African Newsletter 1/2013, Health promotion at work

African 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 23, number 1, April 2013

Health promotion at work

African Newsletter

Contents

on Occupational Health and Safety Volume 23, number 1, April 2013 Health promotion at work

3 Editorial

Published by Finnish Institute of Occupational Health Topeliuksenkatu 41 a A FI-00250 Helsinki, Finland

Articles

Editor in Chief Suvi Lehtinen Editor Marianne Joronen Linguistic Editors Alice Lehtinen Delingua Oy Layout Kirjapaino Uusimaa, Studio The Editorial Board is listed (as of January 2013) on the back page.

A list of contact persons in Africa is also on the back page.

This publication enjoys copyright under Protocol 2 of the Universal Copyright Convention. Nevertheless, short excerpts of articles may be reproduced without authorization, on condition that source is indicated. For rights of reproduction or translation, application should be made to the Finnish Institute of Occupational Health, International Affairs, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland.

The African Newsletter on Occupational Health and Safety homepage address is: http://www.ttl.fi/AfricanNewsletter The next issue of the African Newsletter will come out at the end of August 2013. The theme of the issue 2/2013 is Prevention culture.

African Newsletter is financially supported by the Finnish Institute of Occupational Health, the World Health Organization, WHO, and the International Labour Office.

Social determinants of health, and the workplace Sir Michael Marmot, Peter Goldblatt UCL

4 Visible workplace health promotion in Botswana

Sinah Yamogetswe Seoke BOTSWANA

7 Health promotion at workplaces in Tanzania

Vera Ngowi TANZANIA

9 Occupational health nursing practice in the private sector in South Africa Louwna Pretorius SOUTH AFRICA

13 Occupational health and safety in the informal sector – an observational report

G.J. Sekobe, N.M. Mogane, M.G.I. Ntlailane, K.A. Renton, M.J. Manganyi, G.E. Mizan, C.D. Vuma, T. Madzivhandila, S.A. Maloisane, K.C. Lekgetho SOUTH AFRICA

16 How can we support young immigrants’ health and work ability at workplaces?

Merja Turpeinen, Anne Salmi, Jaana Laitinen FINLAND

18 Networking emphasized in Dresden

Suvi Lehtinen

19 Occupational safety and health (OSH) training at ARLAC

Mary Muchengeti ARLAC / ZIMBABWE

21 Health aspects of child labour in the crushing of granites in central Benin

A.P. Ayélo, B. Aguêmon, A. Santos, F. Gounongbé, L. Fourn, B. Fayomi BENIN

Photographs of the cover page: © International Labour Organization / M. Crozet

© Finnish Institute of Occupational Health, 2013

Printed publication: ISSN 0788-4877 On-line publication: ISSN 1239-4386

The responsibility for opinions expressed in signed articles, studies and other contributions rests solely with their authors, and publication does not constitute an endorsement by the International Labour Office, World Health Organization or the Finnish Institute of Occupational Health of the opinions expressed in it.

Editorial

Michael Marmot

Peter Goldblatt

Social determinants of health, and the workplace “The poor health of the poor, the social gradient in health within countries, and the marked health inequities between countries are caused by the unequal distribution of power, income, goods, and services, globally and nationally, the consequent unfairness in the immediate, visible circumstances of people’s lives – their access to health care, schools, and education, their conditions of work and leisure, their homes, communities, towns, or cities – and their chances of leading a flourishing life. This unequal distribution of health-damaging experiences is not in any sense a ‘natural’ phenomenon but is the result of a toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics. Together, the structural determinants and conditions of daily life constitute the social determinants of health and are responsible for a major part of health inequities between and within countries.”

F

WHO Commission on Social Determinants of Health – final report

or many years, the social, political and economic situation in much of Africa provided little reassurance that the health inequities between the continent and the rest of the world, as well as those within and between countries, would improve. But there are signs, over the last decade, of progress in all these dimensions of inequity. Much will need to be done, by countries, communities and civil society within Africa and by the international community at large, to ensure that sustainable reductions in inequities are achieved, that the benefits of economic growth are experienced by all, and that public health lessons are learnt both from Africa’s own experiences and from the impact of rapid economic growth elsewhere in the world.

According to the 2012 World Health Statistics, in 13 countries in Africa life expectancy at birth in 2009 was 50 years or less – all in sub-Saharan Africa – while it was over 70 in five countries on the African Mediterranean coast. A massive health divide. Nonetheless this represents a major improvement compared to the position in 2000, when the life expectancy figure was below 50 in 22 countries across the continent. As a result, the range between countries was four years less in 2009 than in 2000, and average life expectancy for the WHO Afro Region rose by four years – a bigger increase than in any other region.

The rate of GDP growth in Asia has been high throughout this period, and it has been increasing steadily, from an initially low level, in much of

the African continent. As a result, the average growth rate in Africa is predicted to overtake that in Asia during the current decade; the Arab spring has swept through North Africa; and many of the wars in the south have come to an end. These are all signs of hope – but we still have a long way to go to reach the conditions needed to achieve health equity in Africa. Some key indicators continue to place the WHO Afro Region in a poor position, as regards drinking water quality, sanitation, universal health service coverage, rates of mortality, malaria, TB and HIV/AIDS. All of these have a greater impact on people and communities further down the social gradient and on countries poorly equipped to carry the burden or address the root causes.

For the future, a real concern must be the increase in non-communicable diseases (NCD) and their social distribution. The WHO African Region already has the highest NCD mortality rates in the world, particularly from CVD, and the highest prevalence of raised blood pressure in adults. As we have already seen in some countries in Africa, as economic well-being improves and Western diets and smoking habits spread, so these behaviours cease to be those of the elite only, and spread to those who are less educated – creating new social gradients. In conquering communicable diseases we need to ensure that we also address the social conditions that give rise to these and to NCDs. Work is a big part of this. Work provides income, a purpose in life, self-esteem, social relations – but it can also be degrading, dehumanizing, dangerous, and damaging to health in various ways. Addressing social determinants of health will entail, among other things, addressing the crucial role of work in damaging or enhancing health.

Professor Sir Michael Marmot UCL Institute of Health Equity m.marmot@ucl.ac.uk

Professor Peter Goldblatt

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Sinah Yamogetswe Seoke BOTSWANA

Visible workplace health promotion in Botswana Introduction

According to the Bangkok Charter, “Health promotion is the process of enabling people to increase control over their health and its determinants, and thereby improve their health. It is a core function of public health and contributes to the work of tackling communicable and non-communicable diseases and other threats to health (1).” The main elements in health promotion to be noted are to enable individuals to be responsible for their own health and also the creation of an atmosphere that enables people to be continuously active participants in health promotion initiatives in every setting of their everyday life in order to curb ill-health and ensure quality of life. The WHO recognizes that the workplace “offers an ideal setting and infrastructure to support the promotion of health (2).”

Promoting health in the workplace is reported to benefit enterprises in the form of lower illness-related cost and an increase in productivity (3). Any intervention in the workplace that promises the prevention of ill-health is consequently providing occupational health and safety (OH&S) that will see an improvement in the well-being of the workforce thereby leading to a reduction in occupational diseases, accidents, and injuries. The objective of OH&S is to ensure that workplaces are safe to operate in, that operations do not impact negatively on the health of workers, and safety awareness amongst personnel is increased (4). Consequently, OH&S initiatives lead to promoting the preservation of health in the workplace.

The concept of workplace health promotion has been incorporated into Occupational Safety and Health Management Systems (OSH MS). A typical OSH MS includes empowering employees so that they take responsibility for their safety and health, not only their own, but also that of their fellow workers. This is in accordance with the Ottawa Charter (5) which states that health promotion supports individuals’ development through the provision of information and education relating to health. “By so doing, it increases the options available to people to exercise more control over their own health and over their environments, and to make choices conducive to health (5).” One of the main elements of OSH MS is training and the continuous provision of information to the workforce so that they understand the health and safety risks of their workplace [6]. According to 4 • Afr Newslett on Occup Health and Safety 2013;23:4–6

the World Bank (6), having an appropriate OSH MS in the workplace can improve staff performance and availability for work, help in recruiting and retaining key skills and expertise, and reduce workers’ compensation insurance costs and medical expenditures (6).” In this sense, health promotion (in terms of OH&S) is an investment in the workforce, their employability and potential productivity.

In the recent years, the application of systems models in OH&S, now referred to as the OSH Management Systems (OSH MS) approach has gained the attention of enterprises, governments and international organizations as a promising strategy to harmonize OH&S and business requirements, and to ensure more effective participation of workers in implementing preventive measures (7). In the implementation of OSH MS, all the workplace elements to assess hazards and risks are considered; commitments are made at all levels of the organization; management and workers are involved in the process at their level of responsibility (4).

According to Robson et al. (8), there are studies that have shown that a more developed OSH MS is correlated with lower injury rate; thereby ensuring improved well-being in the workplace.

Background

The 2012 Global Competitiveness Report revealed that Botswana has improved its competitiveness ranking from position 80 to 79 out of 144 countries (9). The country was praised for having achieved the fastest levels of economic growth in the world, even outstripping China. This is largely attributed to the country’s well-known relatively good governance and institution of property rights, which has been reported to have given most of the population an interest in political stability (10). Botswana’s Gross Domestic Product (GDP) per capita impressively stands at US$9,481 (11). According to the Central Statistics Office (11), the composition of the GDP by sector stands at 1.8% for agriculture, 59.5% for industry (including mining), and services at 35.2% (11).

According to Botswana Vision 2016 (12), Botswana’s policy initiative, the government’s vision is to have a healthy, compassionate nation that is informed and providing a sustainable contribution to the country’s development.

Health and well-being promotion is of paramount impor-

Photo: access by DOHS Public Relation Desk Officer, Mr Armstrong Dube.

The World Day for Safety and Health on 28th April has been celebrated since 2006 in Botswana.

tance in achieving Botswana’s prosperity.

An informed nation is a critical element in health promotion since information empowers and enables individuals and communities to take control of their own health and determinants of health. This fits well with the WHO Bangkok Charter definition of health promotion.

