Nursing Personnel Convention, 1977 (No. 149) - Guatemala (Ratification: 1995)

Direct Request (CEACR) - adopted 2021, published 110th ILC session (2022)

The Committee takes note of the supplementary information provided by the Government in light of the decision adopted by the Governing Body at its 338th Session (June 2020). The Committee is proceeding with the examination of the application of the Convention on the basis of the supplementary information received from the Government in 2020, as well as on the basis of the information at its disposal in 2019.

Article 2(2)(a). Education and training. In response to its previous comments, the Committee notes the detailed information provided by the Government on the education and training system for nursing personnel implemented by various private and public universities, the different training cycles they provide (such as degrees, master degrees and specializations) and the number of graduates per year from those institutions. The Committee notes that, according to statistical information from the Ministry of Public Health and Social Assistance (MSPAS), 500 persons enrol each year in the National Nursing Schools, 15 per cent of whom drop out after the first year. The Government indicates that, within the framework of the 2018–2022 Regional Plan, the development of activities is planned to modernize the nursing profession with a view to building skills at professional and auxiliary level of those who work in the areas of health and the MSPAS hospitals, as well as in the Guatemalan Social Security Institute. The Government indicates that such activities will be implemented in cooperation with, inter alia, the National Nursing Council, the Association of Nurses of Guatemala and the College of Nursing Professionals. In addition, there are plans for joint efforts to ensure that nursing personnel of all levels can access lifelong education and to promote doctorates in nursing, which are currently only offered by a private university. The Committee also requests the Government to continue sending up-to-date detailed information on any measures taken or envisaged to provide nursing personnel with appropriate education and training for the performance of their functions, as well as the impact of these.

Article 2(2)(b). Remuneration of nursing personnel. In its previous comments, the Committee requested the Government to indicate the current status of the process of reclassification of wages for nursing personnel and to provide information on the outcome thereof. The Government indicates that in April 2019, the first phase of the process of reclassification of posts for permanent hiring of nursing graduates was initiated. The Government adds that the total number of nursing graduates working in MSPAS could not benefit from the first phase of reclassification of wages owing to budgetary constraints. Therefore, in the first phase, 410 nursing graduates benefited, while it is expected that the remaining nursing graduates, including nursing graduates hired in technical services (approximately 800), will benefit from the subsequent phases of the reclassification process. The Government also reports that 132 community, hospital and teaching members of nursing staff hired on temporary contracts were reclassified as permanent staff. In addition, the Government indicates that measures are envisaged to provide those working in the paramedic category with the opportunity to be promoted to other categories and to carry out nursing functions, which would improve the working conditions of such personnel. The Committee requests the Government to continue to provide detailed and up-to-date detailed information on the status of the process of reclassification of wages for nursing personnel and the outcome thereof.

Application in practice. The Committee notes the detailed information provided by the Government on the number of nursing personnel registered in different categories. It notes the Government’s indication in its supplementary report that, according to 2020 statistical information of the MSPAS, there are 4,730 nurses, 32,770 nursing assistants and 2,967 nursing technicians in the country. With regard to the migration of nursing personnel, the Committee notes that, according to the assessment of programmes on human resources in health conducted by the Pan American Health Organization and the World Health Organization, 32 per cent of health workers who emigrate from the country are part of nursing personnel. The above assessment shows that the main reasons are expectations for better pay and working conditions, as well as more opportunities for professional development. Lastly, the Committee notes the Government’s indication that, between March and July 2020, the General Labour Inspectorate received 136 complaints concerning nursing personnel, mostly from the department of Guatemala. The Government also indicates that the General Labour Inspectorate made it possible to submit complaints in order to prevent and control the spread of the virus in the country’s public and private sector workplaces, through the web page of the Ministry of Labour and Social Welfare, a telephone line and the various departmental offices of the General Labour Inspectorate. The Committee requests the Government to continue to provide detailed and up-to-date information on the manner in which the Convention is applied in practice, including statistical data on the number of nursing personnel – disaggregated by sex, age and region, sector of activity, training level and functions – and also statistics on the nursing personnel/population ratio, the number of persons enrolling in nursing schools and the number of persons leaving the profession each year, and copies of official reports or studies relating to nursing services. The Committee also requests the Government to continue to provide up-to-date information on any practical difficulties encountered in the application of the Convention, such as the shortage or migration of nursing personnel.

