African Newsletter
Volume 20, number 3, December 2010
Injury and disease
reporting systems
O N O C C U P A T I O N A L H E A L T H A N D S A F E T Y
Contents
3 Editorial
N. Henwood SOUTH AFRICA
Articles
4 ILO list of occupational diseases and health care workers
S. Niu ILO
10 Protection of health care workers with focus on respiratory
health
K. Michell SOUTH AFRICA
13 Hepatitis in the context of Botswana
NK. Mwaniki BOTSWANA
16 Safety implication of pesticides use in vegetable cultivation
Example:
small-scale farmers in Dar es SalaamBK. Kaoneka, E. Lekei, AJ. Rwazo, JJ. Matee TANZANIA
20 Ethiopian migrant workers’ perceptions of the UK’s health
and safety regulations
TA. Jemaneh ETHIOPIA
23 Towards Better Work and Well-being - International
conference
T. Pääkkönen FINLAND
African Newsletter
ON OCCUPATIONAL HEALTH AND SAFETY
Volume 20, number 3, December 2010
Improving occupational injury and disease reporting systems
Published by
Finnish Institute of Occupational Health Topeliuksenkatu 41 a A
FI-00250 Helsinki, Finland
Editor in Chief Suvi Lehtinen Editor Marianne Joronen Linguistic Editors Alice Lehtinen Sheryl S. Hinkkanen Layout
Liisa Surakka, Kirjapaino Uusimaa, Studio
The Editorial Board is listed (as of June 2009) on the back page.
A list of contact persons in Africa is also on the back page. This publication enjoys copyright under Protocol 2 of the Universal Copyright Convention. Nevertheless, short excerpts of articles may be reproduced without authoriza-tion, on condition that source is indicated. For rights of re-production or translation, application should be made to the Finnish Institute of Occupational Health, International Affairs, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland. The African Newsletter on Occupational Health and Safety homepage address is:
http://www.ttl.fi/AfricanNewsletter
The next issue of the African Newsletter will come out at the end of April 2011. The theme of the issue 1/2011 is
Mining.
African Newsletter is financially supported by the Finnish In-stitute of Occupational Health, the World Health Organiza-tion, WHO, and the International Labour Office.
Photographs of the cover page:
© International Labour Organization, M. Crozet Finnish Institute of Occupational Health, 2010 Printed publication: ISSN 0788-4877
On-line publication: ISSN 1239-4386
The responsibility for opinions expressed in signed articles, studies and other contributions rests solely with their authors, and publication does not constitute an endorsement by the International Labour Office, World Health Organization or the Finnish Institute of Occupational Health of the opinions expressed in it.
47 Editorial
Tsuyoshi Kawakami ILO
Articles
48 Injury and disease reporting in Tanzania
Joshua Matiko Tanzania
50 Themes of the African Newsletter in 2011
51 Reporting systems of occupational diseases in Nigeria
Obehi Okojie Nigeria
54 Occupational health and safety in Egypt - an overview
Valenti Antonio, Mohamed Omaira, D. Venanzi, L. Fantini, S. Iavicoli
57 Singapore’s framework for reporting occupational
acci-dents, injuries and diseases
Lee Hock Siang, Alvian Tan Singapore
61 Identification and reporting of work-related diseases
Jorma Rantanen
Contents
The responsibility for opinions expressed in signed articles, studies and other contributions rests solely with their authors, and publication does not constitute an endorsement by the International Labour Office, World Health Organization or the Finnish Institute of Occupational Health of the opinions expressed in it.
he improvement of reporting systems for oc-cupational accidents and diseases is an in-creasingly important challenge in many African countries. Occupational accidents and diseases, particularly those occurring in small workplaces, are often left unreported in the government reporting system. Many occu-pational diseases emerge long after exposure to health hazards, and may be misdiagnosed. Countries that are still in the process of developing accident and disease reporting systems receive a limited number of occupational accident and disease reports, and may underestimate the real magnitude of the problem. We need to further accelerate our efforts to develop workable reporting systems and help occupational accident and disease victims receive timely care and compensation. Reliable occupa-tional accident and disease statistics facilitate the identification of priority areas for action and the implementation of strategic national OSH policy for prevention. The ILO, in co-operation with WHO, has strengthened technical co-operation activities in these areas. The ILO Code of Practice on Recording and No-tification of Occupational Accidents and Diseases is frequently referred to as sound guidance. Regional and international co-operation to exchange practical experiences has been promoted. Many countries need to address the following points to strengthen their accident and disease reporting systems. The first thing to do is to ensure all employers know their report-ing duties and whom to report to. Frequent campaigns through the mass media, seminars, and training workshops are useful. Busy employers need easy-to-use reporting systems. The for-mat of the reporting must be well-structured and concise for timely response. By linking accident and disease reporting to the Employment Injury Insurance scheme, several countries have succeeded in receiving an increasing number of acci-dent and disease reports. The reported occupational acciacci-dent and disease information should be compiled and analysed for identifying hazardous industries and consolidating govern-ment action plans. The roles of labour inspectors are vital in all the implementation steps of reporting systems. Inspectors train employers and workers in the system and provide practi-cal assistance. Labour inspectors also investigate accidents to identify their root causes and implement practical preventive measures. The data obtained should be analysed by gender, age, type of industry and size of undertakings in order to identify specific support measures. We must ensure that occupational accident and disease reporting systems cover all workers in the same workplace, including subcontractors, part-time workers and migrant workers.
Occupational disease victims need practical support from medical professionals, occupational health physicians and nurs-es, and other occupational health service providers, for proper
diagnosis, treatment and compensation. Compared to occu-pational accidents, the improvement of occuoccu-pational disease reporting is often more complex and requires intensive tech-nical and political efforts. General medical practitioners, who are often the first contact of occupational disease victims, need to be trained in occupational diseases and be familiar with oc-cupational health hazards. Consultation systems between gen-eral practitioners and occupational disease specialists should be established to facilitate the correct diagnosis of occupational diseases. The ILO’s new list of occupational diseases adopted in 2010 is a useful reference for occupational health practitioners, government officials, workers, and employers to increase their knowledge and understanding of occupational diseases. Oc-cupational disease victims need the co-operation of employers for reporting their diseases and receiving proper treatment and compensation. They also require the assistance and advice of medical professionals when applying for compensation. Work-ers suffering from occupational diseases are often unfamiliar with the procedures on how to apply for compensation. We need to build user-friendly consultation systems for workers. Co-operation and support from both employers’ and workers’ organizations are also vital. Health and labour officials should strengthen their co-ordination and co-operation for increas-ing the reportincreas-ing of occupational diseases. Occupational dis-ease cases are often diagnosed in a general hospital, and may be reported in the epidemiological reporting system of the health ministry together with other diseases. Both suspected and de-tected occupational disease cases should be communicated to the occupational accident and disease reporting systems for proper government actions.
Functioning occupational accident and disease reporting systems are an important pillar of the National OSH System. The data, information and experiences obtained from the systems indicate a country’s OSH performance. To improve OSH per-formance, we need to share practical information with workers and employers regarding reporting systems and results. Gov-ernments should further strengthen their efforts to upgrade reporting systems and extend the service to vulnerable groups of workers. The ILO strongly supports their commitment for practical solutions.
