FINAL REPORT

Reporting organisation Finnish Institute of Occupational Health/ Ms. Suvi Lehtinen (Project Manager)

Project ID in the NDPHS Database and hyperlink to the project

NDPHS Pipeline ID: 83 URL: http://www.ndphs.org/?database,view,project,1178

Title of the project

Developing the National OSH System and Improving Health and Preventing Accidents in the High-risk Sectors in North-West Russia

Project period: 1 Jan 2009 - 31 Dec 2009

MSAH grant agreement: STM/2640/2009 dated 12 March 2009

Ministry for Foreign Affairs grant agreement:

HEL8193-35

Rapporteurs: Suvi Lehtinen, Timo Leino, Seppo Olkkonen, Kari Kurppa, Taina Pääkkönen

Contents:

FINAL REPORT ................................................................................................................................1 1. Analysis of the project environment .........................................................................................................2 2. Project performance .................................................................................................................................2 3. Impact assessment.................................................................................................................................10 4. Project in relation to stakeholders / local reform processes / objectives of the NDPHS........................11 5. Sustainability factors and to which extent they are ensured ..................................................................11 6. Risks & critical factors ............................................................................................................................12 7. Recommendations for future projects and programmes (lessons learned) ...........................................12

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Executive Summary

1. Analysis of the project environment Although the Project was aimed at improving the occupational health and safety situation in the North-West region of the Russian Federation, it was also intended to provide the members of the Baltic Sea Network on Occupational Health and Safety (BSN) with practical experience and models that can be used in each member country after adapting the models into the local circumstances and culture. The Project is intended to provide opportunities for the North-West Russian occupational health and safety organizations to benefit from the OH&S expertise and knowledge of the international level (ILO, WHO, ICOH), the Baltic Sea region level, as well as the Finnish national experience when developing the Russian occupational health and safety system and infrastructure. Also, the Project launched the implementation of the NDPHS Strategy on Health at Work (http://www.ndphs.org///documents/779/NDPHS_Strategy_on_Health_at_Work.pdf) in Russia, and through this provided experience for the NDPHS to improve the implementation of the strategy in other member countries, and also to further develop the strategy and the work of the SIHLWA/OSH group of the Northern Dimension Partnership in Public Health and Social Well-being. The project has been granted (in 2008) funds that were used to launch the project activities in 2008, and a part of the remaining funds were requested to be transferred to 2010 for completing the planned project activities. The Pipeline funding was only available for 1 Jan to 31 Dec 2009 and therefore mainly used for covering the costs of the project activities in 2009.

2. Project performance The elements of the Project have proceeded mainly according to the plans. There have been some delays, because of many acceptable reasons. The interest of the experts on both sides has been good, which promises long-term commitment for improving occupational health and safety in North-West Russia. The five project elements were planned as follows:

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2.1 Project Objectives 2.1.1 Two to three (2–3) regional Occupational Safety and Health (OSH) profiles, (Leningrad Oblast, Murmansk, Republic of Karelia) The ILO Convention No. 187 of 2006 urges and encourages the countries to develop the OSH system of the country by preparing a national OSH profile which is expected to reveal the strengths in occupational health and safety, as well as point out to factors that need to be further developed. The aim was to prepare regional profiles that may in the long run lead to a national OSH profile of the Russian Federation. The profiles describe the current status of OSH and recognize and identify gaps and needs for development. The aim of this component was to contribute to the preparation of two to three regional profiles and learn about the process as well as about the occupational health and safety situation in the regions, described in a systematic way. 2.1.2 Support for preparation of a Regional OSH Programme The ILO Convention No. 187 on Promotional Framework provides a stepwise development cycle for improving occupational safety and health in the countries. According to the Convention, a national OSH profile provides a description of the status of OSH in a country or a region, and identifies the needs for development. It also provides background information needed for the preparation of a national OSH programme. The aim of the regional and national OSH programme is to provide a framework on how to arrange occupational health services, prevent accidents and illnesses due to work environment, and ensure the promotion of work ability of all working people. The support for preparing a regional OSH programme for Karelia has been delayed due to the delays in making the regional profile. 2.1.3 BOHS-project for the development of occupational health services The ILO Convention No. 161 on Occupational Health Services was endorsed by the International Labour Conference in 1985. It has been in force for 25 years, but still a large part of the working population in all countries is without access to competent occupational health services. Within the World Health Organization (WHO), ILO (International Labour Office) and International Commission on Occupational Health (ICOH), a novel approach of Basic Occupational Health Services was launched in December 2003. This approach was recommended by the 13th ILO/WHO Joint Committee on Occupational Health, held in December 2003 (http://www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---safework/documents/publication/wcms_110478.pdf). Since then, it has been tested and piloted in several parts of the world. BOHS principles

