Sickness Insurance (Industry) Convention, 1927 (No. 24) - Djibouti (RATIFICATION: 1978)

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The Committee notes with deep concern that the Government’s reports, due since 2018, have not been received. In light of the urgent appeal launched to the Government in 2020, the Committee is proceeding with the examination of the application of the Convention on the basis of the information at its disposal.

In order to provide a comprehensive view of the issues relating to the application of the ratified Conventions on social security, the Committee considers it appropriate to examine Conventions Nos 19 (equality of treatment, industrial accidents), 24 (sickness insurance, industry), 37 (invalidity insurance, industry), and 38 (invalidity insurance, agriculture) together.

Article 1(1) and (2) of Convention No. 19. Equality of treatment in relation to compensation for industrial accidents. In its previous comments, the Committee noted that since the Convention was ratified in 1978, it has been drawing the Government’s attention to the need to amend section 29 of Decree No. 57-245 of 1957 concerning compensation for industrial accidents and occupational diseases. This provision sets out that foreign workers injured in industrial accidents who are no longer resident in the country receive a lump sum payment instead of a periodic payment, while nationals are not subject to the same condition of residence in order to obtain a periodic payment as compensation for an industrial accident. In the absence of new information in this regard, the Committee once again requests the Government to take the necessary measures, without delay, to grant to the nationals of any other Member having ratified the Convention, who suffer personal injury due to industrial accidents happening in its territory, or to their dependents, the same treatment in respect of worker’s compensation as it grants to its own nationals, as provided for under Article 1(1) of the Convention. The Committee particularly requests the Government to proceed with the formal amendment or repeal of section 29 of Decree No. 57-245 so as to ensure equality of treatment to foreign workers and their dependents without conditions of residence, in accordance with the terms of Article 1(2) of the Convention.

Articles 1, 3 and 6 of Convention No. 24. Setting up a system of compulsory sickness insurance. Sickness benefits. In its previous comments, the Committee requested the Government to provide information on the introduction of a universal sickness insurance within the framework of the reform of the system of social protection announced by the Government in 2008. It also expressed the hope that this new insurance system would cover the payment of sickness benefits to insured persons, which were currently covered by employers, contrary to the terms of Articles 1 and 3 of the Convention. While reiterating its concern at the absence of a Government report, the Committee takes due note that Act No. 24/AN/14/7th L of 5 February 2014 establishes a universal sickness insurance system (AMU) and that Decree No. 2014-156/PR/NITRA of 21 June 2014 issues the establishment of the Universal Health Insurance Solidarity Fund. The Committee specifically notes that universal sickness insurance covers basic healthcare for the entire population living in the territory (section 2 of Act No. 24/AN/14/7th L), by “covering the costs of the services provided by the contractual providers” (section 4) in addition to the benefits covered by the compulsory sickness insurance system provided for workers and other protected groups. Nevertheless, the Committee notes that cash benefits are not covered by the above Act and that, according to the information contained in Social Security Programs Throughout the World: Africa, 2019 of the International Social Security Association (ISSA), they remain the responsibility of the employer. The Committee recalls that under Article 3 of the Convention, read in conjunction with Article 1, sickness benefits payable to an insured person unable to work by reason of the abnormal state of his or her bodily or mental health, must be financed from a system of compulsory sickness insurance and shall not be borne directly by the employer. Further, in accordance with Article 6 of the Convention, this system, must be administered by self-governing institutions, which shall be under the administrative and financial supervision of the competent public authorities or private institutions specially approved by the competent public authority.

In the light of the foregoing, the Committee requests the Government to take the necessary measures, without further delay, to give effect to Articles 3 and 6 of the Convention by establishing compulsory insurance, under the supervision of the State, for the payment of sickness benefits to workers protected by the Convention. In addition, the Committee requests the Government to provide detailed information on the manner in which Act No. 24/AN/14/7th L and Decree No. 2014-156/PR/NITRA, as well as other legislation subsequently adopted in relation to the universal sickness insurance and the Universal Health Insurance Solidarity Fund, give effect to the Convention. The Committee also requests the Government, if current statistics allow, to provide information on the healthcare provided by the universal sickness insurance and the compulsory sickness insurance systems.

