Consultation on Strengthening of Occupational Health Services in the Baltic
Countries
6-7 November 1995
Copenhagen, Denmark
Summary Report
Introduction
Country reports
Reports of the three Working Groups
Plans of the countries in the field of occupational health
and safety and needs for foreign assistance
Conclusions and recommendations
Introduction
1. Dr. Boguslaw Baranski, Regional Adviser, a.i., Occupational Health
of the WHO Regional Office for Europe, welcomed the participants of the Consultation
on Strengthening of Occupational Health Services in the Baltic Countries,
on behalf of Dr. Stanislaw Tarkowski, Director, Environment and Health.
The consultation was stated to be a continuation to two previous WHO consultations;
one organized by the WHO Headquarters in Moscow, Russian Federation, dealing
with the development of occupational health services in the countries in transition
(8-9 February 1994); and the other organized by the WHO Regional Office for
Europe, charting the situation of occupational health services in countries
in socioeconomic transition, held in Lodz, Poland (15-17 December 1994). Dr.
Baranski also mentioned that the WHO Regional Office for Europe had, in collaboration
with the Ministries of Social Affairs in Estonia, of Welfare in Latvia, of
Social Security and Labour and of Health in Lithuania, organized a round-trip
survey of international experts in the above-mentioned countries. The countries
had accepted to use this framework project on occupational health and safety
as a starting-point for the development of their national programmes in occupational
health and safety. The report of the survey was used as the basis for this
consultation as well.
2. Professor Jorma Rantanen, Finland, was elected Chair and Ms. Suvi
Lehtinen, Finland, Rapporteur of the Consultation. The programme of the
Consultation is attached as Annex 1 and the list of participants as Annex
2 to this Summary Report.
3. The scope and purpose of this Consultation was to contribute to the medium-term
programme agreed upon between the appropriate Ministries in Estonia, Latvia,
Lithuania and the WHO Regional Office for Europe, by:
a) presenting and discussing the incoming conceptual models of the work
environment, safety and health services (WESHS) in Estonia, Latvia and Lithuania
b) reviewing the present situation and planned programmes in Estonia, Latvia
and Lithuania to strengthen occupational health and safety services (work
environment, safety and health services)
c) reviewing and discussing the technical and educational support rendered
so far to the Baltic countries in the area concerned
d) presenting and discussing the contents and type of support needed recently
to strengthen WESHS in Estonia, Lithuania and Latvia
e) discussing possible mechanisms and ways of international assistance to
strengthen WESHS in the Baltic countries, including bilateral and multilateral
agreements and the concerted actions of several foreign supporting organizations.
4. Dr. Boguslaw Baranski, WHO, Regional Office for Europe, presented
the goals of the Consultation in more detail, giving background information
about the general developments in occupational health and safety. He also
described the main objectives of occupational health services (OHS), stating
that the improvement of the work environment is the core activity as it ensures
primary prevention. In addition, he mentioned the health surveillance of workers,
adaptation of work and the work environment to the needs of the workers, as
well as promotion of a healthy lifestyle and the workers' right-to-know as
important elements in OHS.
He emphasized the importance of the multidisciplinary occupational health
team which should comprise an occupational health physician, occupational
hygienist, occupational health nurse, ergonomist, occupational psychologist
and safety engineer. Only a few countries in the world cover the whole multidisciplinary
group in their OHS.
Occupational health is an important element in the Environment and Health
Action Plan for Europe endorsed by the ministers of the Environment and the
ministers of Health of the European Member States of the WHO and the Members
of the European Commission, responsible for environment and health. The planning
process at the country level includes the definition of targets, planning
of detailed aims, management of actions by key and complementary actors, monitoring
and evaluation of progress, and review and reformulation of programmes.
5. Dr. Anna Ritsatakis, WHO, Regional Office for Europe, presented
the WHO Policy of Health for All. The policy is based on equity in health
and the right to participate. Dr. Ritsatakis described the role of occupational
health in the overall policy.
In the Health for All Strategy the following questions are asked:
Where is health promoted and sustained? What are the strategies and investments
that produce the greatest health gains? What strategies and investments help
reduce inequities in health?
The work environment is an important sub-environment for all those who take
part in working life (40 h/week, 40 weeks/year, around 40 years of life).
Health should not be adversely affected by work, the effects of health status
on work should be investigated, the emphasis being now on promoting the overall
health of the workers. The present policy of WHO is not only to prevent diseases
but to strongly promote health and activities that enhance a healthy life-style.
