African Newsletter 2/2013, Prevention culture by Työterveyslaitos

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 2, August 2013

Prevention culture

African Newsletter on Occupational Health and Safety Volume 23, number 2, August 2013

Prevention culture Published by Finnish Institute of Occupational Health Topeliuksenkatu 41 a A FI-00250 Helsinki, Finland Editor in Chief Suvi Lehtinen Editor Marianne Joronen Linguistic Editors Alice Lehtinen 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.

Contents 3 Editorial

Building prevention culture Seiji Machida, ILO SafeWork

Articles 28 Promoting social security and prevention of occupational diseases in Africa Hans Horst Konkolewsky

ISSA

31 The Finnish Zero Accident Forum Markku Aaltonen

FINLAND

32 Preventive occupational safety and health culture: the situation in developing countries Yusuf Katula

UGANDA

35 Towards safety prevention culture in Kenya Pius W. Makhonge

KENYA

37 Safety education – a preventive measure in OH&S: the case of agriculture S.T. Olowogbon, A.S. Akinwande

NIGERIA

41 Prevention of non-communicable diseases at the workplace in Tanzania Mwele Malecela, Mary Mayige

TANZANIA

The African Newsletter on Occupational Health and Safety homepage address is: http://www.ttl.fi/AfricanNewsletter

44 Publications

The next issue of the African Newsletter will come out at the end of December 2013. The theme of the issue 3/2013 is Construction.

46 8. Global Conference on Health Promotion Suvi Lehtinen

45 Conferences

FINLAND

Photographs of the cover page: © International Labour Organization / J. Maillard

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

Building prevention culture

he fostering and promotion of a prevention culture or in ILO terms “Preventative safety and health culture” at both national and enterprise levels is a fundamental basis for improving occupational safety and health (OSH) performance in the long term. Continuous improvement of national OSH performance requires a systematic approach with various actions. These actions should include introduction of a national legal framework, a government inspection, a training network and technical support services. With the framework of national OSH system, prevention activities have to be carried out at the enterprise level by the management and the workers as an integral part of a business operation. Every day, both employers and workers have to make decisions which have impact on OSH performance. Thus, it is critical that management and workers share common values on safety and health, in other words enterprise preventative safety and health culture. Such an enterprise culture should facilitate joint efforts to continuously improve OSH performance with the right balance of business objectives and prevention. The starting point for the building of national or enterprise preventative safety and health culture is to understand what it would cover. According to the Promotional Framework for Occupational Safety and Health Convention, 2006 (No. 187), “a national preventative safety and health culture” is a culture in which the right to safe and healthy working environment is respected at all levels, where government, employers and workers actively participate in securing a safe and healthy working environment through a system of defined rights, responsibilities and duties, and where the principle of prevention is accorded the highest priority. An important basis for preventative safety and health culture is the recognition by all concerned, including management and workers that workers have the right to a safe and healthy working environment. Such a right is often clarified in national legislation as a fundamental right of workers. In the countries where it is not clarified, the provisions of the Convention No. 187 could be referred to as a basis. Active participation of all concerned, in formulating policy and action plans both at the national and enterprise levels, is another

critical factor for practical OSH prevention measures. In order to build national or enterprise preventative safety and health culture, improvement of OSH knowledge and awareness at all levels (government officials, corporate top management, supervisors, and workers) is essential. Continuous and systematic activities including information, consultation and training have to be implemented for this purpose. These activities should promote basic principles of prevention such as assessing occupational risks or hazards; eliminating hazards; and combating occupational risks or hazards at source. One of the concrete steps taken by the ILO to promote the building and the maintenance of a national preventative safety and health culture is the observation of the World Day for Safety and Health at Work on 28 April every year. Various national and enterprise level activities are organized around the World Day in over 100 countries facilitating active discussions for the improvement of national and enterprise level OSH systems. Another important mile stone is the adoption of the Seoul Declaration on Safety and Health at Work at the Safety and Health Summit in 2008. The Seoul Declaration recognizes that promoting high levels of safety and health at work is a responsibility of society as a whole and calls for building and maintenance of a national preventative safety and health culture and placing OSH high on national agendas. We should continue to build preventative safety and health culture among all concerned as a fundamental pillar for improving OSH performance and as a facilitator and promoter for strengthening national and enterprise OSH systems and programmes.

Seiji Machida Director, SafeWork, ILO International Labour Office

Afr Newslett on Occup Health and Safety 2013;23:27 •

Hans Horst Konkolewsky ISSA

Promoting social security and prevention of occupational diseases in Africa Photo by John Hogg / World Bank

Introduction

Occupational diseases are posing an ever increasing challenge to workers’ compensation systems. Out of the 2.34 million annual work-related deaths reported by the International Labour Organization (ILO) (1), the vast majority – approximately 2.02 million – are due to work-related diseases. As a consequence, occupational safety and health policy is shifting from an injury and accident centered approach to one that increasingly is occupational disease focused. To effectively address occupational diseases (ODs), many social security organizations responsible for insuring and compensating these risks are adopting a more proactive and preventive approach. Their leitmotif can best be described as ‘prevention is better than compensation’. Adopting such an approach also forms part of a broader understanding of the role that social security can play in promoting and shaping a national prevention culture.

Global ranking of occupational diseases

As the main insurer of occupational diseases, social security plays a key role in addressing the consequences of occupational diseases. A survey conducted in 2011 among 123 member organizations of the International Social Security Association (ISSA) allows for the preparation of the following “top five” listing. The main ODs giving rise to claims are respiratory diseases, musculoskeletal disorders and diseases caused by physical agents (Figure 1). Figure 1. Top 5 occupational diseases compensated by ISSA member organizations (2011) Types of ODs

28 • Afr Newslett on Occup Health and Safety 2013;23:28–30

Percentage of total

Respiratory diseases

28.8%

Musculoskeletal disorders

18.5%

Diseases caused by physical agents

18.5%

Skin diseases

11.7%

Biological agents and infections or parasitic diseases

6.8%

National lists

Social security institutions normally base their decisions on awarding compensation for an occupational disease on the official national OD list, which in many cases is based on the ILO’s list of occupational diseases. As the nature of health risks at work is changing rapidly as a consequence of new technologies, substances, work organization and environmental conditions, it is crucial that these lists are updated regularly. The ILO has established international criteria for updating national OD lists (see Box 1).

Box 1: ILO criteria for updating national OD lists: • causal relationship with a specific exposure; • occurrence in connection with the work environment; • higher frequency among con cerned groups of persons; • scientific evidence of a clearly defined pattern of disease follow ing exposure and plausibility of cause.

Challenges for social security

When addressing ODs, social security systems are faced with the challenge of how to best protect the insured, while delivering excellent services and sustaining viable social security systems. Over the last years the ISSA organized several Technical Seminars in Africa1 which identified a series of important questions that social security institutions should take into consideration: Sustainability of the social security system Some ODs, such as asbestosis, silicosis or other diseases of the respiratory system and occupational cancers are characterized by a long latency or recovery period, which makes it difficult for social security administrations to calculate the duration of treatment and associated costs. For other ODs, such as infectious diseases, skin ailments or diseases caused by very high or low temperatures, a probability of successThe Seminars were held in Kribi, Cameroon (March 2007), in Marrakesh, Morocco (October 2012) and in Banjul. Gambia (April 2013).