Articles 1, 4, and 5(2), of Conventions Nos 37 and 38. Establishment of a compulsory invalidity insurance system for workers generally incapacitated for work. Conditions for entitlement to a pension. In its previous comments, the Committee noted the absence of a specific branch relating to invalidity benefits within the national social security system and requested the Government to establish an invalidity insurance scheme in order to give effect to Conventions Nos 37 and 38, which required the institution of compulsory invalidity insurance. The Committee further noted that, under Act No. 154/AN/02/4th-L of 31 January 2002 codifying the operation of the Social Protection Institute and the general retirement scheme for salaried employees, workers aged 50 years and over who are affected by a permanent physical or mental impairment, were only entitled to claim an early retirement pension when they had accrued a minimum of 240 contribution months (section 60 ff). In this regard, the Committee emphasized that the fixing of a minimum age at which a person can receive invalidity benefit was in breach of Article 4 of Conventions Nos 37 and 38, which do not permit the right to invalidity benefits to be conditional upon reaching a specific age, although a qualifying period not exceeding 60 contribution months may be imposed under Article 5 of the above Conventions. In the light of the foregoing, and in the absence of information on any measures that may have been taken by the Government to remedy the gaps in implementation noted above, the Committee requests the Government to take all necessary measures, without further delay, to give full effect to Conventions Nos 37 and 38 by establishing a compulsory invalidity insurance system or introducing invalidity benefits within its national social insurance system, guaranteeing the right of workers covered by the Conventions to such benefits under conditions at least equivalent to those set out in Articles 1, 4 and 5 of the Conventions.

Application of the Conventions in practice. Implementation of the national social protection strategy. While reiterating its concern at the absence of a Government report, the Committee takes due note of the adoption of the National Social Protection Strategy (SNPS) 2018–2022 of the Republic of Djibouti, established by Act No. 043/AN/19/8th L of 23 June 2019, as the national reference document for all regulations on social protection (section 2). In particular, the Committee notes that some of the priority pillars set out therein relate to matters covered by the social security Conventions ratified by Djibouti, as do the objectives laid out, which are aligned to some extent with the objectives of the relevant Conventions. Thus, the first pillar of the SNPS aims to guarantee the right to food security, while the second pillar provides for income guarantee for children to improve nutrition and health. With respect to invalidity, the aim of the third pillar is to ensure an income for older persons and those who are unable to work because of disability. The overall objective of the fourth pillar of the SNPS is to guarantee minimum income support for people of working age who are unable to earn an adequate income owing to life accidents and covers outcome 3.1, which aims to guarantee a minimum income for life to those who have a permanent physical disability that prevents them from returning to paid work, including those who have suffered an industrial accident or have an occupational disease. The Committee also observes the multiple references to the ILO Social Protection Floors Recommendation, 2012 (No. 202) in the SNPS, as a reference standard for the implementation of a national social protection floor, according to the above objectives, pillars and targets, in addition to the basic guarantees contained in Recommendation No. 202 with supplementary social protection programmes. The Committee welcomes the adoption of the SNPS 2018 – 2022 and hopes that its implementation will contribute to strengthening the application of the social security Conventions ratified by Djibouti. The Committee requests the Government to keep it informed of any measures adopted or envisaged in this regard.

The Committee has been informed that, based on the recommendations of the Standards Review Mechanism Tripartite Working Group (SRM Tripartite Working Group), the Governing Body has decided that Member States for which Convention No. 24 is in force should be encouraged to ratify the most recent Medical Care and Sickness Benefits Convention, 1969 (No. 130) or the Social Security (Minimum Standards) Convention, 1952 (No. 102), accepting Parts II and III of this instrument (see GB.328/LILS/2/1). The Member States for which Conventions Nos 37 and 38 are in force should be encouraged to ratify the Invalidity, Old-Age and Survivors’ Benefits Convention, 1967 (No. 128), accepting its Part II, or Convention No. 102, accepting its Part IX. Conventions Nos 102 (Parts II and III) and 130 reflect the more modern approach to medical care and sickness benefits, while Conventions Nos 102 (Parts IX) and 128 (Part II) reflect the more modern approach to invalidity benefits. The Committee therefore encourages the Government to follow up the Governing Body’s decision at its 328th Session (October–November 2016) approving the recommendations of the SRM Tripartite Working Group, and to consider ratifying Convention No. 128 (accepting Part II), Convention No. 130 and/or Convention No. 102 (accepting Parts II and III, as well as IX), which are the most up-to-date instruments in these subject areas.