Observation (CEACR) - adopted 2021, published 110th ILC session (2022)

The Committee takes note of the supplementary information provided by the Government in light of the decision adopted by the Governing Body at its 338th Session (June 2020). The Committee is proceeding with the examination of the application of the Convention on the basis of the supplementary information received from the Government in 2020, as well as on the basis of the information at its disposal in 2019.

The Committee notes the observations made by the Autonomous Popular Trade Union Movement and the Global Unions of Guatemala, received on 16 October 2020, which denounce the recruitment of nursing personnel through temporary contracts for professional services to perform work of a permanent nature, and the precarious working conditions of these workers. In particular, they report that these workers do not have access to the rights established for nursing personnel in the labour legislation relating to aspects such as holidays, access to benefits of the Guatemalan Social Security Institute, healthcare, maternity leave or breastfeeding breaks. They also report that, in the context of the COVID-19 pandemic, the nursing personnel under the aforementioned contractual arrangements who were infected with the virus did not receive medical assistance, and were required to go to work despite presenting symptoms of COVID-19. In addition, they highlight that they were not provided with personal protective equipment (PPE) and were refused access to COVID-19 testing. The workers’ organizations indicate that on 25 May 2020, they submitted an application for protection (amparo) to the Constitutional Court, which ordered the Ministry of Health to immediately adopt the necessary measures to issue PPE to all workers and to protect those workers considered to be high risk. The workers’ organizations also indicate that they submitted an application for protection (amparo) for the misuse of temporary contracts, for health sector services to carry out labour activities, with a proven relationship of permanent dependence. The workers’ organizations also denounce the initiation of dismissal proceedings as a reprisal against the workers who promoted and supported the submission for the above remedies. In addition, they denounce the significant salary differences between nursing personnel who perform the same functions but who are hired under different contractual terms or in different regions. Lastly, the workers’ organizations report that in the last four years, graduates of the nursing schools in Quiche, Cobán and Guatemala Capital have not received their academic certificates, which prevents them from accessing employment. Furthermore, they report the absence of adequate and sufficient protection measures in the context of the COVID-19 pandemic, including the lack of PPE and measures to minimize the risks to which workers are exposed. The Committee requests the Government to provide its reply in this regard.

COVID-19 pandemic. Measures adopted concerning public health. The Committee notes the detailed information provided by the Government in its supplementary report on the various public health measures adopted to address the effects of the COVID-19 pandemic. The Government indicates that on 16 March 2020, it issued Governmental Decree No. 5-2020 declaring a state of public disaster throughout the national territory as a result of the COVID-19 pandemic, which has subsequently been extended on several occasions. The Government indicates in its supplementary report that, in March 2020, the Plan to prevent, contain and respond to COVID-19 cases in Guatemala, developed by the Ministry of Public Health and Social Assistance (MSPAS), was approved. The measures in the Plan to be adopted to address the epidemiological threat posed by COVID-19 include ongoing training and active participation of personnel from the different levels of healthcare in the various coordination forums of the health sector and emergency response system, as well as the National Coordinating Body for Disaster Reduction (CONRED). The Committee invites the Government to provide up-to-date information in its following report on the impact of the pandemic on the implementation of national policies and programmes relating to nursing services and nursing personnel with a view to ensuring the objectives of the Convention.