Figure 2. Delays in processing technical requests

120 % 100 % 80 %

43 %

60 % 40% 20 % 0%

38 % 8% 11 %

15 %

13 %

> 90 days

26 %

23 %

60 - 90 days

23 %

11 %

18 %

46 - 59 days

13 % 20 % 11 %

32 %

38 %

15 %

10 %

34 %

30 - 45 days < 30 days

2009 2010 2011 2012 Source: CNSS-DGA-AC & Budget, December 2012.

ful recovery can be anticipated. In order to be able to insure occupational diseases, social security institutions must therefore be aware of the latency periods and potential hidden costs of occupational diseases. Increasing coverage of the working population Africa’s occupational disease challenges are also closely linked to the informal sector, resulting in high numbers of workers without occupational accident and disease insurance coverage. Workers in the rural informal sector often receive irregular income because of their seasonal employment. In addition, some micro and smallscale enterprises in the informal sector do not have a permanent work location, which makes it difficult for social security institutions to contact them. The Social Security and National Insurance Trust of Ghana found that these difficult economic and geographic circumstances add to the general unwillingness to pay contributions. (2) This unwillingness amongst people working in the informal sector is closely linked to a general lack of awareness of the concept and benefits of social security and to a certain extent distrust as regards the institutions administering social security funds. The ISSA is therefore assisting its member organizations in developing good governance practices and improving their management and administration systems. Combined with public awareness campaigns such efforts, according to experiences in other regions, could lead to higher levels of social security coverage amongst people working in the informal sector.

Underreporting As an example, only 109 ODs were regis-

tered in Senegal between 2000 and 2010 (3), which are approximately 11 cases per year for a country with over 13 million inhabitants and a GDP of 13.8 billion USD. (4) Many OD-cases remain unregistered in Africa, because neither the workers concerned, nor their employers are sufficiently informed about the possibility to receive compensation and consequently do not present compensation claims. Again there is a need for information campaigns to raise awareness about the benefits and services of social security as regards ODs. In addition, national statistics on public health, occupational accidents and disease cases would need to be further developed and regularly updated. Diagnosis and service quality It is paramount for social security systems to ensure that the covered population does not face economic insecurity as a consequence of possible delays in ascertaining the validity of their claim to worker compensation benefits. If there is a pertinent risk that occupational diseases are not recognized as such by the treating physicians, including family doctors, procedures should be developed for the diagnosis, the reporting and recording of ODs. An appropriate infrastructure needs to be developed allowing for accurate diagnosis and treatment carried out by a sufficient number of qualified and well-trained medical staff. Diagnosis, treatment and individual preventive measures should also be carried out at the earliest stage possible in order to foster a more rapid recovery. In terms of service quality response rates, positive developments can already be noted: Gabon’s National Social Security Fund (CNSS) managed to significant-

Afr Newslett on Occup Health and Safety 2013;23:28–30 •

ly reduce the response time to claims over a period of three years. In 2009, almost half of the claims took over 90 days to be processed. This duration was gradually reduced which contributed to an increased client satisfaction of 95.9% for services delivered. (Figure 2) Legal mandate for prevention Other important challenges as regards the prevention of ODs are the current limitations in the legal mandate and the organizational structure of the social security institution. Usually, the institution’s mandate is reduced to offer insurance against occupational risks, and in the case of work accidents or ODs, to offer benefits, including compensation. The prevention of the occupational injury, however, is not included in their legal mandates as such activities normally fall under the responsibility of a state authority, e.g. the ministry of labour or the state labour inspectorate. The ISSA strongly advocates for an active involvement of social security institutions in prevention, supplementing and supporting the responsible safety and health authorities, and has prepared occupational risk prevention guidelines for its global membership. Notably, some institutions in Africa have already taken or are initiating measures to include risk prevention in their core insurance activities: •

Gabon’s National Social Security Fund has created a structure for the prevention of ODs that focuses on the prevention and early diagnosis of certain illnesses, including both communicable and certain chronic diseases.

sponsibility for social security and Occupational Safety and Health (OSH). The management of social security and OSH has been delegated to the National Social Security Authority (NSSA) which now runs an OSH division of 98 persons, dealing with promotion and training, factory and labour inspections, occupational health services as well as research and development. A tripartite Zimbabwe Occupational Safety and Health Council (ZOHSC) has also been set up providing a forum for discussion and consensus building.

Outlook

The above mentioned examples demonstrate that social security institutions in Africa are still facing important challenges with regard to protecting workers against occupational diseases, and in the event that they occur, to offer adequate benefits and services. But they also showcase the potential of social security to provide a significant contribution to the existing national occupational prevention systems and thereby to help shape a national prevention culture. Importantly, social security systems in Africa increasingly acknowledge the added value of investing in people, supporting employment and improving the general health of the population, both for the sustainability of their systems and for society as a whole. (5) Therefore, the role of social security in conducting prevention activities and specifically addressing occupational diseases should be

• After Nigeria’s 2010 reform of its work injury programme, the Nigeria So cial Insurance Trust Fund (NSITF) now provides compensation for in sured workers and their dependents for work-related death, injury, disease and disability. The new Act also rec ognizes mental stress as a work-re lated chronic health problem for which compensation may be paid. This devel opment suggests that occupational safety and health specialists and the NSITF staff be trained for work acci dent prevention and the handling of cases. • In Zimbabwe, the Ministry of Labour and Social Services has the overall re30 • Afr Newslett on Occup Health and Safety 2013;23:28–30

further strengthened. The ISSA has developed a set of three Prevention Guidelines, addressing occupational risk prevention, workplace health promotion and return-to-work, and providing basic principles, planning tools and good practices to help social security institutions introduce and conduct prevention services. (6) In addition, from 2014 onwards the ISSA’s new Centre for Excellence will offer member organizations technical support and capacity building facilities in their efforts to develop prevention services as an integrated part of their overall programme. Given the high levels of interest in these guidelines expressed amongst the ISSA’s membership in Africa2, the future outlook for the prevention of occupational accidents and diseases in the region looks positive. Hans-Horst Konkolewsky Secretary General International Social Security Association (ISSA) 4 Route des Morillons Case postale 1 CH-1211 Geneva 22 Switzerland issa@ilo.org www.issa.int 2 According to the ISSA’s 2012 member survey, 70 % of members in Africa are interested in Workplace health promotion, 64 % in Prevention of work injuries, and 41 % in Return to work guidelines.

References 1. The prevention of occupational diseases, International Labour Office, Geneva, 2013. 2. Technical Seminar on Work Accidents and Occupational Diseases in Africa, Banjul, Gambia, 25.04.2013–26.04.2013, International Social Security Association, Geneva, 2013. 3. Seneweb. Retrieved 02 August 2013: “Occupational diseases” http://www.seneweb.com/news/Sante/ maladies-professionnelles-109-cas-enregistres-entre-2000-et-2010_n_93462.html 4. International Monetary Fund. Retrieved 02 August 2013. Country profile “Senegal” http://www.imf. org/external/pubs/ft/weo/2013/01/weodata/weorept.aspx?pr.x=36&pr.y=16&sy=2009&ey=2012&scs m=1&ssd=1&sort=country&ds=.&br=1&c=722&s=NGDPD%2CNGDPDPC%2CPPPGDP%2CPPPPC% 2CLP&grp=0&a= 5. Africa: A new balance for social security (Developments and trends, 2012). Geneva, International Social Security Association. http://www.issa.int/layout/set/print/Resources/ISSA-Publications/AfricaA-new-balance-for-social-security 6. The ISSA Guidelines on occupational risks as well as other prevention related Guidelines will be launched at the World Social Security Forum in Doha, Qatar in November 2013. http://www.issa.int/News-Events/Events/wssf2013

Markku V. P. Aaltonen FINLAND

The Finnish Zero Accident Forum Photo by Sarno Ojell

Introduction

Occupational accidents are unwanted adverse events at work which affect not only individuals, but also society as a whole. As well as having a negative impact on health, they also negatively affect the success of a company, its image, recruitment practices and staff turnover. It is therefore important to develop new methods and approaches for improving safety. It is estimated that if all ILO Member States used the best accident prevention strategies and practices that are already easily available, some 300,000 deaths and 200 million accidents could be prevented annually (1). The member organizations of Zero Accident Forum receive the Safety Level Certifications 2012.

