African Newsletter

O N O C C U PAT I O N A L H E A LT H A N D S A F E T Y
Volume 22, number 1, May 2012

Economics in occupational health and safety

African Newsletter
on Occupational Health and Safety Volume 22, number 1, May 2012 Economics in occupational health and safety Published by Finnish Institute of Occupational Health Topeliuksenkatu 41 a A FI-00250 Helsinki, Finland Editor in Chief Suvi Lehtinen Editor Marianne Joronen Linguistic Editors Sheryl S. Hinkkanen Alice Lehtinen Layout Liisa Surakka, Kirjapaino Uusimaa, Studio The Editorial Board is listed (as of December 2011) 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 Aairs, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland. The African Newsletter on Occupational Health and Safety homepage address is: http://www.ttl./AfricanNewsletter The next issue of the African Newsletter will come out at the end of August 2012. The theme of the issue 2/2012 is Small-scale enterprises and informal sector. African Newsletter is nancially supported by the Finnish Institute of Occupational Health, the World Health Organization, WHO, and the International Labour Oce, ILO.
Photographs of the cover page: International Labour Organization / M. Crozet Window cleaner (salary of 1 USD per day) working without security devices on a building under construction. Dar Es Salaam.

Contents
3 Editorial
Well-being at work - the worlds next megatrend? Guy Ahonen

Articles
4 Economics of occupational health and safety
Guy Ahonen, Tomi Hussi FINLAND

6 Microeconomics of rms compliant with occupational safety and health

Haji Habitu H. Semboja TANZANIA

10 Economics in occupational health and safety: the agricultural perspective

Samuel T. Olowogbon, Ademola J. Jolaiya NIGERIA

13 How to create economic incentives in occupational safety and health

Dietmar Elsler OSHA EU

16 Smallholders use of pesticides in Ugandan agriculture

Joachim Duus, Jens C. Streibig, Deogratias Sekimpi, James Maziina, Erik Jrs DENMARK/UGANDA

18 Are SMS-messages the way forward in spreading health information?

Erik Jrs, Aggrey Atuhaire, Katia Buch Hrvig, Lene Kierkegaard, Majbrit Mlgaard Nielsen, Mercy Wanyana, Bernadette Mirembe, Charles Okorimong, Deogratias Sekimpi DENMARK/NIGERIA

20 An overview of occupational health and safety in the Republic of Mauritius

Yoosoof Jauhangeer MAURITIUS

23 Knowledge, attitudes and practices of cervical cancer screening among a group of female sex workers in Libreville, Gabon
Pearl Comlan, JP. Ngou Mve Ngou, AM. Mouanga, B. Mabika Mabika, F. Ezinah, J. Djeki GABON/CONGO

26 ICOH 2012 in Cancun, Mexico

Suvi Lehtinen FINLAND 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 Oce, World Health Organization or the Finnish Institute of Occupational Health of the opinions expressed in it.

Finnish Institute of Occupational Health, 2012 Printed publication: ISSN 0788-4877 On-line publication: ISSN 1239-4386

Editorial

Well-being at work the worlds next megatrend?

n 1982, John Naisbitt published Megatrends: Ten New Directions Transforming Our Lives. In his book Naisbitt states the following forthcoming trends, i.e. shifts: 1) from a post-industrial to an information society, 2) away from national economies towards interdependent communities, 3) from shortterm to long-range profits, 4) from centralized hierarchical structures to flatter decentralized corporations, 5) from dependence on institutional help to self-reliance, 6) from representative to participatory democracy, 7) from hierarchies to social networks, 8) from a unified society to diverse groups of people. Now, 30 years later we know that some of Naisbitts predictions were right, and some were wrong. The role of information and knowledge has increased and the world has become more global. However, the time span of companies has become shorter rather than longer, and the structure of organizations has not become more clearly decentralized than before. In hindsight there is a conspicuous gap in Naisbitts list: he did not mention the environmental trend, the green revolution. Today no car manufacturer can survive without taking into account fuel consumption and CO2 emissions in its strategy, and no construction company can market houses without mentioning their energy aspects. Naisbitts omission is understandable, and actually very useful. It tells us that great general omissions are possible, and can be made by experts as well as the general public. I argue that the current great omission relates to well-being at work. Just as everybody in the early 1980s had some knowledge of environmental pollution and global warming, everyone today is acquainted with problems at work. But now, like then, few people are aware of the huge importance of this issue. In economic terms, environmental issues have to be taken seriously because their long-term consequences are enormous. The possible disappearance of great land areas as a result of melting polar ices is one example of the magnitude of this problem. Accordingly, the widening gap between productive and nonproductive lifetime is becoming unbearable in most industrial societies. This is mainly due to a rapidly changing demographic structure: people are simply living longer. What makes the demographic problem a work well-being problem? Basically, peoples willingness and ability to work determines the amount of productive time. People are not willing and able to work unless workplaces are safe and people perceive their work as meaningful and rewarding. According to current estimates, people in Finland work an average of 34 years of their average 80 life years. And this gap is rap-

idly widening. At current annual pension levels, the costs per productive hours are becoming so high that nobody is willing to pay them. There are many potential solutions to this dilemma. Mathematically the problem can be solved by dropping the monetary level of the pensions; but this is hardly possible without great social disturbances. In principle we could also solve the problem by reducing our standard of living or by managing to significantly increase the productivity of work. Neither of these courses of action seem possible in the foreseeable future. The most viable solution seems to be the extension of work careers. This means extending careers at their beginning, middle and end. At the beginning, by making people start working earlier in life: one solution to this is to shorten average study times. In the middle, by helping people in their prime working years avoid excess work-related exposures and stress. And at the end, by adapting work to suit the age-related capacity to work. In short, the solution to the demographic challenge is well-being at work. We need to increase the quality of work, i.e. peoples willingness and ability to work longer, and employers willingness to have more diverse personnel. The above problem is obviously most severe for highly industrialized countries with an unfavourable demographic structure. This same challenge also applies to all countries in the world, because safe and healthy work is a basic human right everywhere. We already have some good practices and tools that can be adapted to all environments and cultural contexts, such as the WISE and WIND methods developed by the ILO and the Basic Occupational Health Services approach developed by WHO, the ILO and ICOH. But further improving working conditions and well-being at work is relevant for two other reasons. Firstly, because consumers all over the world are increasingly inclined to make ethically sustainable choices. This includes both the environmental and social aspects. And secondly, because global competitiveness requires an increase in innovativeness. To do this, companies have to take into account the well-being of their personnel. Only people make innovations.

Guy Ahonen DSc (Econ.), Professor Director, Knowledge Management

Afr Newslett on Occup Health and Safety 2012;22:

Guy Ahonen, Tomi Hussi FINLAND

Economics of occupational health and safety

Introduction
Interest in evidence on the economic aspects of occupational health and safety is growing. Although activities aimed at improving the well-being of employees have traditionally been seen as costs, the logic of economics is now turning towards knowledge-intensiveness, and the role of human capital and knowledge-processing skills is starting to stand out in a new light. Employees of organizations are increasingly being seen as central elements of productivity. Earlier, the means of production were taken care of by maintaining machinery, but in todays world it is being recognized that similar attention must be given to personnel. It is also a fact that todays globalizing financial markets are leading to tougher competition among companies. The use of all resources, including human resources, must be as efficient as possible. Consequently, personnel issues are increasingly assessed in monetary terms. The ageing of the population places more and more economic pressure on companies in highly industrialized countries. Those dealing with occupational health issues must be able to put their arguments into financial terms in order to communicate at the strategic level of companies. Otherwise human resource issues are relegated to a marginal role. To promote occupational health, we need to present strong business cases along with their financial logic. We must especially demonstrate the cost savings and resource promoting mechanisms of occupational health. Costs of early retirement are, of course, dependent on the legislation of each country. For example in Finland, the companys share of costs depends on the size of the company. Large companies have to pay their retirement costs according to their risk category. This category is dependent on the number of early-retirement cases over the last two years. Changes of risk category have a considerable financial effect as they define the percentage of the wage sum that the company has to pay for pension insurance. While the cost savings perspective is highly limited, it is usually adopted too narrowly. Although sickness absences, accident costs and early retirement costs can easily run up considerable sums in themselves, consequences such as the need to use supplementary workers, and personnel turnover should also be included in these calculations. If a person is absent from work, the lost labour input may often have to be replaced. This can be handled, for example, by employees working overtime or by hiring temporary substitutes. Both of these means are typically more expensive than work carried out during normal hours. Poor work-related well-being can also result in increased personnel turnover. It is important to note that excessive turnover creates extra costs both through the leaving employee and the new recruit.

Strategic and managerial approaches

Cost savings approach

Traditionally, the economic aspects of occupational health have focused on cost savings. Discussion has centred on topics such as lowering sickness absence rates, reducing accident costs and avoiding the costs of early retirement. Sickness absences are relatively easy to monitor and it is also quite easy to estimate the cost of one absence day. As a starting point for these calculations, the price of a sickness absence day is calculated as at least salary costs plus related employer costs. Obviously, this does not yet cover all productivity aspects, as profitable business activities must exceed costs. However, even a rough estimate of the cost of a sickness absence day helps show the magnitude of the issue, and thus raises interest for further elaborating evaluations. Sharing this information across the organization can be also valuable in terms of awareness-raising.
4 Afr Newslett on Occup Health and Safety 2012;22:45

In todays business environment, personnel issues have to be included on the strategic agenda. As the most effective use of an organizations human capital provides the grounds for sustaining the competitive advantage, maintaining and promoting employee well-being is a key challenge for sustaining the innovativeness of organizations. This perspective places occupational health and safety professionals closer to the strategic core of the organization. However, this mandate can only be justified by the ability to communicate about these activities in a management language. Basically, the fundamental reason of existence for organizations in the private sector is to create long-term return on investment. Therefore, the aim of public health promotion, for example, is not a valid argument for companies. We already have evidence of the positive effects of health on business goals in scientific terms, but this still has an only moderate effect on the management practices of organizations. Management control can be seen as a mediating activity between strategic planning and task control. Placing occupa-

tional health on this agenda presents numerous challenges to contemporary discourse, but at the same time it also presents an opportunity to include occupational health and safety issues on the agenda of organizations executives. Research on Management Control systems are the path to gaining a more solid position for occupational health and safety in both the strategic planning of the organizations and in concrete management practices. We also need to present convincing strategic business cases in order to persuade companies of the benefits of occupational health and safety activities. Strategic business cases of occupational health management are not about problem-solving that typically results in cost-savings, but more about actually linking health objectives and strategies to the organizations business strategy and development activities. The importance of strategic business cases is based on the rationale that monetary investments may be difficult to earn back via lowering sickness and/or insurance costs. The participation of relevant stakeholders also helps to identify changes in, for instance, delivery time, reliability and client satisfaction. This broader view of the results helps to create a better understanding of the true value of development of occupational health in companies. Furthermore, although strategic business cases are important examples of how companies have achieved success in their development activities, evidence in direct monetary terms is also needed. Strategic approach development results in intangible gains, which are difficult to formulate in a straightforward manner. These outcomes need to be supported with financial outcomes. After drawing top level managements interest to these issues, it is easier to discuss the more demanding perspectives, which are typically mostly qualitative and context-bound. A common problem related to the evaluations of financial outcomes is that they are mostly carried out on a short-term basis and based on cross-sectional data. The nature of strategic level occupational health and safety activities is typically such that real results are based on changes in processes. Therefore, long-term follow-up is required.

emphasizing their new role, other major development requests have been imposed on occupational health services. The economic perspective discussed in this article provides insight into how we should be developing our occupational health and safety services. We must stress that although occupational health and safety expertise is currently growing, its potential has not yet been fully utilized. Private sector organizations exist for business purposes, and establishing the business logic is the key to realizing a more central role for occupational health and safety activities. It has generally been quite widely accepted that improving employee well-being is a win-win setting. This means that an individual benefits in terms of better quality of life, and that the organization can expect its personnel to be more productive.

Photo Suvi Lehtinen

This standpoint however is not sustainable as either ideological thinking or contemporary jargon, and we need to be able to provide further evidence on this relationship. As the ageing population, and therefore the need for extending careers, affects many countries, the challenges are rather similar everywhere. The differences in the actual policies and activities of companies are based on country level differences in legislation. However, the basic fundamental problem is the same and the above presented ideas can be used as a starting point for developing solutions to these problems.
Guy Ahonen, Tomi Hussi Finnish Institute of Occupational Health Topeliuksenkatu 41 a A 00250 Helsinki Finland guy.ahonen@ttl.

