Section 1
About the BES Healthcare CLA.

"Together we are stronger in providing the BESt health care."

This is the first Collective Labor Agreement entered into by the Employers: Saba Cares Foundation, St. Eustatius Health Care Foundation, St. Eustatius Auxiliary Home Foundation, Fundashon Mariadal and Mental Health Caribbean jointly with the unions: Algemene Federatie van Bonairiaanse Werknemers (AFBW), All For 1 Union St. Eustatius (AF1) and Saba United People's Labor Union and Association (SUPLUA).

With the conclusion of this CLA, they have taken a first firm step towards the establishment of one common employment conditions policy for healthcare on the BES. This has effectively converted a long-standing aspiration into a clear-cut result. Through this CLA, the Parties have specifically acted on the ambition expressed in the July 2022 conference to arrive at one joint CLA.

All of this has taken place based on the concept that acting together is preferred and a required factor in addressing the issues faced by Employers and Employees at present and in the future: Together we are stronger in providing the best health care!

In the establishment of this joint CLA, the Parties have been guided by the following principles:

Providing care is work centered on people; a joint Collective Labor Agreement is an essential instrument in order to continue to provide quality care.

The care organizations and the Unions consider a joint CLA for the BES an indispensable tool in order to maintain sufficient and qualified care personnel. This joint CLA is a key instrument in establishing a healthy, properly functioning labor market.

The CLA Parties’ intention is to prevent mutual competition regarding employment conditions through this CLA. This is vital in a labor market that is under pressure and that extends particularly outside the BES. In addition, the joint CLA supports the objectives of the Collaborative Association of Hospitals (DCHA) and Dutch Caribbean' Mental Health (GGZ CAS-BES) in areas such as capacity planning, training and education. In discussions with the relevant Parties, the Employers and the Unions can also act jointly and thereby create a better position for discussing the issues relevant to them. A CLA that is agreed with and for multiple healthcare organizations moreover provides efficiency gains.

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The joint CLA has a social function

With the enhancement of employment condition standards, the joint CLA makes a relevant contribution to improving the Employees’ standard of living (in relation to the cost of living). Poverty reduction has been one of the Government's policy objectives over a long period of time. A joint CLA can indirectly contribute to reducing the poverty issue in the Caribbean Netherlands, provided that financial resources will be provided.

In line with this, by contributing to the Employees’ standards of living, the CLA can also make a positive contribution to the health situation and (consequently) to the citizens of the islands, because it facilitates them in establishing a healthy lifestyle. This ultimately causes the joint CLA to have an effect on healthcare expenditure (i.e.: control).

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The joint Collective Labor Agreement has a basis and level of ambition

The joint CLA goes back to the start of the current CLAs of Saba and St. Eustatius on the one hand and Fundashon Mariadal on the other. These CLAs were originally based on the same principles, which is visible in aspects such as in the use of the job grading system FWG 3.0 and the salary structure. In particular, differences in available financial resources at the care organizations have over time resulted in differences in (primary) employment conditions between the two CLAs.

The parties have based the joint CLA on the standards of the primary employment conditions of the CLA Fundashon Mariadal (2022). As regards the standards of the BES Healthcare CLA, this therefore constitutes the starting point for this new joint CLA.

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Ambition

However, the Parties' ambition extends further and has been defined by the Parties in the text included below. This ambition is based on the following passage from the coalition agreement 'Looking out for each other, looking forward to the future' (2022).

A better future for the entire Kingdom

We share a past and a future in the Kingdom. A future we are designing together. After ten years of economic stagnation and the blows of a hurricane and a pandemic, the Netherlands wants to support the three Caribbean countries in steering the right course towards sustainable growth. This will be affected as intended in the Charter: on the basis of equality, reciprocity and on the basis of a fair exploration of needs and wishes for any adjustments to the Charter. In the Caribbean Netherlands we will continue our efforts to make Bonaire, Saba and St. Eustatius an equal part of the Netherlands.

