-care system and to the financial possibilities of the State. The Government indicates that in the period 1999-2002, a total number of 92,000 health-care employees were laid off and that significant public funds are allocated every year for redundancy pay, adjustment assistance, preferential loans and other rehabilitation measures in an effort to mitigate the unfavourable effects for nurses and midwives of restructuring programmes. With regard to any possible improvements in the working conditions of the active nursing personnel, the Government makes renewed reference to the Ministerial Regulation of December 1999 on the setting of minimum standards concerning the staffing of health-care establishments with nurses and midwives which prevents unjustified downsizing of employment and guarantees adequate care to patients. The Governments adds, however, that in November 2002 the Minister of Health, reacting to information referring to instances of non-compliance with the said Regulation on the part of health-care provider managers called upon all entities to fully respect the nurses’ and midwives’ employment standards in force. The Committee invites the Government to supply more specific information on the nature and extent of those instances of non-compliance and to indicate the practical measures taken in response.

For its part, the Polish Trade Union of Nurses and Midwives (OZZPiP) denounces extensive violations of the labour legislation, mainly in the form of delayed payment of wages, non-payment of statutory pay increases, wage supplements and annual bonuses, unjustified wage deductions, and non-payment of redundancy pay or other benefits upon termination of employment. The Committee examines these allegations in an observation addressed to the Government under Convention No. 95. Suffice it to note here that the facts and practices denounced in the communication of OZZPiP - and entirely confirmed by official statistics provided by the National Labour Inspection Service (PIP) - seem to corroborate the allegation that nurses and midwives are in fact experiencing difficult working conditions, especially income insecurity.

Article 7. The Committee notes the information supplied by the Government in response to its previous direct request on this point. The Government indicates that educational activities related to HIV prevention continue within the framework of the "National Programme on preventing HIV, care of persons living with HIV and persons with AIDS for the years 1999-2003". The Government also refers to recent publications on prophylactic and diagnostic procedures in the case of HIV infection or AIDS disease which are made available to nurses free of charge throughout the country. The Committee would be grateful if the Government would continue to provide information on future activities in matters affecting the occupational health and safety of nursing personnel.

Part V of the report form. The Committee notes the Government’s statement that the main difficulties encountered in the practical application of the Convention relate to the bad financial situation of most health-care institutions and the pressing need to readjust employment and pay levels in order to ensure the financial stability of the health-care providers. The Committee asks the Government to continue to provide general information on the effect given to the Convention in practice, including relevant statistics, extracts from official reports and recent studies on the socio-economic conditions prevailing in the nursing profession and any other particulars which would enable the Committee to better evaluate the Government’s policy concerning nursing services and nursing personnel.

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The Committee notes the information supplied by the Government in its report and requests it to provide further details on the following points.

Article 7 of the Convention. The Committee recalls that in its previous direct request it noted information sent by the Government on certain aspects of: the adoption of the regulation of the Ministry of Health and Social Welfare, 30 May 1996, concerning medical examinations and the range of prophylactic health care for employees; the launching of the "National programme for the prevention of HIV infections and nursing HIV and AIDS patients" by the Ministry of Health and Social Welfare; the preparation of a document entitled "Prevention and diagnosis in HIV and AIDS infections"; the publication of a handbook entitled "AIDS - how to reduce the risk of HIV infection in nursing practice"; the organization countrywide of a number of vocational training courses for nurses and midwives.

The Committee previously requested the Government to continue to provide fresh information on any other measures taken in this area. It renews that request and hopes that the Government will continue to provide information in this respect in its next report.

Part V of the report form. The Committee asks the Government to provide information on the application of the Convention in practice, including statistical information on the strength of the nursing staff and the number of nurses leaving the profession, and to indicate any difficulties met in applying the Convention.

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The Committee notes the information provided in the Government’s report in reply to the comments made by the Trade Union of Medical Analysis Technicians and the National Trade Union of Nurses and Midwives of Poland alleging the non-application of Convention No. 149, which were transmitted to the Government on 24 July and 11 September 2000, respectively. Following these comments, the Government transmitted to the ILO in January 2001, by way of response, a copy of the Self-Government Act of the Provinces of 5 June 1998, which did not bear any relation in principle to the matters raised by the above organizations. Later, in September 2001, the Government provided a report containing certain elements of a reply to the above comments. The Committee recalls that, in addition to its observation of 2000, it also commented on the application of the Convention in 1999. The Committee had then requested information from the Government relating, among other matters, to Article 2, paragraph 2(b), and Articles 3 and 7 of the Convention. Following the receipt of the Government’s last report, the Committee wishes to draw the Government’s attention to the following points.