Bibliography
Aura O, Ahonen G & Ilmarinen J. Strategisen hyvinvoinnin tila Suomessa 2010 -tutkimus (Strategic wellness in Finland 2010 [in Finnish]). Excenta Oy: Helsink, 2010. Aura O, Ahonen G & Ilmarinen, J. Strategisen hyvinvoinnin tila Suomessa 2009 -tutkimus (Strategic wellness in Finland 2009 [in Finnish]). Excenta Oy: Helsinki, 2009. Hussi T & Ahonen G. Business-oriented Maintenance of Work Ability. Reports of the Ministry of Health and Social Aairs 2007:17. Ministry of Health and Social Aairs: Helsinki, 2007. Hussi, T. Essays on Managing Knowledge and Work Related Wellbeing. Svenska handelshgskolan Hanken: Helsinki, 2005. Johanson U, Ahonen G, Roslender R. (eds.) Work health and management control. Thomson Fakta: Stockholm, 2007.

Conclusions

In Finland, the importance of occupational health services has already been put forward. Labour market partners have engaged in the so-called Work Life Quality group, which tackles the issue of longer careers. Besides

Afr Newslett on Occup Health and Safety 2012;22:45

Haji Habitu H. Semboja TANZANIA

Microeconomics of Firms Compliant with Occupational Safety and Health

International Labour Organization / M. Crozet

Introduction

This paper discusses the economics of occupational safety and health (OSH) from a microeconomic point of view (13). An attempt is made to present it as a simple Occupational Safety and Health Economic Model. The paper includes a specification of the objective production function and inputs for firms compliant with OSH; the cost minimization problem; a solution for cost minimization; the conditional factor demand; typologies of minimum cost solutions; and a conclusion.

The OSH economic model assumptions

We consider occupational safety and health (OSH) as a cross-disciplinary area concerned with protecting the safety, health and welfare of people engaged in work or employment in formal or organized firms or microeconomic and corporate entities (13). This paper treats an occupation as a regular productive activity performed for payments of economic units optimizing long-term social economic welfare during social economic processes. The paper assumes that production firms compliant with OSH are economic rational entities always maximizing profit. Also assumed is that one of the corporate social responsibility goals of these formal firms is to ensure optimal OSH standards (1). The goal of occupational safety and health programmes is to foster a safe and healthy work environment. As secondary effects, OSH may also protect co-workers, family members, employers, customers, suppliers, nearby communities, and other members of the public who are impacted by the workplace environment as well as reducing medical care, sick leave and disability benefit costs. OSH may involve interactions among many subject areas, including occupational medicine, occupational (or industrial) hygiene, public health, safety engineering/industrial engineering, chemistry, health physics, and ergonomics (4).

OSH economic model, production function and inputs

Major OSH production function

Firms compliant with OSH in general transform a large number of inputs into a number of outputs, but to simplify
6 Afr Newslett on Occup Health and Safety 2012;22:69

the analysis I will initially restrict myself to the case of a firm using two inputs (x1, x2) to produce a single output Y. It is possible to describe the technical constraints on production in a variety of ways. In most of this paper, I will use the OSH production function to relate the firms OSH output to its OSH inputs, but this can be generalized by introducing the production set as an alternative description of the feasible input and output combinations (5). The OSH Economic Model assumes that there are two major inputs in the production of goods and services, and that both input and output markets are operating in perfectly competitive market conditions (5). In the process of maximizing profits, firms aim at improving resource productivity through less wastage, less down time, higher industry manufacturing process yield, etc. and thus producing higher quality products (2).

ing, which has great influence potentials on workers productivity and compliance with safety standards.

OSH cost minimization problem

The paper presents the behaviour of economic profit-maximizing firms compliant with OSH and operating in competitive market environments (5). The profitmaximization problem can be broken up into two steps or processes. The problem of how to minimize the costs of producing any given level of output, and how to choose the most profitable levels of output. This paper focuses on the first step minimizing the costs of producing a given level of output. In economics, a cost is a price paid, or otherwise associated with, a commercial event or economic transaction. Costs are often further described based on their timing or their applicability.

Lausanne Institute for Management Development rankings) for its occupational OSH ratings (7). It found that more competitive countries have superior OSH ratings. At the very least this indicates that economies with lower OSH standards are not more competitive, and that investment in OSH is not made at the expense of competitiveness.

Major OSH cost items

Workers

Objective functions of OSH

The first inputs are workers (x1,), who have to be engaged, employed and trained in the soft skills of OSH. That is, all workers are provided with the required knowledge, information and skills to work in a way that meets occupational health and safety requirements. Education and vocational training in OSH is dynamic and continuous throughout production time and not a one-off investment. It is a regular workplace engagement influenced by basic workplace conditions and processes, with a view to avoiding accidents and enhancing productivity. Education and vocational training are required when firms employ new employees, when firms advance production technologies or systems, and when there is a change in work processes, work stations, and a number of other influencing factors that contribute to meeting safety requirements.

Capital equipment and machinery

The second inputs are capital equipment and machinery (x2). Formal firms provide the employees with other inputs, such as physical resources, management and psychosocial support, to comply with occupational health and safety requirements. Such resources include a well-organized workplace or office environment, the provision of safe capital equipment, machinery, tools, and the deployment of a result-oriented human relations mechanism to meet employees physical and psychosocial well-be-

A firm or microeconomic entity compliant with OSH is guided by the corporate value of minimizing cost, improving health, safety and productivity, and increasing employees morale (1). Economic decisions involving OSH are deliberate management planning tools occupying a very prominent position in an organizations corporate value chains. That is, economic incentives aim to stimulate enterprises to invest in management of occupational safety and health by making it more financially attractive (6). Nothing in the organizational corporate value chains would have made provisions for OSH resources to be well defined and integrated into strong leadership commitment in principles, systems and in actions. These are reliable input processes and strategies in reducing both short-term and long-term direct and indirect OSH costs arising from work processes during accidents. Medical treatment cost, absenteeism, claims, high insurance premiums, equipment damage and other related costs are also reduced (13). Every success recorded in OSH breakthroughs in these formal firms is credited to the commitment reflected by policies, laws, regulations, government, and company leadership as well as the support of all member staff and all communities in strict compliance to previously set operational safety policies and guidelines. The International Labour Office computed competitiveness rankings (based on the

There are three major OSH cost items or components. Let us simplify that occupational health is about 1) prevention, 2) the promotion and 3) maintenance of the highest degree of the physical, mental and social wellbeing of workers in all occupations. We consider workers as important inputs or factors of production in industrial processes. These workers can be working proprietors, active business partners, unpaid family workers, salaried managers and salaried directors, part-time workers on the payroll, seasonal workers on the payroll, apprentices on the payroll, and outworkers on the payroll who are paid for the work done. In this context, the first OSH cost component is concerned with the prevention amongst workers of departures from health caused by their working conditions. The second OSH cost component is about the protection of workers in their employment from risks resulting from factors adverse to health. The third OSH cost component is related to the placing and maintenance of the worker in an occupational environment adapted to his physiological and psychological capabilities. In other words, the main focus of a firm compliant with OSH is (i) the maintenance and promotion of workers health and working capacity; (ii) the improvement of the work environment and work so they become conducive to safety and health; and (iii) the development of work organizations and working cultures in a direction which supports health and safety at work and, in doing so, the promotion of a positive social climate and smooth operation and the enhancement of productivity at the undertakings (13).

Solution for OSH cost minimization

Let us assume that we have included all costs of production in the calculation of costs, and let us make sure that everything
Afr Newslett on Occup Health and Safety 2012;22:69

is being measured on compatible quantities, currencies and time scales (5). The solution to our OSH cost-minimization problem the minimum cost necessary to achieve the desired level of output will depend on relative prices and desired output levels. The OSH cost minimization solution determines the optimal or desired choices and levels of both labour and capital inputs. The choices of these inputs that yield minimal costs for the firm will in general depend on the input prices and the level of output that the firm wants to produce. The cost minimization solution yields the conditional factor demand functions, or derived factor demands (5). They measure the relationship between the prices and output and the optimal factor choice of the firm, conditional on the firm producing a given level of output.

den to business and the benefits of adequate control of health and safety at the workplace is called cost-benefit analysis (CBA). In practice, studies on the costs of workplace accidents and work-related ill health have normally been concerned with multiple OSH cost components or typologies (2). This paper examines various minimum OSH cost typologies. These are costs associated with accidents that result from injury and also the more numerous accidents that merely involve damage or loss to property, plant, materials, or loss of business opportunity. Determining the cost of workplace accidents and work-related illness starts by analysing working days lost per year, on the basis of which the financial cost per year is calculated, based on workers productivity before illness and not on salaries (also called financial costs).

We may be specifically interested in opportunity costs, that is, the cost of an opportunity forgone, rather than accounting costs.

Opportunity cost

Conditional OSH factor demands

The conditional OSH factor demands give the cost-minimizing choices for a given level of output; the profit-maximizing factor demands give the profit-maximizing choices for a given price of output (5). Conditional OSH factor demands are usually not directly observed; they are a hypothetical construct. They answer the question of how much of each factor would the firm use if it wanted to produce a given level of output in the cheapest way (5). However, the conditional factor demands are useful as a way of separating the problem of determining the optimal level of output from the problem of determining the most cost-effective method of production. It is easy to show that costs must increase if either factor price increases: if one good becomes more expensive and the other stays the same, the minimal costs cannot go down and in general will increase. Similarly, if the firm chooses to produce more output and factor prices remain constant, the firms costs will have to increase.

Direct and indirect OSH costs

The first types are two sub-types of minimization of OSH costs. These are the direct costs and the indirect costs associated with incidents and/or unhealthy workplaces and their impact on the organization (including both insured and uninsured costs).

Fixed and quasi-xed OSH costs

Typologies of minimum OSH cost solutions

The second types are fixed and quasi-fixed costs. Fixed costs are costs associated with the fixed OSH factors: They are independent of the level of output, and, in particular, they must be paid whether or not the firm produces output. For example, a watchman gets into an accident in closed manufacturing plant. Quasi-fixed costs are OSH costs that are also independent of the level of output, but only need to be paid if the firm produces a positive amount of output. There are no fixed costs in the long run, by definition. However, there may easily be quasifixed costs in the long run. If it is necessary to spend a fixed amount of money before any output at all can be produced, then quasifixed costs will be present.

There is no doubt that action to protect, maintain and improve standards of health and safety in the workplace involves costs (1). This is recognized in the health and safety legislation in the quantification of general duties by the term reasonably practicable, which involves some degree of balancing of the additional costs and benefits of safety improvement. A need to balance between the minimum OSH costs and bur8 Afr Newslett on Occup Health and Safety 2012;22:69

Accounting and opportunity cost

Accounting cost or historical cost

In economics, accounting cost or historical cost is the total amount of money or goods expended in an endeavour. It is money paid out at some time in the past and recorded in journal entries and ledgers. We use the term to distinguish opportunity OSH costs from the costs recorded in accounting records.

Opportunity cost is a term used in economics meaning the cost of something in terms of an opportunity foregone. For example, if an industrial firm decides to invest in human resources in the form of internal training on OSH skills, the opportunity cost is some other thing that might have been done with the workers instead. Opportunity costs may be viewed in terms of an increased number of accidents, damage and deterioration of health, and the increased costs of insurances. Note that opportunity cost is not the sum of the available alternatives, but rather of any particular one of them. The opportunity cost of the company decision to invest in human resource is the loss the human might have created in further production but not all of these in aggregate. It is incontestable that the cost of poor safety and health at firm level can be substantial and can have significant cost effects on the public and society at large. These occupational risk-related costs may influence the following safety decisions of a firm: wage premiums paid to attract workers to risky jobs, insurance payments to injured workers including sick leave and workers compensation benefits, premiums for workers, compensation insurance, government fines for safety violations and injury-related costs such as workplace disruptions and loss of worker-specific job skills (8). Although many corporate firms operating in uncompetitive and poor economies might find it difficult to begin using economic analyses and evaluation to assess the impact of a lack of occupational health and safety, this should be seen as a necessity in many developing societies with limited human resources. Other opportunity costs may include interruption of production immediately after an accident, the lowered morale of coworkers, damage to equipment and materials, reduction in product quality following an accident, reduced productivity of injured workers on light duty, and the overhead costs of spare capacity maintained to lessen the potential effects of any accidents (2 3, 6).