Botswana has become more dependent on Small and Medium-sized Enterprises (SMEs) as its strategy to diversify its economic growth and eradicate poverty. The country has developed a national strategy for poverty reduction (13), which puts private sector development and trade expansion at the centre of economic development. The strategy includes strengthening private sector development with an added stimulus, particularly focusing on SMEs and the informal sector (13). With this national plan, the country will experience an increase in the number of SMEs. SMEs are an intervention strategy on poverty eradication and need health promotion programmes as small-scale industries are prone to occupational hazards. Botswana will do its best to recognize that a healthy workforce is a key to overcoming poverty and increasing productivity The increase in SMEs will heighten the difficulty in enforcing the current national prescriptive legislation statutes. At present, there is an acute shortage of OSH inspectors across the country. Currently, there is a significantly disproportionate ratio of

inspectors to workplaces. It therefore becomes important to have a mechanism in place that will ensure self-monitoring of workplaces through OSH MS.

Activities contributing to Health Promotion in Botswana

In 2011, the Ministry of Labour and Home Affairs through its tripartite constituents signed the Botswana Decent Work Country Programme 2011–2015 with one of its outcomes being “workers and enterprises benefit from improved safety and health condition at work (14).” The activities include the development of a national OSH policy and programme that will see, amongst other things, the revitalization of the CIS-national Occupational Safety and Health (OSH) information centre (14).

The Ministry of Health, with relevant stakeholders, has consistently over the years, implemented health promotional initiatives as follows: • Smoking reduction and implementa tion of the Tobacco Act • Reduction in the use of alcohol and drugs • Mental health promotion • Promotion of sexual and reproductive health and HIV\AIDS prevention • Prevention of cancers • Promotion of physical activities for health.

Workplace Wellness Programme: Implementation Guide has been developed

by key stakeholders in the country that include organizations and businesses, with the aim of promoting the health and wellbeing of employees, and the vision of seeing “transformed, healthy and productive workforce (15).” Government departments and agencies, parastatals, and some private companies have developed activities, which have gradually become culture, and which include most commonly an annual wellness week across different government ministries and departmental weekly short session at a specific time in the week throughout the year for employees to gather for prayers, talks, discussions and address employee well-being issues. Workplace committees have been set up to organize the following: • Health screenings and well-being day/ week activities • Peer education and counselling • Talks covering different topics (such as stress management, personal finan cial management, health topics).

Awareness on OSH Promotion

Botswana has implemented several awareness campaigns that are continuously and gradually addressing the improvement in workplace health promotion.

1. World Day for Safety and Health at Work on 28 April The ILO celebrates the annual World Day for Safety and Health at Work on 28 April to promote the prevention of occupational accidents and diseases globally. It is an awareness-raising campaign intended to focus international and national attention on emerging trends in the field of occupational health and safety. It encourages improvement in working conditions and the environment. The day has been observed since 2006 in Botswana. Participants include government, utilities companies, private sector, workers’ organizations and employers’ organizations.

2. Safety, Health and Environment (SHE) Awareness Safety, Health and Environment (SHE) is recognized as a fairly new concept in Botswana, but an important concept that has potential to “promote efficiency and reduce losses by continuously improving employee awareness of their health and safety to promote productivity (16).” This is a non-legislated concept that has been

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Photo by Koketso Dumedisang

adopted by utility companies in Botswana and mining firms in the country to enhance the culture of OSH among employees. The continuous SHE publicity includes raising awareness among employees and the public, raising awareness and informing employees about SHE activities which are key workplace health promotion strategies. These are aimed at achieving “improved efficiency, high productivity, improved employee welfare, low numbers of labour disputes, and low levels of staff turnover and absenteeism, and reduced compensation costs, high ecoefficiency and sustainable development of resources (16).”

Possible Interventions to Improve Workplace Health Promotion

1. Botswana National CIS Centre needs to acquire resources to ensure that national stakeholders have access to appropriate OH&S information. The centre should commence active promotion of ILO/CIS activities locally to increase the usage of OH&S information through CIS products. This can be done through publicity and through direct contact with scientific, technical and medical organizations, and with SMEs and workers’ organizations. Information is an

Ms Kagelelo Kemiso, assistant Librarian showing Botswana CIS-Centre collection.

empowerment tool that can provide education in OH&S, with the aim of communicating knowledge, understanding and skills that will enable managers and workers in the workplace to recognize risk factors to their health and enable them to avoid or manage such factors in the work environment.

2. It is important to have an effective comprehensive holistic and multi-sectoral

Literature 1. World Health Organization. The Bangkok Charter for Health Promotion in a Globalized World. 2005, Geneva, WHO Press.

2. World Health Organization. Occupational Health: Workplace health promotion. www.who.int/oocupational_health/topics/workplace [accessed 3/1/2013] 3. Alli BO. 2nd. Fundamental principles of occupational health and safety. Geneva: ILO Publications, 2008.

4. International Labour Organization. OSH management system: A tool for continual improvement.

Turin: International Training Center of the ILO, 2011.

5. World Health Organization. The Ottawa Charter for Health Promotion. 1986; Geneva: WHO Press.

6. World Bank. Getting to Green- a sourcebook of pollution Management Policy Tools for Growth and Competitiveness. World Bank Group Publication [cited 2013 Feb 7]. Available from www.worldbank. org.

7. Makin AM, Winder C. A new conceptual framework to improve the application of occupational health and safety management system. Safety Science 2008;46:930–48.

8. Robson LS, Clarke JA, Cullen K, Bielecky A, Severin C, Bigelow PL, et al. The Effectiveness of Occupational Health and Safety Management System interventions: A Systematic Review. Safety Science 2006 Jul; 45:329–53.

9. The Global Competitiveness Report 2012–2013. Country/Economy profile: Botswana.

10. Stevens P. The real determinants of health.

11. Central Statistics, National Accounts Statistics Brief. 2008.

12. Presidential Task force. Long term vision for Botswana: Towards Prosperity for all. 1997, Gaborone Botswana: Government Printer.

13. Government of Botswana. Government of Botswana – United Nations Programme Operational Plan (2010–2014). United Nations Systems in Botswana, 2009.

14. International Labour Organization. Decent Work Country Program for Botswana 2011 to 2015. ILO Publications, 2011.

15. Ministry of Health. Workplace Wellness Programme: Implementation Guide.

16. Water Utilities Corporation. Strategy document on the implementation of safety health and environment in the water utilities corporation.

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approach to health promotion interventions.

An improved national health system, which includes an integrated national OH&S system, will deliver effective workplace health promotion. Collaboration and coordination among stakeholders will bring efficiency in health promotion efforts.

Conclusion

A healthy workforce is an important prerequisite for economic growth and the global competitiveness of the country. Workplace health promotion should be a continuous process, lived by every worker and employer and it should be continuously improved. All levels of Botswana government, central and local government, non-governmental agencies, and the community need to play an integral role in the sufficient delivery of workplace health promotion.

Acknowledgement

I would like to show my appreciation to Agnes Moamogwe and Kagelelo Girlly Kemiso, who are officers at the Division of Occupational Health and Safety. They were supportive and provided some of the literature material used in this submission.

Dr Sinah Yamogetswe Seoke Ministry of Labour and Home Affairs Department of Occupational Health and Safety 136 Independence Avenue CIS National Centre Private Bag 00241 Gaborone, Botswana syseoke@gov.bw

Vera Ngowi Tanzania

Health promotion at workplaces in Tanzania A health-promoting workplace recognizes that a healthy workforce is essential and that the health of workers is determined not only by occupational hazards, but also by social and individual factors, and access to health services. A health-promoting workplace provides workers at all levels with appropriate administrative systems and procedures and safe working practices. In Tanzania the concept of workplace health promotion is ambiguous due to the fact that the majority of the working population do not have secure jobs and work in informal workplaces that are not regulated. In such cases, worker health promotion as opposed to workplace health promotion is important, and prioritizing the informal sector in public health, particularly health promotion, is necessary. It is common knowledge that healthy, safe workers produce more than those who are ailing.

Health is not only a product of individual behaviour, but also of forces that might be outside the individual’s control.

Programmes such as fitness, stress management, smoking cessation, and nutrition/weight reduction are health promotion programmes that target individuals, whereas the promotion of health through work organization and design target physical and psychosocial environments. In order for health promotion to be meaningful and ensure the health and safety of workers, it has to focus on both individual behaviour and work organization and design.

Hazards at workplaces in Tanzania

Workers in Tanzania are exposed to numerous health and safety hazards, which might be physical, chemical, biological, mechanical, ergonomic, or psychosocial. Workers view hazards as part of life and at times take no precautions to prevent harm. Among the small-scale Tanzanite miners in Tanzania, deaths from work occur so regularly that people believe that deaths are necessary for these precious stones to be found, that it is the cost that the earth demands for giving them up (1). This fatalism may be dismissed as the result of ignorance or superstition, but on closer observation, it may just be an extreme example of a group of workers that has had no choice but to accept one of the fundamentals underlying occupational health and safety: that the health and safety of workers is a basic cost of production that cannot be avoided. This Easter holiday, on Good Friday, more than 36 people (most likely workers) died and several were injured at a construction site in Dar-es-Salaam when a 16-storey building collapsed on them. This was one of several similar inci-

dences to occur in the country. During the same period in Moshono, Arusha, 14 workers died and a number were injured in a quarry following a land slide. Workers in agriculture are poisoned by pesticides every day, but the blame is usually placed on the victims for failure to follow instructions when handling hazardous chemicals. The workers in Tanzania show a mentality of despair with regard to health and safety hazards. The majority trust their government to protect them through regulations and information sharing, regarding, for example, hazardous chemicals. But when a government or employer decides not to invest in necessary measures such as health promotion to protect its workers, the cost is transferred to those workers, who pay with their health, injuries, and sometimes their lives.

