Nursing Personnel Convention, 1977 (No. 149) - Zambia (RATIFICATION: 1980)

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Articles 2 and 5 of the Convention. National policy concerning nursing services and personnel. Consultations. The Committee takes note of the data provided in the 2017 Annual Report of the General Nursing Council of Zambia (hereinafter the GNC) but notes the Government’s indication that much of the information requested by the Committee was not yet available at the time of submission of the report. The Committee notes that, as at 31 December 2017, a total of 36,683 nurses and midwives were registered with the GNC, distributed across the different professional nursing categories. In addition, a total of 20,817 nurses and midwives renewed their annual practising licenses. The Government also indicates that in 2017, the GNC issued a total of 60 verifications for nurses and midwives seeking registration and employment abroad, an increase from 44 in 2016. In the first quarter of 2018, the GNC issued 26 verifications. The Committee notes the Government’s indication that most nurses and midwives seeking verification from the GNC are in search of better salaries and working conditions as well as opportunities for advanced education. The Government clarifies that the GNC cannot specify the number of nurses and midwives who have migrated abroad, since not all foreign employers require verification. Moreover, not all nurses and midwives who seek verification go on to leave the country. The Committee nevertheless recalls its 2013 direct request, in which it noted that the dire health worker shortage – principally due to brain drain, but also to internal migration – represents an ongoing challenge for the Ministry of Health. In this regard, the Committee notes that the National Health Policy (2017–20) refers to critical shortages of health workers, which lead to abnormal staff to patient ratios, as well as to an inequitable distribution of available health workers, particularly in the rural areas, which experience difficulties in attracting and retaining qualified health workers. It further notes the new National Human Resources for Health Strategic Plan 2018–24, which refers to the longstanding severe shortage of human capital in the health system and notes that Zambia will need to almost double its health workforce by 2025 to adequately serve its population. The strategic priorities contained in the Strategy include strengthening retention and motivation systems and improving work environments. The Committee requests the Government to provide up-to-date information on the measures taken or envisaged to implement the new National Human Resources for Health Strategic Plan 2018–24 and the results achieved. The Committee further requests the Government to indicate the measures taken with a view to containing or reversing the migration of nurses and midwives, particularly measures to strengthen education and lifelong learning systems, create additional full-time jobs and improve working conditions, including career prospects and remuneration, with a view to attracting men and women to the profession and retaining them in it. In addition, the Committee requests the Government to indicate the manner in which the participation of nursing personnel in the planning of nursing services and consultations with such personnel on decisions concerning them are ensured, as required under the Convention.

Part V of the report form. Application in practice. The Committee requests the Government to provide detailed information, disaggregated by age, sex and region, concerning the situation of nursing personnel in the country, including the numbers of nursing personnel by sectors of activity, levels of training and functions and their ratio to the population, as well as the number of those who leave the profession each year.

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Article 2(2) of the Convention. National policy concerning nursing services and personnel. The Committee notes the Government’s reference to the latest National Human Resources for Health Strategic Plan (2011–15) which, among other issues, outlines specific strategies to contain migration of health-care workers. The Committee also notes the Government’s reference to the Zambian Health Workers Retention Scheme (ZHWRS), which was initiated to attract health-care personnel (doctors and, as from 2007, also nurses, laboratory technicians and midwives) to work in rural and remote areas mainly through various financial incentives. The award payments of the ZHWRS range from 30 to 75 per cent of the health-care worker’s basic salary per year based on the remoteness of the health facility in which the worker is placed, while workers on the ZHWRS who successfully complete the three-year contract are awarded a bonus payment of an amount nine times their monthly allowance. The Committee understands, however, that despite this effort the critical shortage of health workers remains a source of grave concern for public authorities. According to recent studies, there is currently a shortage of 27,000 health workers, including 10,387 registered nurses, while the staff-to-population ratio is one nurse per 1,800 people, well below the country’s desired minimum of one health worker per 400 people. Noting that the dire health worker shortage – principally due to external brain drain but also internal migration – is an ongoing challenge to the Ministry of Health, the Committee requests the Government to continue to provide up-to-date information on the implementation of the strategic plan for human resources for health, in particular, as regards efforts to address the health worker shortage and the results achieved.