Article 2 of the Convention. National policy for nursing services and nursing personnel. The Committee notes the detailed information provided by the Government regarding the regulations on the nursing profession and the various studies conducted on the situation of health workers in the country, including nursing personnel. In particular, the Committee notes the reports provided by the Government regarding the evaluations carried out in 2005 and 2013 on achievement of the targets established in the National Plan for the development of human resources in health 2007–2015. The Committee also notes that the Government refers to the development of the Regional Plan of the nursing professionals’ group of Central America and the Caribbean 2018–2022. Its lines of action include: building the human resources of nursing personnel, improving the working conditions of nursing personnel and strengthening continuous and lifelong education for these workers. The Government indicates that such lines of action would be agreed upon by representatives of nursing associations and colleges affiliated with the International Council of Nurses (ICN) at a meeting to be held in Singapore in 2019. The Committee also notes the Government’s indication that, within the framework of the II Central American and Caribbean Summit on “the development of nursing in Central America, a collective project to improve health” organized in October 2017, a declaration was signed by nursing personnel representatives of the participating countries. The Government indicates that the declaration includes pillars of work relating to governance, vocational internships and training for human resources, working conditions of nursing personnel, technical cooperation projects between national nursing associations, professional nursing colleges and the International Council of Nurses, the implementation of strategies to strengthen work within nursing networks, and the regulation of national policy and law on nursing. The Government adds that participants in the II Regional Summit undertook to disseminate the declaration at the national level, follow up on the agreements, strengthen union organization and carry out studies on the situation of nursing personnel. In this connection, the Government reports the development of a study by the Nursing Services Development Unit of the MSPAS on the working conditions of nursing personnel in Guatemala. This study highlights that obstacles to improving the working conditions of nursing personnel comprise the insufficient number of nursing personnel in the country owing to the lack of funding for recruitment, the heavy workload of nursing personnel who perform functions that are not part of their jobs, the lack of unified salaries for nursing personnel, the absence of ongoing occupational safety and health programmes, and salaries that are not commensurate with the qualifications and responsibilities of the position. With respect to the activities of the Interinstitutional Council, the Government refers to the establishment of the National Observatory of Human Resources in Health in 2012 and the coordination of interinstitutional actions with a view to developing proposals on plans for the training for human resources in health. Furthermore, the Committee notes the approval in 2019 of the regulations for the nursing staff of the hospital network of the MSPAS. The objectives of the regulations include standardizing the nursing staff functions according to position and academic degree, strengthening the quality of nursing care in the country’s hospital network, and systematizing discussion forums for nurses for the comprehensive analysis of the development of the profession at the different levels of care. The Committee requests the Government to provide detailed and up-to-date information on the impact on nursing services and nursing personnel of the measures adopted within the framework of the 2018–2022 Regional Plan and the declaration adopted at the II Central American and Caribbean Summit on the development of nursing, as well as the new regulations for the nursing staff of the hospital network of the MSPAS. The Committee also requests the Government to provide up-to-date information on the consultations carried out with the employers’ and workers’ organizations concerned, where such organizations exist, with regard to the abovementioned measures (Article 2(3)).

Article 7. Occupational safety and health. The Committee notes the Government’s indication that, in May 2015, measures were adopted with a view to implementing safety and health policies for health workers in compliance with the goals set out in the Regional Plan for human resources in health. The Committee notes, however, that according to the assessment on achievement of this goal conducted by the interinstitutional committee for joint actions of the academic and health sectors, the level of achievement reached only 25 per cent. The Committee also notes the detailed information provided by the Government in its supplementary report on the safety and health measures taken in the context of the COVID-19 pandemic. The Government refers, inter alia, to the approval on 14 June 2020 of Governmental Agreement No. 79 of 2020, which complements the 2014 regulations on occupational safety and health, relating to the prevention and control of the spread of COVID-19 in all workplaces in the public or private sector in the country. The Agreement sets out the implementation of occupational safety and health measures that allow for safe working conditions to minimize the risk of infection. In this connection, it establishes a series of obligations for the employer, such as providing PPE for the prevention and control of the spread of COVID-19 in the workplace. The Government reports that in August 2020, the Department of Occupational Safety and Health carried out an initial operation in 18 private sector hospitals to monitor compliance with the obligations established in the Agreement.