Dr. Tsuyoshi Kawakami
Senior Specialist in Occupational Safety and Health
ILO Decent Work Technical Support Team for East and South East Asia and the Pacific, Bangkok, Thailand
Strengthening occupational
accident and disease
reporting systems
Photo by M. Crozet © International Labour Organization
Injury and disease reporting
in Tanzania
Joshua M. Matiko
TANZANIA
Introduction
Collection of data on injuries and dis-eases is inadequate in most countries. In some of the countries where there is an adequate data collection system, most of the data is not fully compara-ble from one country to the next be-cause of variations in definitions, re-cording and notification systems. The motivation to report injuries and dis-eases varies according to the types of incentives provided in the compensa-tion and social security systems. Severe injuries and diseases, such as fatalities, poisoning, acute inhalation of respira-tory toxic substances and dermatitis, among others, are frequently recorded by workers’ compensation systems or social security systems.
Countries where workers’ compen-sation is the source of injury and dis-ease data normally encounter several limitations, such as lack of standardiza-tion in the eligibility requirements for reporting, lack of standard case defini-tions, disincentives to workers and em-ployers to file claims, inadequate num-bers of physicians to recognize chronic occupational diseases with long laten-cy periods and the usual gap (several years) between initial filing and reso-lution of a claim (1). The net effect of these limitations is that there is signifi-cant under-recording of occupational disease by workers’ compensation or insurance systems.
Under-reporting of injuries is a worldwide issue. However, the more severe the work-related injuries or dis-eases are, the more reliable the data are as well. This means that fatalities are the most reliable category, best suited for comparisons between countries. Injury statistics usually include insured work-ers only, but the majority of employees in developing countries such as Tanza-nia are not insured. Therefore, under-reporting is believed to be very high.
Statutory requirement to
report injury and disease in
Tanzania
In Tanzania, reporting of injuries and diseases is required under some pieces of legislation ad-ministered by different government enforcing authorities. The legislation currently requiring reporting of injuries and diseases is the Work-men’s Compensation Ordinance of 1949 Cap 263 and its amendments and the Notification of Accidents and Occupational Diseases Or-dinance of 1953 Cap 330. In other words, all occupational injuries must be reported un-der the Accidents and Occupational Diseases Notification Ordinance, and employees must be insured against occupational injuries un-der the Workmen’s Compensation Ordinance. Both ordinances are administered by the La-bour Commissioner. However, the Workmen’s Compensation Ordinance of 1949 Cap 263 was repealed by the Workers’ Compensation Act No 20 of 2008. The Workers’ Compensa-tion Act is broader than the previous act but its commencement date has yet to be announced in the official gazette (2); hence for the time being it is not applicable.
According to the Occupational Health and Safety Act No 5 of 2003 and its regula-tions, administered by the Chief Inspector of Occupational Safety and Health Authority, reporting of injuries and diseases is also re-quired (3). Although all of the legislation has been announced in the official gazette, with the exception of the Workers’ Compensation Act, only the Workmen’s Compensation Ordi-nance is functioning to some degree. To a large extent, workers make an important contribu-tion here; they are motivated to report injuries and diseases so that they can be compensated. Therefore, this article focuses on the notifica-tion of injuries and diseases under the Work-men’s Compensation Ordinance.
Workmen’s Compensation
Ordinance
Workers’ compensation was established in 1949 following the enactment of the Work-men’s Compensation Ordinance Cap 263. The main objective of the Ordinance as per its pre-amble is to provide compensation for fatalities and injuries suffered by workmen arising out of and in the course of their employment. The ordinance provided that in a situation where an accident causes loss of a worker’s life, or disables a worker for at least three consecutive days, thus preventing the worker from earn-ing full wages, the employer or his/her rep-resentative should report the accident to the labour office (4). There are 32 labour offices throughout the country. Since the enactment of the Workmen’s Compensation Ordinance,
all accidents of the above-mentioned nature have been reported, mainly for the purpose of compensation. The workers’ compensation data have limited or no information on inju-ries and diseases in important sectors, such as agriculture and the informal sectors, which account for more than 85% of employment in Tanzania (5).
In the case of occupational diseases noti-fication, the ordinance is read simultaneously with the Notification of Accidents and Occu-pational Diseases Ordinance. The responsibil-ity to report occupational diseases is placed on employers and medical practitioners. Medi-cal practitioners who are not in the service of the government or are not employed at the workplace where a disease occurs should be given incentive so that they would report oc-cupational diseases (6). Any medical prac-titioners who fail to give notification should be penalized.
Workers’ compensation
reports
All employers in the private sector are obliged to insure their employees. When an employee in the private sector is injured, the insurance company submits a report on the occupation-al injuries to the labour office. This report is then used for the compensation process. In the public sector, a report is submitted directly by the government, which carries liability for public servants.
Coverage
All employees regardless of the economic ac-tivity, except for agriculture and informal sec-tors or self-employed persons, are not covered unless they are insured. Although small ployers are legally obliged to insure their em-ployees for workers’ compensation, it is known that many of them fail to do so, and hence they do not report occupational accidents. In such cases, compensation may be paid informally.
Method of reporting
The employer is responsible for reporting the accident to a labour office, which is given a form for the employee concerned. The acci-dent details are recorded on the form, and a medical officer has to make an assessment of the extent of the injuries. For non-fatal cases, the extent of the injury is assessed for three factors: the percentage of permanent incapac-ity due to the injury, the estimated time ab-sent from work, and the estimated time on light duties.
Information on the
notification form
The accident notification form consists of in-formation about the employer (name, address, nature of industry or business); the injured person (name, age, sex, place of domicile, and in case of fatality the next of kin); the accident (date, time and place of accident, description of how accident happened, occupation of in-jured person); and the injury (fatal or non-fa-tal, whether the person was absent from work for at least three days, particulars of the injury, name of the medical practitioner or hospital attended; earnings per month at the time of the accident). The medical officer provides the following information: dates of treatment as an in-patient and out-patient; date of the abil-ity to resume duty; period and percentage of total or partial incapacity; percentage of per-manent incapacity; the nature of the injury; and the location of the injury.
Problems in the current
reporting system
The reporting of accidents and occupational diseases is only done to obtain compensation for insured employees. Employees in agricul-ture and informal sectors and self-employed persons are not insured; therefore, accidents and occupational diseases are not reported in those sectors. Data on those accidents and occupational diseases reported to the Labour Commissioner are not analysed. Hence it is very difficult to ascertain the trend of their occurrences.
Medical
practitioners
who are not in
the service of the
government or
are not employed
at the workplace
where a disease
occurs should be
given incentive
so that they
would report
occupational
diseases.
Some of the existing legislation, such as the Occupational Health and Safety Act, the notification ordinance, and the compensation ordinance are not adequately enforced. As a result, data on accidents and occupational dis-eases are missing.
Other problems are as follows:
• Since there are two separate reporting sys-tems, i.e. reporting under workers’ com-pensation and the Occupational Health and Safety Act, the same injury or occupational disease may be reported twice.
• Under the current compensation system, the compensation rates are very low (a max-imum of about USD 72 for permanent total disability) and do not provide any motiva-tion for reporting.
• The reporting under workers’ compensa-tion is done only for accidents involving an injury of person or fatality. Hence, acci-dents where there are no injuries or fatali-ties are not reported.
• There is insufficient number of occupation-al medicoccupation-al officers. Most occupationoccupation-al dis-eases therefore are not recognized or re-ported.
• There is poor coordination and networking among enforcing authorities and hospitals
or health centres. For this reason, occupa-tional accidents or diseases that are recog-nized in hospitals or health centres are not reported to the authorities.
Recommendations
• A comprehensive notification and re-cording system should be established and should cover all accidents, including those in which injury or fatality does not occur. The system should also cover all sectors, including self-employed persons.
• The reporting under workers’ compen-sation and the Occupational Health and Safety Act should be harmonized or co-ordinated.
• There should be coordination and network-ing among the government enforcnetwork-ing au-thorities and hospitals or health centres so that occupational diseases can be recog-nized and reported.
