Nov 20, 1998 - India and Pakistani ... bounded by the Bay of Bengal from the south, and Indian .... One Civil Surgeon acts as factory inspector (medical person) ...
Industrial
Health
World
1999, 37,116-121
The Present Health
State and Future
Report
Prospects
on Industrial
Health
of Occupational
in Bangladesh Md Shawkatuzzaman
LASKARI*,
1Department
of Hygiene
2 Bangladesh
Medical
Bangladesh
developing care
is difficult
country
Government
rectified
Reconsideration
and
India
the
Harun
Pakistani
A RASHID2
service
system
is a fairly
like in most
general new
medical
field,
are operated
in 1971.
as the
by several
of the occupational
adopted
and
Most
according avoiding
time,
and
foundations
were
country
Bangladesh
care
activities
Legal
Japan
1998
At the present
health
era,
of the
of
20,
health
health
and Transport.
liberation
health
country.
Occupational
and
Government
of the occupational
November
occupational
occupational
Industry
after the
developing
between
and
on British
by
and accepted
in Bangladesh.
Health,
based
of Bangladesh
been
young
industrialization
as Labour,
system
30, 1998
demarcation
to be recognized
such
health-care
have
a clear
is undergoing
ministries,
October
is a relatively
countries,
1 and
HARADA
, Yamaguchi University School of Medicine, Ube 755-8505, Research Council , Mohakhali, Dhaka-1212, Bangladesh
Received
Abstract:
Noriaki
to the
duplication
amended
of the ILO
by the
Labour
laws
Conventions.
for the `occupational
health'component in severalministries mightbehelpfulto achieve thesuccessful provision ofan occupational
health
Key
Occupational
words:
service
in the
developing
health,
Bangladesh.
Occupational
health
activities
, Labour
laws,
Developing
country,
Bangladesh
the course
Introduction
facing It is reported with review
in the WHO press release
of the various
in October
aspects of health
light of data from about thirty countries
it is mentioned
that depending
health services'.
that the need for occupational
is particularly
acute
industrialized
countries,
global working
developing
where
approximately
population
live'}.
Moreover, and
Bangladesh,
newly
80% of the a relatively
experiences economy country
and poverty and varying
and attracting is achieving
but has fairly degrees
foreign
of success investment.
rapid progress
diverse
growth
in opening
up
Recently,
the
in industrialization.
In 9
*To whom
correspondence
should
be addressed
.
newly
the nation
is
arising.
part of Pakistan as "East Bengal/East Pakistan" after departure of the British from the Indian subcontinent and then the sovereign state after the liberation from Pakistan in 19712>. The average distribution of Bangladeshi population by age, and labour force by gender and sector is shown in Table
young and developing country, mainly depends on agriculture and continues to face daunting problems of underemployment
problems
General information Bangladesh,though a small country is situated in the South Asian green belt, is the 9t"most densely populated country (except for some island countries) in the world today. Bangladesh, with area of 147,570 square kilometers, is bounded by the Bay of Bengal from the south, and Indian States (West Bengal, Meghalaya, Tripura and Assam) and Myanmar from the west to the east. Bangladesh becomes
on
health services
in the
this rapid progress,
health
1994
at work in the
the country and the region, from 20% to 90% of the workers have no access to occupational
of achieving
occupational
1. The total population
in 1995 was 120 millions
and about
64 millions of them were 15 years of age and over. Although
'
OCCUPATIONAL
Table
Table
1.
2.
Distribution
Vital
HEALTH
of Bangladeshi
statistical
Table
ACTIVITIES
3.
indicators
Average
population
IN BANGLADESH
by age,
and
labour
117
force
by gender
and
sector
affiliation
for Bangladesh
annual
growth
of the economy
in Bangladesh
industrialdevelopment has prompted migration to the cities, about 82% of the total population live in rural area. The labour force is decreasing in agriculture and increasing in industry. The major cities are Dhaka, Chittagong, Khulna, Sylhet and Rajshahi. Dhaka, the capital, is the largest. Chittagong, the country's major port, is the second in importance. A number of industrial areas, such as Narayangonj, Tongi, Tejgaon, Rupgonj, Savar, Kalurghat, Sholashahar, Faujdar Hat, Daulatpur, have been developed around Dhaka, Chittagong and Khulna.