Why the zero accident goal?

Zero accident vision (ZAV) is increasingly adopted by companies. Enterprises simply want to eliminate workplace accidents, because they are tired of their negative consequences. ZAV is based on the assumption that all accidents are preventable. If accidents are not preventable immediately, they very likely will be in the long run. ZAV thus provides an ethically sustainable basis for accident prevention. However, zero accident thinking is both an intellectual and a practical challenge for safety work. Promoting this vision is an important weapon in the battle against fatalism, which is quite common.

Zero Accident Forum in Finland

The Zero Accident Forum has been active since 2003 in Finland. The Forum is a voluntary network of Finnish workplaces, and is open to any workplace, regardless of its size, economic sector or level of occupational safety. The Forum is a network through which the Finnish Institute of Occupational Health promotes accident prevention together with Finnish workplaces. Members of the Forum share a common vision of becoming leaders in safety, and are willing to share their experiences for the benefit of other members. The Forum provides examples of good practices from other workplaces, spreads success stories, and moti-

vates and encourages workplaces to strive for a high level of safety. The Forum also organizes national and regional seminars and provides materials and tools to promote the “vision zero” concept. Materials include campaigns, websites and the Zero Accident Forum Newsletter. Commitment to the zero accident goal is the key to Forum membership. In joining the Forum, workplaces commit to working together to improve safety at work by accepting six basic statements issued by the Forum. Over 300 organizations from all over Finland had joined the Zero-Accident Forum by August 2013. These workplaces employ over 300,000 people, which is more than 10% of the Finnish working population. (2)

Conclusions

Normally workplaces aim to lower their number of accidents, but in practice this is not easy. Even if they succeed in reaching a good safety level, it is difficult to maintain it. Workplaces should thus be encouraged to set a goal of “zero accidents”. (3) Only this vision can provide an ethically sustainable basis for accident prevention. Safety is a value as such, and an accident-free workplace should be a human right for every worker.

Safety is also a part of the quality of production. Accidents and near-accidents indicate problems in work processes. Safety culture is part of the company image. It is easy to lose but very difficult to regain. The safety and health of employees can also be an integral part of a company’s competitiveness. Markku V.P. Aaltonen Finnish Institute of Occupational Health Topeliuksenkatu 41 a A 00250 Helsinki, Finland markku.aaltonen@ttl.fi

References 1. Takala, J., 2002. Introductory Report: Decent Work – Safe Work. Paper Presented at the XVIth World Congress on Safety and Health at Work, Vienna, 27 May 2002. 2. The Finnish Zero Accident Forum [homepage on the Internet]. [cited 2013 08 17]. Available from: www.ttl.fi/zeroaccidentforum. 3. Gerard I.J.M. Zwetsloot, Markku Aaltonen, Jean-Luc Wybo, Jorma Saari, Pete Kines, Rik Op De Beeck. The case for research into the zero accident vision. Safety Science, Volume 58, October 2013, Pages 41–48. http:// dx.doi.org/10.1016/j.ssci.2013.01.026 [cited 2013 08 17].

Afr Newslett on Occup Health and Safety 2013;23:31 •

Yusuf Katula UGANDA

Preventive occupational safety and health culture: the situation in developing countries Introduction

Uganda is a country with a population estimated at 30.7 million people and a labour force estimated at 13.4 million (1). The country has an active labour force of 12.9 million people. More than 70% of the population is actively involved in agriculture, most of which is subsistence agriculture. However, there are commercial firms in the area of sugar cane, for the production of sugar, with more than ten sugar processing factories. The three main players produced an estimated 357,000 tonnes, while new players are estimated to have produced 20,000 tonnes for the financial year of 2012/13. The planting, weeding, loading and unloading of sugar cane has to some extent been mechanized, but the sugar cane is usually cut manually. Large quantities of chemicals are used in the early stages of cane growing, namely fertilizers and weed killers. The second main crop is tea, which is grown by both

Photo by Suvi Lehtinen

32 • Afr Newslett on Occup Health and Safety 2013;23:32–34

companies and outgrowers. The production of tea stands at 56 million kg, which is obtained from about 23,000 hectares. The sector employs about 50,000 people, the majority of whom (70%) come in for green leaf plucking on the plantations. Tea, like other commercial crops, requires the application of chemicals – especially for pest and weed control. The third important crop, which is termed non-traditional and whose production picked up in the 1990s, is flowers. There are over 16 flower firms in Uganda, dealing in both cut flowers and roses, all of them grown in greenhouses. The sub-sector employs about 25,000 workers directly, the majority of whom are women of reproductive age. Significant gains have been made in the push for industrial development, which is partly agro–processing for value addition. The iron and steel industry is still in its infancy. The first decade of this millennium brought the discovery of oil and gas deposits in the country, creating the prospect of an emerging oil and gas industry, with all its complexities in terms of safety and health. The above picture indicates that Uganda is an economy which is significantly agricultural-based. Resources at the disposal of the inspectors would be required so that they could constantly monitor the workplaces where the work is being done. This has not been the case, as the country has an established structure with less than 40 inspectors nationwide whose work is specific to safety and health at the workplace. In 2007, eleven workers were killed when a hotel structure under construction in Bwebajja, along Entebbe Road, collapsed and in 2009, seven workers were fatally wounded while working on a construction site in the capital, Kampala. Investigations showed that at one of the sites, where the excavation ran more than 15 metres deep, no adequate and suitable measures had been put in place to ensure that the soil on the hanging wall of the excavation would not collapse on the workers below. At the other site, though the persons supervising the building work were competent, their experience for construction of that magnitude appeared to have been inadequate, as one of the major causes

Photo by Barbra Khayongo

was the removal of concrete supports for the floors before the concrete had properly set. The quality of the materials and the mixtures was another issue.

The situation in other developing countries

The early part of the year has been very traumatic for many families in Bangladesh. On 24 April 2013, a building housing a garment manufacturing concern on the outskirts of Dhaka, the capital, collapsed, killing more than 1,100 workers and leaving a score of others with varying degrees of injuries. Fifteen days later, in the very same capital of Bangladesh, another eight workers met their death when a fire broke out at night at another garment manufacturing facility. Late last year, on 11 September 2012, a garment factory in Karachi, Pakistan caught fire, killing 289 employees largely due to smoke inhalation, burns and stampede. The fire began as a result of an explosion in the boiler house. Investigations found that: I) all of the factory’s exit doors were locked and many of its windows were covered with iron bars, which made it difficult for workers to escape when the fire broke out. Consequently, many of the deaths were caused by suffoca tion. II) there were deficiencies in fire safety preparedness which had been noted previously but had purportedly been rectified. III) the owner had reportedly prevented inspections of the factory by the authorities. Meanwhile in Lahore, still in Pakistan, at the same time, a shoe factory caught fire, killing 25 employees largely also due to smoke inhalation, burns and stampede. The fire started as a result of sparks from an electric generator installed in the garage of the premises, where chemicals were also kept. The garage served as the workers’ only entry and exit point. In summary, all of the above incidences, which took a large toll on the lives of workers, were preventable. The common denominator in all of these cases is that the regulatory agencies were not only ineffective, but in some cases they were too weak to be felt on the ground. This is the prevailing situation in many developing countries, where many governments focus largely on economic growth without paying attention to the quality of the work environment. The

At one accident scene: House on construction collapsed as the material mixture was poor and no competent workers were undertaking the works.

situation is exacerbated by the high numbers of unemployed persons.