References
1. Sundstrom-Frisk C. Accidents. In; OSH for De-velopment, Elgstrand K, Petersson NF. Editors. 2009, Royal Institute of Technology: Stock-holm.
2. United Republic of Tanzania, Workers
Com-pensation Act No 20, 2008: Dar es Salaam. 3. United Republic of Tanzania, Occupational
Health and Safety Act No 5, 2003: Dar es Sa-laam.
4. Government of Tanganyika, Workmen’s Com-pensation Ordinance Cap 263, 1949: Dar es Salaam.
5. Tanzania Bureau of Statistics, Integrated La-bour Force Survey – Analytical Report. 2006: Dar es Salaam.
6. Government of Tanganyika, Notification of Accidents and Occupational Diseases Ordi-nance Cap 330, 1953: Dar es Salaam.
Joshua M. Matiko
Occupational Safety and Health Authority (OSHA) P. O. Box 159 Dar es Salaam Tanzania
Themes of the African Newsletter in 2011
Theme Deadline for manuscripts 1/2011 Mining - 28th February 2011 2/2011 Information society and transfer of technology 31st May 2011 3/2011 Climate change including the green agenda 30th September 2011
Readers are encouraged to submit manuscripts addressing the above themes. Also articles on other topics in the field of occupational health and safety are welcome.
Please let the Editorial Office know in advance if you are planning to submit a manuscript. Submitted articles will be published provided there is space in the Newsletter.
Please send the manuscripts to:
Ms. Suvi Lehtinen, Editor in Chief African Newsletter
Finnish Institute of Occupational Health Topeliuksenkatu 41 a A
FI-00250 Helsinki, Finland Fax No. +358 30 474 2548 E-mail: [email protected] Enquiries also the Editor: [email protected]
African Newsletter
Volume 20, number 1, April 2010
Health care workers
O N O C C U PAT I ON A L H E A LT H A N D S A F E T Y
African Newsletter
Volume 20, number 2, August 2010
Risk assessment at workplaces
O N O C C U PAT I ON A L H E A LT H A N D S A F E T Y
Systems
for reporting
occupational
diseases
in Nigeria
Obehi Okojie
NIGERIA
An occupational disease is generally accepted as
any disease contracted as a result of an exposure to
a condition or conditions in the workplace or work
environment. The absence of reliable information about
the incidences of occupational accidents and diseases is
a major obstacle to curbing the appalling toll of
work-related deaths and injuries. Despite enormous advances
in technology, preventive medicine and the means to
prevent accidents, the International Labour Office (ILO)
and the World Health Organization (WHO) estimate
that around 1.2 million work-related deaths, 250 million
accidents and 160 million work-related diseases occur
worldwide each year.
Death, illness and injury on such a scale impoverish individuals and their families, and they undermine attempts to improve working conditions. In addition to im-measurable human suffering, they cause major economic losses for enterprises and societies as a whole, such as lost produc-tivity and reduced work capacity. It is esti-mated that around 4 per cent of the world’s gross domestic product (GDP) is lost in terms of various direct and indirect costs including compensation, medical expens-es, property damage, lost earnings and re-placement training (1).
Information is therefore needed, par-ticularly by those charged with the task of remedying this situation, in order to
derstand what preventive action is necessary. This information must be sufficiently com-prehensive and above all accurate (1). For any preventive measure at any level to be evidence-based and meaningful, the data required de-pend heavily on the reporting of occupational diseases and injuries.
With a total land area of 923,768 square kilometres, Nigeria is the fourth largest coun-try in Africa. The councoun-try is divided into 36 states and the Federal Capital Territory, Abu-ja. Oil and gas reserves make up 99 per cent of export revenues, 78 per cent of govern-ment revenues, and 39 per cent of the GDP. The contributions of other sectors to the GDP in 2006 were as follows: agriculture (32.5%), wholesale and retail (13.5%), industry, ex-cluding petroleum (2.9% and other sectors (1.5%). Since 1980, oil production has ac-counted for more than two-thirds of the GDP and more than 80 per cent of total govern-ment revenues (2).
Among occupational categories, sales and services and agriculture are the most com-mon for both women and men. The sales and service sector employs half (52%) of employed women as against 27 per cent of men, while agriculture employs 24 per cent of women and 41 per cent of men, respectively. Another 14 per cent of women and 18 per cent of men are engaged in skilled manual jobs (3).
Existing legal instruments
About twenty Conventions and Recommen-dations by the ILO, including the Labour Sta-tistics Convention of 1985 (No. 160), encour-age the compilation of statistics on occupa-tional injuries and diseases, but only some of them refer to recording and notification The ILO code of practice on the recording and notification of occupational accidents and diseases provides useful guidance to compe-tent authorities in developing national sys-tems both for the recording of accidents and diseases at the level of the enterprise, and for the compilation of statistical data at the na-tional level. The Office distributed the code to all member States in 1997 and undertook a special exercise to review the establishment of national policies and programmes. This was done to address the statements made by a Meeting of Experts to draw up the code in 1994, which emphasized the instrumental role of the recording and notification of accidents and diseases for the study and identification of the causes of accidents and diseases (4).
Nigeria has adopted some of these instru-ments promoting occupational health and safety through the promulgation of certain laws, such as the Factories Act of the Laws of the Federation of Nigeria (5). Sections 51, 52 and 53 of Part VI of the Factories Act of
Ni-geria make provision for reporting of occupa-tional diseases and accidents.
The Factories Act Cap 126, Laws of the Federation of Nigeria, 2004 is the legislation for the enforcement of safety and health stand-ards in Nigerian workplaces. It stipulates mini-mum standards of safety and health for Nige-rian factories. It provides for the enforcement of the Act by occupational safety and health officers in the Inspectorate Department of the Federal Ministry of Labour and Productivity.
Part VI, section 53 of the law is entitled Notification of Industrial Disease and it states that “the occupier of any factory who be-lieves, suspects or has reasonable ground for believing or suspecting, that a case of occu-pational disease has occurred in the factory, shall forthwith send written notice of such a case, in the prescribed form and accom-panied by the prescribed particulars, to the nearest inspector; and the provisions of this Act with respect to the notification of acci-dents shall apply to any such case in like man-ner as to any such accident as is mentioned in those provisions.”
Diseases included on the list
The occupational diseases requiring notifica-tion are shown below:
1. Lead poisoning, including poisoning by any preparation or compound of lead, or its sequelae
2. Phosphorous poisoning by phosphorous or its compounds, or its sequelae 3. Mercury poisoning by mercury, its
amal-gams and compounds, and its sequelae 4. Manganese poisoning or its sequelae 5. Arsenic poisoning by arsenic or its
com-pounds and its sequalae 6. Aniline poisoning
7. Carbon bisulphide poisoning
8. Benzene poisoning, including poisoning by any of its homologous, their nitro or amido derivatives, or its sequelae 9. Chrome ulceration due to chromic acid
or bichromate of potassium, sodium or ammonium, or any preparation of these substances
10. Anthrax 11. Silicosis
12. Pathological manifestations due to: a) Radium or other radioactive substances b) X-rays
13. Toxic jaundice due to tetrachlorethane or nitro or amido derivatives of benzene or other poisonous substances
14. Toxic anaemia
15. Primary epitheliomatous cancer of the skin due to the handling or use of tar or pitch. Bitumen, mineral oil, paraffin or the com-pounds, products or residues of these sub-stances
16. Poisoning by halogen derivatives of hydro-carbons of the aliphatic series
17. Compressed air illness 18. Asbestosis.
Data are generated and collected at the state level. The occupier of any factory is ex-pected to report any of the listed occupational diseases. In addition, reports of factory inspec-tion are sent by factory inspectors to their state office of the Federal Ministry of Labour, which then forwards the reports to the Federal Min-istry of Labour Office in Abuja, where they are collated for the country.