• Available to all working people • Addressing to local needs • Adapted to local conditions • Affordable to providers and clients • Organized by the employer for employees • Provided by the public sector for the self-employed and the informal sector • Supported by intermediate level services

In the BOHS approach, occupational health services are developed in a stepwise manner

• Stage I. Starting level If no services are available, this is a starting point. The content of the service focuses on accident risks, heavy physical work, basic sanitation and hygiene, and on the most

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hazardous chemical, physical and biological factors. Advising the client to seek help from expert services constitutes an important part of the service.

• Stage II. Basic Occupational Health Services (BOHS) This is the infrastructure-based service working as close as possible to the workplaces and communities. The service provision model may vary depending on the local circumstances and needs (see page 17). The personnel, usually a physician and a nurse, have a short training (some 10 weeks) in occupational health. They would benefit from the support of a safety expert who is competent in accident prevention and basic safety. The content of services is described in this leaflet and the associated practical guides (toolboxes).

• Stage III. International Standard Service This level is the minimum objective for each country as stipulated by the ILO Convention No. 161. The service infrastructure has several optional forms and the content is primarily preventive, although also curative services may be appropriately provided. The service staff should be led by a specially trained expert (usually an occupational health physician) and the team should preferably be multidisciplinary or the multidisciplinary content of the service should be ensured with appropriate support services from specialized units (such as an institute of occupational health).

• Stage IV. Comprehensive Occupational Health Services (COHS) This level is usually found in the big companies of industrialized countries or it may be provided by large OHS centres providing services for high numbers of various types of client companies. The staff works as a multidisciplinary team often including several specialists like specialist physician, occupational health nurse, occupational hygienist, ergonomist, psychologist, safety engineer, etc. The content of services is comprehensive covering prevention, curative services, health promotion, promotion of work ability, and development of healthy work organizations. The Stages I and II are primarily designed for the smallest and micro-enterprises, the self-employed and the informal sector which have no possibilities to start immediately from the International Standard level three. Big industries and well organized SMEs should, however, always start to establish the level three services and that level should be the minimum objective for each country and each workplace in the long term as stipulated by the ILO Conventions Nos. 161 and 155.

BOHS as a part of the national health infrastructure has been described as follows: The overall national system for health services and for occupational safety and health determines the organizational form of the BOHS infrastructure system. BOHS are a part of that interaction either organizationally or functionally. For example, the role of the health administrator becomes more prominent if the occupational health services belong to the Ministry of Health. The key issue is not the form but the availability and functionality of the system so that the health and safety needs of working people in all sectors and every workplace are adequately addressed. The infrastructure of BOHS has the following characteristics:

1. Constitutes a part of integrated infrastructure for health and safety 2. Can be carried out by several types of service units 3. Collaborates with and takes support from primary health care 4. Collaborates with safety services 5. Specially tuned to serve the small and underserved workplaces