Conclusion

It has been argued that investments in

occupational safety and health factors are perhaps most commonly promoted through ethical arguments (13, 910). However, corporate decisions about safety and health measures have usually been negotiated as part of the general conditions of employment in industry (1). In a case where the costs of a course of action are not immediately apparent, there may even be an illusion that the benefits of that action cost nothing at all; this is a hidden cost. It is important, as individuals and as societies, to compare these opportunity costs associated with various courses of actions. However, some opportunities may be difficult to compare for all relevant dimensions. The model suggests that governments, their regulators and agencies aim to improve occupational safety and health (OSH) in order to reduce the cost to society of injury and illness, while at the same time improving competitiveness and national efficiency. The paper considered OSH as a contributory factor to the economic viability of any corporate entity. Profit maximization and cost minimization solutions integrate the economic advantages of good occupational health practice and suggest that the costs of ensuring safety are equally important in reducing the number of accidents and damage (3,9). Improvements to poor health can lead to an effective reduction in costs and a

greater labour productivity and plant utilization This, in turn, can improve efficiency and thereby heighten the sustainable profitability of businesses compliant with OSH. Labour productivity is also improved by reducing the number of people who retire early or who are unable to work due to injury and illness, thereby cutting the healthcare and social costs of injury and illness, increasing the ability of people to work by improving their health, and improving total

productivity by stimulating more efficient capital, equipment, machineries, working methods and production technologies.
Haji Habitu H. Semboja Department of Economics University of Dar es Salaam P.O. Box 35096 Dar es Salaam TANZANIA haji@semboja.com

References
1 Kankaanp E, van Tulder M, Aaltonen M, De Greef M. Economics For Occupational Safety And Health SJWEH Suppl. 2008;(5):913. 2. European Agency for Safety and Health at Work, (EASHW). National economics and occupational safety and health: Gran Via, 33, E-48009 Bilbao 2007. 3. European Agency for Safety and Health at Work, (EASHW). Occupational safety and health and economic performance in small and medium-sized enterprises: A review. Luxembourg: Oce for Ocial Publications of the European Communities 2009. 4. Lahiri S, Markkanen P, Levenstein C. Cost eectiveness of occupational health interventions: preventing occupational back pain, American Journal of Industrial Medicine, 2005;48(6):51529. 5. Varian HR. Microeconomic Analysis. Third Edition University of Michigan USA W. W. Norton and Company, 1992. 6. Elsler D, Eeckelaert L. Factors inuencing the transferability of occupational safety and health economic incentive schemes between different countries. Scand J Work Environ Health. 2010;36(4):32531. 7. Takala J. Introductory Report: Decent Work Safe Work. XVIIth World Congress on safety and Health at Work. International Labour Oce, Geneva 2005. 48 p. http://www.ilo.org/public/english/region/eurpro/moscow/areas/safety/docs/worldcongressreporteng.pdf 8. Ruser J, Butler R. The Economics of Occupational Safety and Health, Foundations and Trends in Microeconomics: 2010 Vol. 5: No 5, pp 30154. http://dx.doi.org/10.1561/0700000036. 9. Manyele SV, Bilia M. Chemicals management and occupational health in Tanzania Challenges and strategies for improvement. Afr Newslett on Occup Health and Safety 2003;13:569. 10. Cullen J. Health and Safety. A Burden on Business? Ichem E, Process Safety & Environmental Protection 1994;72(B):39.

World Day for Safety and Health at Work on 28 April 2012 - Promoting safety and health in a green economy
The 2012 World Day for Safety and Health at Work focused on the promotion of occupational safety and health (OSH) in a green economy. There is a shift in the world to a greener and more sustainable economy. However, even if certain jobs are considered to be green, the technologies used may protect the environment but not be safe at all. As the green economy develops, it is essential that safety and health at work are integrated into green jobs policies. This implies integrating risk assessment and management measures in the life cycle analysis of all green jobs. A true green job must integrate safety and health into design, procurement, operations, maintenance, sourcing and re28 April 2012 cycling policies, certication systems and occupational safety and health quality standards. This is especially relevant for sectors such as construction, waste recycling, solar energy production and biomass processing.
PROMOTING SAFETY AND HEALTH IN A GREEN ECONOMY
WORLD DAY FOR SAFETY AND HEALTH AT WORK
Supported by the International Social Security Association

Work says the greening of the economy should be accompanied by the proper integration of workplace safety and health measures: Report on Promoting safety and health in a green economy The report looks at dierent green industries from an occupational safety and health perspective, and shows that while green jobs improve the environment, revitalize the economy and create new employment opportunities, they may also present a number of known and unknown risks for workers. Moving towards a green economy implies setting higher standards for environmental protection while, at the same time, incorporating workers safety and health as an integral part of the strategy. The greening of the economy serves as an ideal platform for comprehensive methods to protect the workers, the general environment and the surrounding communities. Only then will we be contributing to an environmentally sustainable and socially inclusive outcome, only then, will we achieve safe, healthy and decent work in a green economy, says Mr Seiji Machida, Director of the ILO Programme on Safety and Health at Work and the Environment (SafeWork). Find out more: Jobs in the green economy should be safe and healthy, ILO says http://www. ilo.org/safework/events Read the interview: Zooming in on the safety and health dimension of greening the economy See also: Message by Juan Somavia, Director-General of the ILO

Promoting safety and health in a green economy A new report by the ILO launched for the World Day for Safety and Health at

Afr Newslett on Occup Health and Safety 2012;22:69

S. T. Olowogbon, A.J. Jolaiya Nigeria

International Labour Organization / M. Crozet

Economics in occupational health and safety: the agricultural perspective

Introduction
The realization of the African Green Revolution and its contribution to food security and economic growth in Sub-Saharan Africa is threatened by many factors (1). The direct effect of these factors on agricultural production and food security will be exacerbated by greater exposure to occupational diseases and illnesses that reduce labour productivity. Sub-Saharan Africa countries have more than 54,000 fatal occupational accidents annually; approximately 42 million work-related accidents took place that caused at least three days absence from work; the fatality rate of the region is 21 per 100,000 workers; the accident rate is 16,000 per 100,000 workers; and the fatal accident rate in agriculture is 22.5 per 100,000 (2). On a global scale, agricultural accidents place a great burden on the economy, resulting in reduced return on investment (ROI) in agriculture; moreover, the burden of injuries/ illness (BOI) is on the increase. This impedes workers efficiency, decreases agricultural output and weakens productivity. In this regard, Prof. N. G. Mankiw, Professor of Economics at Harvard University, defines productivity as the amount of goods and services produced from each hour of workers
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time (3). This implies that human capital is a necessity for maximum productivity. Hence, protecting the well-being of farm workers should be a moral and social responsibility of employers and government. Occupational health and safety is a product of collaboration and cooperation among all stakeholders, and it provides a way forward for the elimination or effective control of occupational hazards and the protection of workers against work-related illnesses, injuries and diseases. (4) Health and safety have been identified to have a strong influence on, and to be invaluable to, any sector of the economy. Effective management of health and safety can help to deliver improved productivity and efficiency. It has been tied to positive performance indicators (PPIs) (5). Aside from farming, agriculture covers many other associated activities such as crop processing and packaging, irrigation, pest management, grain storage, animal husbandry, and construction. In addition, agricultural work also includes domestic tasks (carrying water or wood for fuel, etc.). The distinguishing characteristic of agricultural work is the fact that it is carried out in a rural environment where there

is no clear-cut distinction between working and living conditions. As agricultural work is carried out in the countryside, it is subject to the health hazards of a rural environment as well as those inherent in the specific work processes involved (6). Due to the nature of the agricultural work, workers in this sector are exposed to many hazards; hence there is a need for agricultural workers to have a health and safety orientation. Recent innovations in agriculture have added drastically to the dangers or hazards faced by farm workers. The use of chemicals can expose them to chemically related toxic material that is dangerous to health. Some equipment, tools and machinery expose them to hazards and excessive noise pollution. The cumulative effect of all these hazards associated with new technologies in the long run affect the well-being of these workers. An effective health and safety programme should be in place to mitigate the effect of such hazards. The following hazards have been identified in agriculture:

(A) Worker
Sicknessabsence,reducedmoraleand effectiveness,injuries,temporaryor permanentincapacitation,orfatality

(B)Coworker
Decreased moraleand effectiveness

(C)WorkersFamily
Psychologicalimpact

(D)DirectCosts
Medicalbills,compensation, paymentforworknotdone, costofreplacingdamaged equipmentandmachinery, trainingandother administrativecosts

(XYZ) FARMACCIDENTS

(E)Decreasedoutputand
ProductionLosses IndirectCosts Costofreplacingtheinjured worker,costoftrainingthenew worker,poorhealthandsafety couldleadtopoorpublic relations,andittakestimefora newworkertoadjust(losttime)

(F)DamagetoEquipment
Animal Building Machinery

Source:S.T.Olowogbon,2011HealthandSafetyOrientationinAgriculture
Figure1.Holisticeffectsoffarmaccidents Source:S.T.Olowogbon,2011HealthandSafetyOrientationinAgriculture Figure 1. Holistic eects of farm accidents

Physical/Environmental hazards

These hazards include the following: Excessive noise from machines can cause permanent noise-induced hearing loss or deafness. Prolonged exposure to excessive noise can cause permanent hearing losses unless noise control measures are taken. Farm workers experience one of the highest rates of hearing loss among all occupations. This is caused in part by the many potential sources of loud noise on the farm: tractors, combines, grinders, choppers, shotguns, conveyors, grain dryers, chain saws, etc. Radiation and extreme temperatures, both cold and heat, can have assorted health impacts, such as the following: Excessive cold can lead to hypothermia, frostbite and chilblains. Excessive heat can cause heat cramps, heat exhaustion, heat stroke and heat dermatoses. Vibration from machines can lead to hand-arm vibration syndrome (HAVS), which is four times more prevalent among farm workers (7).

neuropathy. The dusts have been known to cause diseases ranging from byssinosis, occupational asthma, and pneumonitis to non-specific chronic obstructive pulmonary disease (COPD) (7,8,9).

are also vulnerable to epidemic fevers, cholera, diarrhoea and dysentery (8,9).

Economics of farm injury and fatality

Ergonomic hazards

The man-machine relationship and other working conditions put cumulative strain on the musculoskeletal system. This has been identified to cause musculoskeletal disorders, including back pain and osteoarthritis of the knee, which is common among agricultural workers.

Biological hazards

Chemical hazards

In agriculture, the major sources of chemical exposures are pesticides, herbicides and fertilizers, vapours, fumes and some organic dusts from grains and even poultry dusts. Some of these chemicals have been known to have health effects, such as carcinogenicity (the capacity to cause cancer), mutagenicity (the capacity to induce mutations), teratogenicity (the capacity to affect the foetus), psychiatric disorders and delayed

Since farmers must come into contact with animals, it is not surprising that some occasionally contract animal diseases that are transmissible to man (zoonoses). Some of the identified diseases include schistosomiasis contracted from snails, ascariasis (ascararis and hook worm infections are endemic among rural populations), rabies, campylobacter bacterial infection via contaminated food meats (especially chicken), water taken from contaminated sources (streams or rivers near where animals graze), and milk products which are not properly pasteurized, which can lead to food poisoning. Farmers

According to the research of Dr Pollock of the Australian Centre for Agricultural Health and Safety, farm-related injury and deaths cost the Australian economy 651 million dollars in four years (2001 2004). He further explained that: The figure of $651 million equates to 2.7% of the 2008 farm gross domestic product (GDP). However, this is a conservative estimate, as there are many other costs of a farm injury death, that are unquantifiable, such as grief, emotional loss, and pain and suffering (10). Meanwhile, other costs are not readily available and there are no accurate data sources, for example, loss of farm production, production delays, damage to machinery or equipment, insurance, taxation and community losses (11). The cost incurred can either be direct or indirect. Direct costs are costs that have a direct relationship with an incident or accident, such as workers compensation, accident insurance, production losses, and damage to plant and equipment, while the indirect costs or hidden costs are those costs
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incurred from an accident with some hidden implications, such as time wasted, the cost of training, and the impact of a relatives death on farm families and rural communities. Figure 1 shows the effects and economic cost of farm accidents. AC show the effect on the employee, while DF show the effect on the employer.

