African Newsletter 1/2013, Health promotion at work

African NewsletterVolume 23, number 1, April 2013

O N O C C U P A T I O N A L H E A L T H A N D S A F E T Y

Health promotion at work

Contents

3 Editorial Social determinants of health, and the workplace Sir Michael Marmot, Peter Goldblatt UCL

Articles

4 Visible workplace health promotion in Botswana Sinah Yamogetswe Seoke BOTSWANA

7 Health promotion at workplaces in Tanzania Vera Ngowi TANZANIA

9 Occupational health nursing practice in the private sector in South Africa Louwna Pretorius SOUTH AFRICA

13 Occupational health and safety in the informal sector – an observational report G.J. Sekobe, N.M. Mogane, M.G.I. Ntlailane, K.A. Renton, M.J. Manga- nyi, G.E. Mizan, C.D. Vuma, T. Madzivhandila, S.A. Maloisane, K.C. Lekgetho SOUTH AFRICA

16 How can we support young immigrants’ health and work ability at workplaces? Merja Turpeinen, Anne Salmi, Jaana Laitinen FINLAND

18 Networking emphasized in Dresden Suvi Lehtinen

19 Occupational safety and health (OSH) training at ARLAC Mary Muchengeti ARLAC / ZIMBABWE

21 Health aspects of child labour in the crushing of granites in central Benin A.P. Ayélo, B. Aguêmon, A. Santos, F. Gounongbé, L. Fourn, B. Fayomi BENIN

African Newsletter ON OCCUPATIONAL HEALTH AND SAFETYVolume 23, number 1, April 2013 Health promotion at work

Published by Finnish Institute of Occupational Health Topeliuksenkatu 41 a A FI-00250 Helsinki, Finland

Editor in ChiefSuvi Lehtinen

EditorMarianne Joronen

Linguistic EditorsAlice LehtinenDelingua Oy

Layout Kirjapaino Uusimaa, Studio

The Editorial Board is listed (as of January 2013) on the back page. A list of contact persons in Africa is also on the back page.

This publication enjoys copyright under Protocol 2 of the Universal Copyright Convention. Nevertheless, short excerpts of articles may be reproduced without authorization, on condition that source is indicated. For rights of reproduction or translation, application should be made to the Finnish Institute of Occupational Health, International Affairs, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland.

The African Newsletter on Occupational Health and Safety homepage address is:http://www.ttl.fi/AfricanNewsletter

The next issue of the African Newsletter will come out at the end of August 2013. The theme of the issue 2/2013 is Prevention culture.

African Newsletter is financially supported by the Finnish Institute of Occupational Health, the World Health Organization, WHO, and the International Labour Office.

Photographs of the cover page:

© International Labour Organization / M. Crozet

© Finnish Institute of Occupational Health, 2013

Printed publication: ISSN 0788-4877On-line publication: ISSN 1239-4386

The responsibility for opinions expressed in signed articles, studies and other contributions rests solely with their authors, and publication does not constitute an endorsement by the International Labour Offi-ce, World Health Organization or the Finnish Institute of Occupational Health of the opinions expressed in it.

Editorial

Afr Newslett on Occup Health and Safety 2013;23:3 • 3

Social determinants of health, and the workplace“The poor health of the poor, the social gradient in health within countries, and the marked health inequities between countries are caused by the unequal dist-ribution of power, income, goods, and services, globally and nationally, the conse-quent unfairness in the immediate, visible circumstances of people’s lives – their access to health care, schools, and education, their conditions of work and lei-sure, their homes, communities, towns, or cities – and their chances of leading a flourishing life. This unequal distribution of health-damaging experiences is not in any sense a ‘natural’ phenomenon but is the result of a toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics. Together, the structural determinants and conditions of daily life consti-tute the social determinants of health and are responsible for a major part of health inequities between and within countries.”

WHO Commission on Social Determinants of Health – final report

For many years, the social, political and economic situation in much of Africa provided little reassurance that the health inequities between the continent and the rest of the world, as well as those within and between countries, would im-prove. But there are signs, over the last decade, of progress

in all these dimensions of inequity. Much will need to be done, by countries, communities and civil society within Africa and by the international com-munity at large, to ensure that sustainable reductions in inequities are ac-hieved, that the benefits of economic growth are experienced by all, and that public health lessons are learnt both from Africa’s own experiences and from the impact of rapid economic growth elsewhere in the world.

According to the 2012 World Health Statistics, in 13 countries in Afri-ca life expectancy at birth in 2009 was 50 years or less – all in sub-Saharan Africa – while it was over 70 in five countries on the African Mediterranean coast. A massive health divide. Nonetheless this represents a major impro-vement compared to the position in 2000, when the life expectancy figure was below 50 in 22 countries across the continent. As a result, the range between countries was four years less in 2009 than in 2000, and average life expectancy for the WHO Afro Region rose by four years – a bigger increase than in any other region.

The rate of GDP growth in Asia has been high throughout this period, and it has been increasing steadily, from an initially low level, in much of

the African continent. As a result, the average growth rate in Africa is pre-dicted to overtake that in Asia during the current decade; the Arab spring has swept through North Africa; and many of the wars in the south have come to an end. These are all signs of hope – but we still have a long way to go to reach the conditions needed to achieve health equity in Africa. Some key indicators continue to place the WHO Afro Region in a poor position, as regards drinking water quality, sanitation, universal health service coverage, rates of mortality, malaria, TB and HIV/AIDS. All of these have a greater im-pact on people and communities further down the social gradient and on countries poorly equipped to carry the burden or address the root causes.

For the future, a real concern must be the increase in non-communica-ble diseases (NCD) and their social distribution. The WHO African Region already has the highest NCD mortality rates in the world, particularly from CVD, and the highest prevalence of raised blood pressure in adults. As we have already seen in some countries in Africa, as economic well-being im-proves and Western diets and smoking habits spread, so these behaviours cease to be those of the elite only, and spread to those who are less educa-ted – creating new social gradients. In conquering communicable diseases we need to ensure that we also address the social conditions that give rise to these and to NCDs. Work is a big part of this. Work provides income, a purpose in life, self-esteem, social relations – but it can also be degrading, dehumanizing, dangerous, and damaging to health in various ways. Addres-sing social determinants of health will entail, among other things, addres-sing the crucial role of work in damaging or enhancing health.

Professor Sir Michael Marmot Professor Peter GoldblattUCL Institute of Health [email protected]

Michael Marmot Peter Goldblatt

4 • Afr Newslett on Occup Health and Safety 2013;23:4–6

IntroductionAccording to the Bangkok Charter, “Health promotion is the process of enabling people to increase control over their health and its determinants, and thereby improve their health. It is a core function of public health and contributes to the work of tackling communicable and non-commu-nicable diseases and other threats to health (1).” The main elements in health promotion to be noted are to enable in-dividuals to be responsible for their own health and also the creation of an atmosphere that enables people to be contin-uously active participants in health promotion initiatives in every setting of their everyday life in order to curb ill-health and ensure quality of life. The WHO recognizes that the workplace “offers an ideal setting and infrastructure to sup-port the promotion of health (2).”

Promoting health in the workplace is reported to ben-efit enterprises in the form of lower illness-related cost and an increase in productivity (3). Any intervention in the workplace that promises the prevention of ill-health is con-sequently providing occupational health and safety (OH&S) that will see an improvement in the well-being of the work-force thereby leading to a reduction in occupational diseas-es, accidents, and injuries. The objective of OH&S is to en-sure that workplaces are safe to operate in, that operations do not impact negatively on the health of workers, and safe-ty awareness amongst personnel is increased (4). Conse-quently, OH&S initiatives lead to promoting the preserva-tion of health in the workplace.

The concept of workplace health promotion has been incorporated into Occupational Safety and Health Manage-ment Systems (OSH MS). A typical OSH MS includes em-powering employees so that they take responsibility for their safety and health, not only their own, but also that of their fellow workers. This is in accordance with the Ottawa Char-ter (5) which states that health promotion supports indi-viduals’ development through the provision of information and education relating to health. “By so doing, it increas-es the options available to people to exercise more control over their own health and over their environments, and to make choices conducive to health (5).” One of the main ele-ments of OSH MS is training and the continuous provision of information to the workforce so that they understand the health and safety risks of their workplace [6]. According to

Visible workplace health promotion in Botswana

the World Bank (6), having an appropriate OSH MS in the workplace can improve staff performance and availability for work, help in recruiting and retaining key skills and ex-pertise, and reduce workers’ compensation insurance costs and medical expenditures (6).” In this sense, health promo-tion (in terms of OH&S) is an investment in the workforce, their employability and potential productivity.

In the recent years, the application of systems models in OH&S, now referred to as the OSH Management Systems (OSH MS) approach has gained the attention of enterpris-es, governments and international organizations as a prom-ising strategy to harmonize OH&S and business require-ments, and to ensure more effective participation of work-ers in implementing preventive measures (7). In the imple-mentation of OSH MS, all the workplace elements to assess hazards and risks are considered; commitments are made at all levels of the organization; management and workers are involved in the process at their level of responsibility (4). According to Robson et al. (8), there are studies that have shown that a more developed OSH MS is correlated with lower injury rate; thereby ensuring improved well-being in the workplace.

BackgroundThe 2012 Global Competitiveness Report revealed that Bot-swana has improved its competitiveness ranking from po-sition 80 to 79 out of 144 countries (9). The country was praised for having achieved the fastest levels of economic growth in the world, even outstripping China. This is large-ly attributed to the country’s well-known relatively good governance and institution of property rights, which has been reported to have given most of the population an in-terest in political stability (10). Botswana’s Gross Domestic Product (GDP) per capita impressively stands at US$9,481 (11). According to the Central Statistics Office (11), the composition of the GDP by sector stands at 1.8% for agri-culture, 59.5% for industry (including mining), and services at 35.2% (11).

According to Botswana Vision 2016 (12), Botswa-na’s policy initiative, the government’s vision is to have a healthy, compassionate nation that is informed and provid-ing a sustainable contribution to the country’s development. Health and well-being promotion is of paramount impor-

Sinah Yamogetswe SeokeBOTSWANA

Afr Newslett on Occup Health and Safety 2013;23:4–6 • 5

tance in achieving Botswana’s prosperity. An informed nation is a critical element in health promotion since information empowers and enables individuals and communities to take control of their own health and determinants of health. This fits well with the WHO Bangkok Charter defi-nition of health promotion.