Source: http://www.ttl.fi/BOHS

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2.1.4 Risk assessment and risk reduction Mechanisms for more effective implementation of existing legislations, including occupational safety and health inspection, and provision of occupational health services for all, should be developed by starting from sectors of the highest risks and most urgent needs. This aim has been strived for by supporting the preparation of a Situation Analysis on Occupational Health and Safety in the Transport Sector in Russia, which includes summaries on labour force demography, structure of industry (enterprises by size, ownership, etc.), actors, occupational health services, risks, health parameters, attitudes, etc. The work is well under way, but a few challenges for collecting some statistical data needed for the profile have also been faced. 2.1.5 Information and communication Information is a cornerstone in the development of occupational health and safety. Therefore, one component of the North-West Russia project is information and awareness raising. It is also of the utmost importance that we do not need to produce the information materials over and over again, but we can utilize the existing information materials as easily as possible. 2.2 Results and impacts achieved 2.2.1 Component I. Preparation of National OSH Profiles The Leningrad Oblast profile has been prepared in cooperation with the Committee for Labour and Employment of Population of the Leningrad Region and the Sub-regional Office of International Labour Organization for Eastern Europe and Central Asia. The Finnish Institute of Occupational Health has supported the preparation of the profile with consultation and information to the occupational health component. The Leningrad Oblast profile is available in Russian and English. The Murmansk OSH profile is currently available only in Russian. The Karelian OSH profile is being made by the Ministry of Labour of the Republic and will be published in the first quarter of 2010 after approval by the Tripartite Committee of Labour. The preparation of OSH profiles has been based on the contracts between the OSH organizations and the ILO Office in Moscow. The input of the Finnish Institute of Occupational Health has been to support the inclusion of occupational health indicators and contents, and to provide expert consultancy on those issues in particular. The co-operation with the ILO Moscow Office in the profile work has proceeded smoothly.

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In order to provide information about the development of occupational health and safety in Finland and to demonstrate practical examples, the first study visit was arranged on 14–18 June 2009 in Helsinki and Tampere for a group of five (5) Russian experts. The second study visit intended for autumn 2009 has been postponed due to scheduling problems. The second visit has been considered to be arranged in autumn 2010, if funds are available. 2.2.2 Component II. Preparation of the National OSH Programme This element and the outcome depend on the regional profiles to be made. The preparation of the profiles has taken some more time than planned and therefore the support for drafting of the regional programme is delayed until 2010, if funds are available. 2.2.3 Component III. Providing Basic Occupational Health Services The BOHS guideline was translated into Russian already earlier by two various organizations. There were some differences in the two translations, and they were compared. The guideline was finalized, edited and published in 2009. In addition to the basic guideline, two brief guides have been published in English. BOHS 2: Surveillance of the Work Environment and BOHS 5 on Risk Assessment. These will be translated into Russian later on. A symposium on development of occupational health services was organized on 27–29 May 2008 in Moscow together with the Federal Ministry of Health and Social Development (funded by the previous 2008 project). The purpose of the meeting was to examine the feasibility of the Basic Occupational Health Services approach in the Russian Federation. The meeting gathered a total of 60 experts to discuss the occupational health service situation in the country. The representatives of the Federal Ministry were positive towards carrying out a feasibility study, e.g. in the Republic of Karelia, if found appropriate. The WHO Regional Office for Europe and the ILO Moscow Office were also involved in the implementation of the Symposium. (Summary Report)

In order to examine the feasibility of Basic Occupational Health Services in the Republic of Karelia, a joint symposium was organized on 17–18 December 2009. The joint symposium was attended by both the Ministry of Health and Social Development and the Ministry of Labour. This is extremely important for the practical collaboration to proceed smoothly in practice. The Symposium comprised three specific topics: BOHS, OSH profiles, and follow-up of the results of the Inter-Reg project carried out in 2003–2005. One session was entirely devoted to discussing the concept and approach of Basic Occupational Health Services. A SWOT analysis was made on occupational health and safety in the Republic of Karelia. It was agreed that when examining the feasibility of Basic Occupational Health Services, the Ministry of Labour would contact workplaces that could serve as pilot companies. The involvement of workplaces should be done on a voluntary basis. In addition to regional OSH profiles, also two presentations were heard about the sectoral profiles in road transport in St. Petersburg and in Finland. The symposium was very interactive in nature, and all the presentations were followed by intensive and informative of discussion. The

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excellent interpreters contributed to the success of the symposium. The proposal for the way forward is now being discussed in the Ministry of Health of Karelia. A proposal on how to continue the practical collaboration is being prepared. This element strongly contributes also to the implementation of the WHO Global Plan of Action on Workers Health, Objective 3. (Summary Report) The Symposium was attended by 25 experts from Karelia and Finland.

