LABOUR RELATIONS, EMPLOYMENT CONDITIONS …

1 LABOUR relations , EMPLOYMENTCONDITIONS AND PARTICIPATIONIN THE health SECTORDr Pedro BritoCoordinator, Human ResourcesDevelopment Program,PAHO/WHO, Washington DCPedro GalinNOGAL, AC, Buenos AiresLawyer, External consultant, PAHOM arta NovickSociologist, CONICETR esearcher at Industrial Instituteof University of Gral. SarmientoExternal consultant, PAHOW orkshop on Global health Workforce StrategyAnnecy, France, 9-12 December 2000 World health OrganizationDepartment of Organization of health Services DeliveryGenevaSwitzerland2001 2 2r 2y D2 PHHI 2 2 2 2 2 2 2 2 2 2r 2y @ ryAD2 2 2 2 2 2 !2 2y F2 2 2 !D # D2 2 !2 # D2 D2 2 2 D2 2 2 2# D2 2 2 2 2 2 2 2 2 $ 2# 2 2 FLabour relations , EmploymentConditions and Participationin the health SectorDr Pedro BritoCoordinator, Human Resources Development Program,PAHO/WHO, Washington DCe-mail: GalinNOGAL, AC, Buenos AiresLawyer, External consultant, PAHOe-mail: NovickSociologist, CONICETR esearcher at Industrial Institute of University of Gral.

2 SarmientoExternal consultant, PAHOe-mail: 1 health care sector reform and 1 Decentralization of personnel 2A new agenda for human resources 2 Reforms, players and 2 Management of human resources within sector reform .. 3 Various models of EMPLOYMENT and LABOUR relations in health 4 LABOUR regulation models.. 4 Models of public administration reform .. 5 Models for EMPLOYMENT and LABOUR 6 Types of EMPLOYMENT and LABOUR CONDITIONS in the health sector .. 6 EMPLOYMENT and Contract 7 Regulatory framework and contract modalities .. 7 Multiple EMPLOYMENT .. 8 LABOUR relations , organization and working CONDITIONS .. 9 Collective LABOUR 9 Working CONDITIONS .. 10 participation in management .. 11 Notes and 12x1 LABOUR relations , EMPLOYMENT CONDITIONS and participation in the health SectorWorkshop on Global health Workforce Strategy 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 E D2 2 2 F 2 2 X r 2 2 2 2 2 E X2 2 2 F 2 2 2 2 2 2 2 2 2 2 Y2 2 2 2 2 2 2 F 2 2 2 2 2 2 2 2 2 2 D2 2 2 2 2 2 2 2 FIntroductionHealth care sector reform and re-organization 2 2 2 2 2 2 2 2 2 2 F2e 2 2QS$ 2 2 E 2% &2 2 2 2 2@IAD2 * 2W$ 2 2v 2e 2 2@PAF2e 2 E 2 2 2 2 2 2 2 2v 2e D2 2 2 2 2 2 2 & 2 2 2 2 2 F2 2% 2 2 2 2 2 2 2 2 2 2 D2 2 2 2 2 D2 2 2 2 2 2 D2% 2 2 2 2 * 2% 2 2 2 2 F 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 %2.

3 E F2e 2 2 2 D2 2 2 2 2 2 2 2 2 F2 2 2 2 2 2 2 2 2 2 2 2 . 2 2 2 F 2 IWVH1 2 2 IWWH1 2 %2 2 2 2 2 2 2 2% % F2h 2 E 2 2 2 2 2 2@ E 2 * 2 2SH72 2US72 2 1 2 2 AD2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 F2y 2 * 2 2 2 ry2 2 2 2 2 2 2 2 2@ F F2 2 2 A2 2 2 2 2 2 2 2 2 2 2 2@QAFs 2v 2e D2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 g D2 2 2 2 2 2 2 D2 2 2 2 2 2 F2 2 2 2% 2 2 2 2 2 2 2@RAD2r 2w 2 2 2 2 2 2 2 2 2 F2s 2 2 D2 %2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 E 2 *F2w 2 2 2 2 2 2 2 @ 2 * 2 2 2 2 2 2 2 2 A2 2 2 2 2@ 2 2 2w 2 2r 2 2 2 AF2p 2 2 2 2 2 2 2 2 2 2 2@SA2 2 2 2 Fi 2% 2 2 2 2 2 2 2 2 2 2 2 D2 2 E 2 2 2 D2% 2 2 2 2 D2 2 2 2 2 2 2 2 2 2@TAF2 D2 2 2 2 2 2 2 2 2 2 2% 2 2 F2 2 2 2 2 2 2 2 2 2 E 2 F2e 2 D2 2 2 2 2 2 2 2 2 2 2 Workshop on Global health Workforce Strategy2 2 D2 2 2 2 2 2 2 2 2 2 2 2 2 2 F * D2 2 2 2 2 2 2% 2 2 2 2 2 2 D2 2 2 2 2 2 2 2 2 2 2 2 2 Fq 2 & D2 2 2 2 2 2 2 2 2 E F2r 2 % &