It has turned out in the implementation of the Health for All Policy that
more detailed planning and setting of objectives is needed, as well as much
more thorough evaluation of the success of various activities. If the aim is
to increase equity in health, the objectives and results of various activities
should be measurable. The experiences of others should be fully utilized, especially
by the setting of good examples.
Dr. Ritsatakis described the national policy implemented in the UK, where
a health policy reform has been sought by a strategy based on disease priorities,
HIV, cancer, coronary heart disease and stroke, mental illness and accidents.
A part of this policy is to insist on evidence on its effectiveness.
In the discussion it was stated that the WHO, European Union and some countries
have taken health promotion strongly into their programmes. It should, however,
be kept in mind that occupational health aspects and work environment risks
cannot and should not be diluted by putting emphasis too one-sidedly on general
health promotion only.
Instead of a disease-oriented approach, e.g. in the Netherlands a population-based
approach has been taken into use. The countries that are now choosing models
for their health service provision systems should be able to learn from other
countries' choices, their strengths and weaknesses. In all decisions, the
cultural, political, and financial situation should be taken into account.
Country Reports
Models and the situation analysis of occupational health and safety in
the Baltic countries
Estonia
6. Dr. Hubert Kahn, Director of the Estonian Centre for Occupational
Health, presented the Estonian country report. The transition to a market
economy in Estonia has also changed the contents and functions of occupational
health and safety (OH&S) services. He described the situation of OH&S
in the Soviet Estonia and compared it to the present situation. The measurements
done at workplaces were previously financed by the State, but are now funded
by the companies and enterprises. The number of health care service units
has not declined. The total number of the workforce is about 0.7 million and
the number of registered occupational diseases was 110 in 1990. The number
of new enterprises has steadily increased after the country's independence.
The National Work Environment Board is in charge of labour inspection activities
in the country. Today there are no occupational health physicians in the districts.
The Health Protection Board and the Work Environment Board are currently two
separate organizations, the Health Protection Board representing the previous
system of organizing the services. Now the question is whether these two organizations
should be combined to one Working Environment Board. At present, experts from
both organizations carry out factory inspections.
Latvia
7. Professor Maija Eglite, Director of the Institute of Labour Medicine,
Latvia, presented the country report of Latvia. The total number of workers
is 1.3 million, and the number of diagnosed occupational diseases was 188 in
1994 (the rate being 23.5/100,000 economically active inhabitants). The number
of fatal accidents has decreased. About 15 new laws have been passed during
the past few years. At present there are 20 physicians at the Center of Occupational
Health and Radiological Medicine. There are 4 regional centres of occupational
health in the country. In addition, in some factories and enterprises there
are also departments of occupational health, but not in all.
An association of occupational health physicians has been recently established.
200 occupational health physicians are planned to be trained; at the moment
there are 40 occupational health physicians active in the country.
Lithuania
8. Dr. Remigius Jankauskas, Director of the Occupational Medical Centre,
Lithuania, presented the country report. He described the legal background for
the occupational health and safety services in Lithuania. There are separate
organizations for occupational health services and labour inspection in the
country. Lithuania is divided into 10 regions, with one regional centre in each
region. The main functions of Work Environment and Health Services in Lithuania
include consulting, control and labour inspection.
All the inspection activities in OH&S, OHS and labour issues are supervised
by the Ministry of Labour; the Ministry of Health is responsible for providing
the OHS. Preparation of the bill on establishing an occupational health research
institute as a service institution and provider of support is under way and
is expected to be finalized in 1996.
The services can be divided into state occupational hygiene services, occupational
medical services, and services of the National Occupational Medical Centre.
In Lithuania, about 200,000 workers work in hazardous work environments. The
total number of the workforce is 1.74 million. About 300 occupational diseases
are reported each year. The main tasks of the services are the creation of the
legal basis, evaluation of the work environment, setting of hygienic standards
and development of hygienist manpower resources.
Assistance provided to the Baltic Countries
Denmark
9. Mr. Tommy Modest of the Danish Work Environment Service, described
the assistance provided by the Danish authorities. The programme consists of
the management systems, training programmes for employees and employers, and
the goal is to establish a safety organization in the three Baltic countries.
The training has comprised a training course for 8 Lithuanian legal advisers.
The collaboration also includes the sending of some Danish lawyers to Lithuania
to give advice on the modelling of legal instruments in the field of occupational
health and safety. Another seminar has been held on the development of the registration
of occupational accidents. Training of inspectors has also been organized, so
that the courses are held both in Lithuania and in Denmark, including the training
and education of safety representatives. In 1996, a seminar will be organized
once a month in Lithuania in the form of training of trainers in selected branches
of economy. At the end of the projects 45 trainers will have been trained. Training
on dangerous equipment has been arranged in Latvia. In addition, training on
the documentation and analysis of occupational injuries will be organized in
Latvia. In Estonia, the Danes have arranged an exchange of information and organized
seminars on documentation and analysis, and the prevention of occupational accidents.