1. The Committee notes the Government’s information concerning the introduction in 1999 of a new model of health-care functioning. From that year, successive measures have been adopted to improve conditions of employment and develop nursing-care resources, based on the following: the transformation of the system for the education of nurses and midwives, according to the European standards that are in force; the creation of new jobs through the restructuring of health care; the development of the conditions to acquire new professional qualifications; and the improvement of conditions of work.

2. The Committee notes in particular the adoption on 3 February 2001 by the Sejm of the Republic of Poland of the Act to amend the Act respecting the professions of nurses and midwives (Dziennik Ustaw No. 16, text No. 169), adapting Polish legislation respecting the training and practice of the nursing profession to European Council directives, and the Programme of Transformation of Nurses’ and Midwives’ Education for the years 2001 05, developed under the above Act. The Committee notes that this Programme includes the introduction of professional university studies (BA) for nurses and midwives in 2001-03 in around 30 universities in Poland. The Committee requests the Government to inform the ILO of the practical measures taken under the above Act and Programme. The Committee also notes that a programme of restructuring in the field of health care has been undertaken since 1999. It notes that in 2001-02, this programme has been implemented in accordance with the instructions of the Cabinet dated 28 December 2000 (Dziennik Ustaw No. 122, text No. 1326 as subsequently amended), issued under the Act of 12 May 2000 respecting the principles of supporting regional development (Dziennik Ustaw No. 48, text No. 550 as subsequently amended), copies of which have been provided to the ILO and will be examined once they have been translated. The Committee requests the Government to provide information on the application in practice of this programme and, in particular, improvements that have been made as a result in the provision of health care. The Committee also recalls that, in accordance with Article 2, paragraph 3, of the Convention, when adopting and applying a policy concerning nursing services and nursing personnel, the Government is bound to consult the employers’ and workers’ organizations concerned. In view of the comments made by the Trade Union of Medical Analysis Technicians and the National Trade Union of Nurses and Midwives of Poland, the Committee requests the Government to indicate whether the consultations envisaged by this provision of the Convention were held and, if not, to take the necessary measures to ensure that the organizations concerned are consulted in future.

3. The Committee notes that, in reply to the comments of the above workers’ organizations alleging poor working conditions of nursing personnel, the Government refers to the general legislation (the Civil Code and the Labour Code) and to certain specific provisions such as the Act on health-care units of 30 August 1991 (Dziennik Ustaw No. 91, text No. 408 as subsequently amended) and the Instructions of the Minister of Health and Social Protection of 13 July 1998 on contracting health services (Dziennik Ustaw No. 93, text No. 592). The Committee notes that this information does not enable it to assess the quality of the conditions of work of the personnel concerned, which are distinct from the laws and regulations existing on this subject. It therefore requests the Government to indicate whether a policy to provide nursing personnel with satisfactory employment and working conditions, including career prospects and adequate remuneration, which are likely to attract persons to the profession and retain them in it so that they can provide nursing care of the quantity and quality that are necessary to provide patients with the highest possible level of health care, has been adopted and applied effectively, in accordance with Article 2, paragraphs 1 and 2, of the Convention.

4. The Committee notes the information that independent public health-care units no longer have the status of (state) budget units and that, in accordance with section 77-2(1) of the Labour Code, the terms of wage settlements are those set out in the salary regulations until the employees are covered by the enterprise or sectoral collective agreement. The Committee notes that, according to the Government, there are no grounds for determining the salary rules for employees of independent public health-care units in the form of instructions or sectoral collective agreements. It notes that it is only in the case of public health services organized as budget units that the Minister of Health can, under the terms of section 40(2) of the Act of 30 August 1991, determine the salary rules for the employees. The Committee draws the Government’s attention to the fact that it has not provided any information in reply to the allegations made by the Trade Union of Medical Analysis Technicians and the National Trade Union of Nurses and Midwives of Poland to the effect that the wage scales are not adapted to the work performed and that the wages are declining. It therefore requests the Government to provide detailed information in its next report on these points.