4 D2 2 2 2 D2 2 2 2 2 2 2 2 F2p 2 2 2 2 2 2 * 2 2 2 2 2 2% & 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 F 2 2 2 2 2 2 2 2 2 E 2 E 2 D2 2 2 2 2 2 2 2 2 D2 2 2 2 E 2 2 E 2 2 2 D2 2 2 2 2 2 2 2 2 2 2 2 F2 2 2 2 2 2% 2 2 2 D2% 2 . 2 2 2 D2 2 2 %Fe 2 2 2 2 2 2 2 2 2 D2 2 % 2 2 Xh 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 % 2 2 2 F2 2 2 2 & 2 2 2 2 2v 2e 2 2 2 2i E 2 2@UAF2e 2 2v 2e 2 2 D2 2 2 2 2 2 E 2 2 2 2 2@ D2 2 2 2 A2 D2 2 2 2 D2 2 2 2 2@ 2 2 2 . AF2 2 2 2 2 2 2w 2 2r 2@VA2 2 2 2 2 2 2 2w 2 2 2 F2s 2 D2 2 2 . 2 2 2 2 2 2 2 2 2 2@WAD 2 2 2 2 2 2% e2 2 2 2 2 2 2 % 2 2 2 2 2 2 2 2 2 2 X2 2 2 D2% 2 2 2 2 2 2 2 2 2 D2 2 2 2 Y2 2 2 2 2 D2% 2 2 2 2 %2 2 2 2 2 2 * 2 2 2 2@IHAF 2 2 2 2 2 2 2 2 2 2 2 2 2 2% 2 2 2 2A2 2 2 2 2 2 2 & 2 2 2 2 2 % F2 %2 2 2 2 2 2 2 2 2 2 2 F D2 2 2 g 2 2 2 2 2 2 2 2 2 2 2 2 2 2 F 2 * 2 2 2 2 2 2 2 2 2 2 2% 2 2 2 2 2 2 2 2 2 Fs 2 D2 % 2 2 & 2 2 2 2% &2 2 2 2 2 2.

5 2 2 2 2 2 2 2 2 2 % F2 2 2 2 2 D 2 2 2 2 2 2 2 D2 2 2 2 2% & 2 2 D2 %2 2% 2 2 2 2 D2 2 2 2 2& % 2 2 2 2 Fx3 LABOUR relations , EMPLOYMENT CONDITIONS and participation in the health sector 2 2 2 2 D2 2 2 2 2 2 F2 2 E 2 2 %2 2 2 2 2 D2 2 2 2 E 2 2 2 2 % F2 2 %2 2 2 2 2 2% & 12 2 E 2% 2 2 2 2 2 2 2 F 2 % 2 2 2 2 2 2 2 2 2% 2 2 2 2 2 2 2 2 2 FManagement of human resources within sector reformh 2 2 2 2 D2 %2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 F2e 2 2 2 2 2 2 2 & 2 2 2v 2e D2 2 2 2 2 2 2 2 2 2 2 2 2 F2 2 2 2 2 2 &2 2 2 2 2 2 2 D2 2 % 2 2 E 2 2 2 2 2 2 F 2 2 2 2 D2 2 2 2 2 2 2 2 2 D2 E 2 2 % & D2 D2 2 2 2 F2 2 2 2 2% 2 2 2 2 2 2 F2 2 2 2 2 2 2 2 2 2 2 2@IIAF2g 2 2 2 2 2 D2 2 2 2 2 D2 . 2 2% & 12 D2% 2 2 2 & 2 2 2 2 2 2 D2 2 2 2 2 2 % &Fg 2 2 2 2 2 2 2 2 2 2 2@ F F2 2 2 2 2 2% &2 A2 2 2 2 2 2 2 2 2 2 E 2 2 2 2 2.

