Observation (CEACR) - adoptée 2014, publiée 104ème session CIT (2015)

Convention (n° 149) sur le personnel infirmier, 1977 - Fédération de Russie (Ratification: 1979)

Article 2 of the Convention. National policy concerning nursing services and nursing personnel. The Committee notes that the Government has last provided substantive information on the implementation of the Convention in 2003. In its latest report, the Government fails to address any of the points that the Committee has been raising since 2004 (including the restructuring of health care, the pay system for nursing personnel, and the participation of representative bodies of nurses in the planning of nursing services) and limits itself to providing information concerning the employment of women, maternity protection and persons with family responsibilities.

The Committee understands, however, that there have been important developments in the past few years that may have an impact on the application of this Convention, for instance the establishment of the Commission on Health Care by Government Resolution No. 1018 of 8 October 2012, and the elaboration of the state programme on health-care development in pursuance of Presidential Executive Order No. 596 of 7 May 2012. The Committee also understands that, as announced by the Government in January 2013, the implementation of regional health-care modernization programmes for the period 2011–13 is under way and that approximately 700 billion roubles (RUB) (US$19.9 billion) had been allocated to these programmes. Apart from construction of health-care facilities and modernization of medical equipment, such initiatives entailed amendments to 57 federal laws and resulted in certain regions in salary increases and new remuneration systems for medical personnel.

Yet, the Committee notes that serious challenges persist, especially as regards the staffing of the health-care system with highly qualified and motivated personnel. The Committee notes, in particular, that as indicated in a Government meeting held in April 2013 and devoted to human resources development in the health-care system, at present the nurses per doctor ratio is two to one instead of five to one in most countries with modern health-care systems. In the same meeting, the Minister of Health Care stated that in the past ten years the number of nurses per 10,000 inhabitants declined from 97 to 90 whereas the country requires an estimated 117.5 nurses per 10,000 inhabitants. The Minister added that even though 59,000 nurses were trained per year, 90,000 nurses were leaving the profession annually, of whom only 15,000 due to retirement, and the remaining simply seeking better jobs.

Moreover, the Committee notes the information contained in the 2013 United Nations Development Programme (UNDP) report, entitled National Human Development Report for the Russian Federation – Sustainable Development: Rio Challenges, which concludes that despite considerable improvements in the health-care system in recent years, further changes are needed over a period of eight to ten years to meet present challenges, including greater efficiency in the use of financial, material and human resources and special focus on priorities such as the skills and motivation of staff. The report also puts forward a series of recommendations, including the introduction of more efficient work contracts for health-care workers (higher wages and linkage to specific levels of service quality and quantity), introduction of a new system for certification of personnel, reform in the system of professional medical education and training and a greater role for professional communities in the management of health care. The Committee requests the Government to provide detailed information on measures, initiatives or campaigns implemented under the various health-care development programmes as well as the regional health-care modernization programmes (2011–13), aimed at promoting the attractiveness of the nursing profession and improving the employment conditions of nursing personnel. The Committee also requests the Government to specify whether and how representative workers’ organizations, such as the Russian Nurses Association, are effectively consulted in the formulation of new policies, or the setting up of new structures or programmes which might impact on the employment and working conditions of nursing personnel.