Mr. Modest mentioned the lack of funding as the most important problem.
In conclusion, the Danes have concentrated their activities more on the safety
side, not so much on the development of occupational health services. In the
discussion it clearly came out that there is not enough information disseminated
at the national level. This means that the collaboration between the Ministry
of Labour and the Ministry of Health at the country level should be further
strengthened. There seem to be also communication gaps in the countries; enormous
information gaps regarding the on-going assistance projects seem to exist.
In the discussion, the Group strongly recommended the establishment of a joint
information data base on the activities carried out and going on in the Baltic
countries.
Finland
10. Professor Jorma Rantanen, Director General of the Finnish Institute
of Occupational Health, described the collaboration that has been carried out
between Finland and Estonia during the past twenty years. Up to the beginning
of the 1990s, the collaboration consisted of exchange of information, exchange
of researchers and organizing joint symposia on a rotatory basis. In 1991-92
the collaboration was modified so that it now comprises mainly three elements:
risk surveys, training of experts, and information support. The National Programme
on Occupational Health and Safety was deemed to be the most important starting-point
for the development of any activities in occupational health and safety. The
National Programme would also offer a basis for continuity of the activities
in a situation where Cabinets and responsible ministers change. Professor Rantanen
also described the projects which have been funded by the World Bank, the donor
countries and the recipient countries themselves. The World Bank project also
includes a training element which will be carried out in collaboration with
the universities in Estonia. Also the ILO/FINNIDA programme on the strengthening
of labour inspectorates in the Baltic countries was mentioned. In addition,
the training of labour inspectors (1-2 weeks, 8 experts per year) has been arranged
for Estonian labour inspectors by the Finnish Ministry of Labour.
11. Dr. Eero J. Pertilä, Association of Industrial Physicians
in Finland, expressed an invitation where one or two experts from each Baltic
country were invited to participate in the courses arranged and funded by the
Finnish Association. Also visits to various enterprises can be organized in
order to acquaint the participants with the systems to show how OHS have been
organized at Finnish workplaces.
The problems of the Baltic countries to establish a National Programme on
Occupational Health and Safety were discussed. It turned out that quick political
changes reduce the continuity and sustainability of occupational health and
safety measures in the countries. In case no legislation is available, funding
for occupational health and safety is not provided from the state budget. This
makes the further development of OH&S at the national level even more difficult.
Norway
12. Dr. Axel Wannag, Directorate of Labour Inspection, Norway presented
the activities carried out by Norwegian funding. He described how training had
been implemented through directing funds to NIVA which organizes complementary
training courses for experts in occupational health and safety. He emphasized
the need for networking of occupational health experts in both the Baltic countries,
but also in the Nordic countries.
Sweden
13. Ms. Christina Ekeberg, Director, Training Programmes for OHNs,
National Institute for Working Life, Sweden, presented the Swedish assistance
programmes in the Baltic countries. The assistance has consisted of material
aid to Estonia; in 1993 an AAS was delivered to Latvia. In addition, training
in the counting of asbestos fibers has been arranged in Latvia. The Swedish
Institute has planned a 6-week training course on OS&H for Baltic experts
in 1995-96. 26 participants from Estonia, Latvia, Lithuania, Poland, Russia
and Belorussia are invited to the course. Five training weeks will take place
in Sweden, including both theoretical and practical training. One week will
be organized in Poland. Ms. Ekeberg also mentioned a project, scheduled for
1995-96, on establishing a training centre in the field of occupational safety
and ergonomics in Poland. In addition to the collaborative activities of the
National Institute, it was mentioned that also some Swedish universities have
organized training courses for trainers in the three Baltic countries.
14. In conclusion, a lot of information had been shared, and the participants
had been made aware of the ongoing activities. More activities had been recommended,
but the limiting factor is the lack of funds. The Nordic countries and expert
communities are ready and willing to contribute to the development of occupational
health and safety in the Baltic countries. On the basis of the reports, training
has been carried out as a priority activity. It was the conclusion of the Consultation
Group that training is the right priority. The projects carried out so far have
not provided answers to all the questions posed by the present Consultation,
which implies that this Consultation was sorely needed.
