Dr. Tawfik A. M. Khoja

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OCCUPATIONAL HEALTH PRACTICES IN DEVELOPING
COUNTRIES

• Dr. Tawfik A. M. Khoja
• MBBS, DPHC, FRCGP, FFPH (UK)
• Director General GCC/ HMC

Dr. Mohamed S. Hussein Dr. PH,M.PH,M.Sc. Head of
Studies Research Division
Oman 20-22 Dhul-Qada 1427 H / 11-13 December 2006
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IN THE NAME OF ALLAH, THE MOST GRACIOUS, THE MOST
MERCIFUL
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INTRODUCTION
The term refers to countries that are capitalist
democracies, that are technologically advanced,
and whose citizens have a high standard of
living. The United States, Canada, Japan,
Australia, and most of the countries of Western
Europe are examples of first-world countries.
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The term is a phrase that was used to describe
the Communist countries within the Soviet Union's
sphere of influence. Along with "First World" and
"Third World", the term has been used to divide
the nations of Earth into three broad
categories. The term has largely fallen out of
use because the countries to which it referred
mostly abandoned Communism, and their mutual
interests, after the 1991 collapse of the Soviet
Union. The other two terms remain in widespread
use.
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These are countries that were previously
considered developing countries and that now have
a more advanced economy, yet not fully developed.
Countries that have more advanced economies than
developing nations but haven't yet gained the
level of those in the First World are grouped
under the term Newly Industrialized Countries or
NICs. Current examples includes China, India,
Mexico, South Africa or Brazil to name a few.
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In recent years, as many "developing" countries
have industrialized, this term has been coined to
refer to countries that have "lagged behind" and
still lack industrial infrastructure
The term Fourth World (as least developed
countries) is used by some writers to describe
the poorest Third World countries, those which
lack industrial infrastructure and the means to
build it. More commonly, however, the term is
used to describe indigenous peoples or other
oppressed minority groups within First World
countries.
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Least Developed Countries
(LDCs or Fourth World countries) are countries
which according to the United Nations exhibit the
lowest indicators of socioeconomic development,
with the lowest Human Development Index ratings
of all countries in the world.
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A country is classified as a LEAST DEVELOPED
COUNTRY if it meets three criteria based on

• low-income (GNI per capita of less than US 750)
• human resource weakness (based on indicators of
  nutrition, health, education and adult literacy)
  and

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• economic vulnerability (based on instability of
  agricultural production, instability of exports
  of goods and services, economic importance of
  non-traditional activities, merchandise export
  concentration, and handicap of economic
  smallness, and the percentage of population
  displaced by natural disasters).
• The classification currently applies to around 50
  countries. As of 2006, the least developed
  country in the world is East Timor.

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CHARACTERISTICS
Least developed countries generally suffer
conditions of extreme poverty, ongoing and
widespread conflict (including civil war or
ethnic clashes), extensive political corruption,
and lack political and social stability. The form
of government in such countries is often
authoritarian in nature, and may comprise a
dictatorship, warlordism, or a kleptocracy. The
majority of LDCs are in Sub-Saharan Africa.
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Current LDCs
 Least Developed Countries
Asia (10 Countries)
Oceania (5 Countries)
Africa (34 Countries)
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DEVELOPING COUNTRY
 High human development  Medium human
development  Low human development
 Unavailable
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DEVELOPING COUNTRY
Is a country with a relatively low standard of
living, undeveloped industrial base, and moderate
to low Human Development Index (HDI). The term
has tended to edge out earlier ones "Third
World", which has come to have unintended
negative connotations associated with it.
Developed countries , in comparison, usually
have economic systems based on continuous,
self-sustaining economic growth in the tertiary
and quaternary sectors and high standards of
living.
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Another term synonymous to developing country is
Less developed country (LDC) or Less
economically developed country (LEDC). LEDC is a
term used by modern geographers to portray the
countries classified as "developing countries"
more accurately, specifying that they are less
economically developed, which usually correlates
best with other factors such as low human
development.
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The ultimate objective
Occupational safety and health can be defined as
a multidisciplinary activity aiming at
The ultimate objective of occupational health is
a healthy, safe and satisfactory work environment
and a healthy, active and productive worker, who
is free from both occupational and
non-occupational diseases and who is capable and
motivated to carry out his or her daily job and
is able to experience job satisfaction and
develop both as a worker and as an individual.
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Occupational safety and health problems
Approximately 45 of the worlds population and
58 of the population over 10 years of age belong
to the global workforce, I.e. 60-70 of the
adult male and 30 - 60 of the adult female
population of the world.
Hundreds of millions of people throughout the
world are employed today in conditions that breed
ill health and/or are unsafe (WHO 1999).
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- Annually, an estimated 160 million new cases
of work-related diseases occur worldwide,
including respiratory and cardiovascular
diseases, cancer, hearing loss, musculoskeletal
and reproductive disorders, mental and
neurological illnesses.
- Only 5-10 of workers in developing countries
and 20-50 of workers in industrial countries
(with a few exceptions) are estimated to have
access to adequate occupational health services.
In the USA, for example, 40 of the workforce of
some 130 million employees do not have such
access.
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• Even in advanced economies, a large proportion of
  work sites is not regularly inspected for
  occupational health and safety.

