Nursing Personnel Convention, 1977 (No. 149) - United Republic of Tanzania (RATIFICATION: 1983)

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Article 2 of the Convention. National policy on nursing services and nursing personnel. The Committee notes that a copy of the 2017 National Health Policy (NHP) is provided by the Government in reply to its previous request. The 2017 NHP sets objectives to facilitate the provision of basic health services that are of good quality, equitable, accessible, affordable, and sustainable, as well as gender-sensitive. The Government reports that, to this end, the 2017 NHP should be implemented in a manner consistent with the implementation of other policy instruments, namely: the National Development Vision 2025, the National Five Year Development Plan 2016/17–2020/21; the (Tanzania) Sustainable Development Goals 2030; and the Health Sector Strategic Plan 2015–20 (HSSP IV). The Government indicates that one of the objectives common to these instruments is to improve the quality of primary health-care services by addressing the lack of skilled human resources and enhancing the capacity of health workers at all levels in the health sector. In this regard, the HSSP IV indicates that, even though the number of health workers, especially clinical personnel, is increasing in Tanzania (as of 2014 there were 2,843 nursing officers, 4,861 assistant nursing officers and 13,848 enrolled nurses and midwives), remote and rural areas are still facing major shortages and many primary health facilities in these areas do not have enough qualified staff. The HSSP IV therefore calls for the Nursing and Midwifery Services to focus on increasing skills for nurses and midwives that will contribute to the Government’s commitment of reaching public expectations by providing quality services. In this regard, the HSSP IV calls on the Tanzania Nurses and Midwives Council to champion ethics in clinical practice to safeguard patients’ rights. It further recommends that the nursing and midwifery services concentrate on creating a clinical instructors’ programme for students and interns, in collaboration with the 57 nursing schools, to facilitate skills development. Moreover, the Ministry of Health and Social Welfare (MOHSW), in collaboration with Council Health Management Teams (CHMTs), is required to introduce an orientation plan to rotate and relocate staff to facilitate their understanding of the new working environment. The Committee requests the Government to provide information on the impact of the implementation of the 2017 NHP and HSSP IV on the working conditions of nursing personnel as well as on measures taken for attracting and retaining nursing personnel, including midwives, particularly in rural and remote areas of the country. It further requests the Government to provide statistical information, disaggregated by age and sex, on the number of persons entering and leaving the profession annually, the number of nursing and midwifery personnel by category and grade, the proportion of nursing personnel and midwifery in relation to other workers in the health sector and their geographic distribution in the territory, particularly in remote and rural areas.

Article 5. Consultations with representative organizations of nursing personnel. The Government reports that during the financial year 2017–18, a total of seven collective agreements were concluded with the private health sector. The Committee notes that one of the main strategies of the 2017 NHP includes requiring intensive consultations with all stakeholders, harmonization and institutional relations through the adoption of Agreements and Memoranda of Understanding. It further notes that the HSSP IV was developed through a participatory process comprising representatives of Ministries, Departments and Agencies (MDAs), non-governmental organizations (NGOs) and the private sector, as well as development partners (DPs). The Committee requests the Government to continue to provide information on consultations held with representative organizations of nursing personnel and to provide copies of collective agreements currently in force between the Government and the private health sector, relevant to employment conditions of nursing personnel, particularly in relation to remuneration, occupational safety and health and hours of work.

Article 6. Working conditions of nursing personnel. In response to the Committee’s previous comments, the Government indicates that it will examine the possibility of making special arrangements or benefits concerning the specific conditions applicable to nursing personnel in the context of the ongoing Labour Law Reform. The Committee further notes that the 2017 NHP requires the Government to ensure that all health sector staff are adequately remunerated, that their working and living conditions are improved, and to enhance the availability of adequate social economic infrastructural facilities, equipment and medical supplies to all Tanzanians. In this regard, the HSSP IV stipulates that the Ministry shall introduce a stepwise certification towards accreditation (SWCA) system, which is designed to make the quality of health care more visible, more acceptable to users, and safer for both clients and health-care sector workers. The system establishes a Star Rating mechanism for all primary health-care facilities, allowing the Council to identify and support underperforming health facilities and bring them up to the desired standard. Recalling the requirement set out by the Convention that nursing personnel shall enjoy conditions of employment at least equivalent to those of other workers, the Committee requests the Government to provide updated information on the outcome of its examination for making special arrangements or benefits applicable to nursing personnel and on measures taken or envisaged to guarantee that nursing personnel enjoy conditions of employment and work at least equivalent to those of other workers in the following fields: (a) hours of work, including regulation and compensation of overtime, inconvenient hours and shift work; (b) weekly rest; (c) paid annual holidays; (d) educational leave; (e) maternity leave; (f) sick leave; and (g) social security. The Committee draws the Government’s attention to Paragraphs 25–56 of the Nursing Personnel Recommendation, 1977 (No. 157), which provide useful guidance in this regard.

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Article 2 of the Convention. National policy on nursing services and nursing personnel. With reference to its previous comment on national health care policy and the institutional framework within which the representative organizations of nursing personnel are consulted, the Committee notes the Government’s reference to the adoption of the National Health Policy in 2007 as well as various governmental Directives. Furthermore, in its previous comment, the Committee had requested the Government to transmit a copy of the latest edition of the National Nursing and Midwifery Policy Guidelines. In this regard, the Committee notes that the Government’s report does not provide a copy of the latest edition of the Guidelines and does not provide information on the review process of the 2002 National Nursing and Midwifery Policy Guidelines. The Committee once again requests the Government to provide up-to-date information regarding the review process of these Guidelines and to transmit a copy of the latest edition of the Guidelines. The Committee would also appreciate receiving a copy of the 2007 National Health Policy and a copy of the Government Directives providing for the consultation of the representative organizations of nursing personnel.

