Asian-Pacific Newsletter

O N O C C U PAT I O N A L H E A LT H A N D S A F E T Y
Volume 16, number 2, September 2009

Occupational
health services
Asian-Pacific Newsletter
on Occupational Health and Safety
Contents
Volume 16, number 2, September 2009
Occupational health services
27 Editorial
Published by Jorma Rantanen, ICOH/Finland
Finnish Institute of Occupational Health
Topeliuksenkatu 41 a A 28 Situation of occupational health services in Thailand
FI-00250 Helsinki, Finland Somkiat Siriruttanapruk, Thailand

Editor-in-Chief 30 Occupational health services in Nepal

Suvi Lehtinen Sunil Kumar Joshi, Pranab Dahal, Nepal
Editor
33 Occupational health services in Vietnam
Inkeri Haataja
Nguyen Thi Hong Tu, Luong Mai Anh, Vietnam
Linguistic Editing
Sheryl Hinkkanen 38 Good occupational safety and health practices
Khamphat Onlasy, Lao People’s Democratic
Layout Republic
Liisa Surakka, Kirjapaino Uusimaa, Studio
40 Occupational health services for the informal sector
The Editorial Board is listed (as of 1 December 2008)
Jorma Rantanen, ICOH/Finland
on the back page.

This publication enjoys copyright under Protocol 2 of 42 Application of the PAOT-GOHS programme to SMEs
the Universal Copyright Convention. Nevertheless, in Korea
short excerpts of the articles may be reproduced Myung Sook Lee, Republic of Korea
without authorization, on condition that the source
is indicated. For rights of reproduction or translation, 44 ASEAN-OSHNET Workshop on Good OSH Practices
application should be made to the Finnish Institute of Singapore, 18–19 Feb 2009
Occupational Health, International Affairs, Topeliuk- Lee Hock Siang, Singapore
senkatu 41 a A, FI-00250 Helsinki, Finland. Tsuyoshi Kawakami, ILO

The electronic version of the Asian-Pacific Newslet-
ter on Occupational Health and Safety on the Inter-
net can be accessed at the following address:
http://www.ttl.fi/Asian-PacificNewsletter
The issue 3/2009 of the Asian-Pacific Newsletter
deals with new emerging risks.
45 Integration of workers’ health in primary health care
strategies – meeting report
Suvi Lehtinen, Finland
46 OSH for Development – Book review
Jorma Rantanen, Suvi Lehtinen, Finland

Asian-Pacific Newsletter is financially supported

by the Finnish Institute of Occupational Health, the
World Health Organization, WHO (the US NIOSH
grant ”International Training and Research Support
of World Health Organization (WHO) Collaborating
Centers in Occupational Health”), and the Interna-
tional Labour Office.

Photograph on the cover page:

Kari Kurppa, Finnish Institute of Occupational Health

Printed publication:
ISSN 1237-0843
The responsibility for opinions expressed in signed articles, stu-
On-line publication:
dies and other contributions rests solely with their authors, and
ISSN 1458-5944
publication does not constitute an endorsement by the Interna-
tional Labour Office, the World Health Organization or the Fin-
© Finnish Institute of Occupational Health, 2009
nish Institute of Occupational Health of the opinions expressed
in them.
 From Alma Ata to BOHS
A
t the World Health As-
sembly in 1977, the leg-
endary WHO Director
General Halfdan Mahler
presented the goal of Health for All by
the Year 2000, or HFA 2000. Mahler’s
ambitious vision received widespread
and formal acceptance at the WHO-
UNICEF Alma-Ata Declaration on
Primary Health Care in 1978. The Alma-Ata Declaration af-
firmed health as a fundamental human right and called for
a transformation of conventional health care systems and for
broad intersectoral collaboration and community involve-
ment. In practice, it meant shifting the focus from what at the
time was a hospital-dominated health policy (that had not
been effective) to local community-level grassroots-oriented
services and preventive health policies as well. The whole HFA
2000 philosophy was based on the principles of universality
and equity: health services for all and everywhere, as a basic
service and basic right for everyone.
Since then, that philosophy has experienced many suc-
cesses and also setbacks. The year 2000 proved to be too
soon and the objective was not appreciated by neo-liberal-
istic politicians. But the basic idea has always survived: It
is now well incorporated into the UN Millennium Devel-
opment Goals. The most recent signs of survival and even
further development of the idea under the leadership of Dr.
Margaret Chan, the current Director General of WHO, were
seen in the World Health Report 2008 focusing on primary
health care, in the Final Report of the WHO Commission on
Social Determinants of Health 2009 and in the 2009 World
Health Assembly Resolution 62.12 on Primary Health Care
Including Health Systems Strengthening and 62.14 on So-
cial Determinants of Health.
The Alma Ata Declaration addressed occupational
health by defining primary health care as follows:
“It is first level of contact of individuals, the family and
community with the national health system bringing health
care as close as possible to where people live and work, and con-
stitutes the first element of a continuing health care process.”
In the globalizing world, the development of occupa-
tional health services has not been all that impressive. The
coverage of services for the whole workforce of the world is
hardly 15 per cent. The workers most in need in small-scale
enterprises, micro enterprises, agriculture and the informal
sector do not have access to occupational health services.
The objective of Occupational Health for All set in the WHO
Global Strategy on Occupational Health in 1995 has not got
much closer in the past 15 years. The 2009 UN Millenni-
um Development Goals for Decent Work still show major
inequities in the conditions of work, particularly in Africa
and Asia. Although positive developments in many regions
are reported, the absolute level is still unsatisfactory in all
regions of Asia and Africa and in some regions the trend
even shows decline rather than improvement. There are also
signs of regression as a consequence of the current global
financial crisis. On the other hand, fragmentation and the
number of unprotected workers are growing.
To provide a response to the global occupational health
challenges, the WHO/ILO/ICOH joint effort on the devel-
opment of Basic Occupational Health Services (BOHS) was
launched in 2003. BOHS is an implementation of the Alma
Ata principles in the field of occupational health.
A particular problem in the current world of work is
the growing fragmentation of work life caused by outsourc-
ing, downsizing of production, fixed and short-term em-
ployment patterns, growing self-employment and employ-
ment in the informal sector. Particularly the countries in
socioeconomic transition and developing countries face
these major problems. The provision of services for those
in need requires the development of new service provision
models that are adapted to local conditions, are low in cost,
provide wide workforce coverage and still meet the qual-
ity requirements of competent occupational health. Market
mechanisms are not going to meet these needs; therefore
public-sector responsibility is the key factor in develop-
ment of BOHS.
Implementation of BOHS has been incorporated in na-
tional health or occupational safety and health strategies in
many countries, and experiments on its further adjustment
to the national and local conditions are in progress. Interest-
ing and good examples are given by the pilot projects in, for
example, China, Vietnam, Thailand and Brazil. Many coun-
tries are planning or preparing for BOHS Pilots, including
the South-East European countries, East African countries
and countries of the Northern Dimension Partnership col-
laboration in Northern Europe.
The inequities in occupational health and safety con-
stitute one of the most striking inequities among the coun-
tries and people of the world. The BOHS strategy and ap-
proach are an attempt to alleviate that inequity and support
the achievement of both the UN Millennium Development
Goals and the WHO Occupational Health for All objectives.
The International Conference on Primary Health Care, Alma
Ata, 12.9.1978.
Declaration of Alma-Ata.
http://www.un-documents.net/alma-ata.htm
United Nations. Millennium Development Goals: 2009 Pro-
gress Chart
http://millenniumindicators.un.org/unsd/mdg/Resources/
Static/Products/Progress2009/MDG_Report_2009_Pro-
gress_Chart_En.pdf
United Nations The Millennium Development Goals Report.
New York 2009.
http://millenniumindicators.un.org/unsd/mdg/Resources/
Static/Products/Progress2009/MDG_Report_2009_En.pdf
WHO. Global Strategy on Occupational Health for All.
Geneva 1995.
WHO. World Health Report 2008. Geneva 2008.
WHO. The 62nd World Health Assembly. Resolution 62.12
and Resolution 62.14. WHO Geneva 2009.
Jorma Rantanen
Asian-Pacific
Asian-Pacific
Newslett
Newslett
on Occup
on Occup
Health
Health
andand
Safety
Safety
2009;16:27
2009;16 • 27