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The Committee notes with deep concern that the Government’s report has not been received. It is therefore bound to repeat its previous comments. The Committee informs the Government that, if it has not supplied replies to the points raised by 1 September 2021, then it may proceed with the examination of the application of the Convention on the basis of the information at its disposal at its next session.

Repetition

Article 1 of the Convention. Setting up a system of compulsory sickness insurance. The Committee notes that Act No. 212/AN/07/5ème-L establishing the National Social Security Fund (CNSS) provides that new complementary social instruments such as sickness insurance will be instituted by means of regulations (section 5 of the Act). It also notes the adoption of Act No. 199/AN/13/6ème-L of 20 February 2013 extending treatment coverage to self-employed workers and of Decree No. 2013-055/PR/MTRA of 11 April 2013 establishing CNSS registration procedures and contributions for self-employed workers. The Government states that these items of legislation are the precursor to establishing a universal sickness insurance system in Djibouti in the near future. The Committee hopes that once this insurance system is established it will cover the payment of sickness benefits to insured persons, which are currently covered by employers, contrary to the terms of the Convention. It requests the Government to keep it informed of any developments regarding the introduction of a universal sickness insurance system.

The Committee expects that the Government will make every effort to take the necessary action in the near future.

CMNT_TITLE

The Committee notes with deep concern that the Government’s report has not been received. It is therefore bound to repeat its previous comments. The Committee informs the Government that, if it has not supplied replies to the points raised by 1 September 2020, then it may proceed with the examination of the application of the Convention on the basis of the information at its disposal at its next session.

Repetition

Article 1 of the Convention. Setting up a system of compulsory sickness insurance. The Committee notes that Act No. 212/AN/07/5ème-L establishing the National Social Security Fund (CNSS) provides that new complementary social instruments such as sickness insurance will be instituted by means of regulations (section 5 of the Act). It also notes the adoption of Act No. 199/AN/13/6ème-L of 20 February 2013 extending treatment coverage to self-employed workers and of Decree No. 2013-055/PR/MTRA of 11 April 2013 establishing CNSS registration procedures and contributions for self-employed workers. The Government states that these items of legislation are the precursor to establishing a universal sickness insurance system in Djibouti in the near future. The Committee hopes that once this insurance system is established it will cover the payment of sickness benefits to insured persons, which are currently covered by employers, contrary to the terms of the Convention. It requests the Government to keep it informed of any developments regarding the introduction of a universal sickness insurance system.

The Committee expects that the Government will make every effort to take the necessary action in the near future.

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The Committee notes with regret that the Government’s report has not been received. It is therefore bound to repeat its previous comments initially made in 2014.

Repetition

Article 1 of the Convention. Setting up a system of compulsory sickness insurance. The Committee notes that Act No. 212/AN/07/5ème-L establishing the National Social Security Fund (CNSS) provides that new complementary social instruments such as sickness insurance will be instituted by means of regulations (section 5 of the Act). It also notes the adoption of Act No. 199/AN/13/6ème-L of 20 February 2013 extending treatment coverage to self-employed workers and of Decree No. 2013-055/PR/MTRA of 11 April 2013 establishing CNSS registration procedures and contributions for self-employed workers. The Government states that these items of legislation are the precursor to establishing a universal sickness insurance system in Djibouti in the near future. The Committee hopes that once this insurance system is established it will cover the payment of sickness benefits to insured persons, which are currently covered by employers, contrary to the terms of the Convention. It requests the Government to keep it informed of any developments regarding the introduction of a universal sickness insurance system.

The Committee hopes that the Government will make every effort to take the necessary action in the near future.

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Article 1 of the Convention. Setting up a system of compulsory sickness insurance. The Committee notes that Act No. 212/AN/07/5ème-L establishing the National Social Security Fund (CNSS) provides that new complementary social instruments such as sickness insurance will be instituted by means of regulations (section 5 of the Act). It also notes the adoption of Act No. 199/AN/13/6ème-L of 20 February 2013 extending treatment coverage to self-employed workers and of Decree No. 2013-055/PR/MTRA of 11 April 2013 establishing CNSS registration procedures and contributions for self-employed workers. The Government states that these items of legislation are the precursor to establishing a universal sickness insurance system in Djibouti in the near future. The Committee hopes that once this insurance system is established it will cover the payment of sickness benefits to insured persons, which are currently covered by employers, contrary to the terms of the Convention. It requests the Government to keep it informed of any developments regarding the introduction of a universal sickness insurance system.