Botswana has become more dependent on Small and Medium-sized Enterprises (SMEs) as its strategy to diversify its eco-nomic growth and eradicate poverty. The country has developed a national strate-gy for poverty reduction (13), which puts private sector development and trade ex-pansion at the centre of economic develop-ment. The strategy includes strengthening private sector development with an added stimulus, particularly focusing on SMEs and the informal sector (13). With this na-tional plan, the country will experience an increase in the number of SMEs. SMEs are an intervention strategy on poverty eradication and need health promotion programmes as small-scale industries are prone to occupational hazards. Botswana will do its best to recognize that a healthy workforce is a key to overcoming poverty and increasing productivity

The increase in SMEs will heighten the difficulty in enforcing the current national prescriptive legislation statutes. At present, there is an acute shortage of OSH inspec-tors across the country. Currently, there is a significantly disproportionate ratio of

inspectors to workplaces. It therefore be-comes important to have a mechanism in place that will ensure self-monitoring of workplaces through OSH MS.

Activities contributing to Health Promotion in BotswanaIn 2011, the Ministry of Labour and Home Affairs through its tripartite constituents signed the Botswana Decent Work Coun-try Programme 2011–2015 with one of its outcomes being “workers and enter-prises benefit from improved safety and health condition at work (14).” The activi-ties include the development of a national OSH policy and programme that will see, amongst other things, the revitalization of the CIS-national Occupational Safety and Health (OSH) information centre (14).

The Ministry of Health, with relevant stakeholders, has consistently over the years, implemented health promotional in-itiatives as follows:• Smokingreductionandimplementa- tion of the Tobacco Act• Reductionintheuseofalcoholand drugs• Mentalhealthpromotion• Promotionofsexualandreproductive health and HIV\AIDS prevention• Preventionofcancers• Promotionofphysicalactivitiesfor health.

Workplace Wellness Programme: Im-plementation Guide has been developed

by key stakeholders in the country that in-clude organizations and businesses, with the aim of promoting the health and well-being of employees, and the vision of see-ing “transformed, healthy and productive workforce (15).” Government departments and agencies, parastatals, and some pri-vate companies have developed activities, which have gradually become culture, and which include most commonly an annu-al wellness week across different govern-ment ministries and departmental weekly short session at a specific time in the week throughout the year for employees to gath-er for prayers, talks, discussions and ad-dress employee well-being issues. Work-place committees have been set up to or-ganize the following:• Healthscreeningsandwell-beingday/ week activities• Peereducationandcounselling• Talkscoveringdifferenttopics(such as stress management, personal financial management, health topics).

Awareness on OSH PromotionBotswana has implemented several aware-ness campaigns that are continuously and gradually addressing the improvement in workplace health promotion.

1. World Day for Safety and Health at Work on 28 AprilThe ILO celebrates the annual World Day for Safety and Health at Work on 28 April to promote the prevention of occupation-al accidents and diseases globally. It is an awareness-raising campaign intended to focus international and national attention on emerging trends in the field of occupa-tional health and safety. It encourages im-provement in working conditions and the environment. The day has been observed since 2006 in Botswana. Participants in-clude government, utilities companies, pri-vate sector, workers’ organizations and em-ployers’ organizations.

2. Safety, Health and Environment (SHE) Awareness Safety, Health and Environment (SHE) is recognized as a fairly new concept in Bot-swana, but an important concept that has potential to “promote efficiency and re-duce losses by continuously improving employee awareness of their health and safety to promote productivity (16).” This is a non-legislated concept that has been

The World Day for Safety and Health on 28th April has been celebrated since 2006 in Botswana.

Photo: access by DOHS Public Relation Desk Officer, Mr Armstrong Dube.


adopted by utility companies in Botswana and mining firms in the country to enhance the culture of OSH among employees. The continuous SHE publicity includes raising awareness among employees and the public, raising awareness and informing employees about SHE activities which are key work-place health promotion strategies. These are aimed at achieving “improved efficiency, high productivity, improved employee wel-fare, low numbers of labour disputes, and low levels of staff turnover and absenteeism, and reduced compensation costs, high eco-efficiency and sustainable development of resources (16).”

Possible Interventions to Improve Workplace Health Promotion1. Botswana National CIS Centre needs to acquire resources to ensure that nation-al stakeholders have access to appropriate OH&S information. The centre should com-menceactivepromotionofILO/CISactivi-ties locally to increase the usage of OH&S information through CIS products. This can be done through publicity and through di-rect contact with scientific, technical and medical organizations, and with SMEs and workers’ organizations. Information is an

Literature

1. World Health Organization. The Bangkok Charter for Health Promotion in a Globalized World. 2005, Geneva, WHO Press.

2. World Health Organization. Occupational Health: Workplace health promotion. www.who.int/oocu-pational_health/topics/workplace [accessed 3/1/2013]

3. Alli BO. 2nd. Fundamental principles of occupational health and safety. Geneva: ILO Publications, 2008.

4. International Labour Organization. OSH management system: A tool for continual improvement. Turin: International Training Center of the ILO, 2011.

5. World Health Organization. The Ottawa Charter for Health Promotion. 1986; Geneva: WHO Press.6. World Bank. Getting to Green- a sourcebook of pollution Management Policy Tools for Growth and

Competitiveness. World Bank Group Publication [cited 2013 Feb 7]. Available from www.worldbank.org.

7. Makin AM, Winder C. A new conceptual framework to improve the application of occupational health and safety management system. Safety Science 2008;46:930–48.

8. Robson LS, Clarke JA, Cullen K, Bielecky A, Severin C, Bigelow PL, et al. The Effectiveness of Occupa-tional Health and Safety Management System interventions: A Systematic Review. Safety Science 2006 Jul; 45:329–53.

9. The Global Competitiveness Report 2012–2013. Country/Economy profile: Botswana.10. Stevens P. The real determinants of health.11. Central Statistics, National Accounts Statistics Brief. 2008.12. Presidential Task force. Long term vision for Botswana: Towards Prosperity for all. 1997, Gaborone

Botswana: Government Printer.13. Government of Botswana. Government of Botswana – United Nations Programme Operational Plan

(2010–2014). United Nations Systems in Botswana, 2009.14. International Labour Organization. Decent Work Country Program for Botswana 2011 to 2015. ILO

Publications, 2011.15. Ministry of Health. Workplace Wellness Programme: Implementation Guide.16. Water Utilities Corporation. Strategy document on the implementation of safety health and environ-

ment in the water utilities corporation.

Ms Kagelelo Kemiso, assistant Librarian showing Botswana CIS-Centre collection.

Photo by Koketso Dumedisang

empowerment tool that can provide educa-tion in OH&S, with the aim of communi-cating knowledge, understanding and skills that will enable managers and workers in the workplace to recognize risk factors to their health and enable them to avoid or manage such factors in the work environ-ment.

2. It is important to have an effective comprehensive holistic and multi-sectoral

approach to health promotion interventions. An improved national health system, which includes an integrated national OH&S sys-tem, will deliver effective workplace health promotion. Collaboration and coordination among stakeholders will bring efficiency in health promotion efforts.

ConclusionA healthy workforce is an important prereq-uisite for economic growth and the global competitiveness of the country. Workplace health promotion should be a continuous process, lived by every worker and employer and it should be continuously improved. All levels of Botswana government, central and local government, non-governmental agen-cies, and the community need to play an in-tegral role in the sufficient delivery of work-place health promotion.

AcknowledgementI would like to show my appreciation to Ag-nes Moamogwe and Kagelelo Girlly Kemiso, who are officers at the Division of Occupa-tional Health and Safety. They were support-ive and provided some of the literature ma-terial used in this submission.

Dr Sinah Yamogetswe SeokeMinistry of Labour and Home AffairsDepartment of Occupational Health and Safety136 Independence AvenueCIS National CentrePrivate Bag 00241Gaborone, [email protected]


A health-promoting workplace recognizes that a healthy workforce is essential and that the health of workers is de-termined not only by occupational hazards, but also by so-cial and individual factors, and access to health services. A health-promoting workplace provides workers at all levels with appropriate administrative systems and procedures and safe working practices. In Tanzania the concept of workplace health promotion is ambiguous due to the fact that the ma-jority of the working population do not have secure jobs and work in informal workplaces that are not regulated. In such cases, worker health promotion as opposed to workplace health promotion is important, and prioritizing the infor-mal sector in public health, particularly health promotion, is necessary. It is common knowledge that healthy, safe workers produce more than those who are ailing.

Health is not only a product of individual behaviour, but also of forces that might be outside the individual’s control. Programmes such as fitness, stress management, smoking cessation,andnutrition/weightreductionarehealthpromo-tion programmes that target individuals, whereas the promo-tion of health through work organization and design target physical and psychosocial environments. In order for health promotion to be meaningful and ensure the health and safety of workers, it has to focus on both individual behaviour and work organization and design.

Hazards at workplaces in TanzaniaWorkers in Tanzania are exposed to numerous health and safety hazards, which might be physical, chemical, biologi-cal, mechanical, ergonomic, or psychosocial. Workers view hazards as part of life and at times take no precautions to prevent harm. Among the small-scale Tanzanite miners in Tanzania, deaths from work occur so regularly that people believe that deaths are necessary for these precious stones to be found, that it is the cost that the earth demands for giv-ing them up (1). This fatalism may be dismissed as the re-sult of ignorance or superstition, but on closer observation, it may just be an extreme example of a group of workers that has had no choice but to accept one of the fundamentals un-derlying occupational health and safety: that the health and safety of workers is a basic cost of production that cannot be avoided. This Easter holiday, on Good Friday, more than 36 people (most likely workers) died and several were injured at a construction site in Dar-es-Salaam when a 16-storey build-ing collapsed on them. This was one of several similar inci-

dences to occur in the country. During the same period in Moshono, Arusha, 14 workers died and a number were in-jured in a quarry following a land slide. Workers in agricul-ture are poisoned by pesticides every day, but the blame is usually placed on the victims for failure to follow instruc-tions when handling hazardous chemicals. The workers in Tanzania show a mentality of despair with regard to health and safety hazards. The majority trust their government to protect them through regulations and information sharing, regarding, for example, hazardous chemicals. But when a government or employer decides not to invest in necessary measures such as health promotion to protect its workers, the cost is transferred to those workers, who pay with their health, injuries, and sometimes their lives.