Economics of occupational health and safety from the mathematical perspective

Occupational accidents cause direct and indirect or hidden costs for the whole society. A popular way to demonstrate this is the iceberg model. (12) There are many variations in the relative proportions of the costs, but the proportion of indirect costs is usually much greater than direct costs. On the other hand, these economic calculations are made in industrialized countries that have established specific compensation and social security systems. Often in developing countries, an accident that occurs in the workplace does not cause direct costs. In addition, the proportion of hidden costs is not so big in small and medium-sized enterprises (13, 14). Another commonly used argument is that poor countries and companies cannot afford safety and health measures. There is no evidence that any country or company in the long run would have benefited from a low level of safety and health. On the contrary, recent studies by the ILO, based on information from the World Economic Forum (2002) and the Lausanne Institute of Management, demonstrate that the most competitive countries are also the safest. Selecting a low-safety, low-health and low-income survival strategy is not likely to lead to high competitiveness or sustainability (14, 15). Harrod (1934) and Doman (1946) developed a model which explains an economys growth rate in terms of the level of savings and productivity of capital. Mathematically, the model can be put as: Y = (KL), where Y = output; K = capital investment and L = labour force. That is, output is a function of capital and labour. Its implications are that growth depends on the quantity of labour and capital; more investment leads to the accumulation of capital, which generates economic growth. This can be extended to mean that economic growth can be achieved when there is a safe labour force and low risk to capital investment. If there is no reduction in capital investment and the labour force, then there will be no reduction in output.
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Mathematically, Y=F (SK*SL)-------------(1) Where S=safety Assuming that safe capital or a low level of risk to capital reduces damages to property means a safe condition, then SK = a safe condition and a safe labour force, which reduces injury to personnel, this being due to safe action, then: SL = Safe Action. This means that if we substitute SK and SL then Y = F (safe condition; safe action)----(2) This means output is a function of safe action and a safe condition. If there is an increase in safe actions and a safe condition, there will be high economic output and a rise in development. And if there are unsafe actions and an unsafe condition, the result will be low economic output and low development (16). This implies that the wealth of any farm business depends on the health of its workers.

food security, the health of workers in this sector needs to be addressed, since workers health and safety has a strong link to productivity. It is therefore good business sense to have an effective health and safety programme in place because your business demands it, your workers and customers deserve it, and your business future and practice cannot be there without it. Hence, attaining a safe workplace is a product of collaboration and cooperation among all stakeholders, the sole aim being to eliminate, or implement effective control of, occupational hazards and protect workers against work-related illnesses, injuries and diseases in order to optimize productivity in the agricultural sector.
Samuel T. Olowogbon Occupational Health and Safety Division of Vertext Media ltd, Mokola Ibadan, Nigeria. E-mail: olowogbonsam@yahoo.com Ademola J. Jolaiya Department of Agricultural Economics University of Ilorin, Nigeria E-mail: ademola.john24@yahoo.com

Conclusion

An adept knowledge of the economics of farm safety is a necessity for agricultural development in any economy. To ensure global

References
1. Ngigi N. Stephen. Climate Change Adaptation Strategies: Water Resources Management Options for Smallholder Farming Systems in Sub-Saharan Africa. The MDG Centre for East and Southern Africa of the Earth Institute at Columbia University, New York, 2009. (with nancial support from the Rockefeller Foundation). 2. Hmlinen P, Takala J, Saarela KL.Global estimates of occupational accidentsInternational Labour Ofce (ILO), SafeWork, Geneva 2005, Switzerland. 3. Mankiw NG. Principles of Economics. Second Edition, 2001, 837 pp. Harcourt College Publishers Sea Harbor Drive, Orlando, USA. 4. National Policy on Occupational Safety and Health, Federal Government of Nigeria, Tunlads Concept, Abuja Nigeria 2006, 19 p. 5. Smallman C, John G. New Zealand Department of Labour Report 2001. http://www.dol.govt.nz/publications/research/good-sense/good-sense_06.asp, available online. 6. National Safety Council. International Accident Facts (Illinois, United States, 1995). 7. El Batami MA. Health of Workers in Agriculture: World Health Regional Publication, Eastern Mediterranean Series 25. 2003 Cairo, Egypt. 8. Oluwagbemi BF. Basic Occupational Health and Safety. Vertext Media Limited, 2007 Ibadan, Nigeria. 9. Ide C. Pastoral care, Safety Health Practitioner Magazine, Nov 2008 United Media. 10. Pollock K. 2010. http://www.farmsafe.org.au/index.php?article=content/recent-news/economic-costsof-farm-injury-deaths. 11. Day LM, Cassell E, Li L, McGrath A. Preventing Farm Injuries Overcoming the Barriers A report for the Rural Industries Research and Development Corporation 1999. http://www.monash.edu.au/muarc/ reports/Other/RIRDC15a.pdf. 12. Andreoni D. Cost of occupational accidents and diseases. International Labour Organisation, Occupational Safety and Health Series 54, Geneva 1986. 13. Larsson T, Betts N. The variation of occupational injury cost in Australia: estimates based on a small empirical study. Safety Science 1996;24:14355. 14. World Economic Forum, 2002. Responding to the Leadership Challenge: Findings of a CEO Survey on Global Corporate Citizenship. Available at http://www.weforum.org/pdf/GCCI/Findings_of_CEO_ survey_on_GCCI.pdf. 15. ILO Safety in numbers. Pointers for a global safety culture at work. International Labour Oce, Geneva 2003. 16. Abdulsalami OL, Ibrahim BB, Salifu AJ. Environmental Sustainability in A Developing Economy: Nigerian Institute of Safety Professionals Journal 2011:2(2) ISSN-0794-4985.

D. Elsler European Agency for Safety and Health at Work Spain

How to create economic incentives in occupational safety and health

Photo Suvi Lehtinen

Introduction

European countries could benefit from introducing more economic incentives to promote workplace health and safety, rewarding the organizations that work hardest to protect their employees. This is the message of the economic incentive project, undertaken by the European Agency for Safety and Health at Work (EU-OSHA). Some EU Member States already offer various kinds of financial rewards for businesses that invest in keeping their employees safe. These rewards range from state subsidies and grants, through to tax breaks, preferential terms for bank loans, and lower insurance premiums for the bestperforming businesses. The European Union strategy 200712 on occupational safety and health (OSH) recognizes the need to use eco-

nomic incentives to motivate enterprises to apply good practices in their prevention work (1). EU-OSHA contributes to meeting this need by providing information on the types of economic incentives that are most likely to succeed. Research has shown that external economic incentives can motivate further investments in prevention in all organizations and thus lead to lower accident rates. This project gives the clearest indication yet that these types of incentives are effective, and encourage organizations to improve their occupational health and safety. According to Elsler et al. (2), for every euro spent through incentive schemes, up to 4.81 is saved through reduced accident and disease rates, and lower rates of absenteeism as working conditions improve. As well as this business case for the incentive-providing
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organizations, further arguments to introduce an economic incentive scheme, especially for private or state-run insurance companies are as follows: Improvement of corporate social responsibility (especially in large companies) Improved reputation of the insurance company Creating winwin situations with clients Competitive advantage (for private insurance companies). The project was inspired by the European OSH Strategy 20072012, which aims to reduce occupational accidents by 25%. Several products were delivered in its first phase: A dedicated web portal on economic incentives in OSH in 22 languages: http:// osha.europa.eu/en/topics/economic-incentives A comprehensive report entitled Economic incentives to improve occupational safety and health: A review from the European perspective (3) A fact sheet (summarizing the report in 22 languages) Two articles in a peer-reviewed scientific journal (Scandinavian Journal for Work, Environment & Health) (2,4) A series of expert group workshops, documented in our events section A collection of case studies for our good practice database. The second phase of the project delivers more practical products for organizations that are interested in developing or optimizing their own incentive scheme: A practical guide for incentive-giving organizations http://osha.europa.eu/en/publications/ literature_reviews/guide-economic-incentives/view sectoral compilations with preventive solutions that can be incentivized. http://osha.europa.eu/en/publications/ reports/innovative-solutions-OSHrisks/ view The practical guide is based on the findings of the economic incentives project and is intended to serve as a practical and user-friendly guide to help incentive providers create or optimize their own economic incentive schemes. The primary target audience is organizations that can
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provide economic incentives to improve OSH, such as insurance companies, social partners or governmental institutions. These organizations are regarded as important intermediaries to stimulate further efforts in OSH in their co-operating enterprises; for example as clients of insurance institutions. One conclusion of the EU-OSHA project is that incentive schemes should not only reward past results of good OSH management (such as accident numbers in experience rating), but should also reward specific prevention efforts that aim to reduce future accidents and ill-health (3). Experts of the project therefore suggested the development of compilations of innovative and evidence-based preventive solutions, starting with the three sectors of construction, health care and HORECA (hotels, restaurants, catering). The preventive measures from these compilations are worth promoting in their own right, as well as applying to economic incentive schemes. These preventive solutions can be used as a basis for incentive-providing organizations to develop their own incentive scheme, adapted to the specific situation in their sector and country. So far, the economic incentive project has already encouraged different EU Member States to learn from each other, and to exchange good practice in designing incentive schemes. All in all, the project shows that economic incentives can be effective in nearly all countries, despite the wide differences in their social security and accident insurance systems. The project and its results have been presented at conferences and workshops in numerous European countries, including Bulgaria, Cyprus, the Czech Republic, Germany, Italy, Sweden, Slovenia and the UK. Some practical consequences have already been observed. For example, the Italian workers compensation authority INAIL has developed a new incentive scheme that takes into account the experiences and good practices of other countries and is therefore based on the best available international knowledge. With a budget of over 60 million in 2011, and of 205 million in 2012, the INAIL scheme targets small and medium-sized enterprises in particular. Experts estimate that it could lead to benefits worth 180 million at society level in 2011 and 615 million in 2012.

The following economic incentives to promote occupational safety and health can be found in European countries (3): Insurance premium variations, dependent on for example Occupational accidents and diseases (experience rating) The specific risk of the sector Prevention activities such as training, investments, personal protection measures State subsidies, for example for innovative investments or reorganization Tax incentives, such as better write-off conditions Better banking conditions, for example lower interest rates Non-financial incentives, for example, certification of OSH management systems or awards. Many common incentive schemes in Europe are based on insurance premium reductions. If the premium reductions are simply calculated according to the risk of the company, taking into account past accident insurance and disease rates, this so-called experience rating process is very easy to apply. In addition, a large number of companies can take part in this incentive scheme, as it applies to all insured companies. Research on the effectiveness of experience rating found evidence (for example 5) that a lower rate of accidents is achieved. The effect of experience rating has been analysed in depth in the incentive scheme of the Finnish agriculture sector. Using administrative data, Rautiainen et al. (6) conducted interrupted time series analyses which showed that the premium discount reduced the overall claim rate by 10.2%, meaning the reduction of more than 5000 accidents. However, the authors do not exclude the possibility that underreporting could have contributed partly to the claim reduction, although no farmer would actually benefit economically from such a practice. The possible bonus in the insurance premium would always be much lower than the cost of an accident which would not be reimbursed if it was not reported. Under-reporting is often discussed as a possible negative side effect of experience rating. As the Finnish example shows, such a practice hardly ever leads to a positive economic benefit for the under-reporting company, if the incentive scheme is designed in the right way.

Types of incentives

Kohstall et al. (7) propose that both positive and negative incentives should be used in an incentive system. Through negative incentives (or disbenefits), companies that remain significantly above the sectors average accident rate can be obliged to pay an augmented insurance premium. This would increase the visibility of bad OSH performance and therefore raise awareness in the enterprises concerned. Normal insurance premiums are usually planned into the budgets of companies. A positive variation is of course welcomed, but only a negative variation will force companies to adapt their budget planning and therefore make them think more deeply about taking preventive measures. Further negative deviation in insurance premiums can serve as a psychological foot in the door for labour inspectors or safety representatives trying to persuade an enterprise to put more effort into OSH. Although overall, research literature provides convincing evidence for the positive effects of experience rating, there are nevertheless some potential shortcomings connected with this method. For example, small and medium-sized enterprises (SMEs) in particular rarely profit from such incentive schemes. Because of this, the insurance schemes of FBG (Germany) and INAIL (Italy) combine an experience rating system with a funding system that also rewards specific prevention activities. The statistical evaluations of both case studies have proven the effectiveness of such an approach, leading to significantly lower accident rates and better health outcomes among participating enterprises. For SMEs it is important to create a direct link between OSH activities and a reward, such as an insurance premium reduction. Therefore, effort-based incentive schemes are more effective for SMEs than pure experience rating approaches. Possible adaptations of this type of incentive scheme could be a start, with high premiums that are reduced annually if no accidents occur (as in car insurance). Another idea could be to reward increased reporting in order to receive more detailed information on accidents/diseases.