Article 5. Consultations with representative organizations of nursing personnel. With reference to its previous comment on collective agreements currently in force in the healthcare sector, the Committee notes that a copy of the adopted Labour Institutions Wage Order (GN. 196 of June 2013), based on recommendations from various Wage Boards, is provided by the Government. It also takes good note of the Government’s indications that agreements have been concluded between the Tanzania Union for Government and Health Employees (TUGHE) and different health facility owners and employers at an institutional level. The Committee asks the Government to keep providing information on any collective agreement in force in the healthcare sector or any regulatory text that may have been the result of consultations with representative organizations of nursing personnel.

Article 6. Working conditions of nursing personnel. In its previous comment, the Committee had requested the Government to transmit detailed information concerning the specific conditions applicable to nursing personnel. In this regard, the Committee notes the Government’s reply that there are no legal texts providing for terms and conditions of employment of nursing personnel in a manner distinctly different from other workers. It also notes the Government’s reference to the Employment and Labour Relations Act, 2004, which applies to all employees both in the public and private sectors. As indicated before by the Committee, the specificity of nursing services often calls for particular working conditions which take account of the constraints and hazards inherent in the profession. In this connection, the Committee had also referred to Paragraphs 30 43 of the Nursing Personnel Recommendation, 1977 (No. 157), which gave useful guidance on this point. The Committee therefore requests the Government to examine the possibility of making special arrangements or benefits, including national laws and regulations or collective agreements, concerning the specific conditions applicable to nursing personnel, especially in relation to shift work, overtime, inconvenient hours and rest periods.

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The Committee notes that the Government’s report has not been received. It hopes that a report will be supplied for examination by the Committee at its next session and that it will contain full information on the matters raised in its previous direct request, which read as follows:

Repetition

Article 2 of the Convention. National policy on nursing services and nursing personnel. With regard to the Government’s earlier indication that a new edition of the 2002 National Nursing and Midwifery Policy Guidelines was due for review to reflect ongoing changes in the health sector, the Committee notes that the Government’s report does not provide any further details on the review process or its possible outcome. The Committee therefore requests the Government to provide up to date information on national health-care policy, including measures taken or envisaged to facilitate the effective utilization of nursing personnel in the country and to promote the fullest use of the qualifications of nursing personnel in the various health-care establishments. It also requests the Government to provide more detailed information on the institutional framework within which the representative organizations of nursing personnel are consulted with respect to the elaboration and application of policies and principles regarding the nursing profession and the determination of conditions of employment and work of nursing personnel. Finally, the Committee would thank the Government for transmitting a copy of the latest edition of the National Nursing and Midwifery Policy Guidelines.

Article 3. Education and training. The Committee notes the Government’s explanations on the admission requirements, educational programmes and specialties offered in the field of nursing and midwifery. The Committee would be grateful if the Government would continue to provide information on the duration and levels of nursing education and training, the nursing personnel structure (e.g. professional nurses, auxiliary nurses and nursing aides) established by reference to education and training, specific programmes for continuing nursing education and skill advancement as well as any other activity, programme or initiative aimed at improving the quality standards of nursing education and training.

Article 5. Consultations with representative organizations of nursing personnel. The Committee notes the Government’s statement that it is doing every possible effort to improve working terms and conditions for nursing personnel. The Government also indicates that apart from the Tanzania National Nurses Association (TANNA), the Tanzania Union for Government and Health Employees (TUGHE) was very much involved in the health sector wage board for the purpose of fixing minimum wage rates for health employees. The Committee once again requests the Government to transmit copies of any collective agreement currently in force in the health-care sector or of any regulatory text, such as wage board decisions, that may have been the result of consultations with representative organizations of nursing personnel.

Article 6. Working conditions of nursing personnel. The Committee notes the Government’s reference to the Employment and Labour Relations Act, 2004, and the Social Security (Regulatory Authority) Act, 2008, which apply to all employees both in the public and private sectors. The Committee recalls that the specificity of nursing services often calls for particular working time arrangements and results in rather uncommon work organization and consequently working conditions. The Committee refers, in this connection, to Paragraphs 30–43 of the Nursing Personnel Recommendation, 1977 (No. 157), which offer some guidance on this point. The Committee would therefore be interested in receiving detailed information, including copies of any relevant legal texts not previously communicated, concerning the specific conditions applicable to nursing personnel relating to shift work, overtime, inconvenient hours, rest periods or any other aspect of employment regulated in a manner distinctly different from other workers.

Article 7. Occupational health and safety of nursing personnel. The Committee notes that nurses and midwives guidelines and practice protocols for prevention of HIV/AIDS infection from needle stick and sharp objects have been developed while training is provided on matters such as reporting needle stick injuries, exposure from infectious materials, and health-care facilities to provide post-exposure prophylaxis (PEP). The Committee requests the Government to keep the Office informed of all relevant developments in this respect. It would also appreciate receiving a copy of the guidelines and practice protocols for HIV/AIDS prevention referred to in the Government’s report.

