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

Nursing Personnel Convention, 1977 (No. 149) - United Republic of Tanzania (Ratification: 1983)

Article 2 of the Convention. National policy on nursing services and nursing personnel. The Committee notes that a copy of the 2017 National Health Policy (NHP) is provided by the Government in reply to its previous request. The 2017 NHP sets objectives to facilitate the provision of basic health services that are of good quality, equitable, accessible, affordable, and sustainable, as well as gender-sensitive. The Government reports that, to this end, the 2017 NHP should be implemented in a manner consistent with the implementation of other policy instruments, namely: the National Development Vision 2025, the National Five Year Development Plan 2016/17–2020/21; the (Tanzania) Sustainable Development Goals 2030; and the Health Sector Strategic Plan 2015–20 (HSSP IV). The Government indicates that one of the objectives common to these instruments is to improve the quality of primary health-care services by addressing the lack of skilled human resources and enhancing the capacity of health workers at all levels in the health sector. In this regard, the HSSP IV indicates that, even though the number of health workers, especially clinical personnel, is increasing in Tanzania (as of 2014 there were 2,843 nursing officers, 4,861 assistant nursing officers and 13,848 enrolled nurses and midwives), remote and rural areas are still facing major shortages and many primary health facilities in these areas do not have enough qualified staff. The HSSP IV therefore calls for the Nursing and Midwifery Services to focus on increasing skills for nurses and midwives that will contribute to the Government’s commitment of reaching public expectations by providing quality services. In this regard, the HSSP IV calls on the Tanzania Nurses and Midwives Council to champion ethics in clinical practice to safeguard patients’ rights. It further recommends that the nursing and midwifery services concentrate on creating a clinical instructors’ programme for students and interns, in collaboration with the 57 nursing schools, to facilitate skills development. Moreover, the Ministry of Health and Social Welfare (MOHSW), in collaboration with Council Health Management Teams (CHMTs), is required to introduce an orientation plan to rotate and relocate staff to facilitate their understanding of the new working environment. The Committee requests the Government to provide information on the impact of the implementation of the 2017 NHP and HSSP IV on the working conditions of nursing personnel as well as on measures taken for attracting and retaining nursing personnel, including midwives, particularly in rural and remote areas of the country. It further requests the Government to provide statistical information, disaggregated by age and sex, on the number of persons entering and leaving the profession annually, the number of nursing and midwifery personnel by category and grade, the proportion of nursing personnel and midwifery in relation to other workers in the health sector and their geographic distribution in the territory, particularly in remote and rural areas.

Article 5. Consultations with representative organizations of nursing personnel. The Government reports that during the financial year 2017–18, a total of seven collective agreements were concluded with the private health sector. The Committee notes that one of the main strategies of the 2017 NHP includes requiring intensive consultations with all stakeholders, harmonization and institutional relations through the adoption of Agreements and Memoranda of Understanding. It further notes that the HSSP IV was developed through a participatory process comprising representatives of Ministries, Departments and Agencies (MDAs), non-governmental organizations (NGOs) and the private sector, as well as development partners (DPs). The Committee requests the Government to continue to provide information on consultations held with representative organizations of nursing personnel and to provide copies of collective agreements currently in force between the Government and the private health sector, relevant to employment conditions of nursing personnel, particularly in relation to remuneration, occupational safety and health and hours of work.

Article 6. Working conditions of nursing personnel. In response to the Committee’s previous comments, the Government indicates that it will examine the possibility of making special arrangements or benefits concerning the specific conditions applicable to nursing personnel in the context of the ongoing Labour Law Reform. The Committee further notes that the 2017 NHP requires the Government to ensure that all health sector staff are adequately remunerated, that their working and living conditions are improved, and to enhance the availability of adequate social economic infrastructural facilities, equipment and medical supplies to all Tanzanians. In this regard, the HSSP IV stipulates that the Ministry shall introduce a stepwise certification towards accreditation (SWCA) system, which is designed to make the quality of health care more visible, more acceptable to users, and safer for both clients and health-care sector workers. The system establishes a Star Rating mechanism for all primary health-care facilities, allowing the Council to identify and support underperforming health facilities and bring them up to the desired standard. 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 provide updated information on the outcome of its examination for making special arrangements or benefits applicable to nursing personnel and on measures taken or envisaged to guarantee that nursing personnel enjoy conditions of employment and work at least equivalent to those of other workers in the following fields: (a) hours of work, including regulation and compensation of overtime, inconvenient hours and shift work; (b) weekly rest; (c) paid annual holidays; (d) educational leave; (e) maternity leave; (f) sick leave; and (g) social security. The Committee draws the Government’s attention to Paragraphs 25–56 of the Nursing Personnel Recommendation, 1977 (No. 157), which provide useful guidance in this regard.