Occupational health and safety is a reality, wherever work is done. It is not a question of whether the cost can be borne, but by whom it will be borne. Safety hazards at work are more pronounced than health hazards, and they attract media attention and thus create awareness. However, some diseases associated with the work environment impact on productivity. Our modern lifestyle exacerbates these diseases, which are now increasing in Tanzania. These diseases include high blood pressure, diabetes mellitus, cancer, infertility, and psychiatric problems. Hypertension is very common in Tanzania; it is seen in 44–48% of executives. Overweight, obesity, lack of exercises, poor eating habits (more salt and sugar in foods) and excessive consumption of alcohol may contribute to hypertension.

Widespread tobacco use and drug abuse is another alarming development in the country. The current young workforce is at higher risk of smoking and drug abuse. The World Health Organization (WHO) predicts that the smoking of tobacco will become the biggest single cause of death in the 21st century.

Health promotion in Tanzania

Health promotion in Tanzania targets individuals and is seen as important for attaining the health-related United Nations Millennium Development Goals (MDGs), which aim for a reduction in child mortality; improvement in maternal health, the prevention and control of HIV/AIDS, a reduction in tuberculosis and malaria, access to better sanitation, and clean drinking water. The World Health Report (2) indicates that mortality, morbidity and disability attributed to the major non-communicable diseases currently account for about 60% of all deaths and 47% of the global burden of dis-

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Photo by Vera Ngowi

References 1. WAHSA,2008. Work and Health in Southern Africa. Findings and outputs of the WAHSA Programme, 2004–2008. Department of Occupational and Environmental Health, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, South Africa.

2. WHO, 2002. The World Health Report 2002 - Reducing Risks, Promoting Healthy Life http://www.who.int/whr/2002/en/ accessed 22 March 2012.

3. Ngowi AVF, Rongo LMB and Mbise TJ. Community-Based Monitoring of Pesticides Impact in Ngarenanyuki, Tanzania.

In the Encyclopedia of Environmental Management 2012, DOI: 10.1081/EEEM-120046906.

Fire hazard for cooks.

ease, figures which will rise to 73% and 60%, respectively by 2020. The country is aware that 66% of the deaths attributed to noncommunicable diseases occur in developing countries including Tanzania, where those affected are on average younger than in industrialized countries. However, investment in research to determine factors contributing to the diseases is limited.

Health promotion initiatives have therefore focused on the need to reduce the level of exposure to the major risks resulting from an unhealthy diet and physical inactivity.

Identifiable patterns of behaviours, which are determined by the interplay between an individual’s personal characteristics, social interactions, and socioeconomic and environmental living conditions, characterize lifestyles. Lifestyle habits that people choose either voluntarily or involuntarily, such as unhealthy food (e.g. use of sugars and salts), poor hygiene, coping mechanisms, exercise, alcohol use and cigarette smoking are known to affect their health. For example: If someone is obese (fat) he/she is more likely to develop high blood pressure and diabetes than someone who is not obese. Similarly, if one is always nervous and tense, one is at a greater risk of developing hyperacidity or a gastric ulcer.

Therefore, to save Tanzanians from developing the non-communicable diseases within the scope of health education and health promotion, the general population is 8 • Afr Newslett on Occup Health and Safety 2013;23:7–8

encouraged to return to the old style of eating more fruit and vegetables, and less fat, salt and refined foods; and to involve themselves in more physical activities and avoid tobacco and alcohol.

Health promotion at workplaces in Tanzania

In Tanzania lifestyles have changed, thanks to urbanization, globalization and the changed spectrum of occupation, accompanied by an increase in motor vehicles. More young people are moving from rural to urban areas to seek employment and a better life. They work in construction sites and factories (food, beverage, steel, and textile), in a number of activities, such as brick laying.

Workers’ health promotion needs to assure safe working practices for workers.

Workers can adopt safe working practices to improve their own health by developing an understanding of their local work environment in relation to their health. They need to know the joint impact of the physical and psychosocial environment on health, and that personal health practices and an individual’s sense of worth is determined by environmental factors. Those who mine and think that a person has to die while mining so they can get minerals need to know that it is not true.

Workers can be encouraged to develop their knowledge of health and safety hazards in their work environment to enable

them to develop clear safe working procedures. They can improve their knowledge of equipment used at work and use advances in technology to innovate new methods of working safely. Workers could also be encouraged to involve their communities in developing new working practices to ensure sustainability.

For example, the way in which a farmer controls a pest will greatly depend on available resources, perceptions, and attitudes toward risk. Small-scale horticultural farmers in Tanzania are intensively exposed to highly toxic pesticides. (3) These are predominately WHO Hazard Class II pesticides – i.e., moderately hazardous, such as organophosphate insecticides, which can cause acute poisoning (headaches, vomiting, blurred vision, tremors), as well as chronic effects (damage to the nerves, cancer).

Training these farmers to conduct self-surveillance and monitor pesticide exposures has resulted in increased awareness, and a significant reduction in hazardous practices.

Dr. AVF Ngowi Department of Environmental and Occupational Health, School of Public Health and Social Sciences Muhimbili University of Health and Allied Sciences Dar-es-Salaam, Tanzania

Louwna Pretorius SOUTH AFRICA

Occupational health nursing practice in the private sector in South Africa Introduction

Attaining the general goal of “Health for all by the year 2000” as put forward by the World Health Organization (WHO), requires input from all resources of industry and other economic sectors.

The International Labour Organization Convention (ILO) at their International Labour Conference outlined three fundamental principles: • Work should take place in a safe and healthy environment • Conditions of work should be consistent with workers’ well-being and human dignity.

• Work should offer real possibilities for personal achieve ment, self-fulfillment and service to the society.

The joint ILO/WHO Committee in 1992 stressed that the scope of occupational health is very broad and involves the disciplines of occupational medicine, occupational hygiene, occupational safety, ergonomics, engineering and toxicology.

Occupational Health contributes to “sustainable development” as outlined in the Rio Declaration on environment and development, which emphasizes people’s rights to lead “healthy and productive lives in harmony with nature; sustainable development implies development that meets the needs of the present without compromising the ability of future generations to meet their own needs”(1).

Professionals in health services management cannot function in isolation. Employees are citizens with certain rights (Chapter 3 of the South African Constitution deals with the fundamental rights that includes some of the following aspects: equality, human dignity, freedom and security of people, privacy, religion, freedom of expression/movement, access to information, labour relations to name a few).

The occupational health professional must function within the legal framework at national and provincial levels as well as by-laws issued by local authorities. The Occupational Health Service (OHS) is obliged to ensure optimal health care delivery within these legislative parameters. If the health care delivery does not meet the required standards, medicolegal risks will occur which could be detrimental to the employee (2).

The Occupational Health practice in the South African context (given on site at an OHS facility) includes but is not limited to the following:

• Occupational medicine • Occupational hygiene • Primary health care.

It is important to understand that Occupational Medicine and Primary Health Care are practised by the Occupational Medical Practitioner (OMP) and the Occupational Health Nursing Practitioner (OHNP), while Occupational Hygiene is a specialized field practised by qualified Occupational Hygienists. Related disciplines such as occupational health nursing, occupational medicine, occupational hygiene, ergonomics, safety organization and management, quality and environmental issues are integrated in most private sector organizations to develop a total healthcare programme, which will best serve the needs of the industry.

These disciplines are always interlinked as described in Figure 1. and will therefore always function together in an effective Safety, Health and the Environment (SHE) programme.

Sociological considerations

Sociology deals with the way people behave and aims to understand and predict human behaviour, in particular behaviour of a person in a group. Communities in South Africa

• Identification • Measurement • Evaluation • Control

BIOLOGICAL

OCCUPATIONAL HYGIENE

OCCUPATIONAL MEDICINE

• Medical surveillance programme • Compiance with legislative requirements • Occupational disease/ injury management

SOCIAL UPLIFTMENT HAZARD ANTICIPATION

PRIMARY HEALTH CARE

• Life-style education • Early identification of illness/disease • Chronic disease management

Figure 1. South African perspective on occupational health

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Photos Alma Schultz

The facilities to provide areas for private counselling.

groups who had less information about diseases often as a result of limited education, less ability to read and less access to the most recent information about diseases. The standard of health service delivery in these areas or groupings is not always desirable.

The family and disease

vary from deprived communities in informal settlements, to more affluent communities in the urban and other areas. Therefore disparity in healthcare delivery is evident between those people that can afford it (medical schemes) and those that cannot.

The activities of the OHS are to a great extent determined by the finances available, as well as the needs of the community. The occupational health nursing practitioner must always consider the employee as a part of a family, a work situation, a community, the social class structure, a religious or recreational group. Social causes of diseases are of particular interest to occupational health professionals. Factors such as productivity, age structure, literacy levels, labour stability/ unemployment and the health profile of the community are closely associated with the economic system and its influences (3).

The work a person does may not only be the cause of disease or of physical and mental stress, it may also influence non-occupational diseases. Many effects of work are adverse, but employment actually also offers opportunities for stimulating activities and is often the source of establishing social contacts and friendships.

The effects of health on work may be considered at three levels. Firstly, there are the young and middle-aged who have no apparent health problems. Secondly, there are those whose work ability has been impaired by illness or injury. These workers should continue working unless the condition is made worse by work. Thirdly, there are those whose health may impact on the health and safety of fellow colleagues or the community. Airline pilots, vehicle drivers, crane drivers, employees exposed to extremes of heat and cold, hazardous chemicals are legally required to be certified medically fit to perform their task.

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Culture and disease It is important to remember that the Western world’s approach to disease differs from that of other cultures. Due to the diversity of the society relating to religious, political, cultural affiliations and beliefs, it is imperative that OHS acknowledges the various groupings, knows the possible health profiles and renders care in accordance with the client needs.

Certain race groups are more prone to diseases, which provides the OHS team with an opportunity to be on the lookout for existing or developing disease profiles.

It is essential for the OHNP to understand the client’s beliefs system about health and disease. By understanding the point of reference he/she can interpret the patient’s condition and adjust the treatment accordingly. Compliance with the medical regime is crucial and many African patients may use both western and traditional medicine.