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Article 2 of the Convention. National policy on nursing services and nursing personnel. With regard to the Government’s earlier indication that a new edition of the 2002 National Nursing and Midwifery Policy Guidelines was due for review to reflect ongoing changes in the health sector, the Committee notes that the Government’s report does not provide any further details on the review process or its possible outcome. The Committee therefore requests the Government to provide up to date information on national health-care policy, including measures taken or envisaged to facilitate the effective utilization of nursing personnel in the country and to promote the fullest use of the qualifications of nursing personnel in the various health-care establishments. It also requests the Government to provide more detailed information on the institutional framework within which the representative organizations of nursing personnel are consulted with respect to the elaboration and application of policies and principles regarding the nursing profession and the determination of conditions of employment and work of nursing personnel. Finally, the Committee would thank the Government for transmitting a copy of the latest edition of the National Nursing and Midwifery Policy Guidelines.

Article 3. Education and training. The Committee notes the Government’s explanations on the admission requirements, educational programmes and specialties offered in the field of nursing and midwifery. The Committee would be grateful if the Government would continue to provide information on the duration and levels of nursing education and training, the nursing personnel structure (e.g. professional nurses, auxiliary nurses and nursing aides) established by reference to education and training, specific programmes for continuing nursing education and skill advancement as well as any other activity, programme or initiative aimed at improving the quality standards of nursing education and training.

Article 5. Consultations with representative organizations of nursing personnel. The Committee notes the Government’s statement that it is doing every possible effort to improve working terms and conditions for nursing personnel. The Government also indicates that apart from the Tanzania National Nurses Association (TANNA), the Tanzania Union for Government and Health Employees (TUGHE) was very much involved in the health sector wage board for the purpose of fixing minimum wage rates for health employees. The Committee once again requests the Government to transmit copies of any collective agreement currently in force in the health-care sector or of any regulatory text, such as wage board decisions, that may have been the result of consultations with representative organizations of nursing personnel.

Article 6. Working conditions of nursing personnel. The Committee notes the Government’s reference to the Employment and Labour Relations Act, 2004, and the Social Security (Regulatory Authority) Act, 2008, which apply to all employees both in the public and private sectors. The Committee recalls that the specificity of nursing services often calls for particular working time arrangements and results in rather uncommon work organization and consequently working conditions. The Committee refers, in this connection, to Paragraphs 30–43 of the Nursing Personnel Recommendation, 1977 (No. 157), which offer some guidance on this point. The Committee would therefore be interested in receiving detailed information, including copies of any relevant legal texts not previously communicated, concerning the specific conditions applicable to nursing personnel relating to shift work, overtime, inconvenient hours, rest periods or any other aspect of employment regulated in a manner distinctly different from other workers.

Article 7. Occupational health and safety of nursing personnel. The Committee notes that nurses and midwives guidelines and practice protocols for prevention of HIV/AIDS infection from needle stick and sharp objects have been developed while training is provided on matters such as reporting needle stick injuries, exposure from infectious materials, and health-care facilities to provide post-exposure prophylaxis (PEP). The Committee requests the Government to keep the Office informed of all relevant developments in this respect. It would also appreciate receiving a copy of the guidelines and practice protocols for HIV/AIDS prevention referred to in the Government’s report.

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.

Part V of the report form. Application in practice. The Committee notes that according to the statistical information provided by the Government in its report, there are currently 22,217 registered nurses of whom 2,217 are men and 20,000 are women. It also notes the data on schools offering nursing studies and that on average 1,750 students are enrolled per year in the certificate, 560 in the diploma, and 77 in the advanced diploma programme. The Committee would appreciate if the Government would continue supplying up to date information on the practical application of the Convention, both in continental Tanzania and in Zanzibar, for instance, statistical data and characteristics of the composition of the nursing workforce (e.g. age, gender), the number of nurses exiting or joining the profession every year, the nurse-to-population ratio, copies of official reports or studies addressing nursing-related issues, any practical difficulties experienced in the application of the Convention, such as shortage or migration of qualified nurses, etc.

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The Committee recalls its previous comment in which it had requested the Government to provide a detailed and fully documented report on the effect given to the Convention both in law and practice in continental Tanzania and in Zanzibar. The Committee notes that the Government’s report addresses only partially the points raised previously and therefore wishes once again to draw the Government’s attention to the following points.

Article 2, paragraphs 1 and 3, of the Convention. Policy on nursing services and nursing personnel. The Committee notes the Government’s reference to an official document entitled “National Nursing and Midwifery Policy Guidelines 1st edition of 2002” and the indication that the said document is due for review to reflect ongoing changes in the health sector. The Committee would appreciate receiving a copy of the 2002 policy guidelines and requests the Government to keep the Office informed of all future developments regarding the implementation and the eventual revision of the guidelines. It also requests the Government to specify whether these policy guidelines were formulated in consultation with employers’ and workers’ organizations concerned, as prescribed by this Article of the Convention.

Article 2, paragraph 2(a), and Article 3. Education and training of nursing personnel. The Committee notes the summary information provided by the Government concerning the role of the Tanzania National Nurses’ Association (TANNA) – formerly known as Tanzania Registered Nurses’ Association (TARENA) – in reviewing study curricula, in training tutors and in monitoring and evaluating nursing schools. It also notes the Government’s reference to the Nursing Service Unit, and the Tanzania Nurses and Midwives Council as forming a collaborative team responsible for ensuring high-quality education for nurses and midwives. It requests the Government to provide a clear description of the entry qualifications and standards for nursing practice as well as the educational programmes currently in place for the various nursing specialty areas.