Occupational health and safety is a reality, wherever work is done. It is not a question of whether the cost can be borne, but by whom it will be borne. Safety hazards at work are more pronounced than health hazards, and they attract media attention and thus create awareness. However, some diseases associated with the work environment impact on productivity. Our modern lifestyle exacerbates these diseas-es, which are now increasing in Tanzania. These diseases in-clude high blood pressure, diabetes mellitus, cancer, infertil-ity, and psychiatric problems. Hypertension is very common in Tanzania; it is seen in 44–48% of executives. Overweight, obesity, lack of exercises, poor eating habits (more salt and sugar in foods) and excessive consumption of alcohol may contribute to hypertension.

Widespread tobacco use and drug abuse is another alarm-ing development in the country. The current young workforce is at higher risk of smoking and drug abuse. The World Health Organization (WHO) predicts that the smoking of tobacco will become the biggest single cause of death in the 21st century.

Health promotion in TanzaniaHealth promotion in Tanzania targets individuals and is seen as important for attaining the health-related United Na-tions Millennium Development Goals (MDGs), which aim for a reduction in child mortality; improvement in maternal health,thepreventionandcontrolofHIV/AIDS,areduc-tion in tuberculosis and malaria, access to better sanitation, and clean drinking water. The World Health Report (2) in-dicates that mortality, morbidity and disability attributed to the major non-communicable diseases currently account for about 60% of all deaths and 47% of the global burden of dis-

Vera NgowiTANZANIA

Health promotion at workplaces in Tanzania


ease, figures which will rise to 73% and 60%, respectively by 2020. The country is aware that 66% of the deaths attributed to non-communicable diseases occur in developing countries including Tanzania, where those affected are on average younger than in in-dustrialized countries. However, investment in research to determine factors contribut-ing to the diseases is limited.

Health promotion initiatives have there-fore focused on the need to reduce the level of exposure to the major risks resulting from an unhealthy diet and physical inactivity. Identifiable patterns of behaviours, which are determined by the interplay between an individual’s personal characteristics, social interactions, and socioeconomic and envi-ronmental living conditions, characterize lifestyles. Lifestyle habits that people choose either voluntarily or involuntarily, such as unhealthy food (e.g. use of sugars and salts), poor hygiene, coping mechanisms, exer-cise, alcohol use and cigarette smoking are known to affect their health. For example: If someoneisobese(fat)he/sheismorelikelyto develop high blood pressure and diabetes than someone who is not obese. Similarly, if one is always nervous and tense, one is at a greater risk of developing hyperacidity or a gastric ulcer.

Therefore, to save Tanzanians from de-veloping the non-communicable diseases within the scope of health education and health promotion, the general population is

encouraged to return to the old style of eat-ing more fruit and vegetables, and less fat, salt and refined foods; and to involve them-selves in more physical activities and avoid tobacco and alcohol.

Health promotion at workplaces in TanzaniaIn Tanzania lifestyles have changed, thanks to urbanization, globalization and the changed spectrum of occupation, accompa-nied by an increase in motor vehicles. More young people are moving from rural to ur-ban areas to seek employment and a better life. They work in construction sites and fac-tories (food, beverage, steel, and textile), in a number of activities, such as brick laying.

Workers’ health promotion needs to as-sure safe working practices for workers. Workers can adopt safe working practices to improve their own health by developing an understanding of their local work environ-ment in relation to their health. They need to know the joint impact of the physical and psychosocial environment on health, and that personal health practices and an indi-vidual’s sense of worth is determined by en-vironmental factors. Those who mine and think that a person has to die while mining so they can get minerals need to know that it is not true.

Workers can be encouraged to develop their knowledge of health and safety haz-ards in their work environment to enable

Fire hazard for cooks.

them to develop clear safe working proce-dures. They can improve their knowledge of equipment used at work and use advances in technology to innovate new methods of working safely. Workers could also be en-couraged to involve their communities in developing new working practices to ensure sustainability.

For example, the way in which a farmer controls a pest will greatly depend on avail-able resources, perceptions, and attitudes toward risk. Small-scale horticultural farm-ers in Tanzania are intensively exposed to highly toxic pesticides. (3) These are pre-dominately WHO Hazard Class II pesti-cides – i.e., moderately hazardous, such as organophosphate insecticides, which can cause acute poisoning (headaches, vomiting, blurred vision, tremors), as well as chron-ic effects (damage to the nerves, cancer). Training these farmers to conduct self-sur-veillance and monitor pesticide exposures has resulted in increased awareness, and a significant reduction in hazardous practices.

Dr. AVF NgowiDepartment of Environmental and Occupa-tional Health,School of Public Health and Social SciencesMuhimbili University of Health and Allied SciencesDar-es-Salaam, Tanzania

Photo by Vera Ngowi

References

1. WAHSA,2008. Work and Health in South-ern Africa. Findings and outputs of the WAHSA Programme, 2004–2008. Depart-ment of Occupational and Environmental Health, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, South Africa.

2. WHO, 2002. The World Health Report 2002 - Reducing Risks, Promoting Healthy Life http://www.who.int/whr/2002/en/ accessed 22 March 2012.

3. Ngowi AVF, Rongo LMB and Mbise TJ. Community-Based Monitoring of Pesti-cides Impact in Ngarenanyuki, Tanzania. In the Encyclopedia of Environmental Management 2012, DOI: 10.1081/E-EEM-120046906.


Louwna PretoriusSOUTH AFRICA

IntroductionAttaining the general goal of “Health for all by the year 2000” as put forward by the World Health Organization (WHO), requires input from all resources of industry and other eco-nomic sectors.

The International Labour Organization Convention (ILO) at their International Labour Conference outlined three fundamental principles:• Workshouldtakeplaceinasafeandhealthyenvironment• Conditionsofworkshouldbeconsistentwithworkers’ well-being and human dignity.• Workshouldofferrealpossibilitiesforpersonalachieve- ment, self-fulfillment and service to the society.

ThejointILO/WHOCommitteein1992stressedthatthescope of occupational health is very broad and involves the disciplines of occupational medicine, occupational hygiene, occupational safety, ergonomics, engineering and toxicology.

Occupational Health contributes to “sustainable devel-opment” as outlined in the Rio Declaration on environment and development, which emphasizes people’s rights to lead “healthy and productive lives in harmony with nature; sus-tainable development implies development that meets the needs of the present without compromising the ability of fu-ture generations to meet their own needs”(1).

Professionals in health services management cannot function in isolation. Employees are citizens with certain rights (Chapter 3 of the South African Constitution deals with the fundamental rights that includes some of the fol-lowing aspects: equality, human dignity, freedom and secu-rityofpeople,privacy,religion,freedomofexpression/move-ment, access to information, labour relations to name a few). The occupational health professional must function with-in the legal framework at national and provincial levels as well as by-laws issued by local authorities. The Occupation-al Health Service (OHS) is obliged to ensure optimal health care delivery within these legislative parameters. If the health care delivery does not meet the required standards, medico-legal risks will occur which could be detrimental to the em-ployee (2).

The Occupational Health practice in the South African context (given on site at an OHS facility) includes but is not limited to the following:

Occupational health nursing practice in the private sector in South Africa

• Occupationalmedicine• Occupationalhygiene• Primaryhealthcare.

It is important to understand that Occupational Medi-cine and Primary Health Care are practised by the Occupa-tional Medical Practitioner (OMP) and the Occupational Health Nursing Practitioner (OHNP), while Occupation-al Hygiene is a specialized field practised by qualified Oc-cupational Hygienists. Related disciplines such as occupa-tional health nursing, occupational medicine, occupational hygiene, ergonomics, safety organization and management, quality and environmental issues are integrated in most pri-vate sector organizations to develop a total healthcare pro-gramme, which will best serve the needs of the industry. These disciplines are always interlinked as described in Fig-ure 1. and will therefore always function together in an effec-tive Safety, Health and the Environment (SHE) programme.

Sociological considerations Sociology deals with the way people behave and aims to un-derstand and predict human behaviour, in particular behav-iour of a person in a group. Communities in South Africa

BIOLOGICAL

OCCUPATIONAL MEDICINE

SOCIAL UPLIFTMENT

PRIMARYHEALTH CARE

HAZARDANTICIPATION

OCCUPATIONALHYGIENE

• Identification• Measurement• Evaluation• Control • Medical surveillance

programme• Compiance with legislative requirements• Occupational disease/ injury management

Figure 1. South African perspective on occupational health

• Life-style education• Early identification of illness/disease• Chronic disease management


The facilities to provide areas for private coun-selling.

Photos Alma Schultz

vary from deprived communities in infor-mal settlements, to more affluent commu-nities in the urban and other areas. There-fore disparity in healthcare delivery is evi-dent between those people that can afford it (medical schemes) and those that cannot. The activities of the OHS are to a great ex-tent determined by the finances available, as well as the needs of the community. The oc-cupational health nursing practitioner must always consider the employee as a part of a family, a work situation, a community, the social class structure, a religious or recrea-tional group. Social causes of diseases are of particular interest to occupational health professionals. Factors such as productivity, agestructure,literacylevels,labourstability/unemployment and the health profile of the community are closely associated with the economic system and its influences (3).

The work a person does may not only be the cause of disease or of physical and men-tal stress, it may also influence non-occu-pational diseases. Many effects of work are adverse, but employment actually also offers opportunities for stimulating activities and is often the source of establishing social con-tacts and friendships.

The effects of health on work may be considered at three levels. Firstly, there are the young and middle-aged who have no apparent health problems. Secondly, there are those whose work ability has been im-paired by illness or injury. These workers should continue working unless the condi-tion is made worse by work. Thirdly, there are those whose health may impact on the health and safety of fellow colleagues or the community. Airline pilots, vehicle drivers, crane drivers, employees exposed to ex-tremes of heat and cold, hazardous chemi-cals are legally required to be certified medi-cally fit to perform their task.

Culture and diseaseIt is important to remember that the West-ern world’s approach to disease differs from that of other cultures. Due to the diversity of the society relating to religious, politi-cal, cultural affiliations and beliefs, it is im-perative that OHS acknowledges the various groupings, knows the possible health pro-files and renders care in accordance with the client needs.

Certain race groups are more prone to diseases, which provides the OHS team with an opportunity to be on the lookout for ex-isting or developing disease profiles.

It is essential for the OHNP to under-stand the client’s beliefs system about health and disease. By understanding the point of referencehe/shecaninterpretthepatient’scondition and adjust the treatment accord-ingly. Compliance with the medical regime is crucial and many African patients may use both western and traditional medicine. They normally use western medicine for minor ailments or acute infections, e.g. in-jury or suturing, but when symptoms are not easily apparent, e.g. hypertension, they would rather turn to traditional healers. Having respect for the patient’s choice of treatment is important. Where both western and traditional medicines are used it is im-portant to make sure they do not counteract each other.