Situation of occupational health
services in Thailand
Somkiat Siriruttanapruk, Thailand
Introduction
In Thailand more than half of the total popu-
lation is working (1), most of them (38%) in
the agricultural sector. The rest work in man-
ufacturing, construction, and service sectors.
Each year at least 200,000 cases of occupa-
tional injuries and diseases are diagnosed and
compensated (3% of workers under the Thai
workmen’s compensation Scheme) (2). This
affects not only workers’ health, but also pro-
ductivity and the economy of the nation as a
whole. Therefore, it is important for all rele-
vant agencies to co-operate in order to iden-
tify and implement effective preventive and
control measures to alleviate problems. One
of the most important and necessary preven-
tive and control measures is the provision of
occupational health (OH) services.
The Regulation relating to OH services
in the country is under the Labour Protec-
tion Act 1998 (3). This law requires employers
to provide OH services for their employees.
Employers have to arrange OH professionals
to fulfil this obligation. The type and number
of OH professionals to be hired depends on
the type of the enterprise (i.e. high-risk work)
and the number of employees. For example,
the list of target enterprises includes mines,
petrochemical manufacturing, construction,
28 • Asian-Pacific Newslett on Occup Health and Safety 2009;16:28–9
Photos by Bureau of Occupational and Environmental Diseases
transportation, electricity production, etc. Re-
garding the type of OH professionals, employ-
ers have to appoint at least one safety officer in
enterprises which have more than 50 employ-
ees (one safety officer for every 50 employees).
One OH nurse has also to be arranged in en-
terprises which have more than 200 employ-
ees (another OH nurse has to be hired, if the
number of employees is more than 1,000). In
addition, one OH physician has to be arranged
in enterprises which have more than 500 em-
ployees. The Regulation also describes all im-
portant OH service activities for OH profes-
sionals to perform.
There are at least three models of OH serv-
ice system in Thailand: the in-house service
model, the private health centre model and
the community health centre model (4). The
in-house service model, or the big industry
model, is the provision of OH services by in-
plant units, usually staffed by a team of full-
time OH professionals. This model is typical of
large units in the manufacturing and process-
ing industries (5). According to the previously
mentioned regulation, most enterprises, espe-
cially large enterprises, comply with the law by
providing OH services according to this mod-
el. Most medium-sized or small enterprises (or
even some large enterprises), where employ-
ers cannot afford to hire full-time staff, prefer
to arrange OH services by buying the services
from private hospitals or private companies.
This model is now becoming common in the
country. The rest of the working population,
especially workers in the informal economy,
access the OH services provided by the gov-
ernment health care services, such as govern-
ment hospitals and primary care units (PCUs).
A survey of OH services provided by
different types of service providers
Although several types of OH services have
been provided in the country, there is no infor-
mation about such services in terms of qual-
ity, coverage and effectiveness. Therefore, the
Bureau of Occupational and Environmental
Diseases, Ministry of Public Health, the main
authority for OH services in the country, de-
cided to conduct a survey to collect informa-
tion about the current situation of OH serv-
ices (4). The study was carried out in 2006. The
aim of the study was to describe current situa-
tion of OH services in the country by different
types of service providers. It was intended to
explore characteristics and activities of such
OH services and to determine obstacles and
needs for OH service improvement.
This was a qualitative study design. The
methods included a literature review, an in-
terview of representatives of OH service-pro-
viders, a seminar for relevant organizations,
and data analyses. OH personnel from sever-
al kinds of OH service teams were invited for
in-depth interview. The sample included elev-
en governmental hospitals and PCUs, twelve
private hospitals and eleven OH teams from
eleven big enterprises.
Provision of OH services by
governmental healthcare services
The results of the survey showed that most
governmental hospitals provided OH servic-
es. Most of these hospitals, especially regional
and general hospitals, have set up an Occupa-
tional Medicine (OM) section to be respon-
sible for OH service provision. OM sections
have already been established in most regional
and general hospitals in the country. This fa-
cilitates the provision of OH services in the
provinces. The survey also showed that the
OH service activities provided by governmen-
tal hospitals were varied. The type and amount
of OH activities depended on the size of the
hospitals, structure, resources, competency
of OH teams, and supportive policy from the
hospital’s director. The main activities of OH
services include health risk assessment, work-
ers’ health assessment, health education, and
diagnosis and treatment of occupational dis-
eases. Apart from providing the OH services
to enterprises, the OM sections in those hos-
pitals also provided OH services for their own
healthcare staffs in the hospitals.
Although the OH services provided by
governmental hospitals can increase the cov-
erage of OH services in the country, such serv-
ices by hospitals still focus mainly on employ-
ees from medium-sized and large-scale in-
dustries. Most workers, especially workers in
the informal economy, still cannot access OH
services. For this reason, the Bureau of Occu-
pational and Environmental Diseases decided
to conduct a pilot project, with the support of
the ILO, in order to expand OH services to
underprivileged workers (6). The aim of the
project was to set up and develop OH services
in PCUs through development of the knowl-
edge and capacity of PCU staff in the field of
occupational health. After the project was im-
plemented, the results showed that the integra-
tion of basic OH services into the PCUs was
favourable. The PCU staff have the capacity to
provide OH services and to conduct related
health promotion activities for target workers.
Provision of OH services by industrial
in-house services and private
hospitals
Regarding in-house OH services, the study
showed that all enterprises participating in
the study provided OH services to their em-
ployees. This was because of the selection of
sample in the study. The OH personnel in the
teams included either part-time or full-time
staff. Most of occupational physicians work
part-time in the factories. The main activity
of services focuses on curative care for general
and occupational diseases. Nowadays, many
enterprises are starting to add a disease pre-
vention and health promotion strategy to their
service activities. Although OH service activi-
ties have been conducted in all target facto-
ries, very few employers use OH service infor-
mation effectively for further prevention and
control of occupational diseases.
Up to now, some private hospitals have
also started providing OH services. Although
the activities of the services are quite similar
to those provided by governmental hospitals,
the main service provision by private hospitals
focuses on workers’ health screening. The ad-
vantages of private hospitals in providing OH
services include a pro-active approach at target
enterprises, flexible administration, and easy
resource allocation. However, shortage of OH
personnel, especially occupational physicians,
and lack of a supportive policy from the hos-
pital’s director are still the main obstacles to
the provision of OH services by private hos-
pitals. Nowadays, some private health com-
panies have been established to provide only
OH services to industries.
National plans and strategy for
improvement of OH services in
Thailand
Although the OH services have developed
and expanded very well, several problems
and obstacles still exist to delay the progres-
sion of the OH service system in the coun-
try. These include a lack of OH personnel, no
supportive policy from the top policymakers,
lack of advanced knowledge on OH, insuffi-
cient law enforcement, and ineffective use of
information for further prevention and con-
trol of occupational diseases. The Bureau of
Occupational and Environmental Diseases
under the Ministry of Public Health recog-
nizes the problems and identifies the needs
to support the provision of OH services by
several OH service-providers. Therefore, the
Bureau has collaborated with relevant organi-
zations and academia to develop the national
plans and strategy for OH service improve-
ment. The main action plans consist of the
development of an OH service standard and
guidelines, support for OH services in pri-
vate sectors and enterprises, development of
quality assurance for OH services, capacity
building for OH personnel in the country,
Asian-Pacific Newslett on Occup Health and Safety 2009;16:28–9 •
and development of networking among OH
service-providers.
Conclusions
OH services are very important for the OH
system. The models of OH services are varied
and include big industry, private hospital, and
community health centre models. Activities of
OH services are also varied, ranging from only
curative care for diseases to disease prevention
and health promotion. Factors affecting the
quality of the OH services include the support-
ive policy of government and enterprises, the
numbers and competency of OH personnel in
each OH team, effective law enforcement, and
investment in OH services. Although several
OH services have been provided for some Thai
workers, the development of such services is
still needed. Therefore, relevant government
organizations have to collaborate to solve the
problems and obstacles in order to improve
the quality of OH services in the country.
Acknowledgement
The author would like to thank the Health
System Research Institute, Thailand for sup-
porting the study survey.
References
1. National Statistical Office. The Labor Force
Survey, Whole Kingdom Quarter 2: April–June
2007. Ministry of Information and Communica-
tion Technology; 2007.
2. Workmen’s Compensation Fund, Social Security
Office. Annual Report; 2008.
3. Ministry of Labour. The Labour Protection Act.
1998; 1998.
4. Siriruttanapruk S, Termvichakorn P, Chamchod
C, Sinsongsuke T. The Situation of Occupational
Health Services in Industrial Sector. Research
report; 2006.
5. Rantanen J. Occupational Health Services in the
Nordic Countries. In: Jeyaratnam J, Chia KS, ed.
Occupational Health in National Development.
World Scientific. Singapore, 1994: 397–405.
6. Siriruttanapruk S, et al. Integrating Occupational
Health Services into Public Health Systems: A
Model Developed with Thailand’s Primary Care
Units. Informal Economy, Poverty and Employ-
ment: Thailand Series, Number 2, ILO; 2006.
Dr. Somkiat Siriruttanapruk
Bureau of Occupational and Environmental
Diseases
Department of Disease Control
Ministry of Public Health
Tivanont Rd, Nonthaburi 11000
Thailand
somkiatk@health.moph.go.th
29

A patient working with vibrating equipment for a long period with suspicion of Raynaud’s Disease.
Occupational health services in Nepal
Sunil Kumar Joshi, Pranab Dahal, Nepal
Background
The global workforce constitutes more
than half of the world’s population (1).
Sound health and healthy working con-
ditions are thus prerequisites. Issues re-
lating to the health, safety, work abil-
ity and well-being of each worker are
fundamental and concern overall so-
cioeconomic development. This rais-
es the need for occupational health as
an important tool and strategy to en-
sure workers’ health, to enhance econo-
mies through improved and increased
productivity, to assure quality prod-
ucts and to increase work motivation
and maintain job satisfaction (2). Oc-
cupational health services (OHS) are
therefore an effective tool to increase
workers’ overall quality of life and to
promote development of society at all
levels.
30 • Asian-Pacific Newslett on Occup Health and Safety 2009;16:30–2
The notion of OHS dates back to
1978, with WHO Alma Ata Declara-
tion (Article VI) (3). Reinforced by ILO
Convention No. 161 on Occupational
Health Services and the WHO Global
Strategy on Occupational Health for
All, the Alma Ata Declaration (4) em-
phasized the need for organizational
services to cater for the occupational
needs of all working people worldwide.
Occupational health services is a
multi-prong approach which requires
the availability of services to all work-
ing people but stresses local adapta-
tion measures. OHS prioritizes cater-
ing to local needs, but seeks afforda-
ble means; it ensures that employers
remain obliged to the workforce and
strives for intermediate-level services
so that implementation would be more
effective. It moreover makes necessary
arrangements for fostering basic serv-
Photo by Sunil Kumar Joshi
ices, as stipulated by the ILO Conven-
tions No. 161 and 155 (5).
Despite serious efforts, much still
Despite remains to be done. The gravity of the
serious issue is indicated by the fact that, fol-
lowing more than three decades of
efforts, multifarious needs assessment and
prioritization, more than 80% of the
much global workforce work and live without
adequate access to OHS (2).
still
remains Nepalese perspective
to be Industrialization is a major foundation
for the development of any country. A
done. global phenomenon, industrialization
has emerged as an important economic
driving force and a common indicator
of development. For the sustainability
and continued development of indus-
trialization, it is essential to have in-
creased production and enhanced pro-
ductivity, for which safe work and a safe work-
place are the complementary base.
A nation practising subsistence agricul-
ture is in transition as concerns its industri-
al development. The workforce in Nepal is
largely engaged in informal sectors, such as
agriculture and service industries. The indus-
trial set-up is dominated by medium-sized
and household-level industries; very few large-
scale industries are in operation. The concept
of occupational health and safety is relatively
new and very few industries maintain opti-
mum occupational standards. The nation at
large is still ignorant of occupational health
issues. The government has already put into
place several legal provisions on occupation-
al health and safety, including a few acts [the
Labour Act (2048/1992) and its subsidiaries]
and some international regulations.
Although the legal requirements regard-
ing OHS are not tough, the greatest constraints
are still grounded in effective implementation,
successful enforcement and periodic updates
of legal systems. This provides an opportunity
to instill the concept of OHS, its utility and its
impacts on making working conditions ap-
propriate. The recent globalization of econo-
mies has also provided a newer dimension:
Nepal, with its strategic geopolitical position-
ing, has the potential to be an industrial hub
and prosperous trading centre. The presence
of resources in abundance and of relatively
cheap labour provides an opportunity to in-
crease industrial activities. The tourism-based
service industry and agro-based industries
are still unaware of OHS. Harnessing these
sectors along with the industrial sector will
provide a broader platform and wider audi-
ences for OHS.
Trends and practices of OHS in Nepal
The concept of OHS in Nepal is in its initial
stage, as the principle and ideologies under-
pinning the notion of OHS have not gained a
foothold in Nepal at all levels. Occupational
safety is considered significant in mechanized
industries, while its importance in other sec-
tors still needs to be justified.
The current practice of occupational safe-
ty is largely guided by the Labour Act of Ne-
pal, which stipulates the provision of workers’
health care, factory inspection and labour in-
spection. The Labour Act of Nepal ensures the
provision of first aid in industrial enterprises
with more than 50 employees, and an aca-
demically trained medical assistant in the case
of industrial enterprises with more than 400
workers. If an industrial enterprise has more
than 1,000 employees, there should be a medi-
cal doctor and a medical assistant. The factory
inspection functions to promote occupational
safety and health conditions in the establish-
ments and demands for optimum conditions
as per the Act. Likewise, labour inspection is
carried out to assess information on workers’
health conditions.
The major limiting factors in these modes
of inspections are the significant loopholes in
the existing legal provisions and failure to act
as changes emerge. Moreover, the meticulous
task of inspection requires human resourc-
es with considerable insight of occupational
health and safety, but such resources are often
lacking. Other limiting factors include the un-
even distribution of inspecting units, a lack of
necessary training and orientation for surveil-
lance, and incomplete coverage of all industri-
al establishments. These conditions have led to
a shortage of ample information and statistics
on occupational health and safety practices
in the nation. Occupational health and safety
measures should not be motivated by fear of
punishment and penalization under the law;
they should be cultivated as a working culture
and a prerequisite for work.
The government realized the need for oc-
cupational health and safety, and established
a separate unit aimed at maintaining occupa-
tional standards. This effort led to the occu-
pational safety and health project born more
than a decade ago. The project goal was to pro-
vide training, review legal frameworks and as-
sist in creating primary information on occu-
pational health conditions. It was also respon-
sible for triggering the momentum of change
to establish the necessary occupational stand-
ards at industrial enterprises. The project is
still in operation, but it lacks coordination
of the efforts required by various ministries
and departments, and the human resources
allocated for the project are often inadequate
to perform the assignments. The lack of ad-
equate working procedures and skilled hu-
man resources also limit the project, and lack
of resources always puts constraints on effec-
tive achievement of the objectives and goals
of the project.
Most industries and employers are prof-
it-oriented. The obligation of providing safe
working conditions is often overlooked, mak-
ing work and working conditions hazardous.
An easy escape mechanism is provided by
loopholes in the legal systems. This tendency
has increased risk and has meant a many-fold
rise in work-related hazards .
The labour force, on the other hand, has
united into federations resembling political in-
stitutions rather than organizations designed
to ease work-related problems. These labour
unions are largely guided by political interests
and act according to their political affiliation.
A few prudent initiatives have been made by
the labour force, but they always lack effective
coordination amongst them; there is also the
absence of a voice for the unions. Thus, these
Asian-Pacific Newslett on Occup Health and Safety 2009;16:30–2 •
efforts have not led to solutions addressing the
much aspired concerns of workers. The labour
force at the bottom rung of the ladder still fac-
es hardship as a deaf ear is often turned to their
pleas, and issues pertaining to healthy work-
ing conditions are often overlooked by both
the state and employers. This side of those in
need has not been able to advocate for change
effectively. The reality of this situation is such
that workers are still collectively bargaining
for issues relating to minimum wages, equal
remuneration and other basic needs that over-
shadow issues pertaining to OHS or safety.
The picture is not bleak everywhere. The
onset of foreign direct investment and the
emergence of a few multinational companies
have been able to depict the best practices of
OHS. It has been observed that these foreign
investment settings together with the estab-
lishment of an industrial set-up lead to the
importing of working culture. This process
has helped to reinforce the concept of OHS in
Nepal. These industries have been involved in
surveillance of the work environment, surveil-
lance of workers’ health, preventive measures,
emergency preparedness and diagnosis of oc-
cupational illness at regular intervals. This ap-
proach is also shared by a few international
projects ongoing in Nepal. These best prac-
tices are yet to spread to a greater number of
industries, production houses and others in
the informal sector.
The lack of coordinated efforts has led to
serious occupational hazards. The most com-
mon hazards in the industries of Nepal are
associated with industrial injuries, accidents,
mechanical and chemical hazards and psy-
chosocial hazards. A few cases of death have
been reported. The causes of industrial acci-
dents are varied, but major causes are the igno-
rance of workers and employers and the negli-
gent efforts of the government. Among other
causes, violation of safety rules is important.
Other factors include lack of formal training,
worker attitudes, lack of supervision, use of
old or outdated machines or equipment, poor
layout, congested workplaces and unsuitable
working conditions (5). Industrial enterprises
also lack measures to provide diagnosis of oc-
cupational diseases and treatment facilities. So
far, the safety measures adopted by establish-
ments in order to prevent accidents are lim-
ited to supervision, a few initiatives of repair
and maintenance, and a scant use of personal
protective equipments.
The occupational hazards in these in-
stances pertain only to the industrial work-
force, as very few studies on agricultural and
service industries have been carried out. The
larger side of the picture is absent, as the ma-
jority of the workforce are still engaged in
both formal/informal agricultural and serv-
ice sectors.
31