• A Symposium at the federal level organized • New updated Basic guideline on BOHS in Russian • A SWOT analysis on occupational health services in the RF • Articles written on occupational health services in the Barents Newsletter 3/2009 • Joint Symposium in Petrozavodsk, Republic of Karelia to discuss the feasibility of BOHS • A SWOT analysis on occupational health and safety in the Republic of Karelia

Final meeting (IIIb) and follow-up seminars are transferred to 2010 due to the late timing (17–18 December 2009) of the Joint Symposium in Karelia. 2.2.4 Component IV. Improving Health and Preventing Accidents in High-Risk Sectors FIOH supported this project component by a) Expert consultations in Saint Petersburg region, b) by organizing a round-table meeting in collaboration with MAPS to discuss the occupational health and safety situation and identify the current challenges in road transport in the Saint Petersburg region concerning occupational health and safety information, and c) organizing the collected data into a systematic format. (d) Expert support was also given to experts of MAPS for planning the content of the OSH profile in the road transport sector in Saint Petersburg region, collection of relevant information and editing it into a jointly agreed format of the summary profile. The presentations made in the round-table meeting (in 2008) have been edited and printed as bilingual proceedings "Occupational Safety and Health of Truck Drivers and Passenger Transport Drivers in Saint Petersburg and the Leningrad Region" (Russian and English), 144 pages. See below (enquiries with bsn (at) ttl.fi).

The Proceedings were compiled, edited and published by the Medical Academy of Postgraduate Studies (MAPS) and the Finnish Institute of Occupational Health. The occupational health and safety situation in the Russian transport sector was discussed also in the Jubileum Symposium of MAPS on 13–15 May 2009 in St. Petersburg, and the plans for the situation analysis and other actions were further discussed. Consultation have been provided also through e-mail correspondence and in connection with other meetings (Ms. Suvi Lehtinen, Dr. Kari Kurppa, Dr. Seppo Olkkonen, Prof. Sergei Grebenkov and Dr. Elena Milutka), e.g. in October 2009 in Riga during the Annual Meeting of the Baltic Sea Network on Occupational Health and Safety. Consultation meetings were arranged on 21-23 September 2009 and 10 December 2009 in St. Petersburg to follow up with the progress of the sectoral profile and to recognize potential problems.

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Another Follow-up meeting looking into the progress of the sectoral profile work is planned to be carried out in late February 2010. The Follow-up round table -meeting is planned to be organized in March or April 2010. 2.2.5 Component V. Advocacy, awareness raising, adding to the knowledge Barents Newsletter on Occupational Health and Safety, editing and publishing, 6 issues in 2008–2009 (3 per year). The Barents Newsletter on Occupational Health and Safety was established in 1998 by the Finnish Institute of Occupational Health (FIOH) and the respective institutions in North-West Russia, Sweden and Norway. It is edited and published by FIOH in English and Russian three times a year. The aim is to provide a publishing forum and a channel for dissemination of occupational health and safety information in the Barents Region. It is accessible at URL: http://www.ttl.fi/BarentsNewsletter. The Barents Newsletter was utilized in 2008–2009 for the information dissemination of the North-West Russia project. The themes of the issues in 2008 were: 1/2008 OSH profiles, 2/2008 Transport industry, and 3/2008 Risk assessment. The themes in 2009 were: 1/2009 Mining and metallurgy, 2/2009 Information and networking, and 3/2009 Occupational health services. The themes in 2008 issues supported the components I and IV of the FIOH-North-West Russia project in particular, and the 2009 topics Components 3 and 5, respectively. The ILO World Safety and Health Day was taken into account in the Newsletter. In both years, the ILO Health and Safety Day materials were presented in the Barents Newsletter. Three (3) Barents Newsletters on Occupational Health and Safety were published in 2009 (see http://www.ttl.fi/barentsnewsletter). The Newsletters have been distributed through normal circulation, but also at the BSN Annual Meeting and SIHLWA/NDPHS meeting in Riga, and in the symposium (element III) arranged in Petrozavodsk in December 2009.