Article 5, paragraph 1. Consultations with representative organizations of nursing personnel. While noting the Government’s reference to regular meetings between the members of the TANNA central committee and management to discuss, among other issues, pay incentives, leave and other benefits, the Committee requests the Government to provide additional information on the practical results of these meetings (for instance signature of collective agreements) and to transmit copies of any relevant documents.

Article 6. Conditions of employment and work. The Committee requests once more the Government to provide full particulars on the protection afforded to nursing personnel in light of the constraints and hazards inherent in the profession, especially in terms of hours of work and rest periods, paid absence and social security benefits.

Article 7. Occupational safety and health conditions of health workers. The Committee notes the Government’s reference to several measures taken in view of the spread of HIV/AIDS infection, including the urgent hiring of additional personnel to reduce workload, the distribution of protective gear, the development of guidelines to better inform personnel of HIV/AIDS infection risk from injection, post‑exposure prophylactic measures for those injured with sharp objects, and the provision of home support for infected personnel. The Committee would appreciate if the Government would continue supplying information in this regard, including statistics on HIV-infected nursing personnel, the specific measures for their protection from HIV infection and other contagious diseases and the practical results achieved so far.

Part V of the report form. The Committee notes the Government’s indication that at present there is an acute shortage of nursing personnel and also a considerable increase of the workload of those in service because of the HIV/AIDS situation. The Committee would be grateful if the Government would communicate in its next report general information of a practical nature concerning the application of the Convention, including the overall number of registered nurses (if possible broken down by age and sex), the number of nursing schools and the number of students enrolled per year, statistical data on the migration of medical personnel principally for economic reasons, copies of official documents or studies on nursing issues such as activity reports of the Nurses and Midwives Council, information on regional initiatives such as the East, Central and Southern African College of Nursing Professional Regulatory Framework (ECSACON-PRF), etc.

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The Committee notes that the information provided by the Government in its last report relates only to the application of the Convention in Zanzibar and provides no general overview of the situation prevailing in the country with regard to health-care policy and nursing services. The Committee recalls that no report on the application of the Convention in continental Tanzania has been submitted since 1993 and notes with regret that the fragmentary information relating to Zanzibar does not permit a complete assessment of the extent to which the Convention is given effect in national law and practice. The Committee considers that in the interest of maintaining a meaningful dialogue with the supervisory organs of the Organization, the Government should make a genuine effort to collect and transmit all relevant information regarding the employment and working conditions of nursing personnel in both private and public medical institutions. The Committee notes with concern that according to the Government’s reports there seems to be no specific policy at the national level regarding nursing services nor does it appear that the employers’ and workers’ organizations have been consulted in this respect.

Under the circumstances, the Committee asks the Government to prepare for its next session a detailed and fully documented report on the effect given to the main requirements of the Convention both in continental Tanzania and in Zanzibar, particularly as regards: (i) the formulation of a national policy on nursing services designed not only to improve the standards of public health care but also to provide employment and working conditions which are likely to attract persons to the profession and retain them in it. (Article 2(1) and (2)(b)); (ii) measures relating to nursing education and training as may be taken in consultation with representative professional associations such as the Tanzania Registered Nurses’ Association (TARENA) (Article 2(2)(a) and Article 3); (iii) the institutional framework and practical modalities of consultations, if any, with the employers’ and workers’ organizations concerned in matters of nursing policy (Article 2(3) and Article 5(1)); (iv) sufficient protection for nursing personnel, in light of the constraints and hazards inherent in the profession, especially in terms of hours of work and rest periods, paid absence and social security benefits (Article 6); (v) measures to improve the occupational safety and health conditions of health workers, including any specific initiative aimed at protecting nursing personnel from HIV infection (Article 7).

Finally, the Committee requests the Government to provide, in accordance with Part V of the report form, up-to-date information on the practical application of the Convention both in continental Tanzania and in Zanzibar, including for instance statistics on the nurse-to-population ratio, the number of students attending nursing schools and the number of nurses leaving or joining the profession, as well as any difficulties encountered in the application of the Convention (e.g. migration of qualified nurses to neighbouring African countries or to developed countries in Europe and North America, etc.).

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The Committee notes with regret that the Government’s report has not been received. It hopes that a report will be supplied for examination by the Committee at its next session and that it will contain full information on the matters raised in its previous direct request, which read as follows:

Article 1, paragraph 3, of the Convention. The Committee notes from the Government’s report that conditions have been established for the registration of nursing personnel who give care on a voluntary basis (such as: (i) having followed a course that is recognized by the Nurses’ and Midwives’ Council; (ii) producing written documents which show the type of organization or hospital where the nursing care is to be given; (iii) benefiting from authorization to stay at least six months in the country; (iv) paying the registration fee). The Committee hopes that the Government will adopt special provisions to formalize the above conditions in accordance with the requirements of the Convention (training appropriate to the exercise of their functions, Article 2, paragraph 2(a); occupational health and safety measures applicable to voluntary nursing personnel, Article 7).

Article 2, paragraph 2(b). The Committee notes that there are no specific legislative provisions or regulations respecting nursing personnel in the private sector, which in most cases is governed by the provisions relating to working conditions in the public sector. The Committee would be grateful if the Government would supply copies of collective agreements applicable to nursing personnel in the private sector in continental Tanzania and Zanzibar.