Although overall, research literature provides convincing evidence for the positive eects of experience rating, there are nevertheless some potential shortcomings connected with this method.

ample those preventive actions concerning knife accidents, falls and slips, machines and traffic safety. The economic incentive may result in up to a 5% reduction in insurance rates. An OSH audit was also offered, in which more than 40 companies participated in 2008. During the period evaluated (2001 to 2007), the participating companies target fulfilment continually improved. Starting at a similar accident rate in 2001 (92 per 1,000 full-time workers) the six-year participants reduced their accident rate to 65, compared to that of only 78 per 1,000 FTE ( Full-time equivalent) among non-participants. A cost-benefit analysis comparing the costs of premiums granted and the theoretical accident cost reduction showed that the financial benefits were significant on the side of the insurance. As a positive side effect, the collected data can serve as a benchmark for other companies and as a foundation for scheme development.
Dietmar Elsler European Agency for Safety and Health at Work, E 48009 Bilbao, Spain E-mail: elsler@osha.europa.eu

References
1. A new Community Strategy on Health and Safety at Work 2007-2012, European Commission, Brussels, 21.01.2007, COM (2007) 62 nal. Available from: http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=COM:2007:0062:FIN:EN:PDF 2. Elsler D, Treutlein D, Rydlewska I, Frusteri L, Krger H, Veerman T, Eeckelaert L, Roskams N, Van Den Broek K, Taylor TN. A review of case studies evaluating economic incentives to promote occupational safety and health, Scandinavian Journal of Work, Environment & Health, 2010;36(4): 289298. Available from http://osha.europa.eu/en/topics/economic-incentives/review-case-studies-econincentives.pdf 3. EU-OSHA European Agency for Safetz and Health at Work. Economic incentives to improve occupational safety and health: A review from the European perspective. European Agency for Safety and Health at Work, Bilbao, Spain 2010. Available from http://osha.europa.eu/en/publications/reports/ economic_incentives_TE3109255ENC/view 4. Elsler, D, Eeckelaert, L. Factors inuencing the transferability of occupational safety and health economic incentive schemes between dierent countries, Scandinavian Journal of Work, Environment & Health 2010;36(4):32531. Available from http://osha.europa.eu/en/topics/economic-incentives/ transferability-econ-incentives.pdf 5. Tompa E, Trevithick S, McLeod C. A systematic review of the prevention incentives of insurance and regulatory mechanisms for occupational health and safety, Scandinavian Journal of Work, Environment and Health 2007;33(2):8595. 6. Rautiainen RH, Ledolter J, Sprince NL, Donham KJ, Burmeister LF, Ohsfeldt R, Reynolds SJ, Phillips K, Zwerling C. Eects of premium discount on workers compensation claims in agriculture in Finland, Am J Ind Med 2005;48(2):1009. 7. Kohstall, Thomas et al. Schlussbericht, Projekt Qualitt in der Prvention. Teilprojekt: Wirksamkeit und Wirtschaftlichkeit nanzieller und nicht nanzieller Anreizsysteme, Teil 2: Finanzielle Anreizsysteme. DGUV: Berlin 2006.

Example: Incentive scheme of the German Butchery Sector Accident Insurance (EU-OSHA, 2010, p. 208)

Premiums are reduced in participating companies for preventive measures, for ex-

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Joachim Duus, Jens C. Streibig, Deogratias Sekimpi, James Maziina, Erik Jrs Denmark, Uganda

Smallholders use of pesticides in Ugandan agriculture

Photo Joachim Duus

Introduction

This article reports the results from a research project on farmers and pesticide dealers knowledge and practice when handling pesticides in two districts of Uganda. The research was performed as part of a baseline study in the project Pesticides, Health and Environment Uganda. The project aims at reducing the health and environmental problems associated with the increased use of pesticides by small-scale farmers in Uganda. Farmers, agrochemical dealers and agricultural technicians are taught the principles and practice of Integrated Pest Management (IPM) in order to reduce the amounts of pesticides used, and health care workers are taught diagnosis, treatment and prevention of pesticide poisonings. The project is run by the Danish NGO Dialogos and the Ugandan NGO UNACOH (Ugandan National Association of Community and Occupational Health). Students and professors from both the University of Copenhagen and Makerere University are involved, as is the Danish Society of Occupational and Environmental Medicine. See www.dialogos.dk

A nation of farmers

A farmer in Wakiso spraying his lettuce with insecticide. Note that he is not wearing any personal protective equipment.

Uganda is a nation of farmers, as 85% of the population lives in the countryside and is more or less dependent on farming and related activities. Of the 17 million arable hectares, only 6 million is currently under cultivation (1). Plant products for home consumption account for about 65% of farmland use, 25% is used for animal production and the remaining 10% is used for cash crops such as tea, coffee, cotton, sugar and horticultural crops (2). In Uganda the number of farmers using pesticides is growing because of the evolution of the farming from mainly organic subsistence farming to a mix of cash crop and subsistence farming involving the use of increasing amounts of pesticide (3). It is difficult to obtain precise figures, but from 1980 to 2004 (4), the import of fertilizers rose by a factor 47 (4), and around 4000 tonnes of pesticides were imported each year in 2002 2004 (2, 5). FAO, the Food and Agriculture Organization of the United Nations, only has erratic statistics on the value of pesticides imported to Uganda. Moreover, it

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is estimated that at a rather large amount is smuggled into the country across non-secured borders (6). The increase in pesticide use is also the result of many agricultural projects aiming to raise production, often as part of the credit packet offered to the farmers (6). Apart from problems among small-scale farmers, pesticide problems occur in the intensive use of pesticides in the cut rose industry in greenhouses, and also in the intensive use of insecticides in cotton production and of fungicides in cultivating potatoes.

References
1.. Pender J, Jagger P, Nkonya E, Sserunkuuma D. Development Pathways and Land Management in Uganda. World Development 2004;32:76792. 2. FAO, Uganda. See http://www.fao.org/countries/55528/en/uga/ (accessed 06-12-2011) 3. Isubikalu P, Erbaugh JM, Semana AR, Adipala E. The inuence of farmer perception on pesticide usage for management of cowpea eld pests in Eastern Uganda. African Crop Science Journal 2008; 31725. 4. Morris M, Kelly VA, Kopicki RJ, Byrelee D. Fertilizer Use in African Agriculture, Lessons learned and good practice guidelines, The world Bank 2007;11215. 5. Tukahirwa EM. Trends in Pesticide Usage in Uganda. In Management of Pests and Pesticides: Farmers Perceptions and Practices, ed. by Tait J and Napompeth B. Westview Press, London 1987;182 90. 6. Sekimpi D. Personal communication from Ugandan National Association of Community and Occupational Health (UNACOH), See http://www.unacoh.org/projects/pestcide-health-andenvironment-phe/ (Accessed 10-04-2012). 7. Karunamoorthi K, Mohammed A, Jemal Z. Peasant association members knowledge, attitudes, and practices towards safe use of pesticide management. American Journal of Industrial Medicine 2011;54:96570.

Small-scale farming and pesticide use

There are around 3 million smallholder households, often with less than a hectare of land to farm (2). They produce the bulk of agricultural commodities. These smallholders do not have the funds or knowledge to take action on unintended pesticide problems in the same way as industrial agriculture. Surveys in cotton, groundnut, cowpea and vegetable producing areas show that from 40 up to 90% of small-scale farmers use pesticides. This means that millions of farmers are using an increasing amount of pesticides. Some of the farmers supply the metropolis with fresh vegetables on a daily basis. The production is extremely intensive, with crop cycles of two or three months and an average crop sequence of more than two per year. Pest infestation and infection on the land cultivating vegetables are massive, and so is spraying with pesticides. Spraying twice a week is common, depending on whether it is the dry or wet season. Spraying generally occurs more frequently in the wet season, due to high pressure from insect pests, diseases and weeds (7). For example, harvested fresh tomatoes on the market are often sprayed with mancozeb in order to prevent the produce from rotting. If the customer can see the residue on the tomato, the price is higher than when signs of spray residues are not conspicuous (6). Surveys on Africans Horn show that a large proportion of small-scale farmers use pesticides, meaning millions of farmers are exposed to pesticides (6).

24 small-scale farmers and 20 pesticide dealers were observed and interviewed, by means of questionnaires, about their knowledge of pesticides, spraying habits, which kind of pesticides they used, farm management, spraying equipment and the use of personal protective equipment (PPE). Twelve farmers and ten pesticide dealers from each district, spread over different counties, were chosen. Small-scale farming in Uganda, as in other African countries, often engages the whole family. Hence the whole family is at risk of pesticide exposure, both when pesticides are applied and also in the homes. Therefore, the people chosen for the questionnaires included both younger and older farmers as well as both genders. The interviewer team included Danish students and UNACOH staff. Most of the villages visited were located far from tarmac roads, and a car with four-wheel drive was used to reach locations. All participants were interviewed individually with the use of standardized questionnaires. The pesticides used were classified by hazard according to the WHO recommended classification (2009). The classification is based primarily on the acute oral and dermal toxicity to rats. It should be stated that the hazard of the pesticides used by the farmers studied in this paper is based on the active ingredient and not the commercially formulated pesticide.

Methods

Results of the survey

This research project took place in the districts of Wakiso and Pallisa, Uganda, in January and February 2011. In all,

First, it can be said that all of the farmers interviewed or observed used knapsack sprayers. No pesticides in WHO class Ia were used. The insecticide dichlorvos, a

WHO class Ib pesticide, was found to be in use by some farmers. Most pesticides were in WHO classes II and III. Paraquat, a WHO class II pesticide, was used by one farmer. Parathion or DDT was not found neither at farms nor in dealers shops. The pesticide used most in both districts was the insecticide Cypermethrin, which belongs to class II. Herbicides were used especially in Wakiso, where rainy conditions favour weeds; glyphosat in different formulations and 2,4-D were used extensively both while growing crops and in between crop rotations. Glyphosate is unclassified in the WHO classification and 2,4-D is classified as a class II preparation. The use of PPE was minimal and the spraying equipment was often in very poor condition. Only 8% of the farmers in Wakiso and none of those in Pallisa used protective gloves. Problems were obvious, especially when mixing and measuring the correct field rate of a pesticide for a given crop. The common practice of indicating the dose in e.g. millilitres or grams per hectare on the label is far from smallholders reality, because their fields are often only 50 to 100 square metres in size. Figure 1 shows that most of the farmers answered that they get their dose from the pesticide label. In practice, the research team observed that often much more was used than recommended on the label; sometimes the whole bottle was used in one spraying session, resulting in an excessive overuse. This might also be due to the fact that many of the smallholders do not read English and therefore do not always understand the instructions on the labels.
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Erik Jrs, Aggrey Atuhaire, Katia Buch Hrvig, Lene Kierkegaard, Majbrit Mlgaard Nielsen, Mercy Wanyana, Bernadette Mirembe, Charles Okorimong, Deogratias Sekimpi Denmark, Uganda

The study also showed major issues with the cleaning of spraying equipment and the disposal of empty pesticide bottles and containers. Often the knapsack sprayers were not cleaned at all. Empty pesticide bottles were littered in the small fields. The pesticides were most often stored in the farmers house without being locked up, and so they were easily accessible to children and others. Many farmers had experienced symptoms of intoxication after handling pesticides. Most dealers had little knowledge about toxicity and the correct dosage and handling of pesticides. Their shops did not comply with Ugandan regulations on the storage of pesticides. Many of the shops did sell protective equipment, but it was not used by farmers. Only a minor percentage of the dealers interviewed were members of the Ugandan National Agro-input Dealers Association (UNADA).

Are SMS messages the way forward in spreading health information?

An exciting experiment was recently carried out in the Pesticide-HealthEnvironment Project run by UNACOH and Dialogos/ICOEPH in Uganda. SMS messages with information on pesticides and reproductive health were sent to 70 farmers. Their effectiveness was later evaluated through follow-up questionnaires and focus group discussions, revealing surprisingly positive results. grammes and now this rather new initiative to spread health messages through SMS messages.

SMS experiment

Conclusion

The use of pesticides in Wakiso and Pallisa entails many health and environmental problems; however, no pesticides classified as WHO class Ia or Ib were found apart from dichlorvos. The main problems were found to be a lack of use of PPE and the farmers failure to follow the instructions for the correct handling of pesticides. Training for both farmers and pesticide dealers could be a way to solve the problems. Moreover, the instruction for use should be adapted to the reality of the small-scale farmers.
Joachim Duus Jens C. Streibig, (Crop Protection) Dept. Agriculture and Ecology University of Copenhagen Hojebakkegaard All 13 DK 2630 Taastrup Denmark Deogratias Sekimpi, James Maziina Uganda National Association of Community and Occupational Health Kampala, Uganda Erik Jrs Clinic of Occupational Medicine, Odense University Hospital, and University of Southern Denmark 18 Afr Newslett on Occup Health and Safety 2012;22:189

PHE project

The project, financed by the PR-NGO from Denmark, is a three-year project, which aims to reduce the negative health effects of pesticides in humans and prevent pesticide pollution of the environment, by 1. Improving the prevention, diagnosis and treatment of pesticide poisonings, 2. Promoting Integrated Pest Management strategies among farmers and 3. Raising awareness in the population and advocating proper control to minimize possible pesticide dangers to both consumers and the environment. As we directly train only around 40 health care workers, 15 extension workers, 12 agrochemical dealers, and 40 farmers who will pass on their knowledge and become teachers of the general population in the project areas, we also have strategies for more widely spreading public information through articles in papers, radio pro-

Three public health students from Copenhagen University and three environmental health students from Makerere University, together with the project staff planned the content of the messages and sent them through a telecommunication company to the farmers in Pallisa over a fourteen-day period in February 2012. Seventy farmers filled in a questionnaire both before and after the messages, and four focus group discussions were conducted with the farmers to evaluate the change in their knowledge and awareness and whether they found the messages useful, and to explore how to improve the messages and whether to continue with the campaign in the future. The participating farmers were both some trained by the PHE-project and some untrained. The messages, sent out with an introductory slogan, were: Children are our future Use boots and other personal protective equipment when handling pesticides to avoid poisoning yourself and to reduce the risk of not being able to have children. Children are our future Change your clothes and wash them and yourself after using pesticides to avoid poi-

Photo UNACOH/Dialoges

to receive them. The untrained farmers requested more information in addition to the messages, e.g. posters, radio programmes expanding on the subjects, and meetings to discuss the contents of the messages.

