Direct Request (CEACR) - adopted 2018, published 108th ILC session (2019)

Nursing Personnel Convention, 1977 (No. 149) - Latvia (Ratification: 1993)

Other comments on C149

Direct Request

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Article 2(1), of the Convention. National policy concerning nursing services and nursing personnel. In its previous comments, the Committee had requested the Government to provide information on measures taken to address the nursing shortage, prevent health-worker migration and ensure satisfactory working conditions for nursing personnel. The Government provides information on the adoption of new regulations and amendments to various legislative provisions related to matters covered by the Convention. The Committee notes in particular the enactment of Regulation No. 1529 on the Procedure for organization and financing of healthcare (17 December 2013), the Order of the Cabinet of Ministers No. 633 on Changing the financing model of the Latvian healthcare system (1 November 2016), and the Order of the Cabinet of Ministers No. 394 on the Conceptual Report of the reform of the healthcare system (7 August 2017). The Government reports that multiple projects have been pursued by the Ministry of Health to improve the healthcare infrastructure, mainly with regard to inpatient health services, the National Health Service (NHS) and general practitioners. Additional programmes for the training and recruitment of healthcare staff have been implemented to ensure the provision of the public quality health services. The Committee notes the Government’s indication that the Operational Programme – Growth and Employment (OPGE) published in 2014, sets priorities for the OPGE’s contribution to the achievement of the Europe 2020 Strategy, which includes improving access to healthcare, particularly in regions with fewer services. Noting that the discrepancy in the availability of doctors and nurses between the capital city and the regions is one of the biggest among the EU countries, with the majority of physicians and nursing personnel employed in the capital city of Riga, the OPGE aims to improve accessibility to healthcare and healthcare support personnel who provide services in priority health sectors (such as cardiovascular, oncology, perinatal and neonatal care and mental healthcare) to persons residing outside of the capital. The OPGE calls for measures to be taken to attract doctors and nursing personnel to the regions, through the introduction of a “business trip” system, where personnel are assigned to regions for a specific period, covering moving allowances and providing opportunities for young health workers to begin and continue to practice in the regions. According to the statistics provided by the Government, between 2013 and 2018, the number of nurses in basic work has continued to decrease (from 9,501 in 2013 to 9,317 in 2018), an increase in the number of nurses in additional work (from 2,588 in 2013 to 3,428 in 2018) and the number of nursing institution graduates (from 285 in 2013 to 461 in 2017) is recorded. The Committee further notes that, according to the OPGE, the average availability of nurses in Latvia is considerably below the average in EU countries and there are more nurses per 10,000 inhabitants in Riga (71.7 per cent) and Latgale (48.7 per cent) than in the other regions of the country. The Committee requests the Government to provide detailed information, including statistical information disaggregated by sex, age and region, on the impact of measures taken in the process of implementing programmes and policies on the improvement of nursing services and on attracting and retaining nursing personnel, including midwives, particularly in rural and remote areas of the country. Taking account of the continued shortage of nursing personnel, the Committee requests the Government to supply information on measures taken or envisaged to ensure access to quality nursing care, particularly for groups in vulnerable situations, such as children, women, people with disabilities and people living in rural areas.

Article 2(2). Employment and working conditions of nursing personnel. The Committee notes the amendments made to the Labour Law of 2002, particularly those relating to the Organisation of Working Time (Chapter 32), Rest Time (Chapter 33) and Leave (Chapter 35). The Government indicates that amendments have also been made to the Medical Treatment Law of 12 June 1997, section 26, modifying the right of medical practitioners to qualify for a medical certificate (1 December 2016). Amendments were also introduced in 2017 to section 53.1, paragraph 7, of the Medical Treatment Law which was challenged on the basis that it discriminated against medical personnel by restricting their right to compensation for overtime hours. Subsequently, section 53.1, paragraph 7, was replaced by Transitional Provision 31. On 15 May 2018, the Latvian Constitutional Court held that both section 53.1, paragraph 7, and section 31 of Transitional Provision of the Medical Treatment Law were incompatible with the principle of equality in the Latvian Constitution and declared it null and void as of 1 January 2019 (Case No. 2017-15-01). The Government further reports that the remuneration of healthcare personnel is a priority, adding that problems in the state-funded healthcare institutions include low rates of remuneration, particularly for middle and lower level personnel. The Committee notes that, from 1 January 2017, the minimum monthly wage was increased and the lowest wage echelons were raised. The Committee notes that by 2018, wages for doctors and functional specialists will increase by 44 per cent, for medical and patient care persons and functional specialists’ assistants by 38 per cent, and for medical and patient care support persons by 24 per cent. Recalling that the Convention calls for measures to be taken to attract and retain people to the nursing profession, ensuring reasonable career prospects and levels of remuneration that take account of the constraints and hazards inherent in the profession, the Committee requests the Government to provide information on the impact of measures taken to improve the terms and conditions of employment, and particularly the remuneration, of nursing personnel.

Part V of the report form. Application in practice. The Committee requests the Government to provide updated detailed information on the application of the Convention in practice, including statistics disaggregated by sex, age and region, on the ratio of nursing personnel to the population, the number of persons enrolled in nursing care schools, the number of men and women nurses who enter and leave the profession each year, the organization and the operation of all institutions which provide healthcare, as well as official studies, surveys and reports addressing human resources issues in the health sector.