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

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

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.