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The Committee notes with regret that the Government’s report has not been received. It must therefore repeat its previous observation, which read as follows:

Repetition

The Committee notes that the system of social protection in force in Djibouti is currently undergoing major restructuring involving the amalgamation of various existing insurance funds. The aim is to rationalize the management thereof, while extending the scope of sickness insurance with a view to the gradual affiliation of the whole population, including persons working in the informal sector. To this end, Act No. 212/AN/07/5e L establishing the National Social Security Fund (CNSS) provides that new complementary social instruments such as sickness insurance, funded supplementary pension plans and voluntary insurance will be instituted by means of regulations. The Committee also welcomes the recent formulation of the programme to promote decent work in Djibouti and the initiative to include a component on social protection. The Committee encourages the Government to take all possible steps to complete the reforms under way and to keep it informed of the progress made with a view to establishing an operational sickness insurance system in the context of the principles guaranteed by the Convention. The Government is also invited to continue its efforts towards integrated management of the social security system providing protection for the greatest possible number of people, if necessary, with technical support from the Office.

The Committee hopes that the Government will make every effort to take the necessary action in the near future.

CMNT_TITLE

The Committee notes that the Government’s report has not been received. It must therefore repeat its previous observation which read as follows:

Repetition

The Committee notes that the system of social protection in force in Djibouti is currently undergoing major restructuring involving the amalgamation of various existing insurance funds. The aim is to rationalize the management thereof, while extending the scope of sickness insurance with a view to the gradual affiliation of the whole population, including persons working in the informal sector. To this end, Act No. 212/AN/07/5e L establishing the National Social Security Fund (CNSS) provides that new complementary social instruments such as sickness insurance, funded supplementary pension plans and voluntary insurance will be instituted by means of regulations. The Committee also welcomes the recent formulation of the programme to promote decent work in Djibouti and the initiative to include a component on social protection. The Committee encourages the Government to take all possible steps to complete the reforms under way and to keep it informed of the progress made with a view to establishing an operational sickness insurance system in the context of the principles guaranteed by the Convention. The Government is also invited to continue its efforts towards integrated management of the social security system providing protection for the greatest possible number of people, if necessary, with technical support from the Office.

The Committee hopes that the Government will make every effort to take the necessary action in the near future.

CMNT_TITLE

The Committee notes that the system of social protection in force in Djibouti is currently undergoing major restructuring involving the amalgamation of various existing insurance funds. The aim is to rationalize the management thereof, while extending the scope of sickness insurance with a view to the gradual affiliation of the whole population, including persons working in the informal sector. To this end, Act No. 212/AN/07/5^e L establishing the National Social Security Fund (CNSS) provides that new complementary social instruments such as sickness insurance, funded supplementary pension plans and voluntary insurance will be instituted by means of regulations. The Committee also welcomes the recent formulation of the programme to promote decent work in Djibouti and the initiative to include a component on social protection. The Committee encourages the Government to take all possible steps to complete the reforms under way and to keep it informed of the progress made with a view to establishing an operational sickness insurance system in the context of the principles guaranteed by the Convention. The Government is also invited to continue its efforts towards integrated management of the social security system providing protection for the greatest possible number of people, if necessary, with technical support from the Office.

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The Committee notes that the Government’s report has not been received. It also notes the comments made by the General Union of Djibouti Workers (UGTD) referring to the need to establish a sickness insurance scheme. The Committee hopes that a report will be submitted for examination at its next session and that it will contain a reply to the UGTD’s comments and to the Committee’s previous observation, which read as follows:

In response to the Committee’s previous comments, the Government confirms that the Social Protection Body (OPS), created in 1997, is responsible for covering medical benefits, but cash benefits remain the responsibility of the employer. The sickness insurance scheme is to be re-examined in the light of the Convention in the context of the review of the labour legislation which the Government plans to undertake with assistance from the Office. The Committee notes this information. It recalls that the sickness benefits payable under Article 3 of the Convention, read in conjunction with Article 1, to an insured person unable to work by reason of the abnormal state of his bodily or mental health, must be financed from a system of compulsory sickness insurance and shall not be borne directly by the employer. In these circumstances, it hopes that the Government will be able to take the necessary measures to ensure that sickness benefit can be paid to all workers covered by the Convention as part of a sickness insurance scheme, in accordance with the provisions of the Convention. The Committee asks the Government to provide a copy of any legislation adopted to this effect and of any texts regulating the provision of medical benefits by the OPS in the event of illness of insured persons, in accordance with Article 4 of the Convention.