Article 2, paragraph 3 read in conjunction with Article 5, paragraph 1. The Committee notes that policy in respect of nursing services has been determined unilaterally and without consultation by the Ministry of Health. However, the Government adds that the Ministry of Health is prepared to collaborate in this respect with the Ministry of Labour. The Committee hopes that this consultation will also be extended to the trade union organizations concerned, in accordance with this provision of the Convention. It requests the Government to provide information on the outcome of these consultations in the public sector, as well as of any consultations organized with nursing personnel in the private sector.

Article 6. The Committee notes Act No. 9 of 1986 respecting nursing personnel in Zanzibar. It requests the Government to supply a copy of any legislative provision or regulation applicable to nursing personnel in continental Tanzania.

Article 7. The Committee notes that there are no occupational health and safety measures specifically applicable to nursing personnel in continental Tanzania. It requests the Government to indicate the measures which have been taken or are envisaged 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. Furthermore, with reference to its general observation of 1990, which was repeated 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 in continental Tanzania the particular risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel: for example, through the arrangement of working conditions, confidentiality of test results, recognition that the cause of infection was occupational, etc.

Part V of the report form. The Committee notes the statistics supplied by the Government in its last report. It hopes that the Government will continue to supply statistics concerning the number of nursing personnel in relation to the population of Zanzibar, and that it will supply data on the number of persons leaving the profession. Please also report any difficulties encountered in practice in the implementation of the Convention.

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The Committee notes with regret that the Government’s report has not been received. It hopes that a report will be supplied for examination by the Committee at its next session and that it will contain full information on the matters raised in its previous direct request, which read as follows:

Article 1, paragraph 3, of the Convention. The Committee notes from the Government’s report that conditions have been established for the registration of nursing personnel who give care on a voluntary basis (such as: (i) having followed a course that is recognized by the Nurses’ and Midwives’ Council; (ii) producing written documents which show the type of organization or hospital where the nursing care is to be given; (iii) benefiting from authorization to stay at least six months in the country; (iv) paying the registration fee). The Committee hopes that the Government will adopt special provisions to formalize the above conditions in accordance with the requirements of the Convention (training appropriate to the exercise of their functions, Article 2, paragraph 2(a); occupational health and safety measures applicable to voluntary nursing personnel, Article 7).

Article 2, paragraph 2(b). The Committee notes that there are no specific legislative provisions or regulations respecting nursing personnel in the private sector, which in most cases is governed by the provisions relating to working conditions in the public sector. The Committee would be grateful if the Government would supply copies of collective agreements applicable to nursing personnel in the private sector in continental Tanzania and Zanzibar.

Article 2, paragraph 3 read in conjunction with Article 5, paragraph 1. The Committee notes that policy in respect of nursing services has been determined unilaterally and without consultation by the Ministry of Health. However, the Government adds that the Ministry of Health is prepared to collaborate in this respect with the Ministry of Labour. The Committee hopes that this consultation will also be extended to the trade union organizations concerned, in accordance with this provision of the Convention. It requests the Government to provide information on the outcome of these consultations in the public sector, as well as of any consultations organized with nursing personnel in the private sector.

Article 6. The Committee notes Act No. 9 of 1986 respecting nursing personnel in Zanzibar. It requests the Government to supply a copy of any legislative provision or regulation applicable to nursing personnel in continental Tanzania.

Article 7. The Committee notes that there are no occupational health and safety measures specifically applicable to nursing personnel in continental Tanzania. It requests the Government to indicate the measures which have been taken or are envisaged 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. Furthermore, with reference to its general observation of 1990, which was repeated 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 in continental Tanzania the particular risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel: for example, through the arrangement of working conditions, confidentiality of test results, recognition that the cause of infection was occupational, etc.

Part V of the report form. The Committee notes the statistics supplied by the Government in its last report. It hopes that the Government will continue to supply statistics concerning the number of nursing personnel in relation to the population of Zanzibar, and that it will supply data on the number of persons leaving the profession. Please also report any difficulties encountered in practice in the implementation of the Convention.

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The Committee notes with regret that the Government’s report has not been received. It hopes that a report will be supplied for examination by the Committee at its next session and that it will contain full information on the matters raised in its previous direct request, which read as follows:

Article 1, paragraph 3, of the Convention. The Committee notes from the Government’s report that conditions have been established for the registration of nursing personnel who give care on a voluntary basis (such as: (i) having followed a course that is recognized by the Nurses’ and Midwives’ Council; (ii) producing written documents which show the type of organization or hospital where the nursing care is to be given; (iii) benefiting from authorization to stay at least six months in the country; (iv) paying the registration fee). The Committee hopes that the Government will adopt special provisions to formalize the above conditions in accordance with the requirements of the Convention (training appropriate to the exercise of their functions, Article 2, paragraph 2(a); occupational health and safety measures applicable to voluntary nursing personnel, Article 7).

Article 2, paragraph 2(b). The Committee notes that there are no specific legislative provisions or regulations respecting nursing personnel in the private sector, which in most cases is governed by the provisions relating to working conditions in the public sector. The Committee would be grateful if the Government would supply copies of collective agreements applicable to nursing personnel in the private sector in continental Tanzania and Zanzibar.

Article 2, paragraph 3 read in conjunction with Article 5, paragraph 1. The Committee notes that policy in respect of nursing services has been determined unilaterally and without consultation by the Ministry of Health. However, the Government adds that the Ministry of Health is prepared to collaborate in this respect with the Ministry of Labour. The Committee hopes that this consultation will also be extended to the trade union organizations concerned, in accordance with this provision of the Convention. It requests the Government to provide information on the outcome of these consultations in the public sector, as well as of any consultations organized with nursing personnel in the private sector.

