Medical standards and worldwide

acceptance of seafarer health certificates

Tim Carter

Norwegian Centre for Maritime Medicine

UK Maritime and Coastguard Agency

International Maritime Health Association

Who determines seafarer

medical standards?

ILO/IMO – international conventions

National maritime/health authorities aligned with national practices/laws and international conventions – output statutory certificate of fitness.

Employers/ P&I clubs – non-statutory standards as part of selection for employment.

Why are there two parallel systems?

What is the purpose of

standards?

Statutory – safeguard maritime safety and minimise risk to individuals. Detail endorsed in political process involving social partners.

Employer – as statutory + reducing costs of illness at sea, repatriation and compensation. Set unilaterally by employers,insurers.

What may standards cover?

The conduct of the examination – valid, consistent, fair, ethical, economical.

The criteria for specific impairments and medical conditions.

The process of taking decisions on fitness.

The issue of a certificate of fitness.

Appeal arrangements.

Perspectives (maritime health)

Procedures and protocols of International Agencies (ILO, IMO,WHO)

Governments (maritime – national and open register, health, social security)

Employers, agents, insurers etc.(HR, crewing, design, supply , P and I)

Seafarers, trade unions etc.(working conditions, equity, members benefits, claims)

Subject experts (risks, remedies – evidence, effectiveness)

Professional bodies (good practice – jobs, income, status)

Drivers for international

action Move from national to global crewing,

management, sourcing (fitness, repatriation)

Move from integrated owners/employers to contract management (less recruitment for defined careers, QA needs)

Inequities in risk and working conditions (‘good and bad’ flags)

Inefficiencies in current arrangements (duplication – certification, costs of poor decisions)

Fairer basis for international competition ( less variation in crewing costs, social security needs)

Building on the past

National arrangements – traditional maritime nations and newer ones. ‘Protected’ and global flags

Previous ILO, IMO, WHO initiatives

Attitudes of employers, unions and governments to health of seafarers and its regulation

Place of and trust in health advisers

Maritime health - scope

Fitness to work at sea – maritime safety, personal ‘risk’, corporate financial risk.

Managing medical emergencies at sea Onshore care, rehabilitation and repatriation Health education and promotion – personal,

environmental Safe and healthy working conditions Passenger risks Infections and spread At interface of ILO, IMO and WHO

IMO approach

STCW revisions. Sight and hearing +physical capability (1995 on). General criteria for fitness added (2012). Reluctance to accept mandatory capability criteria, acceptance for vision.

STCW about issue of certificates – dominance of these as communication mechanism

Did not wish to be involved in 1997 ILO/WHO Guidelines on medical examinations. Now participating in revisions.

IMO key text

STCW 2012 A-1/9 Vision (standards) Physical capability (recommendations) Hearing and speech (recommendations) No impairing medical condition No medical condition aggravated,

leading to unfitness or risk to others No impairing medication Procedures for examination and certification

ILO approach

MLC consolidated many earlier conventions. Parallel convention on fishing

Health scattered through MLC: certificates, medical care on board, care and repatriation, working and living conditions (weak on smoking, diet)

Social security issues: keep the doctors out!

Leading role in supporting guideline development 1997 and now.

ILO key text

MLC 1.2 medical certificate procedures

Hearing and sight

No medical condition aggravated, leading to unfitness or risk to others

MLC 2.5 medical repatriation

MLC 3.1 – 2 accommodation, food

MLC 4.1 – Medical care aboard

MLC 4.3 – occupational health and safety

Developing good practice –

medical examination guidelines

Text from MLC and STCW 2012 as basis.

Shortcomings of 1997 Guidelines

Experience of authorities and others

IMHA w.g. on medical fitness criteria

Special Adviser to ILO developed draft text

Working group to review and modify – 2 meetings 2010 and 2011.

Co-ordinated endorsement by ILO and IMO now in progress.

Users of Guidelines

Maritime Authorities in preparing national regulations

Maritime Authorities in adopting text as national law.

Examining doctors as issuers of certificates

Will they make for more acceptance of certificates internationally and by employers? Text + application in practice.

Supporting initiative – QA of examiners, additional professional guidance, training for examiners, ethical framework.

Conventions, Guidelines and

mutual acceptance of

certificates. Anticipate agreed international medical examination

framework that is detailed enough to be adopted unchanged by flag states. National laws that comply with conventions are the basis for certificate issue.

If framework used then barriers to free movement of seafarers reduced- provided states, employers and seafarers accept the advantages of a common and well founded basis for certificate issue.

Less chance of either unjustified discrimination or of preventable illness and accidents at sea.

Savings in time and cost.

Better basis for decision-taking by maritime health providers.

Barriers to mutual

acceptance

Inertia of maritime authorities

Maintaining advantage for nationals

Links to national social security

Lack of interest by ship operators who have their own PEME arrangements.

Lack of international quality assurance for conduct of examinations and certificate issue.