Implementation: policy interventions and entry points Policy implementation is a chain process with several entry points, as illustrated

in Fig. 7.2. Policy-makers can utilize such entry points as opportunities arise, as

they ultimately work towards reaching the objective of decent work and decent life (i.e. sustainable health, work ability and work life for workers). Most of the actions discussed below need active multisectoral and tripartite collaboration and contribution.

Fig. 7.2 Entry points for multisectoral policy and practical interventions for work and health

7.5.1 Entry point A: implementation of international strategies and instruments

Countries often face difficulties in the ratification and implementation of international covenants and instruments, despite their often unanimous adoption in the international forums. Globally, ILO conventions have had modest ratification rates: collectively only about 20% of the theoretical maximum, with a few important exceptions (65, 66). This drove ILO to undertake special actions for ratification of the most important core conventions, now ratified by over 160 countries (86%). The rates are poorer in specific areas such as OSH: collectively, the three key OSH conventions (No. 155, No. 161, No.187) have been ratified by 20% of countries. Some countries have successfully ratified the conventions but have been unable to implement them: approximately one fifth of the countries, as reported by ILO (50, 66). However, there have been some cases where countries have not achieved successful ratification but have applied conventions in policies and

Health,

as legal guidance, and have implemented them in practice. Available research evidence on the positive impact of ratification on accident risks shows a significant association between high ratification rates of OSH conventions and low risk of fatal accidents (59). Potential actions to overcome difficulties in the implementation of international strategies include incorporating objectives for decent work, safety and health into national development strategies and programmes. These include objectives for ratification and implementation of international agreements and strategies; provision of information to advise national policy-makers designing intersectoral approaches for decent work, and to generate United Nations/ILO mechanisms for international legal and financial sanctions to enforce protection of workers’ rights.

7.5.2 Entry point B: integration and coordination of policies relevant to work and health

Many countries have intersectoral barriers which make productive and systematic collaboration between various jurisdictions problematic. This has been one of the main obstacles in effective implementation of international strategies and instruments. Labour and social policies are closely interdependent in the development of good jobs which ensure health, safety and social protection at work. Other sectors (e.g. education, industry, agriculture) may also offer relevant contributions. In some countries (such as China) and in the EU special high-level intersectoral councils, work life councils, OSH councils or other such mechanisms have been established as advisory bodies to government (or parliament) in order to enhance multisectoral approaches and collaboration. Countries such as the United Kingdom of Great Britain and Northern Ireland and Singapore have assigned financial resources and overarching implementation tasks for such bodies, either directly or through special agencies. Potential actions include the establishment of multisectoral advisory bodies to help policy-makers to coordinate efforts.

7.5.3 Entry point C: ensuring appropriate services, infrastructures and human resources for decent work

The role of labour and OSH inspections is to ensure the enforcement of employment and safety regulations. Inspectorates are available in most countries but almost universally suffer from shortages of resources, facilities and staff.

Often, inspections do not cover small-scale enterprises, self-employed and informal economy workers, in spite of their high risks and often unfavourable working conditions. ILO Labour Inspection Convention (No.  81) provides guidance for minimum requirements for human resources for inspection. It is government’s responsibility to fill the gap in coverage in order to comply with

the requirements of international standards and national law. The ILO’s call for full coverage under the Labour Inspection Convention has supported the ratification policies in general. Convention No. 161 on Occupational Health Services has been ratified by 30 countries. Full coverage is also requested by the WHO Global Strategy on Occupational Health for All but still has not received a widespread response. Global coverage of OHS is as low as 15% of workers and the workers most in need do not have access to such services. Special efforts are needed to reach the underserved sectors and vulnerable groups. The ILO, WHO and the International Commission on Occupational Health (ICOH) have launched models for practical low-cost interventions for small enterprises, the self-employed and informal sector. These have been found feasible and effective at grass-roots levels (e.g. Work Improvement in Small Enterprises – WISE, WIND, BOHS). Potential channels for action are ratification of ILO core conventions, governance conventions and implementation of the WHO’s Global Plan of Action (31, 39, 55, 56).

7.5.4 Entry point D: ensuring decent work at enterprise and workplace levels

The workplace is the ultimate site for ensuring safety and health at work.

This happens best through collaboration between the employer and workers at the OSH committee, as required by ILO Occupational Safety and Health Convention (No.  155), Occupational Safety and Health Recommendation (No. 164), Occupational Health Services Convention (No. 161) and Occupational Health Services Recommendation (No. 171) (50). Globally, the majority of workers are employed by enterprises and in workplaces with limited or no resources for the provision of decent work, including health and safety.