Social class and diseasePeople from lower social classes have less access to the good things in life, which would include a good standard of living, education and good healthcare. People from lower social classes have higher mortality and morbidity rates. Lack of recognition of symptoms leads to neglect and the devel-opment of chronic conditions. This is more likely to occur in previously disadvantaged

groups who had less information about dis-eases often as a result of limited education, less ability to read and less access to the most recent information about diseases. The standard of health service delivery in these areas or groupings is not always desirable.

The family and diseaseWorkers must not be seen as isolated indi-viduals, but as members of families. A work-er with problems at home or at work will likely struggle to concentrate on the task at hand,makinghim/hermorepronetopos-sible incidents, accident or injury. Impor-tant information on the following should bereadilyavailable:Whereishe/sheliving–withfamilyorapart/migrantlabour/con-tractor?

Aspects such as violence, crime and death in the family or any stress-related situ-ation, e.g. threat of redundancy may also in-fluence the performance of employees in the workplace. The occupational health nurs-ing practitioner should take these sociologi-cal and psychological impacts into consid-eration and will be required to perform any necessary referral or counselling.

Occupational health service deliveryIn order to maintain and promote the physi-cal and mental well-being of workers and to adapt the work to the person, occupational health in its broad sense deals with the total health of the employed person. Non-occu-pational diseases and illnesses (e.g. diabe-tes, epilepsy, heart disease, colour blindness, etc.) also have a great influence on the well-being and working capacity of those suffer-ing from them, and endemic or epidemic diseases of non-occupational origin (ma-laria,influenza,HIV/AIDS)canaffecttheworking population and production over a wide spectrum. The interdependence of in-dividuals in the working community has be-come increasingly evident and is now gener-ally recognized (poor vision in a crane op-erator is just as big a risk to the safety of his fellow workers as to himself).

Occupational health services are set up, maintained and used in order that the de-clared aim of occupational health may be attained by means of a comprehensive sys-tem of both medical and technical measures (their mainly preventive role).


Functions of occupational health serviceIndustries differ in size, manufacturing pro-cesses, hazards, etc. Occupational health service delivery within the industry will vary but the general principles stay the same, aiming at preventive and promotive initiatives. The extent of the service will be determined by numerous factors such as the size of the workforce, nature of the indus-try and associated risks profile, geographi-cal proximity to other health care services and employee demographics. South African industries currently provide a large number of curative services, due to the fact that the majority of the labour force does not belong to private medical schemes and public facili-ties are not usually within easy reach of em-ployment facilities; therefore minor prob-lems and day-to-day ailments and chronic diseases are monitored or treated by the oc-cupational health staff.

The essential functions of occupational health services include, but are not limited to the following:

Hazard identification and (Health) risk assessmentAn effective programme for OHS starts with the identification, evaluation and monitor-ing of workplace hazards. Informal walk-through surveys are helpful for the overall assessment of the facility to identify poten-tial “problem areas” pertaining the process, equipment, chemicals, raw materials, occu-pations, tasks and equipment.

A health risk assessment is compiled once the identified hazards and risks have been measured through occupational hy-giene surveys. The results of these surveys are critical in determining the exposure lev-els of employees to certain environmental (occupational hygiene) stressors.

When the Occupational Exposure Limit (OEL) level of an agent (stressor) has been identified as to at or near action level, it will provide an indication of the employees to be medically examined and tested as part of the medical surveillance and biological moni-toring programme (3).

The medical surveillance programme serves as a preventive tool against occu-pational disease and injury incidents and should be the driving force behind the estab-lishment of an occupational health service.

Selection and PlacementTwo types of medical assessments are per-

formed;base-line/preemploymentmedi-cal examinations (prior to employment) and pre-placement (prior to placement or trans-fer). People are placed in certain positions based on a pre-placement medical exami-nation. Pre employment medical examina-tion used to serve as a tool for the selection of employees, based on inherent job require-ment criteria. This medical examination can be used to identify physical or mental dis-abilities which could be a handicap in spe-cific jobs, i.e. a person with chronic respira-tory disease in occupations with dust expo-sure. The pre-placement medical should be done prior to placement to assess the per-son’s ability and, where possible, to match his capacity, no matter how limited, to a suitable job.

The guidance criteria for placement through medical examinations are deter-minedthroughtheuseofperson/jobspeci-fications (inherent job requirement). Refer-ence should be made to legislation that pro-hibits any discrimination regarding employ-ment practices, but that the law also provides guidance to the employer in this regard.

Medical surveillance and periodic health reviews, trend analysis and epidemiological studiesThe system of medical surveillance must be risk-based according to the health hazards that employees are exposed to. Therefore quantification and qualification of the risk exposure, the number of employees exposed per occupation, task and area needs to be indicated.

The medical surveillance programme is designed to provide the employer with rele-vant information on controlling health haz-ards and for the detection, prevention and monitoring of occupational over-exposure, occupationaldiseasesand/orinjuries.Thefunctions of the OHS are covered as part of the induction process for new employees.

Retaining people in suitable employ-ment (vocational rehabilitation)The occupational health service has a re-sponsibility to assist management in identi-fying employees who, as a result of sickness or injury, can no longer continue in their former jobs or need to have these modified to suit their ability. The OHS is involved at an early stage to take measures for re-as-signment/rehabilitation.Employeesinthesecategories represent workers suffering from chronic diseases, terminal conditions and

permanent disabilities.

Supervision of vulnerable groupsIn any working situation vulnerable groups exist, e.g. the young, the old, women, shift workers, disabled people and those with prolonged or repeated absences from work. These absences can be due to chronic ill-nesses. The occupational health staff will supervise these groups and make recom-mendations, i.e. reduce the work load of a worker whose skill or productivity has been reduced as a result of age, injury or disease, arrange for re-deployment where necessary and ensure that no woman of child-bearing age, who plans to have a family or is already pregnant is exposed to substances and an environment that can have a detrimental ef-fect on the unborn foetus.

The OHS are responsible for actively promoting the adaptation of the workplace to the worker, particularly in vulnerable groups.

The provision of First AidProviding first aid, emergency treatment and medical care used to be the main func-tion of the OHS in the workplace. Treating injuries,acuteexposureand/orpoisoningand minor ailments efficiently and speed-ily prevents complications and assists in the rehabilitation process. The OHS plays a cru-cial role in the treatment, reporting, and fol-low up of injuries and diseases and in the re-habilitation process of the employee. Unnec-essary loss of working time, travel expenses and waiting in over-crowded outpatient de-partments can be greatly reduced by a ser-vice providing effective preventive care and medical treatment at the workplace. The role of first aiders and emergency teams in disas-ter management of serious incidents at work is well defined.

There is a tendency for the morale of workers as well as their productivity to in-crease where reliable healthcare is readily available.

In situations where on-site OHS is not available, the line supervisor will be the first person to receive information regarding an occupationalinjury/incident.Inthesecasesthe employer has a pre-arranged agreement with a local Doctor, paramedics, ambulance service or hospital to care for the injured or ill employee. This agreement includes a pro-cess of familiarising the healthcare provid-er with the workplace environment and any potential hazardous agents or process (4).


Photo Alma Schultz

Increased absenteeism from the workplace has been identified, when employees con-sult doctors and nurses, operating in off-site facilities and who are not familiar with the employee’s job and work environment.

Participation in the development of Occupational Health and Safety programmesIn industry the prime responsibility for health and safety rests with management. The availability of an OHS can greatly re-duce the incidence and prevalence of occu-pational diseases and incidents. It includes participation in the investigation and anal-ysis of occupational injuries and occupa-tional diseases; the evaluation of health re-latedaspectsofnewequipment/machineryand the compilation of trend analyses in the prevention of future occupational in-cidents(injury/illness)canbesuccessfullycontrolled or eliminated completely.

The OHS play an active role in the in-duction programme for new as well as es-tablished workers in providing employee health education, awareness and health promotion. It provides also an opportunity to make employees aware of hazards and risks at work, hazardous chemicals and conditions and the role and function of the OHS in promoting health. The OHS play a vital role in ensuring that the employee ismedicallyfitforthejob/occupationforwhichhe/sheisemployed.

Screening workers for early evidence of non-occupational diseasesThe occupational health nursing practi-tioner is in an ideal position to identify the early signs and symptoms of non-occu-pational diseases. Coronary heart disease, hypertension,diabetes,TB,HIV/AIDSandmental illness are just some of the condi-tions. Health education and health promo-tion plays a pivotal role in early diagnosis and treatment which could prevent a full-scale development of the disease profile.

Social services and counsellingCounselling is the empathetic listen-ing to and understanding of another per-son’s problems. Not only does this include health problems but also social and work-related problems. The OHNP plays a very important role in counselling workers and will support the worker in decision-mak-ing. Once the worker has decided how to resolve the problem, the counsellor will

assisthim/herwithinformation,refer-rals and encouragement. Confidentiality is of utmost importance. The establishment of an Employee Assistance Programmes (EAP) and the rehabilitation of injured or sick employees are also covered as part of the counselling process. Social services and counselling may form part of the over-all employee assistance programme. Com-munity resources such as social workers, ministers, psychologists, etc., may also be used.

Occupational health and safetytraining and inductionResearch has found that workers in indus-tries such as mining, chemical manufac-turing, and steel and alloy operations show a higher than average incidence of prob-lems associated with dermatitis, muscu-loskeletal problems, pulmonary disease, mental illness and cancer amongst oth-ers (5).

Health education and safety training can be carried out through formal edu-cation programmes for management and employees or when the individual visits the occupational health service for treat-ment on a one-to-one basis. Training is less costly than treatment. Preventing ill-ness or incidents through proper training and education is far less expensive than re-habilitation.

Occupational health and safety educa-tion should cover all categories of work-ers in order to enhance their awareness of health and safety measures. It provides specialist skills for the worker and should not be taught separately from the work process itself (job specific training). Safe

behaviour at work, the use of personal pro-tective clothing (PPE), attention to per-sonal hygiene and general health should become an integral part of the working habits.

It is of critical importance that em-ployees are informed about the health and safety hazards in the workplace and how to deal with them in terms of control meas-ures. The OHS should be actively involved in providing information pertaining to health hazards and the consequences of possible exposure and the function of the medical surveillance programme in moni-toring health effects. It also includes advice on occupational safety and hygiene, ergo-nomics and the use of PPE.