5. The Committee notes that, with regard to occupational safety and health, the Government refers to sections 94 and 210 of the Labour Code which provide, inter alia, that the employer is obliged to ensure safe and healthy working conditions and that employees have the right to withdraw from work, while retaining the right to remuneration, in the event of physical or mental danger to themselves or others. Recalling that the National Trade Union of Nurses and Midwives of Poland alleged in its comments the non-compliance of employers with the basic principles of safety and health and the absence of legislative provisions on this subject, the Committee requests the Government to indicate whether it has taken additional measures to ensure the effective application of the current provisions.

6. The Committee notes that, with regard to conditions of work, the Government indicates that Poland is currently in a special situation and that the implementation of the first phase of the transformation of the health-care system is causing anxiety among certain occupational organizations. It notes that this restructuring often requires mass redundancies and changes in their jobs and the necessity for them to accept to change their qualifications. The Committee notes that, in the view of the Government, such action does not prove that the Government does not respect the employment and social rights of the staff. The Government indicates that, on the contrary, in its efforts to provide the highest level of health care, which also concerns the level of nursing services, it has recently taken several decisions to achieve these objectives. The Committee notes the introduction in 1999 of the so-called "group nursing practice" as a different form of performing the nurse’s and midwife’s profession. It requests the Government to provide additional information on such practice. Furthermore, it requests the Government to indicate whether the employers’ and workers’ organizations concerned were consulted in this respect. The Committee notes the signature by the Minister of Health on 21 December 1999 of the Directive determining the minimum standards of employment of nurses and midwives in health-care units and requests the Government to provide a copy of the above Directive to the ILO. While noting that a Bill was submitted to the Sejm for the granting of preferential loans to employees who have lost their jobs during the restructuring process, the Committee requests the Government to provide any practical information concerning improvements in the conditions of work of nursing personnel.

7. The Committee notes the adoption of the Act of 22 December 1999 amending the Act on health-care units which is intended, according to the Government, to maintain the rights granted by the Cabinet instructions of 27 December 1974, which were repealed on 30 September 1999. In addition, it notes the information that the above Act, which entered into force on 1 October 1999, maintains the continuity of the rights of employees in public health-care units in relation to working time, as well as of those employed in independent public health-care units, and in terms of the long-service benefit and retirement or pension benefits due to incapacity for work. The Committee also notes the adoption of the Act of 1 March 2001 amending the Act issuing the Labour Code (Dziennik Ustaw No. 28, text No. 301), which introduced the five-day working week. The Government adds that the regulations respecting hours of work, shift-work bonuses, the continuous provision of health care and supplements for employees in emergency ambulance services, also cover employees in the private sector. For all these reasons, the Government considers that the comments of the National Trade Union of Nurses and Midwives of Poland concerning the loss of their acquired rights are difficult to accept. The Committee notes these comments. The Committee hopes to be able to examine the legal texts provided by the Government once they have been translated. In the meantime, it asks the Government to take the necessary measures to ensure compliance with the provisions of the Convention, and accordingly to ensure the rights of nursing personnel in the country.

The Committee is raising other points in a request addressed directly to the Government.

[The Government is asked to report in detail in 2003.]

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The Committee notes the comments made by the Trade Union of Medical Analysis Technicians and the National Trade Union of Nurses and Midwives alleging failure to apply Convention No. 149. The comments were sent to the Government on 24 July and 11 September 2000, respectively. However, the Office has not received the Government’s observations. Pending the Government’s reply, the Committee will refer to the abovementioned communications.

According to the Trade Union of Medical Analysis Technicians, the public authorities are not enforcing the Convention satisfactorily. They have no effective policy to provide nursing staff with satisfactory employment and work conditions including career prospects and decent salaries that would attract and retain staff able to provide services of a quantity and quality such as to secure the highest possible level of medical care for patients.

The National Trade Union of Nurses and Midwives, for its part, alleges that the violation of nurses’ rights is notorious. In its comments, the above union emphasizes that:

-  salary levels are inadequate in relation to the work performed;

-  employers do not comply with the legislation and ignore nursing circles;

-  employers do not comply with basic health and safety principles;

-  work conditions are deteriorating;

-  salaries continue to drop;

-  acquired rights are taken away;

-  employers force nurses and midwives to change their employment, work and salary conditions for less favourable ones;

-  the Health Ministry has adopted virtually no legislation on the employment, working and salary conditions of nurses and midwives or on their education;

-  working conditions are not in conformity with safety requirements.

