BOHS in Transitional Economy

Dr. Sunil Kumar JoshiMD, MPhil (Occup. Medicine), PhD (Public Health), PG Dip Diabetology

Professor of Community MedicineKathmandu Medical CollegeEmail: drsunilkj@gmail.comBOHS in Transitional Economy: Nepal ExperienceToday I would like to talk about basic occupational health services in transitional economy in the context of Nepal. 1Political Transition in NepalUp until 1990, Nepal was a monarchy under executive control of the King.The movement in April 2006 brought a change in the nation's governance: an interim constitution was promulgated, with the King giving up powerIn December 2007, the interim parliament passed a bill making Nepal a federal republic, with a president as head of state and monarchy was abolished.King left Royal Palace on 11 June 2008 and lived as a general public.Nepal has undergone major political transition in the last two decades from Kingdom of Nepal to Federal Republic of Nepal. From the powerful king to constitutional monarchy and then to Ceremonial President and Executive Prime Minister.

During the same period major economic transition has also taken place in Nepal.Privatization of major state owned industries has taken place similarly, nepal has signed Bilateral Investment Promotion Agreement (BIPA) with the neighboring countriesPromotion of Energy based industriesPromotion of 2012/2013 as year of foreign investment2Post Democracy OSH Related Policies in NepalLabour Act 1992, Labour Regulation 1993, Labour and Employment Policy 2005,No separate act on Occupational Safety and Health (OSH) yetNational Health Program: Essential Health Care Services on Occupational Health These are the Post Democracy major legislations related with the occupational safety and health in Nepal. Labour act and labour legislations address the OSH issues at workplace to some extent. These legislations say that OSH at work is the responsibility of the employer, they are more right based approach than the evidence based. They lack proper implementation steps. Labour policy 2005 encompasses the basic OSH issues that need to be addressed in future legislations.NHP, EHCS on OH has mentioned about prevention of occupational diseases like NIHL, eye and skin problems, cancers and injuries. It says that nurses from the district hospitals should visit the industries and give health education. But it also lacks in proper implementation strategy. The country dos not have any national policy, strategy, and plan of action on OHS, and for prevention of ODs and injuries.

3ILO Conventions EndorsedNepal has endorsed all together 11 ILO ConventionsNepal has not yet ratified ILO Conventions No. 155 on Occupational Safety and Health, 161 on Occupational Health Services, 187 on Promotional Framework for Occupational Safety and HealthThough nepal has signed 11 ILO Conventions it is not signatory to major ILO Conventions related with OSH management, such as conventions no. 155. 161, 187 etc.4Why BOHS Economic structures and conditions of work have changed substantially in each workplace The workplaces are more unstable and the jobs have become more precarious and temporaryBig industries are doing well with occupational health services (OHS)Main concerns are SME, SSE, House Hold Enterprises and informal sectorsWhy do we need basic occupational health services in nepal? Most of the major industries in nepal has been privatised. Due to economic hardships, many industries are fragmented and small scale and informal sectors are on rise. Similarly, many small scale enterprises have combined and formed a single enterprise.The workplaces have become more unstable and the jobs have become more precarious and temporaryMain concerns are SME, SSE, House Hold Enterprises and informal sectors that are not only are hazardous to the workers and their family also posses danger to the surroundings.Let us look at few photographs of SSE, HH and IS that show the glimpses of hazardous work environment in nepal.

5Some Photos on OSH in Small Scale Enterprises and Informal Sectors in Nepal

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15Policy Implications and OHSThe Labour Act of Nepal ensures the provision of: First aid facility in industrial enterprises with more than 50 employees, Academically trained medical assistant in the case of industrial enterprises with more than 400 workers,A medical doctor and a medical assistant if an industrial enterprise has more than 1,000 employees. Occupational diseases are required to be reported, but the mechanism is not clearLET us look at some OHS policies and its implication on OCC H SERVICE in nepal.3 slidesAny industrial enterprise with less than 50 employees does not require any OHS facility. First aid facility should be there in industrial enterprises with more than 50 employees, A clinic with academically trained medical assistant (nurse or a health assistant) in the case of industrial enterprises with more than 400 workers,A medical doctor and a medical assistant if an industrial enterprise has more than 1,000 employees. Occupational diseases are required to be reported, but the mechanism is not clear

16Policy Implications and OHSEssential Health Care Services on Occupational Health mention briefly about the interventions required to improve workers' health in term of Chronic Respiratory Disease, Accident, Cancers, Eye and Skin Diseases, Hearing Loss, No specific policy, strategy and plan of action are developed by the Ministry of Health, neither, it has identified the appropriate focal point for Worker's health

17Policy Implications and OHSCompensation for injuries: accident insurance is required in accident prone industries such as construction, transport, hotel, travel, trekking, adventure, rafting, jungle safari and other enterprisesInformal sectors are not included in this scheme

In case of any WR injury, treatment cost will be provided by the insurance plus full salary during hospital admission and treatment. After discharge, 75% salary will be given for three months. Afterwards, no salary. In case of full or partial disability, certain compensation based on labour regulations provided to the workers.