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The participation in the high-level policy forum was delayed to 2010. The FIOH North-West Russia Project, its goals and structure has been described in the following meetings and materials:

• NDPHS/SIHLWA, OSH: 6–7.3.2008, Oslo, Norway • WHO: Planning Committee Meeting of Global Network of WHO Collaborating

Centres in Occupational Health, 28.6.2008, Seoul, Republic of Korea • WHO/EURO: First Meeting of National Contact Persons for Workers' Health, 22–

23.9.2008, Helsinki, Finland • Baltic Sea Network Annual Meeting, 2.10.2008, Vilnius, Lithuania • Baltic Sea States Forum: Baltic Sea States Forum on Occupational Health and

Safety, 9.10.2008, Hamburg, Germany • ICOH 2009, 22–27.3.2009, Cape Town, South Africa • NAM2009 (54. Nordic Work Environment Meeting), 31.8–2.9.2009, Espoo,

Finland • Baltic Sea Network Annual Meeting, 8.10.2009, Riga, Latvia • Journal of the European Parliament, Regional Review: Baltic Sea Region

(http://www.e-pages.dk/dods/139/, 60–61). The structure and framework of the project aroused a great deal of interest in the participants of the session in ICOH World Congress.

2.3 Activities undertaken / resources utilised FIOH experts in 2009:

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• Ms. Suvi Lehtinen, Project Manager (FIOH); project management and expert consultancy (element III and V)

• Dr. Kari Kurppa, Leading Advisor; expert consultancy (element IV) • Dr. Seppo Olkkonen, Team Leader; expert consultancy (element IV) • Dr. Timo Leino, Chief Physician; expert consultancy (elements I and II) • Prof. Jorma Rantanen, Emeritus; expert consultancy (element III) • Ms. Inkeri Haataja, Information officer; general project management and secretarial tasks in

FIOH • Ms. Taina Pääkkönen, Planner; general project management tasks in FIOH • Mr. Mikko Tawast, Russian Language specialist, translation and interpretation tasks

FIOH missions to Russia in 2009:

• 13–15 May 2009; St. Petersburg; Dr. Kari Kurppa, Dr. Seppo Olkkonen, Ms. Suvi Lehtinen • 21–23 September 2009; St. Petersburg; Dr. Kari Kurppa, Dr. Seppo Olkkonen • 10–11 December 2009; St. Petersburg; Dr. Seppo Olkkonen • 16–19 December 2009; Petrozavodsk, Republic of Karelia; Ms. Suvi Lehtinen, Dr. Jorma

Rantanen, Dr. Seppo Olkkonen, Dr. Kari Kurppa, Dr. Pirjo Manninen, Mr. Mikko Tawast Active partners in Russia during 2009:

• MAPS, St. Petersburg: Professor Sergey Grebenkov, Dr. Elena Milutka, Prof. Mikhail Mikheev, et al.

• Ministry of Health, Republic of Karelia • Ministry of Labour, Republic of Karelia • OSH institutions in Karelia

Study visit to Finland in 2009:

• 14–15 June 2009 (Helsinki and Tampere). 2.4 Reasons for deviations (positive and negative) Some delays in arranging workshops/seminars and the second study visit. Delays in regional profiles resulted in the support for national OSH programme being delayed to 2010.

3. Impact assessment When carrying out collaboration in the field of occupational health and safety, the latency time for seeing impacts is longer than 2–3 years. Therefore, the project is composed of various elements, such as training of experts, information support, projects at the workplace level and development of infrastructures (profiles and occupational health service infrastructure). The impacts of training of occupational health and safety experts and information support as well as raising awareness of occupational health and safety can be seen more rapidly. The joint responsibility of the Ministry of Health and Ministry of Labour for organizing the joint symposium in Karelia is beneficial for the further development of joint activities. As health and safety at work are intertwined, it is extremely important that also the Ministry of Health and Ministry of Labour work closely together. The improvement of working conditions is beneficial and a positive factor to all stakeholders. Occupational health and safety is not a burden, but an investment in workers' better work ability and well-being, and thereby to productivity.

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4. Project in relation to stakeholders / local reform processes / objectives of the NDPHS • Assessment of the target audience and projects contribution to local reform

processes Professor S. Grebenkov reported in the 2009 Annual Meeting of the Baltic Sea Network on Occupational Safety and Health that the Russian government has given particular attention to health issues and politically supports action for improving health. Also, the Karelian Ministry of Labour reported (in December 2009 meeting) that OSH legislation is being developed in Russia and that this project gives valuable information and support for the development process. • Projects contribution to NDPHS objectives The Project launched the implementation of the NDPHS Strategy on Health at Work in Russia, and through this provided experience for the NDPHS to improve the implementation of the strategy in other member countries, and also to further develop the strategy and the work of the SIHLWA/OSH group of the Northern Dimension Partnership in Public Health and Social Well-being.

