Direct Request (CEACR) - adopted 2024, published 113rd ILC session (2025)

Nursing Personnel Convention, 1977 (No. 149) - Bangladesh (Ratification: 1979)

The Committee notes the observations by the Bangladesh Employers' Federation (BEF), incorporated in the Government’s report. It also notes the observations of the Trade Union Committee of International Labour Standards (TUC-ILS), received on 1 September 2022, in which it expresses concern that the situation in the private sector for health workers is more vulnerable than the public one, as there are no fixed minimum wages and no definitive working hours. The Committee requests the Government to provide its comments regarding the observations of the TUC-ILC.

Articles 2 and 3(1) of the Convention. National policy concerning nursing services and nursing personnel. Career prospects and remuneration of nursing personnel. Nursing education and training. The Government refers in its report to the adoption in 2019 of the Bangladesh National Strategy for Community Health Workers (CHW) (2019–2030), which complements the Bangladesh Health Workforce Strategy 2015. The goal of the Strategy is to improve health promotion and essential service delivery through an adequately trained and motivated CHW for achieving SDGs in Bangladesh. According to the Strategy, there are more than 185,000 CHWs in Bangladesh, with approximately 70,000 employed by the Government (representing approximately 3.8 CHW per 10,000 population) and the remainder by NGOs. CHWs have diverse scopes of work, and many have been involved with pioneering innovations that have subsequently been scaled up. CHWs include Family Welfare Assistants (FWAs), who provide community-based family planning services under the Directorate General of Family Planning (DGFP); Health Assistants (HAs), who provide immunization and other primary health care services; and Community Health Care Providers (CHCPs), who are managed under a special project to provide a range of preventive and primary curative care at community clinics. The Committee further notes that, according to the National Health Bulletin 2019, one of the top priorities of the Government is the filling up of the vacant positions in the health sector. In this regard, the Committee notes the information provided by the Government concerning the different existing nursing institutions (governmental and non-governmental), which offer different types of nursing education and courses, as well as the number of graduated students and registered/licensed professionals. With respect to the measures taken to improve the working conditions of nursing personnel, the Government indicates that the nursing personnel are getting the salary scale of grade 10 (basic 16,000–38,640 Bangladeshi takas corresponding to approximately US$137–330 monthly) and that they get all the benefits as per other government servants. The Committee notes the information provided by BEF that the salary of nursing personnel is reviewed every year and that in some cases, salary and benefits are fixed in mutual agreements. The Committee also notes the information provided by the Government regarding career advancement opportunities available for nursing personnel, including the possibility of becoming senior nurse, deputy superintendent of nurse, superintendent of nurse, and district public health nurse.

In this context, the Committee notes that, according to the WHO Global Health Observatory, between 2019 and 2021, the number of nursing and midwifery personnel increased from 63,857 to 103,828, and the density of nursing and midwifery personnel (per 10,000 population) from 3.8 to 6.13. In addition, the Committee observes from the national Health Bulletin 2019 that only 3.3 per cent of nurse positions under the Ministry of Health and Family Welfare were vacant. At the same time, the Committee notes that Bangladesh is included in the “WHO health workforce support and safeguard list 2023” of countries with the most pressing health workforce needs, particularly those countries with a density of health workers below the global median (49 per 10,000 population) and a universal health coverage service index below 55. In this context, the Committee notes the absence of information in the Government’s report on measures taken with a view to adopting a revised and updated Health Workforce Strategy and on the assessment of the implementation and results achieved under the previous 2015 Strategy. The Committee therefore reiterates its request to the Government to provide updated information in this respect in its next report, indicating the specific measures taken or envisaged to invest in education and training and improve working conditions, including career prospects and remuneration, to attract and retain both women and men in the nursing profession as well as to increase the quantity and the equitable distribution of nursing personnel.

Application in practice. The Committee notes the information provided by the Government regarding the number of nursing personnel disaggregated by region, which shows that the Dhaka region is with the highest number of nurses and midwives (respectively 9,831 nurses and 1,377 midwives) followed by the Rajshahi region (15,585 nurses and 1,103 midwives). The region with the least number of nursing personnel is Mymensingh (1,893 nurses and only 360 midwives). The Committee observes that the Government does not disaggregate the number of nurses that work in the public and private sectors. It does also not provide information on the number of those who leave the profession each year. Considering that these constitute important parameters to be taken into account when developing a dedicated and comprehensive national policy concerning nursing services and nursing personnel, the Committee requests the Government to provide with its next report detailed updated information, disaggregated by age, sex and region, concerning the situation of nursing personnel – including midwives, 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. It also requests the Government to indicate whether and how such data has fed into the development of the national policy concerning nursing services and nursing personnel and to provide copies of recent reports, studies, or surveys relevant to the matters covered under the Convention.