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Article 2, paragraph 2, of the Convention. National policy concerning nursing services and nursing personnel. The Committee understands that the Government faces a severe shortage of qualified nurses principally due to the massive migration of health workers to foreign countries. According to data published by the Zambian Nursing Council, in the period 1993–2005, 3,500 nurses among the country’s overall 9,000-nurse workforce filled out the documents necessary to work abroad. In 2005, Zambia was reported to be losing 25 nurses per month due to the brain drain. The Committee also understands that in response to this crisis, the Government has developed a Human Resources for Health Strategic Plan 2006–10 aiming at ensuring quality health services through a well-motivated, committed and skilled professional workforce. Key measures of this strategic plan include the recruitment of over 51,000 health workers, the reopening of all nursing schools that had once been closed because of a shortage of tutors, and a retention scheme comprising a package of different incentives. The Committee requests the Government to provide detailed information on the formulation and implementation of any action plan, campaign or initiative designed to contain nurse migration and the results achieved so far. It also requests the Government to indicate how it is ensured that employers’ and workers’ organizations are fully and effectively consulted in the formulation of the national policy concerning nursing services and nursing personnel, as required under this Article of the Convention.

Moreover, the Committee wishes to refer to the commonwealth code of practice for the international recruitment of health workers and its companion document, adopted in 2003. In particular, it notes that the code provides that the international recruitment of health workers must be transparent and fair as regards its process, and that the right of health workers to migrate must not be undermined. At the same time, such recruitment must be mutually beneficial to both recruiting and source countries considering the difference in the capacities of these countries, which may be addressed through technical assistance. In the same vein, the Committee notes the draft WHO code of practice on the international recruitment of health personnel, currently under consideration, which urges member States to enter into bilateral and multilateral arrangements to promote cooperation and coordination on migrant health personnel recruitment processes in order to maximize the benefits and mitigate the potential negative impact of international recruitment of health personnel, and also calls for measures in order to retain and sustain a skilled domestic health workforce by improving their social and economic status, their living and working conditions, their opportunities for employment and their career prospects.

Article 6. Working conditions of nursing personnel. The Committee has been requesting the Government for a number of years to specify the legislative or other instruments regulating the conditions of service of nursing personnel both in the public and private sector and to transmit copies of all relevant texts. The Government has so far provided fragmented information referring in earlier reports to general orders applicable to all civil servants and in others to collective agreements negotiated with the Health and Allied Workers Union. As regards the private sector, the Government has referred to ten joint council collective agreements (none of which appears to cover health services and nursing personnel) and two statutory instruments, Nos 126 and 127 of 1992, covering workers who are not represented by any trade union (nursing personnel does not appear to fall within the scope of application of either instrument). Moreover, the Committee notes that the collective agreement of 25 April 2008 concluded between the Government and the Health Workers Union of Zambia (HWUZ) principally deals with salary scales, various allowances and maternity leave but contains no provisions on hours of work and rest, overtime pay, annual paid leave, sick leave or social security. In light of the foregoing, the Committee would appreciate if the Government would provide in its next report comprehensive information, including copies of any legal texts not previously communicated, regarding the laws and regulations or other documents such as collective agreements which ensure that nursing personnel in both the public and private sector enjoy conditions at least equivalent to those of other workers with respect to working time, weekly rest, annual holidays with pay, educational leave, maternity and sick leave, and social security, as prescribed by this Article of the Convention.