It is recommended that safety and health authorities provide public health interventions and OHS as external support for informal economies.

7.5.5 Entry point E: ensuring access to universal health services for all working people

The vast majority of working people (about 70%) and their families do not have access to comprehensive and competent health care. Poverty may prevent the use of services even when they are available. As health is an important prerequisite of work ability and thus of employability, every working individual and his/her family should be provided with adequate health services. The international experience speaks for a public universal health service, financed through public social insurance or from the public budget (14, 64).

7.5.6 Entry point F: organizing adequate social protection for all working people, including their dependants

The majority (at least 60%) of even formal workers and over 80–90% of the total global workforce live without adequate social protection such as insurance for health and disability; maternity benefits; pension; unemployment benefits;

and insurance coverage for occupational accidents and diseases (14, 17, 64).

Potential channels for action for each entry point are outlined in Box 7.1.

Box 7.1 Actions for each intervention entry point

Entry point A: implementation of international strategies and instruments Action 1. Generation of political support for ratification of international strategies through action of international coalition of global actors such as the ILO, other United Nations organizations and other international allies (OECD, G20, World Bank, IMF, WTO, EU) would help to transpose strategies into national law and further implementation. Potential channels for action: joint campaigns, technical training, information programmes and financing. Use of indicators, country profiles and transparent evaluation reports to ensure effective monitoring, auditing and follow-up of ratification and transposition processes would help to ground the political processes.

Action 2. Provision of information and advice to national politicians and policy-makers concerning design of intersectoral policies and strategies, as proposed by the ILO’s DWA, with an emphasis on decent life dimension, equity, social protection and the positive economic impact of DWA.

Action 3. Generation of United Nations/ILO mechanisms for international legal and financial sanctions and corrective actions to combat severe violations of workers’ basic rights, illegal employment practices and unreasonably hazardous working conditions.

Trade agreements should be conditional on meeting criteria for decent work following the model of elimination of child labour in production of sports consumer goods.

Entry point B: integration and coordination of policies relevant to work and health

Action 1. Establishment of a multisectoral advisory body would help to coordinate the development of decent work life, health, safety and social protection at work that would involve all relevant jurisdictions and social partners. It would be advisable to include objectives for decent employment, safety and health, work ability, social protection, and training and education of employers and working people in governments’ national development policies and plans. Respective bodies for intersectoral coordination and collaboration should also be established for the intermediate and workplace levels.

Box 7.1 contd

Entry point C: ensuring appropriate services, infrastructures and human resources for decent work

Action 1. Governments’ ratification of the ILO core conventions on rights and employment and special conventions on OSH and OHS, and due implementation in collaboration with social partners, are recommended. This would help to ensure decent employment conditions through necessary national regulations, standards and infrastructures with sufficient human resources. Safety inspection and OHS should be extended to all workplaces and workers, including small-scale enterprises, self-employed and informal economy workers. Where appropriate, practical methodologies such as ILO’s WISE, WIND and BOHS approaches should be used (31, 39, 56).

Action 2. Implementation of the WHO Global Plan of Action on Workers’ Health 2008–

2017 calling for organization of access to OHS for all working people including small-scale enterprises, self-employed and informal economy workers and other underserved and vulnerable groups (55).

Entry point D: ensuring decent work at enterprise and workplace levels Action 1. ILO has developed the Decent Work Enterprise Index and manual for implementation of decent work at workplace level. Governments may benefit from ILO’s technical and financial support in initiating national decent work programmes and from utilizing international advice in implementation of WISE, WIND and BOHS approaches (31, 56).

Action 2. Extension of adequate and well-functioning OHS to cover every workplace and all workers. Modern concept of occupational health targets advice and services on the prevention of occupational diseases and accidents, promotion of work ability, provision of outpatient services and rehabilitation. Other important targets are improvement of the work environment and development of work organization.

Action 3. In extending services to all workplaces, public sector interventions may be used to support and serve small-scale enterprises, self-employed and informal economy workers in their efforts to improve conditions of work, work environments and safety and health at work. This happens best in collaboration between the employer and workers within the OSH committee as required by ILO Recommendation No. 164 on Occupational Safety and Health and the Occupational Health Services Recommendation, No. 171 (50).

Entry point E: ensuring access to universal health services for all working people

Action 1. Improvement of primary health-care service coverage to reach every working individual and family, as recommended by WHO, including services for public and community health, and frontline prevention and curative services.

7.6 Way forward – how to overcome the implementation