Consequences

The consequences in the above scenarios are far ranging, the immediate being the unnecessary loss of life on such a large scale. Many of those lost may have been the breadwinners for their families, who thus face an unknown and uncertain future. Globally, the financial burden of compensation, healthcare, rehabilitation and disability that stems from workplace accidents is significant. The cost is estimated to be equivalent to 4 per cent of global GDP per annum. For some developing countries, the cost of work-related accidents alone can be as high as 10 per cent of GDP (2). The economic consequences thus directly connected to the above instances are significant and would have been avoided if the governments had put considerable effort into the promotion of prevention and the achievement of a better work environment. This could be done by enabling their respective national regulatory authorities to work more effectively. In one of the scenarios above, the responsible agencies would need to have: I) the proper designs made by competent personnel, such as architects, on the basis of the client’s needs and the loca tion, II) the designs approved by the competent authorities,

III) IV) V)

a developer to engage a competent firm to draw up the bills of quantities for the structure, a qualified construction firm hired to build the structure, the construction of the structure supervised and built according to the specifications of the design.

Inspection agencies in developing countries

It has been observed in many developing countries that the inspection agencies or authorities are poorly equipped, with many lacking the adequate human resources to carry out monitoring inspections effectively. They also lack both the necessary equipment to assist them in conducting inspections using an evidence-based approach and the necessary professional skills development to enable the inspectors to carry out their duties competently in the continuously changing work environment.

Benefits of prevention

It is of great importance to note that the benefits of prevention have been proved beyond reasonable doubt. A study on the costs and benefits of prevention to companies, conducted by the International Social Security Association (2), indicates that there are benefits resulting from investment in occupational safety and health in microeconomic terms, with the results offering a Return on Prevention ratio of 2.2. In practice, this

Afr Newslett on Occup Health and Safety 2013;23:32–34 •

Photo by Barbra Khayongo

means that for every 1 Euro (or any other currency) per employee per year invested by companies in workplace prevention, companies can expect a potential economic return of 2.20 Euros. Prevention measures at the individual level support workers’ well-being and are therefore essential for a healthy and active life. For workers, investment in prevention measures leads to a significant decrease in reported work accidents, fatalities and occupational diseases. The improved health and employability which thereby accrues helps secure stable incomes and improved living conditions for the workforce. For employers, investment in prevention is not only a legal and moral obligation, but it is also good for the success of their businesses and their corporate image. A healthy workforce leads to workers’ increased productivity, which in turn leads to better competitiveness on their respective markets.

The way forward

Work-related accidents and illnesses can and indeed must be prevented. Therefore there is a need for action at all levels – international, national and company levels, respectively. Developing countries need to move a step further and I) enact adequate national legislation on occupational safety and health and pro mote compliance with it by facilitat ing the responsible national authori ties so that they can run effective pre vention programmes, II) provide more and better education and training, with occupational safety and health integrated into both voca tional training courses and enterprise training programmes, III) adopt a positive commitment and en sure that once they have committed themselves, they follow up with the necessary practical measures, IV) build networks and synergies among the regulatory authorities, to promote more effective activities. Industrialized countries, the destination of some of the goods and services, also have a role to play. It is important to note that both the industrialized and the developing countries are party to the Seoul Declaration on Safety and Health at Work, 2008 (3) either directly or indirectly. The declaration proclaims that: “A national preventative safety and

Workers in a steel plant have no proper personal protective equipment.

health culture is one in which the right to a safe and healthy working environment is respected at all levels, where governments, employers and workers actively participate in securing a safe and healthy working environment through a system of defined rights, responsibilities and duties, and where the principle of prevention is accorded the highest priority”, among others, and that: “Governments should: I) Ensure that continued actions are taken to create and enhance a national pre ventative safety and health culture, II) Ensure that the occupational safety and health of workers is protected through an adequate and appropriate system of enforcement of safety and health stand ards, including a strong and effective labour inspection system. Therefore the industrialized countries could play an active role by ensuring that goods or services destined to their countries are produced under conditions which satisfy certain minimum safety standards. Second-

34 • Afr Newslett on Occup Health and Safety 2013;23:32–34

ly, technical support for skills development to enable them address workplace issues more effectively, will go a long way in assisting in the promotion of the preventive safety culture. Employers should take prevention as an integral part of their activities, as high safety and health standards at work go hand in hand with good business performance.”

Conclusion

Developing countries need to embrace a preventive safety and health culture for the benefit of their economies and their labour force. Yusuf Katula Principal General Safety Inspector Occupational Safety and Health Department Ministry of Gender, Labour and Social Development P. O. Box 227 Kampala, UGANDA Email: ykmkat@yahoo.com/ ykmkat@gmail. com

References 1. The Status of Labour Market Information in Uganda, June 2011, p9–10. 2. International Social Security Association, Social Policy Highlight 19: Prevention is good for health and good for business, p. 2–4. 3. Seoul Declaration, 2008 on Safety and Health at Work. http://www.seouldeclaration.org/en/content/download/81/323/version/3/file/Seoul_Declaration_ EN.pdf http://www.ilo.org/wcmsp5/groups/public/@dgreports/@dcomm/documents/statement/ wcms_095910.pdf

Literature Prevention: A Global Strategy, ILO Report for World Day for Safety and Health at Work Geneva, 2005, http://www.ilo.org/legacy/english/protection/safework/worldday/products05/report05_en.pdf

Pius W. Makhonge KENYA

Towards safety prevention culture in Kenya Introduction

There appears to be no single definition of “safety culture”. The term first arose after the investigation into the Chernobyl nuclear disaster in 1986, which led to safety culture being defined as “an organizational atmosphere where health and safety is understood to be, and is accepted as the number one priority”. There is an old saying that ‘accidents do not just happen, they are caused!’ They are caused by the way we do things, so culture as a factor is vital in the causation. This could lead us to ask ourselves a few questions. a) What makes workplace supervisors and managers want to ensure health and safety in the workplace without a gov ernment officer visiting the workplace and directing im provements to be undertaken? b) What makes employees see the need to help manag ers implement measures to create a safer work environ ment and also encourage fellow employees to support safety in the workplace? c) In a nutshell, how can everyone be encouraged to act safely whether someone is watching or not?

Photo by © International Labour Organization / M. Crozet

Factors for promoting occupational safety and health culture

The available literature indicates that there are several factors that play an important role in improving the overall occupational health and safety performance of an organization and also create a good safety culture. Such factors include the following: • Formulation and implementation of a Health and Safety Policy both at national and enterprise levels. The policy is an important tool in directing the way forward on safety and health matters. • Including occupational health and safety programmes in organizational strategic plans which ensure that resources are allocated to safety so that safety matters do not come as afterthought. • Performance measurement to provide information on the extent to which plans were undertaken and for account ability.

Training of workers at all levels on health and safety is very important.

Afr Newslett on Occup Health and Safety 2013;23:35–36 •

Photo by Tom Namasaka

The World Day for Safety and Health at Work commemoration event where best performing institutions and individuals on occupational safety and health practice were awarded certificates.