In this context, the Committee recalls that nursing personnel who, given the specific characteristics of their work must be in close physical contact with their patients, are at high risk of becoming infected while treating patients with suspected or confirmed COVID-19, particularly when precautions to control the spread, including the use of PPE, are not strictly applied. In this respect, the Committee wishes to draw the Government’s attention to paragraph 49 of the Nursing Personnel Recommendation, 1977 (No. 157), which sets out that: “(1) All possible steps should be taken to ensure that nursing personnel are not exposed to special risks. Where exposure to special risks is unavoidable, measures should be taken to minimize it; (2) Measures such as the provision and use of protective clothing, immunization, shorter hours, more frequent rest breaks, temporary removal from the risk or longer annual holidays should be provided for in respect to nursing personnel regularly assigned to duties involving special risks so as to reduce their exposure to these risks; and (3) In addition, nursing personnel who are exposed to special risks should receive financial compensation. The Committee requests the Government to indicate whether the abovementioned measures adopted in 2015 and Governmental Agreement No. 79 of 2020 have been effective in the prevention and control of COVID in the workplace, and to provide detailed and up-to-date information on the continued application of safety measures, including: the provision of PPE and training on its proper use;, the provision of adequate breaks during shifts and limitation of excessive hours wherever possible, with a view to protecting the health and well-being of nursing personnel; and limiting, as far as possible, their risk of contracting COVID-19. In addition, it requests the Government to provide detailed and up-to-date information on the number and result of the checks carried out on compliance with Governmental Agreement No. 79 of 2020 concerning nursing personnel.

The Committee is raising other matters in a request addressed directly to the Government.

Direct Request (CEACR) - adopted 2018, published 108th ILC session (2019)

Article 2 of the Convention. National policy for nursing services and nursing personnel. The Committee notes the Government’s indication, in reply to its previous comments, that progress has been made, in the context of the implementation of the “Regional labour plan 2010–18” of the Central American Group of Nursing Professionals, with regard to the training of nursing personnel, and that a new “Regional plan 2018–20” is currently being drawn up. The Government indicates in general terms that the conditions of work of nursing personnel have improved and job opportunities in hospitals, health areas, health centres and private companies have increased. The Government adds that, with the aim of bringing health services closer to population groups that have limited access, the number of jobs for nursing personnel in health centres and health posts in rural areas has been increased, thereby creating new employment opportunities. In addition, various measures have been taken by the Ministry of Public Health and Social Assistance (MSPAS) to provide nursing personnel with appropriate education and training, such as updating the “Unified programme for the university level technical training for nurses” in 2015 in collaboration with national schools and private universities and with advisory support from the Pan American Health Organization (PAHO). The Government refers to the “National human resources development plan for the health sector 2007–15” and to the establishment of the College of Nursing Professionals, which has 760 registered members (80 per cent women, 20 per cent men). The Committee notes that the “General policy 2016–20” of the Government highlights the lack of funding in the health services in relation to gross domestic product (GDP) from previous years and the unequal distribution of human resources in the health sector. The policy document also indicates that most health-care teams were concentrated in the metropolitan area and adjoining departments and were not widely distributed among the economically and socially disadvantaged population groups requiring health services. The Committee also notes that, as a result, the top priorities of the abovementioned policy include health sector reform, the objectives of which include the training of personnel and the development of health sector careers. Lastly, the Committee notes that the Government does not provide information on the activities of the inter-institutional council, which was set up to find ways to curb the migration of qualified nursing personnel. The Committee requests the Government to provide information on the “Regional plan 2018–20” and the “National human resources development plan for the health sector 2007–15” with regard to nursing personnel, and on the implementation thereof. The Committee once again requests the Government to provide detailed, up-to-date information on the activities of the inter-institutional council. Moreover, the Committee requests the Government to provide detailed, up-to-date information on all other measures that have been adopted or planned, including those taken in the context of health sector reform, to provide nursing personnel with education and training appropriate to the exercise of their functions (Article 2(2)(a)). The Committee also requests the Government to provide information on measures taken or contemplated to ensure employment and working conditions, including career prospects and remuneration, which are likely to attract persons to the profession and retain them in it (Article 2(2)(b)). The Committee further requests the Government to provide information on consultations held with the employers’ and workers’ organizations concerned, where such organizations exist, with regard to the abovementioned measures (Article 2(3)).

Article 2(2)(b). Remuneration of nursing personnel. The Government indicates that the National Nursing Council is seeking to improve wages and professional recognition for nursing personnel. Such recognition has not been entirely possible for various reasons, especially the fact that there is no professional category for nursing in the manual of posts and wages, and so nursing graduates do not receive professional recognition. The Government adds that the process of reclassification of nursing posts and wages should enable progress to be made in this area. With regard to technical nursing personnel, the Government refers to the adoption of Government Decision No. 543-2013 of 30 December 2013 establishing the wage scale for paramedics. The Committee requests the Government to indicate the current status of the process of reclassification of wages for nursing personnel and to provide information on the outcome thereof.