5. Sustainability factors and to which extent they are ensured • Political support Political support for examining the feasibility of the BOHS approach has been received, from both the Federal Ministry of Health and Social Development of the Russian Federation and the preliminary green light from the Ministries of Health and Labour of the Republic of Karelia. • Institutional capacities The personnel resources in all organizations involved are relatively thin. Therefore, it would be extremely important to have some funds available within the Project to cover the costs of some expert work (surveys, desk work, etc.) in order to find appropriate and relevant information (basic facts, demography etc.) for various parts of the Project. • Economic & financial resources The funding of the Project has been most valuable for the implementation of the Project activities. It would be important also in the future to be able to cover the travel, accommodation costs of Russian colleagues when they contribute to the objectives of the Project.

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• Socio-cultural acceptability The risk assessment and occupational health service infrastructure of workplaces in the Russian Federation is different from the Nordic approach. It is important to try to ensure and adapt the models and approaches to the local circumstances and local infrastructures. This requires more time than was expected. • Appropriate technology The project elements deal with training of occupational health and safety experts and providing consultative support to them in their development efforts of occupational health and safety in the country. Therefore, no specific technological solutions are needed. If the BOHS approach is selected to be piloted with a feasibility study in Karelia, a briefcase with direct-reading instruments will be needed for the experts to facilitate their work. • Environmental impacts The risk assessment to be made in the workplaces can also be expected to improve the general environment in the long run, as it is known that many of the exposures are several times more intensive in the work environment than in the general environment. • Gender issues In occupational health and safety, the target groups and beneficiaries are men and women equally. Some specific occupational health and safety problems of women are dealt with in the issue 1/2010 of the Barents Newsletter on Occupational Health and Safety, with the theme on 'Women and Work'. • Stakeholder motivation The first stakeholder motivation in both St. Petersburg (road transport) and in Karelia (development of service infrastructures) has been nicely ensured by the Russian partners.

6. Risks & critical factors The main risk is the overload of the Russian colleagues to carry out the programme elements.

7. Recommendations for future projects and programmes (lessons learned) Larger issues to consider in the future are that more time should be allocated for the local partners to prepare for the project implementation. Also, more efforts need to be put for finding ways to confirm the participation of the local partner for the whole project period and to have the support of the local decision-makers. Practical minor lessons learned were that in future reserving more funds and also time for interpretation and translation services is needed, and to have multiple entry visas for the whole project period; to shorten the time used for making the travel arrangements. This was in part done already within this project period.

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List of attachments to the final report (1 Jan – 31 Dec 2009)

1. NDPHS Strategy on Health at Work available at URL: http://www.ndphs.org///documents/779/NDPHS_Strategy_on_Health_at_Work.pdf

2. Report of the 13th ILO/WHO Joint Committee on Occupational Health

available at URL: http://www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---safework/documents/publication/wcms_110478.pdf

3. Basic Occupational Health Services Guideline (in English and Russian)

available in English at URL: http://www.ttl.fi/BOHS; enquiries on the Russian version with FIOH; suvi.lehtinen@ttl.fi

4. Surveillance of the Work Environment, BOHS 2 (in English)

enquiries with FIOH; suvi.lehtinen@ttl.fi

5. Risk Assessment, BOHS 5 (in English) enquiries with FIOH; suvi.lehtinen@ttl.fi

6. Status of the Working Conditions and Occupational Safety and Health in the Leningrad Region (in

Russian and English) enquiries with Committee for Labour and Employment of Population of the Leningrad; uprzan@scnlo.ru

7. Status of the Working Conditions and Occupational Safety and Health in Murmansk (in Russian) enquiries

with ILO Moscow Office, rudakov@ilo.org

8. Occupational Safety and Health of Truck Drivers and Passenger Transport Drivers in Saint Petersburg and the Leningrad Region (bilingual publication, both in Russian and English) enquiries with FIOH, bsn@ttl.fi or MAPS, medtrud@mail.ru

9. Barents Newsletter on Occupational Health and Safety; 2009 issues

vol 12, no. 1: Mining and metallurgy vol. 12, no. 2: Information and networking vol 12., no. 3: Occupational health services (OHS) Available at URL: http://www.ttl.fi/BarentsNewsletter

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