• The International Labour Organization (ILO) has
  estimated that in 1997, the overall economic
  losses resulting from work-related diseases and
  injuries were approximately 4 of the worlds
  Gross National Product.

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There is a universal shortage of both expert
resources and training in developing and newly
industrialized countries in the South. This is
due to three main reasons
a) Lack of effective legislation and absence or
lack of requests from authorities and employers
make the employment opportunities for such
experts minimal .
b) The vocational training institutions and
universities have not organized and developed
curricula for the training of experts in
occupational health .
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c) Training is oriented to clinical occupational
medicine only which , though important, does not
give a full response to the needs for expertise
in a preventive workplace - oriented occupational
health service
D) Problems related to



growing mobility of worker
populations and occurrence of new
occupational diseases of various origins.
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The overall exposure pattern
There is a wide variation in economic structures,
occupational structures, working conditions, work
environment, and the health status of workers in
different regions of the world, in different
countries and in different sectors of economies.
There are also special occupational settings and
types of enterprises, where work and workplace
deviate substantially from the norm.
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The least developed countries that still employ
the major part of the workforce in agriculture
and other types of primary production face
occupational health problems that are different
from those experienced in the industrial
countries. In the least developed countries
the occupational factors are aggravated by
numerous non-occupational factors such as
parasitic and infectious diseases, poor hygiene
and sanitation, poor nutrition, general poverty
and illiteracy.
Cont . .
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Work usually takes place in an environment that
does not always meet required standards.
Family members of the entrepreneurs and workers,
including children, pregnant women and elderly
people, share the work in small-scale
enterprises, such as home industries, small farms
and cottage industries, particularly in
developing countries.
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Case Studies
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Improving occupational safety and health
standards in the tanning industry in South East
Asia. Country surveys were carried out in
several South East Asian countries by the United
Nations Industrial Development Organization
(UNIDO), in connection with its regional
programme for Pollution Control in the Tanning
Industry in India, Indonesia, Nepal, and Sri
Lanka . The surveys indicated that the tanning
industrys performance in terms of safety and
health at work and quality management was poor.
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• Lessons learned
• Change is best stimulated by starting from the
  real problems and conditions in the companies
  instead of the priorities of outsiders.
• Approaches have to be flexible and informal.
• - Exchange of experience amongst entrepreneurs
  can be used to promote positive attitude to
  change.

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• Emphasis should be put on local improvement
  measures which are already in use.
• Highlight demand driven concept (designed at
  entrepreneurs own initiative).
• Link OSH standards and practices with improved
  profit, cost savings.
• - Involve pro-active entrepreneurs to act as
  advocates of the cause.

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Fighting the pesticide related health problem in
Central America. Despite awareness of the
problems associated with pesticide use, they have
persisted, and are even increasing in some
regions of the developing world. Nowhere is this
more apparent than in Latin America. The region
produces 40 of the worlds bananas, 60 of the
worlds coffee, and 25 of the worlds beans.
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Health impact of occupational risks in the
informal sector in Zimbabwe. Information about
occupational health in the informal sector is
lacking, despite its size and growing
contribution to employment.
Work organization, hygiene and ergonomic problems
accounted for a significant share of inspected
and reported workplace risks across all areas of
informal sector work.
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The significant under-detection of occupational
morbidity is exacerbated by the almost complete
lack of coverage of occupational health services
in the informal sector. There were few built-in
safety measures. Personnel Protective Equipment
was used by less than 5 of workers, compared to
the 55 doing work where it was judged that PPE
would be needed.
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• LEARNING TOGETHER
• TO WORK TOGETHER
• FOR HEALTH

