1. 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

2. 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?

3. 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.

4. 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.

5. 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)

6. 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)

7. 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

8. 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

9. 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.

10. 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

11. 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.

12. 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

13. 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.

14. 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.

15. 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.

16. 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.