6 2 2 2 2 2 2% 2 2 2 & 2 2 2 F2s 2 2 D2 2% 2 2 2 2 %2 2 2 2 Uhiyr D) D hp s rs urhy u rp xr T i h v r pr r s rs D yvph v s xr 29rpr hyv h v 28uh tr v ur Hv v vr i u p hy h q s p v hy 28uh tr v sv h pr h q h r qhyv vr 2Ir h htr r qhyv vr ) r r hyv h v pv t i v t s r vpr h r p 28uh tr v ph r qry h v h h q p yr yr ry 2@ r v s p r htr 28 pr v u hyv 2B rh r r y v s r vpr h q v r r v 28uh tr v s p v h q r p r r pvr 29r h q s hyv h q q p v v 2P th v h v hy puh tr h q h rsr r pr s rh x 2 Ghi syr vivyv ) r h q r rph v p hp v t rpuh v 2@ uh v r s h pr h q r hy h v 28uh tr v v pr v r 2Q pr rt yh v u h r pr qr ry r 2Q sr v hy hpp rqv h v h q pr vsvph v 6 RXUFH 3$+2 :+2 +XPDQ 5 HVRXUFHV 'HYHORSPHQW 3 URJUDP Workshop on Global health Workforce Strategy4 2 2 2 2 %2 2 2% 2 2 2 2 2 D2 2 2 2 2 2 F2 2 2 2 * 2 2 E 2 E D2 2 2 %2 2 D2 2 * 2 2 2 2 2 E D2 2 2 FVarious models of EMPLOYMENT and LABOUR relations in health sectorsi 2 2 2 2 2 2 2 2@ 2 2 2 A2 2 2 2 2 2 2 2 2 2 % &2 2 2 * 2 2 2 2 2 2 2 2 F2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 F2s 2 2 2& 2 2 2 2 2 2% 2 2 2 2 2 2 2 2 2 D2% 2 2 2 2 2 2 2 F2 2 2 D2% 2 2 2 D2 2 2 2 2 2 & 2 % 2 2 2 2 2 2 & 2% 2@IPAFp 2 2 D2 * 2 2 2 2 2 2 2 2 2 2 2 2 2 2% 2 2 2 2 2 2 2% 2 2 2 % &D2 2 D2 2 2 F2 2 2 2 2 2 2 2 2 2 2 2 FLabour regulation models.

7 2 2 2 2 2 2 2 2 2 X2 2 2 i D2 2e E * 2 2 2t F2i 2 * 2 2 2 2 e2 2 2 2 2 2 2 2 2 2 %2 D2% 2 2i 2 E 2 2 F2t 2 2 2 2 2 2 2 2 D2 2 2 2 Fy *2 2 2 2e 2 2 2 2 2 % 2 2 2 2 2 WH1 2 2 & 2 2 2 2 2 2 2 2 F2 2 2 2 2 2. 2 2 F2p 2 D2 2 2 2 2 2 2 2 2 2 2 & 2 2 2% 2 2 2 2 2 2A2 2 2 2 2 2 2@IQAF2yigh2 2 2 2 2 2 2 2 2 2 2 2 2 2 2% 2 & 2 2% & 2 D2 D2 2% 2 2% & 2 2 2@IRAF2 2 &2 E % 2 2 2 2@ 2 2 2 2 2 A2 2 % 2 2 2 2 % 2 2 2 2 2 2 2 2 2@ISAFe 2 2 2 2 2 2 2 2 2 %2 2 2 2 % 2 2 2 2 F2 2 2 2 * X2 2% 2 2 E G 2 2 2 2 2 %2 2 2 . 2 2 2 2 2 2 2 E F2e 2 2 2 2 2 2 2 G E 2 2 2 % 2 2 2@ 2 2 A2 2 2 2 2 G F2 2 2 2 2 2 % 2 2 2 G 2 2 2 2 IWVH1 2 2 2 2 2 2 2 2 2 2 2 2 E 2 2 2@ITAF2s 2 IWWV2yigh2 2 2 2% 2 2 2 2% 2 2 2 2 . 2 2 % 2 2 2 %2 2@IUAF2s 2 IWWW2yigh 2 2 2 * 2i 2 2v 2@i vA2 2 2 2 2 2 & 2@IVAF2 2 2 2 2 2 2 2 2 2 2 E 2 2 2 2 2 D2 2 2 2 2PU2 2 % 2 2 2 IWVH1 x5 LABOUR relations .