Article 7. Occupational safety and health of nursing personnel. The Committee notes the Government’s indication that Factories Act (Cap. 441) is being reviewed with a view to extending its scope and covering all workers and workplaces in the country, including hospitals, clinics and any other workplaces employing nursing personnel. It also notes that a number of health-care institutions have put in place in-house measures to ensure the safety and health of nurses. The Committee requests the Government to keep the Office informed of the revision process of the Factories Act and to transmit more detailed information on the occupational health and safety measures implemented by specific hospitals and clinics or relevant initiatives undertaken by the Nurses Association.

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. Recalling that the Government has last communicated general information on the practical application of the Convention in 1994, the Committee would be grateful if the Government would supply up to date information in this respect, including for instance, statistics on the number of nurses entering and leaving the profession per year, the nurse–population ratio, copies of official reports or studies addressing nursing-related issues (e.g. activity reports of the General Nursing Council established under the Nurses and Midwives Act of 1997), any practical difficulties encountered in applying the Convention, etc.

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The Committee notes the Government’s succinct report and regrets that it does not contain concrete answers to the points raised in the Committee’s previous direct request. It hopes that the Government’s next report will provide detailed information relating to the application of Articles 6 (conditions equivalent to the other workers for working time, weekly rest and educational leave) and 7 (provisions concerning occupational health and safety), of the Convention.

In addition, the Committee requests the Government to provide copies of the collective agreements relating to nursing personnel in different branches of industry, as well as of the collective agreement referred to in its report. The Committee also repeats its request for information on the provisions of the Statutory Instruments Nos. 126 and 127 relating to weekly rest and educational leave of the nursing personnel.

Point V of the report form. The Committee requests the Government to provide information on the possible difficulties encountered in the implementation of the Convention or any further information that would enable the Committee to evaluate the manner in which the Convention is applied in practice in the country.

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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 6(a), (b) and (d) of the Convention. Further to its previous comments the Committee notes that the Government has not mentioned in its last report the legal provisions governing weekly hours of work for nursing personnel in the civil service. It is therefore bound to request once more to the Government to provide more details on the abovementioned legislation and to supply the Office with a copy of the relevant text.

The Committee observes that with the report for the period ending 30 June 1993, the Government only enclosed text of legislation intended for those who are not effectively represented by any trade union. The Committee recalls that in its previous comments it requested the Government to provide samples of the agreements related to nursing personnel in the branches of industry. The Committee hopes that the Government will provide samples of these agreements.

In addition, the Committee notes that the Government’s report does not reply to its previous comments requesting information on the provisions of the Statutory Instruments Nos. 126 and 127 which subject nursing personnel to the scope of application of these instruments and which provide that weekly rest and educational leave are to be granted. The Committee trusts that the Government will supply the requested information with its next report.

Article 7. The Committee takes note of the indication of the Government that nursing personnel are subjected to medical check-ups only on first appointment and during confirmation and that examination to detect the AIDS virus is done on a voluntary basis. The Committee notes also that consultations have been initiated with the Ministry of Health concerning measures to be taken to adapt national legislation on health and safety at work to the particular risk of accidental exposure to human immunodeficiency virus (HIV). It requests the Government to report on any progress achieved in this respect.

Part V of the report form. The Committee hopes that the Government will provide information on any practical difficulties encountered 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 6(a), (b) and (d) of the Convention. Further to its previous comments the Committee notes that the Government has not mentioned in its last report the legal provisions governing weekly hours of work for nursing personnel in the civil service. It is therefore bound to request once more to the Government to provide more details on the abovementioned legislation and to supply the Office with a copy of the relevant text.

The Committee observes that with the report for the period ending 30 June 1993, the Government only enclosed text of legislation intended for those who are not effectively represented by any trade union. The Committee recalls that in its previous comments it requested the Government to provide samples of the agreements related to nursing personnel in the branches of industry. The Committee hopes that the Government will provide samples of these agreements.

In addition, the Committee notes that the Government’s report does not reply to its previous comments requesting information on the provisions of the Statutory Instruments Nos. 126 and 127 which subject nursing personnel to the scope of application of these instruments and which provide that weekly rest and educational leave are to be granted. The Committee trusts that the Government will supply the requested information with its next report.