• Training of workers at all levels on health and safety so that workers have the skills and knowledge to perform their work safely. • Appropriate risk assessments for the purpose of identifying the risks and providing the control measures before work is done. • Reporting and recording of all acci dents, both minor and serious. This provides an opportunity to think about small things that can turn into greater dangers. • A clear communication plan for effec tive transfer of information from man agement to staff and back, as well as horizontal communication between individuals, departments and teams, is important for achieving good health and safety performance. Visible safety posters, safety policy statements, notic es and newsletters describing safety issues and accident statistics demon strate good safety communications. • Self-regulation through regular inter nal audits by management and health and safety committees. This ensures continuous improvement without wait ing for an enforcement officer to direct the necessary improvements. • Involving workers directly and health and safety committees in the improve-

•

ment processes provides a good opportunity for workers’ input and ownership of the safety plan and arrangements. And lastly recognizing and celebrating success through a system of regular rewards is likely to motivate everybody to do even better in safety matters.

In Kenya efforts have been made to include most of the aforementioned factors in the national occupational safety and health legislation. In addition, a national occupational health and safety policy has been formulated and approved by the Cabinet. One key issue addressed in the policy is mainstreaming safety education at all levels of school learning. Once in place it is hoped that it will establish and foster a health and safety culture among the workers of the future early as they grow. To create capacity at a professional level, two universities have started postgraduate training programmes on occupational health and safety . Those trained can be used at national and enterprise levels to promote health and safety in workplaces. Furthermore, the government is in the process of building an institution to provide solutions-oriented research and skills development in occupational health and safety.

36 • Afr Newslett on Occup Health and Safety 2013;23:35–36

Funding for effective development and implementation of occupational safety and health programmes has been a serious challenge to the growth of occupational health and safety. To address this challenge, the government has established an occupational health and safety fund to support the development and implementation of systems for occupational health and safety.

Conclusion

The initiatives outlined above, if adequately implemented and with commitment from all players in the long run, will bring about the desired change in the way occupational health and safety is perceived and the culture of safety at work.

Pius Makhonge Director Ministry of Labour Directorate of Occupational Safety and Health Services P.O. Box 34120 -00100 Nairobi, Kenya

S.T Olowogbon, A.S Akinwande NIGERIA

Safety education – a preventive measure in OH&S: the case of agriculture Introduction

The farm is not just the workplace of most rural dwellers; it is also their home. In addition, farming is not just an occupation for these dwellers but their way of life and source of livelihood. This underscores the importance of a safe farm environment to work and to live. It has been said that; ‘If man knows what is good he would do it’ and ‘how can he know what is good if he is not informed’. In this regard, it has been observed in different quarters and by various agricultural stakeholders that farm safety is yet to be accepted as a core concept that could contribute substantially to the successful running of any farm business. It has also been recognized that where there is no or inadequate knowledge on an issue – in this case farm safety – people will suffer. Knowledge and education should be adapted as a means of promoting the mental well-being and traditions of the various people, conserving as far as possible all sound and healthy elements in the fabric of their social life while advancing well-being. Knowledge can also be adapted where necessary as a tool to change circumstances through the introduction of progressive ideas able to serve as an agent of natural growth and evolution (1). Effective awareness can be evaluated or measured by the level of attitudinal change among farm workers, from poor safety habits to a good and sound safety culture. The need to raise the level of awareness about farm safety was substantiated by the results of my study on the knowledge, attitudes and perceptions about farm safety, conducted among agricultural professionals with at least a secondary-level degree and among farm workers. According to the study, 40% of the agricultural professionals were at an average level on the scale of awareness about occupational health and safety issues in agriculture, while 32% were at a low level and 28% at a very low level.

If the situation is that poor among professionals, what is the fate of the farmers on the field? Among the farmers, about 80% of the respondents had a severe wrist/hand injury and 75% lower back pain, both ailments being workrelated. On average, 63% of the respondents have been unable to do their work as a result of occupational injuries and illness leading to lost time, restricted work cases and fatalities; all of these mean loss of production. In addition, 80% of the respondents do not use any form of personal protective equipment (PPE) due to poor knowledge about the role of PPE. Moreover, 80% of the farmers are not even aware of farm safety concepts and procedures, let alone their application. Inadequate information and lack of awareness together with cost implications were ranked the highest on the list of constraints hindering the adoption of farm safety measures. Thus, on the basis of the study, the dissemination of information on farm safety, a subsidized well-implemented farm safety programme, and a record-keeping and reporting system for farm accidents were recommended (2). Photo by Suvi Lehtinen

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Photo by J. Maillard, © International Labour Organization

Safety and health education to agricultural personnel about hazardous chemicals and other hazards in farm work cannot be overemphasized. Family members as well as children should also be informed and protected.

While there may be variability in the data, based on the economic development of nations, the above study reflects the need for massive global awareness on farm safety.

Ways of creating the required awareness Training agricultural extension workers in farm safety Agricultural extension education in health and safety is a focal issue in disseminating knowledge to farmers about how to reduce occupational injuries, illnesses and fatalities and about the use of knowledge as a tool for improving both the production level and the standard of living in the agricultural sector. Hence, the importance of health and safety extension education in agriculture cannot be overemphasized. There is a need to create awareness about farm health and safety and how it affects or influences the productivity of the sector by training the extension workers. Extension education is an applied behavioural science, the knowledge of which is applied to bring about desirable changes in the behavioural complex of human beings usually through various strategies, programmes of change, by applying the latest scientific and technological innovation (3). Since agricultural extension workers are the closest to these farmers, they are then equipped with the right information on farm safety

for them to be able to deliver efficient information to the end users or target group, who in this case are the farmers.

Integrating farm health and safety into the agricultural curriculum The purpose of health and safety education for agricultural personnel is to enhance awareness about the hazards to which they may be exposed, and ultimately for them to take appropriate action to control the hazards and prevent occupational accidents, intoxication, musculoskeletal disorders, diseases. Prevention reduces lost time due to injuries and restrictions, thereby increasing productivity. The specific learning needs of those engaged in agriculture vary according to the ecological and agricultural patterns of the particular region. Small subsistence farmers have different learning requirements from those of progressive commercial farmers. Educational services for rural areas and developing countries must take note of this. In addition to basic education, rural agricultural dwellers need instructions in simple agrarian technology, particularly in the case of subsistence farmers. Literacy training for adults is essential for them to understand agrarian technology (4). One of the aims of an occupational health and safety programme is to protect workers from accidents in the workplace.

38 • Afr Newslett on Occup Health and Safety 2013;23:37–40

Therefore, safety programmes should include education and training elements. Education and training in this sector are used in the context of acquisition of knowledge and skills. It is usual to consider this as a process involving three stages: the provision of information; a change in the recipients’ attitudes; and the alteration of behaviour. These stages must be kept in mind when considering health and safety education programmes in the agricultural industry (4). The inclusion of farm safety in the education curriculum for agriculture students from the primary level to tertiary institutions would also help in creating the required awareness.

Effective communication on farm safety Communication is a necessary skill for farm safety awareness. An extra effort should be made so that the communication is effective in order for the goals of farm safety to be achieved. For provision of information, the custodian of the information must be competent in conveying the message, with accurate and timely information explained in simple terms, using the appropriate media while also studying the situational and cultural context of the audience. The communication process does not end at that. It proceeds to scrutinizing for attitudinal change in the audience, from poor farm

safety habits to a good farm safety culture, which in turn alters their behaviour. At this point we can say that the communication has been effective, since the goal has been met. This tool is essential for extension workers and big farm organizations with a large workforce. Farm works need this information, and it must be communicated to them. The process is said to be complete if both the sender and the receiver of the message perceive the message in the same way.