Barriers to OHS
The industrial history of Nepal is rather short.
To keep pace with the contemporary world,
Nepal has been turning wheels at full speed
and overlooking issues of occupational health
and safety. The major obstacle to instilling the
concept of OHS in Nepal lies in the inability
of stakeholders to grasp the utility and im-
portance of OHS. Occupational health and
safety procedures require adequate surveil-
lance of the work environment and risk assess-
ment, both of which are missing completely
from most industries in Nepal. Neither have
most industries been able to conduct peri-
odic health surveillance and health exami-
nations to determine workers’ health status.
Control measures for preventive and emer-
gency preparedness are also absent in most
industries. Likewise, diagnostic procedures
for occupational disease and recordkeeping of
such events are lacking. It will therefore take
some time to develop the concept of OHS with
preventive, curative and rehabilitative meas-
ures under a single umbrella of OHS among
entrepreneurs in Nepal.
The barriers to OHS identified in Nepal can
be generalized as follows:
• Lack of awareness concerning OHS at all
levels
• Faulty legal systems and lack of periodic
updates
• Inability to establish OHS as an integral
component of work life
• Lack of professional expertise
• Resource constraints.
Industrial enterprises in Nepal have failed
to develop the infrastructures necessary for ef-
fective implementation of occupational health
programmes, including OHS. Similarly, no
efforts have been made to establish research
programmes and to facilitate training and ed-
ucation in relation to OHS. The wish to create
a primary desk for generating OHS informa-
tion services and databanks is also lacking. It
is noteworthy that efforts for OHS delivery
need to be started from the beginning; the few
existing initiatives have remained incomplete
and unable to trigger ripple effects.
The way forward
The task of providing OHS and maintaining
a safe and healthy work environment is not
easy. It requires a sincere and coordinated ef-
fort of all. Workers need to be empowered to
advocate for improved working conditions.
They should be informed and educated on
occupational grounds for an effective occu-
pational response through their meaningful
participation (3). Workers should also be in-
32 • Asian-Pacific Newslett on Occup Health and Safety 2009;16:30–2
The OHS of a private company
formed of their rights concerning their work-
ing conditions, potential hazards and risks
associated with their work and workplace. A
mechanism is required for their holistic trans-
formation so that they are able to participate
in planning and decision-making concerning
occupational health and other aspects of their
work, safety and health (6).
Employers should be made to under-
stand their responsibility for workers’ safe-
ty and health, and they should honour this
obligation. It is also necessary to make them
understand that OHS is an investment that is
likely to result in motivation, job satisfaction,
a good ambience and increased responsibility
on the job. This chain of events will ultimately
trigger qualitative and quantitative product
increments, solidarity and a sense of owner-
ship amongst all.
Government agencies also need to be en-
couraged to develop a special national frame-
work, policy and programmes for occupation-
al health, including actions for providing com-
petent OHS for all people at work (3). The
programme should focus on developing ap-
propriate legal provisions and systems for ef-
fective enforcement. It should have an inbuilt
mechanism of inspection and surveillance by
professional authorities who are made respon-
sible for maintaining optimum occupational
health and safety at workplaces.
It has to be understood that occupation-
al health and safety, socioeconomic develop-
ment, and the quality of life and well-being of
working people are intricately woven, inter-
linked fabrics. This suggests that any prudent
inputs in occupational health – whether in in-
tellectual or economic terms – always result in
increased productivity and have a significant
impact on the national economy in terms of
economy and sustainability (5).
Photo by Sunil Kumar Joshi
The concept of occupational safety is new
in Nepal. Best practices need to be shared ad-
equately. OHS providers need to bridge the
gulf of bureaucratic systems and employers’ te-
nacity, and must ensure the presence of an in-
formed workforce. This will help reduce work-
related vulnerabilities and establish occupa-
tional health and safety for all.
References
1. Basic Occupational Health Services (BOHS).
Working Paper for the Joint ILO/WHO Com-
mittee on Occupational Health, 9–12 December
2003. Geneva.
2. Basic Occupational Health Services: Strategy,
Structures, Activities, Resources. Rantanen J.
WHO, Helsinki, 2005.
3. Declaration on Occupational Health for All:
World Health Organization, Geneva, 1994.
4. Declaration of Alma-Ata. International Confer-
ence on Primary Health Care, Alma-Ata, USSR,
6–12 September 1978.
5. Global Strategy on Occupational Health for
All. The Way to Health at Work. World Health
Organization, Geneva, 1995.
6. Joshi SK, Dahal P. Occupational Health in Small
Scale and Household Industries in Nepal – A
Situation Analysis. Kathmandu University Medi-
cal Journal (KUMJ). 2008 Apr–Jun;6(2):152–60.
7. World Health Organization. Identification and
control of work-related diseases. Technical report
series 714. WHO, Geneva 1985:1–71.
Dr. Sunil Kumar Joshi
Mr. Pranab Dahal
International Commission on Occupational
Health (ICOH), Nepal
c/o Department of Community Medicine
Kathmandu Medical College
P.O. Box 21266
Sinamangal, Kathmandu
Nepal
Occupational health services in Vietnam
Nguyen Thi Hong Tu, Luong Mai Anh
Vietnam
Introduction
Located in Southeast Asia with an ar-
ea of 330,991 km2 and 63 provinces,
Vietnam has a population of 82 million
people, of which the working popu-
lation makes up more than 50%. The
economy of Vietnam has been grow-
ing very fast recently. The GDP per
capita in 2007 was USD 835, and the
economic growth rate in 2008 was
8.5%. Along with economic develop-
ment, the number of enterprises has
also been increasing. There are more
than 160,000 enterprises (General Sta-
tistics Office, 2003), of which small-
scale and medium-sized enterprises
make up more than 95%. However,
this intensive process of industrializa-
tion has contributed to environment
pollution with its significant impacts
on human health and communities.
Only a small proportion of enterpris-
es provide occupational health serv-
ices to workers; 3–5% of enterprises
provide monitoring of working con-
ditions, 22–25% of workers receive pe-
riodic medical examinations and less
than 10% of workers at risk are covered
with specific examinations for occupa-
tional diseases. The work processes in
many enterprises are associated with
a number of traditional occupational
hazards, such as silica dust, noise, vi-
bration or hazardous chemicals. Only
15% of enterprises, mostly large-scale
enterprises, provide health services to
workers as required by law.
In November 2006 the Vietnam-
ese Government approved the National
Programme on Labour Protection and
Occupational Health and Safety. This
programme has been developed and
completed in consultation with the
National Council of Labour Protec-
tion and the active contribution of
the related Ministries, sectors, prov-
inces and enterprises all over the coun-
try. This is a landmark of progress
for occupational safety and health in
Vietnam.
The paper provides an updated pic-
ture of occupational health services in
Vietnam, describes the mission of oc-
cupational health and safety for the pe-
riod 2010–2015 and presents its oppor-
tunities and challenges.
Surveying the situation
A systematic review of the period
1996–2008 was conducted. The docu-
ment on that review includes periodic
reports from all the provincial preven-
tive medical centres of Vietnam’s 63
provinces, as well as reports submitted
by related ministries and branches to
the General Department of Preventive
Medicine, relevant legal documents,
studies and surveys.
Results
Occupational health system
Nowadays, Vietnam has an effective
health service system ensuring that
medical prevention and curative activi-
ties are implemented well. These activi-
ties are conducted by 30 institutes and
central hospitals, over 100 provincial
preventive medical centres that direct
disease prevention and health promo-
tion, nearly 700 provincial and district
general hospitals and more than 10,000
communal medical stations and local
health care facilities. The total number
of hospital beds is over 136,500. The
public health sector has a roster of
nearly 200,000 medical officers.
In addition, Vietnam has an occu-
pational health system with levels rang-
ing from central to local and including
the General Department of Preventive
Medicine and Environment (Occupa-
tional Health and Injury Prevention
Department), four research institutes
in three regions, 58 preventive medical
centres and six occupational and envi-
ronmental health centres under pro-
vincial/city administration. Nation-
wide, there are 45 provincial preventive
medical centres that have occupation-
al disease clinics with nearly 600 staff
members specialized in occupational
health. In addition, there are 13 occu-
pational health centres in ministries or
branches. At district level, nearly 700
district health centres look after public
The total health and occupational health.
Among the organizations giving oc-
number cupational health training are the Na-
tional Institute of Occupational and En-
of vironmental Health and three regional
institutes. Seven medical university col-
hospital leges have contributed to training of oc-
cupational health officers for different
beds levels and localities. Medical secondary
is over schools are in charge of training tech-
nicians. The training programmes con-
136,500. sist of training in OHS for MDs, bach-
elor’s level training, retraining in OHS
The practice for MDs and others at provin-
cial level and enterprise level, and tai-
public lor-made specific training programmes.
At provincial and ministry levels,
health although occupational health staff have
been trained and retrained, the number
sector of staff is less and less, and the pro-
has a fessional staff are limited in number.
Medical doctors accounted for about
roster of 48% and secondary degree-holders
for 32% of staff (Table 1). Most cen-
nearly tres are furnished with the necessary
equipment. However, at district lev-
200,000 el, 57 % of district health centres do
not have enough essential equipment
medical for OSH. Each centre has only one or
officers. two staff members working on occupa-
tional health; the majority of them are
nurses or assistant doctors with limit-
ed experience and knowledge of OSH.
At the community and enterprise
levels, there are more than 10,000 com-
munal health stations and health sta-
tions at enterprises. About 22.6% of all
enterprises have health staff or health
stations; these are mainly concentrated
Asian-Pacific Newslett on Occup Health and Safety 2009;16:33–7 • 33
in large-scale enterprises, which account for Table 1. Number of health staff in charge of OSH at provincial and ministry or branch levels
88% of all health services at enterprises (42%
Provincial level Ministries/ Total in 2005
of large enterprises have health staff and 50%
branches
have a health station). (Table 2)
Health staff, of whom: 305 265 570