The training of occupational health and safety experts is an appropriate area
on which to direct activities. Educational schemes for experts, where the structures
are relatively stable, are an important cornerstone of the development. In addition
to occupational health personnel, also occupational safety experts should be
included, as the training of a multidisciplinary team should be ensured. Lack
of or insufficiently designed educational curricula for occupational health
professionals hamper development of educational systems and the attainment of
full professional qualifications.
International Social Security Association (ISSA)
15. Mr. Dieter Beyer of ISSA presented the objectives of the Association.
The ISSA is a worldwide association of institutions, which fulfil tasks in social
security. The members of ISSA are ministries, governmental agencies, and nongovernmental
organizations. Private companies may become affiliated members, if they work
in the field of social security.
ISSA covers the whole area of social security, mainly social insurance, from
sickness funds, old age pension schemes, and occupational accidents insurance
to family allowance programmes and help for the poorest. The aim of ISSA is
to collect and disseminate experiences, to perform the tasks of the members
in the best possible manner. This comprises not only the exchange between members,
but also information to the public, and to those participating in other activities
which could help reaching ISSA's goals. The prevention of occupational accidents
and illnesses is part of the ISSA programme. For this purpose ISSA organizes
World Congresses on Occupational Safety and Health, together with ILO and a
hosting national institution. The next of these congresses will be held in Madrid,
Spain in April 1996. ISSA also organizes, through its International Sections,
Congresses and Symposia on prevention in special sectors of industry or other
prevention topics and publishes articles and other material on prevention.
The insurance system has been organized in different ways in different countries,
from private to semi-private to governmental systems. ISSA has members on all
continents. One of the Standing Committees of ISSA is 'Prevention of Occupational
Accidents and Occupational Diseases'. Information, research, chemical industries,
mining, metal industries, electricity, machine safety, health services, education
and training, personal protective devices, are Sections within this Committee.
The topics dealt with e.g. in the health service sector are chemical substances,
infections and ergonomics. ISSA has surveyed occupational health services, including
the numbers and the qualifications of the occupational health personnel in its
Member Countries. One conclusion, on the basis of the survey, was that the competence
and qualification requirements of the occupational health personnel should be
carefully looked into and registered. A list of ISSA members in the Baltic and
Nordic countries is attached as Annex 3 to this Report. Not all ISSA members
are active in the field of prevention.
The question of financing occupational health services through the insurance
system was taken up in the discussion. A large occupational health service in
Germany has been financed by social security. Previously in Germany, small companies
did not have to render occupational health services. Now this has been changed
so that all workplaces have to provide occupational health services.
Nordic Institute of Advanced Training in Occupational Health (NIVA)
16. Dr. Timo Leino of the Finnish Institute of Occupational Health
described the training activities of NIVA in the area of occupational health.
NIVA is a training institution funded by the Nordic Council of Ministers, i.e.
the 5 Nordic countries. The courses are intended mainly for Nordic experts,
but other participants are also accepted. In 1991-93 some scholarships have
been offered to participants from the Baltic countries, as the need for the
training of occupational health and safety experts was evident.
The NIVA strategy aims at the transfer of Nordic expertise and the improvement
of the knowledge and skills of the Baltic experts. The basic course on occupational
health was organized on 2-6 October 1995. Two courses have been planned for
1996: the first one on measurement and analysis of OH&S hazards and the
second one on planning and reporting of research projects. The topic of the
fourth module, planned for 1997, is occupational health and safety in practice.
These courses will be organized in Tallinn, Estonia.
Reports of the three Working Groups
Working Group 1 on Legislation
17. Working Group 1 had analyzed the prerequisites for the legislation on
occupational health and safety. The main objectives of occupational health services
were defined as improving the work environment, health surveillance of employees
a) related to their working conditions, b) general health surveillance of the
employees related to their general working ability, first aid, adapting of the
work and the work environment to the worker, rehabilitation, and promotion of
a life-style conducive to health, and the workers' right-to-know about the relationship
between the environment and health.
The definition and contents of the health surveillance were taken up in the
discussion, as was also the contents of rehabilitation. In many countries rehabilitation
services at the workplace level are mainly concentrated on the maintenance of
the working ability of every worker, taking into account his/her personal abilities
and working conditions. OHS play a key role in this activity, being aware of
the working conditions as well as of workers' personal health status and working
ability. It was agreed that, in order to be effective, the rehabilitation actions
should be focussed on as early a phase as possible of the development of potential
problems.
