The right to safety and health at work is preserved in the United Nations Universal Declaration of Human Rights in 1948; and a basic principle of the promotional framework for occupational safety and health convention of the International Labour Organization (ILO) in 2006 1.
At the onset of the twenty-first century, technological progress, rapidly growing industry and national economies brought rapid changes in working conditions, work processes and organization 2,3. This has increased industrial accidents and occupational diseases 2 all over the world, and their cost in terms of human suffering and economic burden is therefore significant 1.Definitions and Terms:- Worker: means any person male or female not less than 16 years old who performs work in return for wages of whatever type in service and subject to the management or supervision of the employer, whether his contract of service is written or oral, expressed or implied or for the purpose of training or probation, or who performs manual or semi manual work whether skilled or unskilled in consideration of wage of whatever kind 4.- Employer: Any person who employs, under a contract of employment, one person or more in return for any type of remuneration 5.- Hazard: the inherent potential to cause injury or damage to people’s health 6.- Accident: is any unplanned vent that resulted in injury or ill health of people, or damage to materials or equipment, plant, environment or a loss of business opportunity 7.- Serious Accident: means any accident causing death or 50 percent or more disability, or causing injury to more than one worker, and also fire, explosion or collapse that causes damage in the means of production or places of work 4.
– Occupational health: defined by the joint committee of the International Labour Organization and the World Health Organization ILO/WHO in 1950 is “the promotion and maintenance of the highest degree of physical, mental and social well-being of all workers in all occupations” 8.- occupational health and safety (OHAS) / (OHS), or occupational safety and health (OSH): is generally defined as the science of the anticipation, recognition, evaluation and control of hazards arising in or from the workplace that could impair the health and well-being ofworkers, taking into account the possible impact on the surrounding communities and the general environment 1.- Industrial health and safety (IHS): work-related health and safety, which usually focuses on the ways in which the workers should be protected from various work exposures.
The concept of IHS has been expanded to cover the prevention of work-related accidents, injuries and diseases 2.The global context:The ILO has estimated that 2 million occupational fatalities occur every year across the world; and the total annual rate of occupational accidents, fatal and non-fatal, is estimated at 270 million. Industrial sectors’ fatality rate in different regions in the world ranged from 13.4 to 26.4 (15.9 in Sudan) 7.
In sub-Saharan Africa, each year 54,000 workers die and 42 million work-related accidents take place causing at least three days’ absence from work. It was noticed that injury rates and accident severity are higher in the developing nations than the western and industrialized ones 1,2. Reasons behind that comprise, inter alia, crowded and poor working conditions, economic constraints, illiteracy, and careless attitudes of the workers. This is an indicator of absent or frail OSH management system 2.
However, occupational accidents are underreported in developing countries, (Sudan is no exception). This could be attributed to the lack of convenient recording system, expertise, regulations, enabling legislations, and coordination between the concerned authorities 9,10. Various kinds of professions may be employed by the state, but these officials are not always trained in occupational health, nor in industrial hygiene or safety-related topics. In fact, they are prompted by their personal interests and not by the duties and responsibilities they are assigned to 2. Statistically, the highest rates of occupational deaths worldwide appear to occur in the domains of agriculture, forestry, mining and construction 1. Sadly, in the developing world, there is increasing import of second-hand machinery, and dumping of toxic hazardous wastes flowing from the western nations 2.
Types of hazards usually encountered at the workplace can be classified into biological, chemical, mechanical, physical, psychological, environmental, fire, and ergonomic 2,6. There are certain groups at risk of occupational accidents and diseases as stated by the ILO including women, children, home-based workers, part-time workers, migrants, ageing workers and drivers 1. Occupational and industrial accidents are all caused by preventable factors that could beeliminated through the development and the implementation of a solid occupational safety and health management system 1,6. There is a globally agreed set of indicators for OHS as shown in fig. (1).Figure (1): List of all occupational health and safety indicators, sourced from http://www.
health.state.mn.us/divs/hpcd/cdee/occhealth/indicators/The National Context:The OSH in Sudan was recognized through the legislations of the Federal Ministry of Labour (FMOL), the competent national authority on safety and health at work, which issued many regulatory decrees and acts since the forties of the last century (table 1). At Khartoum State Ministry of Health (SMOH), the directorate of occupational health and safety is under the environmental health, a sub-directorate of the primary health care. A sub-office for OHS has been established recently at the Federal Ministry of Health (FMOH).