Occupational health services Medical doctors 129 145 274

For many years in Vietnam, occupation- Pharmacists 11 7 18
al health services (OHS) focused mainly on Other university graduates 58 37 95
state-owned enterprises, which were approx- Secondary-level graduates 106 76 182
imately only 6.7% of all enterprises (about
Occupational disease expertise 29 16 45
10,720 enterprises out of a total of 160,000
enterprises in the whole country). Source: Annual report of the General Department of Preventive Medicine in 2005

Because mechanization has not spread

extensively yet, production is based mainly Table 2. Health unit in enterprises
on human resources. Therefore, a number of
workers in our country face occupational haz- No. of en- No. of enterprises Health staff at enterprise
Enterprise size terprises
ards, such as occupational accidents, occupa- Health Health
Total Physician
staff only station
tional diseases, etc. Promotion of basic occu-
pational health services (BOHS) currently is Small-scale 15,752 73 25 162 16
(<50 workers)
an urgent issue in our country. Basic occupa-
tional health services are implemented by pro- Medium-sized 3,742 651 154 1,191 168
(50–200 workers)
vincial, district or branch preventive medical
Large (>200 workers) 5,352 2,226 2,485 7,441 1,147
centres and by health organizations in enter-
prises. Provincial preventive medical centres Total 24,846 2,950 2,664 8,794 1,331
and provincial occupational and environmen- Percentage 11.9 10.7 15.1%
tal health centres are responsible for develop- Source: Annual report of the General Department of Preventive Medicine in 2008
ing a plan and organizing the implementation
of occupational health activities, occupational
Table 3. Different types of occupational health services at provincial level
disease prevention, as well as the monitoring
and supervision of the work environment and Provinces (n=44)
Different types of occupational health services No. %
working conditions causing occupational dis-
eases and occupational injury. They organ- Monitoring and inspection of workplace/production facilities 36 81.8
ize occupational disease prevention activities, Measurement and inspection of the work environment, recording
40 90.9
follow-up and supervision. In addition, they of labour hygiene
provide guidance on periodic health examina- Recommendation of measures to improve labour conditions at
31 70.5
tions, occupational disease examination and workplaces
assessment of occupational diseases. The im- Participation in approval of the design of production facility
14 31.8
(hygiene aspects)
plementation of those services varies across
the country, depending on capacity and the Health examinations in the selection of employees 14 31.8
situation. The five regular services that the Routine health examinations for employees 38 86.4
provincial level can provide are measurement Occupational checks for employees 32 72.7
and inspection of the work environment and
Participation in professional certification 15 34.1
recording of labour hygiene (90.9%); routine
health examinations for employees (86.4%); Preparation of reports on occupational hazards and diseases 23 52.3
monitoring and inspection of workplace/pro- Implementation of occupational health programmes/projects 17 38.6
duction facilities (81.8%); occupational checks Median 26 59.0
for employees (72.7%); and recommendation
of measures to improve labour conditions at Source: Survey of the General Department of Preventive Medicine conducted in 2008 on the situation of the provin-
workplaces (70.5%) (Table 3). cial preventive medical centres in Vietnam’s 45 provinces.
At district level, the main activities of
BOHS include the provision of education,
information and communication, monitor- Table 4. Training situation in 1996–2008
ing occupational safety conditions, making 1996-2000 2001-2005 2006-2008
profiles and organizing periodic health exami-
No of trainees/year 16,947 71,195 485,927
nations for employees in medium-sized and
No of enterprises/year 2,418 4,790 7,540
small-scale enterprises (SSEs). At communal
health stations, the related tasks are to man- Number of training courses/year 238 914 2,456
age the health of workers in SSEs or farmers in Source: Annual report of the General Department of Preventive Medicine and Environmental Health 1996–2008
their locality, to do health examinations, and
to provide training and first aid.
BOHS at enterprise level cover education, ment, identification of high-risk factors, control provision of first aid, accident monitoring, and
information and communication, monitoring of personal protective equipment, organization participating in the investigation process.
of working conditions and the work environ- of periodic health examinations for employees,

34 • Asian-Pacific Newslett on Occup Health and Safety 2009;16:33–7

Achievements of occupational health 50 %
services 45 %

Identification of workers at high risk 40 %

According to the annual report, mining and 32 %
construction workers have the highest per- 30 %
centage of exposure to high risks. (Figure 1)
20 %
Implementation of education, information
and communication and training for workers/ 11 %
enterprises 10 %
6%
The average number of enterprises per year 3% 2% 2%
where training was provided has risen from 0% Mining Construction Metallurgy Transport Fertilizer Ceramics Others
one year to the next, particularly in the peri-
od 2006–2008, but the numbers are still very
Figure 1. Percentage of workers exposed to high risk by industrial branches
low. (Table 4)
Source: Annual reports of the General Department of Preventive Medicine and Environmental Health in 2008
Education, information and communica-
tion activities aimed at employees and employ-
ers have been carried out during the annual The measured samples (%) exceeding the TWA
national weeks on occupational health and 50 %
safety, held in March, and throughout the year.
In 2008, 5,150 booklets were printed for the 40 %
national week and 47,876 leaflets and posters
were distributed then. More than 1,607 news 31.2
items and short clips were broadcast on tel- 30 % 30.8 27.9
26.2 25.2 25.8
evision and radio. A big exhibition was held, 22.3 22.0 21.4 25.4
20.2 20.9
and a competition on good OSH officers at 20 % 17.3 17.0
enterprises was conducted; 227 enterprises 15.4 14.3
13.0 12.2 12.0 11.9
and 7,916 competitors took part in the com- 9.9
10 % 6.6 6.8 7.6
petition.

Monitoring of the work environment 0%

Microclimate Dust Noise Light Toxic gases Radiation Vibration Others
Every year, from 2,000 to 3,000 enterpris-
es have been monitored. During the period 1996-2000 2001-2005 2007-2008
2007–2008, out of a total of 501,194 measured
Figure 2. Work environment monitoring 1996–2008
samples, 27.4% exceeded the time-weighed
Source: Annual report of General Dept. of Preventive Medicine and Environmental Health 1996–2008
average (TWA). Noise and vibration are the
two main factors with the highest percentages
exceeding the TWA. (Figure 2) Risk Factors
With regard to the monitoring of asbes- Exposure to blood 81.6 %
tos in high-risk work environments, a survey 52.7 %
on pollution in the work environment of fi- Exposure to 71.7 %
microorganism 56.8 %
brocement factories conducted in 2005 found
Exposure to 19.7 %
that six out of 23 factories had asbestos con- radiation 5.9 %
centrations of 4.2–5.6 fibres/cm³ air (which is 34.6 %
Unpleasant smell
8–11 times higher than hygienic standards). 12.1 %
In four out of 23 factories, the level of asbes- 47.4 %
Chemical
tos dust was 2–4 times higher than hygienic 54.4 %
standards. In the remaining 13 factories, the Dust 57.7 %
67.7 %
asbestos concentration in workplace air was
0.18–0.53 fibres/cm³. Noise 56 %
29.7 %
At present, the occupational health and
28.1%
safety of health care workers are not given Wet
16.8%
sufficient attention. Health care workers are
Poor breathing air 46.8 %
at high risk of work-related diseases because 36.3 %
of their exposure to blood-borne pathogens 54.7%
and other infections (hepatitis B, hepatitis Hot
39.7 %
C, HIV/AIDS, SARS, tuberculosis, avian flu
virus, etc.), occupational stress, harassment, 0% 20 % 40 % 60 % 80 %
shift work, ergonomic hazards and occupa-
Therapeutic HCWs Epidemic prevention HCWs
tional accidents, such as needle stick inju-
ries. Yet the health, safety and well-being of Figure 3. Evaluation of work environment of health care workers (HCWs)
health care workers are essential for improv- Source: National survey on the health situation and work environment of health care workers in 2006–2008, NIEOH

Asian-Pacific Newslett on Occup Health and Safety 2009;16:33–7 • 35

 Annual health examination and monitoring
ing the performance of the whole health care 67.7% of health care workers working to pre-
system. Their work environment assessment vent epidemics are exposed to dust, 56.8% to In 2008, 3,874 enterprises out of 12,444 re-
has shown that therapeutic health care work- microorganisms and 54.4% to chemicals, re- porting enterprises (31.1%) had conducted
ers are exposed to two main factors, blood spectively. (Figure 3) regular health examinations for their work-
(81.6%) and microorganisms (71.7%), while ers. This represents an increase of 1.3 times
on the corresponding figure in 2007. In all,
1,981,195 workers were under regular health
80 % examination, accounting for 39.6% of work-
71.9
ers reported. This is an increase of 1.56 times
60 % compared to 2007. Thus, the average number
54.8
of workers under regular health examination
41.7 per year in the period 2007–2008 is 2.5 times
40 % 33.5 higher than in the period 2001–2005. In 2008,
the percentage of workers whose health was
20 % 15.8 classified as weak (class IV and V) was 6.6%,
which represents a decrease of 1.6 times on
the rate in 2007.
0%
Poor work Excessive Difficult High number High number of The general health of workers has been
environment workload treatment cases of patients patients’ relatives evaluated through regular health examina-
tions and consultation. Data for 2008 show the
Figure 4. Occupational stress among health care workers
highest rate, 33.2%, for respiratory diseases.
Source: National survey on health situation and working environment of health care workers in 2006–2008, NIEOH
The second highest rate, 13.9%, was recorded
for diseases of digestion and the third high-
est rate, 7.8%, for eye diseases. 48.6% of health
Pulmonary diseases
76.2 %
care workers suffered from occupational stress
Infectious diseases 1 %
caused mainly by a poor work environment
Skin diseases 2.5 % (71.9%). (Figure 4)
The sick leave situation was also deter-
mined. In 2008, the rate of sick leaves was
Noise-induced hearing 12.7% and the average number of days on sick
loss 16.1 % leave was 3.5.