The same union alleges that no legal protection is anticipated for nurses and midwives in connection with the health-care reform despite the fact that the Health Ministry should expect the emergence of legal situations unfavourable for this group of workers.

The Committee hopes that the Government will send its observations on the comments made by the Trade Union of Medical Analysis Technicians and the National Trade Union of Nurses and Midwives so that the Committee can examine these matters at its next session in 2001.

[The Government is asked to report in detail in 2001.]

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Further to its previous comments the Committee notes with interest the information provided by the Government in its report on the adoption of Law No. 91 of 5 July 1996 and its later amendments on nursing and midwife professions' ruling qualifications and titles among other issues. It also notes the information of the Government on the adoption of several regulations related to matters covered by the Convention. The Committee will proceed to examine these texts in order to enable it to formulate, if necessary, any relevant comments on the manner in which they give effect to the provisions of the Convention.

In addition, the Committee notes the indication of the Government on the ratification of the European Agreement on training and education of nurses, stating that a three-year curriculum is planned to be experimentally introduced to start with the beginning of the new academic year in October 1999 in some schools.

The Committee also notes the information supplied by the Government in relation to the following provisions of the Convention.

Article 2, paragraph 2(b) of the Convention (in conjunction with Part V of the report form). The Committee takes note of the indication of the Government that particulars on workers of the private sector will be available in 2000. It also takes note that article 133 of the Labour Code provides that overtime working cannot exceed 150 hours, and that article 143 provides that the employee is entitled to exchange additional payment for overtime working for leisure time. It also notes the indication that, according to national legal provisions, the person or organization who sets up the health-care institution should control the compliance of it with the provisions of the labour law; and additionally, this legislation, including the safety and hygiene of work, is entrusted to the State Labour Inspectorate.

Article 2, paragraph 3. The Committee takes note of the information provided by the Government that the representatives of the employers' and workers' organizations are associated with the development of the programmes of courses. It also notes the information that the Centre of Postgraduate Education of Nurses and Midwives has been established at a national level to ensure a proper coordination of activities to prepare the general curricula for the several forms of the postgraduate education. The Committee observes that no response is given with the Government's report to its previous request on the extent to which the employers' and workers' organizations concerned have been associated with the formulation of a policy for nursing services and nursing personnel. It hopes once more than the Government will provide relevant information on this matter with its next report.

Article 7. The Committee notes the information supplied by the Government on the following points:

-- the adoption of the regulation of the Ministry of Health and Social Welfare of 30 May 1996 concerning medical examinations and the range of prophylactic health care for employees;

-- the launching and introduction of the "National Programme of Preventing HIV Infections and Nursing HIV and AIDS Patients" by the Ministry of Health and Social Welfare;

-- the elaboration of a document entitled "The preventive and diagnostic actions in case of an HIV infection and AIDS disease" after consultations with the employers' and workers' organizations concerned, which sets forth the prophylactic measures of the health department and contains the patterns of standards of conduct in the occupational work of nurses and midwives belonging to the medical staff group at high risk of exposure to HIV infection;

-- the publication of the handbook entitled "AIDS -- How to reduce the risk of HIV infection in the nursing practice" for raising the level of education of nurses and midwives;

-- the organization all over the country of several training courses for nurses and midwives within the scope of prevention of HIV/AIDS and post-exposure procedures.

In addition, the Committee takes note of the information contained in the Government's report according to which HIV infection could be recognized as an occupational disease, on proving that the HIV infection has been acquired at the workplace during occupational activities. Finally, the Committee notes the indication of the Government that the sanitary inspection bodies are in charge of taking the necessary remedial measures in cases of contraventions to the hygienic and health legal requirements.

The Committee requests the Government to continue to provide further information about other measures taken on this subject.

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The Committee notes the information supplied by the Government in its report. It regrets to note, however, that the report does not answer the questions raised in its previous comments. The Committee must therefore raise the same points in its new comments.

