Implementation of the oh policy of namibia final report ivanov


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Implementation of the oh policy of namibia final report ivanov

  1. 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 15 October 2011INTRODUCTIONThe 60th World Health Assembly in 2007 endorsed the WHO Global Plan of Action onWorkers Health (2008-2017) and urged Member States "to devise, in collaboration withworkers, employers and their organizations, national policies and plans for theimplementation of the global plan of action on workers health as appropriate and toestablish appropriate mechanisms and legal frameworks for their implementationmonitoring and evaluation."1Namibia participated actively in the development of the WHO global plan of action andwas among the first Member States to develop and formally adopt a national policy onoccupational health according to the global plan. The policy covers all workplaces andsectors of activity in the country. It provides analysis of the status of occupationalhealth, the policy and institutional framework for action and the resource implications.Currently, the Ministry of Health and Social Services is reviewing the implementation ofthe National Occupational Health Policy and asked WHO to provide advice about thefuture 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 areaof occupational health in Namibia and interviews with professional and senior staff fromthe Ministry of Health and Social services and the Labour Inspection department of theMinistry of Labour carried out in the period 7-11 February 2011 in Windhoek.FUNCTIONS OF THE MINISTRY OF HEALTH AND SOCIAL SERVICESThe functions of the Ministry of Health and Social Services (MOHSS) in the area ofoccupational health are determined by two major pieces of law:1 Resolution WHA60.26. Workers Health: Global Plan of Action, available at 1
  2. 2. 1. Government notice No 156 "Regulations Relating to the Health and Safety ofEmployees at Work" issued under the Labour Act2. The Public Health Act from 1919The Health and Safety Regulations is a very comprehensive regulatory framework foroccupational health. It is based on the modern approaches to occupational health -employer responsibility, participation of workers, provision of occupational healthservices. However, the capacity for implementation and enforcement of the regulatoryframework can be further strengthened.The MOHSS has several functions with regard to the implementation of the legalrequirements for occupational health.A. ENFORCEMENT FUNCTIONThe Presidential decree on the implementation of the Health and safety Regulationsdefines the MOHSS as the competent government authority for the administration ofcertain Health and Safety Regulations under the Labour Act1. 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 surveillanceObservations:  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). 2
  3. 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; 3
  4. 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 regulationsMHSS is supposed to administer the enforcement of the health-related regulationsunder the Labour Act.Under the 1919 Public Health Act, some occupational health functions are carried out byenvironmental 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 WORKERSUnder the Health and Safety Regulations, the permanent secretary of the MHSS shallensure that the ministry and public health facilities under its jurisdiction comply with 4
  5. 5. the Labour Act and the requirements for health and safety - this includes not only thoseregulations 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 HEALTHPublic health services under the MOHSS provide several services to employers outsidethe health sector in order to help them comply with the requirements of the health andsafety regulations:1. Medical surveillance of high risk workers- preliminary and periodic medicalexaminations and clinical examinations and tests (X ray, lung function, biologicalexposure 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. 5
  6. 6. 2. Workplace risk assessment - is not clear whether the public health sector under theMHSS has capacity to assess occupational health risks - this is again responsibility of allemployers3. Training - this includes training in first aid, maybe also safe use of hazardoussubstances and other forms of training - this function again shall not interfere with theenforcement by the CMOOH and the health inspectors.Again, there is a need for clear distinction between the provision of services toemployers and enterprises outside the health sector by public health facilities belongingto the MOHSS and the function of the Office of the CMOOH to control compliance andenforce the Health and Safety Regulations in the domain of occupational health.STRATEGIC DIRECTIONS FOR STRENGTHENING OCCUPATIONALHEALTH  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 diseasesRECOMMENDATIONS1. 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 6
  7. 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 networking3. 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. 7