Working Group 2 on Services
18. Working Group 2 had analyzed the core functions of the occupational health
services. These included surveillance of work and the work environment, advice
and assistance to enterprises regarding the improvement of the work environment,
medical examinations, information, assistance in the rehabilitation of disabled
workers, assistance in organizing first aid, and health promotion. The model
of organizing OHS was also analyzed by the Group, as they had identified the
problem of the provision of the services; large companies have often organized
OHS as a department within the company, while small enterprises could not do
so and they had to arrange their OHS from structures outside the company. These
structures could be an OHS which had been set up jointly among several small
enterprises, the OHS could be provided by the government or it could be a profit-making
company selling services to the industry. The closer to the enterprises and
the management of the enterprises the OHS are organized, the better as close
connections facilitate the delivery of preventive services from the OHS. In
addition, the support services needed for OHS were described, as was also the
funding of OHS.
The administrative model of OHS was described. The administration and control
of compliance were discussed. Some kind of legislation is needed, and it should
be enforced and controlled. The inspection activities can be stringent or be
based on incentive-type enforcement. In most cases the inspection responsibility
lies with the Ministry of Labour. In some cases there is a shared responsibility
between the Ministry of Labour and Ministry of Health.
In the discussion, the concept of health promotion versus an OHS restricted
to the work environment-related hazards was taken up. It was noted that the
principle of OHS is to prevent occupational health risks. The proponents of
the work environment-restricted OHS feared that any additional task for the
OHS - such as health promotion - would take the focus and resources away from
the primary preventive task of OHS. The proponents of the health promotion
concept fully acknowledged the primary preventive task of OHS, but felt that
this could be accommodated into the health promotion approach. In this activity
the general health promotion should focus on the conditions and prerequisites
of the workplaces in order to support a healthy work environment and healthy
working practices, as well as a healthy life-style, but without diluting the
efforts for prevention of work environment-related hazards. The objective
of OHS can also be seen as a resource for developing the company and the working
life, in addition to identifying and preventing the risks of the work environment
and the work itself. This activity aiming at a healthy company would well
accommodate the health promotion. It was agreed to include health promotion
in the core functions of occupational health services, if it is defined in
such a way that it should be related to the work context and the work environment,
and be carried out by the occupational health personnel.
It was stated that the Baltic countries seem to be in phase 2 in the graph
describing the historical developmental stages of occupational health services
Figure 1. The three development phases of occupational
health services.
Concerning the administration of the governmental agencies in charge of
work environment inspection and of the OHS it was stated that the total quality
management (TQM) system should be introduced to the activities. In Finland,
this principle has been included in the legislation on OHS, as is also in
the Netherlands where it is also associated with the certification of the
services.
The support services for OHS include specialized services (e.g. diagnosis
of occupational diseases, hygienic measurements, ergonomic analyses, biological
analyses, physiological testing, etc.), research, information services, and
specialized training services which all are needed as support for the appropriate
implementation of OHS at the workplace level. The organization of support
services can be implemented in several different ways: a centralized model
(Institute of Occupational Health), public agency model; decentralized model
(universities, research institutions, etc.); or combinations of these. The
Baltic countries need to consider which support services are needed in their
countries and how these services should be organized. The issue of TQM was
again raised in the discussion on this topic. In Latvia, as well as in Estonia,
the centralized model seemed most appropriate. Lithuania will most probably
choose a combination model.
The Consultation Group saw it inevitable to organize specialized support
services to provide support for the front-line services. The services may
be partly paid by the clients but it was concluded by the Consultation Group
that subsidies by the Government are needed. In small countries, such as the
Baltic states, Centres of Excellence for providing these services should be
established. It was agreed that it is most likely that such centres cannot
be developed and maintained at sufficient level without governmental subsidy.
The different options for organizing OHS were widely discussed. The primary
health care philosophy (going to the workers, looking at their work environment),
applying the principle of participation, was agreed upon as the main starting-point
for organizing services. Such philosophy can be applied irrespectively of
the model of organization of services.
It is a universal principle that the OHS should be funded at the primary
level solely by the employers, even when the public sector provides the services,
as in the case of small enterprises. Particularly in small countries, such
as the Baltic states, some kind of public funding is, however, needed also
for the front-line services to ensure equality between the enterprises in
obtaining services. The enterprises should also pay for the services they
get from the occupational health institutes.
There are several models for macro-level funding of OHS: entirely or partly
publicly financed system, the EU model in which the employer is responsible
for all costs and no subsidies are provided to the OHS activities, insurance-based
financing system which can also be seen as a publicly funded system. The support
services are in most countries a publicly funded activity.
In order to ensure the independence of the enforcement and control, the inspection
should be financed by the government. Some service fee schemes may, however,
be developed, but inspection should not be dependent on such fees.