Conclusions

The SMS health messages were found useful reminders but should not be used alone.

soning yourself and to reduce the risk of not being able to have children. Children are our future Do not use pesticides when pregnant, it can lead to pesticide poisoning and miscarriage. Children are our future Use pesticides in doses as recommended on the pesticide container or by the pesticide agro dealer, as stronger mixtures can poison you and your unborn child. Children are our future Breastfeeding mothers should avoid exposure to pesticides as it can poison them, enter their breast milk and lead to poisoning the baby. Children are our future Do not bring children into a garden being sprayed with pesticides or a garden that has recently been sprayed with pesticides. Children are our future Keep pesticides out of reach and locked up to avoid poisoning your children and the rest of your family by accident.

Each message sent cost 75 UGX, the equivalent to 0,025 euro.

Results

The SMS messages were taken very positively by all the farmers but one, as they desire information of all kinds, especially on agriculture, which is their main means of survival. When knowledge before and after were compared among participants, new learning had taken place, especially among the non-trained farmers. The

trained IPM farmers did not gain new knowledge as such, but the SMS messages reminded them about what they had already learned. The messages encouraged them to pass on their knowledge to fellow farmers in evening classes as expressed by one, and even share them in the church, as told by another. The farmers were able to recall the brief content of the messages, i.e. information about pregnancy and avoiding contact with pesticides, personal protection and good hygiene when spraying pesticides, keeping pesticides locked up etc. It was clear that the SMS information enriched the farmers own knowledge, and that they shared it with fellow farmers and neighbours in discussions in the villages. This however, risks posing the possible danger of creating false knowledge on pesticide hazards, as not all farmers knowledge was correct. This experiment had various constraints, e.g. lack of means of charging phones in the villages, messages often received with delays, lack of knowledge on how to open the SMS messages, inability to read, lack of money for buying airtime, farmers fear that when the message is opened money will be deducted from their account, etc. The messages were sent in the local Ateso language as well as in English, which was important, as many of the farmers could not read English. The farmers all requested that the messages be continued, on fixed week days so they could be alert

The result of this study surprised us, as we thought that SMS messages could mainly only be used as reminders or in emergency situations to alert people. It is now our opinion that SMS messages can be used to spread health information, as they are taken seriously, and are read and discussed by the farmers, their families and neighbours. However, they cannot stand alone, due to their limited content, and should be followed up by meetings and discussions in the villages organised by trained farmers and agricultural extension workers, radio programmes that expand on the subjects raised in the messages, and posters. An idea could be to send a weekly message to participants in the project to remind them to pass on the acquired knowledge and to create discussions. This is in contrast to the way in which SMS messages have normally been used for reminding people about e.g. meetings to go to, pregnancy control, treatments to take, emergencies all of which do not need any specific follow up. SMS messages still seem to have some power of attraction, as they are relatively new to the Pallisa District society, where an estimated 75% of farming families now have a mobile phone. Given the positive response from the farmers, SMS messaging is certainly something the PHE project will include in its activities in the future.
Erik Jrs (1,2) Aggrey Atuhaire(3) Katia Buch Hrvig(4) Lene Kierkegaard(4) Majbrit Mlgaard Nielsen(4) Mercy Wanyana(5) Bernadette Mirembe(5) Charles Okorimong(5) Deogratias Sekimpi(3) 1. Danish NGO Dialogos 2. Danish NGO ICOEPH 3. Ugandan NGO UNACOH 4. Copenhagen University, Public Health 5. Makerere University, Environmental Health
Afr Newslett on Occup Health and Safety 2012;22:189

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Yoosoof Jauhanger MAURITIUS

An overview of occupational health and safety in the Republic of Mauritius

Flag of the Republic of Mauritius1

Coat of Arms of the Republic of Mauritius

Introduction

The Republic of Mauritius, a group of tropical islands in the Indian Ocean, became independent from Britain on 12th March 1968 and became a Republic on 12th March 1992. The island of Mauritius, the largest of these islands, has an area of 720 square miles and a population of 1.2 million. Mauritius has the standard of living of a middle-income developing country with a per capita GDP of USD 7,593. Thanks to the provision of free education in 1976, the literacy rate is above 90%. This high literacy rate has assisted Mauritius a great deal on its way towards the diversification of its economy. Mauritius has successfully graduated from a less developed mono-culture economy to being reckoned a newly industrialized country.

Health and safety legislation

Mauritius a member of ILO

Mauritius has been a member of the International Labour Organization since 1969 and has ratified 44 Conventions, among them four mentioned below
Mauritius -Member since 1969 C. 81 C. 138 C. 160 C. 182
1

Health and safety was introduced in Mauritius in early 1975 with the Labour Act. A few years later, in 1980 the Health, Safety and Welfare Regulations came into force; these deal with electricity, foundries, building and excavation work. Even now, certain sections are still in force, while those dealing with electricity and building works have in part been replaced with new regulations. The Occupational Safety, Health and Welfare Act (OSHWA) was enacted in 1988 and proclaimed in May 1989. That Act brought about drastic change in the field of occupational health and safety in Mauritius by defining the duties of employers and employees. The Act further placed an obligation on employers to appoint a safety and health officer if the number of persons at a place of work is above 100. Together with the OSHWA of 1988, a series of regulations came into force. Some are still valid and applicable till now as follows: The Occupational Safety Health and Welfare (Fees and
44 Conventions ratied (35 in force) 2 February 1969 30 July 1990 14 June 1994 8 June 2000

Labour Inspection Convention, 1947 (No. 81) Minimum Age Convention, 1973 (No. 138) Minimum age specied: 15 years Labour Statistics Convention, 1985 (No. 160) Acceptance of Articles 7-10 and 12-15 of Part II has been specied pursuant to Article 16, paragraph 2 of the Convention. Worst Forms of Child Labour Convention, 1999 (No. 182)

The colours of the ag may not correspond to the ocial colours.

20 Afr Newslett on Occup Health and Safety 2012;22:202

Registration) Regulations, 1989 (repealed) The Occupational Safety Health and Welfare (First Aid) Regulations, 1989 (with a few amendments regarding the first aid requisites). The Occupational Safety Health and Welfare (Woodworking Machines) Regulations, 1989. The Occupational Safety Health and Welfare (Asbestos) Regulations, 2004. The Occupational Safety and Health Act (OSHA) was enacted in 2005 and proclaimed in 2007. This Act was passed with the aim of consolidating and widening the scope of legislation on safety, health and the welfare of employees at work.

Figure 1. Departments of the OSH Inspectorate.

The enforcing body

The Occupational Safety and Health Inspectorate of the Ministry of Labour and Industrial Relations is responsible for ensuring compliance with the law. With a staff of 50, the Inspectorate is divided into four Departments (Figure 1).

Under this Act, the following Regulations have been made by the Minister: The Occupational Safety and Health (Fees and Registrations) Regulations, 2007 The Occupational Safety and Health (Electricity at Work) Regulations, 2009 The Occupational Safety and Health (Employees Lodging Accommodation) Regulations, 2011 The Occupational Safety and Health (Fees and Registrations) (Amendment) Regulations, 2011 The Occupational Safety and Health (Scaffold) Regulations, 2011.

The Judiciary

The Advisory Council for Occupational Health and Safety

To give advice and assistance to the Minister of Labour and Industrial Relations and Employment, an Advisory Council for Occupational Health and Safety was set up under the OSHA 2005. The Council consists of a Chairperson, who is the Director of the Occupational Health and Safety, and eight members respectively representing the Government, employers and the employees as well as two members having wide experience in the field of occupational health.
Table 1. Accidents amf fatalities in 19892010
Year Accidents (N) Fatalities (N) Year Accidents (N) Fatalities (N) 1989 13,758 12 2000 4,557 9 1990 11,908 14 2001 4,225 10

The Industrial Court, which is responsible for looking after all cases under the Occupational Safety and Health Act, is situated at Port Louis and is headed by the President of the Court. Any party that feels aggrieved by the decision of the Industrial Court may make an appeal to the Supreme Court. Finally, there is the Privy Council of Her Majesty the Queen of the United Kingdom. The penalty for any misdoing under the OSHA 2005 is a fine of up to Rs.75,000 (approximately USD 2,500) and up to 1 year of imprisonment for an employer, and a fine of up to Rs. 5,000 for an employee. Up till now, no employer has been jailed nor has an employee been fined. The President of the Industrial Court frequently quotes the following as Jurisprudence Machinery is dangerous if in the ordinary course of human affairs, danger can be reasonably anticipated from the use of it without protection ; even if the workman has disobeyed instructions or the accident was due to his haste, hurry, carelessness or indolence Where it is proved that the machine is dangerous to a person who is employed to use it and actually causes injury to that person when he is so using it, it is a dangerous machine.

The Factories Act is there not only to protect the careful, the vigilant and the conscientious workman, but human nature being what it is, also the careless, the indolent, the inadvertent, the weary and even, perhaps, in some cases, the disobedient Moreover, It is for the prosecution to prove that the accused company wilfully and unlawfully failed to discharge the duty imposed upon it by section 5 of the Occupational Safety and Health Act 2005, which is to ensure the health and safety of its employees at work as far as is reasonably practicable. It is however for the defence to show on a balance of probabilities that it was not reasonably practicable to comply with such obligation. Any party may additionally claim civil damages under the Civil Code (Napoleon) for any prejudice caused by an accident or ill health.

Statistics on accidents and ill health

There has been a marked decrease in the number of accidents in Mauritius, mainly because of the great effort from the safety and health officers and the officers of the Ministry of Labour, and also because of the shift from an agricultural economy to service industry. (Tables 1) Records on reportable accidents are kept at the level of the Occupational Safety and Health Inspectorate. Records on industrial injury are kept at the level of the Ministry of Social Security for the private sector only. Records on occupational diseases are kept at the level of the Ministry of Health.

1991 10,234 19 2002 3,564 14

1992 10,505 20 2003 532 25

1993 10,348 27 2004 566 18

1994 8564 16 2005 396 6

1995 6382 14 2006 426 8

1996 5639 17 2007 149* 10

1997 5277 10 2008 151* 13

1998 5271 10 2009 184* 15

1999 4457 10 2010 181* 13

Afr Newslett on Occup Health and Safety 2012;22:202

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Health and safety professionals

There are approximately 300 safety and health officers in Mauritius. The majority hold the basic qualifications: a Diploma in Occupational Health and Safety. More and more safety and health officers are upgrading their qualifications with a BSc degree. To practise as a safety and health officer, the person should be registered with the Occupational Safety and Health Inspectorate of the Ministry of Labour for the particular place of work and can work on a parttime basis for a maximum of four places of work with 100500 employees. One safety and health officer should be employed on a full time basis where there are between 500 2000 employees. Most professionals are grouped with Institution of Occupational Safety and Health Management (IOSHM), which was created in 1981. IOSHM is a member of the Asia Pacific Occupational Safety Organization (APOSHO) and the International Network for Safety and Health Practitioner =rganisation (INSHPO). The IOSHM has signed a Memorandum of Understanding with the IOSH (UK) and with the Korean Occupational Safety Health Agency (KOSHA). As a member of APOSHO, the members of the IOSHM regularly participate in the annual meetings and conferences, whereby sharing of experience and knowledge takes place.