Enforcement
Factory inspectors are supposed to undertake daily inspection of factories at the state lev-el and then submit monthly report from the state level to the Federal Ministry of Labour. To ensure compliance, factory inspectors are expected to issue warnings or notices if any ir-regularities are noticed. They should then fol-low enforcement of the warning, e.g. sealing of the factory or prohibiting the use of harmful processes if the irregularities are not checked..
Personal communication from the Direc-tor of InspecDirec-torate of FacDirec-tories, Federal Minis-try of Labour, Abuja revealed that, in practice, sealings or prohibitions occur rarely because the factories are usually owned by powerful individuals in the society: the political class or their friends. In situations where a factory inspector attempts to insist on enforcement of the existing regulations, he may be mo-lested. Currently there are only 60 factory
in-Currently there
are only 60
factory inspectors
distributed all
over the country
and answerable
to the Director,
Inspectorate of
Factories. Abuja
has seven of the
nation’s 60 factory
inspectors.
spectors distributed all over the country and answerable to the Director, Inspectorate of Factories. Abuja has seven of the nation’s 60 factory inspectors.
Although there is a system in place in Ni-geria for the reporting of occupational diseas-es, the system is weak and ineffective. There is little or no information documented on re-ported occupational diseases available at the Federal Ministry of Labour for the last five years.
However, the story is different for the mul-tinational oil and gas companies operating in the country to exploit Nigeria’s oil and gas resources. These companies have a well-es-tablished system of reporting of occupational diseases, which is primarily directed by the ex-isting health and safety laws of the countries of origin, usually in the technologically devel-oped countries of Europe and North America. These companies report to their head offices outside the country.
In addition, these companies have well-es-tablished occupational health services that are appropriately operated by well-trained occu-pational health physicians, nurses, hygienists etc. They pay a high premium for promoting and protecting workers’ health, with the ulti-mate aim of maximizing productivity.
Challenges
The poor status with regard to the reporting of occupational diseases in Nigeria can be at-tributed to the many factors outlined below: • The number of factory inspectors is inad-equate to cover all the factories in Nigeria. • Many workplaces in Nigeria have poor or
non-existing occupational health services, making diagnosis and identification of the occupational diseases a near impossibility. • The current economic situation in the coun-try has given rise to an increasing number of workplaces and new technologies or processes, causing previously unknown hazards in all areas of the economy. These new hazards are not covered under the ex-tant legislation.
• The attitude of employers and workers and their organizations continue to be mostly apathetic and nonchalant on issues of oc-cupational health and safety.
• The insignificant penalties cannot guaran-tee compliance with the Factories Act. • There is a lack of political will to enforce
existing regulations.
Recommendations
The following recommendations are made with the hope that they will help to revive the comatose reporting system of occupational diseases in Nigeria.
• Increase in the number of factory inspec-tors in Nigeria
• Provision of working materials and mobil-ity for the inspectors
• Establishment of an electronic database sys-tem and network between states
• Enforcement of the rule of law
• Making the penalties realistic so that they would be real deterrents to offenders • Health education of the employers and
em-ployees so that they would appreciate the need for reporting and the benefits of safety in the workplace.
References
1. ILO. Report on Recording and notification of occupational accidents and diseases and ILO list of occupational diseases. Geneva. Ju-ne, 2002.
2. Federal Republic of Nigeria (FRN). African pe-er review mechanism: Country review report.
3. Abuja, Nigeria: Federal Republic of Nigeria, 2008.
4. National Population Commission (NPC) [Ni-geria] and ICF Macro. 2009. Nigeria Demo-graphic and Health Survey 2008. Abuja, Ni-geria: National Population Commission and ICF Macro.
5. ILO. Recording and notification of occupa-tional accidents and diseases. An ILO code of Practices. ILO, Geneva, 1996.
6. Factories Act of Nigeria. The Laws of the Fe-deration of Nigeria, 2004, Vol. 6.
Professor Obehi Okojie
Department of Community Health Faculty of Medicine
College of Medical Sciences University of Benin PMB 1154 Benin City Nigeria
Occupational health and safety in Egypt:
An overview
A. Valenti, M. Omaira, D. Venanzi, L. Fantini, S. Iavicoli
ITALY, EGYPT
Introduction
The Arab Republic of Egypt is a lower-mid-dle income country with a population of 83 million (1) involved in an economic, social and demographic change process (2). The main problem faced by the Egyptian econ-omy is to provide real employment opportu-nities to an ever-growing number of workers and to improve the quality of work (3). From this perspective, Egypt is a country that re-flects the typical, critical situation of develop-ing countries characterized by poor workdevelop-ing conditions due to various factors, including the lack of effective occupational health and safety (OH&S) management systems and the limited application of legislation in the field of OH&S.
The aim of this study is to compile a pic-ture of OH&S in Egypt both through the anal-ysis of injury statistics and by highlighting availableresources and tools for a proper and effective OH&S management. Particular at-tention is paid to analysis of Egyptian OH&S regulations.
OH&S legislative framework
The Egyptian labour market is regulated by
Law 12/2003, which devotes a specific section
(Book V) to occupational safety and health and assurance of the adequacy of the work environment. This legislation applies to all es-tablishments in the private and public sectors, civilian and government units, local (munici-pal) government services and public authori-ties; it does not apply to domestic servants and family members who are direct dependents of the employer.
In addition to Law 12/2003, some rele-vant Ministerial decrees contain more spe-cific provisions regarding health and safety at work. Decree No. 126/2003 defines procedures and forms for notification of work-related ac-cidents, injuries, fatalities and diseases, and
Decree No. 211/2003 specifies the necessary
conditions required for a safe work environ-ment. Special chapters of the latter Decree pre-scribe “maximum allowable concentrations”
for more than 600 chemical agents in the work environment, safe levels for physical param-eters (i.e. noise, vibration, radiation, illumina-tion) and a list of suspected chemical carcin-ogens. Decree No. 134/2003 defines both the types of establishments (employing at least 50 workers) covered by this decree as well as the OH&S services and committees and the related OH&S training institutions.
The law on occupational diseases is Law
79/1975, the Social Insurance Law. This
legisla-tion applies to all civil servants in government and public-sector services without an age lim-it, workers over the age of 18 years with regu-lar employment in the private sector, workers in public institutions and public sector units regardless of age, small employers, the self-employed, Egyptian workers abroad, and tem-porary workers (4).
The main structure of the Egyptian legis-lation seems in general to be appropriate for covering the basic OH&S principles, although the principles of workers’ protection are ap-plied mostly in companies employing 50 or moreworkers. The same level of protection needs to be extended to all workers exposed to specific risks (biological, chemical, carci-nogenic, etc.), with a view to approximation to the EU framework approach.
Egyptian labour market
According to a national survey conducted by the Economic Research Forum (ERF) in co-operation with the Central Agency for Pub-lic Mobilization and Statistics (CAPMAS), the main statistical agency of the Egyptian Government, the market labour force grew from 17.2 million in 1998 to 25 million in 2009. The growth rate was more than 4 per cent per annum. This rise is attributed to an increase in both the working-age population (15–64 years) and female workforce participa-tion rates. Female participaparticipa-tion in the labour force grew from 3.9 million in 1990 to about 5.5 million in 2008, at a rate of 1.9 per cent per annum (Table 1) (5,6).