Working Group 3 on Training and Information
19. Working Group 3 had analyzed the ways of organizing and contents of
training and education for occupational health experts. The entire multidisciplinary
OHS team should be trained. The competence requirements for occupational health
experts are high; however, in the present situation the training of occupational
health specialists should be carried out more quickly. In Estonia there are
24 occupational health physicians at the moment. The technical universities
should be incorporated into the training schemes as the previous training
of occupational hygienists was mainly based on medical competence. In Lithuania,
two separate curricula for physicians are offered, one concentrating on occupational
hygiene and the other on health services.
The basic training of occupational health specialists (physicians, nurses,
ergonomists, psychologists, physiotherapists, occupational hygienists, etc.)
is given in the universities and colleges where occupational health elements
(minimum 20-30 h) should be incorporated already into the basic training.
The complementary training of the multidisciplinary team members should be
divided into joint multidisciplinary training and specialist training; the
latter training should be organized in an occupational health institution
(6 weeks during a period of 6 months). The Group recommended that the further
development of the curricula of occupational health specialists be started
immediately. This might also require some assistance from the Nordic countries.
The need for disseminating information to occupational health experts and
ensuring the feedback system for information was recognized. Training materials
are a key element in this activity. In addition, basic statistics, such as
demographic statistics, registers of occupational diseases, exposures, accidents,
occupational hazards, medical care providers, etc. are needed in order to
be able to direct the measures in an appropriate way. All countries of the
Baltic Region need further development in this sector.
The possibility of expanding the joint bilateral projects to multilateral
programmes was taken up in discussion.
Plans of the countries in the field of occupational health and safety
and needs for foreign assistance
Estonia
20. Mr. Ivar Raik, Ergonomics Specialist, National Working Environment
Board, presented the Estonian plan for future developments in occupational health
and safety. He emphasized the importance of preventing occupational accidents.
The number of 'old' legal provisions is high; now it is time to establish a
framework of relevant provisions for future activities. The Act on Occupational
Safety and Health is under preparation, and it is expected to be passed by Parliament
early in 1996. Also the establishment of the Work Environment Council (tripartite)
is anticipated. The country is planning to ratify ILO Convention No. 161 on
Occupational Health Services.
Latvia
21. Professor Maija Eglite, Institute of Labour Medicine, Latvia described
the future plans of Latvia in the field of occupational health and safety. She
first described the organizational structure of occupational health and safety
procedures, and mentioned that the name of the Institute will be changed to
reflect more the aims and tasks of the Institute. The OHS system is being planned
to be restructured. ILO Convention No. 161 on Occupational Health Services is
under ratification. Several objectives were also mentioned in the area of the
training of occupational health personnel. A national information centre on
the work environment and health is in planning stage. It would help to promote
networking among the work environment institutions.
Lithuania
22. Dr. Remigius Jankauskas, Occupational Medical Centre, presented
the future plans of Lithuania. The National Programme on Occupational Safety
and Health has already been prepared and has been adopted by the Government.
The Programme includes the overall improvement of the work environment in the
country. One of the arguments for approving the National Plan has been that
the costs can be reduced to one tenth of all the costs incurred by occupational
accidents and occupational diseases. The information services will be improved
throughout the country by establishing networks which fully utilize the existing
resources. According to the National Programme, the Government of Lithuania
has allocated funds also for the acquisition of equipment and instruments. The
training of occupational health and safety personnel is included in the Action
Plan, and these projects were the ones that were deemed to need external funding
e.g. from the Nordic countries.
23. The concrete mechanisms for carrying out the joint activities and for
fulfilling the needs of the Baltic countries were discussed. The conclusions
and recommendations are reported below.
Conclusions and Recommendations
1. The transition process in the Baltic countries from a centralized model
to market economies is going on. The experiences from other Western European
countries have shown that the balanced socioeconomic development is critically
dependent, not only on the economic and technological progress, but also simultaneously
on the consideration of the social dimensions of the working life. This inevitably
implies the development of occupational health and safety services for all workers
in all sectors of economy, irrespectively of the size of the company or mode
of employment. These principles have also been spelled out in the ILO Convention
No. 155 on Occupational Safety, Health and Work Environment, No. 161 on Occupational
Health Services, European Union Framework Directive 391/89, and WHO Health for
All Strategy and Workers' Health Programme.
The Consultation recommended that the countries of the Baltic Region continue
their efforts to develop the policies and national programmes for occupational
health and safety in view of protection and promotion of health and safety of
the working people, and thus contributing positively to balanced socioeconomic
development of the country at large, and to ensure all the citizens an opportunity
to conduct a socially and economically productive life.
