Day 2 1 carter seahealth 4 12[1]
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Day 2 1 carter seahealth 4 12[1] Presentation Transcript

  • 1. Medical standards and worldwideacceptance 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 spreadAt 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 textSTCW 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 medicationProcedures for examination andcertification
  • 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 textMLC 1.2 medical certificate proceduresHearing and sightNo medical condition aggravated,leading to unfitness or risk to othersMLC 2.5 medical repatriationMLC 3.1 – 2 accommodation, foodMLC 4.1 – Medical care aboardMLC 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 certificatesWill 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.