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

Nursing Personnel Convention, 1977 (No. 149) - Tajikistan (Ratification: 1993)

The Committee notes with concern that the Government’s report has not been received. It expects that the next report will contain full information on the matters raised in its previous comments.

Repetition

Article 2 of the Convention. Formulation and implementation of a policy concerning nursing services and nursing personnel. In its previous comments, the Committee requested the Government to communicate copies of Ordinance No. 7 of 10 January 2000 establishing the national nursing care centre as well as any other official texts adopted in the context of the implementation of its policy on nursing services and nursing personnel. The Committee notes that the Government’s report does not provide this information. The Government refers to the establishment of the Tajik Nursing Association in 1997, indicating that the Association aims to bring together Tajikistan’s nurses and midwives, strengthen their role in maintaining public health care and enhance advocacy for nursing. The Government adds that the Midwives Association of Tajikistan was established on 16 October 2014, in order to enhance the prestige of midwives and develop their knowledge. The Committee notes that, according to a 2016 report of the European Observatory on Health Systems and Policies (the EO report) entitled Tajikistan: Health System Review, the number of nurses per 100,000 population in Tajikistan declined, from 597 in 1990 to 350 in 2004, before increasing again to 444 in 2013. Despite this more recent increase, the EO report indicates that the ratio of nurses in Tajikistan to population size remains one of the lowest in the region and that, in addition, Tajikistan’s health-care system suffers from pronounced regional imbalances, with health-care workers concentrated in urban areas, notably in Dushanbe, due to challenges in rural and remote areas that include low salaries, outdated medical equipment and the poor condition of health facilities. The EO report refers to incentives introduced by the Ministry of Health and Social Protection aimed at improving the distribution and motivation of health-care workers, to attract them to rural and remote areas. The Committee requests the Government to provide in its next regular report, due in 2018, detailed information on the impact of measures taken in the framework of its policy concerning nursing services and nursing personnel and which are aimed at attracting and retaining nursing personnel, including midwives, particularly in rural and remote areas of the country, as well as statistical information reflecting trends in this sector. It further requests the Government to provide information regarding the consultations held with the social partners with respect to the formulation and implementation of the policy, as called for under Article 2 of the Convention. The Committee once again requests the Government to provide a copy of Ordinance No. 7 of 10 January 2000 establishing the national nursing care centre and any other official texts adopted in the context of the implementation of its policy on nursing services and nursing personnel.

Articles 3 and 4. Basic requirements in relation to teaching and training. The right to exercise the profession. In its previous comments, the Committee requested the Government to indicate the basic requirements in relation to the teaching and training of nursing personnel, and the conditions governing the right to practice nursing care and services. The Government indicates that the national nursing centre and regional nursing centres in Sughd Region, Khatlon Region and the Gorno-Badakhshan Autonomous Region were set up as of 10 January 2000 in order to coordinate the development of nursing in Tajikistan, to develop educational policy at both the graduate and post-graduate levels and to review practice among intermediate medical staff. In accordance with Ministerial Order No. 877 of 17 October 2014, courses to enhance the qualifications of intermediate medical staff are being held at the national nursing centre to enhance the knowledge, professional competencies, practical skills and abilities of intermediate medical staff. The Government indicates that there are currently 23 medical colleges in Tajikistan (16 public and seven private) where training is provided for intermediate medical staff with various specialties. The Committee notes the indication in the EO report that nursing is still poorly developed and many nurses are underqualified. According to the EO report, reforming medical education has been one of the key directions of reform, with upgraded nursing training. The Committee further notes from the EO report that a nursing faculty has been established at the Postgraduate Medical Institute, and nurse training has been upgraded to a four-year course. Retraining is also provided through a six-month continuing medical education course for physicians and nurses who wish to retrain in the area of family medicine. The Committee once again requests the Government to indicate the basic requirements in relation to the teaching and training of nursing personnel, and the conditions governing the right to practice nursing care and services. It also once again requests the Government to provide a copy of any relevant law or regulation in this regard.

Article 5. Consultations with nursing personnel. The Government indicates that the Tajik Nursing Association was established under the auspices of the American International Healthcare Alliance in 1997 in order to bring together Tajikistan’s nurses and midwives, to strengthen their role in maintaining public health care and to enhance advocacy for nursing. The Tajik Nursing Association, together with the National Nursing Centre, drew up an Ethical Code for Nurses. The Midwives Association of Tajikistan was later established on 16 October 2014 with the aim of bringing together the country’s midwives, enhancing their prestige and their role in society and developing their knowledge. The Committee requests the Government to provide further information on the measures taken to promote the participation of nursing personnel in the planning of nursing services. It also requests the Government to provide information on the consultations held with such personnel, including the Tajik Nursing Association and the Midwives Association of Tajikistan, on decisions concerning them, in a manner appropriate to national conditions. The Committee further requests the Government to provide additional information on the application of the Ethical Code for Nurses.

Article 6. Conditions of employment. The Government indicates that intermediate medical staff are employed in accordance with the Labour Code. Government or sectoral awards are granted in accordance with length of service and particular merit. For intermediate medical staff, the working day lasts between eight and 14 hours. Overtime is not compensated. Weekly rest days, annual paid leave, study leave, pregnancy and maternity leave, sick leave and social security are also provided for under the Labour Code. Recalling the requirement set out by the Convention that nursing personnel shall enjoy conditions of employment at least equivalent to those of other workers, the Committee requests the Government to indicate the provisions guaranteeing that nursing personnel enjoy conditions of employment and work at least equivalent to those of other workers in relation to hours of work, including regulation and compensation of overtime, inconvenient hours and shift work.