Application in practice. The Committee observes that, according to statistical information supplied by the Government in its “General policy 2016–20”, as at 31 December 2015 there were 1,217 professional nurses and 5,690 contracted nursing assistants. In 2015, a total of 431 nursing assistants and 193 professional nurses accessed the profession. However, the Committee notes the Government’s indication that it does not have any statistical data on the number of nursing personnel who have emigrated to other countries in search of work. The Committee requests the Government to provide detailed, up-to-date information on the manner in which the Convention is applied in practice, including statistics on the numbers of nursing personnel – disaggregated by sex, sector of activity, level of training and functions – and also statistics on the nursing personnel/population ratio, the number of persons enrolling in nursing schools and the number of persons leaving the profession each year, and copies of official reports or studies relating to nursing services. The Committee also requests the Government to provide information on any practical difficulties encountered in the application of the Convention, such as the shortage or migration of nursing personnel.

Direct Request (CEACR) - adopted 2013, published 103rd ILC session (2014)

Article 2 of the Convention. National policy for nursing services and nursing personnel. Further to its previous comment regarding the problems of nursing migration, the Committee wishes to draw the Government’s attention to the WHO Global Code of Practice on the International Recruitment of Health Personnel, adopted in 2010, which recognizes (paragraph 3.3) the specific needs and special circumstances of countries that are particularly vulnerable to health workforce shortages and provides (paragraph 5.7) that Member States should consider adopting measures to address the geographical maldistribution of health workers and to support their retention in underserved areas, such as through the application of education measures, financial incentives, regulatory measures, social and professional support. The Committee notes the Government’s indication that it has set up an inter-institutional commission with a view to developing methods to avoid the phenomenon of migration of qualified nurses. The Government also refers to the Regional Work Plan 2010–15 under the Central American Group of Nursing Professionals which seeks to develop responses to the same issue. The Government further indicates that a considerable number of nurses have been trained in the period 2008–12 thanks to international cooperation projects supported by Canada, Japan, the Republic of Korea and Spain. The Committee requests the Government to provide in its next report updated information on the activities of the inter-institutional commission as well as the implementation of the Regional Labour Plan 2010–15, and any results achieved in terms of containing the flow of nurses leaving the country and improving the distribution of the health-care workforce between rural and urban areas.

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

Article 2, paragraph 1, of the Convention. Formulation and implementation of a policy for nursing services and nursing personnel. The Committee notes the adoption of Decree No. 07-2007 of 20 February 2007 establishing an Act for the provision of nursing care and also its implementing regulations of 11 January 2008 (Acuerdo Gubernativo No. 56-2008), which establish the National Council for Nursing Care and the Nursing Services Development Unit. The Committee also notes the Government’s indication that the Ministry of Public Health is responsible for managing the implementation of policies in the area of health and for coordinating the various public, private and community bodies. It further notes the Government’s statement that efforts have been made to establish national policies for nursing services. These efforts have resulted in a national workplan drawn up in cooperation with the National Nursing School of Guatemala, the Guatemalan Association of Professional Nurses and also the chief nurses of public hospitals and health centres. The Committee notes that this plan – the “Integrated nursing care development plan 2008–12” – deals with the reinforcement of nursing care management capacity, professional competence, coordination of services, training and communication, and human resources.

The Committee understands that there are substantial disparities in the country regarding the distribution of human resources in the area of health care between rural and urban areas since 70 per cent of nursing personnel work exclusively in hospitals, leaving rural health centres with serious shortages of nursing staff. It notes that in 2005 a programme for the promotion of basic nursing care was launched by the National Nursing School of Cobán in five municipalities in the north of Guatemala to enable nursing personnel in rural districts to be trained by the most qualified personnel from urban areas.