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First do no harm
Occupational Health in the Gulf Countries
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GENERAL FEATURES IN THE GULF COUNTRIES

• Gulf countries have large industrial communities
  with a great workforce exposed to various
  hazardous agents in their occupations.
• Occupational health statistics are few
• Reporting is lacking or not available

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• Most of the countries have several limitations or
  constraints hindering occupational health and
  safety services and programmes at facility, local
  (municipal) and national levels. The main
  obstacles are related to -
• lack of enabling legislation
• lack of standards
• Not enough of expertise
• Coordination between concerned authorities is not
  complete.
• lack of participation of the employers
  organizations, nongovernmental organizations,
  etc.

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• Insufficient budgetary resources or human
  resources.
• lack of educational programmes.
• Conflicts between various authorities responsible
  for occupational health and safety services.
• No full coordination between various partners
  responsible for occupational health program.
• There is considerable under reporting of
  occupational morbidity, both injury or disease
  and mortality.
• Policies that comprehensively address
  occupational health are not enough.

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is brighter
The outlook
Always think
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HEALTH MINISTERS COUNCIL OCCUPATIONAL HEALTH
IN THE GULF COUNTRIES

• The Health Ministers Council for the Cooperation
  Council states issued 3 resolutions in the field
  of occupational health, as follows
• Resolution 8 issued by the conference 14 of
  the Health Ministers Council held in Riyadh,
  Kingdom of Saudi Arabia (26 October 1983) which
  included
• Approval on the work papers submitted by the
  General Secretariat in this respect.
• Assigning the General Secretariat to call upon a
  technical committee involving specialized people
  from different authorities to study

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1. Setting a platform and clear vision about
   occupational health programmes in the light of
   the existing problems , the industrial
   development projects, and the rapidly increasing
   development witnessed in the region.
2. Setting a work plan for development of
   occupational health services according to the
   recent developments in this regard.

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• Organizing a symposium with participation of all
  concerned departments in the ministries of health
  and other related ministries and agencies for the
  purpose of
• Defining the responsibility of each, and methods
  of coordination between various partners.
• Developing legislations and regulations of
  occupational health.
• Human power development necessary for work in
  this field.

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• Resolution 1 issued by the Conference 18 of
  the Health Ministers Council held in Doha
  Qatar (21-23 /1/1985), as follows
• Follow up on the occupational health symposium to
  discuss specific subjects making full use of the
  symposium held lately in Iraq in cooperation with
  WHO.

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• Resolution No. 5 issued by the conference 20
  of the Health Ministers Council held in Muscat
  Oman (5-8/1/1986) which involved the following
• Circulation of the recommendations issued by the
  symposium held in Bahrain (27-29 /10/1989) as
  well as the reports of the subcommittees.
• Each country of the member states should
• Establish a national committee for occupational
  health and safety which should define the
  responsible body for each activity of
  occupational health and safety as well as methods
  of coordination among them.

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• Developing the regulations and legislations of
  workers health and safety as well as the safety
  of the production facilities, work environment
  and the surrounding environment.

• Setting a plan to make available and train
  specialized and technical caders at various
  levels to be involved in occupational health
  services.

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• Taking necessary actions to make occupational
  health services available and accessible through
  primary health care programmes especially for
  those working in agriculture, small workshops and
  distant places. Training of physicians,
  technical middle-level cader should be trained to
  conduct these services in addition to equipping
  the facilities to make their work easy.

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VITAL MESSAGE AHEAD
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The Executive Body in its 65th meeting held in
Riyadh (4-6/11/1427 H 25-27 /11/2006 G)
discussed the subject of occupational health and
issued recommendation (1) which included

1. Establishment of a Gulf Committee for
   Occupational Health and Safety affiliated to the
   Executive Board. Each country should nominate
   its representative from among those specialized
   in the field of occupational health and safety.