8 EMPLOYMENT CONDITIONS and participation in the health sector 2 2 2 IWWH1 F2g 2% 2 2 D2 2 2 2 2% 2 2 2 2i v2 2 2@e 1 2 AFs 2 2% % 2 2 2p G 2 2 2 2 2 X2 h 2 2 & 2 G 2 2 2 2 2 2 c2w 2 % 2 2 Fs 2 2 2 2 2 2 2 2 2 2 2 E 2 2 2 2 2 F2f 2 2 2 2 2 2 2 2 2% & 2 F2e2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 D2 2 2 2 2 2 2 2 12 * 2 2@IWAFe 2 2 2 2 2 % 2 2 X2v 2e 2 2 Ei 2e Fy * 2 2 2 2 2 2 2 E D2 2 2 2 2 2 2 & 2 2 2% 2 2 2 2 & 2 F2y 2 2 2 D2 2 2 E 2 2 2 2i 2e 2 2 2 & 2 2 2 E D2 2 2 2 2 2 2 2 2 2 2 2 2 * E 2 2 2 % F2s 2 2 2 2 2 2 2 2 2 2 2 2 2 D2 2 2 2% E 2 F2 2 E *2 2 2 2 2i 2e 2 2 2 2 2 2 2 2 XJ q % 2 2% 2 2 2 2 2% 2@PHAJ s 2u 2 2% 2 2 2 2 2 2 2 2 2 2 D2 2 2% & 2 2 2 2 2 2 2 2 2@PIAD2 2 2% &E 2% 2 2 2 2 2 2 2 % J 2 2 2 2 2 2 IWWH1 2 %2 %2 2 2 2% 2 2 2 2 12 % 2 2@2 2 2 2 2 2 AF 2 2 2 2e 2 2 2 2 * 2 & 2 2 2 2 2 2 2 2 2 2 2 2 & 2 2 2 2 2 2 2% & 2 2 2@PPAF 2 *2 2 2% 2& % 2 2v 2e X2 2 2 2 2 2 2 2 2 2 2 2 2 2 2% 2 2 2 2 % 2 2 2 2 2 F2v 2 D2 2 D2 2 & 2 * D2 2% 2 2 2@ 2 * AD2 2 2 % 2 2 2 F2s 2 2 IWWH1 2 2 2 2 2 2 2 2 2 2 2 D2 2 2 2 2% & 2 2 * 2 2 FFF2@ A2 2 2 2 2 2 % D2 2 2 2 D2 2 2 2 2 2 2 2 2 2@PQAF2s 2 2 2 D2 2 X2 2 2 2 D2 2v 2e D2 2 2 2 2% 2 2% 2 2 2 2 2 D2 2 2 2% 2 2 2 E 2 2 2 2 2 2 2 2 D2 2 2yigh2 2@PRAF 2 X2 2 2 2 2 2 2 2 2 * D2 E 2 2 E 2 2 2 2 2 2 2 2 2 2 2A2 2 2A2 2 2 2 2 F2y 2 2 2 D2 2 2 2 2 2 2 2 FModels of public administration reform 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 F2s 2 2 D2 2 2 2 2 2 2 2 2 2 2 2f &2 2 2% 2 2 2 IWWH1 2@ 2 2% 2 2 2 2 2 2 2 2 2 2 2 2 AXWorkshop on Global health Workforce Strategy6 2 2 2 2% 2 2 s 2 2% 2 2 2 2 2 2& 2 2 2 2 X2 D2 D2 2 2 2 Fi* 2% 2 2 2 2 2 2 2 2 2 D2 2 2 22 2 2 2 D2% 2 2 2 F2 2 2 2%