2. There are at present several international assistance projects going on
in all Baltic countries. The coordination of various projects is not sufficient,
as the countries are in different phases of socioeconomic transition. The information
about on-going activities in the Baltic Region is insufficient, and an information
gap exists both within and between the countries, as well as between various
external contributors.
Every actor in the Baltic Region should ensure that the activities be
intended for and aimed at the target countries according to their needs. All
efforts should be made to seek for collaboration and synergism between various
programmes and projects. A data base should be established to collect information
about on-going activities and plans for various projects in occupational health
and safety which are to be carried out in the Baltic countries.
3. The situation in developing national occupational health and safety systems,
including occupational health services in the Baltic countries, is complex and
to some extent difficult to describe. Some countries have elaborated a National
Programme for stepwise development of the occupational health and safety field;
some others are still in a preparatory stage. Many externally supported projects
are carried out but they are not all fully integrated into the national programme
objectives.
Countries should continue the preparation and implementation of a National
Programme on Occupational Health and Safety which will allow also the donors
to contribute to the implementation of the specific programme objectives and
elements, still leaving the National Programme as an entity in balance. When
completed, such programme documents should be made available for the donors
and collaborative partners to ensure appropriate coordination.
4. Internationally accepted guidance in the form of ILO Conventions and WHO
guidelines are available and provide a sound basis for preparing and developing
such national policies and programmes. The Consultation, however, identified
a need to prepare a technical guideline to establish a model for a national
occupational health and safety programme, and thus support the practical implementation
of the policies.
The international instruments available should be fully utilized when preparing
the policy documents. WHO and ILO in collaboration with other international
organizations should provide comprehensive models for national occupational
health systems in order to facilitate the countries to make their choices on
the model best feasible for their national needs. In addition to the policy
documents, also numerous technical reports produced by WHO, should be distributed
to the Baltic countries.
5. Some countries face certain difficulties in the preparation and further
development of the National Programme, and some of them would need support in
that task concerning policy-making, technical and expert advisory services.
Besides established national policy, certain critical prerequisites for policy
implementation were identified, such as expert human resources, training and
information, technical equipment and facilities and support services.
In order to ensure the effective implementation of the Programme, each
country should review the critical prerequisites for its implementation. Such
requirements are e.g. legislation and an identified responsible government body,
an enforcement system with appropriate inspection, competent OHS personnel,
and sufficient infrastructures with support services as well as systems for
participation and collaboration of workers and employers.
6. On the basis of the national reports presented to the Consultation and
the surveys carried out, the competence requirements of occupational health
personnel vary substantially from one country to another. There is a need to
harmonize such competence requirements not only in the Baltic countries but
also throughout Europe.
The competence requirements of the OHS personnel should be developed to
cover all groups of experts (occupational health physicians, occupational health
nurses, occupational hygienists, occupational psychologists, physiotherapists,
ergonomists, safety engineers, and other relevant professions) in the multidisciplinary
team of OHS. The WHO should play a central role in harmonizing internationally
the qualifications of OHS personnel. The Nordic countries have expressed their
special interest to support such development.
7. The training of occupational health specialists varies in the various countries.
The curricula are different, and the contents are not harmonized. The Nordic
countries expressed their interest to contibute to such training, and to the
training of trainers in particular. The Baltic countries need to pay special
attention to organizing their training curricula of OHS experts to fulfil the
qualification requirements, and to providing sufficient human resources for
the implementation of this training in practice.
The curricula of occupational health specialists should be further developed
and harmonized. For this purpose, a special meeting on the development of training
curricula should be convened. The training courses arranged within the framework
of the Nordic assistance programmes should be integrated into the national training
curricula. The curricula developed elsewhere in Europe should be taken into
account as much as possible (e.g. European Community) to ensure European-wide
harmonization.
8. In order to ensure the practical measures for occupational health and safety
at the workplace level, the training of and information for managers and workers
was also deemed important.
The training and dissemination of information also to managers and workers
should be organized in cost-effective ways. Such training and information, if
needed, should be financed by public funds or NGOs.
9. There is an abundance of training materials in occupational health and
safety in the Nordic countries in both Nordic and English languages.
In the long run, the most central training materials selected by the Baltic
countries themselves should be translated into the local Baltic languages, especially
as regards materials intended for larger target groups. In order to facilitate
the internationalization of the expert communities, English textbooks should
be used in the education of occupational health experts.
10. The training and education of young researchers in the OH&S field
needs to be further developed in the Baltic countries to help strengthen and
develop strong and autonomous expert communities in occupational health and
safety.