They normally use western medicine for minor ailments or acute infections, e.g. injury or suturing, but when symptoms are not easily apparent, e.g. hypertension, they would rather turn to traditional healers.

Having respect for the patient’s choice of treatment is important. Where both western and traditional medicines are used it is important to make sure they do not counteract each other.

Social class and disease People from lower social classes have less access to the good things in life, which would include a good standard of living, education and good healthcare. People from lower social classes have higher mortality and morbidity rates. Lack of recognition of symptoms leads to neglect and the development of chronic conditions. This is more likely to occur in previously disadvantaged

Workers must not be seen as isolated individuals, but as members of families. A worker with problems at home or at work will likely struggle to concentrate on the task at hand, making him/her more prone to possible incidents, accident or injury. Important information on the following should be readily available: Where is he/she living – with family or apart/migrant labour/contractor?

Aspects such as violence, crime and death in the family or any stress-related situation, e.g. threat of redundancy may also influence the performance of employees in the workplace. The occupational health nursing practitioner should take these sociological and psychological impacts into consideration and will be required to perform any necessary referral or counselling.

Occupational health service delivery In order to maintain and promote the physical and mental well-being of workers and to adapt the work to the person, occupational health in its broad sense deals with the total health of the employed person. Non-occupational diseases and illnesses (e.g. diabetes, epilepsy, heart disease, colour blindness, etc.) also have a great influence on the wellbeing and working capacity of those suffering from them, and endemic or epidemic diseases of non-occupational origin (malaria, influenza, HIV/AIDS) can affect the working population and production over a wide spectrum. The interdependence of individuals in the working community has become increasingly evident and is now generally recognized (poor vision in a crane operator is just as big a risk to the safety of his fellow workers as to himself).

Occupational health services are set up, maintained and used in order that the declared aim of occupational health may be attained by means of a comprehensive system of both medical and technical measures (their mainly preventive role).

Functions of occupational health service

Industries differ in size, manufacturing processes, hazards, etc. Occupational health service delivery within the industry will vary but the general principles stay the same, aiming at preventive and promotive initiatives. The extent of the service will be determined by numerous factors such as the size of the workforce, nature of the industry and associated risks profile, geographical proximity to other health care services and employee demographics. South African industries currently provide a large number of curative services, due to the fact that the majority of the labour force does not belong to private medical schemes and public facilities are not usually within easy reach of employment facilities; therefore minor problems and day-to-day ailments and chronic diseases are monitored or treated by the occupational health staff.

The essential functions of occupational health services include, but are not limited to the following:

Hazard identification and (Health) risk assessment An effective programme for OHS starts with the identification, evaluation and monitoring of workplace hazards. Informal walkthrough surveys are helpful for the overall assessment of the facility to identify potential “problem areas” pertaining the process, equipment, chemicals, raw materials, occupations, tasks and equipment.

A health risk assessment is compiled once the identified hazards and risks have been measured through occupational hygiene surveys. The results of these surveys are critical in determining the exposure levels of employees to certain environmental (occupational hygiene) stressors.

When the Occupational Exposure Limit (OEL) level of an agent (stressor) has been identified as to at or near action level, it will provide an indication of the employees to be medically examined and tested as part of the medical surveillance and biological monitoring programme (3).

The medical surveillance programme serves as a preventive tool against occupational disease and injury incidents and should be the driving force behind the establishment of an occupational health service.

Selection and Placement Two types of medical assessments are per-

formed; base-line/pre employment medical examinations (prior to employment) and pre-placement (prior to placement or transfer). People are placed in certain positions based on a pre-placement medical examination. Pre employment medical examination used to serve as a tool for the selection of employees, based on inherent job requirement criteria. This medical examination can be used to identify physical or mental disabilities which could be a handicap in specific jobs, i.e. a person with chronic respiratory disease in occupations with dust exposure. The pre-placement medical should be done prior to placement to assess the person’s ability and, where possible, to match his capacity, no matter how limited, to a suitable job.

The guidance criteria for placement through medical examinations are determined through the use of person/job specifications (inherent job requirement). Reference should be made to legislation that prohibits any discrimination regarding employment practices, but that the law also provides guidance to the employer in this regard.

Medical surveillance and periodic health reviews, trend analysis and epidemiological studies The system of medical surveillance must be risk-based according to the health hazards that employees are exposed to. Therefore quantification and qualification of the risk exposure, the number of employees exposed per occupation, task and area needs to be indicated.

The medical surveillance programme is designed to provide the employer with relevant information on controlling health hazards and for the detection, prevention and monitoring of occupational over-exposure, occupational diseases and/or injuries. The functions of the OHS are covered as part of the induction process for new employees.

Retaining people in suitable employment (vocational rehabilitation) The occupational health service has a responsibility to assist management in identifying employees who, as a result of sickness or injury, can no longer continue in their former jobs or need to have these modified to suit their ability. The OHS is involved at an early stage to take measures for re-assignment/rehabilitation. Employees in these categories represent workers suffering from chronic diseases, terminal conditions and

permanent disabilities.

Supervision of vulnerable groups In any working situation vulnerable groups exist, e.g. the young, the old, women, shift workers, disabled people and those with prolonged or repeated absences from work.

These absences can be due to chronic illnesses. The occupational health staff will supervise these groups and make recommendations, i.e. reduce the work load of a worker whose skill or productivity has been reduced as a result of age, injury or disease, arrange for re-deployment where necessary and ensure that no woman of child-bearing age, who plans to have a family or is already pregnant is exposed to substances and an environment that can have a detrimental effect on the unborn foetus.

The OHS are responsible for actively promoting the adaptation of the workplace to the worker, particularly in vulnerable groups.

The provision of First Aid Providing first aid, emergency treatment and medical care used to be the main function of the OHS in the workplace. Treating injuries, acute exposure and/or poisoning and minor ailments efficiently and speedily prevents complications and assists in the rehabilitation process. The OHS plays a crucial role in the treatment, reporting, and follow up of injuries and diseases and in the rehabilitation process of the employee. Unnecessary loss of working time, travel expenses and waiting in over-crowded outpatient departments can be greatly reduced by a service providing effective preventive care and medical treatment at the workplace. The role of first aiders and emergency teams in disaster management of serious incidents at work is well defined.

There is a tendency for the morale of workers as well as their productivity to increase where reliable healthcare is readily available.

In situations where on-site OHS is not available, the line supervisor will be the first person to receive information regarding an occupational injury/incident. In these cases the employer has a pre-arranged agreement with a local Doctor, paramedics, ambulance service or hospital to care for the injured or ill employee. This agreement includes a process of familiarising the healthcare provider with the workplace environment and any potential hazardous agents or process (4).

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Photo Alma Schultz

behaviour at work, the use of personal protective clothing (PPE), attention to personal hygiene and general health should become an integral part of the working habits.

It is of critical importance that employees are informed about the health and safety hazards in the workplace and how to deal with them in terms of control measures. The OHS should be actively involved in providing information pertaining to health hazards and the consequences of possible exposure and the function of the medical surveillance programme in monitoring health effects. It also includes advice on occupational safety and hygiene, ergonomics and the use of PPE.

Increased absenteeism from the workplace has been identified, when employees consult doctors and nurses, operating in offsite facilities and who are not familiar with the employee’s job and work environment.

Participation in the development of Occupational Health and Safety programmes In industry the prime responsibility for health and safety rests with management.

The availability of an OHS can greatly reduce the incidence and prevalence of occupational diseases and incidents. It includes participation in the investigation and analysis of occupational injuries and occupational diseases; the evaluation of health related aspects of new equipment/machinery and the compilation of trend analyses in the prevention of future occupational incidents (injury/illness) can be successfully controlled or eliminated completely.

The OHS play an active role in the induction programme for new as well as established workers in providing employee health education, awareness and health promotion. It provides also an opportunity to make employees aware of hazards and risks at work, hazardous chemicals and conditions and the role and function of the OHS in promoting health. The OHS play a vital role in ensuring that the employee is medically fit for the job/occupation for which he/she is employed.

Screening workers for early evidence of non-occupational diseases The occupational health nursing practitioner is in an ideal position to identify the early signs and symptoms of non-occupational diseases. Coronary heart disease, hypertension, diabetes, TB, HIV/AIDS and mental illness are just some of the conditions. Health education and health promotion plays a pivotal role in early diagnosis and treatment which could prevent a fullscale development of the disease profile.

Social services and counselling Counselling is the empathetic listening to and understanding of another person’s problems. Not only does this include health problems but also social and workrelated problems. The OHNP plays a very important role in counselling workers and will support the worker in decision-making. Once the worker has decided how to resolve the problem, the counsellor will 12 • Afr Newslett on Occup Health and Safety 2013;23:9–13

assist him/her with information, referrals and encouragement. Confidentiality is of utmost importance. The establishment of an Employee Assistance Programmes (EAP) and the rehabilitation of injured or sick employees are also covered as part of the counselling process. Social services and counselling may form part of the overall employee assistance programme. Community resources such as social workers, ministers, psychologists, etc., may also be used.

Occupational health and safety training and induction Research has found that workers in industries such as mining, chemical manufacturing, and steel and alloy operations show a higher than average incidence of problems associated with dermatitis, musculoskeletal problems, pulmonary disease, mental illness and cancer amongst others (5).

Health education and safety training can be carried out through formal education programmes for management and employees or when the individual visits the occupational health service for treatment on a one-to-one basis. Training is less costly than treatment. Preventing illness or incidents through proper training and education is far less expensive than rehabilitation.

Occupational health and safety education should cover all categories of workers in order to enhance their awareness of health and safety measures. It provides specialist skills for the worker and should not be taught separately from the work process itself (job specific training). Safe

Employee well-being, health education, promotion and rehabilitation Health promotion is an active process, which is directed at changing people’s attitudes and influencing their behaviour, for the better, in health-related matters. The aims of health promotion and education are to make health a high priority in the individual’s value system, to teach people the principles of healthy living and to provide information concerning health issues and services. Examples include information on HIV/AIDS, fitness, well-being and lifestyle.