Article 6. The Committee notes Act No. 9 of 1986 respecting nursing personnel in Zanzibar. It requests the Government to supply a copy of any legislative provision or regulation applicable to nursing personnel in continental Tanzania.

Article 7. The Committee notes that there are no occupational health and safety measures specifically applicable to nursing personnel in continental Tanzania. It requests the Government to indicate the measures which have been taken or are envisaged 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. Furthermore, with reference to its general observation of 1990, which was repeated 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 in continental Tanzania the particular risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel: for example, through the arrangement of working conditions, confidentiality of test results, recognition that the cause of infection was occupational, etc.

Part V of the report form. The Committee notes the statistics supplied by the Government in its last report. It hopes that the Government will continue to supply statistics concerning the number of nursing personnel in relation to the population of Zanzibar, and that it will supply data on the number of persons leaving the profession. Please also report any difficulties encountered in practice in the implementation of the Convention.

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The Committee notes with regret that the Government’s report has not been received. It hopes that a report will be supplied for examination by the Committee at its next session and that it will contain full information on the matters raised in its previous direct request, which read as follows:

Article 1, paragraph 3, of the Convention. The Committee notes from the Government’s report that conditions have been established for the registration of nursing personnel who give care on a voluntary basis (such as: (i) having followed a course that is recognized by the Nurses’ and Midwives’ Council; (ii) producing written documents which show the type of organization or hospital where the nursing care is to be given; (iii) benefiting from authorization to stay at least six months in the country; (iv) paying the registration fee). The Committee hopes that the Government will adopt special provisions to formalize the above conditions in accordance with the requirements of the Convention (training appropriate to the exercise of their functions, Article 2, paragraph 2(a); occupational health and safety measures applicable to voluntary nursing personnel, Article 7).

Article 2, paragraph 2(b). The Committee notes that there are no specific legislative provisions or regulations respecting nursing personnel in the private sector, which in most cases is governed by the provisions relating to working conditions in the public sector. The Committee would be grateful if the Government would supply copies of collective agreements applicable to nursing personnel in the private sector in continental Tanzania and Zanzibar.

Article 2, paragraph 3 (in conjunction with Article 5, paragraph 1). The Committee notes that policy in respect of nursing services has been determined unilaterally and without consultation by the Ministry of Health. However, the Government adds that the Ministry of Health is prepared to collaborate in this respect with the Ministry of Labour. The Committee hopes that this consultation will also be extended to the trade union organizations concerned, in accordance with this provision of the Convention. It requests the Government to provide information on the outcome of these consultations in the public sector, as well as of any consultations organized with nursing personnel in the private sector.

Article 6. The Committee notes Act No. 9 of 1986 respecting nursing personnel in Zanzibar. It requests the Government to supply a copy of any legislative provision or regulation applicable to nursing personnel in continental Tanzania.

Article 7. The Committee notes that there are no occupational health and safety measures specifically applicable to nursing personnel in continental Tanzania. It requests the Government to indicate the measures which have been taken or are envisaged 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. Furthermore, with reference to its general observation of 1990, which was repeated 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 in continental Tanzania the particular risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel: for example, through the arrangement of working conditions, confidentiality of test results, recognition that the cause of infection was occupational, etc.

Part V of the report form. The Committee notes the statistics supplied by the Government in its last report. It hopes that the Government will continue to supply statistics concerning the number of nursing personnel in relation to the population of Zanzibar, and that it will supply data on the number of persons leaving the profession. Please also report any difficulties encountered in practice in the implementation of the Convention.

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The Committee notes with regret that the Government’s report has not been received. It hopes that a report will be supplied for examination by the Committee at its next session and that it will contain full information on the matters raised in its previous direct request, which reads as follows:

Article 1, paragraph 3, of the Convention.  The Committee notes from the Government’s report that conditions have been established for the registration of nursing personnel who give care on a voluntary basis (such as: (i) having followed a course that is recognized by the Nurses’ and Midwives’ Council; (ii) producing written documents which show the type of organization or hospital where the nursing care is to be given; (iii) benefiting from authorization to stay at least six months in the country; (iv) paying the registration fee). The Committee hopes that the Government will adopt special provisions to formalize the above conditions in accordance with the requirements of the Convention (training appropriate to the exercise of their functions, Article 2, paragraph 2(a); occupational health and safety measures applicable to voluntary nursing personnel, Article 7).

Article 2, paragraph 2(b).  The Committee notes that there are no specific legislative provisions or regulations respecting nursing personnel in the private sector, which in most cases is governed by the provisions relating to working conditions in the public sector. The Committee would be grateful if the Government would supply copies of collective agreements applicable to nursing personnel in the private sector in continental Tanzania and Zanzibar.

Article 2, paragraph 3 (in conjunction with Article 5, paragraph 1).  The Committee notes that policy in respect of nursing services has been determined unilaterally and without consultation by the Ministry of Health. However, the Government adds that the Ministry of Health is prepared to collaborate in this respect with the Ministry of Labour. The Committee hopes that this consultation will also be extended to the trade union organizations concerned, in accordance with this provision of the Convention. It requests the Government to provide information on the outcome of these consultations in the public sector, as well as of any consultations organized with nursing personnel in the private sector.

Article 6.  The Committee notes Act No. 9 of 1986 respecting nursing personnel in Zanzibar. It requests the Government to supply a copy of any legislative provision or regulation applicable to nursing personnel in continental Tanzania.