Occupational disease examinations

Up to 2008, 26 out of the total of 63 provinces
Poisoning 4.5 % had carried out occupational disease exam-
inations for 18 kinds of diseases; the list of
compensated occupational diseases includes
Figure 5. Occupational diseases, 1996–2008 25 diseases. The cumulative number of work-
ers suffering from compensated occupational
diseases up to 2008 was 24,175 cases, of which
Cases pulmonary diseases accounted for 75.7%,
7,000
deafness and vibration for 16.1%, poisonous
6,186 6,337 diseases for 4.9%, skin diseases for 2.6% and
6,088 6,047
6,000 infectious diseases for 0.7% of cases. (Figure 5)
Several occupational diseases are now be-
5,000 ing paid more attention. They include silico-
4,521 sis, occupational noise-induced hearing loss,
4,089 4,164 occupational skin disease, pesticide poisoning
4,000
and occupational infectious diseases (hepati-
tis). As to asbestosis, there are government
3,000 regulations on limitation of usage of asbestos
2,553
with a view to gradual elimination.
2,000 1,865
1,262 Occupational accidents
1,206 1,083 1,142 Occupational accidents, and the morbidity
1,026
1,000
513 575 536 621 753 and mortality due to occupational injuries,
514 473
have been reported, as have cases of pesticide
0 poisoning. (Table 5)
2002 2003 2004 2005 2006 2007 2008
Every year, 4,800 occupational accidents
Total cases Death cases Severe cases occur, some 5,000 people are injured and there
are nearly 500 deaths. The number of occupa-
Figure 6. Accidents at work, 2002–2008 tional accidents has increased by 8% per year,
Source: Annual report of MOLISA 2001–2008 2.4 deaths per 100,000 population. (Figure 6)

36 • Asian-Pacific Newslett on Occup Health and Safety 2009;16:33–7

Table 5. Pesticide poisoning in 1997–2008

1997–2000 2001–2005 2007–2008

Situation causing poisoning No. of Mortality Mortality No. of Mortality
No. of cases
cases Number % No. % cases No. %
Total, of which 28,108 1,161 4.1% 34,478 937 2.7% 12,779 243 1.9%
- Suicide 20,867 988 85.2% 28,083 849 90.6% 10,259 226 93%
- Food 4,530 149 12.8% 4,849 80 8.5% 993 11 4.5%
- OD 1,792 24 2% 1,337 8 0.9% 646 6 2.5%

Source: Annual report of the General Department. of Preventive Medicine and Environmental Health 1997–2008

Mission, opportunities and challenges
of OHS in Vietnam for the period
2011–2015
Mission
OHS for the period 2010–2015 are addressed
in many strategy documents, including the
national strategy for development of the sys-
tem of preventive medicine up to 2020, the
national standard for provincial preventive
medical centres up to 2015 and the national
programme on labour protection.
Target indicators on OSH for the period
2011–2015 include
• To increase the coverage of enterprises
with a work environment meeting hygi-
enic requirements.
• To decrease the morbidity of occupation-
al diseases. 100% of workers shall receive
health care services and occupational
health services.
• 100% of workers diagnosed with occupa-
tional accidents and occupational diseases
shall be treated and provided with health
care and rehabilitation services.
• More than 80% of workers in sectors and
jobs with strict occupational safety and
health requirements and OSH officers shall
be trained in OSH.
Opportunities
Currently, the legislation on occupational
health and safety in Vietnam is quite com-
prehensive. There are sufficient supportive
strategy documents on occupational health
and close interministerial collaboration in this
field. Together these provide good opportuni-
ties for occupational health and safety activi-
ties in Vietnam.
Many occupational health and safety
projects are carried out. The National Pro-
gramme on Labour Protection 2006–2010 has
largely been implemented in all 63 provinc-
es with the objectives of improving working
conditions, reducing pollution of the work
environment, preventing occupational acci-
dents and occupational diseases, taking care
of workers’ health and improving awareness
of and compliance with laws on labour pro-
tection.
To aim at dealing with OSH priorities in
this period, besides the above project, in the
cooperation with the Japanese Ministry of
Health, and WHO/ILO, the Ministry of Health
is implementing the project “Worker’s Health
Protection 2008–2012” with the general objec-
tive of strengthening the national capacity for
protecting and promoting workers’ health and
with the specific objectives of implementing
BOHS, preventing asbestos-related diseases,
improving the capacity to monitor the work
environment and diagnose occupational asbes-
tosis, and promoting workers’ health care, OH
services and occupational disease prevention.
Challenges
Despite the above-mentioned advantages for
the development of occupational health serv-
ices in Vietnam, there are still many difficul-
ties and challenges. Pollution of the work en-
vironment is still at a high level. Work-related
diseases and occupational diseases have been
increasing annually. Awareness of health at
work among employees and employers is still
relatively low. Limited law enforcement and an
insufficient regulatory base also contribute to
sustaining work practices that lead to ill health
and injuries. Professional staff working in this
field at all levels is still limited in terms of both
quantity and quality. The underinvestment in
occupational health infrastructure and insuf-
ficient supply of equipment and materials do
not allow adequate surveillance of the work
environment and workers’ health. And finally,
ILO Convention No. 161 has not been ratified
in Vietnam yet.
Conclusion
In conclusion, there are many challenges for
the implementation of occupational health
services. Government and OSH-related or-
ganizations have made efforts to deal with
these problems. The most important thing is
that Vietnam can learn from the lessons and
experiences of how other advanced countries
have addressed the OSH problems they faced
and can avoid the mistakes already made. In
addition, the key success elements in dealing
with OSH problems are strong support from
government and local authorities and close
multisector collaboration, and support from
the international agencies and experts.
References
1. Global Strategy on Occupational Health for
All. The Way to Health at Work. World Health
Organization, Geneva, 1995.
2. Rantanen J. Basic occupational health services,
2007.
3. Occupational health, curriculum for bachelor
on public health, Publishing House of Medicine,
2008, p 147–56.
4. Annual report on occupational health of the
General Department of Preventive Medicine
and Environmental Health MOH, Vietnam
1996–2008.
5. Annual report of MOLISA 2001–2008.
6. National survey of NIOEH on situation of health
and working environment of health care worker,
2006–2008.
7. Survey of General Department of Preventive
Medicine and Environmental Health on situation
of provincial preventive medicine centres in
2008.
8. Health Statistics Year Book 2008.
9. Website of Government Statistic Bureau.
10. National strategy for preventive medicine system
development up to 2015.
11. National standard for provincial centres of pre-
ventive medicine up to 2015.
Assoc. Prof. Dr. Nguyen Thi Hong Tu
President of Vietnam Association on
Occupational Health
1B Yersin Street, Hanoi, Vietnam
E-mail: nghongtu@yahoo.com
Dr. Luong Mai Anh
General Department of Preventive Medicine and
Environment
Ministry of Health, 138A Giang Vo street, Hanoi,
Vietnam

Asian-Pacific Newslett on Occup Health and Safety 2009;16:33–7 • 37

 ➠
A small construction site in Luangprabang Province

Good occupational safety and health practices

Khamphat Onlasy
Lao People’s Democratic Republic

Background
This is the one part of action checklist for small construction sites
Since Lao People’s Democratic Republic start-
MATERIALS HANDLING AND STORAGE.
ed implementing the new economic policy,
many investments have been made in infra-
structure, factories and other small enterpris- Do you propose action?
es. These investments involve Lao workers,
the number of whom is increasing constantly. 1. Clear, marked transport ❑No ❑Yes ❑Priority
Most of these workers come from the country- ways.
Remarks:……………………….............
side, however, and their knowledge of occupa- …………………………….…….................
tional safety and health (OSH) is low. There-
fore, the first national tripartite consultation
seminar on OSH was held in 2000, covering 2. Holes and openings are
Do you propose action?
three priority action areas: small enterprises; securely fenced off or
construction; and agriculture. The second tri- provided with fixed, ❑No ❑Yes ❑Priority
partite workshop was organized in 2004. It was clearly marked covers.
Remarks:……………………….............
an important step toward the development …………………………….…….................
of the National OSH Plan of Action. In 2005
Lao People’s Democratic Republic adopted the
Occupational Safety and Health Work Plan 3. Remove all projecting nails Do you propose action?
2005–2010, which was the first five-year work in timber.
❑No ❑Yes ❑Priority
plan in Laos. The work plan focuses on work
improvement for small enterprises (WISE) Remarks:……………………….............
and in small construction sites (WISCON). …………………………….…….................
The Lao government has been placing
great importance on issues regarding work 4. Use carts, hand- Do you propose action?
trucks, rollers, mo-
safety by: ❑No ❑Yes ❑Priority
• improving labour legislation covering bile storage racks
OSH at the workplace and other wheeled Remarks:……………………….............
• installing national and provincial OSH devices when mo- …………………………….…….................
mechanisms ving materials.
• promoting cooperation with ASEAN
5. Use hoist, conveyers or Do you propose action?
member states, the ILO and other inter-
national organizations other mechanical means ❑No ❑Yes ❑Priority
• building the OSH structure, along with Na- for moving or lifting heavy
materials. Remarks:……………………….............
tional OSH Committee and the provincial
…………………………….…….................
OSH committees in order to achieve effec-

38 • Asian-Pacific Newslett on Occup Health and Safety 2009;16:38–9

 tive implementation of the national OSH
programme according to the government’s
strategy, with the aim of extending socio-
economic development to the rural areas
of the country in 2000–2020.
The main functions of an OSH commit-
tee are to:
• coordinate committee members and stake-
holders
• conduct training and workshops on OSH
➠
• disseminate regulations and guidelines on
OSH
A small factory in Huaphan Province
• monitor and implement workplace inspec-
tions
• gather and report data on OSH activities
and accidents at work to the National OSH
Committee
• encourage good practices by issuing
awards to good practitioners and by giv-
ing adequate warnings or penalties to those
breaking OSH regulations.
➠
Good OSH practices: Progress made
The launching and implementation of OSH
at the provincial level has led to some posi- A small factory in Vientiane, the capital
tive progress: Employers and workers are be-
ginning to understand the benefits of OSH.
The provincial committees have conducted
workshops on OSH for small and medium- April 2009, training on WISE and WISCON productivity and to reduce work-related inju-
sized enterprises (SMEs) and construction has been organized in three provinces, with a ries and disease.
sites. Training on OSH has been provided for total of 90 participants. The WISE and WIS- We still face some difficulties or challeng-
trainers. Meetings have been held to evalu- CON training functioned as a workable ap- es, however. Some enterprises are not famil-
ate and improve the implementation of OSH. proach for improving small enterprises and iar with the concept of OSH and feel that pre-
Workplace inspections have been carried out. small construction sites. Collaborative train- vention is too costly, The OSH administra-
In addition, reports have been submitted to ing networks among the government, employ- tion has a budget that is too limited and the
the OSH National Committee. ers and workers were useful for reaching many national legislative framework on OSH has
Steps have been taken to train provincial small enterprises and small construction sites. some shortcomings. The Lao OSH staff has
staff to work with small enterprises and small As a practical measure for achieving wider limited knowledge and experiences, and they
construction sites. One aim is to visit small coverage of this method for improving OSH, lack specialized tools for performing inspec-
enterprises or construction sites and collect every year on April 28 the Ministry of La- tions effectively.
good examples of safety and health by using bour and Social Welfare delivers a speech on Compared against the situation in the
the action checklist shown below. A second the anniversary of the World Day for Safety past, our society now knows more about oc-
aim is to train representatives of the govern- and Health at Work. Capacity-building for cupational safety and health, and people are
ment staff, workers, and employers to serve as inspectors is carried out in order to promote better aware of how to protect themselves. But
safety and health trainers. Another aim is to effective OSH inspection and prevent work- we also need to learn more about good prac-
assist trained trainers in the provinces in or- related injuries and diseases. Workers, labour tices, and we need additional support and as-
ganizing on-site WISE or WISCON training units, and officials are encouraged to pay at- sistance, both technically and financially, from
directly for workers and site managers. Their tention to occupational safety and health at national and international stakeholders to be
training makes use of the collected good ex- workplaces, in order to reduce work-related able to enhance capacity-building for OSH
amples as practical training materials. For this injuries and diseases, especially in small en- staff, raise OSH awareness among the public
purpose, we have used the action checklist terprises and at construction sites. The pho- as a whole and within enterprises in particular,
provided by ILO. tos show working conditions before and after harmonize the Lao OSH legislation and OSH
The trained government staff, workers and their improvement. organization framework, and also to provide
site managers have implemented improve- specialized tools for effective OSH inspection.
ments in OSH that are basic and easy to un-
Conclusion
derstand. The improvements achieved using Mr. Khamphat Onlasy
available local materials pertain to, among Occupational safety and health makes human Deputy Director, Labour Inspection Division
others, storage and handling of materials, life safer and healthier, and is emerging as a Department of Labour Management
how to work at heights, machine safety, the topic discussed increasingly in our contempo- Ministry of Labour and Social Welfare
physical environment and welfare facilities. rary society. The aim is to ensure that man- Lao People’s Democratic Republic
Trained trainers have expanded training ac- agers, staff members and workers have more E-mail: khamphat@yahoo.com
tivities in different provinces. As of March– pride and feel confident at work, to increase