The responsibility for health does not lie with the government or the medical profession alone. It is also every individual’s own responsibility to manage his or her own health. Through training and education, individuals are taught to take responsibility for their own health. The right to health services remains the responsibility of the government, industry, etc. The OHNP participation is pivotal in establishing health education, promotion, and well-being as well as rehabilitation programmes.

Administration of service/Policy and procedure development The OHS is responsible for the development of appropriate occupational practice policies and procedures and maintaining an accurate confidential record management system (5).

Policy and procedure development forms part of the OHNP management process of planning, organizing, co-ordinating, and control which may include aspects such as financial management, re-

cording and reporting, research and communication. The OHNP has a legal obligation to keep records of health services provided to all employees. The record keeping in the OHS includes individual health records, administrative records and miscellaneous records.

Article compiled by: Louwna J. Pretorius (ICOH member/ SCOHN chairperson/ANSA Fellow) Former SASOHN president Occ Health Services Co coordinator Corobrik Pty (LTD) PO Box 49 Germiston 1400 South Africa Louwna.pretorius@corobrik.co.za

References 1. Cliff Dekker Attorneys. King11Report on corporate governance in South Africa: Integrated Sustainability Reporting. Johannesburg. 2002;91–124.

2. Booyens SW (Ed). Introduction into health service management. 3rd edition. Kenwyn: Juta. 2008.

3. Guild R, Ehrlich RI, Johnston JR, Ross MH. Simrac Handbook of occupational health practice in the SA mining Industry. Creda Publishers: Johannesburg.

2001.

4. Rogers B, Travers P, Mc Dougall C. Guidelines for an occupational health and safety service. (AAOHN – American occupational health Nurses Inc), AAOHN Publications: Atlanta, Georgia.1995.

5. Michell K, (Ed). A basic approach to occupational health nursing. Wilpro printers: Johannesburg. 2011:25–33.

Literature Rantanen J, Fedotov IA. Standards, principles and approaches in occupational health services standards. Accessed 1 April 2011.Available from http://www. ilo.org/wcmsp5/groups/public@ed_protect/@protrav/@safework/documents/ publications/wcms_110439.pdf Coetzee S, Pretorius A, Strasheim P. Occupational health nursing in South Africa, 2nd edition. Objective Print: Johannesburg.1997. A2.5

N.M. Mogane, M.G.L. Ntlailane, K.A. Renton, M.J. Manganyi, G.E. Mizan, C.D. Vuma, T. Madzivhandila, S. A. Maloisane, K.C. Lekgetho, G.J. Sekobe SOUTH AFRICA

Occupational health and safety in the informal sector – an observational report Background

The informal sector concept was first introduced by the International Labour Organization (ILO) 30 years ago (1) as a type of trade that takes place outside the formal economy (2). The informal sector (sometimes referred to as the “informal economy”) includes a variety of activities and sub-sectors (3). Examples of informal sector trades are car repairs, spray painting, furniture making and upholstering, food vending, hair dressing, hawking, shoe repairs and telephone operating amongst others. The sector is run mostly by selfemployed people commonly in urban, semi-urban and rural areas of developing countries (2). Activities in the informal sector do not normally obtain formal approval from the relevant authorities and might not be subjected to enforcement by legislation (2). In South Africa, the informal sector is rarely registered with the Registrar of Business and South African Revenue Services (SARS) and it does not pay rates and taxes, but a stipulated rental fee is sometimes paid to a municipality (4).

Risk assessment of the informal sector workplaces

An occupational health and safety risk assessment (HRA) was conducted within

the city of Johannesburg and in two townships just outside the city, using a National Health Laboratory Services risk assessment tool (5) and a checklist/questionnaire. The businesses were divided into two groups, A and B. Group A included those trades/activities with shelters, i.e. those operating from a home, from a wellbuilt municipal stall, or forming part of a semi-organized industry that can be classified as a small to medium-sized enterprise (SME). Group B were those trades/activities located on the streets without proper shelter. The results of the HRA are detailed below according to the various types of occupational hazards including physical, chemical, biological, ergonomic, psychosocial, as well as general safety.

Limitations of the study

A variety of trades were selected in order to assess the risks from a wide range of activities. However, it was not feasible to inspect all types of trades/activities due to the limited time and resources available for this study. The observations were made mainly during the mornings, but it is recognized that often the peak business hours are between 16:00–18:00 and also during pay day periods when higher customer movement is anticipated.

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sell empty chemical containers which previously contained a range of toxic chemical mixtures. Exposure to asbestos during brake and clutch repair in older car models is also likely.

Material Safety Data Sheets (MSDS) were not available in all the locations visited. Disposable respirators were occasionally used; however it was found that these were inappropriate for the type of chemicals used.

Hazardous biological agents

Photo NHLS / Occupational Hygiene Unit

Photo 1. Workers who have no proper shelter.

Observations

The businesses observed during this assessment included motor mechanics, panel beating and spray painting, carpentry, aluminium and glass works, welding, food preparation and sales, fruit and vegetable sales, shoe makers and oil processors. The observed health risks, classified according to the different occupational hazards were as detailed below.

Physical hazards Traders were exposed to a range of physical hazards including thermal and cold stresses, noise, vibration and ultraviolet (UV) radiation. Traders in Group B were exposed to extreme cold during winter, while some traders from Group A were exposed to thermal stress in summer and humid conditions, especially caterers in kitchens, due to inadequate ventilation systems. Exposure to ultraviolet radiation from sunlight was common among Group B traders (see Photo 1), whereas Group A traders were also exposed to ultraviolet and infra-red radiation from welding processes.

Traders in the panel beating and spray painting, carpentry, aluminium and steel workshops, welding workshops, as well as the upholstery industries, were exposed to high noise levels and hand-arm vibration (see Photo 2). Group B traders, especially in the central business area, were exposed to continuous background noise from traffic and other activities, such as police car sirens, metal and bottle waste collection.

Wide use of unshaded, self-installed in-

candescent lighting, fitted at close range to the traders, was observed in one Group B location.

Hazardous chemical substances (HCS) In both groups it was found that the traders were exposed to a range of HCS, including both commercial and those that are created as they try to improvise. A strong smell of paint vapours, paint removers and paint thinners was noted during the assessment in the paint mixing and spray painting (motor mechanic and carpentry) facilities. In a study by Spies (2008) (4), spray painting workers were found to be exposed to high concentrations of isocyanates. Fumes from paraffin and liquid petroleum gas used for cooking and heating purposes in kitchens may build up in the stalls resulting in fossil fuel gas inhalation. Exposure to welding fumes that are a complex mixture of HCS were noted in the welding industry.

In car mechanic and upholstery industries, workers were exposed to oil and/ or degreasers. In other locations oil recycling was practised which exposed traders to diesel particulates during the heating process. Dry abrasion of paints from old cars exposed traders to paint and metal dust, as well as lead. In the aluminium and glass works, workers may be exposed to metal (steel, aluminium and copper) and glass dust released during cutting operations. Shoe repairers and carpenters were exposed to leather and wood dust. Possible exposure to other HCS was also observed in some Group B traders who clean and

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Poor maintenance of the ablution facilities used by some Group A traders resulted in unhygienic water accumulation on the floor. In the same location, waste bins waiting to be removed from the kitchen areas were observed to be in poor hygienic condition. This results in microbial growth and possible exposure to hazardous biological agents. In one location in Group B waste water and other waste were disposed of into the storm drainage system area, causing blockages and resulting in a nuisance smell and a breeding place for flies.

The same area was also occupied by homeless people at night resulting in unhygienic conditions and an unpleasant smell around the trading area.

Ergonomics Working in awkward positions as a result of poor working station designs was often observed. Traders lift heavy loads and at times have to carry them over long distances. In many instances no proper ergonomic chairs were available and traders were observed sitting on makeshift “seats” like concrete stools, drums, crates, buckets and other non-ergonomically designed chairs (see Photo 3). Cramped conditions were often observed in some stalls in Group B.

Psychosocial hazards Some conditions that informal traders have to tolerate include violence by customers when the latter are dissatisfied with the products. Theft and occasional confiscation of goods by government officials, for those who cannot afford the rent or do not have permits, are common occurrences for Group B traders. These findings are consistent with the findings reported by Alfers (6).

General safety concerns Fire hazards from the use of paraffin, LPG and unsafe electrical connections and placement of heaters, coupled with clutter of boxes and other flammable materials in stalls of both groups A and B, are a concern. Outdated fire fighting equipment in Group A, a complete lack of it in most of Group B, and a lack of first aid kits in both groups was observed. As previously mentioned, PPE was not widely used; for example a worker was observed wearing canvas shoes in a glass and aluminium workshop.

Conclusion and recommendations

Ergonomics, psychological hazards, as well as general safety concerns were found in both groups. When comparing group A (with enclosed shelters) and Group B (without shelters), group B traders were mostly exposed to a range of physical hazards, while group A were mainly exposed

Photo 2. The identified source of noise and vibration.

Photo 3. Seating facilities that pose a challenge.

Photos NHLS / Occupational Hygiene Unit

to chemical hazards, which were due to poor ventilation systems.

Mitigation of exposure to the above hazards should include introducing the ILO’s programmes such as Work Improvements in Small Enterprises (WISE) (7) and Work Improvement in the Neighbourhood Development (WIND) (8).

Collaboration between state departments, municipalities, traders’ representatives and occupational health experts should help address the need to reduce risks such as: • designing structures which are ergo nomic, safe and well-ventilated • providing training on health effects of hazards exposure, legislation, the types of control measures to employ, specific PPE for specific hazards, proper use and maintenance of PPE, Material Safety Data Sheets, emergency procedures, and first aid • improving accessibility to occupational

health services by incorporating them into the current public health service provided by the municipalities.