Article 2, paragraphs 1 and 2(a) of the Convention. The Committee notes that there was a first reading on 7 April 1994 of bills concerning the nursing and midwifery professions and that the Bills were referred to subcommissions. According to the Government, the adoption of this legislation will be of fundamental importance for issues connected to the exercise of the profession of nurse, including the related rights and duties, particularly as pre-war regulations are still in force. The Government adds that the European Agreement concerning the training and education of nurses was signed on 6 February 1995 with reservation of ratification. One of the results of the implementation of this Agreement is that, by the end of 1995, a three-year nursing training programme will be established in post-secondary medical schools.

The Committee asked the Government to provide copies of the above-mentioned Bills as soon as they have been adopted and to indicate whether the ratification procedure for the European Agreement on the training and education of nurses has been completed.

Article 2, paragraph 2(b) (in conjunction with point V of the report form). The Committee notes the Order of the Minister of Health and Social Welfare of 14 January 1995 amending the Order respecting pay principles for employees in public health service establishments, issued under the Act of 23 December 1994. The Committee also notes that the Government has not sent information on the number of persons leaving the profession, or on the number of persons employed in the private sector. It hopes that the Government will shortly provide relevant data in this connection. The Committee also notes that, in the course of monitoring observance of the provisions of the Convention, the State Labour Inspectorate reported: (i) non-observance of the working hours of nursing staff (failure to respect the limits on overtime work; failure to grant an extra day off during the week in compensation for work on Sundays and public holidays); and (ii) non-remuneration of overtime due to the fact that hours worked are not counted in reckoning monthly pay.

The Committee asks the Government to indicate the measures taken or envisaged to remedy this situation.

Article 2, paragraph 3. The Committee notes that the Government's report does not reply to the following questions raised in the previous comments: (i) the extent to which the employers' and workers' organizations concerned have been associated with the development of the new concept for programmes of courses, specialization and the tasks of the nursing personnel concerned; and (ii) the provision of full information concerning the consultations which have been held or are held in the future with the above organizations with a view to the formulation of a policy for nursing services and nursing personnel.

The Committee hopes that the Government will shortly be in a position to provide the relevant information.

Article 4. The Committee notes the Order of the Minister of Health and Social Welfare of 7 July 1995 amending the requirements concerning employees holding particular work posts in public health care institutions. It asks the Government to continue to provide information, in accordance with the provisions with this Article of the Convention.

Article 7. The Committee notes the Order of the Minister of Health and Social Welfare of 29 March 1994 concerning principles for the allocation to employees of individual means of protection and working clothes. The Committee also notes that, in the course of monitoring observance of the provisions of the Convention, the State Labour Inspectorate noted that the working conditions of nursing personnel in terms of occupational safety and health do not always meet legal requirements. The Committee asks the Government to indicate the measures taken or envisaged to ensure observance of the legislative provisions governing the occupational safety and health of nursing personnel.

Furthermore, with reference to its 1990 general observation, which it reiterated in 1994, the Committee again requests the Government to indicate the measures that have been taken or are envisaged, in consultation with the employers' and workers' organizations concerned, to take into account the particular risk to nursing personnel of accidental exposure to the human immunodeficiency virus (HIV), such as conditions of work, confidentiality of test results, recognition that the cause of infection is occupational, etc.

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Article 2, paragraphs 1 and 2(b), of the Convention (in conjunction with point V of the report form). The Committee notes the Order of the Minister of Health and Social Welfare of 2 February 1994 to amend the Order respecting pay principles for employees in public health service establishments, particularly as regards the increase in the basic wage, night work supplements, allowances for work on Sundays and public holidays' and seniority allowances. It once again notes that the Government has not provided data on the number of persons leaving the profession, or on the number of persons employed in the private sector. It once again hopes that the Government will be in a position to supply the required information in its future reports.

Article 2, paragraph 3. The Government refers, in the context of the work carried out on the reform of primary health care, to the development of a new concept for programmes of courses, specialization and the tasks of the nursing personnel concerned. The Committee requests the Government to indicate the extent to which the employers' and workers' organizations concerned have been associated with the preparation of the concept of programmes and tasks referred to above. Furthermore, the Committee would once again be grateful if the Government would supply full information concerning the consultations which have been held or are held in the future with the above organizations with a view to the formulation of a policy for nursing services and nursing personnel.