Furthermore, the Committee notes that, according to a recent study by the Pan American Health Organization (PAHO), Guatemala is experiencing a shortage of nursing personnel since the ratio is only 3.6 per 10,000 inhabitants. It also notes, according to a study published in 2004, that 34 per cent of qualified nursing personnel have emigrated to the United States and auxiliary nursing staff represent 82 per cent of the workforce in this area. The Committee understands that the main causes of migration of qualified nursing personnel abroad are low wages, the economic situation, the low standard of living, family needs, poor career prospects and the lack of public policies in this area. It wishes to refer to the Code of practice currently being drafted by the WHO concerning the international recruitment of health personnel, 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 which 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. While noting the efforts made by the Government and also the need to collect up to date information in this area, the Committee requests the Government to supply detailed information on (i) the application of the “Integrated nursing care development plan
2008–12” and the “Programme for the promotion of nursing care 2005” and also the results achieved, and (ii) any developments in the situation of nursing personnel and, if applicable, information on any additional measures taken or contemplated to contain the phenomenon of migration of qualified nursing personnel abroad.

Article 2, paragraphs 2(b) and 3. Pay for nursing personnel. Consultation with employers’ and workers’ organizations. Further to its previous comment, the Committee notes that the Government’s report does not contain any specific reply to the comments made by the Trade Union Confederation of Guatemala (UNSITRAGUA) dated 25 August 2003 and sent to the Government on 8 October 2003. Specifically, UNSITRAGUA indicated that: (i) overtime worked by nursing personnel was not paid and there was no adequate procedure for the compensation of hours worked in the event of changes in terms of duty; and (ii) there was no collective agreement concerning conditions of work which applied specifically to nursing personnel, the nursing trade unions not having being consulted. The Committee recalls that, in accordance with the provisions of the Convention, each Member must take the necessary measures to provide nursing personnel with employment and working conditions, including career prospects and remuneration, which are likely to attract persons to the profession and retain them in it. In addition, the policy concerning nursing services and nursing personnel must be formulated in consultation with the employers’ and workers’ organizations concerned. The Committee requests the Government to provide detailed information on the matters raised by UNSITRAGUA.

Article 5. Participation of nursing personnel in the planning of nursing services and consultation of personnel on decisions concerning them. The Committee recalls that UNSITRAGUA also indicated that nursing personnel did not participate in the planning of nursing services, decisions on this subject being taken unilaterally by the directors and heads of assistance centres. While recalling that Article 5 of the Convention requires the adoption of measures to promote the participation of nursing personnel in the planning of nursing services and consultation with such personnel on decisions concerning them, the Committee requests the Government to send its comments in reply to the allegations made by UNSITRAGUA.

Article 7. Occupational safety and health. With regard to the conditions of employment and protection of nursing personnel, the Committee recalls that UNSITRAGUA emphasized that there was no health and safety policy for nursing personnel, particularly as regards the risk of contamination by HIV/AIDS owing to the lack of suitable protective equipment in national hospitals, thus obliging nursing personnel to work under dangerous conditions. 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 measure taken or contemplated in order to improve the protection of nursing personnel against infectious diseases, including HIV/AIDS.

Direct Request (CEACR) - adopted 2003, published 92nd ILC session (2004)

The Committee notes the Government’s report. The Committee also takes note of the observations made by the Trade Union Confederation of Guatemala (UNSITRAGUA) which were transmitted to the Government on 8 October 2003. The Committee will examine the Government’s report and the comments of the organization in detail at its next session and welcomes any additional information that the Government may wish to provide.

Direct Request (CEACR) - adopted 1999, published 88th ILC session (2000)

The Committee notes with interest the information provided by the Government that a Bill respecting the exercise of the profession of nursing was transmitted to Congress for approval in 1997. The Committee trusts that the Government will provide with its next report the text of the above Act as approved.

Article 1, paragraph 3, of the Convention. The Committee notes that, according to the Government, as under the terms of the national Constitution all work has to be remunerated, there is no nursing personnel giving nursing care and services on a voluntary basis. Nevertheless, the Committee requests the Government to state whether in practice, as often happens, there are personnel who occasionally provide nursing services on a voluntary basis in dispensaries or health posts. If such is the case, it would be grateful if the Government provides information on the measures which have been adopted or are envisaged to protect such personnel.