Asian-Pacific Newslett on Occup Health and Safety 2009;16:38–9 • 39

Occupational health services
for the informal sector
Jorma Rantanen
ICOH/Finland

The informal sector; an alien in its

own country

The informal sector (IS) is a poorly defined

concept, which varies greatly between differ-
ent contexts and different users. However, the
very nature of the informal sector determines
the whole life, operations, economic and social
relations, as well as occupational health and
safety, of the sector.
The most widely used definition is given
by the ILO:
The informal sector is broadly characterised
as consisting of units engaged in the production
of goods or services with the primary objective
of generating employment and incomes to the
persons concerned. These units typically oper-
ate at a low level of organisation, with little or
no division between labour and capital as fac-
tors of production and on a small scale. Labour
relations – where they exist - are based mostly
on casual employment, kinship or personal and
social relations rather than contractual arrange-
ments with formal guarantees.
The ambiguity of the concept has long
been unfavourable for the development of
the sector and for the provision of necessary
policy and legal instruments. In recent years,
the IS has attracted more political interest in
both International Organizations and national
policies. This is associated with the growing
role of IS in the developing world in particu-
lar, but also in the industrialized world. While,
for example, the ILO started the discussion
of IS already in the 1970s, the first extensive
discussion in the highest forum of ILO policy
– the International Labour Conference – did
not take place until 2002. These discussions
thoroughly covered the need for services in
the informal sector, including those of occu-
pational safety and health. Since the meetings,
informal sector needs have been a penetrating
principle in most ILO policies. Parallel policy
actions have also been undertaken by the In-
ternational Social Security Association (ISSA),
covering social protection, pensions, health,
and accident insurance in the informal sector.
Important for employment, but
historically not for policies
Due to the very nature of the IS, its size is dif-
ficult to measure. The informal sector provides
It is important that the questions are truly understood during health interviews conducted by the
basic occupational health services. (Vietnam)
jobs and reduces unemployment and under-
employment. It is a survival strategy for the
poorest fraction of society and sustains their
families, households and communities. Ac-
cording to the World Bank, in most cases, the
jobs are low-paid, and job security, social se-
curity, and working conditions are poor. Al-
though the informal sector enhances entrepre-
neurial activity, it does so to the detriment of
state regulation compliance, particularly re-
garding tax and labour. It helps alleviate ab-
solute poverty, but in many cases the informal
sector workers belong to the working poor.
The size of the informal labour market
varies from the estimated 40–57% of total em-
ployment in Latin America and the Caribbean,
to 40–85% in Asia and 60–78% in Africa. (Ta-
ble 1). The contribution of the informal sector
to the national economy varies respectively be-
tween 13% and 52% of the GDP in 12 Asian
developing countries (average 26%) and be-
tween 50% and 80% of GDP in Sub-Saharan
African countries.
The World Bank observations speak for
the growing size and importance of the in-
formal sector in the national economy during
economic downturns and periods of economic
adjustment and transition, as during the cur-
rent process of globalization and global eco-
nomic crisis (Figure 1).
The safety and health situation in the
informal sector
Research reports on occupational health in
the informal sector are rare. In general, safety
and health risks are found to be more prev-
alent than in the formal sector, and safety
policies and practices often non-existent or
very poor. The most advanced countries and
highly developed companies have found that
a high-quality work environment is condu-
cive to health and safety, work ability and the
well-being of workers, but also to productiv-
ity and the quality of products and services.
Thus they continue to invest in occupational
health. There is enormous inequality in the ac-
cess to occupational health services between
countries, sectors of economy, groups of work-
ers and geographical areas. The availability of
services is not determined by real needs but
several other factors, and where the needs are
highest, as in the informal sector, the access
to services is most unlikely to occur. Para-
doxically, where the risks are the highest and
the starting level the least developed, ben-

40 • Asian-Pacific Newslett on Occup Health and Safety 2009;16:40–2

 Table 1. Contribution of informal sector to employment and generation of new jobs.
efits from occupational health are found to
be the highest.
Region
Occupational health situation has not im-
proved very much in the informal sector over Sector Latin America and
Africa Asia
the last 30 years. Several international instru- the Caribbean
ments have been available but they have not
Non-agricultural employment 57% 78% 45-85%
been effective. The globalization era, together
with the current global economic crisis have Urban employment 40% 61% 40-60%
even increased inequalities in health and safe-
ty. New innovative approaches in occupational Creation of new jobs 83% 93% NA
health are needed to meet the challenges facing
the informal sector. As the changes of work life Source: Charmes, J. 2000. Background paper for UN Statistical Division, The World’s Women 2000: Trends and Statistics
are global, the responses of occupational health
also need to be generated on a global scale.
Informal Economy in % GNP 1999/2000

New policies and actions needed 60

52.6
A number of policy and practical actions for 50
44.6 43.4
providing services for the informal sector have
38.4 36.8
been initiated in recent years, according to the 40 35.6
guidance of the International Organizations, 31.1
30 26
ILO, WHO and ICOH. 23.1
The ILO Global Strategy on Occupation- 19.4 18.4
20 15.8
al Safety and Health (2003) and Framework 13.1
Convention 187 (2006) include principles for 10
e.g. the provision of services to the informal
0
sector, the WHO Global Plan of Action for
ka

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AV ina
es

an

sh
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ia

am

E
pa

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Workers’ Health calls the member states to
an

in

de

go
ist
ila

ay

ne
In

Ch
Ne

tn
pp
iL

ER
on
la
k
a

al

do

e
Pa
Th

Vi
ng
illi

M
Sr

provide basic occupational health services

In
Ph

Ba

for all, and the ICOH strategic objectives for

2003–2012 contain the development of serv-
ices and competences for basic occupational
health services.
In view of occupational health, the IS
shows the following characteristics:
• Possibly urban or rural, units may be either
scattered or concentrated in special zones
• Often family ownership of production
units, but also co-operatives
• Household or special sites for production
units
• Low or non-existent contribution to tax-
ation and social security, with no social
protection
• Small-scale of operations in urban and
suburban environments may be extreme-
ly tight
• Labour-intensive, high workload, low
technology
• Low level of education, but also some high
manual or other skills
• Unregistered employment
• Uncovered by regulation, inspection and
services
• High occurrence of health and safety haz-
ards
• Poor general hygiene and environmental
health.
For the organization and provision of oc-
cupational health services, the IS sets special
challenges, such as the following:
• Poverty and social exclusion from organ-
ized society, including the labour market
Figure 1. Weight of informal sector as percentage of GDP in 12 Asian Countries.
Source: ILO Turin Training Centre 2009. Original source of data: Schneider, F. (2002), “Size and measurement of the
informal economy in 110 countries around the world”, Rapid Response Unit, The World Bank, Washington, DC.
• Low level of organization of IS people and
inability to defend their rights and enti-
tlements
• No employer-employee relationship or, if
it exists, unregulated
• Scattering of workers into thousands of
small units mostly without any co-ordi-
native organ
• Low awareness in the sector itself of oc-
cupational health and safety hazards and
need of services
• Need for external support for occupation-
al health
• Often low awareness and interest among
the authorities, social partners and service
providers towards improvement of condi-
tions of work
• Most of the international and national in-
struments and mechanisms for occupa-
tional health and safety are inappropri-
ate and unfeasible for the informal sector
• There is a greater need for services than
for inspection.
New initiatives by International
Organizations
Already in the 1980s, the ILO introduced prac-
tical tools for occupational safety and health
practices in the informal sector, such as WISE
for SMEs and WIND for agriculture.
Keeping in mind the above challenges, the
International Commission on Occupational
Health, ICOH, has, together with the ILO and
WHO launched a new concept on Basic Occu-
pational Health Services, BOHS. The BOHS ap-
proach is intended to organize grassroots level
occupational health activities so that they are
available for all working people. The integra-
tion of occupational health services with pri-
mary health care services has been proposed
as a realistic opportunity to reach the work-
places and workers even in the scattered in-
formal sector. This would also produce more
cost-effective services. Such services should be
available for every workplace and working in-
dividual in the world. Guidelines for the mod-
els, infrastructures, practices and work tools
are being prepared for this objective through
collaboration between the International Or-
ganizations.
Introducing BOHS to grassroots level in
countries requires the following:
• Adopting a primary health care approach,
as a service provision strategy
• Keeping sound occupational health con-