The Nordic countries should financially assist in arranging of special
fellowships in OH&S for Baltic students, by jointly organizing training
curricula, exchanging young researchers, and by providing fellowships for PhD
studies in which the main work for the doctoral thesis is to be done in the
home country. Postgraduate studies, however, could be carried out also in other
countries. The balanced development of various disciplines relevant for occupational
health services should be considered.
11. A legislative basis is important in OHS. The responsibility of employers
to organize OHS according to the legislation is the starting-point. The professional
responsibility for the contents and delivery system of the services should be
ensured by training and by inspection, or by implementing total quality management
systems plus incentive systems. Appropriate officially adopted guidelines on
'good occupational health practice' have been produced by some countries. In
addition, some European countries have already taken a certification system
into use.
The employers' obligation to provide OHS should be enforced and inspected
by appropriate mechanisms. The countries should carefully examine the system
most suitable for them, and design inspection and TQM systems facilitating the
further development of OHS systems. Appropriate officially adopted guidelines
on 'good occupational health practice' should be produced by the Government,
the social security system, or some other relevant professional body.
12. The employer is primarily responsible for organizing and funding the services.
The pure market economy model for funding of OHS seems to be insufficient, mainly
for small and medium-sized enterprises. Reimbursement or some other incentives
have been used by some countries as an incentive for developing services or
complying to the legislation. The Consultation recognized the need to provide
public support for the organization and maintenance of back-up support services
needed by front-line occupational health practice.
The funding of OHS rests primarily on the employer, but possibilities to
develop the services through an insurance-based system or public financing should
be examined. The countries themselves should make the decision concerning the
funding model of OHS. OHS should be ensured free entry to the workplaces either
as a condition of public funding or to be defined in the legislation.
13. The occupational health and safety activities planned and developed in
the Baltic countries are not parallel, but there are some similarities in the
systems. The Consultation Group emphasized that occupational health services
need to be developed as a special service, but at the same time it is of utmost
importance that horizontal collaboration is ensured at the national and local
levels. Particularly collaboration with general health services, environmental
health services, safety services and primary health care services is important.
The countries should identify all the collaborative links between OHS and
relevant organizations and services, and encourage the establishment of permanent
collaboration at the national and operational level. The networking within the
countries and internationally is strongly recommended.
14. The country reports presented to the Consultation Group revealed specific
needs for assistance both from WHO and from the Nordic countries. The Consultation
Group discussed the mechanisms and forms of future collaboration. The Nordic
Institute for Advanced Training in Occupational Health (NIVA) has received special
funding from the Nordic Council of Ministers for Baltic participants, and training
courses specially designed for Baltic countries have been and will be offered
according to the plans of NIVA. There are also several other practical forms
of collaboration for Nordic-Baltic collaboration, e.g. between professional
associations.
A more detailed plan of action for practical collaboration should be compiled,
based on proposals, submitted by the Nordic and Baltic organizations to WHO/EURO/OCH
servicing as the secretariat, on activities and events to be carried out in
1996-2000, and on how to ensure their funding. The various collaborative partners
should find and locate their programme elements and projects within the framework
of such an action plan.
15. The Telematic Information Network was deemed to be an effective way to
strengthen collaboration and improve synergism between the activities carried
out by several bodies in the Baltic Region. The Network could contain information
about the ongoing projects and events of occupational health and safety in the
Baltic Region, training opportunities, informative materials, and possibly information
bulletin boards.
The establishment of the Telematic Information Network on Occupational
Health and Safety between the countries around the Baltic Sea was agreed upon
by the partners participating in the Consultation. The Finnish Institute of
Occupational Health was delegated the task of functioning as a focal point in
the Network.
16. The Baltic Region is an important and rapidly developing area in Europe
and requires full attention and support from WHO/Euro for the development
of occupational health and safety systems, practices, infrastructures, training
and research.
It was recommended that the WHO Regional Office for Europe allocate sufficient
funds and other resources for developing occupational health and safety in
the Baltic Region.
17. The Consultation Group recognized with great satisfaction that the International
Organizations (ILO, WHO, OECD, etc.) have numerous projects going on in the
Baltic countries, relevant to occupational health and safety.
Information about these projects should be compiled and included in
the data base and, where possible, collaborative links should be created between
such international and Nordic programmes.
18. The evaluation and follow-up of the decisions and recommendations made
in this Consultation are important for the feedback about the successful activities.
A follow-up meeting should be organized by the WHO Regional Office for
Europe in late 1996 in Latvia, in 1997 in Lithuania and in 1998 in Estonia
in collaboration with the respective countries.
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