1. IMPLEMENTATION OF THE OCCUPATIONAL HEALTH
POLICY OF NAMIBIA:
STRENGHTENING THE HEALTH SYSTEM FOR PROTECTING AND
PROMOTING THE HEALTH OF ALL WORKERS
Report by Dr Ivan D. Ivanov, Scientist, Occupational Health,
World Health Organization, Headquarters, Geneva
ivanovi@who.int
15 October 2011
INTRODUCTION
The 60th World Health Assembly in 2007 endorsed the WHO Global Plan of Action on
Workers' Health (2008-2017) and urged Member States "to devise, in collaboration with
workers, employers and their organizations, national policies and plans for the
implementation of the global plan of action on workers' health as appropriate and to
establish appropriate mechanisms and legal frameworks for their implementation
monitoring and evaluation."1
Namibia participated actively in the development of the WHO global plan of action and
was among the first Member States to develop and formally adopt a national policy on
occupational health according to the global plan. The policy covers all workplaces and
sectors of activity in the country. It provides analysis of the status of occupational
health, the policy and institutional framework for action and the resource implications.
Currently, the Ministry of Health and Social Services is reviewing the implementation of
the National Occupational Health Policy and asked WHO to provide advice about the
future strategic directions for the work on occupational health in Namibia.
This report builds upon the review of the official policy and legal documents in the area
of occupational health in Namibia and interviews with professional and senior staff from
the Ministry of Health and Social services and the Labour Inspection department of the
Ministry of Labour carried out in the period 7-11 February 2011 in Windhoek.
FUNCTIONS OF THE MINISTRY OF HEALTH AND SOCIAL SERVICES
The functions of the Ministry of Health and Social Services (MOHSS) in the area of
occupational health are determined by two major pieces of law:
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Resolution WHA60.26. Workers' Health: Global Plan of Action, available at
http://www.who.int/occupational_health/WHO_health_assembly_en_web.pdf
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2. 1. Government notice No 156 "Regulations Relating to the Health and Safety of
Employees at Work" issued under the Labour Act
2. The Public Health Act from 1919
The Health and Safety Regulations is a very comprehensive regulatory framework for
occupational health. It is based on the modern approaches to occupational health -
employer responsibility, participation of workers, provision of occupational health
services. However, the capacity for implementation and enforcement of the regulatory
framework can be further strengthened.
The MOHSS has several functions with regard to the implementation of the legal
requirements for occupational health.
A. ENFORCEMENT FUNCTION
The Presidential decree on the implementation of the Health and safety Regulations
defines the MOHSS as the competent government authority for the administration of
certain Health and Safety Regulations under the Labour Act
1. To administer the regulations on:
 Occupational diseases;
 Welfare facilities;
 Hazardous chemicals;
 Asbestos, silica, lead, diving, noise, vibration, radiation;
 First aid;
 Occupational health services; and
 Medical surveillance
Observations:
 Not very clear delineation of authority for administration of the Health and
Safety regulations between Ministry of Health and Social services and the
Ministry of Labor;
 Gaps in responsibility - it is not clear which governmental agency is responsible
for the control over the transport of hazardous substances, ergonomics, handling
of loads, pesticide safety;
 Unclear role of MHSS in the Labour Advisory Council, probably not very effective
mechanisms for collaboration between responsible ministries;
 Excluded from the scope of the regulations: farms/cooperatives, small and
medium enterprises <5 persons, shops, professional services, teaching/education
institutions (are these totally not regulated, how health protection is organized
for these groups).
