The Present State and Future Prospects of Occupational

Industrial Health 1999, 37,116-121 World Report on Industrial Health The Present State and Future Prospects of Occupational Health in Bangladesh Md Shawkatuzzaman LASKARI*, Noriaki HARADA 1 and Harun A RASHID2 1 Department of Hygiene, Yamaguchi University School of Medicine, Ube 755-8505, Japan 2 Bangladesh Medical Research Council, Mohakhali, Dhaka-1212, Bangladesh Received October 30, 1998 and accepted November 20, 1998 Abstract: Bangladesh is a relatively young and developing country. 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. Occupational health is a fairly new field, as the country is undergoing industrialization and occupational health activities are operated by several ministries, such as Labour, Health, Industry and Transport. Legal foundations of the occupational health-care 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. Reconsideration of the occupational health service system avoiding duplication for the `occupational health' component in several ministries might be helpful to achieve the successful provision of an occupational health service in the developing Bangladesh. Key words: Occupational health, Bangladesh Occupational health activities, Labour laws, Developing country, Introduction It is reported in the WHO press release in October 1994 with review of the various aspects of health at work in the light of data from about thirty countries that depending on the country and the region, from 20% to 90% of the workers have no access to occupational health services'. Moreover, it is mentioned that the need for occupational health services is particularly acute in the developing and newly industrialized countries, where approximately 80% of the global working population live'}. Bangladesh, a relatively young and developing country, mainly depends on agriculture and continues to face daunting problems of underemployment and poverty but has fairly diverse growth experiences and varying degrees of success in opening up economy and attracting foreign investment. Recently, the country is achieving rapid progress in industrialization. In *To whom correspondence should be addressed. 9 1. the course of achieving this rapid progress, the nation is facing occupational health problems newly arising. 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 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 The total population in 1995 was 120 millions and about 64 millions of them were 15 years of age and over. Although

' OCCUPATIONAL HEALTH ACTIVITIES IN BANGLADESH 117 Table 1. Distribution of Bangladeshi population by age, and labour force by gender and sector affiliation Table 2. Vital statistical indicators for Bangladesh Table 3. Average annual growth of the economy in Bangladesh industrial development 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. Vital statistical indicators Bangladesh has recorded strong progress in reducing its total fertility rate from more than six births per woman in 1980 to fewer than four in 1995 (Table 2). The infant mortality rate decreased from 138 per 1000 live births in 1980 to 79 per 1000 in 1995 (Table 2). Life expectancy at birth has increased from 43 years for females and 45 years 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 (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 entering first grade completes primary school education. As a result of this school dropout pattern, the adult literacy rate is among the lowest in the world (38% in 1995, male 49% and female 23%)).

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 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 industrial policy 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 product stood at US$ 240 in 1995 and 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 Community medicine 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 officer and successors of an entrance examination. Only 20 students are enrolled every year. The course program is 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. Occupational Diseases The occupational diseases required to be notified are followed. 1) Poisoning by 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 Government of Bangladesh is conscious about the 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 HEALTH ACTIVITIES IN BANGLADESH 119 occupation connected with the transport of passengers, 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 17th year shall be employed or 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. 4) 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. 5) 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. 6) 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. 7) 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 workers employed in shops, commercial and establishments not being factories. Organizations Dealing with Health Occupational industrial 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 with regard to health and hygiene, safety, benefit, 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 LASKAR et al. 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 Medical Officers, Labour Welfare Officers, etc. 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, determination of losses, medical benefits, etc. Research in Occupational Health The history of developed countries has clearly shown the crucial role of research in efforts to accelerate overall socioeconomic development. Research is an important tool for the development of occupational health in developing countries providing a scientific basis for policy-making, priority-setting, problem-solving, professional training, and evaluation'. Very limited research articles/reports originating from Bangladesh regarding to occupational health related areas are available8-15~. Main research topics involve work place evaluation, investigation on industrial pollution and effects of work exposure on quality of life of workers, and stress and burnout in the working population. Occupational health expertise, research fund allocation and other facilities do not correspond to the needs. Therefore, collaboration with colleagues in developed countries to advance shared goals in research, education, training, and public policy might be helpful for strengthening occupational health research in Bangladesh. Future Prospects of Occupational Health in Bangladesh Bangladeshi workers being employed in different countries of the world bring with them the consequences exposures of the previous from the country they served and their absorption after returning home will have significant effects in the future on the prevalence of occupational diseases in Bangladesh. Although the Labour laws are in force, child labour can be noticed in many industries in Bangladesh. Different initiations are taken place to counteract this problem. For 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 sufficient evidence 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 interaction between work and environmental exposures (occupation-related accidents, noise-induced hearing loss, occupationally related 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 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 among several ministries can bring a number of benefits, such as sharing information, generating new ideas, increased political support and more efficient use of commonly needed and available resources. There should be compulsory training in basic occupational health for health-care workers, and occupational health and safety training should be included in the curriculum of vocational training institutes to educate workers at the start of their career on safe and healthy work practices. References 1) Press Release WHO/80 (20th October 1994) WHO Collaborating Centres launch a global strategy towards Industrial Health 1999, 37,116-121

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