N.M. Mogane, M.G.L. Ntlailane, K.A. Renton, M.J. Manganyi, G.E. Mizan, C.D. Vuma, T. Madzivhandila, S. A. Maloisane, K.C. Lekgetho, G.J. Sekobe National Institute for Occupational Health NHLS National Health Laboratory Service 25 Hospital St., Constitution Hill &106 Joubert St Ext., Braamfontein, Box 4788, Johannesburg, 2000 South Africa www.nhls.ac.za www.nioh.ac.za

References 1. Bangasser PE. The ILO and the informal sector: an institutional history EMPLOYMENT PAPER [serial on the Internet].

2000. Available from: http://www.ilo.org/ wcmsp5/groups/public/--ed_emp/documents/publication/wcms_142295.pdf 2. Philippines Got. Government of the Philippines: Philippines social reform agenda, master plan of operations, workers’ protection and welfare, workers especially in the informal sector.

3. Becker KF. Fact finding study The Informal Economy, SIDA 2004. Available from: http://rru.worldbank.org/Documents/ PapersLinks/Sida.pdf.

4. Spies A. Assessment of the exposure associated health effects to hexamethylene diisocyanate (HDI) in automotive spray painting processes in small, medium and micro enterprises. Johannesburg: University of the Witwatersrand, 2006.

5. National Health Laboratory Services risk assessment tool http://www.nioh. ac.za/?page=risk_assessments&id=88 6. Alfers L. Occupational health & safety for informal workers in Ghana: a case study of markets and street traders in Accra: Available from: http://erd.eui.eu/media/2010/ Alfers-201006.pdf.

7. ILO. Work improvement in small enterprises – WISE. Rural development through decent work [serial on the Internet]. 2011. Available from: http://www.ilo. org/wcmsp5/groups/public/---ed_emp/ documents/publication/wcms_159283. pdf.

8. ILO. Work improvement in neighbourhood development – WIND. Rural development through decent work [serial on the Internet]. 2011. Available from: http://www.ilo.org/wcmsp5/groups/ public/---ed_emp/documents/publication/wcms_159173.pdf.

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Merja Turpeinen, Anne Salmi, Jaana Laitinen Finland

How can we support young immigrants’ health and work ability at workplaces?

Everybody acknowledges the importance of young people entering into work life and obtaining work experience. What about their work ability and health? It is equally important that they learn the most profitable ways to promote their own health and work ability from the very beginning of their work careers. These include, for instance, taking account of and coping with the special characteristics of their work, resting and eating well. Paying attention to your health and work ability from the beginning of your work career will result in work creating well-being, also later in life. In a similar way, successful entrance into work life helps young immigrants integrate into their new home country. How can we support these important processes of obtaining work and taking care of one’s work ability and health already at a young age? What about employers – what can they do?

In 2012, the Finnish Institute of Occupational Health (FIOH) started a project to promote the work ability of young immigrants at the beginning of their careers (NuMaT project). The NuMaT project gathers best practices and examples of how young immigrants can find jobs in challenging labour markets. NuMaT also seeks to gather best practices concerning orientation periods and initial training and how to put these into practice at workplaces.

In the project interviews, young immigrants have talked about their entrance into the Finnish labour market. Several employers, supervisors and workmates from multicultural work environments have also shared their views on young immigrants’ arrival at workplaces. In the NuMaT project we have classified some of the common problematic situations with the help of the Work ability house (Työkyvyn talo in Finnish) (1), a model developed by Professor Juhani Ilmarinen in the 1990s. It is a multidimensional work ability model that is primarily based on several studies and development projects conducted in the 1990s on occupational wellbeing in different industrial sectors and among different age groups. The holistic image of work ability consists of both the resources of the individual and factors related to work and the environment outside of work (2, 3). The dimensions of work ability can be depicted in the form of a work ability house, its floors, and the surrounding environment.

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New work, new country – challenging situations for young people

When moving to a new country you need to learn many things, possibly even a new language. It may also be challenging to find work, especially for young people with little or no work experience at all. Occupational competence requirements may also vary and young immigrants’ vocational education is not always recognized in the new home country. Immigrants may have to either study further in the same field or begin a totally new career path. Employers may also have prejudices against hiring an immigrant.

As challenging as it is, finding their first job is nevertheless crucial for gaining a position in the labour market.

Working is a good way for them to familiarize themselves with the new culture. Social networks play an important role for young immigrants when trying to find work. Although family also offers significant social support, some young immigrants may be under pressure if relatives expect them to succeed and sometimes even provide financial support for relatives in their country of origin.

Young people need to learn how to act in the work environment and work community. Unfortunately some young immigrants may be confronted with discrimination. This is challenging, especially for those with less education and no work experience. They may lack knowledge regarding their right to equal treatment and how to act in difficult situations at the workplace. Some may be too shy to speak up for themselves. Possible linguistic difficulties or a lack of social networks may make the situation even harder to handle.

Nevertheless, young immigrants seem to be highly motivated to learn and succeed at work and to build their careers and lives in their new home country.

Methods of support: promoting young immigrants’ work ability and health at the workplace

Open-minded recruiting – a trump card?

Knowledge about the task at hand should be given honestly and explicitly to young applicants who have little work experience. Mutual understanding of the expectations and duties at work and of the required qualifications are a good start.

The Work Ability House describes the different dimensions that affect the worker’s work ability.

The figure is based on the model developed by Professor Juhani Ilmarinen).

Book: Ikävoimaa työhön (Age Power), FIOH 2011.

As an employer, it is also important to reflect on your own attitudes and to critically evaluate whether the organization’s recruiting practices may discriminate some applicants. On what grounds do you turn applications down? Do recruiting procedures implicitly favour certain cultural backgrounds? Every applicant is an individual with different kinds of competencies.

Are you willing to recognize the benefits of backgrounds or competences that are not so familiar among your present personnel or among other job-seekers? Perhaps these new qualifications or individual features could offer something extra to the organization. Could they, for instance, offer help in improving customer service?

Clear instructions and the right to ask – orientation and initial training form a valuable basis Good initial training is well-planned, entrusted in several people’s hands and evaluated together with the new employee. You must allocate enough time and resources.

The best support for the young immigrant worker comes in the form of encouragement: encourage them to ask about anything that might be unclear, strange, or just comes to mind. Be clear and make sure in several different ways that you have been understood properly. Use different kinds of materials, e.g. illustrated work instructions, pictures etc. as instruments in initial training.

Guide the new employee in the organization’s culture, practices and informal procedures. What is appropriate and desirable

behaviour at the workplace and why? The language of the workplace should also be addressed. Does initial training include the use of professional terms, jargon or terms that are only used in your organization?

Usually the new employee is also told about the ways in which the organization promotes the professional skills, motivation and health and safety of its employees.

It is good to go through employment legislation and regulations. How about the possible stress-causing factors at work? Do young immigrants receive instructions on how to take care of their well-being at the workplace and through lifestyle choices? The supervisors interviewed in the study stressed the importance of asking immigrant workers discreetly and culture-sensitively about their work ability and of encouraging them to take care of themselves and ask for help from occupational health services if needed.

Welcoming a young immigrant to the work community

If your organization is not used to employing immigrants, it is important to prepare the personnel for receiving immigrant workers into the work community. Discuss the subject and find some information about multicultural workplaces. Some might even hire an outside consultant for help if doubts seem to rise about how to behave around the newcomer.

The supervisor’s role is important in supporting the beginner. Each member of the work community can also do something to make the beginning easier for the newcomer. Do you get acquainted with and chat

with your new workmates? Do you ask them to join the coffee break and lunch? How do you make sure that the new employee is not left alone?

Successful recruitment and initial training practices are good for all new employees. The same applies to supervisory guidance: it needs to be fair, impartial and suitable for every subordinate. Well-being at work can be generated for everyone and by everyone. Like so many other things, wellbeing at work is mostly a matter of will.

Visit the NuMaT project website: www.ttl.fi/en/research/research_projects/ working_career/numat_project/pages/default.aspx The Promoting the work ability of young immigrants at the beginning of their careers (NuMaT) project is funded by the European Social Fund (ESF), and carried out by the Finnish Institute of Occupational Health (FIOH). The first results will be published in the spring of 2013, and the project will continue until 30.6.2014.

NuMaT project Finnish Institute of Occupational Health Topeliuksenkatu 41 a A 00250 Helsinki Finland www.ttl.fi Merja Turpeinen, Researcher Finnish Institute of Occupational Health, Promotion of Work Ability and Health E-mail: merja.turpeinen@ttl.fi Anne Salmi, Senior Specialist Finnish Institute of Occupational Health, Promotion of Work Ability and Health E-mail: anne.salmi@ttl.fi Jaana Laitinen, Team Leader Finnish Institute of Occupational Health, Promotion of Work Ability and Health E-mail: jaana.laitinen@ttl.fi

Literature: 1. http://www.ttl.fi/en/health/wai/multidimensional_work_ability_model/Pages/ default.aspx 2. Gould R, Ilmarinen J, Järvisalo J, Koskinen S (editors). Dimensions of Work Ability, Finnish Centre for Pensions, Helsinki 2008.

3. Tuomi K, Ilmarinen J, Jahkola A, Katajarinne L, Tulkki A. Work Ability Index. 2nd revised edn. Helsinki: Finnish Institute of Occupational Health, 1998.

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Suvi Lehtinen, Finland

A new communicative ”game” was used for information dissemination in the 3rd International Strategy Conference on Occupational Health and Safety.

Networking emphasized in Dresden A total of 150 occupational health and safety experts from 33 countries gathered in Dresden on 6–7 February 2013 for the 3rd International Strategy Conference on Occupational Health and Safety. The importance of the Conference was well reflected by the number of organizers: DGUV as the main organizer in collaboration with WHO, ILO, ISSA, EU-OSHA, IALI, ICOH and IOHA. The theme of the Conference was ‘Networking as a driving force for a culture of prevention’. Prevention of occupational health and safety hazards and risks is by definition multisectorial, multidisciplinary and multifunctional activity. It is therefore important to stop and identify the key players in our societies in order to create a prevention culture. Prevention pays off; 92% of health expenditures in the world go to curative care. Occupational accidents and diseases are preventable in principle, and work-related diseases can be mitigated with appropriate preventive measures. The vast majority of the knowledge needed to improve the situation is already available.