Asian-Pacific Newslett on Occup Health and Safety 2009;16:40–2 • 41


The informal sector includes many different types of streetside businesses (China).
tent as an important principle in service
provision
• Providing BOHS services with simple, low-
cost tools for practical service provision
by introducing good practice guidelines
• Adjusting BOHS services to national and
local circumstances through pilot experi-
ments, then developing the coverage step-
wise
• Organization of two-step training pro-
grammes through the training of train-
ers and service provider training courses.
The use of practical guidelines needs ac-
tive training programmes in all parts of the
world. Local resources are often not imme-
diately sufficient for extensive training pro-
grammes and therefore international collabo-
ration is needed. In the long term, and with the
support of international organizations and na-
tional efforts, every country and every work-
place should be self-sufficient in occupational
health activities.
Many countries start to include the infor-
mal sector in the occupational health strate-
gies and some specifically address the informal
sector in their legislations. Examples of coun-
tries, which in recent years have addressed or
are in the process of responding to the occu-
pational health needs of the informal sector ei-
ther through legislative actions, national pro-
grammes, service provision or through BOHS
projects are: Brazil, Chile, China, Thailand,
Vietnam, East African Community (Burundi,
Kenya, Rwanda, Tanzania and Uganda), the
Northern Dimension Partnership Countries
(Northern Europe), the South-East European
Countries (Albania, Croatia, FYR Macedonia,
Montenegro, and Serbia and Kosovo), Turkey,
and North-West Russia. There are several rea-
42 • Asian-Pacific Newslett on Occup Health and Safety 2009;16:40–2
sons to predict that the importance and size
of the informal sector will grow in the future.
Simultaneously, the need for the formaliza-
tion of the sector, development of regulations,
services and conditions of work, protection of
workers’ health and safety, and the provision of
social security will gain importance on policy
agenda throughout the world.
Literature
Charmes J. 2000. Background paper for UN Statisti-
cal Division, The World’s Women 2000: Trends
and Statistics.
International Labour Conference. 90th Session
2002. Report VI. Decent work and the informal
economy. Sixth item on the agenda. International
Labour Office, Geneva.
International Labour Organization. Informal
Economy: Challenges and Opportunities for
Trade Unions. International Training Center, Turin,
Italy 2003.
Jeebhay M, Jacobs B. Occupational health services in
South Africa. South African Health Review 1999.
Available online at: http://www.healthlink.org.za/
uploads/files/chapter19_99.pdf
Rantanen J. Basic Occupational Health Services –
Basic Practices. Afr Newlett on Occup Health and
Safety 2008;18(2):29–31.
Schneider F. “Size and measurement of the informal
economy in 110 countries around the world”,
Rapid Response Unit, The World Bank, Washing-
ton, DC, 2002.
Jorma Rantanen
Past President of ICOH
ICOH International Commission on Occupa-
tional Health
c/o Topeliuksenkatu 41 a A
00250 Helsinki, Finland
E-mail: jorma.rantanen@ttl.fi
Application of
Myung Sook Lee, Korea
Introduction
It has recently become urgent in Korea to
take measures to prevent cardiovascular dis-
eases and musculoskeletal diseases among
workers, as both are increasing rapidly. Al-
so a highly critical task is the prevention of
traditional occupational diseases, such as
pneumoconiosis, occupational hearing loss
and chemical poisoning. Especially small
and medium-sized enterprises (SMEs) are in
great need of improved working conditions,
both for the protection of workers and for
increased productivity.
This programme, an application of the
“Participatory Action Oriented Training
Programme,” or the PAOT programme, was
developed by the Korean Industrial Health
Association (KIHA). The purposes of the
programme are to enhance workers’ aware-
ness in order to prevent occupational dis-
eases and to stimulate their voluntary safety
and health activities. KIHA conducted the
programme later in cooperation with the
Federation of Korean Trade Unions (FKTU)
and the Chungju Regional Office of the Min-
istry of Labour.
Subject of the programme
This programme was named the “Participa-
tory Action Oriented Training Programme
with the Group Occupational Health Serv-
ice (PAOT-GOHS)” because it was designed
for application by the SMEs commissioning
KIHA to provide group occupational health
services 1). KIHA already has experience of
this programme. Several pilot studies were
conducted in 2005 and 2006, with satisfac-
tory results. KIHA has conducted this pro-
gramme for SMEs coordinated with the
Federation of Korean Trade Unions. The
programme was implemented at 19 Kore-
an SMEs in 2007. In 2008 the programme
1)
GOHS: The Industrial Safety and Health Law of Korea
requires all potentially harmful workplaces with 50 or
more workers to hire one or more occupational health
managers. On the other hand, the law grants enter-
prises the option of either hiring health managers or
commissioning a professional organization to provide
occupational health services instead. The latter is cal-
led Group Occupational Health Service (GOHS). The
centres providing group occupational health services
are required to have designated personnel including
doctors, nurses and occupational hygienists. These
professionals visit the workplaces as a team on a re-
gular basis, in order to carry out the role of the health
manager as defined in the law.
the PAOT-GOHS programme to SMEs in Korea
was implemented in another 30 Korean SMEs
jointly coordinated with the Chungju Regional
Office of the Ministry of Labour. In 2009, KI-
HA, the Federation of Korean Trade Unions
and the Chungju Labour Regional Office have
jointly conducted PAOT-GOHS programme
in Korean SMEs.
Development of the training materials
Every year since 2004, KIHA has sent its staff
abroad to attend the PAOT workshops organ-
ized by ILO, Japan (TOSHC) and Vietnam
(ECHO). In view of the differences in work-
ing conditions and the way of thinking, we
have found it necessary to develop training
materials for Korean workers. At first KIHA
made references to WISE (Work Improvement
In Small Enterprises) and other materials de-
veloped by ILO for the PAOT programmes. In
developing action checklists with reference to
the ILO ergonomic guidelines, KIHA started
with the following industries: manufactur-
ing; retail markets; and telecommunications.
The PAOT-GOHS programme has con-
sisted of promotion of various workplace im-
provement strategies, small group activities
with great emphasis on low-cost improve-
ment, support for the PAOT trainers and ex-
perts’ follow-up activities. The programme
has also given priority to encouraging partic-
ipation and to inducing and promoting posi-
tive thinking and action among workers and
managers.
Application of the PAOT-GOHS
programme
This programme was applied at 19 enterprises
in 2007 and 30 enterprises in 2008. It proceed-
ed in four steps: 1) recruitment of participants;
2) training of PAOT facilitators; 3) follow-up
visits to the workplace by the occupational
health personnel of the GOHS; and 4) a work-
shop for the presentation of achievements.
1. Recruitment of participants
Managers whose enterprises suffered
from occupational accidents or diseas-
es the previous year were invited to the
half-day gatherings. We explained the
government’s industrial safety and health
policy and the experiences of the PAOT,
and held a contest for photos illustrating
good examples.
2. Training of PAOT facilitators
We organized two types of PAOT train-
ing courses. One was a three-day course
Group activity in the PAOT-GOHS workshop
for the training of trainers. The other was
a two-day course for workers and man-
agers. The contents of each course were
same: The principle of the PAOT pro-
gramme was described, good examples of
low-cost improvements were presented,
the role of the facilitator was explained,
and information was given about the pre-
vention of musculoskeletal diseases, use
of the action checklist, materials storage
and handling, machine safety, worksta-
tion design, the physical environment
and facilities for wellbeing. Utilization
of the workplace checklist, group discus-
sions and presentations were used as the
training method.
3. Follow-up visits
The follow-up visits to enterprises where
the PAOT-GOHS programme partici-
pants were working were done to col-
lect good examples of improvements
achieved subsequent to the training, and
to encourage the course participants’ own
safety and health activities in their en-
terprises. The staff of the group occupa-
tional health service centre carried out
their original duties in line with follow-
up activities.
4. Workshop for presentation of achieve-
ments
We invited all the managers and PAOT-
GOHS programme participants to the
workshop for presentation of what the
participants had achieved since they had
returned to their workplaces. The pres-
entation also showcased the photo con-
test for good, low-cost examples, and
Asian-Pacific Newslett on Occup Health and Safety 2009;16:42–4 •
the attendants had the opportunity to
exchange valuable information.
Results
Analysis of the results of the programme car-
ried out with the FKTU in 2007 showed that 13
enterprises (87.0%) out of the 15 enterprises
that had submitted an improvement plan had
successfully implemented one or more im-
provements. They had achieved 26 (52.8%) out
of 50 items in the improvement plans.
In 2008, 30 enterprises had participated
in the programme. All of the participants had
submitted improvement plans containing a to-
tal of 122 items for improvement. The enter-
prises had succeeded in achieving 65 (53.3%)
of those items, which covered the broad cat-
egories of materials storage and handling, ma-
chine safety, workstation design, the physi-
cal environment, and facilities for well-being.
Most of the managers and programme
participants responded to the survey after fin-
ishing the whole programme. They reported
that it had been a good opportunity to share
practical ideas for improvement. Some of
them responded that they had had opportu-
nities to discover many positive features in
their own enterprises; features that they had
been unaware of before. Some said that it was
very impressive to find that their work envi-
ronment could be improved at very low cost.
Comparison of the enterprises before and after
the improvements in terms of contents, cost
and the benefit of the improvements revealed
that those improvements brought higher pro-
ductivity along with better safety and health
43
 E-mail: mslee@kiha21.or.kr
control at a very low cost and in a short pe-
lyk3379@hanmail.net
riod of time.
Conclusion and suggestions
The PAOT-GOHS programme yielded en-
couraging results for SMEs that had been vul-
nerable to occupational injuries and diseases.
We may conclude that the successful results
arose from the following:
1. The SMEs had a special rapport with the
group occupational health service, whose
staff made regular visits and kept in close
communication.
2. The SMEs had continuous and steady
support from the professional staff of the
group occupational health service, who
worked together as a team for the SMEs
– not only as a group occupational health
service, but also as a facilitator for the PA-
OT-GOHS programme.
3. The participation of the FKTU and the
regional office of the Ministry of Labour
in application of the PAOT-GOHS pro-
ASEAN-OSHNET Workshop
gramme encouraged both workers and em-
ployers to do their best to improve their
on Good OSH Practices
working conditions with more confidence.
Singapore, 18–19 Feb 2009
The PAOT-GOHS programme may be ap-

plied not only to the SMEs commissioning
professional group occupational health serv-
ices, but also to any workplace wishing to par-
ticipate, even large enterprises. The PAOT pro-
gramme showed its effectiveness on many oc-
casions. We may conclude that the PAOT pro-
gramme, with or without group occupation-
al health services, is applicable to SMEs with
high risks of industrial accidents or diseases.
This approach differs from other tradi-
tional methods of supporting enterprises in
preventing occupational accidents and dis-
eases through technical guidance and assist-
ance. It strives to motivate workers and em-
ployers to work together to find something to
improve and then to draw up an improvement
plan and implement the plan by themselves.
We expect that application of this pro-
gramme to as many SMEs as possible, both
with government support and with the coop-
eration of workers’ and employers’ organiza-
tions, will further strengthen the effectiveness
of the PAOT programme and will bridge the
gap between the law and unaccomplished com-
pulsory measures. Furthermore, workers and
employers alike may become used to control-
ling safety and health matters by themselves, if
they repeatedly seek problems and devise solu-
tions for safety and health in their workplaces.
T
he Singapore Ministry of Man-
power, in collaboration with the
ASEAN Occupational Safety and
Health Network (ASEAN-OSH-
NET) secretariat and International Labour
Organization (ILO), organized the Workshop
on Good OSH Practices on 18–19 February
2009. The workshop involved the active partic-
ipation of representatives from nine ASEAN
countries, Japan, Korea and the ILO. It was
facilitated by two experts, Dr. Kogi from the
Institute of Science for Labour, Japan (current
President, International Commission on Oc-
cupational Health) and Dr. Kawakami from
the ILO.
Each country presented one to two exam-
ples of good OSH practices implemented at
the national level. These were in the area of de-
velopment of national OSH frameworks, en-
forcement strategies, training of safety person-
nel and workers, promotion and outreach ini-
tiatives, coverage of the informal economy and
small and medium enterprises. Mr Suresh Na-
varatnam, a Director from the Occupational
Safety and Health Division, Ministry of Man-
power, Singapore shared on the Programme
Based Engagement (PROBE), an engagement
and enforcement programme targeting high-
risk sectors and how this has contributed to
greater industry ownership of OSH outcomes.
This database of good OSH practices will
be hosted on the ASEAN-OSHNET website
as a platform for the sharing of good OSH
practices. More of such OSH practices would
be added to this database for the benefit of
ASEAN members who can implement rel-
evant practices in their own countries. This
will be a useful resource for members as they
implement their national OSH frameworks as
part of the ASEAN Plan of Action.
Submitted by Dr. Lee Hock Siang and
Dr. Tsuyoshi Kawakami

Myung Sook Lee (APN, Ph.D.)

Director, Health Management Department
Korean Industrial Health Association
Hyesan Building, 1490-32 Seocho 3-dong
Seocho-gu, Seoul, Korea

44 • Asian-Pacific Newslett on Occup Health and Safety 2009;16:42–4

Integration of workers’ health
in primary health care strategies
– meeting report
Photos by Suvi Lehtinen
Suvi Lehtinen, Finland

A
n inter-country consultation took
place on 4–7 May 2009 in Santiago
de Chile to collect countries’ expe-
riences concerning integration of
occupational health with primary health care
(PHC). The meeting was successfully organ-
ized by the Ministry of Health and Ministry of
Labour, Chile in collaboration with WHO. It
brought together a total of 42 participants from
ten different countries to share their experi-
ences of various solutions applied to develop
occupational health services for all working
people in their respective countries.
Dr. Jeanette Vega, Vice Minister of Health,
bid the participants warmly welcome to the
meeting. She mentioned that health and con- Dr. Peter Orris of the USA (on the left) and Dr. Hernan Sandoval of Chile.
ditions of work are extremely important, es-
pecially now that there are so many health-re-
lated problems on the global agenda. Political
will is the basis for improvement in the public
sector. Regulations agreed in international or-
ganizations need to be implemented, she con-
tinued, thereby encouraging the consultation
participants.