Article 5, paragraph 2. The Committee notes the information provided by the Government in its report that the conditions of employment and work of nursing personnel employed in the private sector are not regulated. According to the Government's report, the employers impose their own conditions. The Committee also notes the information to the effect that the Government is not aware of the existence of collective agreements concerning nursing personnel employed in the private sector. The Committee recalls that, in accordance with this provision, their conditions of employment and work shall be determined preferably by negotiation between employers' and workers' organizations. The Committee requests the Government to provide information on the methods that exist in the country for the determination of the conditions of employment and work of nursing personnel employed in the private sector.

Article 5, paragraph 3. With reference to its previous comments, the Committee notes that the Government has not provided a detailed and precise answer concerning the procedures used for the settlement of disputes arising in connection with the determination of terms and conditions of employment of nursing personnel employed in the public sector. The Committee trusts that the Government will provide the information requested in its next report.

Article 6. The Committee notes that the Government's report does not indicate, as requested by the report form, the legislation, collective agreements or other methods under which the application of each of the conditions of work set out in points (a), (b), (c), (d), (e), (f) and (g) of this Article are applied. The Committee hopes that the Government will provide detailed information on this subject in its next report.

Article 7. The Committee trusts that, when the Bill to regulate the exercise of the nursing profession is adopted, the bodies to which reference is made in the Bill will endeavour to improve existing laws and regulations on occupational health and safety by adapting them to the special nature of nursing work and the environment in which it is carried out. With reference to its general observation of 1990, which was repeated in 1994, the Committee requests the Government to indicate the measures taken or contemplated, in consultation with the employers' and workers' organizations concerned, to take into account the particular risk of accidental exposure to HIV among nursing personnel. It also requests the Government to indicate the measures taken or contemplated with respect to nursing personnel who are infected or considered to be infected by HIV (for example, conditions of work, confidentiality of test results, recognition that the cause of infection was occupational, etc.).

Part V of the report form. The Committee requests the Government to provide general information on the manner in which the Convention is applied in practice.

Direct Request (CEACR) - adopted 1998, published 87th ILC session (1999)

The Committee notes the information provided by the Government in its first report. The Committee requests the Government to provide additional information on the following points:

Article 1, paragraph 3, of the Convention. The Committee notes the Government's statement to the effect that there are no special rules established concerning nursing personnel who give nursing care and services on a voluntary basis, since in accordance with the Constitution, all work should be remunerated. The Committee requests the Government to indicate whether, in practice, nursing personnel in Guatemala occasionally offer nursing care and service on a voluntary basis.

Article 2, paragraph 2(b). The Committee requests the Government to provide information in respect of the employment and working conditions of nursing personnel employed in the private sector, also indicating the career prospects and remuneration which are likely to attract persons to the profession and to retain them in it.

Article 4. The Committee requests the Government to indicate whether the regulation of the National Nursing School remains in force or whether it has been repealed and, if so, the Committee requests the Government to provide a copy of the text.

Article 5, paragraph 2. The Committee requests the Government to provide information and copies of texts relative to the collective agreements concluded which concern nursing personnel employed in the private sector.

Article 5, paragraph 3. The Committee requests the Government to provide information relative to the procedures adopted for the settlement of disputes arising in connection with the determination of the terms and conditions of employment of nursing personnel employed in the public sector.

Article 6. With regard to the conditions of work referred to in Article 6(a), (b), (c), (d), (e), (f) and (g) of the Convention, the Committee requests the Government to indicate: (i) whether these conditions are regulated by the provisions of the Labour Code as well as the provisions of the Act respecting the civil service; and (ii) whether there are also collective and other agreements which regulate these conditions of work.

Article 7. The Committee requests the Government to provide additional information on the measures adopted to improve existing laws and regulations on occupational health and safety by adapting them to the special nature of nursing work and of the environment in which it is carried out.

Point V of the report form. The Committee notes the statistical information provided by the Government relative to the number of nursing personnel employed in the public and private sectors. It also notes that the number of persons who are entering the profession is estimated at approximately 10 per cent of the number of persons who are leaving the profession.

The Committee requests the Government to continue to provide general information in respect of the application of the Convention in conformity with the provisions of the Convention.