Employee well-being, health education, promotion and rehabilitationHealth promotion is an active process, which is directed at changing people’s atti-tudes and influencing their behaviour, for the better, in health-related matters. The aims of health promotion and education are to make health a high priority in the individual’s value system, to teach people the principles of healthy living and to pro-vide information concerning health issues and services. Examples include informa-tiononHIV/AIDS,fitness,well-beingandlifestyle.

The responsibility for health does not lie with the government or the medical profession alone. It is also every individ-ual’s own responsibility to manage his or her own health. Through training and ed-ucation, individuals are taught to take re-sponsibility for their own health. The right to health services remains the responsibil-ity of the government, industry, etc. The OHNP participation is pivotal in estab-lishing health education, promotion, and well-being as well as rehabilitation pro-grammes.

Administration of service/Policy and procedure developmentThe OHS is responsible for the develop-ment of appropriate occupational practice policies and procedures and maintaining an accurate confidential record manage-ment system (5).

Policy and procedure development forms part of the OHNP management pro-cess of planning, organizing, co-ordinat-ing, and control which may include as-pects such as financial management, re-


Literature

Rantanen J, Fedotov IA. Standards, princi-ples and approaches in occupational health services standards. Accessed 1 April 2011.Available from http://www.ilo.org/wcmsp5/groups/public@ed_pro-tect/@protrav/@safework/documents/publications/wcms_110439.pdf

Coetzee S, Pretorius A, Strasheim P. Occu-pational health nursing in South Africa, 2nd edition. Objective Print: Johannes-burg.1997. A2.5

References

1. Cliff Dekker Attorneys. King11Report on corporate governance in South Africa: Integrated Sustainability Report-ing. Johannesburg. 2002;91–124.

2. Booyens SW (Ed). Introduction into health service management. 3rd edi-tion. Kenwyn: Juta. 2008.

3. Guild R, Ehrlich RI, Johnston JR, Ross MH. Simrac Handbook of occupational health practice in the SA mining Indus-try. Creda Publishers: Johannesburg. 2001.

4. Rogers B, Travers P, Mc Dougall C. Guidelines for an occupational health and safety service. (AAOHN – American occupational health Nurses Inc), AAOHN Publications: Atlanta, Georgia.1995.

5. Michell K, (Ed). A basic approach to occupational health nursing. Wilpro printers: Johannesburg. 2011:25–33.

cording and reporting, research and com-munication. The OHNP has a legal obliga-tion to keep records of health services pro-vided to all employees. The record keeping in the OHS includes individual health re-cords, administrative records and miscella-neous records.

Article compiled by:Louwna J. Pretorius (ICOHmember/SCOHNchairperson/ANSAFellow)Former SASOHN president Occ Health Services Co coordinator Corobrik Pty (LTD)PO Box 49 Germiston 1400South [email protected]

Background The informal sector concept was first in-troduced by the International Labour Or-ganization (ILO) 30 years ago (1) as a type of trade that takes place outside the formal economy (2). The informal sector (some-times referred to as the “informal econ-omy”) includes a variety of activities and sub-sectors (3). Examples of informal sec-tor trades are car repairs, spray painting, furniture making and upholstering, food vending, hair dressing, hawking, shoe re-pairs and telephone operating amongst others. The sector is run mostly by self-employed people commonly in urban, semi-urban and rural areas of developing countries (2). Activities in the informal sector do not normally obtain formal ap-proval from the relevant authorities and might not be subjected to enforcement by legislation (2). In South Africa, the in-formal sector is rarely registered with the Registrar of Business and South African Revenue Services (SARS) and it does not pay rates and taxes, but a stipulated rental fee is sometimes paid to a municipality (4).

Risk assessment of the informal sector workplaces An occupational health and safety risk as-sessment (HRA) was conducted within

Occupational health and safety in the informal sector– an observational report

N.M. Mogane, M.G.L. Ntlailane, K.A. Renton, M.J. Manganyi, G.E. Mizan, C.D. Vuma, T. Madzivhandila, S. A. Maloisane, K.C. Lekgetho, G.J. Sekobe

SOUTH AFRICA

the city of Johannesburg and in two town-ships just outside the city, using a Nation-al Health Laboratory Services risk assess-menttool(5)andachecklist/question-naire. The businesses were divided into two groups, A and B. Group A included thosetrades/activitieswithshelters,i.e.those operating from a home, from a well-built municipal stall, or forming part of a semi-organized industry that can be classi-fied as a small to medium-sized enterprise (SME).GroupBwerethosetrades/activi-ties located on the streets without proper shelter. The results of the HRA are detailed below according to the various types of occupational hazards including physical, chemical, biological, ergonomic, psycho-social, as well as general safety.

Limitations of the studyA variety of trades were selected in order to assess the risks from a wide range of ac-tivities. However, it was not feasible to in-spectalltypesoftrades/activitiesduetothe limited time and resources available for this study. The observations were made mainly during the mornings, but it is rec-ognized that often the peak business hours are between 16:00–18:00 and also during pay day periods when higher customer movement is anticipated.


ObservationsThe businesses observed during this as-sessment included motor mechanics, panel beating and spray painting, carpentry, al-uminium and glass works, welding, food preparation and sales, fruit and vegetable sales, shoe makers and oil processors. The observed health risks, classified according to the different occupational hazards were as detailed below.

Physical hazardsTraders were exposed to a range of physi-cal hazards including thermal and cold stresses, noise, vibration and ultraviolet (UV) radiation. Traders in Group B were exposed to extreme cold during winter, while some traders from Group A were exposed to thermal stress in summer and humid conditions, especially caterers in kitchens, due to inadequate ventilation systems. Exposure to ultraviolet radiation from sunlight was common among Group B traders (see Photo 1), whereas Group A traders were also exposed to ultraviolet and infra-red radiation from welding pro-cesses.

Traders in the panel beating and spray painting, carpentry, aluminium and steel workshops, welding workshops, as well as the upholstery industries, were exposed to high noise levels and hand-arm vibration (see Photo 2). Group B traders, especially in the central business area, were exposed to continuous background noise from traf-fic and other activities, such as police car sirens, metal and bottle waste collection. Wide use of unshaded, self-installed in-

candescent lighting, fitted at close range to the traders, was observed in one Group B location.

Hazardous chemical substances (HCS)In both groups it was found that the trad-ers were exposed to a range of HCS, in-cluding both commercial and those that are created as they try to improvise. A strong smell of paint vapours, paint re-movers and paint thinners was noted dur-ing the assessment in the paint mixing and spray painting (motor mechanic and carpentry) facilities. In a study by Spies (2008) (4), spray painting workers were found to be exposed to high concentra-tions of isocyanates. Fumes from paraffin and liquid petroleum gas used for cook-ing and heating purposes in kitchens may build up in the stalls resulting in fossil fuel gas inhalation. Exposure to welding fumes that are a complex mixture of HCS were noted in the welding industry.

In car mechanic and upholstery in-dustries,workerswereexposedtooiland/or degreasers. In other locations oil recy-cling was practised which exposed trad-ers to diesel particulates during the heat-ing process. Dry abrasion of paints from old cars exposed traders to paint and metal dust, as well as lead. In the aluminium and glass works, workers may be exposed to metal (steel, aluminium and copper) and glass dust released during cutting opera-tions. Shoe repairers and carpenters were exposed to leather and wood dust. Possible exposure to other HCS was also observed in some Group B traders who clean and

sell empty chemical containers which pre-viously contained a range of toxic chemi-cal mixtures. Exposure to asbestos during brake and clutch repair in older car models is also likely.

Material Safety Data Sheets (MSDS) were not available in all the locations vis-ited. Disposable respirators were occasion-ally used; however it was found that these were inappropriate for the type of chemi-cals used.

Hazardous biological agentsPoor maintenance of the ablution facili-ties used by some Group A traders result-ed in unhygienic water accumulation on the floor. In the same location, waste bins waiting to be removed from the kitchen ar-eas were observed to be in poor hygienic condition. This results in microbial growth and possible exposure to hazardous bio-logical agents. In one location in Group B waste water and other waste were disposed of into the storm drainage system area, causing blockages and resulting in a nui-sance smell and a breeding place for flies. The same area was also occupied by home-less people at night resulting in unhygienic conditions and an unpleasant smell around the trading area.

Ergonomics Working in awkward positions as a result of poor working station designs was of-ten observed. Traders lift heavy loads and at times have to carry them over long dis-tances. In many instances no proper er-gonomic chairs were available and trad-ers were observed sitting on makeshift “seats” like concrete stools, drums, crates, buckets and other non-ergonomically de-signed chairs (see Photo 3). Cramped con-ditions were often observed in some stalls in Group B.

Psychosocial hazardsSome conditions that informal traders have to tolerate include violence by cus-tomers when the latter are dissatisfied with the products. Theft and occasional confis-cation of goods by government officials, for those who cannot afford the rent or do not have permits, are common occurrenc-es for Group B traders. These findings are consistent with the findings reported by Alfers (6).

Photo 1. Workers who have no proper shelter.Photo NHLS / Occupational Hygiene Unit


General safety concerns

Fire hazards from the use of paraffin, LPG and unsafe electrical connections and placement of heaters, coupled with clut-ter of boxes and other flammable materi-als in stalls of both groups A and B, are a concern. Outdated fire fighting equipment in Group A, a complete lack of it in most of Group B, and a lack of first aid kits in both groups was observed. As previous-ly mentioned, PPE was not widely used; for example a worker was observed wear-ing canvas shoes in a glass and aluminium workshop.

Conclusion and recommendationsErgonomics, psychological hazards, as well as general safety concerns were found in both groups. When comparing group A (with enclosed shelters) and Group B (without shelters), group B traders were mostly exposed to a range of physical haz-ards, while group A were mainly exposed

to chemical hazards, which were due to poor ventilation systems.

Mitigation of exposure to the above hazards should include introducing the ILO’s programmes such as Work Improve-ments in Small Enterprises (WISE) (7) and Work Improvement in the Neighbourhood Development (WIND) (8).

Collaboration between state depart-ments, municipalities, traders’ represent-atives and occupational health experts should help address the need to reduce risks such as:• designingstructureswhichareergo- nomic, safe and well-ventilated• providingtrainingonhealtheffectsof hazards exposure, legislation, the types of control measures to employ, specific PPE for specific hazards, proper use and maintenance of PPE, Material Safety Data Sheets, emergency procedures, and first aid• improvingaccessibilitytooccupational

health services by incorporating them into the current public health service provided by the municipalities.