The Committee hopes that the Government will make every effort to take the necessary action in the very near future.

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The Committee notes the Government’s report and the additional information provided.

In response to the Committee’s previous comments, the Government confirms that the Social Protection Body (OPS), created in 1997, is responsible for covering medical benefits, but cash benefits remain the responsibility of the employer. The sickness insurance scheme is to be re-examined in the light of the Convention in the context of the review of the labour legislation which the Government plans to undertake with assistance from the Office. The Committee notes this information. It recalls that the sickness benefits payable under Article 3 of the Convention, read in conjunction with Article 1, to an insured person unable to work by reason of the abnormal state of his bodily or mental health, must be financed from a system of compulsory sickness insurance and shall not be borne directly by the employer. In these circumstances, it hopes that the Government will be able to take the necessary measures to ensure that sickness benefit can be paid to all workers covered by the Convention as part of a sickness insurance scheme, in accordance with the provisions of the Convention. The Committee asks the Government to provide a copy of any legislation adopted to this effect and of any texts regulating the provision of medical benefits by the OPS in the event of illness of insured persons, in accordance with Article 4 of the Convention.

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The Government refers to the Committee's previous comments and indicates in its reports that Djibouti enjoys one of the most effective social protection schemes in East Africa which is organized around two complementary structures, the Social Benefits Fund (CPS) and the Inter-enterprise Medical Service (SMI), and financed by employers' and workers' contributions deducted from wages.

The Committee notes this information and also Act No. 135/AN/3rdL of 6 May 1997 establishing the Social Protection Organisation (OPS) which appears to have replaced the CPS. The Committee notes that the OPS does not cover sickness insurance and that, whereas medical care granted to workers in case of illness within the SMI scheme is free of charge, cash benefits paid to workers in case of illness are the direct responsibility of employers. In this respect, the Committee is bound to recall to the Government that cash benefits due, by virtue of Article 3 of the Convention read in conjunction with Article 1, to an insured person who is rendered incapable of work by reason of the abnormal state of his bodily or mental health must be financed by a compulsory insurance system and must not be the direct responsibility of the employer. Under these conditions, the Committee hopes that the Government will adopt the necessary measures to ensure that sickness benefits shall be guaranteed to all workers who are covered by the Convention in the framework of a sickness insurance scheme, in conformity with the provisions of the Convention. In this respect, the Committee proposes that the Government may wish to accept the offer of ILO technical assistance.

The Committee moreover requests the Government to transmit with its next report a copy of the legislation in force respecting the functioning of the SMI.

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The Committee notes with regret that for the second time the Government's report has not been received. It must therefore repeat its previous observation which read as follows:

The Committee notes from the Government's report that there have been no changes in the application of the Convention. It recalls that for many years it has been requesting the Government to take steps to amend the legislation so as to provide for sickness insurance. It again expresses its hope that, with the technical assistance of the International Labour Office, the Government will endeavour to establish a sickness insurance scheme in accordance with the provisions of the Convention.

The Committee hopes that the Government will make every effort to take the necessary action in the very near future.

CMNT_TITLE

The Committee notes that the Government's report has not been received. It must therefore repeat its previous observation which read follows:

The Committee notes from the Government's report that there have been no changes in the application of the Convention. It recalls that for many years it has been requesting the Government to take steps to amend the legislation so as to provide for sickness insurance. It again expresses its hope that, with the technical assistance of the International Labour Office, the Government will endeavour to establish a sickness insurance scheme in accordance with the provisions of the Convention.

The Government hopes that the Government will make every effort to take the necessary action in the very near future.

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The Committee notes from the Government's report that there have been no changes in the application of the Convention. It recalls that for many years it has been requesting the Government to take steps to amend the legislation so as to provide for sickness insurance. It again expresses its hope that, with the technical assistance of the International Labour Office, the Government will endeavour to establish a sickness insurance scheme in accordance with the provisions of the Convention.

[The Government is asked to report in detail in 1996.]