9 2 2 D2 2 2 2 2 2 2 2 2 2@PSAF2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 D2% 2 % 2 2% 2 2 2 2 %2 2 2 2 2@PTAF 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 % F2g 2 & 2e 2@% 2 2 2 2 2 2 2 2 E 2 2 %AD2f D2s 2 % 2 2 2 2 2 2 2 2g 2 i 2i 2 2 2 2 * F2s 2 2 2 2% 2 2 2 2 2 D 2 2 2 . 2 2 2 2 D2 2 2 2 2 2 2 X2 E D2 D2 2 2@PUAF2e 2 2 * 2 2 D2 E 2 2 2 2 2 2 2 2 D2 2 2 2 2 2 2 2% 2 2 2 2 2 2 2 2 * 2 2@PVAFM odels for EMPLOYMENT and LABOUR relations 2 2 2 2 2 2 X2 D2 E D2 2 2 E F2 2 2 2 2 % 2 2 2 2 2 2 2 2 D2 2% 2 E 2 2 2 F2 2 2 2 2 F2e 2 2% 2 2 2 2 2 2 *2 2 D2 2 2 2 D2 2f 2 2 F2 2% 2 2 2 2 2 % 2 D2 D2 * D2 2 2 2 2 2 2 F2 2 2 2 2 D2 D2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 Fv 2 2 2 2 2 2 D2 2 2 D2 2 2 2 2 2 2 2 2 X2 2 2 2 2 2 X2 2 2 2i D2 2e E * 2A2 E 2 2x 2e 2A2 2 2t D2 2% 2 2 F2e 2 2 Dv 2e 2 2 2i 2e 2 2 2 2 2 2 FTypes of EMPLOYMENT and LABOUR CONDITIONS in the health sectorr 2 2 2A2% 2 2 2 2A2 2 2 % 2 2 2 2 E 2 2 2 2 F2 2 2 2 2 2 2 2 2 2 2 2 2 2@f 2 2f & 2 A2 2 2 2f 2@PWA2 D2 2 2 D2 2 2 2 2 2 % 2 2 2 2 2 2 F 2 2 2 2 2 2 2 2 2 2Q$ 2 X s 2 2 2 2 2 2 g 2 2 2 2 2 2 % h 2 2 %2 2 2% 2

10 2 2 2 2 2 . 2 2 *2 2 2 E & 2@QHAFx7 LABOUR relations , EMPLOYMENT CONDITIONS and participation in the health sector 2 2 2 2 % F2 2 2 2 2 2 2 2 2 2 2 2 & E F2 2 2 % 2 2 2 2 2 2 2 2 * 2 2 2 2 2 2 2 2 F2 2 2 2 & 2 2 2 E 2 2 2 & 2 2 2 2 2 2 D2 2 2 2% 2 2 2 2 X2 2 2 2 2 & 2 2 2 & 2% % & 2 2 2 2 2 2@QIAFg 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 D2 2 2 2 D2 2 2 2 2 2 2 2 2 2@QPAF2e 2 2 2 2i 2 2 2 2@QQEQRA2 %2 2 2 2 2 2% & 2 2 2 2 . 2 2 2 2 2 2 2 2 2 2 E 2 2@ * 2 D2 A 2@QSAFE mployment and Contract Modalitiesi s 2 2 2 2 2 D2 2svy2@QTA2 2Q2 2 & 2 2 2 X 2 2 2 F2e 2 2 * 2 2 2 2 2g 2 2v % 2 IWUR2 2 IWWH2@ 2 2% 2 2 2 2 AF2s 2 2 2e D2g D2 2 2 2S72 2 2 F2s 2v 2e D2 eD2 PVHH 2% 2 2 2 2 2 % 2 2 2 2@QUAF2 2 2 2 2 % 2 2 2 Y2 2 2 D2 2 2 2 2 2 2 2 E F2e 2 2svy2 D2 2 2 2 &2 2 2 2 2 2% F2w 2 2 2 % 2 2 2 E 2 2 % 2 2 2 2 2 2 2 D2 2 2 D2 2 2 2 2 E 2 2 2 2 2 2 2 2 2 F2 2 2 2 2 2 2 2 2 2 F 2 2 2 2 2 2 D2 2 2w * D2 % 2 2 F2s 2 % D2 E 2 2 2 2 2 2 TFP72 2 2 2 IWUH2 2 WFW72 2 IWVHD2 2 2 @QVA2 2 IWWPF 2 2 2 2A2 2 2 2 F2 2svy2 2 2f 2 2 F2e 2 2 2 2 2 2 2 2 2 2 2 2 2 D2 2% 2 2 2 2 2 u2@QWAD2% 2 2% 2 2 2 2 2 2 2 2 * 2 2 2 2 2 & F2 2 2 2 %2 2 2.