for males in 1970 to 58 years for females and 57 years for males in 19953°4). Child immunization has risen from 10 to 70 percent in just five years3~. Schooling Gross primary school enrollment has increased from 54 to 111 percent since 1970, as a result of massive government efforts to increase enrollment in the early 1990s. In 1993, there were 47 females per 100 male students, up from a ratio of 18 to 100 in 1970. Although, primary education
Vital statistical indicators Bangladesh has recorded strong progress in reducing its
(from first grade to fifth grade, age at entrance 6 years) in Bangladesh is free, the dropout rate is high for both boys and girls. Approximately, less than one-half of the children
total fertility rate from more than six births per woman in 1980 to fewer than four in 1995 (Table 2). The infant
entering first grade completes primary school education. As a result of this school dropout pattern, the adult literacy rate
mortality rate decreased from 138 per 1000 live births in 1980 to 79 per 1000 in 1995 (Table 2). Life expectancy at
is among the lowest in the world (38% in 1995, male 49% and female 23%)).
birth has increased from 43 years for females and 45 years
118
MS
LASKAR
et al.
Economic indicators In 1995 the total labour force was 60 millions and of which 42% were females (Table 1). The labour force as in 1990 by category was 64% in agriculture, 16% in industry and 20% in others (Table 1). Jute, tea, rice and tobacco are the most important agricultural products. The dependence on agriculture is a reason of seasonal unemployment among
officer and successors of an entrance examination. Only 20 students are enrolled every year. The course program is
peasants and low standard of their living. To counteract this imbalance, a policy of industrialization was adopted after 1947 by the Pakistani Government and is still pursuing through five-year plans2~.The industrialpolicy in Bangladesh is based on the philosophy of a liberalized and competitive market economy to stimulate rapid industrialization. There are fertilizer factories, jute mills, textile mills, garments factories, paper and board mills, sugar factories, cement factories, glassworks, and aluminum works in Bangladesh2~. Bangladeshi goods for exports are raw jute and jute products, tea, tobacco, hides, skins, newsprint, carpets, ceramics, shrimps, apparel products, etc. Per capita gross national
Occupational
product stood at US$ 240 in 1995and gross domestic product has remained at around 4.5% in the past five years3~.The average annual growth rate in industry, exports of goods and gross domestic investment is increased (Table 3). The labour cost Is very small in Bangladesh. As a result, millions of Bangladeshi people are working in foreign countries like United Kingdom, Middle Eastern countries, Malaysia, Singapore, Brunei, South Korea and so on2~. Occupational
Health
Education
in Bangladesh
Undergraduate education Communitymedicine is a core subject in the undergraduate curriculum in all medical colleges where a department of community medicine (public health) is common. Usually undergraduate teaching in occupational health is given to medical students within the context of the teaching of community medicine. Postgraduate education and training Postgraduate training in occupational health is available only in the Department of Occupational and Environmental Health, National Institute of Preventive and Social Medicine, Dhaka, Bangladesh. A one year full-time course for Master's of Public Health in Occupational and Environmental Health, and workshops, seminars, meetings, etc, are conducted by the Department. The Master's of Public Health in Occupational and Environmental Health is for medical graduates with at least two-years job experience as medical
consisted of three parts- theoretical, practical including field visits and a course-work (thesis). At present, residency training program in occupational medicine is not available and not practiced as a subspecialty in Bangladesh. Diseases
The occupational diseases required to be notified are followed. 1) Poisoningby lead, phosphorus, mercury,arsenic, manganese, nitrous fumes, carbon bisulphide, benzene including any of its homologues, chrome, halogens, 2) Anthrax, 3) Silicosis, 4) Cancer,5) Manifestation of radiation, 6) Toxic anaemia, etc5~. The most important occupational cause of mortality and morbidity in workers is accidental injury. Each year about 5000 workers are killed, injured and impaired due to industrial accidents in Bangladesh5>. Legislation
The Governmentof Bangladesh is conscious aboutthe need for a proper welfare program for the health, safety and welfare of the workers, and statutory provisions have been stipulated in the existing laws which are required to be implemented by the employers. Legal foundations of the occupational healthcare system, based on British India and Pakistani era, were adopted and amended by the Government of Bangladesh after the liberation of the country in 1971. Most of the Labour laws have been rectified by the Government of Bangladesh according to the ILO Conventions. Some6>of the Labour laws which regulate the health, safety and welfare provisions and working conditions of workers are followed. 1) The Workmen's Compensation Act, 1923- Under this Act, it has been made obligatory on the part of the employers to pay compensation to their workers for injury by occupational accidents and occupational diseases arising out of and in the course of employment resulting in death or total or partial disablement. 2) The Dock Labourer's Act, 1934- An Act to give effect to the convention concerning the protection against accidents of workers employed in loading and unloading ships. 3) The Employment of Children's Act, 1938- This Act provides that no child who has not completed his 15th year shall be employed or permitted to work in any