The way forward

However, to cope with the exigency of the work and to give due credit to the profession, it is of crucial importance to: Set up a Professional Safety and Health Officer Council It is very important to create a Professional Safety and Health Officer Council that would be responsible for all matters pertaining to the profession, including registration, guidelines, suggestion to government, sensitization campaigns, statistical collections of accident and illness and carrying out studies and surveys. The members of this council should come both from government and from the private sector. With professionals in the field, this Council would assist the Government much better and direct the resources and action for an optimum use. Upgrading of the basic qualification and salary Presently, the basic qualification to practise as a safety and health officer is a Diploma in Occupational Safety and Health.
22 Afr Newslett on Occup Health and Safety 2012;22:202

However, as most professionals in the field now hold a BSc in Occupational Safety and Health, it is high time to upgrade the requirements level. This upgrading would remove the sense of inferiority when dealing with other professionals, including engineers, architects, etc. This would also increase the basic salary of the existing officers and would help to cope with the scarcity of health and safety officers in the government sector and parastatal bodies, and would help to combat the high turnover rate. However, so as not to penalize the existing safety and health Officers holding a Diploma and having several years of working experience, it is suggested that they be given a special exemption. Bring health and safety to the Board level It is already a requirement to incorporate health and safety issues in companies annual reports. Moreover, it is also compulsory to discuss matters pertaining to health and safety in the Audit and Risk Committee at the Board. However, it is sad to note that only few companies are aware of this provision as well as its benefits, even with the efforts of the Mauritius Employers Federation to sensitize its members toward health and safety. Sensitization campaign and training It is very important that a continuous sensitization campaign is carried out, in order to promote occupational health and safety. It is high time to launch a National Award on health and safety whereby the most safety conscious companies and the most proactive safety and health officers could be recognized for their commitment and efforts. This award could be set up under the aegis of the Safety and Health Officer Council. Moreover, to ensure that the population is conscious about general health and safety issues (including road safety, proper diet, etc.) the sensitization programme should start at the grass-roots level, at preprimary school, and should be strengthened in primary and secondary school. All students in vocational schools and universities should have proper knowledge about the potential hazards inherent in their trade and how to minimize the risk. It is a hopeful and very positive good sign to note that the MITD, Mauritius Institute of Training and Development (formerly the IVTB, Industrial Vocational Training Board) has included a module on health

and safety in all its courses and training. Surely, other universities and training institutions should follow the trend. Companies should ensure that their labour force is properly trained not only to comply with the law, but also to ensure that the work is carried out efficiently with a minimum of risk. More trade unions are putting emphasis on health and safety issues. Some are even organizing sensitization campaigns on a regular basis, to empower their members. Surely, others would continue in this direction. Employee representatives should always ensure that their members have been adequately trained and protected to carry out their work efficiently, effectively and safely. The Occupational Safety and Health Act of 2005 is crystal clear about the compulsory requirement of the employer to provide adequate and appropriate training. Directors of companies should use the training levy of the, HRDC, Human Resources Development Council efficiently so that they would have properly trained personnel to prevent accidents and ill health. Such facilities should be extended to their advisors in health and safety, the safety and health officers. The media, radio, television and newspapers have a key role to play in the sensitization and training campaigns. The media have an important role to play in the sensitization of the population at large, and should not just cover health and safety issues as a juicy piece of information after an accident has occurred. Regional corporation Up till now, there has been no regional corporation between the professionals in field. It is high time that the professionals in the region come together with a platform similar to APOSHO. Seminars and workshop can be organized on a yearly basis for the sharing of knowledge and information.
Yoosoof Jauhangeer Safety and Health Consultant Member of the Advisory Council for Occupational Health and Safety Former President of IOSHM Former Director of International Network for Safety and Health Practitioner Organisation (INSHPO)

P. Comlan, B. Mabika Mabika, A.M. Mouanga, J.P. Ngou Mve Ngou, F. Ezinah, J. Djeki Gabon, Congo

Knowledge, attitudes and practices of cervical cancer screening among a group of female sex workers in Libreville, Gabon
Introduction
Cervical cancer is one of the most prevalent cancers in women. Each year, 440,000 new cases are discovered, 80% of them in developing countries (1). Cervical cancers rank first among all womens cancers in the developing world, where they are diagnosed at a very late stage (2). In Gabon, the cervical cancer screening programme was set up in 1985 in order to detect the presence of cervical cancer among sexually active women, but it is not fully active and lacks guidelines widely disseminated to the public. Ezinah et al. (3) reported that cervical cancer ranks first among womens cancers, accounting for 23.4% of cases. The human papillomavirus (HPV) stereotypes most frequently found in the country are HPV-53, HPV-58 and HPV-16 (4). The four main risk categories facing prostitutes in the sex trade are sexually transmittable infections, violence by their clients and pimps, drug consumption and mental health. For this study, we assessed the knowledge of cervical cancer and the risk factors of this illness among women practising sexual activities for a living. This delicate information about the profession was obtained through confidential and anonymous questioning of the female population in popular areas of Libreville, the capital city of Gabon. they were free to participate in the study and could refuse participation at any time. The questionnaire was formulated on the basis of a review of the literature. It was divided into five sections: sociodemographic characteristics (9 questions); work environment (8 questions); knowledge and practices relating to risk factors of cervical cancers (13 questions); obstacles to cervical cancer testing (9 questions); and, finally, the risks linked with sex work (1 question).

Results

A cross-sectional study

A cross-sectional study was carried out in September 2010 among the prostitutes living in the following popular areas among sex-trade workers Gare Routire, Nkembo Market, and Atong Ab and working around a hotel in Libreville. In all, 57 of the 78 sex workers contacted accepted to participate in the study. Male prostitutes were excluded from this study. The conditions for admission to the study were being a female sex worker for the past two years, willingness to participate in the study, and the completion of a confidential application form. The questionnaire was filled in anonymously, and the only personal identification requested was the persons age. All the participants received a confidentiality guarantee and a clear explanation of the aims of the project and the methodology used. They were also given assurance that

Characteristics of the population. The sex worker population (mean age 21.7 + years; range: 1835 years) included 42 (74%) women under 21 years. All the participants were Africans and were over 18 years old. Women from other continents did not take part in the study. A minority of these women said they had no fixed address (11%) and about half of them lived with their parents (53%). None of them said they benefited from an assistance network or community help. Table 1 shows the distribution of the participants according to their socio-demographic and professional characteristics. The educational level of the participants varied from illiteracy to a higher level of education; over half of the women had a secondary-level education (61%). The majority of female participants (84%) were single. (Table 1.) Work environment. Slightly over one third of the women had started prostitution before the age of 18 (35%). The average period of activity in this profession was 3.5 3.2 years; (range 7 months to 13 years). Half of the women had other occupations (58%), but most of them (74%) admitted that prostitution had been their main income generating activity last month. Two thirds of the participants reported that they found sex work very stressful. Incidents occurring most frequently at work were physical violence (68%), unarmed rape (40%) and armed rape (33%). None of these incidents had been reported to the police, but the women reported that police arrests and threats caused them additional stress (367%). None of the prostitutes had regular days off during the
Afr Newslett on Occup Health and Safety 2012;22:236

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week. Some of them (21%) said they stopped work when they had their menstruation. Knowledge and practices relating to risk factors of cervical cancers. The women in this study in general had a poor knowledge and little awareness of cervical cancer. Table 2 shows the practice and the level of knowledge about cervical cancer risk factors among the sex workers. Only 3.5% of the women interviewed had been to see a gynaecologist in the course of the past year and 5% of them had already had a Pap smear. The use of condoms during sexual intercourses remained low (9%), the main reason for not using condoms being the clients refusal (65%). The majority of these women had a low level of knowledge concerning the links between the risk factors and cervical cancer, such as the number of pregnancies (4%), induced abortions (9%) and HPV infection (11%). More than half of these women linked cervical cancer to smoking habits (61%) and the number of sexual partners (51%). The women (74%) did not know whether HPV could be one of the causes of cervical cancer. Their answers to questions on cervical cancer reflected their knowledge of cancer in general. They all (91%) considered this illness to be fatal, with no possible cure. They reported their experience of friends or members of their family who had died from cervical cancer. Most of them (93%) had heard of cervical cancer but had no idea of how it could be prevented. Durin drawbacks to screening for cervical cancer, the five most frequently mentioned drawbacks to screening for cervical cancer included the fact that: the Pap test is not free (98%), cervical cancer kills even if detected early (91%), the women did not know where to go for a Pap test (95%), they had not received any information or encouragement to take the test from the health officers (86%), and the test is too expensive (81%). Less than half of the women (44%) were worried about pain from the test. Risks evoked by the studied group. None of the women interviewed mentioned the risk of cervical cancer in connection with sex work. By decreasing order of prevalence, the risks given by the women were linked to infection with HIV and sexually transmitted diseases (88%), verbal aggression (83%), and physical violence (81%).
24 Afr Newslett on Occup Health and Safety 2012;22:236

Table 1. Characteristics of the population under study (n=57 persons)

Age > 21 years 21 years Started prostitution before 18 years of age Place of work In the street At home In hotel rooms In all these places Marital status Single Married Divorced Children Yes No Smoking habits Yes No Other profession Yes No Educational level Illiterate Primary Secondary Higher levels 7 12 35 3 12.3% 21.1% 61.4% 5.3% 33 24 57.9% 42.1% 32 25 56.1% 43.9% 38 19 66.7% 33.3% 48 7 2 84.2% 12.3% 3.5% 37 4 10 6 64.9% 7.1% 17.5% 10.5% 15 42 20 26.3% 73.7% 35.1%

Table 2. Knowledge and practices relating to risk factors of cervical cancers

Did you see a gynaecologist last year? Yes No Yes No 2 55 3 54 3.5% 96.5% 5.3% 94.7%

Have you ever had a Pap smear?

The Pap smear is used for early detection of cervical cancer Yes No Do not know Yes No Do not know 4 3 50 5 3 49 7.0% 5.3% 87.7% 8.8% 5.3% 86.0%

Are you at risk of developing cervical cancer?

Use of condoms in vaginal and anal sex practices Always 5 8.8% Occasionally No Yes No Clients refusal Higher pay Expense of the condom Permanent client 27 25 1 56 37 17 16 9 47.4% 43.9% 1.8% 98.2% 64.9% 29.8% 28.1% 15.8%

Use of condoms during oral sex practices

Reasons for not using condoms

There is a relation between cervical cancer and ... the fact of being sexual active Yes No the number of partners Yes No Do not know human papillomavirus Yes No Do not know the number of pregnancies Yes No Do not know induced abortions Yes No Do not know Smoking habits Yes No Do not know 35 10 12 61.4% 17.5% 21.1% 5 23 29 8.8% 40.4% 50.9% 2 27 28 3.5% 47.4% 49.1% 6 9 42 10.5% 15.8% 73.7% 29 7 21 50.9% 12.3% 36.8% 24 33 42.1% 57.9%

Discussion

Our study is the first on the knowledge, attitudes and practice of prostitutes concerning cervical cancer in Gabon. We determined prostitutes knowledge of cervical cancer screening and infection with HPV, their attitudes towards screening for this cancer, and the obstacles to its screening. It was found that the basic knowledge of cervical cancer and infection with HPV was poor. Knowledge of the causes of HPV and the transmission of the virus were inadequate and poor. The level of education may explain these low levels of awareness (5, 6,7). The women did not know the implications and benefit of the screening. They did not know that the Pap test is used for early detection of cervical cancer. Most of the women thought that the test is used to detect an existing cervical cancer. They considered that they ran no risk of developing cervical cancer and thought that they did not need Pap smear screening. Such an attitude requires effective education on the

subject, at a higher level. Emphasis should be placed on the crucial fact that cervical cancer screening detects the tell-tale lesions that appear at an early stage of the illness, and allows early medical care to prevent the cancer from progressing to an invasive cancer (8, 9, 10). The perception of personal susceptibility to cancer may affect knowledge, attitudes and practices (KAP) as well as cervical cancer screening. Hill (11) reported that womens perception of the risk of developing cancer determines their attitudes towards screening. Women should be encouraged to take responsibility for their own health and to become active participants in the screening programme rather than waiting for or depending on recommendations or eventual free screening days. Efforts to promote screening for cervical cancer among women should target information about the risks, the predisposition of developing cancer, beliefs concerning the vulnerability of cancer patients and persuading the women that regular and active screening helps to detect lesions at a pre-cancer stage, helps early treatment and forestalls the development of cancer. Our results are similar to those obtained by Staugham and Seow (12) in Singapore, which revealed that fatalism was a social barrier to screening-related behaviours. The women have to be demystified regarding these interpretations through education and health promotion. The need for health officers to improve health education and to influence compliance was reflected in the womens reports that they had not been informed of the importance of screening by health professionals. According to Ward et al. (13), opportunistic screening was found to increase screening rates. Health promotion campaigns should target prostitutes in order both to increase their knowledge and comprehensions of the risk of their trade and to encourage them to take regular Pap screenings. The participants were ignorant about HPV infection and its links to cervical cancer. There is also a need to educate the prostitutes on the role of HPV in the aetiology of cervical cancer and its prevention. The mass media could play an important role in this context, and its function should be optimized. Furthermore, effective methods for delivering information, such as the use of local celebrities as models to promote screening, could attract womens attention and lead to changes in attitudes that would influence the prostitutes compliance with screening. Our results highlight the problem of the need for information on cervical cancer