Communicator

Audience

Information on farm safety

Training on farm safety, for agroprofessionals

Health and Safety Knowledge

Agricultural professionals

Increased productivity and output

VEA, EA, T & V* Farmers

Increased morale & effiency

Safe working conditions

Healthy workforce

Low sickness absence, few lost time injuries, few restricted work cases and little short term disability.

Attitudinal change and behavioural alternation of farm workers

Figure 1. The funnel blend of the communication process for farm safety.

Figure 2. Farm Health and Safety Extension Education Integration Model and the holistic effect of farm safety information. *Abbreviations: VEA = Village Extension Agent, EA = Extension Agent, T&V = Training & Visit

However, effective communication absolutely requires the consideration of the following factors: * The individuality of the audience * The communicator’s competence in listening and communication skills * Clearly stated goals of communication * Accurate information and the validity of points * The situational and cultural context * The media of delivery * Well-planned method of delivery * Emotional stability and apt gestures

Use of information and communication technology For adequate information and orientation for farmers on health and safety the adoption of information and communication technology (ICT), such as mobile text messaging, email, social networks and other ICT-based measures, would go a long

way in creating the required awareness.

The SMS experiment As reported by Jørs and colleagues in the African Newsletter issue 1 of 2012; SMS messages can be utilized in information dissemination. Three public health students from Copenhagen University and three environmental health students from Makerere University together with the project staff planned the content of the messages and sent them through a telecommunication company to the farmers in Pallisa over a fourteen-day period in February 2012. Seventy farmers filled in a questionnaire both before and after the messages, and four focus group discussions were conducted with the farmers to evaluate the change in their knowledge and awareness, to determine whether they found the messages useful, and to explore how to improve the messages and whether

to continue with the campaign in the future. Some of the participating farmers were trained by the Pesticide-Health-Environment (PHE)-project while others were not. The messages, sent out with an introductory slogan, were: ‘Children are our future – Use boots and other personal protective equipment when handling pesticides to avoid poisoning yourself and to reduce the risk of not being able to have children’. ‘Children are our future – Change your clothes and wash them and yourself after using pesticides to avoid poison etc’. Based on the effectiveness of the method, they concluded that SMS messages can be used to spread health information, as they are taken seriously and they are read and discussed by the farmers, their families and neighbours. However, SMS messages cannot stand alone, due to their limited content; they should be followed up by meetings and discussions in the villages, organized

Afr Newslett on Occup Health and Safety 2013;23:37–40 •

by trained farmers and agricultural extension workers, and by radio programmes that expand on the subjects raised in the messages, and posters (5). Based on this experiment, the use of SMS messages is a welcome development in creating awareness on farm safety .

The use of mass media The use of mass media, such as radio and television programmes on farm safety, would help in creating awareness. Studies have shown that rural dwellers are ardent radio listeners; hence such media could be used in enlightening them on farm safety, since most rural dwellers are farmers.

Well-implemented and formulated occupational policy Incorporating agricultural safety specifically into the national policies, such as the occupational health and safety policy and agricultural policies, would signal the significance and importance of farm safety and its adoption by different stakeholders, for instance farm workers, employers and policy-makers. The stakeholders would also be enlightened better on the consequences of not adopting agricultural safety measures; for example, reduced productivity, increased production losses, increases

in accident cases, decreased morale, fatalities and a bad reputation for farm business.

Social awareness; The social capital approach Social platforms, such as farmers’ cooperating societies, organizations and other social platforms, could be used in creating this awareness. For example, farm safety moments, where a farm safety specialist is invited to present seminars or to talk on some farm safety issues that are of great relevance in the farmers’ contextualized environment, could be included in regular meetings. This could be carried further by holding group discussions ensuring proper assimilation of the concept.

Conclusion

Prevention is better and cheaper than cure. Knowledge and information on farm safety are therefore pivotal to having low sickness absence, few lost time injuries, few restricted work cases, little short-term and long-term disability, and few fatalities in the agricultural sector. There is a need for the massive adoption of all forms of means, method and media in getting the correct and accurate message on farm safety across to the end users in order to

Photo by Trevor Samson /World Bank.

achieve the optimal use and benefits as a preventive measure. Farm safety education is therefore a key preventive measure in OH&S, and the concept should be adopted by the various stakeholders charged with the responsibility of preventing farm-related health and safety challenges. This article is adapted from book; Toyin S. Olowogbon (2013) A Systematic Approach to Health and Safety in Agriculture; a global approach published by LAP LAMBERT Academic Publishing. Heinrich-Böcking-Str. 6-8, 66121, Saarbrücken, Germany, available at www.lap-publishing. com. This article is published with the permission of the publisher. Toyin S. Olowogbon1, Akanmu S. Akinwande2, 1 Occupational Health and Safety Division of Vertext Media ltd, Mokola Ibadan, Nigeria. E-mail: olowogbonsam@yahoo.com

Department of Curriculum Studies Federal College of Education, Okene, Kogi State, Nigeria.

References 1. http://wiki.answers.com/Q/How_is_education_an_agent_for_change 2. Olowogbon ST, Fakayode SB, Jolaiya A, Adenrele AY. ‘‘Economics of farm safety: The Nigerian scenario’’. Journal of Development and Agricultural Economics 2013;5(1):7–11. 3. http://www.krishiworld.com/html/ agri_extension_edu1.html 4. Mostafa A, El Batami. Health of Agricultural Workers in Agriculture: World Health Regional Publication, Eastern Mediterranean Series 25, 2003. 5. Erik Jors, Aggrey Atuhaire, Katia Buch Harvig, Lene Kierkegaard, Majbrit Molgaard Nielsen, [3]Mercy Wanyana, Bernadette Mirembe, Charles Okorimong, Deogratias Sekimpi. Are SMS messages the way forward in spreading health information? Afr Newslett on Occup Health and Safety 2012;22:18–9, Finnish Institute of Occupational Health and Safety.

40 • Afr Newslett on Occup Health and Safety 2013;23:37–40

Prevention of non-communicable diseases at the workplace in Tanzania Introduction

The focus in Tanzania has mainly been on communicable diseases, in particular HIV/AIDS, TB and Malaria. Childhood illnesses, including diarrhoea and upper respiratory tract infections, have also received a great deal of attention. More recently, efforts have been directed towards neglected tropical diseases. However, the burden of communicable diseases is still high, so the increase in non-communicable diseases (NCD) creates a double burden to both individuals and the health system in general. NCDs are becoming more prevalent globally, especially in Sub-Saharan Africa, including Tanzania. WHO (1). estimates that NCDs cause over 36 million deaths each year, 80% of which occur in low and middle-income countries. Cardiovascular diseases account for most NCD deaths (17 million) followed by cancers (7.6 million), respiratory dis-

eases (4.2 million), and diabetes (1.3 million) (2). The prevalence of NCDs and related deaths is expected to grow, with the largest projected increase expected to occur in the African Region by 2020 (3). This is due to socioeconomic transformation, which has raised the level of exposure to NCD risk factors. NCD risk factors include behavioural risk factors: unhealthy diet, excessive alcohol consumption, smoking and low levels of physical activity; and consequent physiological risk factors: raised blood pressure, overweight and obesity, hyperglycemia and hyperlipidemia. NCD risk factors are becoming more prevalent in developing countries such as Tanzania (4). In 2008, WHO (5) reported that in Tanzania NCDs are estimated to cause about 27% of all deaths, with cardiovascular diseases accounting for 12%. Of NCD deaths, over 50%

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Photo by NIMR, Tanzania

Many patients are not aware that they have high blood pressure until it is measured.

occur below the age of 60. The prevalence of raised blood pressure is 39.2%, and overweight and obesity 22%. The burden of NCDs in Tanzania is high both in terms of health care costs and economic loss due to premature mortality and work absenteeism. It is projected that Tanzania will lose about 0.5 billion dollars of its income due to heart disease, stroke and diabetes (6). In Tanzania, a study has shown that working executives were at a higher risk of NCDs, 48% compared to the 10% average of the general population. This difference could be attributed to the work environment, which predisposes to low levels of physical activity and high rates of obesity (7). A recent study carried out among civil servants showed that 58% were either overweight or obese and had low levels of physical activity (a mean of 6000 steps a week) (8). NCDs currently affect people below the age of 60, who constitute the major proportion of the workforce in Tanzania. It is imperative, therefore, that efforts are made to deal with NCDs at the workplace, in order to curb the burden of these diseases.