Much of the growth in the working-age
population is concentrated among youth (15–24 years); this causes severe labour sup-ply pressures on the labour market. Current-ly, about one out of two people of working age (47%) falls in this age class (7). Even in a period of economic growth, the increase in jobs has not been strong enough to absorb the new entrants to the labour market. The lack of work pertains to educated youth more than to illiterate, unskilled middle-aged workers. The problem is particularly acute among women (whose unemployment rate is more than three times higher than that among men) and is worse in the urban areas (Figure. 1) (8).
Sectors having a significant impact on employment are agriculture (32%), services (51%) and industry (17%) (1). With the slow-down in public-sector employment, the pri-vate sector has become the engine for em-ployment growth in the Egyptian economy. Private-sector employment has been growing in excess of 7 per cent per annum, with the most dynamic growth in financial and busi-ness services, transport, storage and commu-nications, trade, restaurants and hotels. A par-ticular aspect of the Egyptian labour market is the continued growth of informal work, in-creasing from 7.5 million in 1998 to 12.2 mil-lion in 2006. The informal sector serves as an important source of low-wage employment for many poor and uneducated jobseekers (7).
Egypt’s situation is similar to that of many other developing countries: data on occupa-tional accidents and diseases are underesti-mates, as is revealed by comparing the number of injuries against the overall population. Sta-tistics on occupational accidents and disease are compiled at the governorate level by enter-prise safety specialists; they are checked and collected by safety inspectors. The statistics are then sent to the Central Administration for Statistics of the Ministry of Manpower and Migration (8). In 2007, CAPMAS estimates that 19,927 occupational accidents took place, of which 103 were fatal. The highest numbers of occupational accidents (76.5%) and fatali-ties (32%) were reported in the manufactur-ing sector (Table 2) (9).
OH&S SYSTEM
The OH&S system is an independent subdi-vision of the Ministry of Manpower and Mi-gration (MoMM). OH&S activities are carried out at four levels:
A) National level. OH&S management
takes place through the Central Authority for Protecting the Labour Force and Working Envi-ronment (CAPLFWE) and the General Admin-istration for Occupational Safety and Health and the Protection of the Working Environ-ment (GAOSHWE). These define the general policies and programmes ensuring the protec-tion of manpower and the procedures for their implementation. They also supervise the imple-mentation of OH&S labour legislation through MoMM structures at the governorate and dis-trict (municipal) levels and the functioning of field offices located at the district level.
B) Governorate level. OH&S management
takes place through twenty-nine governorate offices of the MoMM, which perform the same types of duties as the GAOSHWE at the central level. In particular, they supervise the function-ing of 199 OH&S field offices employfunction-ing about 1,000 OH&S specialists located at district level.
C) District level. About 650 safety
inspec-tors participate in the setting-up of establish-ments and in checking that the OH&S stand-ards are applied. In the event of major acci-dents or hazards, inspection may be carried out with the participation of MoMM staff from three levels.
D) Enterprise level. All enterprises with
more than 50 workers must have an enterprise OH&S policy, including an OH&S department and committees empowered to investigate ac-cidents and diseases, in order both to suggest prevention and control measures and to main-tain statistical information.
The Health Insurance Organization (HIO) plays the greatest role in occupational health, especially with regard to the provision of ther-apy for insured employees, establishment of pre-placement and periodic medical exami-nations, recognition of occupational diseas-es, and notification and registration of occu-pational diseases. The Occuoccu-pational Health Department (OHD) of the Ministry of Health and Population (MoHP) supervises the func-tions of HIO related to pre-employment and periodic medical examinations and analyses the cases of occupational diseases reported both by the HIO and by the OH&S offices of MoMM at governorate levels.
The National Institute of Occupational Safety and Health – NIOSH, a tripartite gov-erning body chaired by the Minister of Man-power – is an independent research agency for OH&S. It is responsible for basic, advanced, specific and specialized training on OH&S for specialists and technicians in OH&S, OH&S
Table 2. Occupational accidents by economic activity and the result of the accident in 2007.
Accident Result Recovery Complete Disability Partial Disability Treat-ment Death Total Republic
Economic Activity Male Female Tot
Transport, Storage & Communication
1,781 3 37 134 12 0 12 1,967
Electricity, Gas, Steam and Hot Water Supplies
205 3 10 1 3 0 3 222
Real Estate Sector, Renting and Business Services
44 0 20 98 15 2 17 59
Activities
Unspecified 135 0 20 98 15 2 17 270
Wholesale & Retail Trade, Repairing Motor Vehicles Domestic and Personal Commodities 284 60 3 0 8 5 35 8 2 0 0 0 2 0 332 73 Brokerage Constructions 1,342 5 84 152 25 1 26 1609
Mining & Quarrying 61 0 3 27 1 0 1 92
Manufacturing 14,310 8 252 643 32 1 33 15,246
Hotels and
Restau-rants 46 0 0 9 2 0 2 57
Total 18,268 22 421 1,113 99 4 421 19,927 Source: CAPMAS, 2007
Table 1. Distribution of the labour force (aged 15–64 years) by gender and place of residence in 1990
and 2008.
1990 2008 Annual growth rate
Men Women Men Women Men Women
Urban 5,202,200 1,482,500 8,201,100 2,373,000 2.5% 2.6% Rural 6,403,800 2,454,100 10,918,800 3,158,300 3.0% 1.4% Total 11,606,000 3,936,600 19,119,900 5,531,300 2.8% 1.9% Source: CAPMAS, 2008 8% 4% 6% 24% 16% 19% 0 5 10 15 20 25 Men Women Urban Rural Total 8% 4% 6% 24% 16% 19% 0 5 10 15 20 25 Men Women Urban Rural Total Source: CAPMAS, 2008
Figure 1. Unemployment rates for women and men (aged 15–64 years) by place of residence
in 2008.
committee members, middle and higher man-agement and production line officers (4).
International cooperation on
OH&S
Many activities, including technical coopera-tion, capacity building, training and informa-tion disseminainforma-tion, have been carried out by some international organizations with a view
to reducing the number of occupational ac-cidents and diseases (10). The current OH&S situation in Africa calls for special attention, and WHO and ILO have responded by initi-ating joint planning exercises and implement-ing activities that have led to international col-laborations, such as the WHO/ILO Joint Af-rican Effort, the East AfAf-rican Regional Pro-gramme on Occupational Health and Safety including the Basic Occupational Health
Serv-ices (BOH&S) supported by the Finnish Insti-tute of Occupational Health (FIOH), and the Work and Health in Southern Africa Project (WAHSA) (11).
The objective of the Joint Effort on Oc-cupational Health and Safety in Africa is to improve working conditions and the work environment in the region, thus reducing the burden of occupational diseases and injuries through intensified coordination of occupa-tional health and safety activities. The pri-orities of the Joint Effort on Occupational Health and Safety in Africa are: a) human resource development, focusing on capacity building; b) provision of assistance with na-tional policies, programmes and legislation; c) information generation and dissemination, research and awareness raising; d) promotion of occupational health and safety to protect workers in particularly hazardous occupa-tions, vulnerable groups (including informal sector workers, women and children), and in newly transferred technologies (12).
In the past few years, several national strat-egies, policies and action plans on protect-ing workers’ health have been identified, in line with the WHO Global Plan of Action on Workers’ Health 2008–2017. Such policies or strategies should cover the enactment of leg-islation, intersectorial coordination, resource mobilization, and an institutional framework (11). The European Union has promoted a series of cooperation initiatives and twinning projects with some countries of North Africa, with the intention of improving different areas of interventions, including OH&S.