N.M. Mogane, M.G.L. Ntlailane, K.A. Renton, M.J. Manganyi, G.E. Mizan, C.D. Vuma, T. Madzivhandila, S. A. Maloisane, K.C. Lek-getho, G.J. SekobeNational Institute for Occupational Health NHLS National Health Laboratory Service25 Hospital St., Constitution Hill &106 Joubert St Ext.,Braamfontein, Box 4788, Johannesburg, 2000 South Africawww.nhls.ac.zawww.nioh.ac.za

Photo 2. The identified source of noise and vi-bration.

Photo 3. Seating facili-ties that pose a chal-lenge.

Photos NHLS / Occupational Hygiene Unit

References

1. Bangasser PE. The ILO and the informal sector: an institutional history EMPLOY-MENT PAPER [serial on the Internet]. 2000. Available from: http://www.ilo.org/wcmsp5/groups/public/--ed_emp/docu-ments/publication/wcms_142295.pdf

2. Philippines Got. Government of the Phil-ippines: Philippines social reform agenda, master plan of operations, workers’ protection and welfare, workers especially in the informal sector.

3. Becker KF. Fact finding study The Informal Economy, SIDA 2004. Available from: http://rru.worldbank.org/Documents/PapersLinks/Sida.pdf.

4. Spies A. Assessment of the exposure as-sociated health effects to hexamethylene diisocyanate (HDI) in automotive spray painting processes in small, medium and micro enterprises. Johannesburg: Univer-sity of the Witwatersrand, 2006.

5. National Health Laboratory Services risk assessment tool http://www.nioh.ac.za/?page=risk_assessments&id=88

6. Alfers L. Occupational health & safety for informal workers in Ghana: a case study of markets and street traders in Accra: Avail-able from: http://erd.eui.eu/media/2010/Alfers-201006.pdf.

7. ILO. Work improvement in small enterprises – WISE. Rural development through decent work [serial on the Inter-net]. 2011. Available from: http://www.ilo.org/wcmsp5/groups/public/---ed_emp/documents/publication/wcms_159283.pdf.

8. ILO. Work improvement in neighbour-hood development – WIND. Rural development through decent work [serial on the Internet]. 2011. Available from: http://www.ilo.org/wcmsp5/groups/public/---ed_emp/documents/publica-tion/wcms_159173.pdf.


Merja Turpeinen, Anne Salmi, Jaana LaitinenFINLAND

Everybody acknowledges the importance of young people en-tering into work life and obtaining work experience. What about their work ability and health? It is equally important that they learn the most profitable ways to promote their own health and work ability from the very beginning of their work careers. These include, for instance, taking account of and cop-ing with the special characteristics of their work, resting and eating well. Paying attention to your health and work ability from the beginning of your work career will result in work cre-ating well-being, also later in life. In a similar way, successful entrance into work life helps young immigrants integrate into their new home country. How can we support these important processes of obtaining work and taking care of one’s work abil-ity and health already at a young age? What about employers – what can they do?

In 2012, the Finnish Institute of Occupational Health (FI-OH) started a project to promote the work ability of young immigrants at the beginning of their careers (NuMaT pro-ject). The NuMaT project gathers best practices and exam-ples of how young immigrants can find jobs in challenging labour markets. NuMaT also seeks to gather best practices concerning orientation periods and initial training and how to put these into practice at workplaces.

In the project interviews, young immigrants have talked about their entrance into the Finnish labour market. Several employers, supervisors and workmates from multicultural work environments have also shared their views on young immigrants’ arrival at workplaces. In the NuMaT project we have classified some of the common problematic situa-tions with the help of the Work ability house (Työkyvyn talo in Finnish) (1), a model developed by Professor Juhani Il-marinen in the 1990s. It is a multidimensional work ability model that is primarily based on several studies and develop-ment projects conducted in the 1990s on occupational well-being in different industrial sectors and among different age groups. The holistic image of work ability consists of both the resources of the individual and factors related to work and the environment outside of work (2, 3). The dimensions of work ability can be depicted in the form of a work ability house, its floors, and the surrounding environment.

How can we support young immigrants’ health and work ability at workplaces?

New work, new country – challenging situations for young people When moving to a new country you need to learn many things, possibly even a new language. It may also be chal-lenging to find work, especially for young people with little or no work experience at all. Occupational competence re-quirements may also vary and young immigrants’ vocational education is not always recognized in the new home coun-try. Immigrants may have to either study further in the same field or begin a totally new career path. Employers may also have prejudices against hiring an immigrant.

As challenging as it is, finding their first job is never-theless crucial for gaining a position in the labour market. Working is a good way for them to familiarize themselves with the new culture. Social networks play an important role for young immigrants when trying to find work. Although family also offers significant social support, some young im-migrants may be under pressure if relatives expect them to succeed and sometimes even provide financial support for relatives in their country of origin.

Young people need to learn how to act in the work envi-ronment and work community. Unfortunately some young immigrants may be confronted with discrimination. This is challenging, especially for those with less education and no work experience. They may lack knowledge regarding their right to equal treatment and how to act in difficult situations at the workplace. Some may be too shy to speak up for them-selves. Possible linguistic difficulties or a lack of social net-works may make the situation even harder to handle.

Nevertheless, young immigrants seem to be highly moti-vated to learn and succeed at work and to build their careers and lives in their new home country.

Methods of support: promoting young immigrants’ work ability and health at the workplace Open-minded recruiting – a trump card?

Knowledge about the task at hand should be given hon-estly and explicitly to young applicants who have little work experience. Mutual understanding of the expectations and du-ties at work and of the required qualifications are a good start.


As an employer, it is also important to reflect on your own attitudes and to criti-cally evaluate whether the organization’s re-cruiting practices may discriminate some applicants. On what grounds do you turn applications down? Do recruiting proce-dures implicitly favour certain cultural backgrounds? Every applicant is an indi-vidual with different kinds of competencies. Are you willing to recognize the benefits of backgrounds or competences that are not so familiar among your present personnel or among other job-seekers? Perhaps these new qualifications or individual features could offer something extra to the organiza-tion. Could they, for instance, offer help in improving customer service?

Clear instructions and the right to ask – orientation and initial training form a valuable basis Good initial training is well-planned, en-trusted in several people’s hands and evalu-ated together with the new employee. You must allocate enough time and resources. The best support for the young immigrant worker comes in the form of encourage-ment: encourage them to ask about any-thing that might be unclear, strange, or just comes to mind. Be clear and make sure in several different ways that you have been understood properly. Use different kinds of materials, e.g. illustrated work instructions, pictures etc. as instruments in initial train-ing.

Guide the new employee in the organi-zation’s culture, practices and informal pro-cedures. What is appropriate and desirable

behaviour at the workplace and why? The language of the workplace should also be addressed. Does initial training include the use of professional terms, jargon or terms that are only used in your organization?

Usually the new employee is also told about the ways in which the organization promotes the professional skills, motiva-tion and health and safety of its employees. It is good to go through employment legisla-tion and regulations. How about the possi-ble stress-causing factors at work? Do young immigrants receive instructions on how to take care of their well-being at the work-place and through lifestyle choices? The su-pervisors interviewed in the study stressed the importance of asking immigrant work-ers discreetly and culture-sensitively about their work ability and of encouraging them to take care of themselves and ask for help from occupational health services if needed.

Welcoming a young immigrant to the work communityIf your organization is not used to em-ploying immigrants, it is important to pre-pare the personnel for receiving immigrant workers into the work community. Discuss the subject and find some information about multicultural workplaces. Some might even hire an outside consultant for help if doubts seem to rise about how to behave around the newcomer.

The supervisor’s role is important in supporting the beginner. Each member of the work community can also do something to make the beginning easier for the new-comer. Do you get acquainted with and chat

with your new workmates? Do you ask them to join the coffee break and lunch? How do you make sure that the new employee is not left alone?

Successful recruitment and initial train-ing practices are good for all new employ-ees. The same applies to supervisory guid-ance: it needs to be fair, impartial and suit-able for every subordinate. Well-being at work can be generated for everyone and by everyone. Like so many other things, well-being at work is mostly a matter of will.

Visit the NuMaT project website:www.ttl.fi/en/research/research_projects/working_career/numat_project/pages/de-fault.aspx

The Promoting the work ability of young immigrants at the beginning of their careers (NuMaT) project is funded by the Euro-pean Social Fund (ESF), and carried out by the Finnish Institute of Occupational Health (FIOH). The first results will be published in the spring of 2013, and the project will con-tinue until 30.6.2014.

NuMaT projectFinnish Institute of Occupational HealthTopeliuksenkatu 41 a A00250 HelsinkiFinlandwww.ttl.fi

Merja Turpeinen, ResearcherFinnish Institute of Occupational Health, Promotion of Work Ability and HealthE-mail: [email protected]

Anne Salmi, Senior SpecialistFinnish Institute of Occupational Health, Promotion of Work Ability and HealthE-mail: [email protected]

Jaana Laitinen, Team LeaderFinnish Institute of Occupational Health, Promotion of Work Ability and HealthE-mail: [email protected]

The Work Abil-ity House de-scribes the dif-ferent dimen-sions that affect the worker’s work ability. The figure is based on the model devel-oped by Profes-sor Juhani Il-marinen). Book: Ikä-voimaa työhön (Age Power), FIOH 2011.

Literature:

1. http://www.ttl.fi/en/health/wai/multidi-mensional_work_ability_model/Pages/default.aspx

2. Gould R, Ilmarinen J, Järvisalo J, Koskinen S (editors). Dimensions of Work Ability, Finn-ish Centre for Pensions, Helsinki 2008.

3. Tuomi K, Ilmarinen J, Jahkola A, Katajarinne L, Tulkki A. Work Ability Index. 2nd revised edn. Helsinki: Finnish Institute of Occupa-tional Health, 1998.

18 • Afr Newslett on Occup Health and Safety 2013;23:18

A total of 150 occupational health and safety experts from 33 countries gath-ered in Dresden on 6–7 February 2013 for the 3rd International Strategy Confer-ence on Occupational Health and Safe-ty. The importance of the Conference was well reflected by the number of organizers: DGUV as the main organizer in collabo-ration with WHO, ILO, ISSA, EU-OSHA, IALI, ICOH and IOHA.