Article 7. The Committee takes note of the indication of the Government that nursing personnel are subjected to medical check-ups only on first appointment and during confirmation and that examination to detect the aids virus is done on a voluntary basis. The Committee notes also that consultations have been initiated with the Ministry of Health concerning measures to be taken to adapt national legislation on health and safety at work to the particular risk of accidental exposure to human immunodeficiency virus (HIV). It requests the Government to report on any progress achieved in this respect.

Part V of the report form. The Committee hopes that the Government will provide information on any practical difficulties encountered 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:

Article 6(a), (b) and (d) of the Convention. Further to its previous comments the Committee notes that the Government has not mentioned in its last report the legal provisions governing weekly hours of work for nursing personnel in the civil service. It is therefore bound to request once more to the Government to provide more details on the abovementioned legislation and to supply the Office with a copy of the relevant text.

The Committee observes that with the report for the period ending 30 June 1993, the Government only enclosed text of legislation intended for those who are not effectively represented by any trade union. The Committee recalls that in its previous comments it requested the Government to provide samples of the agreements related to nursing personnel in the branches of industry. The Committee hopes that the Government will provide samples of these agreements.

In addition, the Committee notes that the Government’s report does not reply to its previous comments requesting information on the provisions of the Statutory Instruments Nos. 126 and 127 which subject nursing personnel to the scope of application of these instruments and which provide that weekly rest and educational leave are to be granted. The Committee trusts that the Government will supply the requested information with its next report.

Article 7. The Committee takes note of the indication of the Government that nursing personnel are subjected to medical check-ups only on first appointment and during confirmation and that examination to detect the aids virus is done on a voluntary basis. The Committee notes also that consultations have been initiated with the Ministry of Health concerning measures to be taken to adapt national legislation on health and safety at work to the particular risk of accidental exposure to human immunodeficiency virus (HIV). It requests the Government to report on any progress achieved in this respect.

Part V of the report form. The Committee hopes that the Government will provide information on any practical difficulties encountered in the implementation of the Convention.

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Article 6(a), (b) and (d) of the Convention. Further to its previous comments the Committee notes that the Government has not mentioned in its last report the legal provisions governing weekly hours of work for nursing personnel in the civil service. It is therefore bound to request once more to the Government to provide more details on the abovementioned legislation and to supply the Office with a copy of the relevant text.

The Committee observes that with the report for the period ending 30 June 1993, the Government only enclosed text of legislation intended for those who are not effectively represented by any trade union. The Committee recalls that in its previous comments it requested the Government to provide samples of the agreements related to nursing personnel in the branches of industry. The Committee hopes that the Government will provide samples of these agreements.

In addition, the Committee notes that the Government's report does not reply to its previous comments requesting information on the provisions of the Statutory Instruments Nos. 126 and 127 which subject nursing personnel to the scope of application of these instruments and which provide that weekly rest and educational leave are to be granted. The Committee trusts that the Government will supply the requested information with its next report.

Article 7. The Committee takes note of the indication of the Government that nursing personnel are subjected to medical check-ups only on first appointment and during confirmation and that examination to detect the aids virus is done on a voluntary basis. The Committee notes also that consultations have been initiated with the Ministry of Health concerning measures to be taken to adapt national legislation on health and safety at work to the particular risk of accidental exposure to human immunodeficiency virus (HIV). It requests the Government to report on any progress achieved in this respect.

Part V of the report form. The Committee hopes that the Government will provide information on any practical difficulties encountered in the implementation of the Convention.

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The Committee notes the information in the government report.

Article 6 (a), (b) and (d) of the Convention. The Committee notes the remuneration scales in Personnel Division Circular No. B.14 of 1988, to implement revised salaries/wages and conditions of service. It once again invites the Government to indicate the legal provisions governing weekly hours of work for nursing personnel in the civil service.