Article 7.  The Committee notes that there are no occupational health and safety measures specifically applicable to nursing personnel in continental Tanzania. It requests the Government to indicate the measures which have been taken or are envisaged 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. Furthermore, with reference to its general observation of 1990, which was repeated 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 in continental Tanzania the particular risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel: for example, through the arrangement of working conditions, confidentiality of test results, recognition that the cause of infection was occupational, etc.

Part V of the report form.  The Committee notes the statistics supplied by the Government in its last report. It hopes that the Government will continue to supply statistics concerning the number of nursing personnel in relation to the population of Zanzibar, and that it will supply data on the number of persons leaving the profession. Please also report any difficulties encountered in practice in the implementation of the Convention.

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The Committee notes that the Government's report has not been received. It hopes that a report will be supplied for examination by the Committee at its next session and that it will contain full information on the matters raised in its previous direct request, which read as follows:

The Committee notes the detailed information supplied by the Government in reply to its previous comments.

Article 1, paragraph 3, of the Convention. The Committee notes from the Government's report that conditions have been established for the registration of nursing personnel who give care on a voluntary basis (such as: (i) having followed a course that is recognized by the Nurses' and Midwives' Council; (ii) producing written documents which show the type of organization or hospital where the nursing care is to be given; (iii) benefiting from authorization to stay at least six months in the country; (iv) paying the registration fee). The Committee hopes that the Government will adopt special provisions to formalize the above conditions in accordance with the requirements of the Convention (training appropriate to the exercise of their functions, Article 2, paragraph 2(a); occupational health and safety measures applicable to voluntary nursing personnel, Article 7).

Article 2, paragraph 2(b). The Committee notes that there are no specific legislative provisions or regulations respecting nursing personnel in the private sector, which in most cases is governed by the provisions relating to working conditions in the public sector. The Committee would be grateful if the Government would supply copies of collective agreements applicable to nursing personnel in the private sector in continental Tanzania and Zanzibar.

Article 2, paragraph 3 (in conjunction with Article 5, paragraph 1). The Committee notes that policy in respect of nursing services has been determined unilaterally and without consultation by the Ministry of Health. However, the Government adds that the Ministry of Health is prepared to collaborate in this respect with the Ministry of Labour. The Committee hopes that this consultation will also be extended to the trade union organizations concerned, in accordance with this provision of the Convention. It requests the Government to provide information on the outcome of these consultations in the public sector, as well as of any consultations organized with nursing personnel in the private sector.

Article 6. The Committee notes Act No. 9 of 1986 respecting nursing personnel in Zanzibar. It requests the Government to supply a copy of any legislative provision or regulation applicable to nursing personnel in continental Tanzania.

Article 7. The Committee notes that there are no occupational health and safety measures specifically applicable to nursing personnel in continental Tanzania. It requests the Government to indicate the measures which have been taken or are envisaged 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. Furthermore, with reference to its general observation of 1990, which was repeated 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 in continental Tanzania the particular risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel: for example, through the arrangement of working conditions, confidentiality of test results, recognition that the cause of infection was occupational, etc.

Part V of the report form. The Committee notes the statistics supplied by the Government in its last report. It hopes that the Government will continue to supply statistics concerning the number of nursing personnel in relation to the population of Zanzibar, and that it will supply data on the number of persons leaving the profession. Please also report any difficulties encountered in practice in the implementation of the Convention.

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The Committee notes the detailed information supplied by the Government in reply to its previous comments.

Article 1, paragraph 3, of the Convention. The Committee notes from the Government's report that conditions have been established for the registration of nursing personnel who give care on a voluntary basis (such as: (i) having followed a course that is recognized by the Nurses' and Midwives' Council; (ii) producing written documents which show the type of organization or hospital where the nursing care is to be given; (iii) benefiting from authorization to stay at least six months in the country; (iv) paying the registration fee). The Committee hopes that the Government will adopt special provisions to formalize the above conditions in accordance with the requirements of the Convention (training appropriate to the exercise of their functions, Article 2, paragraph 2(a); occupational health and safety measures applicable to voluntary nursing personnel, Article 7).

Article 2, paragraph 2(b). The Committee notes that there are no specific legislative provisions or regulations respecting nursing personnel in the private sector, which in most cases is governed by the provisions relating to working conditions in the public sector. The Committee would be grateful if the Government would supply copies of collective agreements applicable to nursing personnel in the private sector in continental Tanzania and Zanzibar.

Article 2, paragraph 3, (in conjunction with Article 5, paragraph 1). The Committee notes that policy in respect of nursing services has been determined unilaterally and without consultation by the Ministry of Health. However, the Government adds that the Ministry of Health is prepared to collaborate in this respect with the Ministry of Labour. The Committee hopes that this consultation will also be extended to the trade union organizations concerned, in accordance with this provision of the Convention. It requests the Government to provide information on the outcome of these consultations in the public sector, as well as of any consultations organized with nursing personnel in the private sector.

Article 6. The Committee notes Act No. 9 of 1986 respecting nursing personnel in Zanzibar. It requests the Government to supply a copy of any legislative provision or regulation applicable to nursing personnel in continental Tanzania.

Article 7. The Committee notes that there are no occupational health and safety measures specifically applicable to nursing personnel in continental Tanzania. It requests the Government to indicate the measures which have been taken or are envisaged 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. Furthermore, with reference to its general observation of 1990, which was repeated 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 in continental Tanzania the particular risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel: for example, through the arrangement of working conditions, confidentiality of test results, recognition that the cause of infection was occupational, etc.

