Direct Request (CEACR) - adopted 2020, published 109th ILC session (2021)

Nursing Personnel Convention, 1977 (No. 149) - Kyrgyzstan (Ratification: 1992)

Articles 2, 3 and 5. National policy on nursing services and nursing personnel. Consultation. In its previous comments, initially made in 2017, the Committee requested the Government to provide updated information on the practical implementation of the national “Programme for the development of nursing 2012–16”, its impact and any follow-up action envisaged. It also requested the Government to clarify whether and how representative organizations of nursing personnel had been associated with the preparation of the programme and other measures giving effect to the provisions of the Convention. The Committee notes with interest the information provided in the Government’s report in relation to the adoption of the Nursing Development and Education Programme in Kyrgyzstan 2019–23 whose objective is to provide training to and strengthen the role of nursing specialists in providing health care to the population. The Programme contemplates, among other measures, the establishment of contemporary nursing practices, as well as the integration of nursing personnel, both in vocational training and in nursing education and practical healthcare. The Committee welcomes the Government’s indication that the representative organizations of nursing personnel participated in the development of the Programme as well as in the realization of studies on nursing. The Government adds that the monitoring and evaluation of the Programme’s implementation will be carried out by the Ministry of Health, the Ministry of Education and Science, the Association of Nursing Specialists of Kyrgyzstan, the Association of Groups of Family Doctors and Family Nurses, and the Association of Medical Colleges of Kyrgyzstan. In addition, the Committee notes the adoption in January 2019 of the Program of the Kyrgyz Republic Government on Public Health Protection and Health Care System Development for 2019–30 “Healthy Person – Prosperous Country”, developed through an inclusive process and with support from the World Health Organization (WHO). According to the Program, it is the fourth such strategic document developed and defines major lines for further healthcare system development and the protection of the public health, aligned with other national policies, such as the National Development Strategy (2018–40). The Program’s objectives include protecting health and strengthening primary healthcare, in pursuit of universal health coverage (UHC) by 2030. The Committee notes that the Program calls for the active participation of stakeholders at all levels of the health system and in all regions of the country, to better ensure ownership of the Program and its successful implementation. Key objectives include reforming nursing education in accordance with new requirements and needs in the healthcare sector. To this end, the Program provides for the development and implementation of a nursing education reform strategy, as well as for the development of the competencies of nursing specialists and those of all specialists with secondary medical education (such as midwives and paramedics). The Committee notes the persistent challenges faced by the public health system, described in the Program, which include insufficient material and financial resources, as well as the lack of required competencies. According to the Program document, while a sufficient number of public health specialists graduate annually from the universities, there is always a workforce shortage as young specialists are not interested in working in their area of specialization, while experienced specialists are in high demand in Commonwealth of Independent States (CIS) and non-CIS countries, particularly in the private health sector. In this respect, the Committee also notes that the Program’s goals include making the healthcare system attractive for nurses, as well as for other health sector professionals. The Committee requests the Government to provide detailed updated information on the nature and impact of the measures taken or envisaged to facilitate retention of the nursing workforce through provision of remuneration packages and career prospects designed to attract them to the profession and retain them in it. It also requests the Government to provide updated detailed information on the nature, implementation, monitoring and impact of the measures adopted, to ensure that nursing personnel, including midwives, are provided with quality education and training appropriate to the exercise of their functions as well as to their professional career development. The Committee further requests the Government to provide a copy of the Nursing Development and Education Programme in Kyrgyzstan 2019–23, as well as copies of new normative or policy documents that may be developed under the relevant health sector programmes in the near future.

Article 7. Occupational safety and health. The Committee notes from the COVID-19 Health System Response Monitor developed jointly by the WHO, the European Commission and the European Observatory on Health Systems and Policies, that the Government has taken a range of measures to ensure that the country can count on a sufficient physical infrastructure and workforce capacity to support an effective response to the COVID-19 outbreak. In particular, the Committee notes measures taken to provide training to health workers on the basis of national clinical guidelines on COVID-19 (Order No. 173 to approve interim clinical guidelines on COVID-19 of 20 March 2020) as well as the establishment of premiums for healthcare workers, including nursing personnel, who are engaged in the treatment of coronavirus patients, paid in addition to their regular salaries. Against this backdrop, the Committee wishes to draw the attention of the Government to Paragraph 49 of the Nursing Personnel Recommendation, 1977 (No. 157), which provides 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 minimise it; (2) measures such as the provision and use of protective clothing, immunisation, 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; (3) In addition, nursing personnel who are exposed to special risks should receive financial compensation.” The Committee recalls that nursing personnel who, due to the specific characteristics of their work must be in close physical contact with their patients, are at high risk of being infected while treating patients with suspected or confirmed COVID-19, especially where infection control precautions, including the use of personal protective equipment (PPE), are not strictly practised. The Committee therefore requests the Government to provide detailed updated information on the nature and impact of safety measures taken or envisaged, including the provision of PPE and training in its correct use, as well as provision of adequate rest breaks during workers’ shifts and limitations on excessive hours wherever possible, with a view to protecting the health and well-being of nurses during the COVID-19 pandemic and in future crises.

Part V of the report form. Application in practice. The Committee requests the Government to provide updated detailed information on the application of the Convention in practice, including statistical data disaggregated by sex, age and region concerning: the ratio of nursing personnel to the population; the number of persons enrolled in nursing schools; the number of female and male nurses who enter and leave the profession each year; the organization and the operation of all institutions which provide healthcare services; as well as official studies, surveys and reports addressing health workforce issues in the Kyrgyzstani health sector.