Demande directe (CEACR) - adoptée 2009, publiée 99ème session CIT (2010)

Article 2, paragraphs 1 and 2, of the Convention. National policy for nursing services and nursing personnel. The Committee notes the Government’s indication that the health sector has undergone comprehensive change since the end of 2007, particularly because of the new integrated national health system, under which the State has become a provider of health services and has enabled the private sector to extend its coverage. It also notes the Government’s reference to a draft Act concerning nursing personnel, which has been before Parliament for some time. It hopes that the Government will adopt this draft Act in the near future and will take account of the comments which the Committee has been making for a number of years. The Committee therefore requests the Government to provide further details concerning the principal components, priorities and objectives fixed by the new integrated national health system, particularly concerning its impact on the conditions of work of nursing personnel, and to supply a copy of the Act concerning nursing personnel, once it has been adopted.

Furthermore, the Committee notes that, on average, there are between ten and 11 nurses per 10,000 population and nursing personnel are leaving the country in order to obtain better conditions of work. It also notes that Uruguay has the lowest number of qualified nurses in the whole of Latin America, with a figure of only 12.2 per cent for nursing personnel and, consequently, the highest figure for auxiliary nurses (87.8 per cent). This phenomenon is accentuated by the fact the MERCOSUR provides for the free movement of workers between its member States (Brazil, Argentina, Paraguay and Uruguay) and, in particular, since the treaty of Asunción signed in 1991 which provides for the possibility of sectoral agreements, especially in the health sphere. In this regard, the Committee wishes to refer to the draft WHO code of practice concerning the international recruitment of health personnel, currently under discussion, 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 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. The Committee therefore requests the Government to supply detailed information on any developments in the situation and on any additional measures taken or contemplated in order to contain the phenomenon of the migration of qualified nursing personnel abroad.

Article 2, paragraph 2(b). Remuneration for nursing personnel. Further to its previous comment, the Committee notes the Government’s indication that, since 2005, the policy of collective bargaining within the Wage Council has brought new developments with regard to the wages of nursing personnel, in both the public and private sectors. It notes that wages for nursing personnel increased by 40 per cent between 2005 and 2009. The Committee also notes that the Government has not supplied any information concerning the specific points raised in its previous comment and requests it once again to indicate: (i) the reasons for nursing personnel leaving the profession or working abroad; (ii) any difficulties still encountered by nursing personnel in the public or private sector, such as redundancies, wage cuts or delays in the payment of wages; and (iii) any measures taken or contemplated, such as the introduction of an incentive bonus system, to remedy this situation in the short term.

Article 3, paragraph 2. Need to coordinate nursing education and training with education and training for other workers in the health sphere. The Committee notes the information supplied by the Government concerning subjects taught at the University of the Republic in the health sphere, particularly with regard to occupational health. However, it notes the Government’s indication that there is still no specific coordination between nursing education and training and the education and training given to other workers in the health sphere. The Committee requests the Government to indicate, in accordance with this provision of the Convention, the measures taken or contemplated to ensure the coordination of education and training for workers in the health sphere.

Article 5. Participation of nursing personnel in the planning of nursing services – determination of conditions of employment and work by negotiation between employers’ and workers’ organizations concerned. Further to its previous comments on this point, the Committee notes the Government’s indication that the restructuring of the Ministry of Public Health, mentioned in its previous report, is going ahead. It notes that the Government does not supply any information concerning the impact of the closure of the Central Nursing Department on the active participation of nursing personnel in the planning of nursing services. The Committee further notes that no progress has been made with regard to the national plan for nursing services, which was due to be drawn up by the Nursing Services Technical Committee. Bearing in mind that it has been raising the question of the participation of nursing personnel in the planning of nursing services for many years, the Committee requests the Government to take the necessary steps without delay to ensure, in accordance with this Article of the Convention, the real and effective participation of nursing personnel in the planning of nursing services and the consultation of such personnel on decisions concerning them. It also requests the Government to indicate whether, since 1999, there has been an agency or service which exercises the tasks for which the Central Nursing Department was responsible, and to keep the Office informed of any developments with regard to the national plan for nursing services.

Article 7. Specific legislation on occupational health and safety adapted to the special nature of nursing work and of the environment in which it is carried out. The Committee notes the Government’s indication to the effect that no particular measure has been adopted with a view to adapting occupational safety and health laws and regulations to the specific nature of nursing work, in accordance with this Article of the Convention. It also notes that the Government does not supply any information concerning any follow-up measures taken in the event of occupational accidents, particularly in cases of contamination by HIV/AIDS. The Committee therefore requests the Government once again to supply information on the conditions of work of nursing personnel and the risks of accidental contamination, on the confidential nature of HIV/AIDS test results, and to indicate whether HIV infection contracted in the course of duty is recognized as an occupational disease. It also requests the Government to send a copy of the revised bio-security standards mentioned in its previous report.

Furthermore, 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 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.

Part V of the report form. Practical application. The Committee requests the Government to continue supplying general information on the manner in which the Convention is applied in practice, including, for example, statistics on the numbers of nursing personnel (by sectors of activity and by levels of training and functions, if possible), the number of persons entering and leaving the profession each year, the number of students enrolled in various nursing schools, copies of official reports or studies on nursing services, copies of branch or establishment collective agreements covering nursing personnel, and information on any practical difficulties encountered in the implementation of the Convention.