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What we lack is informed action and implementation.

The DGUV, together with ILO and ISSA, is preparing for the World Congress in Frankfurt, Germany, scheduled for 24–28 August 2014. This Strategy Conference was one milestone on the road to Frankfurt.

For prevention culture, another stepping stone will be the forthcoming Symposium in Helsinki, Finland, on 25–27 September 2013. The aim of the Helsinki Symposium is to gather research and other evidence available worldwide on what can be done to promote a prevention culture and to ensure the safety and health of all working people and beyond.

In the Dresden Strategy Conference, the discussion in the Workshops revealed a need for the clarification of the concepts of prevention culture, prevention climate, safety culture, and well-being at work.

These concepts will also be discussed in Helsinki in September.

One of the take-home messages was that of Dr. Walter Eichendorf: How can we prepare ourselves for and how can we

manage the unexpected? This thinking reveals the close relationship between safety culture, prevention culture and the crucial need for networking. This discussion will continue in Helsinki in late September at the Culture of Prevention Symposium.

Please mark in your calendars 25–27 September 2013, Helsinki, Finland 24–27 August 2014, Frankfurt, Germany www.ttl.fi/cultureofprevention2013 www.safety2014germany.com Cordial thanks are due to all our colleagues in DGUV for organization of such a successful Conference.

Suvi Lehtinen Chief, International Affairs Finnish Institute of Occupational Health Topeliuksenkatu 41 a A 00250 Helsinki, Finland Suvi.lehtinen@ttl.fi www.ttl.fi

May Muchengeti ZIMBABWE

Occupational safety and health (OSH) training at ARLAC Background of ARLAC

The African Regional Labour Administration Centre (ARLAC) was jointly formed by the ILO and UNDP in 1974 as a project for the development of Labour Administration issues. In October 1982, ARLAC transformed from a project into a unique organization with its independent Governing Council, comprising labour/employment/manpower ministries from its member countries. The International Labour Organization (ILO) and the United Nations Development Programme (UNDP) are also members of the ARLAC Governing Council and Executive Office.

ARLAC has 19 member countries drawn from Englishspeaking African countries with the exception of Egypt.

These are Botswana, Egypt, Ethiopia, Ghana, Kenya, Lesotho, Liberia, Malawi, Mauritius, Namibia, Nigeria, Sierra Leone, South Africa, Somalia, Sudan, Swaziland, Uganda, Zambia and Zimbabwe. Eritrea, Gambia, Mozambique and Tanzania are observer states. ARLAC has two sister organizations in Africa, CRADAT for French-speaking African countries and ACLAE for Arabic speaking African countries.

In accordance with its charter, ARLAC pursues the following summarized objectives (1): • To provide training at all levels of Labour Administration • To provide consultancy and advisory services directed towards labour administration • To conduct studies and research in all aspects of labour administration • To provide information services and production of train ing materials.

Contribution of ARLAC to labour administration capacity building in Africa

ARLAC considers all its objectives as being of paramount importance in strengthening labour administration systems in Africa. However, training is among the major activities of ARLAC – not only in importance, but also in terms of time consumption. Fulfilling the training objective has enabled ARLAC to make a greater impact on not only the trainees; but their respective organizations and countries, communities and families. Of several programmes, the ones on training of trainers stand out as the principal tool for expanding the effective coverage of ARLAC’s training programmes

through the multiplier strategy.

ARLAC training is demand driven and tailor made for the ARLAC constituents. The Principal/Permanent Secretaries and Directors-General responsible for labour/employment/manpower issues in the member states decide and submit the training needs of their respective countries. The programme is then designed on this basis so as to remain relevant and specific to the needs of the member states. On average, ARLAC runs seven courses per year at regional and sub-regional levels. ARLAC also offers an opportunity for national programmes. These are programmes held specifically for a requesting country when they feel they have a unique and immediate training need. Although membership to ARLAC is open to governments through their labour/employment/manpower ministries, ARLAC training programmes may be bipartite or tripartite so as to extend the decent work agenda to all social partners as necessary. Training is also for officials at all levels of the labour administration system.

ARLAC relies on a pool of training and subjects specialists from allied organizations, including the International Labour Organization (ILO). It particularly enjoys fruitful relations with the ILO Regional Offices for Africa and the Decent Work Country Team in Pretoria, South Africa.

The interactive learning draws on the professional expertise and experiences of all those taking part in ARLAC’s programme, in an environment free from the day-to-day pressures of work.

ARLAC on occupational safety and health (OSH) training

ARLAC, as a capacity building organization, acknowledges the part played by the competent safety professionals in achieving steady but significant improvement in site safety.

Clearly, it is doubtful whether the appointment of a safety supervisor, no matter how competent, will achieve an acceptable level of compliance with the health and safety legislation on any site, unless it is competently managed.

Our training is concerned about ensuring that workers are free from physical, chemical, biological and any other work-related hazards within their work environments. It includes a wide range of measures aimed at increasing interest in working life and occupational safety and health at a gen-

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19

eral level. Owing to the tripartite nature of our participants (Government, Employers’ and Workers’ organizations) a comprehensive system of information dissemination through country presentations is achieved and such presentations are usually worked out in cooperation with the social partners.

By and large, the strategy of the occupational safety and health administration is based on the national circumstances of each member country. Our training endeavours to address the problem of whether people have the strength to cope with work today.

For example, we have discovered, through our research activities, that the changes in working life and society, higher demands for qualifications and increased work tempo have added to the worker’s mental load and many people’s tolerance is put to task leading to more workplace accidents. As a result, we urge our member countries to review their OSH administration strategies in order to update them.

ARLAC works very closely with the ILO and advises its membership on the: • Promotion of the application of the prin ciples of the ILO instruments on safety and health at work with a view to facili tating their ratification and implementa tion • Exchange of views and experiences on measures to be taken at the national en terprise level for the improvement of oc cupational safety and health in industry • Exchange of views concerning the role of governments, employers and workers and their organizations on ways of improving the application of the principles con tained in the ILO instruments, and • Examination of the pertinent activities towards facilitating the ratification of ILO Convention 155 (Occupational Safety and Health Convention, 1981) and related Conventions through training, upgrading legislation, information and technical co

operation.

ARLAC has put in place monitoring and evaluation mechanisms to: • Mainstream a feedback system with our alumni • Keep abreast of international trends and standards on occupational safety and health • Regularly assess methods of promoting safety management, and • Assess training as a key to instigating and improving safety, health and welfare at the workplace. This is implemented by way of regular inspections of the work places.

In order to succeed, ARLAC has adopted the integrated approach system of inspection as opposed to the fragmented approaches that are prevalent in most of our member states. The integrated approach has already shown that it requires a properly functioning network to support it. The contribution of the enforcing authorities alone is not enough for achieving good results. We encourage clear division of labour between the members of the network while discouraging any overlapping and competition. All members of the network should work in fruitful cooperation, which is ensured by well-functioning cooperative bodies and by good personal relations.

At the end of it all, we expect the enforcement authorities to have a profound and full knowledge of working life and labour legislation. They must be looking to the future and be capable of flexible networking. The inspection officer ARLAC envisages to mould is more like a manager of systems than an expert in one field. He has negotiation skills and faculties to comprehend and direct large entities and also one who knows the principles and regulations of industrial life. We envisage an individual who should have the ability to cope under stress and to make decisions even in matters

20 • Afr Newslett on Occup Health and Safety 2013;23:19–21

of principle.

The goal of ARLAC training is that participants come up with a communiqué and work plan mapping out their observations, challenges and the recommended way forward. The communiqué and work plan will then be tabled before the annual meeting of Principal/Permanent Secretaries and Directors-General responsible for labour/employment/manpower issues so as to inform them of the outcomes of the workshop as well as to seek their support in the implementation of the work plan. The outcomes of these workshops are also submitted to the ARLAC Governing Council (Labour Ministers) for political backing.

The major challenges affecting health and safety in the workplace as deduced from our various training programmes include the following among others: fragmentation of the OSH service; lack of resources (human, financial, and equipment); ineffective human resource policies and procedures, outdated legislation, undeterrent penalties/ fines; competency levels in the inspectorate, non-complying employers, corruption, weak social partners, increase in the growth of Small and Medium-sized Enterprises and the informal sector.

Tackling these changes on working life demands an integrated approach, merging the traditional, technical and medical issues with the social, psychological, economical and legal ones. The new reality demands global strategies and local responsiveness to enable countries to react by adopting adequate socio-economic policies, avoiding economic turbulence and promoting industrial peace.

The challenges we face in delivering our training mandate, particularly in OSH includes the fact that we are generally a labour administration capacity building institution, we cover a number of labour themes. As a result we are forced to combine a wide range of OSH topics into one training theme so as to make room for other labour administration themes. As a result our short courses cannot be as detailed as is desirable. Our other challenge is that we are a membership driven organization, with membership contributions and ILO funding as our main sources of income. When member countries delay in honouring their obligation to ARLAC, it affects our programming severely.

In its quests to offer labour administrator something more substantive, ARLAC in collaboration with the University of Lagos,

Nigeria has since September 2011 started offering post-graduate programmes in Labour and Employment Studies. One of the compulsory modules is on Labour and Occupational Safety and Health Inspection. This programme was initially created to cater for the needs of long serving labour administrators who have all the experience, but lack the paper certification required for progression and promotion.

It is now open to anyone, with foreign applicants being exempted from taking the qualifying examination for admission to the ELSDD programme.

Despite the positive developments in health promotion activities in many African countries, this article reminds us of the great needs of one of the most vulnerable groups.

The Editor in Chief

Mary Muchengeti ARLAC Information Officer/ Documentalist African Regional Labour Administration Centre (ARLAC) CIS Regional Centre P.O. Box 6097 Harare, Zimbabwe mmuchengeti@arlac.co.zw

Health aspects of child labour in the crushing of granite in central Benin

References African Regional Labour Administration Centre. The ARLAC agreement and rules of procedure of the ARLAC Governing Council. Harare: ARLAC, 1988.