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The Committee regrets to note that the Government's report contains no reply to its previous comments. It must therefore repeat its previous direct request, which read as follows:

The Committee had noted the information supplied by the Government in its report for the period 1991-92. It noted that there is still no sickness insurance scheme in Djibouti, in view of the level of development of the country. It however noted the contacts which had been established with the ILO with a view to reviewing the social security question. The Committee was therefore bound to express the hope once again that, with the technical assistance of the Office at the appropriate time, the Government will be able to progressively apply a general sickness insurance scheme in accordance with the Convention. While awaiting the establishment of such a scheme, it hopes that the Government will be able to adopt in the near future a legal provision laying down the practice that workers who are not housed shall receive the necessary care and medicaments within the context of the enterprise's medical facilities in the event of sickness.

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The Committee notes the information supplied by the Government in its report for the period 1991-92. It notes that there is still no sickness insurance scheme in Djibouti, in view of the level of development of the country. It however notes the contacts which have been established with the ILO with a view to reviewing the social security question. The Committee is therefore bound to express the hope once again that, with the technical assistance of the Office at the appropriate time, the Government will be able to progressively apply a general sickness insurance scheme in accordance with the Convention. While awaiting the establishment of such a scheme, it hopes that the Government will be able to adopt in the near future a legal provision laying down the practice that workers who are not housed shall receive the necessary care and medicaments within the context of the enterprise's medical facilities in the event of sickness.

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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 3 of the Convention. With reference to its previous comments, the Committee notes that in the event of sickness the employer is bound to pay a worker a benefit equal to the worker's pay within the limit established by sections 38 and 39 of the collective agreement adopted in 1973. The Committee also notes that sickness benefit is provided by the employer, in accordance with the provisions of sections 38 and 39 of the above collective agreement. The Committee would emphasise that Convention No. 24 provides for the establishment of a sickness insurance scheme (Article 7) and not for the employer to provide the prescribed benefits directly.

Article 4(a). The Committee notes that workers who are not housed receive the necessary medical care and medicines within the framework of the enterprise's medical service in the event of sickness, and that this is established under an extension of the interpretation of section 19 of Order No. 72-60/SG/CG of 12 January 1972. The Committee hopes that in the near future the Government will take the necessary steps to incorporate this practice into the legislation.

(b) The Committee notes that public health centres provide care at tariffs that are fixed according to categories and that in general care is provided at the centres in accordance with customs that have become established over a number of years in Djibouti, and that the consequent hospitalisation costs are paid by the employer without any participation by the worker, except in cases where there are special provisions in the individual employment contract.

Article 6. The Committee notes that up to the present time, the provisions of section 2 of Order No. 72-60/SG/CG of 12 January 1972 respecting independent medical services have not been applied.

With regard to the possibility of requesting the technical co-operation of the Office, the Committee notes that the Government will not fail to make use of it when necessary. The Committee hopes that the Government will continue to examine how a sickness insurance scheme may be established, in ways that are adapted to the needs and possibilities of the country, in accordance with the fundamental provisions of this Convention.

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Article 3 of the Convention. With reference to its previous comments, the Committee notes that in the event of sickness the employer is bound to pay a worker a benefit equal to the worker's pay within the limit established by sections 38 and 39 of the collective agreement adopted in 1973. The Committee also notes that sickness benefit is provided by the employer, in accordance with the provisions of sections 38 and 39 of the above collective agreement. The Committee would emphasise that Convention No. 24 provides for the establishment of a sickness insurance scheme (Article 7) and not for the employer to provide the prescribed benefits directly.

Article 4(a). The Committee notes that workers who are not housed receive the necessary medical care and medicines within the framework of the enterprise's medical service in the event of sickness, and that this is established under an extension of the interpretation of section 19 of Order No. 72-60/SG/CG of 12 January 1972. The Committee hopes that in the near future the Government will take the necessary steps to incorporate this practice into the legislation.

(b) The Committee notes that public health centres provide care at tariffs that are fixed according to categories and that in general care is provided at the centres in accordance with customs that have become established over a number of years in Djibouti, and that the consequent hospitalisation costs are paid by the employer without any participation by the worker, except in cases where there are special provisions in the individual employment contract.

Article 6. The Committee notes that up to the present time, the provisions of section 2 of Order No. 72-60/SG/CG of 12 January 1972 respecting independent medical services have not been applied.

With regard to the possibility of requesting the technical co-operation of the Office, the Committee notes that the Government will not fail to make use of it when necessary. The Committee hopes that the Government will continue to examine how a sickness insurance scheme may be established, in ways that are adapted to the needs and possibilities of the country, in accordance with the fundamental provisions of this Convention.