Industrial
Health
1999, 37,116-121
OCCUPATIONAL
4)
5)
6)
7)
HEALTH
ACTIVITIES
119
IN BANGLADESH
occupation connected with the transport of passengers,
workers
goods or mails by railway or involving the handling of goods within the limits of any port, and that no child who has completed his 17thyear shall be employed or
establishments
permitted to work in the aforesaid occupations unless the periods of work of such child for any day are so fixed as to allow an interval of rest for at least 12 consecutive hours which shall include at least 7 consecutive hours between 10 p.m. and 7 a.m. The Maternity Benefit Act, 1939- Under this Act, every woman employed shall be entitled to, and her employer shall be liable for the payment of maternity benefit for the actual days of her absence during period of six weeks immediately preceding and including the day of her delivery and for the six weeks immediately following that day. The Minimum Wages Ordinance, 1961- Under this Ordinance, the Government declare the minimum rates of wages for time work, piece work, overtime work and work on the weekly day of rest and for paid holidays. Any employer who contravenes the provisions is liable for punishment. The Tea Plantation Labour Ordinance, 1962- An Ordinance to provide for the welfare of labour and to regulate the conditions of workers in tea plantations. The Factories Act, 1965- Some of the important provisions are: a) keeping the factory premises clean; b) proper disposal of wastes and effluents produced due to manufacturing process; c) proper ventilation and adequate measures to protect workers from excessive temperature; d) measures to protect workers from inhalation of dust and fumes; e) providing artificial humidification in cotton mills; f) provision of sufficient space (500 cft per worker) to avoid overcrowding; g) arranging sufficient and suitable lighting and preventing glare in the factory; h) adequate supply of whole-some drinking water for the worker; i) provision of sufficient number of latrines and urinals; j) provision of spittoons, bathing, washing and canteen facilities; k) provision of first aid appliances, ambulance room or dispensary and medical staffs including Medical Officers; l) prohibiting employment of children below the age of 14 years; m)
provision of suitable creche for worker's children under the age of six years in factories employing more than 50 female workers. 8) The Shops and Establishment's Act, 1965- This Act regulates the holidays, payment of wages, leave, hours of work and certain other allied matters concerning the
employed
Organizations
in shops, commercial
and industrial
not being factories.
Dealing
with
Occupational
Health At the present time like in most developing countries, a clear demarcation
between occupational
health care and
general medical care is difficult to be recognized in Bangladesh. The occupational health and safety services in Bangladesh
are in a developmental
stage as well as the
country itself, and several ministries through various departments and corporations provide health care services to the working population under them. Health care programs are operated in the governmental sector by different ministries through various departments and corporations, such as: 1) Ministry of Health and Family Welfare: Health care as part of national health services is provided by this ministry through hospitals, dispensaries, clinics, etc.; however, do not play special role in terms of occupational health services viz. in industries, factories, agriculture, etc. One Civil Surgeon acts as factory inspector (medical person) for one district in which he is the team leader and heath authority (64 such districts in Bangladesh). One Assistant Director (Industrial Hygiene) is posted in the office of the Director General of Health Services under this Ministry. 2) Ministry of Labour: The Ministry of Labour runs 22 dispensaries established in various industrial and tea plantation areas of the country for the benefit of workers which include facilities for emergency treatment of casualties and family planning. This ministry is responsible for legislation concerning working environment, inspection hygiene, safety, benefit,
with regard to health and compensation and setting
standards. The Inspectorate of Factories under this Ministry is responsible for implementation and enforcement of Factories Act. The Inspectorate has three wings- medical, engineering and general, all under the Chief Inspector of Factories and Establishment. The medical wing is headed by the Deputy Chief Inspector of Factories (medical person). An Inspector may, within the local limits for which he is appointed, enter to' each and every workplace in Bangladesh to ascertain safety of the work environment
and enforcement
of the
provisions of the Factories Act and other laws relating to health and hygiene.
