Direct Request (CEACR) - adopted 2009, published 99th ILC session (2010)

Nursing Personnel Convention, 1977 (No. 149) - Ecuador (Ratification: 1978)

Article 2, paragraphs 1 and 2, of the Convention. National policy for nursing services and nursing personnel. The Committee recalls its previous comment in which it asked the Government to supply further information concerning the activities of a new unit set up to coordinate national policies for nursing personnel. In the absence of a reply from the Government on this point, the Committee wishes to repeat its request to the Government to provide full and detailed information on the formulation and implementation of a national policy aimed at providing the quantity and quality of nursing care necessary for attaining the highest possible level of health for the population.

Furthermore, the Committee notes the statistics supplied by the Government according to which the country has 21,500 nurses, which represent, on average, five to six nurses for 10,000 inhabitants. It understands that the country, like most Latin American countries, is experiencing a shortage of nursing personnel, with a consequent reduction in the quality of care provided for patients. Migration to Chile is particularly evident and this is facilitated by the existence of a reciprocal agreement which recognizes the diplomas of health professionals trained in both countries. Another source of concern in addition to the migration of qualified nursing personnel is that the latter are often replaced by less qualified auxiliary nurses (who already account for almost 70 per cent of all nursing staff). The Committee wishes to refer to the draft WHO code of practice concerning the international recruitment of health personnel, currently under consideration, which encourages member States to conclude bilateral and multilateral agreements to promote cooperation and coordination relating to migrant health personnel in the recruitment process, in order to optimize the advantages and reduce the potentially negative impact of the international recruitment of health personnel, and also calls for measures to conserve and maintain a qualified national workforce of health personnel by improving their economic and social situation, living and working conditions, possibilities of employment and career prospects. The Committee therefore requests the Government to supply detailed information on any developments in the situation and, if appropriate, on additional measures taken or contemplated to contain the phenomenon of the migration of qualified nurses abroad.

Article 4. Legislation concerning the requirements for the provision of nursing care and nursing services. The Committee notes that the Health Code has been amended to become a higher ranked organic law. It also notes the Act concerning assistant nurses which regulates, inter alia, the requirements for practicing as an assistant nurse. The Committee understands that this Act is still at the draft stage. The Committee therefore requests the Government to indicate whether the Act concerning assistant nurses has been adopted and to supply a copy of the Organic Health Act.

Article 7. Occupational safety and health. The Committee notes the Government’s indication to the effect that no particular measure has been adopted with a view to adapting occupational safety and health laws and regulations to the specific nature of nursing work, in accordance with this Article of the Convention. In this regard, the Committee wishes to draw the Government’s attention to the Joint ILO/WHO guidelines on health services and HIV/AIDS, published in 2005, with a view to helping health services to strengthen their capacity for providing workers with a healthy and decent working environment, this being the most effective means of reducing the transmission of HIV and improving the provision of care for patients. The Committee would also like to refer to the discussion held at the June 2009 session of the International Labour Conference on “HIV/AIDS and the world of work”, with a view to the adoption of an international labour recommendation, in particular paragraph 37 of the draft conclusions (see ILC, 98th Session, 2009, Report IV(2), page 310), which states that public health systems should be strengthened, where appropriate, in order to ensure greater access to prevention, treatment, care and support, and to reduce the additional strain on public services, particularly on health workers, caused by HIV/AIDS. The Committee requests the Government to keep the Office informed of any new measures taken or contemplated in order to improve the protection of nursing personnel against infectious diseases, including HIV/AIDS.

Part V of the report form. Application in practice. The Committee requests the Government to continue supplying information on the application of the Convention in practice, including, for example, statistics on the numbers of nursing personnel – by sectors of activity and by levels of training and functions, if possible – the number of persons entering and leaving the profession each year, copies of reports or official studies on nursing services, information on any practical difficulties encountered in the implementation of the Convention, etc.