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3. 2. Specific duties of the Chief Medical Officer for Occupational Health (CMOOH)
according to the Health and Safety Regulations
1. Receive notifications on suspected occupational diseases;
2. Declare hazardous substances;
3. Collect copies of the safety data sheets for hazardous substances;
4. Give permission for importation, mixing, production, use or handling of
carcinogens and other controlled substances;
5. Collect notifications about levels of exposure above the occupational exposure
level or above the biological exposure index;
6. Collect notifications of asbestos processing and records about monitoring of
exposure to asbestos;
7. Approve plans of work on demolition or alteration of asbestos-containing
structures;
8. Control pre-employment and periodic medical examinations of asbestos
workers;
9. Decide on the application of the lead regulations to occasional and incidental
work activities;
10. Decide on additional clinical tests for tetra-alkyl lead;
11. Decide on processes that cerate risk to health from exposure to silica;
12. Keep registration of employers and self-employed persons who engage in sand
blasting and silica process;
13. Determine additional medical procedures for the diagnosis of silica-related
diseases;
14. Keep registration of employers and self-employed persons who engage in sand
blasting;
15. Designate practitioners to undertake medical examination of divers;
16. Define the aspects of medical examination of divers;
17. Conduct, or arrange for conduction, of medical examinations that he considers
necessary;
18. Determine the minimum requirements for registration of occupational healthy
clinics;
19. Decide on how adequate are the first aid and emergency procedures at a
workplace or work-site;
20. Control the presentation of training courses for certificates for first aid;
21. Decide on the provision of first aid attendance when two or more employers
share the same workplace;
22. Decide on the records of injuries to be maintained by the first aid unit or station.
Observations:
 Not clear what the CMOOH does with the notifications received - is there any
follow up action, or just a mailbox function;
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4.  Unclear authority of CMOOH to update the occupational exposure limits and the
biological monitoring indicators in view of the latest evidence;
 Current human resources of the Office of the CMOOH seem insufficient for the
functions under the Labour Act;
 Are there function of this office under other acts, e.g. the Public Health Act, with
regard to chemical safety, pesticide safety;
 Unclear relationship between the CMOOH and field inspectors (environmental
health officers).
3. Inspection of health and safety regulations
MHSS is supposed to administer the enforcement of the health-related regulations
under the Labour Act.
Under the 1919 Public Health Act, some occupational health functions are carried out by
environmental health officers of the MHSS.
Observations:
 The new bill on public and environmental health will replace the Public Health
Act. It covers the functions of environmental health officers but it does not cover
occupational health functions at all. There would be a gap in enforcement of
occupational health;
 Health inspectors seem to have different powers than labour inspectors;
 Unclear how non-compliance is dealt with - improvement note, fines, other
mechanisms to ensure compliance;
 Unclear level of competence of health inspectors in occupational health - what
they are supposed to do, to check whether the employers has fulfilled his
obligations under the health and safety regulations - to do risk assessment,
training, health surveillance, to do notifications etc.;
 Unclear division of responsibilities between health and labour inspectors
(inspectors of factories);
 Unclear relationship between health and labour inspectors, any arrangements for
joint inspection, joint planning, exchange of information;
 Unclear role of health inspectors in the registration of factories - many
occupational health problems can be prevented at the planning stage.
B: FUNCTION OF EMPLOYER OF PUBLIC HEALTH WORKERS
Under the Health and Safety Regulations, the permanent secretary of the MHSS shall
ensure that the ministry and public health facilities under its jurisdiction comply with
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5. the Labour Act and the requirements for health and safety - this includes not only those
regulations that are administered by the MHSS but all health and safety regulations,
including machine safety, accidents, fire safety, dangerous equipment (boilers,
elevators) etc.
Observations:
 Fulfilling the obligations of MOHSS as employer of the public health sector may
be in conflict with its function as administrator/enforcement agency of the
health and safety regulations. A solution to this would be to allocate these
functions to two different departments. On one hand the Office of the Chief
Medical Officer for Occupational Health would concentrate only on the
enforcement and control of occupational health regulations in all sectors and for
all workplaces, including in the public health sector according to its mandate
under the Health and Safety Regulations. On the other hand the Department
responsible for human resources in the MOHSS would build capacity to
implement a national programme for occupational health and safety of public
health workers, including implementation of health and safety requirements in
the public health facilities. Similar division of responsibilities is necessary at the
regional levels so the health inspectors are not forced to inspect the compliance
of the facility they belong to.