In addition, the Parties have stated the following principles:

• The inhabitants of the BES islands are entitled to quality care and appropriate access to such care. Specific steps need to be taken in order to (continue to) accomplish this.
• Care on the BES islands should be of a level that compares to that in the European Netherlands (high quality), and also allow for the unique circumstances specific to the BES islands.
• These specific aspects cover topics such as: the habitants’ health situation (with an increasing demand for care, with frequent cases of one or more chronic illnesses, including mental health problems), aging issues, (the lack of sufficient) financial resources for the purpose of development, investment and maintenance, the availability of the required expert personnel and the fact that the islands are faced with many (managerial and/or organizational) challenges (the insular character).
• In order to continue to provide quality care on the BES islands, the Parties have determined that collaboration is indispensable, specifically in the area of:

• the labor market (issues),
• the employment conditions
• HR issues (including training, retirement and recruitment);
• sustainable employability (including lifelong learning)

• Regarding employment conditions, the Parties have determined that it should not make any difference where an Employee works in the health sector on the BES islands. An equal position should be rewarded equally. The situation should be equal with respect to (primary) labor conditions. This prevents competition on employment conditions, facilitates interchangeability and prevents stagnation. In addition, the level of employment conditions must be such that coming to and working on the BES islands will be appealing. Last but not least, the Parties have determined that working in healthcare on the BES islands, as part of the European Netherlands, means that the level of the employment conditions should be equivalent. This expresses their ambition to achieve a set of employment conditions that is appropriate for working in healthcare on the BES islands and that is equivalent to the level of the healthcare Collective Labor Agreements of the European Netherlands, in particular the CLAs for hospitals, mental health care as well as nursing, care and home care.
• In view of the personnel working in healthcare, the Parties have established that working on the BES islands has specific elements. Some relevant aspects include the average working hours per week, the required flexibility given the labor-market shortage and working in a (sub)tropical climate. In addition, the island character involves specific working conditions.
• The Parties wish to focus on training ("job and labor market fitness"), on sustainable employability (with a responsibility for the Employer and the Employee) and responding to life phases. This may include the use of instruments such as job differentiation, career paths as well as working less if other instruments are not applicable). This effort should contribute to retaining employees for care on the BES islands, to job satisfaction, the ability to continue to contribute to quality care and also to the ability to continue working until retirement age.

With the above aspects, the Parties have established both the ambition in terms of the purpose and level of the BES Healthcare CLA and the instruments and employment conditions to be included in the CLA. The BES Healthcare CLA is initially entered into by the abovementioned Parties. After the establishment of the CLA, the Parties are open to having other healthcare organizations join the BES Healthcare CLA.

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Appropriate funding

In order to execute both this first joint CLA and "the dot on the horizon," appropriate and structural funding will be necessary from the Government. The parties will act jointly as much as possible to accomplish this. Currently the OVA percentage of the European Netherlands^[1] is used to increase the annual budget for personnel costs of the care organizations on the BES islands. The Parties believe that a specific OVA system for the BES-islands is more appropriate given the BES-islands' own economic situation. In view of this, The Parties would like to see the Ministry of Interior Affairs and Kingdom Relations (Dutch: BZK) commission the development of an OVA-BES in 2024, the outcome of which will be available on January 1, 2025. The parties will work together to provide the appropriate criteria and parameters to arrive at a suitable OVA system for the BES islands.

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The joint Collective Labor Agreement has a specific structure

The joint CLA provides uniformity on the one hand and allows for island or organization-specific factors on the other. To achieve this, the parties have opted for a so-called "framework CLA".

This format will ensure that the same, unambiguous agreements are in place for all Employers and Employees, particularly in the field of primary and secondary employment conditions. In addition, this form encourages the Parties to take action on common HR themes together.

In view of the fact that island-specific or organization-specific elements and different types of care are being provided, it will moreover be preferred to be able to (continue to) offer customized employment conditions. This too, will facilitate the chosen form of a framework CLA.

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^[1] The Government Contribution to Labor Cost Development (Dutch: OVA): the NZa's indexation of personnel costs (labor costs) is based on a percentage set by the government: the Government Contribution to Labor Cost Development and Rates of Material (LCD).