In this perspective, aligned with the ob-jectives of the European Neighbourhood Policy (ENP), the Twinning Project Italy/ Egypt on “Organizational Modernization of the Occupational Health and Safety Man-agement System” was launched on 7 Octo-ber 2008 with the aim of contributing to the modernization of OH&S management sys-tems in Egypt and to the improvement of the public policies, procedures and services in this sector, hence reducing the number of work-related deaths and accidents. The Ital-ian Ministry of Labour, Health and Policies is the project leader together with ISPESL (National Institute for Occupational Safety and Prevention), INAIL (National Insurance Institute for Employment Injuries), Formez, Tuscany Region and Italia Lavoro. The project is structured into three areas of interventions: 1) comparative analysis of EU and Egyptian primary and secondary legislation in the field of OH&S; 2) the promotion of institutional capacity building at the central and local lev-els; and 3) the implementation of communi-cation and training activities and schemes to encourage infrastructure funding.
References
1. CIA. Central Intelligence Agency. The World Fact Book. Egypt, September, 2009. 2. ETF. European Training Foundation. Egypt
ETF Country Plan. 2009.
3. WHO-ILO. Meeting Report: WHO/ILO Joint Effort on Occupational health and Safety in Africa. Harare, March 2001.
4. Abo El Ata GA, Nahmias M. Occupational Safety and Health in Egypt – A National Pro-file, Towards Decent Work in North Africa n. 4. ILO, January 2005.
5. Assaad R. Labour Supply, Employment and Unemployment in the Egyptian Economy, 1988–2006. Economic Research Forum (ERF) – Working Paper n. 0701, September 2007. 6. CAPMAS. Central Agency for Public
Mobili-zation and Statistics. Quarterly Labour Force Sample Survey. 2009.
7. Assaad R, Barsoum G. Youth Exclusion in Egypt: In Search of “Second Chances” – Midd-le East Youth Initiative Working Paper No. 2. September 2007.
8. Hassan M, Sassanpour C. Labour Market Pres-sures in Egypt: Why is the Unemployment Ra-te Stubbornly High? InRa-ternational Conference on “The Unemployment Crisis in the Arab Countries”. Cairo, Egypt, 17–18 March 2008. 9. CAPMAS. Central Agency for Public Mobili-zation and Statistics. Labour Force – Work-related injuries, 2007.
10. ILO. Decent work = Safe work. The World of
Work, The Magazine of the ILO, No. 63, Au-gust 2008.
11. Ivanov ID. Developing national plans for wor-kers’ health in Africa. Afr Newslett on Occup Health and Safety 2009;19:28–9.
12. Eijkemans G. WHO/ILO Joint Effort on Oc-cupational Health and Safety in Africa. Afr Newslett on Occup Health and Safety 2004;14:28−29.
A. Valenti, S. Iavicoli
INAIL Research Area (formerly ISPESL – National Institute for Occupational Prevention and Safety)
Department of Occupational Medicine Monteporzio Catone
Rome, Italy
M. Omaira
MoMM – Ministry of Manpower and Migration Cairo, Arab Republic of Egypt
D. Venanzi
Formez PA – Training and Studies Centre for the Modernization of Public Administration
Rome, Italy
L. Fantini
Ministry of Labour and Social Affairs Rome, Italy
International Forum on Occupational
Health and Safety: Policies, Profiles
and Services
OH&S Forum 2011
20-22 June 2011, Hanasaari Cultural Centre, Espoo, Finland
The aim of the International Forum is to look into OSH policies and profiles and make an inven-tory, and then continue with the introduction and further development of occupational health services; Basic Occupational Health Services in particular. In addition, time is reserved for discus-sing the practical tools for solutions and good practices. Our intention is to come up with recom-mendations for further actions for more sustainable solutions in the world of work.
Important dates:
Deadline for abstracts 15 February 2011 Deadline for early registration 31 March 2011
Contacts
Registration and practical information:
TAVI Congress Bureau Tavicon Ltd.
e-mail: [email protected]
Programme of the International Forum:
OH&S Forum 2011 Organizing Committee Finnish Institute of Occupational Health [email protected]
For more information please visit www.ttl.fi/forum2011
International Forum on Occupational Health and Safety: Policies, Profiles and Services
20-22 June 2011,
Hanasaari Cultural Centre, Espoo, Finland
www.ttl.fi/forum2011
Paula Ollila
Finnish Institute of Occupational Health
Paula Ollila
Finnish Institute of Occupational Health
Singapore’s Framework for Reporting
Occupational Accidents, Injuries and Diseases
Lee Hock Siang
Alvian Tan
SINGAPORE
Introduction
A framework for the notification, analysis and production of statistics on occupation-al accidents and diseases is an integroccupation-al part of any national policy and system for oc-cupational safety and health (OSH). This is also emphasized in the ILO’s Promotion-al Framework for OccupationPromotion-al Safety and Health Convention, 2006 (C187) as well as in Occupational Safety and Health Conven-tion, 1981 (C155). Currently, most countries with OSH laws have requirements making it mandatory to report occupational deaths, injuries and diseases to the relevant author-ities. However, many developing countries experience difficulties in their inspection programmes owing to lack of manpower re-sources and lack of reliable data on occupa-tional accidents and diseases. Without a
ro-bust reporting system and reliable data, it is difficult to understand the extent and depth of the relevant OSH issues.
Development of an OSH
Reporting Framework
Evolution of Singapore’s OSH
regulatory landscape
Singapore has adopted a strategic and long-term approach in order to achieve sustainable improvement in Workplace Safety and Health (WSH) performance. A significant milestone in the reform of the OSH landscape was the enactment of the WSH Act (WSHA) in March 2006. This Act, which replaced the preceding Factories Act, marked a significant paradigm shift from focusing on mere compliance with prescriptive rules and regulations to
cham-pioning stronger industry ownership in re-ducing risks at the workplace. The reporting of occupational accidents and diseases was a requirement under the Factories Act and the Workmen’s Compensation Act since the 1960s. However, in line with the changes that had taken place on the regulatory front, the reporting requirements had to be extended beyond factories and workforce. The avail-ability of reliable and broad-based OSH sta-tistics is vital to the success of our national WSH strategy. At the same time, there is a need both to put in place a robust reporting system that would provide information so our efforts would better tackle established work-place hazards and to identify new and emerg-ing hazards to which we need to develop a holistic response. A robust reporting system would enable us to obtain reliable and
Table 1. Overview of reporting requirements under the Workplace Safety and Health (Incident Reporting) Regulations
What to Report?
Who Reports?
What Needs to Be Done?
A workplace accident that causes the death of an
employee The employer of the deceased worker Notify the Commissioner immediately via phone or fax AND Submit an incident report within 10 days of the accident via iReport
A workplace accident that causes injury to an em-ployee, who then receives more than three consecu-tive days of medical leave or is hospitalized for at least 24 hours
The employer of the injured worker Submit an incident report within 10 days of the accident via iReport
If the employee subsequently dies because of the injury, the employer must notify the Commissioner as soon as he/she learns of the employee’s death
A workplace accident that involves a self-employed person or member of the public, causing his/her death or his/her being sent to hospital for treatment.
The workplace occupier Notify the Commissioner immediately via phone or fax AND
Submit an incident report within 10 days of the accident
A dangerous occurrence The workplace occupier Notify the Commissioner immediately via phone or fax AND
Submit an incident report within 10 days of the incident via iReport
An occupational disease The doctor who diagnosed the disease and
The employer of the person with the disease
Submit an incident report within 10 days of diagnosis (doc-tor) via iReport
Submit an incident report within 10 days of receiving the written diagnosis (employer) via iReport.
Note: Employers or occupiers who reported a workplace incident are also required to keep records of the incident for at least three years.
