ILC110/III/(B) – Securing decent work for nursing personnel and domestic workers, key actors in the care economy Introduction due to migration flows from lower- to higher-income regions. For example, the average number of nurses per 10,000 population in the Africa region is 8.7, compared to 83.4 in the Americas.10 Over-reliance on migrant nursing personnel by higher-income countries to the detriment of the supply on nursing personnel in lower-income countries has the potential to undermine the health systems of the latter countries, leading to severe understaffing and poorer health outcomes.11 10. Moreover, healthcare and health systems globally are undergoing rapid changes that are affecting nursing personnel directly, including changes in the burden of disease, with more long-term conditions and non-communicable diseases, as well as the emergence of new diseases, as shown by the COVID-19 pandemic. Further changes include: the increased demand for healthcare from ageing populations in many countries; the migration of health workers, largely from lower- to higher-income countries; the impact of climate change on health, such as heat stress, increased respiratory and cardiovascular diseases, injuries and premature deaths related to extreme weather events; the increasing commodification of health services, which places a premium on measurable procedures; global and national policies that prioritize health and have helped make it the largest and fastest-growing sector in the global economy;12 and scientific and technological advances, such as artificial intelligence (AI) and robotics.13 Nurses and other health workers face many common issues and concerns as a result of these changes, while there are also important differences between countries in education, training and development needs. Domestic workers 11. The inclusion of the Domestic Workers Convention (No. 189) and its corresponding Recommendation No. 201, 2011, in this General Survey is also extremely fitting, as it is now over ten years since their adoption by the Conference. The General Survey examines the evolution of law and practice in Member States over the past decade and identifies the good practices developed and implemented at the national level to give effect to the principles of the instruments. 12. The COVID-19 pandemic has brought into sharp relief the vulnerability of the over 75.6 million domestic workers around the world.14 Most domestic workers (76.2 per cent) are women,15 who are often in informal employment. Many domestic workers are also migrants, who are frequently in informal and precarious employment, thereby increasing their risk of exploitation and abuse. Moreover, migrant female domestic workers, who often come from disadvantaged population groups, are more likely to be victims of intersectional or multiple forms of discrimination, compounding their vulnerabilities. 10 For instance, , foreign-born nurses represented 16.4 per cent of the nursing workforce from 2015 to 2016. In absolute terms, the United States remains the main country of destination for migrant doctors and nurses (45 per cent of all foreign-born health workers who practise in OECD countries). See: OECD (2019), Recent Trends in International Migration of Doctors, Nurses and Medical Students , OECD Publishing, Paris, pp. 17 and 20. See also: WHO, ICN and Nursing Now (2020). State of the world’s nursing 2020, op. cit., p. 37. 11 ibid., p. xiii. 12 WHO (2016). Working for health and growth: Investing in the health workforce , Report of the High-Level Commission on Health Employment and Economic Growth (HEEG), Geneva, p. 21. 13 All-Party Parliamentary Group on Global Health (2016). Triple impact: How developing nursing will improve health, promote gender equality and support economic growth , London, p. 11. 14 ILO (2021). Making decent work a reality for domestic workers: Progress and prospects ten years after the adoption of the Domestic Workers Convention, 2011 (No. 189) . 15 ibid., p. 12. 19