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

Nursing Personnel Convention, 1977 (No. 149) - Kenya (Ratification: 1990)

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 proceeded with the examination of the application of the Convention on the basis of the supplementary information received from the Government this year, as well as on the basis of the information at its disposal in 2019

Articles 2(2) and 3(1) of the Convention. National policy concerning nursing services and nursing personnel. Nursing education and training. In its previous comments, the Committee noted the Government’s indication that nursing in Kenya was undergoing transformation, with the sector being reformed to align itself with the Constitution. The Committee noted the Government’s reference to the Nursing Strategic Direction towards Vision 2030, which aimed to: reorganize the Scheme of Service for Nurses, mainstream processes for improved quality of nursing services; and introduce new programmes. The Committee requested the Government to provide information on the implementation of these large-scale reforms and their impact, particularly in relation to the quality of nursing care. The Government reports that nursing in the country has undergone extensive transformation during the reporting period. It adds that the Scheme of Service for nursing personnel, established in 2015, is due for review, indicating that a Directorate in nursing was established with the support of the Scheme. With respect to measures to promote the retention of nurses, the Committee notes the Government’s indication that the promotion of nurses is being carried out using the current Scheme of Service, and there has been an increase in allowances. The Committee further notes the Government’s indication that nurses are being trained on processes, resulting in improved collaboration with other health workers and better patient care. The availability of specialized care has been increased through nurses who have completed the requisite courses. In addition, mobile clinics have enabled nurses and midwives to provide comprehensive care in communities, reducing healthcare disparities. The Government refers to the “Big Four” plan announced in December 2017, which will guide the development agenda of the country in the period 2018–22, and includes Universal Health Coverage (UHC). The Committee notes with  interest  the launch of Kenya’s Nursing Now campaign in 2018, which seeks to strengthen leadership in nursing as a central principle as well as to achieve UHC. The Government indicates that compiling data on the overseas migration of nurses remains a challenge given that many nurses migrate for other purposes, but start working overseas. Moreover, few nurses request a license from the national regulatory body before migrating. The Committee takes note of the detailed Annexes provided by the Government on the public and private institutions providing nursing education and training and the number of students who graduate from nursing colleges annually. It also notes the detailed information regarding the organization of nursing studies (requirements for entry, levels of education, duration). The Government indicates that there are currently 26 different training programmes (five at certificate level, 19 at diploma level and two at degree level) with different entry requirements and duration of study. Furthermore, post-basic diploma courses are offered in Kenya, providing specialized training in areas such as cardiac nursing and community nursing. With respect to the manner in which nursing education and training is monitored, the Government indicates that the Nursing Council of Kenya (NCK) is mandated to set standards related to the education and practice of nursing and midwifery and of health care through: regulation of nurses and midwives training syllabi and institutions; conducting of licensing examinations; compilation and maintenance of registers, rolls and records required to be kept under the Nurses Act; undertaking disciplinary measures as necessary to maintain a proper standard of conduct and nursing care; and advising the Cabinet Secretary on matters concerning all aspects of nursing. The Committee requests the Government to continue to provide updated information on measures taken or envisaged to promote the retention of nursing personnel and to provide information on the impact of new programmes to improve working conditions of nursing personnel and the quality of nursing care, including on the impact of the Nursing Now campaign. The Committee requests the Government to provide detailed information, including disaggregated statistical data concerning trends in the overseas migration of nurses and information on the impact of measures taken to address this issue. The Committee also requests the Government to continue to provide information on the number of students who graduate from nursing colleges annually and the number of institutions offering nursing education and training, and on the organization and monitoring of nursing education and training.

Article 5(2). Determination of conditions of employment and work. The Government indicates that, although the Kenya National Union of Nurses (KNUN) has concluded collective bargaining agreements with various private nursing institutions, it has not yet concluded a collective agreement to improve the terms and conditions of employment for nurses employed by county governments. The Committee reiterates its request that the Government provide a copy of the collective bargaining agreement between the KNUN and the Government once it has been concluded. In addition, the Committee once again requests the Government to provide copies of the collective bargaining agreements in force between the Government and the Union of Kenya Civil Servants and the Kenya Union of Domestic, Hotels, Educational Institutions, Hospitals and Allied Workers that contain provisions on the employment conditions of nursing personnel.

Part V of the report form. Practical application. The Committee takes note of the registration data provided by the Government, according to which, for the fiscal year 2019-20, there were 366 nurses in private practice and 1,316 nurses registered with the Nursing Council of Kenya. The Committee requests the Government to provide detailed information, disaggregated by age, sex and region, concerning the situation of nursing personnel in the country, including the nurse-population ratio, the number of nursing personnel broken down by those working at public and private healthcare establishments, and the number of those who leave the profession each year and copies of any recent reports or studies addressing nursing-related issues.

Article 7. Occupational, safety and health. The Committee notes the establishment of a National Emergency Response Committee on Coronavirus on 28 February 2020 through Executive Order No. 2 of 2020 and the adoption of the “interim guidelines and protocols for SARS-CoV 2 and COVID-19”. The Committee notes that the guidelines include recommendations for comprehensive prevention and case management strategies, addressed to health care workers taking care of patients suspected or confirmed to have COVID-19. According to “ILO: Country policy responses, COVID-19 and the world of work”, the Government has established the COVID -19 Emergency Response fund in partnership with the private sector. The Committee draws the attention of the Government to Paragraph 49 of Recommendation 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 also draws the Government’s attention to the ILO Guidelines on decent work in public emergency services, 2018, which recognize the need to protect public emergency workers, including emergency health workers, from exposure to communicable diseases. In particular, paragraphs 50 and 51 of the Guidelines stress that suitable and sufficient personal protective equipment (PPE) should be provided as protection against exposure to hazardous conditions for public emergency services (PES) workers and that workers and/or their representatives should be consulted and participate in relation to the selection and correct use of PPE. Noting that nursing personnel, are at high risk of being infected while treating patients with suspected or confirmed COVID-19 when infection control precautions, including use of personal protective equipment (PPE) are not strictly practiced, the Committee requests the Government to provide detailed updated information on the safety measures being taken or that are envisaged, including the provision of PPE and training in its 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 wellbeing of nurses and limiting as much as possible their risk of contracting COVID-19.