Table 2. List of Reportable Occupational Diseases in Singapore
1. Aniline poisoning 2. Anthrax 3. Arsenical poisoning 4. Asbestosis 5. Barotrauma 6. Beryllium poisoning 7. Byssinosis 8. Cadmium poisoning 9. Carbamate poisoning 10. Carbon bisulphide poisoning 11. Chrome ulceration 12. Chronic benzene poisoning 13. Compressed air illness 14. Cyanide poisoning
15. Epitheliomatous ulceration (due to tar, pitch, bitumen, mineral oil or paraffin or any compound, product or residue of any such substance)
16. Hydrogen sulphide poisoning 17. Occupational skin diseases 18. Lead poisoning 19. Liver angiosarcoma 20. Manganese poisoning 21. Mercurial poisoning 22. Mesothelioma 23. Noise-induced deafness 24. Occupational asthma 25. Organophosphate poisoning 26. Phosphorous poisoning
27. Poisoning from halogen derivatives of hydrocar-bon compounds
28. Repetitive strain disorder of the upper limb 29. Silicosis
30. Toxic anaemia 31. Toxic hepatitis
Table 3. Key Features of iReport
prehensive data on accidents and occupational diseases in a timely fashion.
The WSH (Incident Reporting) Regula-tions, which were introduced in March 2006, extended the reporting requirements to all workplaces, requiring all employers to report work-related deaths, injuries, dangerous oc-currences and occupational diseases to the Ministry of Manpower (MOM). Details are elaborated in Table 1. Medical practitioners are required to report any of the
occupation-al diseases listed in the WSH Act. (See Table 2) In April 2008, the Workmen’s Compensa-tion Act was replaced with the Work Injury Compensation Act (WICA), which extend-ed the coverage to almost all employees and provides for compensation to an employee who is injured or develops an occupational disease arising out of, and during the course of, his employment. The reporting require-ments under the WSHA and WICA were al-so re-aligned.
New electronic reporting
system – iReport
To make it easier for stakeholders to report incidents, a national electronic reporting sys-tem known as “iReport” was introduced in March 2006. The iReport is a convenient one-stop system for the reporting of work-related deaths, injuries, dangerous occurrences and occupational diseases for employers, occupi-ers and doctors under the WSHA and WICA (1). The key features of iReport are summa-rized in Table 3.
Since iReport was launched, the
propor-iReport
●A one-stop reporting platform for occupa-tional accidents, injuries and diseases ●Ease of submission – electronic rather than
hard copy
●User-friendly platform
●Allows SMS and email acknowledgement ●Platform to report all workplaces incidents
whether covered by the Workplace Safety and Health Act or not
Figure 1. Trends of accidents and occupational diseases reported to the Ministry of Manpower (MOM)
Figure 2. Workplace fatality rate in Singapore
tion of submissions submitted through elec-tronic means has increased from about 50% in 2006 to more than 90% in 2009 (see Figure 1). This was achieved by engaging the users and enhancing the usability of the system. The sys-tem now allows victims to report their own ac-cidents or to appoint representatives to file an incident notification; doctors can also report workplace injuries. Employees or members of the public can file a notification on a workplace incident or an unsafe act. The notification is then routed to relevant departments for fur-ther processing and investigation.
Benefits of establishing an
OSH Reporting Framework
To provide stakeholders and the public with information, the statistics collected through our reporting system are published in the an-nual report available on the MOM’s website (2). The WSH Council also makes OSH statis-tics available to stakeholders through the me-dia on a semi-annual basis. More importantly, the data are analysed to reveal trends, clusters, patterns and areas of concern that would al-low us to improve our understanding of the OSH situation in Singapore.
Benchmarking of OSH
performance and setting of
national priorities
The strategies and action plans in our nation-al strategy, WSH 2018, were developed based on the identification of major contributors to our workplace fatality and injury rates, and on analysis of critical OSH trends utilizing our data and good practices from other lead-ing countries. The availability of comprehen-sive workplace fatality and injury data has al-so allowed us to set accurate benchmarks for our OSH performance as compared against other countries in the world. We had initially set out to halve our national workplace fatal-ity rate from 4.9 per 100,000 workers in 2004. In view of the good progress made between 2004 and 2008, a more ambitious target was subsequently set – lowering the fatality rate first to 2.5 per 100,000 workers by 2015 and then to 1.8 per 100,000 workers by 2018. This would bring Singapore on a par with the best in the world. Information on the workplace fatality rate in Singapore is shown in Figure 2.
To address the trends analysed from the data collected, specific strategies and policies are usually formulated to address these areas of concern. Data are used as a basis to con-vince and obtain the support of key stake-holders, whether the government or business, for implementing national OSH programmes involving the need for financial or manpower resources. This approach was applied to
iden-25 000 20 000 15 000 10 000 5 000 0
Accidents and Occupational Disease Notifications to MOM
Total Notifications Electronic Submissions Manual Notifications 0
2006 2007 2008 2009 N um be r o f N ot ifi ca tio ns
1st March 2006: WSH(IR) Reg requires notifications and accident reports to be filed under iReport system 1st April 2008: WICA Reg requires notifications and accident reports to be filed under iReport system Feb 2010: Launch of enhanced iReport system. All hardcopy forms were removed from MOM website
Number of workplace fatalities Number of Workplace Fatalities Per 100,000 employed persons
Fatality Rate per 100,000 employed persons 90 80 70 60 50 40 30 20 10 0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 2005 2006 2007 2008 2009 71 62 63 67 70 4.0 3.1 2.9 2.8 2.9 1. Aniline poisoning 2. Anthrax 3. Arsenical poisoning 4. Asbestosis 5. Barotrauma 6. Beryllium poisoning 7. Byssinosis 8. Cadmium poisoning 9. Carbamate poisoning 10. Carbon bisulphide poisoning 11. Chrome ulceration 12. Chronic benzene poisoning 13. Compressed air illness 14. Cyanide poisoning
15. Epitheliomatous ulceration (due to tar, pitch, bitumen, mineral oil or paraffin or any compound, product or residue of any such substance)
16. Hydrogen sulphide poisoning 17. Occupational skin diseases 18. Lead poisoning 19. Liver angiosarcoma 20. Manganese poisoning 21. Mercurial poisoning 22. Mesothelioma 23. Noise-induced deafness 24. Occupational asthma 25. Organophosphate poisoning 26. Phosphorous poisoning
27. Poisoning from halogen derivatives of hydrocar-bon compounds
28. Repetitive strain disorder of the upper limb 29. Silicosis
30. Toxic anaemia 31. Toxic hepatitis
Table 3. Key Features of iReport
tify sectors targeted for the development ded-icated sectoral roadmaps. In 2009, our sta-tistics showed that the marine and construc-tion sectors accounted for nearly 63% of the workplace fatalities and 30.6% of non-fatal injuries (3). To improve safety performance in these sectors, MOM has worked with the WSH Council to develop ten-year sectoral plans for both the marine industry and the construction industry. These plans spell out immediate and long-term measures to tack-le safety chaltack-lenges specific to these sectors, such as enhancing effective risk management, strengthening stakeholders’ involvement and enhancing OSH capability (4).