OSH covers physical and psychological health. The main legislation on OSH is contained in the labour code of 1997, list of factories decree of 1981, and list of factories (occupational health) also of 1981 5. Sudan labour act in 1997 was the most elaborate one, containing provisions on occupational accidents explicitly in article 92, which remained inactive until 2005 9,11 when the Ministry of Manpower imposed keeping accident records in the administration of industrial safety 9. The list of factories and act of 1981 exhibits conditions for industrial hygiene, regulations and precautions concerning the use of leads, periodic medical examinations, and the rights of employees and the duties of the employer. The occupational health and safety Act in Khartoum state signed in February 2011 is merely a state’s law not federal; and there is no actual application of act provisions 12. Moreover, the act neglected thousands of workers in small workshops, construction and mining.
The workers union and experts were not actively involved in developing the laws, which was a pitfall. Table 1:Legislations issued by the federal ministry of labour Factory and Workshops Act 1949Manpower Act1974 (repealed) Industrial Safety Act 1976 (repealed)Labour Code1997 Factories Decree 1981Factories (Occupational health) Act1981 Tobacco Control Act 2005Occupational Safety Compensation Law2007 National Pension Fund Law 2008occupational health and safety Act in Khartoum state2011Table (2): List of Sudan occupational diseasesOccupational diseases caused by chemical agents1.Lead poisoning26.Poisoning of Oxyan (Second Atlemen Deoxin)2.
Mercury poisoning27.Hologenesis (chlorine-chromium-brom)3.Cadmium poisoning28.Insecticide poisoning (chlorine-phosphorus)4.Antimony poisoning29.Carbon monoxide poisoning5.
Manganese poisoning30.Cyanide acid poisoning6.Chromium poisoning31.Ozone poisoning7.Nickel poisoning32.Nitric acid (HNO3) Poisoning8.Palladium Poisoning33.
Carbon disulfide poisoning9.Beryllium poisoning34.Hydrogen peroxide poisoning10.Silver poisoning35.Tobacco poisoning11.Thallium poisoning36.Antibiotics poisoning12.Zinc Poisoning37.
Barium poisoning13.Tin poisoning38.Bismuth poisoning14.
Copper poisoning39.Bacopaln poisoning15.Aluminum poisoning40.Gold poisoning16.Arsenic poisoning41.Metal poisoning17.sulfur oxides poisoning42.
Bromine poisoning18.Poisoning with petroleum, gas or its derivatives43.Plutonium poisoning19.Poisoning with petroleum and their derivatives,44.Zinc poisoningtetrachloroethane and chloroethane20.
Poisoning of solid bromine hydrocarbons and other halogen derivatives45.Vanadium poisoning21.Chloroform poisoning and carbon tetrachloride46.Ammonia poisoning22.Poisoning of plastics including chlorine flannel47.Isospas poisoning!!!!23.Poisoning with Nitrogenol48.
Organic solvent poisoning24.Poisoning with alcohol, glycoprotein and ketone49.Chlorine poisoning25.Poisoning of troglycerin and replacement of Nitric acid (HNO3)50.
Poisoning with derivatives of (Inter – oamtu – euclur) or derivatives of benzene Occupational diseases resulting from physical factorsDeafnessMagnitude of the problem:The WHO estimated that about 15–50% of the labor force in the Eastern Mediterranean Region, including Sudan, is employed in the industrial sector. Maintenance of accident records became mandatory in 2005; before which accident records, statistics, and safety performance were not evaluated. A study was conducted to evaluate and to compare safety performance by accident records among different cities in Khartoum state during the period from 2005 to 2007. The studied samples distributed in the three cities (Khartoum, Omdurman, Bahri) revealed 371 occupational accidents, of which 282 accidents (76.0%) caused injuries, 75 (20.2%) led to disability, and 14 (3.8%) led to fatalities. Khartoum city had the greatest number of accidents, fatalities, and disabilities, followed by Omdurman and Bahri.
The food sector recorded the maximum number of accidents, disabilities, and fatalities; and the worst safety performance was of the chemical sector 9. A second study to explore causes, factors, and out-comes of theoccupational accidents that occurred in various industrial sectors of Khartoum state during the same period revealed that the main types of accidents were “caught in or between things, “faulty action, “and “striking against falling objects” in all industries, indicating thatmachines were the major cause of work-related accidents, followed by unsafe working conditions, and lack of personal protective equipment (PPE). From these studies, one can conclude that there is lack of pronounced enforcement of laws and regulations on occupational safety and health 7.Figure (2): Distribution of incidence rate according to the type of accidents in differentLocalities.In 2013, an assessment was conducted regarding industrial hygiene and occupational safety inKhartoum North revealed the following: only 31.25% of the workers have a safety supervisor, and 3.2% of those undergone a pre-employment medical examination.
