Direct Request (CEACR) - adopted 2019, published 109th ILC session (2021)

Nursing Personnel Convention, 1977 (No. 149) - Lithuania (Ratification: 2007)

Articles 2 and 5 of the Convention. National policy concerning nursing services and nursing personnel. Consultations. The Committee takes note of the Government’s report, much of which reiterates information provided in its previous report. The Committee understands that, according to the OECD Reviews of Health Systems: Lithuania 2018 (the 2018 OECD Review), Lithuania has achieved a profound transformation of its health system after declaring independence in the early 1990s. The 2018 OECD Review indicates that the organization and governance of the system is typical of many European countries and has remained stable over the past two decades, with an appropriate set of policy directions having been consistently pursued over time. Health is a prominent inter-sectoral priority that cuts across Lithuania’s main strategic planning documents; for example, the objective of “Health for All” is one of three horizontal priorities established in the country’s national development strategy: “Lithuania 2030”. Its implementation is governed by a specific inter-sectoral action plan coordinated by the Ministry of Health. In its previous comments, the Committee noted the establishment of a new Health Programme 2011–20 and requested the Government to provide information on its implementation and impact, particularly on the quality of nursing services and the employment conditions of nursing personnel. The Review notes that overall, no systematic tools are in place to assess future needs and gaps, or to evaluate the impact of future policies. The Government reports on indirect measures that, in its view, have had a positive impact on improving the quality of nursing care services. In this respect, the Government refers to the annex that forms part of the Collective Agreement of the National Health System of Lithuania, 31 August 2018, No. 2/S-133, which provides for the allocation of €100 million to increase wages for healthcare professionals as of May 2018. It adds that, depending on educational level, the fixed portion of the basic salary for nursing personnel may not be less than 60–70 per cent of the fixed portion of the basic salary for physicians. The Government also refers to the annex that forms part of the Collective Agreement of the National Health System of Lithuania, which entered into force in January 2019 and focuses on improving the working conditions of healthcare specialists. It takes note of the report on the State of Health in the EU Country Health Profile 2017 on Lithuania (2017 Health Status Profile), prepared by the OECD and the European Observatory on Health Systems and Policies, and available on the website of the European Commission. According to the 2017 Health Status Profile, despite the large emigration of health workers since it joined the EU in 2004, Lithuania has retained a higher number of physicians per capita than the EU average (4.3 per 1000 population compared to 3.6), mainly by increasing the number of graduates. On the other hand, the ratio of nurses to the population (7.7), is below the EU average of 8.4. Main health system challenges include the uneven distribution of physicians across the country, the aging of the health workforce and emigration. The 2017 Health Status Profile indicates that a number of new policies have been put in place to increase the number of nurses and strengthen their role in health services, especially in primary care. Specialist nurse training has been initiated, for example in diabetes and cardiology, where new positions for chronic patient groups have been introduced. The Government indicates that measures aimed at regulating the provision of personal healthcare services are designed to regulate the workload of healthcare professionals with the aim of achieving a 1:2 ratio of doctors to nurses. The Committee also notes that, according to the 2017 OECD Profile, since joining the EU in 2004, Lithuania has experienced large migration outflows of health workers, particularly of nursing personnel, who emigrate abroad in search of better pay and working conditions. It notes that this situation remains a challenge for the country and understands that according to the OECD STAT database, 26,078 nurses migrated abroad in 2018. The Committee requests the Government to provide up to-date information on the implementation and impact of the national Health Programme 2011–20, particularly with respect to improving the quality of nursing services and the employment conditions of nursing personnel. It also requests the Government to provide information on the content, status and impact of the inter-sectoral action plan coordinated by the Ministry of Health, as well as on the allocation of €100 million to increase wages for healthcare professionals pursuant to the Collective Agreement of the National Health System of Lithuania. It reiterates its request that the Government provide detailed, updated information concerning current trends in respect of nursing migration from Lithuania and any measures taken or envisaged to retain nursing personnel, measures in relation to education, vocational guidance and training, as well as in relation to working conditions, including career prospects and remuneration. The Committee also requests the Government to provide information on measures taken or envisaged to ensure the active participation of nursing personnel in the development, implementation and monitoring of policies and general principles regarding the nursing profession.

Part V of the Report Form. Application in practice. The Committee requests the Government to provide detailed updated information, disaggregated by age, sex and region, concerning the situation of nursing personnel in the country, the nurse-population ratio, the number of nursing personnel broken down by those working at public and private healthcare establishments, and the number of those who leave the profession each year and to provide copies of any recent reports or studies addressing nursing-related issues.