The Committee notes that under the ten Joint Council Collective Agreements in force, nursing personnel in the branches of industry covered by these agreements enjoy the same conditions as the other workers, and that hours of work under these agreements range from 40 to 48 hours per week. The Committee once again requests the Government to provide samples of these agreements.

The Committee also takes note of Statutory Instrument No. 126, to cover nursing personnel which does not work in the civil service or falls under the Joint Council Collective Agreements, and Statutory Instrument No. 127 of 1992 which is also to cover nursing personnel working in private surgeries. The Committee would be grateful if the Government could indicate the provisions of these instruments which subject nursing personnel to the scope of application of these instruments. Furthermore, it asks the Government to indicate under which provisions weekly rest and educational leave are to be granted.

Article 7. The Committee notes that nursing personnel is subject to periodical medical check-ups including an examination to detect the AIDS virus. The Committee would appreciate receiving more detailed information on this point, taking into account the questions set out in its General Observation on this issue.

The Commmittee notes the information provided under point V of the report form. It would be grateful if the Government would continue to provide this kind of information, including that concerning any difficulties encountered in the implementation of the Convention.

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Article 1, paragraph 3, of the Convention. With reference to its previous comments, the Committee notes from the Government's reply that voluntary nursing personnel work only on specific development projects, and that the nurses have normal nursing training and have to meet the requirements prescribed in job descriptions for such posts. Their working and employment conditions are covered by employment contracts and their monthly living allowances are agreed between the Government supplying such voluntary staff and the Government of Zambia.

The Committee notes the information supplied by the Government on the application of Article 5, paragraph 3, of the Convention.

Article 6(a), (b) and (d). The Committee notes the detailed information provided by the Government on shift work, overtime and inconvenient hours, weekly rest and educational leave. It also notes that the administrative regulations prescribing 40 hours work per week for the civil service are applicable to nursing personnel in the public service. The Government is therefore invited to indicate the legal texts governing these matters, and a copy of the 1988 collective agreement concluded between the Government and the four civil servants' organisations. Please supply also copies of relevant collective agreements covering, in particular, the conditions of work of nursing personnel in the private sector as set out in paragraphs (a) hours of work; (b) weekly rest; and (d) educational leave.

Article 7. The Committee notes that there have been no developments relating to this Article. It hopes nevertheless that appropriate measures will be taken to improve and adjust existing laws and regulations on occupational health and safety to ensure the effective protection of nursing personnel, inter alia, against risk of accidental exposure to the AIDS virus.

The Committee notes the information provided under point V of the report form. It would be grateful if the Government would continue to provide this kind of information.

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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:

Article 1, paragraph 3, of the Convention. Please supply copies of the special agreements entered into between the Government and agencies employing nursing personnel who give nursing care and services on a voluntary basis.

Article 5, paragraph 3. The Committee noted the statement in the previous report that collective agreements covering the civil service including nursing personnel have been reviewed by the Government from time to time, and that no dispute has occurred between nursing personnel and employers necessitating dispute resolution procedures. Please indicate the procedures which would apply should such a dispute arise.

Article 6. 1. Please supply the administrative regulations in force regarding nursing personnel in the public service covering hours of work, including regulation and compensation for overtime, inconvenient hours and shift work (paragraph (a)); weekly rest (paragraph (b)); and educational leave (paragraph (d)).

2. Please also supply relevant collective agreements relating to nursing personnel in the private sector, particularly with respect to conditions set out in paragraphs (a), (b) and (d) of the Article.

Article 7. The Committee requests the Government to keep it informed of any developments on measures taken or 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, as provided for in the above provision of the Convention.

Point V of the report form. The Committee has noted the statistical data in the previous report on the distribution of nurses by category throughout the country. It would be grateful if the Government would include in its next report statistics on the numbers of nursing personnel in relation to population, the number of patients and other health workers; data on the number of persons leaving the nursing profession, and a general appreciation of the manner in which the Convention is applied in the country, including any practical difficulties encountered.