References
1. Massood S. A plea for a worldwide volunteer cervical cancers education and awareness program. Acta Cytol 1999. 43:539.42. 2. Paraison DJ. A View of cancers in women in Africa. Interfac Africa. 1988. Supplement n1. P 22-25. Cervical Cancer screening in the developing countries: towards a new strategy. World Health Forum. International Review on Sanitary Development, 1987,8;(1): 436. 3. Ezinah Nze Nguema F, Comlan Nsie Obame P, Ngou Mve Ngou JP, Nguizi Ogoula Gerbex S, Mabika Mabika B, Minko Mi Etoua D, Fetissof F. Le cancer du sein au Gabon. Aspects pidmiologiques et anatomopathologiques. Bulletin Mdical dOwendo 2007, 11 (30):2732. 4. Si-Mohamed A, Ndjoyi-Mbiguino A, Cuschieri K, Onas IN, Colombet I, Ozouaki F, Go JL, Cubie H, Blc L. High prevalence of high-risk oncogenic human papillomaviruses harboring atypical distribution in women of child-bearing age , Gabon. in Libreville. J Med Virol. 2005 Nov, 77 (3):4308. 5. McMullin JM, De Alba I, Chvez LR, Hubbel FA. Inuence of beliefs about cervical cancer etiology on Pap smear use among Latina Immigrants. Ethn Health 2005;10:318. 6. Markovic M, Kesic V, Topic L, Matejic B. Barriers to cervical cancer screening: a qualitative study with women in Serbia. Soc Sci Med 2005;61:252835. 7. Breitkopf CR, Pearson HC, Breitkopf DM. Poor knowledge regarding the Pap test among low-income women undergoing routine screening. Perspect Sex Reprod Health 2005;37:7884. 8. Holroyd E, Twinn S, Adab P. Social-cultural inuences on Chinese womens attendance for cervical screening. J Adv Nurs 2004;46:4252. 9. Jirojwong S, Thassri J, Skolnik M. Perception of illness and the use of health care givers among cervical cancer patients at Songkla Nagarind Hospital. A study in southern Thailand. Cancer Nurs 1994;17:395402. 10. Maaita M, Barakat M. Jordanian womens attitudes towards cervical screening and cervical cancer. J Obstet Gynaecol 2002;22:4212. 11. Hill D, Gardner G, Rassaby J. Factors predisposing women to take precautions against breast and cervical cancer. J Appl Soc Psychol 1985;15:5979. 12. Straugham PT, Seow A. Fatalism reconceptualized: a concept to predict health screening behavior. J Gend Cult Health 1998;3:85100. 13. Ward JE, Boyle K, Redman S, Sanson-Fisher RW. Increasing womens compliance with opportunistic cervical cancer screening: A randomized trial. Am J Pre Med 1991;7:28591. 14. Powe BD, Finnie R. Cancer fatalism. The state of the science. Cancer Nurs 2003;26:45467. 15. Shanker S, Selvin E, Alberg AJ. Perceptions of cancer in an African-American community: a focus group report. Ethn Dis 2002;12:27683. 16. Markosyan KM, Babikian T, DiClemente RJ, Hirsch JS, Grigoryan S, del RC. Correlates of HIV risk and preventive behaviors in Armenian female sex workers. AIDS Behav 2007;11(2):32534. Available at: URL: PM: 16823626. 17. Belza MJ, Clavo P, Ballesteros J, Menendez B, Castilla J, Sanz S, et al. [Social and work conditions, risk behavior and prevalence of sexually transmitted diseases among female immigrant prostitutes in Madrid (Spain)]. Gac Sanit 2004;18(3):17783. Available at: URL: PM: 15228915. 18. Nigro L, Larocca L, Celesia BM, Montineri A, Sjoberg J, Caltabiano E, et al. Prevalence of HIV and other sexually transmitted diseases among Colombian and Dominican female sex workers living in Catania, Eastern Sicily. J Immigr Minor Health 2006;8(4):31923. Available at: URL: PM: 16924411.

screening. The pessimistic attitude towards cancer and the misconception that cancer inevitably leads to death should be tackled seriously. The belief that death is inevitable when cancer is diagnosed was identified as another barrier to participation in the screening of and treatment for cancers (14, 15). The participants also revealed that they would have accepted screening if the test had been recommended to them and offered free of charge by a health officer. A woman consulting a gynaecologist is more likely to receive advice concerning screening. However, the other doctors should also contribute to the promotion of screening for cervical cancer by circulating educative material educating women on cervical cancer risks, prevention and early detection in order to improve the practice of screening. The difficulty here lies in the fact that

this group of workers has no financial means of access to any type of health care. In the literature, authors have concluded that the level of protection among such women is low. Living on the brink of society reduces the women power of negotiation. Financial difficulties make them vulnerable in the presence of their clients, who prefer unprotected intercourse and are ready to pay more for it (16, 17, 18). The violence levels reported are probably due to the fact that these activities are carried out illegally in our country. In Gabon, prostitution is still an illicit activity, and so most prostitution is conducted in the context of prohibited activities. Thus it is important to establish a legal framework for the practice of prostitution, a legal framework that would put an end to abuse, violence and substance use disorders. The practice of prostitution as a profession, and
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the related questions such as the authorization to reside and work in the country are not covered by any laws or regulations. Outside a specific legal frame, several legal dispositions regulating the important aspects of the prostitutes lives remain undefined, particularly, their access to health and social benefits. Management by the community authorities of protected workplaces for sex workers, the establishment of mobile counselling structures, and the promotion of collaboration among the police and social and health agents involved are envisaged.

Suvi Lehtinen

ICOH 2012 in Cancun, Mexico

The ICOH Triennial Congress 2012 gathered a total of 1,700 occupational health and safety experts to Cancun, Mexico. The Congress programme, the theme of which was Occupational health for all: From research to practice, was full of interesting and informative contributions on a variety of topics. A total of 11 Keynote Lectures and 30 Semiplenary lectures were presented. The 11 Keynote Lectures covered topics such as occupational health as a human right; occupational health and safety and nanotechnologies; climate change and its impact on occupational health; psychosocial aspects in work life and behavioural medicine; evidence base in occupational health; ethical issues in occupational health and safety; the history of occupational health how to learn from past experiences for the future; lessons learnt from the Fukushima power plant accident and tsunami; setting research priorities; and the WHO and ILO approaches to occupational health and safety. In addition, 884 oral communications were made in Special Sessions and Free Paper Sessions, and 489 posters were presented during the Congress. Participants were very satisfied with the contents of the Congress programme and the practical arrangements of the whole event. In the Opening Session of the ICOH Congress, a life-time service award was granted to Professor emeritus Jorma Rantanen for his 35-year career for the benefit of occupational health worldwide. He served on the ICOH Board in 19871989 and as ICOH President in 20032009.

Conclusion

The knowledge, attitudes and practices (KAP) of the prostitutes concerning the prevention of cervical cancer were found to be poor. To improve their information and correct evaluations concerning the evolution of the sex trade, it is advisable periodically to gather data on the health of female sex workers from involved sources (NGOs, the police). In the face of a situation that is poorly known and constantly evolving, a first step could be to proceed regularly with a formal exercise of examining the health situation of these exposed women in order to limit their risks of developing cervical cancer. A national enquiry may be envisaged in the various towns with the help of cartography.
P. Comlan (1), B. Mabika Mabika (2), AM. Mouanga (3), JP. Ngou Mve Ngou (4), F. Ezinah (2), J. Djeki (1) 1 Dpartement de Sant au Travail Facult de Mdecine Universit des Sciences de la Sant BP 4009, Owendo, Gabon. 2 Dpartement de Pathologie Facult de Mdecine Universit des Sciences de la Sant BP 4009, Owendo, Gabon. 3 Service de psychiatrie, Centre Hospitalier et Universitaire de Brazzaville BP 32, Brazzaville, Congo. 4 Dpartement de Gyncologie Obsttrique Facult de Mdecine Universit des Sciences de la Sant BP 4009, Owendo, Gabon. Contact: Dr Pearl COMLAN BP 1248 Libreville, Gabon Cel. 241 06243873 Fax. 241 731629 pearlcomlan@yahoo.co.uk 26 Afr Newslett on Occup Health and Safety 2012;22:267

The ICOH Triennial Congress in Mexico brought together a huge number of occupational health researchers and practitioners worldwide.

Some African participants from left: Pius Makhonge of Kenya, Barbra Khayongo of Uganda, Irene Karanja of Kenya and Vera Ngowi of Tanzania.

African Session

Ms. Barbra Khayongo of Uganda chaired a Special Session on Occupational Safety and Health Culture in the African Continent. A total of eight presentations were made, including presentations on the South African mining sector, and from Uganda, Kenya, Egypt and Tanzania.

elected Officers and the Board planned for the new Triennium.

ICOH Scientic Committee Ocers meeting

Cancun Charter on Occupational Health for All

In his Opening Keynote, Professor Jorma Rantanen challenged all the Congress participants to launch a Cancun Charter on Occupational Health. This was prepared for approval on the last day of the Congress and signed by the ICOH President, Dr. Kazutaka Kogi, the ICOH Secretary General, Dr. Sergio Iavicoli, the ICOH2012 President, Dr. Jorge Morales, and the Chair of the Drafting Committee, Professor Jorma Rantanen.

The 34 Scientific Committees met in a joint meeting with ICOH Officers and Chairs and Secretaries of the Scientific Committees. The purpose of the meeting was to look into the results of the past triennium and discuss in more detail the integration and collaboration of various Scientific Committees, and ways in which to recruit more members and help the Scientific Committees increase publications.

Organizers of the Congress for conducting the Congress in an excellent and successful way, and to Professor Bonnie Rogers, ICOH Vice President, for all her efforts in the preparation of the Congress programme.

ICOH in brief

ICOH National Secretaries

ICOH meetings

ICOH has a network of National/Area Secretaries in about 60 countries in which ICOH has members. They also met during the Congress to assess the past Triennium, to plan for the next Triennium activities and to discuss issues of mutual interest.

ICOH is an international association with some 1,800 individual members. It also has affiliate and sustaining members. All ICOH members can join three ICOH Scientific Committees according to their own interest areas and their own choice. ICOH members enjoy several discounts of WHO and ILO publications as ICOH is an NGO in official relations with WHO and the ILO. Several scientific journals also grant ICOH members discounts in their subscription rates. For additional information, see www.icohweb.org.

ICOH also organized two General Assembly meetings, one at the beginning of the Triennial Congress and the other at the end of the Congress, in which the new

Excellent organization of the Congress

Special thanks are due to Dr. Jorge Morales and Dr. Elia Enriquez as the Local
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Contact persons/country editors

Chief Health and Safety Ocer Ministry of Labour and Home Aairs Division of Occupational Health and Safety Private Bag 00241 Gaborone BOTSWANA Samir Ragab Seliem Egyptian Trade Union Federation Occupational Health and Safety Secretary 90 Elgalaa Street Cairo EGYPT Ministry of Labour and Social Aairs P.O. Box 2056 Addis Ababa ETHIOPIA Commissioner of Labour Ministry of Trade Industry and Employment Central Bank Building Banjul GAMBIA The Director Directorate of Occupational Health and Safety Services (Commercial Street) P.O. Box 34120 00100 - Nairobi KENYA The Director Occupational Safety and Healh Private Bag 344 Lilongwe MALAWI Mrs Ifeoma Nwankwo Federal Ministry of Labour and Productivity Occupational Safety and Health Department P.M.B. 4 Abuja NIGERIA Peter H. Mavuso Head of CIS National Centre P.O.Box 198 Mbabane SWAZILAND Head of Information Training and Research Occupational Safety and Health Authority (OSHA) P.O. Box 519 Dar es Salaam TANZANIA Commissioner Occupational Safety and Health P.O. Box 227 Kampala UGANDA Tecklu Ghebreyohannes Director of Labour Inspection Div. Ministry of Labour and Human Welfare Department of Labour P.O. Box 5252 Asmara ERITREA Mr Mukhtar Mohamed Ali Mukhtar HSSEQ Expert Government of Sudan Ministry of Electricity & Dams Al Riyadh, Al Mashtal St. Buil. (5), Sq. (16) Khartoum SUDAN

as of 1 December 2011

Editorial Board

Chief Health and Safety Ocer Ministry of Labour and Home Aairs Division of Occupational Health and Safety BOTSWANA Mathewos Meja OSH Information Expert Ministry of Labour and Social Aairs ETHIOPIA Chief Inspector of Factories Ministry of Labour and Social Welfare GHANA Chief Inspector of Factories Ministry of Labour and Industrial Relations MAURITIUS Chief Inspector of Factories Ministry of Labour SIERRA LEONE Mr Mukhtar Mohamed Ali Mukhtar HSSEQ Expert Ministry of Electricity & Dams Government of Sudan Khartoum, SUDAN Seiji Machida, Director Programme on Safety and Health at Work and Environment (SafeWork) International Labour Oce CH-1211 Geneva 22 SWITZERLAND Evelyn Kortum Technical Ocer Occupational Health Interventions for Healthy Environments Department of Public Health and Environment World Health Organization CH-1211 Geneva 27 SWITZERLAND Jorma Rantanen Past President of ICOH ICOH International Commission on Occupational Health Harri Vainio Director General Finnish Institute of Occupational Health FINLAND

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