Article 7. The Committee notes the Guidelines issued by the Minister of Health and Social Welfare of 6 December 1993 concerning the occupational safety and health of personnel of the health service institutions using cytostatic medicaments. Furthermore, with reference to its 1990 general observation, which it 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 to nursing personnel of accidental exposure to the human immunodeficiency virus (HIV): such as conditions of work, confidentiality of test results, recognition that the cause of infection is occupational, etc.

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Article 2, paragraphs 1, 2(b) of the Convention, (in relation to point V of the report form). The Committee takes note of the Order of the Minister of Health and Social Welfare, modifying the Order on pay principles for employees of public health service establishments, especially with respect to increases in basic pay, supplements for night work, allowances for work on Sundays and public holidays and seniority allowances. It further notes that data on the number of persons leaving the profession and on the number of nurses employed in the private sector are not available. It hopes that the Government will be in a position to supply such information in its future reports.

Article 2, paragraph 3. The Government states that it was not able to answer the Committee's question concerning consultations with employers' and workers' organizations concerned, due to the large number of parties involved. The Committee acknowledges that the country is at present undergoing profound structural changes and that uniform procedures of consultation have not yet emerged. However, it would be grateful to receive any information concerning future consultations with the employers' and workers' organizations concerned with regard to the formulation of a policy concerning nursing services and nursing personnel.

Point V of the report form. The Committee has noted the statistical data provided with the report and would be grateful if the Government would continue to communicate such data, including information on the application of the Convention in practice, and on any difficulties encountered.

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Article 2, paragraphs 1, 2(b) and 3, of the Convention (in relation to point V of the report form). The Committee takes note of the information contained in the last report of the Government and related to its previous comments on this point of the Convention. It notes the Order of 2 July 1992 of the Minister of Health and Social Welfare providing for higher remuneration for nursing personnel. It also notes the statistics regarding nursing personnel which do not indicate, however, the number of persons leaving the profession. Likewise, the report does not refer to any other efforts undertaken to attract persons to the nursing profession and retain them in it. The Committee therefore requests the Government to indicate whether other measures have been taken to improve working and employment conditions in both the private and public sectors, so as to make this profession more attractive, in accordance with this provision of the Convention. Please supply statistical data on the number of nurses employed in the private sector, on their level of remuneration in relation also to remuneration paid in practice in the public sector, and data on the number of persons leaving the nursing profession.

Article 2, paragraph 3. The Committee notes the Act of 19 April 1991 on self-government of nurses and midwives providing an important role of such self-government of nurses in respect of training, health policy and organization of health services. However, no reply has been given to the Committee's previous direct request regarding any consultations with the employers' and workers' organizations concerned with regard to the formulation of a policy concerning nursing services and nursing personnel. The Committee again requests the Government to provide such particulars on this point of the Convention.

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Article 2, paragraphs 1, 2(b) and 3, of the Convention (in relation to point V of the report form). The Committee notes the Government's comments to the effect that in recent years there has been the growing shortage of the nursing personnel which leads to the worsening of nursing services and to abandoning of the profession by many nurses to seek employment in other sectors with better pay opportunities. There are also difficulties to recruit new candidates to nursing schools.

The Committee recalls that under this Article of the Convention, the Government shall adopt and apply a policy concerning nursing services and nursing personnel designed to provide the quantity and quality of nursing care necessary for attaining the highest possible level of health for the population. While noting that the Government has already taken various measures to improve both the quantity and the quality of nursing care, especially by wage increases, the Committee hopes that the next report will refer to further measures in this direction and indicate the progress made, in particular in increasing the number of nurses. The Committee notes that comments made by the Government also appear to point to difficulties in regard to the career prospects of nursing personnel. The Committee refers the Government to Paragraphs 21 to 24 of the Nursing Personnel Recommendation in this regard and requests the Government to indicate the measures taken and the progress made in providing nursing personnel with career prospects which are likely to attract persons to the profession and retain them in it.

Article 2, paragraph 3. The Committee requests the Government to supply information on whether the employers' and workers' organisations concerned are consulted with regard to the formulation of a policy concerning nursing services and nursing personnel.

The Committee requests the Government to continue to provide the statistical data asked for in point V of the report form, including data on the number of persons leaving the profession.