For many employees in Tanzania, leading a healthy lifestyle may be a challenge for a number of reasons. Normal working hours in Tanzania are from 8am to 4-5 pm, so most of the day is spent at work. This poses the following challenges: unhealthy diet – many employees do not have access to healthy food or snacks at work and are therefore forced to eat what is available, most of which is unhealthy; the price of food – this may deter people from eating healthy lunches and cause them to resort to cheaply available fast foods. Another challenge is the lack of physical activity. Due to heavy traffic, people are forced to leave their homes very early and return late. This means hardly any time is left for exercise. In the civil servant study, 60% of the staff interviewed indicated that they had no time for physical activity. Other barriers to exercise could be environmental; there are no defined routes for pedestrians and cyclists for example, which means people have no incentive to walk or cycle to work. Another shortcoming is that the culture of leisure time physical activity is nonexistent. The study reported that the proportion of respondents engaging in leisure

42 • Afr Newslett on Occup Health and Safety 2013;23:41–43

time physical activity was less than 7% (9). Employees whose work does not involve physical activity are at a greater risk of NCDs. Socio-demographic and economic transition plays a great role in the current rise in NCDs in developing countries. Increased urbanization in developing countries means that people are more at risk because the urban environment exposes them to more risky behaviour. Socioeconomic factors, cultural factors and lay beliefs also further contribute to the current trends in NCDs and further compound poor health behaviour. In addition, as the control of communicable diseases improves, many people survive to old age and are thus more prone to degenerative diseases. With the increasing risk factors for NCDs, there is a need for an immediate response. The majority of these NCDs are preventable through simple lifestyle measures. What we need are cost-effective culturally appropriate interventions to help people maintain a healthy lifestyle. This would include improved city planning to allow people to walk and cycle, should they choose to do so.

The prevention of NCDs at the workplace will require a multisectoral approach. The occupational health law (Occupational Health and Safety Act of 2003) in Tanzania stipulates that each employee undergo a medical examination at enrolment. This could be expanded to include periodic examinations. Employers should push insurance companies to cover such examinations. Other options that could be useful are the HIV committees already in place at workplaces. In Tanzania, the workplace is obliged to have health committees for HIV that co-ordinate HIV prevention activities and the care of HIV positive individuals. These structures could be used to also co-ordinate NCD prevention activities at workplaces. Another option could be to promote physical activity at the workplace through sports competitions, designated sports days or sports bonanzas. Even simple daily exercises carried out before work could be very useful. More advocacy is needed to raise the profile of the burden of NCDs and to bring them to the attention of policy-makers. Below there are recommendations to create a sustainable health-promoting environment and to reduce the burden of NCDs at workplaces.

Primary prevention

Legislation needs to be put in place to control the harmful use of alcohol, for example, and to reduce smoking. Currently in Tanzania it is illegal to drink alcohol or

smoke at workplaces. Responsible marketing of unhealthy foods also needs to be enforced by law. The sale of sugary drinks and fast foods at the workplace, for example, could be restricted. Workplace screening programmes for high-risk individuals and instituting appropriate prevention interventions would also be useful.

Secondary prevention

References 1. WHO Media centre. Factsheet: Noncommunicable diseases. Updated March 2013. http://www.who.int/mediacentre/ factsheets/fs355/en/ 2. Lim AA, Vos T, Flaxmman AD, et al. A comparative risk assessment of burden of disease and injuries attributable to 67 risk factors and risk factor clusters in 21 regions, 1990 to 2010. A systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012;380(0859):2224–60.

There is a need for measures for early detection of NCDs through screening and referral for appropriate care. Proper care is also essential to prevent further complications and reduce the burden due to NCDs. We must take advantage of existing infrastructure, for example, workplace health education and screening interventions for high-risk groups. Resources for the prevention, care and treatment of NCDs must be mobilized. Employees must be given more access to health insurance schemes.

Rehabilitation

Those with disabilities due to workplace injuries and chronic NCDs have rights to social protection, and their employment must be safeguarded.

Mwele Malecela, Mary Mayige National Institute for Medical Research 2448 Barack Obama Rd, Daressalaam Tanzania

3. The global burden of disease: 2004 update. Geneva, World Health Organization. 4. Mayige M, Kagaruki G, Ramaiya K, Swai A. Non communicable diseases in Tanzania: a call for urgent action (2011).Tanzania Journal of Health Research Volume 14, Number 2, April 2012, http://dx.doi. org/10.4314/thrb.v13i5.7 5. World Health Organization, NDC Country Profiles 2011. http://www.who.int/nmh/ countries/tza_en.pdf 6. Preventing Chronic Diseases: A vital Investment: Geneva, World Health Organization. 2005. 7. Policy Implications of Adult Morbidity and Mortality End of Phase One Report, August 1997. 8. IUHPE – International Union for Health Promotion and Education. Physical Activity among civil servants in Government Ministry, Dar es Salaam, Tanzania: Assessment of knowledge, attitude and practice and population based intervention (preliminary report). 2009. http://iuhpe. org/uploaded/Activities/Scientific_Affairs/CDC/CVHP/TANZANIACaseStudyofCVHP.pdf 9. Tanzania National STEPS Survey of NonCommunicable Risk Factors, 2012.

Recommendations for health-promoting workplaces • • • • • • •

Ensure avaibility of facilities for physical activity, such as gyms Create strong leadership for prevention of non-communicable diseases (NCDs) Promote physical activity among employees Encourage use of stairs instead of lifts at workplaces Ensure avaibility of healthy foods, for example fresh fruits and vegetables available at workplace canteens and price measures to make food cheaply available Strong support from management/employers Stakeholder involvement

Afr Newslett on Occup Health and Safety 2013;23:41–43 •

Prevention of chronic diseases

Prevention of child labour New ILO tool steps up fight against child labour The International Labour Office (ILO) has launched a new tool to guide efforts towards the goal of eliminating the worst forms of child labour by 2016. The tool is “Implementing the Roadmap for achieving the elimination of the worst forms of child labour - A training guide for policy makers”. It defines the worst forms of child labour, presents key strategies for their elimination, outlines recommended actions for governments, employers’, workers’ and other civil society organizations and addresses monitoring and evaluation as an essential feature of successful action plans. This guide is both a training tool and a stepping-stone towards the drafting or revision of a National Action Plan (NAP) against the worst forms of child labour. Contact International Programme on the Elimination of the Child Labour IPEC www.ilo.org/ipec E-mail: ipec@ilo.org

Chronic diseases, such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes, are by far the leading cause of mortality in the world, representing 60% of all deaths. Out of the 35 million people who died from chronic disease in 2005, half were under 70 and half were women. This invisible epidemic is an under-appreciated cause of poverty and hinders the economic development of many countries. Contrary to common perception, 80% of chronic disease deaths occur in low and middle income countries.