120
MS
3) Ministry of Industry: Industries in different corporations under this Ministry have provisions of individual occupational health services, which include employment of full-time or part-time Welfare Officers, etc.
Medical Officers,
Labour
4) Ministry of Transport: Health care services provided by the different branches of this ministry include: railway- medical services through hospitals, health units, clinics and health inspectors for sanitation in large stations; shipping and aviation- medical services through respective affiliated hospitals. Health care services provided in private sector generally include medical services through private clinics and medical centers, first aid, medical examination, losses, medical benefits, etc. Research
in Occupational
The history of developed crucial
in efforts
development.
has clearly
shown the
to accelerate
overall
Research
for the development
of occupational
countries
a scientific
providing
of
Health countries
role of research
socioeconomic
determination
is an important health
basis
tool
in developing
for policy-making,
priority-setting, problem-solving, professional training, and evaluation'. Very limited research articles/reports originating from Bangladesh
regarding
to occupational
areas are available8-15~. Main research
health related
topics involve
stress and burnout
in the working research
do not correspond with colleagues
population.
fund allocation
to the needs. in developed
and and
Therefore,
collaboration
to advance
instance, the Bangladesh Garment Manufacturers' and Exporter's Association signed an agreement in 1995 with the ILO and UNICEF to remove all child workers below 14 years of age from more than 2,000 garment factories and set up a program to rehabilitate them and their families16~. Special attention should be given to the real enforcement of all Labour laws for the health, safety and welfare of the workers in Bangladesh. Overtime work is frequent in privet sector jobs, sometime willingly and sometime on demand of employers. As it is a tradition in Bangladesh, house works are done by women. Thus, working women in Bangladesh have to work more than usual working hours. On the other hand, women do not get the equal remuneration. For example, there is a considerable gap remains in women's nonagricultural wages which is as 42% of men's16~.There is sufficientevidence to raise concerns about the risks to health and safety of long working hours''. Therefore, the issue of working women will receive special emphasis from the occupational health system. More emphasis will be placed on the interactionbetween work and environmentalexposures (occupation-related accidents, noise-induced hearing loss, occupationallyrelated skin diseases and occupational cancer). Worksite health-promotion, reaching out to workplaces and advertising health-promotion programs (e.g., time management, smoking cessation, proper nutrition, physical activity, stress reduction), will be of great importance. Conclusions The duplication in health services for the `occupational
Occupational
and other facilities
countries
et al.
work
place evaluation, investigation on industrial pollution effects of work exposure on quality of life of workers, health expertise,
LASKAR
shared
goals in research, education, training, and public policy might be helpful for strengthening occupational health research
health' component in several ministries besides being wasteful is also not conducive to efficiency. However, for to achieve the successful provision of an occupational health service in the developing Bangladesh, a collaborative effort
in Bangladesh.
among several ministries can bring a number of benefits, such as sharing information, generating new ideas, increased
Future
political support and more efficient use of commonly needed and available resources. There should be compulsory training
Prospects
of Occupational
Health
in
in basic occupational health for health-care workers, and occupational health and safety training should be included
Bangladesh Bangladeshi
workers being employed
in different countries
of the world bring with them the consequences exposures
after returning home will have significant on the prevalence Although be noticed initiations
of the previous
from the country they served and their absorption of occupational
the Labour in many
in the curriculum of vocational training institutes to educate workers at the start of their career on safe and healthy work practices.
effects in the future
diseases
in Bangladesh.
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Industrial
Health
1999, 37,116-121
OCCUPATIONAL
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6)
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ACTIVITIES
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