The theme of the Conference was ‘Net-working as a driving force for a culture of prevention’. Prevention of occupational health and safety hazards and risks is by definition multisectorial, multidisciplinary and multifunctional activity. It is there-fore important to stop and identify the key players in our societies in order to create a prevention culture. Prevention pays off; 92% of health expenditures in the world go to curative care. Occupational accidents and diseases are preventable in principle, and work-related diseases can be mitigated with appropriate preventive measures. The vast majority of the knowledge needed to improve the situation is already available.

Networking emphasized in Dresden

Suvi Lehtinen,FINLAND

What we lack is informed action and im-plementation.

The DGUV, together with ILO and IS-SA, is preparing for the World Congress in Frankfurt, Germany, scheduled for 24–28 August 2014. This Strategy Conference was one milestone on the road to Frankfurt. For prevention culture, another stepping stone will be the forthcoming Symposium in Helsinki, Finland, on 25–27 September 2013. The aim of the Helsinki Symposium is to gather research and other evidence available worldwide on what can be done to promote a prevention culture and to en-sure the safety and health of all working people and beyond.

In the Dresden Strategy Conference, the discussion in the Workshops revealed a need for the clarification of the concepts of prevention culture, prevention climate, safety culture, and well-being at work. These concepts will also be discussed in Helsinki in September.

One of the take-home messages was that of Dr. Walter Eichendorf: How can we prepare ourselves for and how can we

A new communicative ”game” was used for information dissemination in the 3rd International Strategy Conference on Occupational Health and Safety.

manage the unexpected? This thinking re-veals the close relationship between safety culture, prevention culture and the crucial need for networking. This discussion will continue in Helsinki in late September at the Culture of Prevention Symposium.

Please mark in your calendars25–27 September 2013, Helsinki, Finland24–27 August 2014, Frankfurt, Germany

www.ttl.fi/cultureofprevention2013www.safety2014germany.com

Cordial thanks are due to all our col-leagues in DGUV for organization of such a successful Conference.

Suvi LehtinenChief, International AffairsFinnish Institute of Occupational HealthTopeliuksenkatu 41 a A00250 Helsinki, [email protected]


May MuchengetiZIMBABWE

Background of ARLACThe African Regional Labour Administration Centre (AR-LAC) was jointly formed by the ILO and UNDP in 1974 as a project for the development of Labour Administration is-sues. In October 1982, ARLAC transformed from a project into a unique organization with its independent Governing Council,comprisinglabour/employment/manpowerminis-tries from its member countries. The International Labour Organization (ILO) and the United Nations Development Programme (UNDP) are also members of the ARLAC Gov-erning Council and Executive Office.

ARLAC has 19 member countries drawn from English-speaking African countries with the exception of Egypt. These are Botswana, Egypt, Ethiopia, Ghana, Kenya, Leso-tho, Liberia, Malawi, Mauritius, Namibia, Nigeria, Sierra Leone, South Africa, Somalia, Sudan, Swaziland, Uganda, Zambia and Zimbabwe. Eritrea, Gambia, Mozambique and Tanzania are observer states. ARLAC has two sister organi-zations in Africa, CRADAT for French-speaking African countries and ACLAE for Arabic speaking African coun-tries.

In accordance with its charter, ARLAC pursues the fol-lowing summarized objectives (1):• ToprovidetrainingatalllevelsofLabourAdministration• Toprovideconsultancyandadvisoryservicesdirected towards labour administration• Toconductstudiesandresearchinallaspectsoflabour administration• Toprovideinformationservicesandproductionoftrain- ing materials.

Contribution of ARLAC to labour administration capacity building in AfricaARLAC considers all its objectives as being of paramount importance in strengthening labour administration systems in Africa. However, training is among the major activities of ARLAC – not only in importance, but also in terms of time consumption. Fulfilling the training objective has enabled ARLAC to make a greater impact on not only the trainees; but their respective organizations and countries, communi-ties and families. Of several programmes, the ones on train-ing of trainers stand out as the principal tool for expand-ing the effective coverage of ARLAC’s training programmes

Occupational safety and health (OSH) training at ARLAC

through the multiplier strategy.ARLAC training is demand driven and tailor made for

theARLACconstituents.ThePrincipal/PermanentSecre-tariesandDirectors-Generalresponsibleforlabour/em-ployment/manpowerissuesinthememberstatesdecideand submit the training needs of their respective coun-tries. The programme is then designed on this basis so as to remain relevant and specific to the needs of the member states. On average, ARLAC runs seven courses per year at regional and sub-regional levels. ARLAC also offers an op-portunity for national programmes. These are programmes held specifically for a requesting country when they feel they have a unique and immediate training need. Although membership to ARLAC is open to governments through theirlabour/employment/manpowerministries,ARLACtraining programmes may be bipartite or tripartite so as to extend the decent work agenda to all social partners as nec-essary. Training is also for officials at all levels of the labour administration system.

ARLAC relies on a pool of training and subjects spe-cialists from allied organizations, including the Internation-al Labour Organization (ILO). It particularly enjoys fruit-ful relations with the ILO Regional Offices for Africa and the Decent Work Country Team in Pretoria, South Africa. The interactive learning draws on the professional expertise and experiences of all those taking part in ARLAC’s pro-gramme, in an environment free from the day-to-day pres-sures of work.

ARLAC on occupational safety and health (OSH) trainingARLAC, as a capacity building organization, acknowledg-es the part played by the competent safety professionals in achieving steady but significant improvement in site safety. Clearly, it is doubtful whether the appointment of a safety supervisor, no matter how competent, will achieve an ac-ceptable level of compliance with the health and safety leg-islation on any site, unless it is competently managed.

Our training is concerned about ensuring that workers are free from physical, chemical, biological and any other work-related hazards within their work environments. It in-cludes a wide range of measures aimed at increasing interest in working life and occupational safety and health at a gen-


eral level. Owing to the tripartite nature of our participants (Government, Employers’ and Workers’ organizations) a comprehen-sive system of information dissemination through country presentations is achieved and such presentations are usually worked out in cooperation with the social partners.

By and large, the strategy of the occu-pational safety and health administration is based on the national circumstances of each member country. Our training endeavours to address the problem of whether people have the strength to cope with work today. For example, we have discovered, through our research activities, that the changes in working life and society, higher demands for qualifications and increased work tempo have added to the worker’s mental load and many people’s tolerance is put to task lead-ing to more workplace accidents. As a result, we urge our member countries to review their OSH administration strategies in order to update them.

ARLAC works very closely with the ILO and advises its membership on the:• Promotionoftheapplicationoftheprin- ciples of the ILO instruments on safety and health at work with a view to facilitating their ratification and implementation • Exchangeofviewsandexperienceson measures to be taken at the national enterprise level for the improvement of occupational safety and health in industry• Exchangeofviewsconcerningtheroleof governments, employers and workers and their organizations on ways of improving the application of the principles contained in the ILO instruments, and • Examinationofthepertinentactivities towards facilitating the ratification of ILO Convention 155 (Occupational Safety and Health Convention, 1981) and related Conventions through training, upgrading legislation, information and technical co

operation. ARLAC has put in place monitoring and

evaluation mechanisms to:• Mainstreamafeedbacksystemwithour alumni• Keepabreastofinternationaltrendsand standards on occupational safety and health• Regularlyassessmethodsofpromoting safety management, and • Assesstrainingasakeytoinstigatingand improving safety, health and welfare at the workplace. This is implemented by way of regular inspections of the workplaces.

In order to succeed, ARLAC has adopt-ed the integrated approach system of in-spection as opposed to the fragmented ap-proaches that are prevalent in most of our member states. The integrated approach has already shown that it requires a properly functioning network to support it. The con-tribution of the enforcing authorities alone is not enough for achieving good results. We encourage clear division of labour between the members of the network while discour-aging any overlapping and competition. All members of the network should work in fruitful cooperation, which is ensured by well-functioning cooperative bodies and by good personal relations.

At the end of it all, we expect the en-forcement authorities to have a profound and full knowledge of working life and la-bour legislation. They must be looking to the future and be capable of flexible net-working. The inspection officer ARLAC en-visages to mould is more like a manager of systems than an expert in one field. He has negotiation skills and faculties to compre-hend and direct large entities and also one who knows the principles and regulations of industrial life. We envisage an individual who should have the ability to cope under stress and to make decisions even in matters

of principle.The goal of ARLAC training is that par-

ticipants come up with a communiqué and work plan mapping out their observations, challenges and the recommended way for-ward. The communiqué and work plan will then be tabled before the annual meeting of Principal/PermanentSecretariesandDirec-tors-Generalresponsibleforlabour/employ-ment/manpowerissuessoastoinformthemof the outcomes of the workshop as well as to seek their support in the implementa-tion of the work plan. The outcomes of these workshops are also submitted to the ARLAC Governing Council (Labour Ministers) for political backing.

The major challenges affecting health and safety in the workplace as deduced from our various training programmes include the following among others: fragmentation of the OSH service; lack of resources (hu-man, financial, and equipment); ineffective human resource policies and procedures, outdatedlegislation,undeterrentpenalties/fines; competency levels in the inspector-ate, non-complying employers, corruption, weak social partners, increase in the growth of Small and Medium-sized Enterprises and the informal sector.

Tackling these changes on working life demands an integrated approach, merging the traditional, technical and medical issues with the social, psychological, economi-cal and legal ones. The new reality demands global strategies and local responsiveness to enable countries to react by adopting ad-equate socio-economic policies, avoiding economic turbulence and promoting indus-trial peace.

The challenges we face in delivering our training mandate, particularly in OSH in-cludes the fact that we are generally a labour administration capacity building institution, we cover a number of labour themes. As a result we are forced to combine a wide range of OSH topics into one training theme so as to make room for other labour adminis-tration themes. As a result our short cours-es cannot be as detailed as is desirable. Our other challenge is that we are a member-ship driven organization, with membership contributions and ILO funding as our main sources of income. When member countries delay in honouring their obligation to AR-LAC, it affects our programming severely.

In its quests to offer labour administra-tor something more substantive, ARLAC in collaboration with the University of Lagos,


Health aspects of child labour in the crushing of granite in central BeninIntroductionChild labour is still a major problem in developing countries (1, 2) in particular sub-Saharan Africa which shows the high-est rates (3). Apart from its legal and social aspects, child labour is a real public health concern (4).

In Benin, there is political will to fight the worst forms of child labour (5). In-deed, the Republic of Benin ratified Con-ventions numbers 138 and 182 of the In-ternational Labour Organization (ILO) re-lating respectively to the minimum age for admission to employment, 11 June 2001 and the Worst Forms of Child Labour, 11 November 2001.