There is lack of safety education and PPE. It was also found that workers are not aware about their jobs-related hazards. Other findings showed absence of periodic and proper monitoring by the concerned authorities, and standardized safety records were not kept. The study concluded that emergency procedures, PPE, first aid and safety facilities, in addition to indoor environment could be classified as unsatisfactory 12.
The way forward:From all the above, it is clear that the FMOL and FMOH, the responsible authorities for health and safety at work, are lagging behind the influence they are expected to exercise. Therefore, extensive reforms and the adoption of globally endorsed standards may improve the current situation of OHS in Sudan. The Promotional Framework for Occupational Safety and Health Convention, 2006 ILO, recommends the application of a systems approach to the management of occupational safety at national levels. Tools include:• A national OSH policy: governments are responsible for drawing up OSH policies and making sure that they are implemented. Policies will be reflected in legislation, which must be enforced. Policies are more likely to be supported and implemented if both employers and workers participate in their formulation.• A national OSH system including laws, regulations, responsible authorities, mechanisms for ensuring compliance, information & training; mechanisms for the collection and analysis of data on occupational accidents and diseases, support mechanisms for a progressive improvement of occupational safety and health conditions.
• A national OSH programme: the national programme is the “Act” element ofthe “Plan–Do–Check–Act” cycle which is at the heart of the systems management approach to OSH. Steps include:1. establishment of coordination mechanisms for the elaboration and implementation of the programme2. analysis and identification of strong and weak points in the national system3.
identification of priorities4. development of action plan including indicators of success5. launch of the national programme6. establishment of sustainable mechanisms for review, updating of data and continual improvements in effectiveness.The main elements of the OSH management system for the workplace, based on the ILO guidelines, are shown in fig.
(3).Risk assessment is one of the most important tools used in OSH programs. It denotes careful examination of the workplace, targeting causes of harm to the employees and other people, including customers, visitors and members of the public. This can help to determine whether enough precautions were taken or whether more should be done to prevent harm 1.
Carrying out risk assessment in itself will not prevent accidents and ill health, but will play a crucial part in reducing their likelihood 13. The processes of risk assessment are summarized in fig. (4), (5) and (6).Figure (4) risk assessment flowchart sourced fromhttp://labour.govmu.org/English/Documents/Code%20of%20Practice/guidelines/3.
%20Risk%20Assessment%20Guidelines.pdfFigure (6): risk assessment cycle, source: risk assessment guidelinesThe Joint ILO/WHO Committee on Occupational Health in 1995 defined an occupational healthsurveillance system as “a system which includes a functional capacity for data collection,analysis and dissemination linked to occupational health programmes”. It is an importantcomponent of risk assessment.
The concept is new to occupational health and is frequentlyconfused with medical screening. Health screening refers to the early detection and treatment ofdiseases associated with particular occupations, while workplace health surveillance refers to theFigure (5) risk assessment guidelines. Source: risk assessment guidelinesremoval of the causative factors. There are two aspects of an occupational health surveillance system: medical surveillance and hazard surveillance. Medical surveillance is designed to detect potential workplace hazards before irreversible health effects can occur. Screenings are performed at set intervals, often annually, by clinicians with expertise in occupational health. Hazard surveillance involves identifying potentially hazardous practices or exposures in the workplace, assessing their relationships to workers, the effectiveness of controls, and the consistency of exposure measures. Tools for conducting occupational health surveillance include: 1) laboratory investigations using biological specimens like urine or blood; 2) physical examinations, epidemiological cohort and case control studies.
The pulmonary function testing is the backbone of early detection of occupational lung diseases.3) audiometry remains the keystone of diagnosis of noise-induced hearing loss, which is the most common reported occupational disease in all parts of the world 14.Conclusion:Safety and health at work is well known concept and a basic human right for all workers at all times. Many policies, legislations, and regulations were put forward both at the national and international levels to protect and enhance situations of workers world-wide. However, there are many constraints that hinder the enforcement of laws and put the health and lives of labour workers at great jeopardy. Other reasons include lack of training, non-availability of basic equipment and supplies, worker-related causes (literacy, gender, age…etc.
), and many others. In the Sudan, like the rest of the world, legislations are not enforced, and record keeping is below the expected. Ample efforts should be exerted, basically by adoption of evidence-based systems approach that guarantee the implementation and sustainability of satisfactory conditions for the safety and health of all workers.