Informal sectors are not included in this scheme18Obstacles in BOHS PracticesNationLack of adequate qualified and skilled manpower Lack of National strategy for BOHS ManagementLack of commitment, effort & less attention from concern authorities (Government, WHO, ILO)Lack of legal back up mechanisms (ILO Convention C155, C161)Though BOHS are well in practice in some private enterprises with international certifications, it is still not in practice in majority of other enterprises. Here are some of the obstacles in BOHS practices in Nepal.

NationLack of adequate qualified and skilled manpower Lack of National strategy for BOHS ManagementLack of commitment, effort & less attention from concern authorities (Government, WHO, ILO). OSH is not their priority in nepal.Lack of legal back up mechanisms (Since nepal is not signatory to ILO Convention C155, C161, it is not obliged to follow international principle of OSH and OHS )Lack of focal point at government ministries19Obstacles in BOHS PracticesEmployersIsolation and overlooking of BOSH issues by formal and informal sectors/ given low priority Poor institutionalization, lack of ripple effect of good OHS practices in some industriesLack of awareness, commitment and effort

Employers are also not well aware of BOHS. THEY feel that it is just unnecessary expenditure. EmployersIsolation and overlooking of BOSH issues by formal and informal sectors/ given low priority Poor institutionalization, lack of ripple effect of good OHS practices in some industriesLack of awareness, commitment and effort

20Obstacles in BOHS PracticesEmployeesThe labour forces are guided by their political affiliations, lack effective coordination and unity on OHS issues. The workers have still been collectively bargaining for issues relating to minimum wages, equal remuneration etc. thereby, overshadowing issues pertaining to OHS.EmployeesThe labour unions in nepal are guided by their political affiliations, lack effective coordination and unity on OHS issues. The workers are still more concern about power struggle, issues like minimum wages, equal remuneration etc. and OHS issues are their less priority.

21BOHS OpportunitiesOSH issues are considered as an integral part of workers rightDifferent stakeholders have realised the importance of OHS for better health of the workersInternational donors stipulates for stringent OHS provision in the multi national projects.

Though the present legislations and approach of the state, employers and the employees are not in favour of OHS, there is good opportunities for BOHS in nepal in future because:OSH issues are considered as an integral part of workers right in the upcoming constitution of nepalDifferent stakeholders have realised the importance of OHS for better health of the workers. EXAMPLE OF OSHP TRAININGInternational donors stipulates for stringent OHS provision in the multi national projects.

22 Models of BOHS ProvisionHigh priority modelsPrimary health care model: Primary health centres, health posts and sub health posts as starting level OHS to ensure the availability of Occupational Health services to all people specifically living in rural, remote area, poor and disadvantaged population Train the auxiliary health workers on basic occupational health, accident and occupational diseases prevention and management of basic ill health and referral systemWorld Health Organization22 July, 201523Develop the primary health care and district level hospitals Models of BOHS ProvisionHigh priority modelsDistrict hospitals: as an unit of Basic Occupational Health Services; a doctor and a nurse from a specific department to undergo a short training on occupational health.EHCS: District hospitals should provide care to the workers

World Health Organization22 July, 201524 Models of BOHS ProvisionHigh priority modelsTertiary Level Teaching Hospital : as an International Standard Occupational Health Service CentreBPKIHS, a Tertiary Level Teaching Hospital in Eastern Nepal has taken that initiative.

World Health Organization22 July, 201525 Models of BOHS ProvisionOHSCompanyOHSOther ModelsBig Company ModelGroup services

Social security modelPrivate physician Private health centre

26BOHS Improvement Strategy Political CommitmentLegislationsLeadership Role, Responsibility & AccountabilityInformation, Education & Communication MonitoringReporting 27Effective BOHS Promotional Strategy Safe & Healthy Work environment Government Employer & Employer Federation Employee & Trade unionDonors Policy formation Standard set upTechnical & financial assistance Implementation of BOHSCatalyst for implementation Cooperation on Program Technical & Financial Assistance Cooperation at workplaceCatalyst for implementation28For the promotion of BOHS, there should be effective partnership between major stakeholders like government, employers and their federation, employee and trade unions and donors. That will lead to safe and healthy work environment.My GoalsOccupational Safety and Health international network buildingPressure building at local, national and regional levelProper implementation of existing legislationsNational Policy Development on Occupational Health Services/BOHS implementationCapacity building MY GOALSOccupational Safety and Health international network building through ICOH and other OHAs like IAOH etc. is important for promotion of OH and pressure building at local, national and regional levelProper implementation of existing legislationsNational Policy Development on Occupational Health Services/BOHS implementationCapacity building

29Few Photos on OSH Awareness Arising and Capacity Building Activities in Nepal

We have been conducting regular activities in nepal to create awareness on OSH AND also capacity building.31

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Thank You37