Implementation of the WHO Global

Plan of Action
Dr. Orielle Solar, from the Ministry of Health,
emphasized the need to integrate occupational
health into public health services. The occupa-
tional health component needs to be strength-
ened. It is a very central objective also in the
development of conditions of work in general.
The WHO Global Plan of Action on Work-
ers’ Health from 2007 provides clear and real-
istic guidance for the development of occupa-
tional health services, particularly for under-
served and high-risk sectors or groups such as
agriculture, SMEs and micro-enterprises, the
self-employed and the informal sector. The
integrated PHC-OHS approach is expected to
be a particularly feasible approach for achiev-
ing the objectives of the Global Plan of Action.
Objective 3 of the Global Plan deals with im-
proving access to basic occupational health
services by means of the primary health care
approach.
The efforts for health system reform on-
going at WHO provide excellent opportuni-
ties for the improved inclusion of OHS into
the health system, for integration with PHC
Participants of the consultation.
and for expansion of services to cover all un-
derserved sectors.
Experiences from pilot projects were
shared
Countries’ experiences of developing their oc-
cupational health services with a view to im-
proved coverage and integration of occupa-
tional health services into PHC were reported.
Several countries, including the UK, Thailand,
Finland, Italy, The Netherlands, Brazil, South
Africa, Chile, Cuba, and the USA, shared the
lessons learned from their experiments. The
approaches and methods varied widely, as did
the degree of development and implemen-
tation of pilot experiments. It was deemed
important that the experimental process and
procedure be planned and documented sys-
tematically, in order to be able to evaluate the
results achieved and to make modifications
and improvements, if needed.
The summary report of the meeting, al-
so including the countries’ situation with re-
gard to the models and forms of occupation-
al health services, will be published in due
course.
Suvi Lehtinen, Chief
International Affairs
Finnish Institute of Occupational Health
Topeliuksenkatu 41 a A
FI-00250 Helsinki
Finland
E-mail: suvi.lehtinen@ttl.fi

Asian-Pacific Newslett on Occup Health and Safety 2009;16:45 • 45

OSH for Development – Book review
Jorma Rantanen and
Suvi Lehtinen
Elgstrand K, Petersson NF (Eds.).
OSH for Development.
ISBN 978-91-633-4798-6, June 2009.
Sweden has a strong tradition in occupational
safety and health both nationally and inter-
nationally. The book under review has been
prepared and published by the Swedish occu-
pational health and safety expert community.
It is based on the 20-year long training activi-
ties of Swedish colleagues conducted in col-
laboration with the developing world. Com-
piling the training course materials taught was
deemed an appropriate, although time-con-
suming endeavour. The result shows that it
was worthwhile.
The book comprises 798 pages – a pack-
age of 2 kilograms of useful information. The
intended readership is wide – OSH experts in
developing countries covering the full spec-
trum of OSH professions and actors. The book
widely covers the whole topical spectrum of
occupational health and safety. The balance
of the content is excellent: history, future per-
spectives, main risk factors and outcomes,
key target groups, OSH system at all levels
(workplace, national and global), and finally
the generation of change, including project
guidelines. In spite of 46 authors the editorial
process has kept the structure and content of
chapters well standardized, giving the book a
very concise structure as a whole.
The compactness of chapters suffers slight-
ly because of the ”collection nature” of the
texts, which may be related to the use of lec-
ture handouts as a starting point. The same
can be said regarding figures and tables, which
have not been specially edited for this book,
but taken from lecture handouts.
Most of the chapters contain several prac-
tical guides and check-lists, which can be di-
rectly used in occupational health practic-
es. This is a most valuable contribution of
the book for guiding practical actions at the
workplace. Sometimes the chapters contain
descriptions of both risk factors and conse-
quent health outcomes in the same chapter.
Some subchapters deal only with risk factors
followed by a separate subchapter on related
diseases or injuries. As they are well inter-
linked, it does not disturb the reader.
In addition, the book has specific chapters
on planning occupational health and safety
activities at the national level, as well as in-
troducing the international activities on the
global perspective on OSH.
46 • Asian-Pacific Newslett on Occup Health and Safety 2009;16:46–7
The history of OSH constitutes a compact
but deep analysis on the evolution of OSH. It
once again confirms the claims that: a) the
history of humankind is very much the his-
tory of work; and b) work life has been in the
forefront of general societal development. The
most important message for the reader is: the
old industry-based safety and health paradigm
based on the well-organized enforcement sys-
tems and developed industrial relations has
decayed, and a new socio-technical paradigm
is needed, although it will be extremely chal-
lenging to implement it in the world of frag-
menting structures, and weakening social co-
hesion and solidarity.
Chapter 3 covers the basic physiology of
manual work, energy metabolism and nutri-
tion, musculoskeletal disorders and workplace
design and ergonomics. The texts are based on
classical textbooks and scientific references of
work physiology and ergonomics, and are thus
most reliable. The textbook material leaves
out some recent interesting research findings,
but this has little impact on the chapters as a
The balance of
the content is
excellent: history,
future perspectives,
main risk factors
and outcomes,
key target groups,
OSH system at all
levels (workplace,
national and
global), and finally
the generation of
change, including
project guidelines.
whole; the key observations are well-estab-
lished and widely accepted conclusions of the
current state of the art.
Chapter 4 describes the concept of risk
and presents risk control strategies, accidents
and their prevention, noise, and both hand-
arm and whole body vibration. The risk chap-
ter introduces generic risk prevention strat-
egies, the tools and roles of various actors,
including insurance. The subchapter on ac-
cidents gives an overview of the evolution of
accident theories, emphasizes work and work
environment as the source of accident risks,
and safety management approaches includ-
ing major hazards, as well as the behavioural
aspects of workers, supervisors and manag-
ers. Safety policy and safety culture are briefly
mentioned as important guiding principles for
accident prevention.
The subchapters on noise, vibrations, radi-
ation, electrical safety and fire safety are com-
pact and practice-oriented, providing a good
insight into the hazards concerned and their
prevention.
Chapter 5 on chemicals is a typical exam-
ple of the mixed character of the chapters. It
starts logically on chemical risk assessment,
goes through the most common groups of
chemicals, pesticides, solvents and gases, dusts
and metals, and then jumps to skin disorders
and epidemiological methods.
Chapter 6 on the prevention of biological
hazards covers the main sources of biologi-
cal risks and hazardous biological agents, and
the industries and work in which they occur,
including the special hazards of health care
workers. Numerous guidelines for prevention
and control are given, including the preven-
tion of needle stick injuries, the immunization
of health care workers against hepatitis B, and
post-exposure prophylaxis of HIV exposure.
Occupational exposure to malaria, tuberculo-
sis and several bacterial and viral agents are
also covered.
The psychological risks at work and their
management are discussed in Chapter 7. The
main background paradigm is the Karasek
control-demand model, emphasizing the work
environment and work organization as sourc-
es of risks. Consequently the prevention strat-
egies introduced a focus on the improvement
of work organization in Chapter 8, which de-
scribes the strategies for enterprise survival,
new principles of work organization, learning
at work and managerial leadership develop-
ment, as well as management of change and
team work. Extensive background literature
has been utilized as the source of evidence,
for this often a much debated topic.
The special and often seriously under-
served target groups, such as child labour,
women workers and migrants in particular,
their occupational health and safety prob-
lems and needs, and their management are
extensively discussed, and guidance for man-
agement of the challenges and problems have
been presented by taking support from the
policies and instruments of the International
Organizations, ILO, UNICEF and IOM (In-
ternational Organization for Migration). In-
cluding this chapter in the book is particularly
important in view of serving the target groups
which do not belong to the ”core workforce”.
A special merit is granted to Chapter 10
on the informal sector and small enterpris-
es; a much discussed, but little researched ar-
ea, which is a growing sector of employment
in both industrialized and developing coun-
tries. The gaps between needs for occupation-
al health and safety and the provision of reg-
ulations, enforcement, support and services
are certainly at their widest in these sectors.
The ILO and other available tools for action-
oriented projects are introduced, but system-
wide solutions still remain to be developed.
Management and participation cultures
for occupational health and safety activities
are introduced well, and the importance of
participatory principles in all OSH activities
is emphasized by using the ILO-OSH manage-
ment guidelines as the background source of
information. Interesting examples of preven-
tive interventions are presented. The special bal governance through policies and actions tive concluding items. The book is intend-
subchapter on occupational health services re- of International Organizations, both socially ed mainly to serve as a textbook for studies
ports on the extremely low coverage of occu- and economically oriented, are analysed. The of occupational health and safety. The large
pational health services in the world, and calls ILO Strategies, UNEP, and WTO activities are book would have benefited from inclusion
for prevention. Solutions are drawn from the described. The WHO Global Strategy on Oc- of the key lessons available at the end of each
ILO Convention No. 161 and from the WHO/ cupational Health for All is particularly exten- chapter, which would have helped crystal-
ILO/ICOH guidelines for basic occupational sively discussed. lize the content into a few important points.
health services. The book ends with a Chapter on actions It is understandable that an 800-page
The systems approach in occupational for change, with two important sub-chapters, book that has been prepared over several
safety and health needs policies, strategies one on Strategy for change and the other one years has some parts that are not fully up-
and programmes, regulations, enforcement, describing Project guidelines. These are both dated. For example, the ILO endorsed the
and education and training of all actors, in- extremely important reading for anybody car- Convention on Promotional Framework on
cluding governmental officers, employers and rying out project-type OSH activities with Occupational Safety and Health No. 187 in
workers and experts in the OSH field. Chapter funding from external sources. Chapters such 2006, which could have been described in
11 covers these issues emphasizing the role of as these are rarely seen, but are very useful for detail.
social partners in all phases of occupational the utilization of all the knowledge presented There are some missing references in
health and safety development, from policies in the book, making it work in practice. texts, such as on page 21, in the statement
and strategies to practical implementation. To sum up, the book is very useful for all of former UN Secretary General, Mr. Kofi
Special attention is given to training all the trainers and trainees in occupational health Annan which was first published in the Af-
above groups of actors. and safety, in developing countries in particu- rican Newsletter on Occupational Health
The globalization of work life in Chapter lar, but also in the industrialized world. and Safety 1997;7(3):51. On page 756, the
12 is well described by using evidence available Recommended actions from the Bangkok
from several sources, particularly from inter- Occupational Health Research Workshop
Friendly suggestions for the next
national organizations and national examples. 2000 refer to the results of the Internation-
edition
The impacts of structural changes and their al Conference on Health Research for De-
challenges to occupational health and safety The chapters are relatively extensive and some velopment.
are well described, and the strategies for glo- of them contain summary tables or respec-

Asian-Pacific Newslett on Occup Health and Safety 2009;16:46–7 • 47

Editorial Board Le Van Trinh
Director
as of 1 December 2008 National Institute of Labour Protection
99 Tran Quoc Toan Str.
Hoankiem, Hanoi
Ruhul Quddus K. Chandramouli VIETNAM
Deputy Chief (Medical) Joint Secretary
Department of Inspection for Factories and Ministry of Labour Gabor Sandi
Establishments Room No. 115 Head, CIS
4, Rajuk Avenue Shram Shakti Bhawan International Occupational Safety and
Dhaka-1000 Rafi Marg Health Information Centre
BANGLADESH New Delhi-110001 International Labour Office
INDIA CH-1211 Geneva 22
Chimi Dorji SWITZERLAND
Licencing/Monitoring Tsoggerel Enkhtaivan
Industries Division Chief of Inspection Agency Evelyn Kortum
Ministry of Trade and Industry Ministry of Health and Social Welfare Technical Officer, Occupational Health
Thimphu Labour and Social Welfare Inspection Agency Interventions for Healthy Environments
BHUTAN National ILO/CIS Centre Department of Public Health and
Ulaanbaatar 210648 Environment
Yang Nailian Baga Toirog 10 World Health Organization
National ILO/CIS Centre for China MONGOLIA 20, avenue Appia
China Academy of Safety Sciences and CH-1211 Geneva 27
Technology Lee Hock Siang SWITZERLAND
17 Huixin Xijie Head, International Collaboration
Chaoyang District OSH Specialist Department Jorma Rantanen
Beijing 100029 Occupational Safety and Health Division ICOH, Past President
PEOPLE’S REPUBLIC OF CHINA Ministry of Manpower c/o Finnish Institute of Occupational Health
18 Havelock Road, # 03-02 Topeliuksenkatu 41 a A
Leung Chun-ho Singapore 059764 FI-00250 Helsinki
Deputy Chief Occupational Safety Officer SINGAPORE FINLAND
Development Unit
Occupational Safety and Health Branch John Foteliwale Harri Vainio
Labour Department Deputy Commissioner of Labour (Ag) Director General
25/F, Western Harbour Centre Labour Division Finnish Institute of Occupational Health
181 Connaught Road West P.O. Box G26 Topeliuksenkatu 41 a A
Hong Kong Honiara FI-00250 Helsinki
SOLOMON ISLANDS FINLAND