Strategic enforcement and
programme planning
The collection and analysis of such statistics
has enabled us to set priorities, plan our pro-grammes and activities as well as carry out strategic enforcement to raise OSH stand-ards in Singapore. One example of how this was applied is Programme-based Engage-ment (ProBE), an initiative launched in 2006. ProBE is designed to focus intervention ef-forts on priority areas where the root causes of safety and health deficiencies are concen-trated. The process starts with the identi-fication of “hotspots” or problematic areas that are major contributors to fatal and se-rious accidents and proceeds to the analysis of statistics, data, trends and reports to ar-rive at priority programmes for ProBE. This approach allows us to deploy our regulatory efforts where they are needed most to bring about quantum improvements in safety per-formance and maximum benefit for work-ers and employwork-ers. Over the past few years,
MOM has covered a total of nine priority areas under ProBE, including areas such as work on scaffolds, confined spaces, noisy work proc-esses, metalworking, forklift operations, work involving machines, flammable and hazardous substances, use of lifting equipment (cranes) and work at heights. The programme has suc-ceeded in reducing fatalities, building capa-bilities and raising awareness (5).
Other information monitoring
and development of newer
indicators for monitoring
workplace risks
The availability of reliable and broad-based OSH statistics is crucial. In addition to existing OSH data on fatalities, injuries and accidents, there should be adequate and comprehensive monitoring mechanisms for all possible OSH risks, such as exposures to hazardous agents and factors, near misses and unsafe acts. This would allow us to track the progress of OSH improvements closely and to calibrate inter-ventions where required. Some of the other sources of data for our reference, especially in collating the occupational disease rates, in-clude those obtained from other departments within the ministry, other government minis-tries or from the industry (Figure 1). Among these are: (a) industry safety and health man-agement systems audit reports; (b) accident and disease investigations; (c) inspection and enforcement reports from the OSH inspec-tors; (d) administrative data from work injury claims; (e) monitoring and surveillance sub-missions (such as industrial hygiene monitor-ing reports and medical examination results, e.g. blood lead levels); (f) ad-hoc surveys of specific industry sectors or work; (g) econom-ic and manpower data and trends; (h) health
data, including those derived from chronic disease registers.
In addition, we are also looking at devel-oping suitable indicators for the monitoring of major hazard workplaces, e.g. at petrochemi-cal plants and refineries. Workplaces which seek to assess how well they are managing to process safety hazards cannot rely solely on in-jury and fatality data. Excessive reliance on oc-cupational illness and injury rates, which are usually lagging indicators, can lead to a false sense of security about process safety. Meas-ures that relate specifically to process hazards need to be developed so that deviations or early indication of failures in the management system are detected.
Conclusion
While Singapore has made significant im-provements in putting in place a comprehen-sive OSH framework that includes strong leg-islation, policies, a sound structure and func-tional systems, there are still significant gaps when we benchmark ourselves against leading countries in OSH. For example, more work could be done in the area of occupational health to increase the reporting rates for oc-cupational diseases. One main issue we cur-rently face is that the consequences of poor management of occupational health issues are less obvious and take a longer time to manifest. To address this challenge, we launched a new workplace health strategy in April 2010. One of the areas identified was the need for more comprehensive collection of data by strength-ening reporting mechanisms and providing greater compliance assistance in the recogni-tion and diagnosis of occuparecogni-tional diseases. Given the critical importance of having such accurate depiction of the OSH landscape so
that pressing OSH issues can be tackled on the ground effectively, a robust reporting frame-work would contribute to the effectiveness of the OSH framework in the country.
The authors acknowledge the contributions of Mr Clarence Tang and Mrs Alice Teo from the Ministry of Manpower for their valuable inputs.
References
1. http://www.mom.gov.sg/ireport/ 2.
http://www.mom.gov.sg/workplace-safety-health/resources/Pages/reports-statistics.aspx 3. Workplace Safety and Health Council. Workplace
Safety and Health, 2009, National Statistics https://www.wshc.sg/wps/PA_InfoStop/dow nload?folder=IS2010053100599&file=WSH_ Statreport2009_singles_hr.pdf
4. https://www.wshc.sg/wps/portal/ wsh2018?openMenu=-1
5. Programme-based Engagement, accessed on 2 August 2010, http://www.mom.gov.sg/ workplace-safety-health/programmes/Pages/ engagement-intervention.aspx#probe.
Dr Lee Hock Siang
Director (OSH Specialist)
Occupational Safety & Health Division
Alvian Tan
Senior OSH Specialist
Occupational Safety & Health Division Ministry of Manpower, Singapore 18 Havelock Road ,
Singapore 059764
Table 4. Confirmed chronic occupational diseases in Singapore, 2000–2009
Work-related diseases
– A challenge for occupational health and
public health training and practice
Jorma Rantanen
FINLAND
Photo by Suvi Lehtinen
Introduction
The concept of a work-related disease was originally defined by a WHO Expert Com-mittee in 1985 (1). The ComCom-mittee recognized the following conditions as work-related: a. The classic occupational diseases, in which
the factors in work environment are pre-dominant and essential in the causation of disease,
b. Diseases caused by exposures from home workers’ working processes to family mem-bers or by worksite exposures to memmem-bers in the neighbourhood community c. Multifactor diseases which, when
occur-ring in workers,
• may be partially caused by occupation-al factors
• may be aggravated, exacerbated or accel-erated by workplace exposures
• may impair working capacity.
The Expert Committee also stated that work-related diseases are often more com-mon than occupational diseases and deserve adequate attention by the health services and occupational health services.
The 1985 Expert Committee already rec-ognized several groups of diseases which were recognized as work-related, including: a. Behavioural responses and psychosomatic
illnesses b. Hypertension c. Ischemic heart disease
d. Chronic non-specific respiratory disease e. Locomotor disorders.
Current situation in the
identification of work-related
morbidity
Since the 1985 Expert Committee, clinical and epidemiological research has provided a great deal of new evidence on the work-relatedness of the diseases recognized by the Committee and on several new diseases. The attribution by work varies widely depending on disease and type of work, as well as on local working conditions and health condi-tions of the community. A substantial part of work-related morbidity has been associated
with common non-communicable and com-municable diseases prevalent among popula-tions, such as cardiovascular disorders, res-piratory disorders and musculoskeletal dis-orders (2, 3). Due to their high prevalence, their work-relatedness is important to rec-ognize, as occupational causality provides avenues for effective prevention in the oc-cupational settings. In principle, all occu-pational diseases can be prevented and the risk of multifactorial work-related diseases (WRDs) can be reduced to a substantial ex-tent (which does not always correspond di-rectly with the percentage of attribution) (4). On the other hand, if the causal factors do expose workers at the workplace, the preven-tive, control and curative actions directed to non-occupational settings may remain
inef-fective. The high prevalence of chronic non-communicable diseases among workers, and particularly among older workers calls for preventive actions in occupational health in order to protect and maintain work ability and avoid health and economy losses from diseases among the productive fraction of population (5, 6).
Examples of studies providing
evidence of work-relatedness
in the working population’s
morbidity
A few examples of studies providing evidence on the work-relatedness of common non-communicable and non-communicable diseases are briefly discussed here.
Diseases
Infectious and parasitic diseases
Tuberculosis
Pneumococcal disease
Malignant neoplasms (site)
Oral cavity Pharynx Oesophagus Stomach Colon Rectum
Liver and intrahepatic bile ducts Gall bladder
Pancreas
Nose and nasal sinuses Larynx
Lung and bronchus Bone
Melanoma of skin
Other malignant neoplasms of skin Mesothelioma (all sites)
Breast
Uterus (cervix uteri and corpus uteri) Ovary Prostate Kidney Urinary bladder Brain Hodgkin’s disease Non-Hodgkin’s lymphoma Leukaemia
Diseases of the circulatory system
Ischemic heart disease Cerebrovascular disease
Diseases of the respiratory system
Pneumonia
Chronic obstructive pulmonary disease Asthma
Pneumoconiosis
Cryptogenic fibrosing alveolitis
Diseases of the genitourinary system
Chroni