Healthy Workplaces campaign

Chronic diseases and health promotion World Health Organization Avenue Appia 20 CH-1211 Geneva Switzerland chronicdiseases@who.int

Working together for risk prevention

Noncommunicable diseases

Find useful information on webside: www.healthy-workplaces.eu

The Global Status Report on Noncommunicable Diseases 2010 is the first report on the worldwide epidemic of cardiovascular diseases, cancer, diabetes and chronic respiratory diseases, along with their risk factors and determinants. See material on Internet: http://www.who.int/chp/en/

European Weeks for Safety and Health at work in October 2012 and 2013

Central to the Healthy Workplaces Campaign is the provision of resources to help employers, workers and other stakeholders to improve occupational safety and health. Check out our case studies, publications, practical tools along with campaign and promotional materials. • Case studies • Publications • Preventive solutions checklists for construction, health care and Horeca sectors (hotels, restaurants, catering) • Practical tools • Online interactive Risk Assessment (OiRA) • Campaign essentials • Promotion materials • Napo film • Online Campaign toolkit European Agency for Safety and Health at Work Gran Via 33, 48009 Bilbao, Spain E-mail: information@osha.europa.eu

44 • Afr Newslett on Occup Health and Safety 2013;23:44

International Conference on Monitoring and Surveillance of Asbestos-Related Diseases 2014 11-13 February 2014 Hanasaari Cultural Center Espoo, Finland The Finnish Institute of Occupational Health is organizing the conference in collaboration with the International Commission on Occupational Health, ICOH. The Conference will deal with the most recent research results and the current views of leading experts on asbestos exposure monitoring, diagnostics and early detection of asbestos-related diseases (ARDs). The main themes of the Conference are: • Exposure monitoring • ARDs – mechanisms and causation • Epidemiology and trends of ARDs • Health surveillance, biomarkers and diagnostic tools • Screening of asbestos-related lung cancer • Asbestos exposure in asbestos removal work The Conference is open to everyone interested in prevention of asbestos exposure and asbestos-related diseases. It aims at bringing together occupational health and safety experts and scientists, occupational hygienists, public health managers, decision-makers, and insurance experts. Deadline for abstract submission 15 October 2013 Deadline for early registration 15 December 2013 More information on the conference, abstract submission and registration on the website www.ttl.fi/helsinkiasbestos2014 Contact information Helsinki Asbestos 2014 Secretariat Finnish Institute of Occupational Health E-mail: helsinkiasbestos2014@ttl.fi Conference Office TAVI Congress Bureau Email: helsinkiasbestos2014@tavicon.fi

Sharing a Vision for Sustainable Prevention XX World Congress on Safety and Health at Work 2014 Global Forum for Prevention 24-27 August 2014 Frankfurt, Germany The World Congress 2014 offers a platform for the exchange of information and opinion to experts in safety and health, representatives of companies and employees, decisionmakers from government and public authorities, the social partners, and anyone active in the area of occupational safety and health. Political fora, specialist events and workshops provide an opportunity to pool experience, to co-operate on specific issues, and to present best-practice examples. The three main topics are: Prevention Culture – Prevention Strategies – “Vision Zero” Challenges in Occupational Health Diversity in the World of Work Deadline for receipt of abstracts is 30 November 2013. Deadline for early bird register by 15 December 2013. The Organizers International Labour Organization (ILO) International Social Security Association (ISSA) German Social Accident Insurance (DGUV) Contact German Social Accident Insurance (DGUV) “XX World Congress on Safety and Health at Work 2014 Global Forum for Prevention” Alte Heerstrasse 111 53757 Sankt Augustin, Germany E-mail: safety2014germany@dguv.de Registration and information: www.safety2014germany.com

Afr Newslett on Occup Health and Safety 2013;23:45 •

Suvi Lehtinen, Finland

Photo by Sami Perttilä

8. Global Conference on Health Promotion Health promotion is crucial to us all, including the 3.2 billion working people of the world. This topic with all its aspects was discussed in detail on 10−14 June 2013 in Helsinki, Finland. The 8th Global Conference on Health Promotion was organized by the World Health Organization (WHO) in collaboration with the Finnish Ministry of Social Affairs and Health, the National Institute of Health and Welfare, and the Finnish Institute of Occupational Health. Mr. Sauli Niinistö, President of the Republic of Finland, opened the 8th Global Conference, by emphasizing that people’s health and well-being are of the utmost importance for all nations. Health is a pivotal precondition for achieving many other goals in our societies. Yet we need to remember that health is also an essential value in its own right. Health also forms a central area of public policy-making. Good public health does not simply include hospitals 46 • Afr Newslett on Occup Health and Safety 2013;23:46–47

and a functioning health system. In addition to these, it requires the prevention of diseases and active promotion of well-being. Mr. Niinistö concluded his opening remarks by saying that the role of the World Health Organization in advancing health continues to be of central importance. Dr. Margaret Chan, Director General of WHO, reminded us of the importance of consistent long-term commitment to health, despite many deviating and even conflicting interests. She also emphasized that decisions related to health are often made outside the health sector. Professor Mwele Malecela, Director General, National Institute for Medical Research, United Republic of Tanzania, described the activities of the IANPHI Network. She emphasized the role of the National Public Health Institutes in implementing health promotion activities, involving communities to contribute to the work. She also described the

Photos by Sami Perttilä

Nearly 900 delegates from all over the world discussed during five days how political decisions on health are implemented into practical actions.

positive effects and impacts that a joint network can have for stimulating development in the countries. Learning from neighbours and sharing information form the cornerstones of a global network. Dr. Kimmo Leppo, one of the founding fathers of the health promotion movements, was awarded the Citation for Lifetime Achievement in Health Promotion. Dr Leppo, who is former Director General of the Health Department at the Ministry of Social Affairs and Health in Finland, has held several key positions in Finnish health planning. “It almost seems that whenever something important was happening in health policy, whether at national, regional or global level, Kimmo Leppo was there,” says Zsuzsanna Jakab, Director of the WHO Regional Office for Europe. Kimmo Leppo expressed his gratitude at the award ceremony on Thursday. “This Citation is a great honour and I accept it with gratitude and humility. I have been

lucky to always work with excellent teams over the decades.” “One thing I have learnt in the course of my working life, particularly in health promotion, is the importance of combining different perspectives in order to understand issues, work out solutions and manage policy processes,” Dr. Leppo concluded.

Further information on the presentations of the 8th Global Conference on Health Promotion http://www.healthpromotion2013.org and the book Health in All Policies is available as a full text at: http://www.hiap2013.com/?page_id=17

Afr Newslett on Occup Health and Safety 2013;23:46–47 •

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 Safety and Health Services P.O. Box 34120-00100 Nairobi KENYA The Director Occupational Safety and Healh Private Bag 344 Lilongwe MALAWI

IC ECOL A

BE L

H. Ali El Sherif Chief Medical Officer Occupational Health Service Ministry of Health and Social Services P/Bag 13198 Windhoek Namibia

441 763 Printed matter

SLY-Lehtipainot OY, Kirjapaino Uusimaa, Porvoo

as of 1 January 2013 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 Kebreab Zemer Ghebremedhin Ministry of Labour and Human Welfare Department of Labour P.O. Box 5252 Asmara ERITREA

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 Safety and Health Ministry of Labour, Industrial Relations & Employment 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 Geneva, SWITZERLAND Evelyn Kortum Technical Officer Occupational Health Interventions for Healthy Environments Department of Public Health and Environment World Health Organization Geneva, SWITZERLAND Jorma Rantanen Past President of ICOH ICOH International Commission on Occupational Health Harri Vainio Director General Finnish Institute of Occupational Health FINLAND