Notwithstanding the efforts to eradi-cate the worst forms of child labour in Be-nin, the phenomenon continues to grow in various forms. A recent study reported 2424 children working in mines and quar-ries in Benin. Some 1302 of them were em-ployed in the crushing of granite (6).

The characteristic hardness of gran-ite and the force required to crush it rep-resents an inherent risk to a child’s health working in this environment. It is essen-tially this aspect that the present article in-tends to highlight so that it can be used in

the fight against the worst forms of child labour in Benin.

How the survey was carried outThe study was conducted in three munici-palities (Dassa-Zoumé, Glazoué and Sav-alou) in the Department of Hills, one of the administrative departments in central Benin. Granite crushing work in this ar-ea is related to its high hills; a significant source of raw materials. It is a descriptive study of the work environments. The study is focused on 21 work sites and was con-ducted during August 2012. In total, 178 children aged 5 to 14 were identified. A questionnaire was administered directly to children (able to express themselves) or their parents on the basis of their individ-ual consent. An observation grid and pho-tos were used to complement the informa-tion collected on sites visited.

The variables studied are related to the characteristics of the children, the activi-ties carried out and health problems. The results are as follows:

The prevalence of child labour in the granite crushing quarry is 49%. Some 90% of children work on behalf of their parents. The data on the profile of children (Table

Despite the positive developments in health promotion activities in many African coun-tries, this article reminds us of the great needs of one of the most vulnerable groups.

The Editor in Chief

A.P. Ayélo, B. Aguêmon, A. Santos, F. Gounongbé, L. Fourn, B. FayomiBENIN

Nigeria has since September 2011 start-ed offering post-graduate programmes in Labour and Employment Studies. One of the compulsory modules is on Labour and Occupational Safety and Health Inspec-tion. This programme was initially created to cater for the needs of long serving la-bour administrators who have all the ex-perience, but lack the paper certification required for progression and promotion. It is now open to anyone, with foreign ap-plicants being exempted from taking the qualifying examination for admission to the ELSDD programme.

Mary MuchengetiARLACInformationOfficer/DocumentalistAfrican Regional Labour Administration Centre (ARLAC)CIS Regional CentreP.O. Box 6097Harare, [email protected]

References

African Regional Labour Administration Centre. The ARLAC agreement and rules of procedure of the ARLAC Governing Council. Harare: ARLAC, 1988.

Report on The Prevention of Occupational diseases etc. see: www.ilo.org/safeday


1), the activities performed, the duration of work (Table 2) and the health problems reported (Table 3) are as follows:

Variables Number %

Age (N = 178)

5–9 years 92 52

10–14 years 86 48

Gender (N = 178)

Boys 87 49

Girls 91 51

School level (N = 178)

Primary 140 79

Secondary 28 16

None 10 6

Variables Number %

Activities

Transporting granite (N = 160) 140 88

Crushing granite into fine gravel (N = 173) 165 95

Sieving gravel (N = 175) 144 82

Daily duration of work (N = 178)

Less than 8 hours 40 23

8 hours and more 138 78

Number of days per week (N = 175)

< or = 5 days 29 17

6 days and more 146 83

SymptomsNumber

(N = 178)%

Cough 134 75

Cold 137 77

Eye problems 92 52

Headache 139 78

Muscle pain 134 75

Joint pain 178 100

Profile of children surveyedTable 1. Distribution of children according to age, sex, school level

Activities performed and the duration of workNinety-three percent of the activities per-formed by children (transport, crushing and sieving) are manual. The mean weight of loads carried is 39 kg. Some 80% of chil-dren are not happy with the activities as-signed to them. The proportion of children and duration of the activities carried out are indicated in Table 2.

Health problems reported by childrenEighty-six percent of the children surveyed reported being victims of accidents with injuries (44%), sprains (54%) and 3 cases of fracture. Other health problems identified are summarized in Table 3 below.

Table 2. Proportion of children according to their activities and the duration of work.Table 3. Distribution of children according to health problems reported.

Photos 1–2. Boys and girls transporting blocks of granite.

Photos: Alain Santos Beninese


DiscussionOur results show that children represent about half (49%) of the labour used in the granite crushing quarry in central Benin. This massive use of child labour in an ac-tivity with high muscle stress or a signifi-cant consumption of energy is a violation of ILO Conventions Numbers 138 and 182. Indeed, it is clearly stated in Article 3d of ILO Convention No. 182 that the term “the worst forms of child labour” includes works which, by its nature or the circumstances in which they apply is likely to harm the health, safety or morals of children.

Most (94%) children identified on the sites are enrolled at school. However, stud-ies have shown elsewhere such as in Bang-ladesh (7) that children engaged in eco-nomic activities are poorly educated, con-trary to our results. This difference could be explained by the fact that our study was conducted during school holidays where children participate massively in the eco-nomic activities of households. The cur-rent reality in poor countries could also explain the high prevalence of child labour in the quarry during the period. Neverthe-less, it does not seem sufficient to justify the child abuse seen below.

Children are first asked to carry gran-ite blocks of 39 kg on average (Photos 1-2) that they will crush (Photo 3) into grav-

el. However, with respect to the weight of loads to be carried by the child, the law ofBenin(InterministerialOrderNo.132/MFPTRA/MSP/DC/SGM/DT/SSTof2November 2000 establishing the nature of work and categories of enterprises pro-hibited to women, pregnant women and young men, and the age limit which the prohibition applies limits the maximum weight carried to 15 kg for male staff aged 14 and 8 kg female staff of 14 years.

Studies have shown that repeated early exposure of children to this type of dan-gerous work puts them at high risk of de-veloping chronic diseases such as arthritis and silicosis (4). This is probably the cause

References

1. UA Segal, A Ashtekar. Detection of intrafamilial child abuse: children at intake at a children’s obser-vation home in India. Child Abuse Neglect 1994;18:957–67.

2. MN Esin, S Bulduk, H Ince. Workrelated risks and health problems of working children in urban Istanbul, Turkey. J Occup Health 2005;47:431–36.

3. OIT. Un avenir sans travail des enfants, Rapport global du directeur général, Conférence internation-ale du travail, 90e session, Bureau international du travail, Genève, 2002.

4. J Kasper, D Parker. Child Labour. International Encyclopedia of Public Health 2008:583–90.5. P Ayelo, P Baloïtcha, B Fayomi. Situation socio sanitaire des apprentis en milieu artisanal à Cotonou. J Int Santé Trav 2010;2:31–9.6. IPEC-Bénin. Etude sur le travail des enfants dans les mines et carrières en République du Bénin. OIT-

IPEC-Bénin 2008:32–6. 7. A Hadi. Child abuse among working children in rural Bangladesh: prevalence and determinants.

Public Health 2000;114:380–84.

Photo 3. The activity of crushing.

A.P. Ayélo1, B. Aguêmon1, A. Santos1, F. Gounongbé2, L. Fourn1, B. Fayomi1

1. Department of Public and Occupation-al Health, Faculty of Health Sciences, Co-tonou, University of Abomey Calavi, Re-public of Benin.2. Department of Public and Occupation-al Health, Faculty of Medicine, University of Parakou, Benin.

of muscle and joint pain of which the chil-dren complain in our study. Coughs and colds reported by children could be ex-plained by the inhalation of mineral dust that is released through the crushing pro-cess. The case of ocular trauma observed in one child was due to gravel being pro-jected into the eye and this reflects eye problems reported by 52% of the children surveyed.

ConclusionThe children are subjected to harsh work-ing conditions in a granite crushing quar-ry in Benin. The characteristic hardness of the material in the quarry and all the health problems that arise indicate that most children (80%) suffer seriously from these activities.

Corresponding author:Dr. Paul Ahoumenou Ayelo Occupational Health PhysicianUnit of Research and Education in Occupational Health and Environment, 01BP 188 Cotonou, BeninTel. (+229) 97026378, Fax: (+229) 21305223. Email: [email protected]

Photo: Alain Santos Beninese

Contact persons/country editors

Editorial Boardas of 1 January 2013

Director, Department of Occupational Health and Safety(Ministry of Labour and Home Affairs)BOTSWANA

Mathewos MejaOSH Information ExpertMinistry of Labour andSocial AffairsETHIOPIA

Chief Inspector of FactoriesMinistry of Employment andSocial WelfareGHANA

The Director, Occupational Health and SafetyMinistry of Labour and Industrial RelationsMAURITIUS

Chief Inspector of FactoriesMinistry of LabourSIERRA LEONE

Seiji Machida, DirectorProgramme on Safety and Health at Work and the Environment (SafeWork)International Labour Office4, route des Morillons CH-1211 Geneva 22SWITZERLAND

Evelyn Kortum Technical OfficerOccupational HealthInterventions for Healthy EnvironmentsDepartment of Public Health and EnvironmentWorld Health OrganizationCH-1211 Geneva 27SWITZERLAND

Jorma RantanenPast President of ICOHICOH International Commission on Occupational Health

Harri VainioDirector GeneralFinnish Institute of Occupational HealthFINLAND

DirectorDepartment of Occupational Health and Safety(Ministry of Labour and Home Affairs)Private Bag 00241GaboroneBOTSWANA

Samir Ragab SeliemEgyptian Trade Union FederationOccupational Health and Safety Secretary90 Elgalaa StreetCairoEGYPT

Ministry of Labour and Social AffairsP.O. Box 2056Addis AbabaETHIOPIA

Commissioner of LabourMinistry of Trade Industry and EmploymentCentral Bank BuildingBanjulGAMBIA

The DirectorDirectorate of OccupationalHealth and Safety ServicesP.O. Box 3412000100 - NairobiKENYA

The DirectorOccupational Safety and HealthPrivate Bag 344Lilongwe MALAWI

Mrs Ifeoma NwankwoFederal Ministry of Labour and ProductivityOccupational Safety andHealth DepartmentP.M.B. 4 AbujaNIGERIA

Peter H. MavusoHead of CIS National CentreP.O.Box 198MbabaneSWAZILAND

Chief ExecutiveOccupational Safety andHealth Authority (OSHA)Ministry of Labour and EmploymentP.O. Box 519Dar es SalaamTANZANIA

CommissionerOccupational Safety and Health Ministry of Gender, Labour and Social DevelopmentP.O. Box 227KampalaUGANDA

Tecklu GhebreyohannesDirector of Labour Inspection Div.Ministry of Labour and HumanWelfareDepartment of LabourP.O. Box 5252AsmaraERITREA

SLY-Lehtipainot OY, Kirjapaino Uusimaa, Porvoo

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