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The committee shall review the working paper
presented by Dr. Yousef Al-Nesf Executive Body
members of Kuwait as a platform for the work of
this committee taking into consideration the
issue of setting occupational health strategies
in such a way that does not overburden the
Ministers of Health in the Cooperation Council
and does not add tasks for which other
governmental sectors are responsible.
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1. The Gulf Committee for Occupational Health shall
   hold its first meeting in Muscat in the second
   half of 2007 to formulate the vision, mission and
   objectives as well as the mechanism of work and
   responsibilities. In addition , the Committee is
   requested to set a strategy / fifth plan for
   promotion of occupational health in the
   Cooperation Council States.

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1. Each country has to establish a national
   committee for occupational health and safety.
2. Calling upon the member states to effectively
   participate in the Occupational Health Conference
   going to be held in Muscat Sultanate of Oman
   throughout the period 20-23 Dhul Qada 13427 H
   corresponding to 11-13 December 2006.

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FRESH STRATEGIES FOR A NEW ERA
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Recommendations

1. Revival of occupational health programmes and
   services in the Gulf countries, in such a way
   that these programmes should include the core
   services required for strengthening occupational
   health practices (e.g. preventive, curative,
   emergency, first aid, research, etc)
2. Stress on coordination among various partners,
   providers and stakeholders for joint efforts to
   deliver occupational health and safety services
   at various levels. These are

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• Formal agencies, such as the ministries of
  health, labour (and social affairs), and the
  ministry of the environment institutions of
  social/health insurance, other insurance agencies
  the civil defense, universities, schools and
  other educational facilities, other education,
  defense research institutes, interior, etc) and
  national funds.
• Employers and employees organizations
• Nongovernmental organizations
• Consulting firms.

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• Strengthening the concept of workplace health
  promotion and implementation of various
  strategies e.g .
• physical fitness
• healthy nutrition
• smoking cessation
• health heart
• stress free work life
• safe work environment

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1. Top level commitment of the Ministries of Health
   with OHS.
2. Establishing units/departments or divisions and
   programmes of OHS which should be well designed,
   staffed and equipped with occupational health
   laboratories.
3. Good coordination with other related authorities
   / bodies e.g. the ministries of industry,
   agriculture, labour, municipalities, etc.
4. Policies have to be changed appropriately to
   promote the health of the workers. These
   policies should be supported with legislations
   and regulations that should be formulated and
   implemented followed up and updated.

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1. Establishing a database about OHS, its services,
   indicators, morbidity and mortality statistics,
   burden etc.
2. Fostering a culture that values and encourages
   health in the workplace.
3. More communication and networking with relevant
   agencies and organizations, especially WHO, ILO,
   UNDP, UNICEF, ISO, IPCS, CCUI Etc.
4. Full coordination with universities and
   institutions in the field of OHS training and
   education.

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12. Each government should establish or
strengthen its national centre for occupational
health and, the network of centres given the
responsibility of carrying out research,
information, training, and if appropriate
advisory and analytical and measurement services
in support of occupational health practices and
safety situation and effective international
collaboration in research should be ensured.
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1. Future Perspective Strategies revitalization of
   the Gulf Occupational Health Committee to
   undertake the mission of coordination between
   the Gulf states proposing programmes and setting
   policies to promote occupational health and
   safety.
2. Establishing a Gulf occupational health and
   safety Institute or Center to undertake the
   responsibility of training the Gulf national
   cadres and to assure having the expertise in this
   field.
3. Utilization of successful experiences in
   designing, implementing and monitoring of
   occupational health promotion programmes.

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• Conduction of a series of occupational health
  hygiene surveys of existing occupational health
  hazards, infrastructure and capacity for
  occupational health in the Gulf countries to
  determine the current situation of occupational
  health and safety (situation analysis) with the
  assistance of WHO and other related institutions
  in this field .
• Workplace health programs that focus on both risk
  factors in places of employment and the promotion
  of healthy life styles to reduce and prevent
  chronic disease.

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• Coordination between occupational health services
  and overall health services. Occupational health
  services, consisting of efforts to prevent work
  related disease and disability as well as to
  recognize and treat them once they occur, must
  be coordinated with overall health services.

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• Promotion of research in the field of
  occupational health and safety delineate the
  epidemiology of these diseases, and address
  various issues e.g. occupational mortality and
  morbidity leading to developing strategies for
  control and prevention.

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ULTIMATLY OUR MISSION IS
Keeping PEOPLE Well Getting PEOPLE
Better Helping PEOPLE Cope
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• Thank you for your
• kind attention

Wishing you all the best