Point V of the report form. The Committee notes the statistics supplied by the Government in its last report. It hopes that the Government will continue to supply statistics concerning the number of nursing personnel in relation to the population of Zanzibar, and that it will supply data on the number of persons leaving the profession. Please also report any difficulties encountered in practice in the implementation of the Convention.

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The Committee notes the information and copies of the legislation supplied in the Government's report in reply to its previous comments. It requests the Government to furnish further information on the following provisions of the Convention:

Article 1, paragraph 3, of the Convention. According to the report, no use is made of the services of voluntary nursing personnel in Zanzibar and hence no special rules have been established concerning such staff. The Committee would appreciate receiving information on whether there are voluntary nursing personnel in mainland Tanzania, and if so whether any special rules have been adopted concerning them.

Article 2. The Committee notes the information communicated by the Government on nursing policies in mainland Tanzania and in Zanzibar. It requests the Government to supply copies of the Acts governing the Government's policy in respect of all services provided in public and private hospitals. Please furnish any available information on the nature of consultations carried out in this respect between the Government, the Nurses and Midwives Council and the trade unions concerned.

Article 2, paragraph 2(b). The Committee notes the information concerning the working conditions of nursing personnel employed in the public sector in Zanzibar. The Committee requests the Government to provide information on the working conditions, including career prospects and remuneration of nursing personnel, in the private sector. Please supply copies of the legislative provisions regulating employment and working conditions of the nursing personnel both in the public and private sector, in Zanzibar as well as in mainland Tanzania.

Article 5, paragraph 1. Please supply more detailed information on the participation of nursing personnel in the planning of nursing services and the consultation with such personnel on decisions concerning them at all levels, especially in hospitals or health centres, in both the private and public sectors.

Article 5, paragraph 2. The Committee notes the statement in the report that the determination of conditions of employment and work in Zanzibar is ensured through discussions with nursing personnel. Please indicate whether such consultations are provided for in any legal text, and if so, please supply a copy of it. Please indicate also how the conditions of work of nursing personnel are determined in mainland Tanzania, and provide copies of rules or regulations or collective agreements fixing these conditions.

Article 5, paragraph 3. The Committee notes the information concerning mainland Tanzania on the subject of individual disputes. It would appreciate receiving information on the methods used for settling collective disputes. The Committee notes that the settlement of disputes arising in connection with termination of terms and conditions of employment of nursing personnel in Zanzibar is sought through negotiation with the National Workers' Organisation (JUWATA) and through discussion meetings and agreements. It requests the Government to supply additional information on the settlement of such disputes as concern nursing personnel. The Committee notes that the report states that a procedure other than negotiation was established by the Government of Zanzibar; please provide information on this procedure.

Article 6. The Committee notes the information supplied in the reports relating to conditions of work for nursing personnel in mainland Tanzania and in Zanzibar. It requests the Government to supply copies of the legislative provisions regulating each of the subjects covered in this Article, in so far as they may differ from the provisions applicable to all workers. It appears from the information in the report that conditions of work for nursing personnel are different in mainland Tanzania and in Zanzibar.

Article 7. The Committee notes the information relating to an occupational health nurse, who is responsible in Zanzibar for laying down occupational health rules and for advising the Minister on their implementation. Please indicate whether similar provisions have been put into place in mainland Tanzania. The Committee also requests the Government to supply more detailed information on the activities of this nurse, especially in respect of the adapting of existing laws and regulations to the special nature of nursing work. The Committee also hopes that the Government will indicate the necessary measures taken both in mainland Tanzania and in Zanzibar to apply the existing health and safety regulations to nursing personnel, and to adapt those regulations to the special nature of nursing work, inter alia, to protect nursing personnel against occupational exposure to the AIDS virus.

Point V of the report form. The Committee notes the information and statistics supplied on nursing personnel in Zanzibar. It requests the Government to continue to provide such information both in respect of Zanzibar and mainland Tanzania. Please indicate in particular the distribution of nursing personnel between the public and private sectors, the number of persons entering and leaving the profession, the number of nursing personnel in relation to population, and the number of patients and of other workers in the health field, in accordance with this point of the report form.

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The Committee notes that the Government's report has not been received. It hopes that a report will be supplied for examination by the Committee at its next session and that it will contain full information on the following matters raised in its previous direct request:

Articles 3 and 4 of the Convention. Please supply copies of the Nursing Ordinance of 1952 and of any other text respecting the responsibilities of the Nurses and Midwives Council. Please also supply a copy of the text in which the national policy on the type of health care to be provided to the nation is set out, and to which the Government referred in its previous report.

Article 5, paragraph 2. Please indicate how effect is given to this provision of the Convention for both nursing personnel in the private sector and nursing personnel in the public sector.

Article 5, paragraph 3. Please supply copies of the provisions that apply to the settlement of disputes for both nursing personnel employed in the private sector and nursing personnel employed in the public sector.

Article 6. Please supply copies of the legal provisions or regulations and/or collective agreements that determine the terms and conditions of employment of nursing personnel in the fields covered by paragraphs (a) to (g) of this Article and indicate the extent to which these conditions are comparable with those established for other workers in general.

Article 7. Please indicate the measures that have been taken to give effect to this Article.

Point V of the report form. Please supply the information requested under this point of the report form regarding the manner in which effect is given to the Convention in practice.