Report on The Prevention of Occupational diseases etc. see:

www.ilo.org/safeday

A.P. Ayélo, B. Aguêmon, A. Santos, F. Gounongbé, L. Fourn, B. Fayomi BENIN

Introduction

Child labour is still a major problem in developing countries (1, 2) in particular sub-Saharan Africa which shows the highest rates (3). Apart from its legal and social aspects, child labour is a real public health concern (4).

In Benin, there is political will to fight the worst forms of child labour (5). Indeed, the Republic of Benin ratified Conventions numbers 138 and 182 of the International Labour Organization (ILO) relating respectively to the minimum age for admission to employment, 11 June 2001 and the Worst Forms of Child Labour, 11 November 2001.

Notwithstanding the efforts to eradicate the worst forms of child labour in Benin, the phenomenon continues to grow in various forms. A recent study reported 2424 children working in mines and quarries in Benin. Some 1302 of them were employed in the crushing of granite (6).

The characteristic hardness of granite and the force required to crush it represents an inherent risk to a child’s health working in this environment. It is essentially this aspect that the present article intends to highlight so that it can be used in

the fight against the worst forms of child labour in Benin.

How the survey was carried out

The study was conducted in three municipalities (Dassa-Zoumé, Glazoué and Savalou) in the Department of Hills, one of the administrative departments in central Benin. Granite crushing work in this area is related to its high hills; a significant source of raw materials. It is a descriptive study of the work environments. The study is focused on 21 work sites and was conducted during August 2012. In total, 178 children aged 5 to 14 were identified. A questionnaire was administered directly to children (able to express themselves) or their parents on the basis of their individual consent. An observation grid and photos were used to complement the information collected on sites visited.

The variables studied are related to the characteristics of the children, the activities carried out and health problems. The results are as follows: The prevalence of child labour in the granite crushing quarry is 49%. Some 90% of children work on behalf of their parents.

The data on the profile of children (Table

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21

Photos: Alain Santos Beninese

1), the activities performed, the duration of work (Table 2) and the health problems reported (Table 3) are as follows:

Profile of children surveyed Table 1. Distribution of children according to age, sex, school level

Variables

Number

%

5–9 years

92

52

10–14 years

86

48

Age (N = 178)

Gender (N = 178) Boys

87

49

Girls

91

51

School level (N = 178) Primary

140

79

Secondary

28

16

None

10

6

Photos 1–2. Boys and girls transporting blocks of granite.

Activities performed and the duration of work

Ninety-three percent of the activities performed by children (transport, crushing and sieving) are manual. The mean weight of loads carried is 39 kg. Some 80% of children are not happy with the activities assigned to them. The proportion of children and duration of the activities carried out are indicated in Table 2.

Health problems reported by children

Eighty-six percent of the children surveyed reported being victims of accidents with injuries (44%), sprains (54%) and 3 cases of fracture. Other health problems identified are summarized in Table 3 below.

Table 3. Distribution of children according to health problems reported.

Table 2. Proportion of children according to their activities and the duration of work.

Variables

Number

%

Transporting granite (N = 160)

140

88

Crushing granite into fine gravel (N = 173)

165

95

Sieving gravel (N = 175)

144

82

Activities Number (N = 178)

%

Cough

134

75

Daily duration of work (N = 178)

Cold

137

77

Less than 8 hours

40

23

Eye problems

92

52

8 hours and more

138

78

Headache

139

78

Number of days per week (N = 175)

Muscle pain

134

75

< or = 5 days

29

17

Joint pain

178

100

6 days and more

146

83

Symptoms

22 • Afr Newslett on Occup Health and Safety 2013;23:21–23

Photo: Alain Santos Beninese

of muscle and joint pain of which the children complain in our study. Coughs and colds reported by children could be explained by the inhalation of mineral dust that is released through the crushing process. The case of ocular trauma observed in one child was due to gravel being projected into the eye and this reflects eye problems reported by 52% of the children surveyed.

Conclusion

The children are subjected to harsh working conditions in a granite crushing quarry in Benin. The characteristic hardness of the material in the quarry and all the health problems that arise indicate that most children (80%) suffer seriously from these activities.

Photo 3. The activity of crushing.

Discussion

Our results show that children represent about half (49%) of the labour used in the granite crushing quarry in central Benin.

This massive use of child labour in an activity with high muscle stress or a significant consumption of energy is a violation of ILO Conventions Numbers 138 and 182.

Indeed, it is clearly stated in Article 3d of ILO Convention No. 182 that the term “the worst forms of child labour” includes works which, by its nature or the circumstances in which they apply is likely to harm the health, safety or morals of children.

Most (94%) children identified on the sites are enrolled at school. However, studies have shown elsewhere such as in Bangladesh (7) that children engaged in economic activities are poorly educated, contrary to our results. This difference could be explained by the fact that our study was conducted during school holidays where children participate massively in the economic activities of households. The current reality in poor countries could also explain the high prevalence of child labour in the quarry during the period. Nevertheless, it does not seem sufficient to justify the child abuse seen below.

Children are first asked to carry granite blocks of 39 kg on average (Photos 1-2) that they will crush (Photo 3) into grav-

el. However, with respect to the weight of loads to be carried by the child, the law of Benin (Interministerial Order No. 132/ MFPTRA/MSP/DC/SGM/DT/SST of 2 November 2000 establishing the nature of work and categories of enterprises prohibited to women, pregnant women and young men, and the age limit which the prohibition applies limits the maximum weight carried to 15 kg for male staff aged 14 and 8 kg female staff of 14 years.

Studies have shown that repeated early exposure of children to this type of dangerous work puts them at high risk of developing chronic diseases such as arthritis and silicosis (4). This is probably the cause

Corresponding author: Dr. Paul Ahoumenou Ayelo Occupational Health Physician Unit of Research and Education in Occupational Health and Environment, 01BP 188 Cotonou, Benin Tel. (+229) 97026378, Fax: (+229) 21305223.

Email: paulayelo@yahoo.fr

A.P. Ayélo1, B. Aguêmon1, A. Santos1, F. Gounongbé2, L. Fourn1, B. Fayomi1

1. Department of Public and Occupational Health, Faculty of Health Sciences, Cotonou, University of Abomey Calavi, Republic of Benin.

2. Department of Public and Occupational Health, Faculty of Medicine, University of Parakou, Benin.

References 1. UA Segal, A Ashtekar. Detection of intrafamilial child abuse: children at intake at a children’s observation home in India. Child Abuse Neglect 1994;18:957–67.

2. MN Esin, S Bulduk, H Ince. Workrelated risks and health problems of working children in urban Istanbul, Turkey. J Occup Health 2005;47:431–36.

3. OIT. Un avenir sans travail des enfants, Rapport global du directeur général, Conférence internationale du travail, 90e session, Bureau international du travail, Genève, 2002.

4. J Kasper, D Parker. Child Labour. International Encyclopedia of Public Health 2008:583–90.

5. P Ayelo, P Baloïtcha, B Fayomi. Situation socio sanitaire des apprentis en milieu artisanal à Cotonou.

J Int Santé Trav 2010;2:31–9.

6. IPEC-Bénin. Etude sur le travail des enfants dans les mines et carrières en République du Bénin. OITIPEC-Bénin 2008:32–6.

7. A Hadi. Child abuse among working children in rural Bangladesh: prevalence and determinants.

Public Health 2000;114:380–84.

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Contact persons/country editors Editorial Board

Director Department of Occupational Health and Safety (Ministry of Labour and Home Affairs) Private Bag 00241 Gaborone BOTSWANA Samir Ragab Seliem Egyptian Trade Union Federation Occupational Health and Safety Secretary 90 Elgalaa Street Cairo EGYPT Ministry of Labour and Social Affairs P.O. Box 2056 Addis Ababa ETHIOPIA Commissioner of Labour Ministry of Trade Industry and Employment Central Bank Building Banjul GAMBIA The Director Directorate of Occupational Health and Safety Services P.O. Box 34120 00100 - Nairobi KENYA The Director Occupational Safety and Health Private Bag 344 Lilongwe MALAWI

Mrs Ifeoma Nwankwo Federal Ministry of Labour and Productivity Occupational Safety and Health Department P.M.B. 4 Abuja NIGERIA Peter H. Mavuso Head of CIS National Centre P.O.Box 198 Mbabane SWAZILAND Chief Executive Occupational Safety and Health Authority (OSHA) Ministry of Labour and Employment P.O. Box 519 Dar es Salaam TANZANIA Commissioner Occupational Safety and Health Ministry of Gender, Labour and Social Development P.O. Box 227 Kampala UGANDA Tecklu Ghebreyohannes Director of Labour Inspection Div. Ministry of Labour and Human Welfare Department of Labour P.O. Box 5252 Asmara ERITREA

as of 1 January 2013

Director, Department of Occupational Health and Safety (Ministry of Labour and Home Affairs) BOTSWANA Mathewos Meja OSH Information Expert Ministry of Labour and Social Affairs ETHIOPIA Chief Inspector of Factories Ministry of Employment and Social Welfare GHANA The Director, Occupational Health and Safety Ministry of Labour and Industrial Relations MAURITIUS Chief Inspector of Factories Ministry of Labour SIERRA LEONE Seiji Machida, Director Programme on Safety and Health at Work and the Environment (SafeWork) International Labour Office 4, route des Morillons CH-1211 Geneva 22 SWITZERLAND Evelyn Kortum Technical Officer Occupational Health Interventions for Healthy Environments Department of Public Health and Environment World Health Organization CH-1211 Geneva 27 SWITZERLAND

RD

IC ECOL A

BE L

NO

Jorma Rantanen Past President of ICOH ICOH International Commission on Occupational Health

441 763 Printed matter

SLY-Lehtipainot OY, Kirjapaino Uusimaa, Porvoo

Harri Vainio Director General Finnish Institute of Occupational Health FINLAND