C. FUNCTION OF PROVIDER OF SERVICES IN OCCUPATIONAL HEALTH
Public health services under the MOHSS provide several services to employers outside
the health sector in order to help them comply with the requirements of the health and
safety regulations:
1. Medical surveillance of high risk workers- preliminary and periodic medical
examinations and clinical examinations and tests (X ray, lung function, biological
exposure indicators, blood tests, audiograms, etc.) required by the regulations.
 These obviously are paid for by the employers and may constitute an income for
the respective health facilities.
 Such services are also provided by private health facilities and there is obviously
competition.
 There is potential conflict of interests between the function of the MHSS as
enforcement agency of the health and safety regulations and the function of
service provider, these should be kept separate, e.g. the health inspectors should
not be giving recommendations about the facilities to carry out medical
surveillance, the CMOOH should only issue guidelines about medical surveillance
but not be engaged in its execution.
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6. 2. Workplace risk assessment - is not clear whether the public health sector under the
MHSS has capacity to assess occupational health risks - this is again responsibility of all
employers
3. Training - this includes training in first aid, maybe also safe use of hazardous
substances and other forms of training - this function again shall not interfere with the
enforcement by the CMOOH and the health inspectors.
Again, there is a need for clear distinction between the provision of services to
employers and enterprises outside the health sector by public health facilities belonging
to the MOHSS and the function of the Office of the CMOOH to control compliance and
enforce the Health and Safety Regulations in the domain of occupational health.
STRATEGIC DIRECTIONS FOR STRENGTHENING OCCUPATIONAL
HEALTH
 More focus on primary prevention of occupational healthy risks
 More proactive approach to enforcement and service provision
 Building human resource capacities for occupational health - occupational
medicine, hygiene, nursing, psychology, ergonomics
 Strengthening occupational health services - public/private, and mechanisms for
their financing
 Incorporating essential elements of occupational health in primary care and
general practice
 Strengthening enforcement
 Building national capacity for occupational health and safety
 Linking occupational health to other public health programmes - HIV, TB,
malaria, non-communicable diseases
RECOMMENDATIONS
1. Strengthen enforcement function of MHSS under the health and safety regulations
 Clarify the functions of environmental health officers in the area of occupational
health
 Develop working methods for workplace health inspection
 Adopt a more proactive approach to enforcement at national and regional level -
to raise awareness about regulations, hazards, to prevent non-compliance
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7.  To establish a mechanism for intersectoral collaboration on occupational health
and safety under the Labour Advisory Council - committee for health and safety
 Establish closer collaboration with factory inspectors at national and regional
level - joint inspections, exchange of information.
2. Strengthen financing for occupational health
 Establish a national fund for health and safety to finance national activities,
campaigns, research, training, information on health and safety - for example a
trust fund/foundation pooling together funds from state budget, social security,
private sector/employers, part of tobacco & alcohol excise duties, fines under
health and safety regulations)
 Reform the financing of occupational health services - move from pay-for-service
to longer term contractual arrangements, to pooling together financial resources
and to networking
3. Strengthen institutional and human resource capacities
 Define and strengthen the occupational health functions in the laws on public
health and primary health care
 Work with the private sector to ensure that all workers and employers have
access to occupational health expertise that is currently concentrated only in the
big companies.
 Establish national centre of excellence in health and safety, such as a
department/unit in the national institute dealing with public health bringing
together multidisciplinary expertise in occupational medicine, occupational
hygiene, occupational safety to carry out research, information dissemination,
and training in occupational health
 Establish occupational health services, separate from the Office of CMOOH to
provide support to non-health sector employers in fulfilling their responsibilities
in occupational health and safety. Such services will carry out risk assessment,
medical surveillance, training, advice on improving workers' health and working
conditions. The costs of these services should be covered entirely by the
employers through individual contracts or better through pooling together
funds.
 Establish national programme for occupational health and safety of public health
workers under the MOHSS (separately from the Office of CMOOH) to ensure that
public health facilities comply with the Health and Safety regulations and to
protect and promote the health and safety of public health workers as a means
to improve human resources for health.
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