Healthy Workplace in Nepal

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[Healthy Workplace: Assessment And Case Studies In Nepal] Page i

HEALTHY WORKPLACE: ASSESSMENT AND CASE STUDIES IN NEPAL

SUBMITTED TO

WORLD HEALTH ORGANIZATION

Researchers:

Chhabi Ranabhat (MPH, MA, M Ed)

Dinesh Bhatta (Environmental Engineer)

[ACKNOWLEDGEMENTS]

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ACKNOWLEDGEMENTS

we would like to extend my sincere gratitude to Dr. Salma Burton, and the executives/ officials of World Health Organization (WHO) for providing opportunity for this holistic work. The overall guidance from Mr. Nam Raj Khatri (WHO) is deeply appreciated.

The help of Mr. Ganesh Bhakta Shrestha (MBS), Mr. Madhav Bista (BPH), Mr. Kiran Mishra (Sociologist), Dr. Kirti Kusum Joshi (Urban Planner), Mr. Youb Raj Bhatt (Occupational Health Safety Expert), Mr. Anil K.C. (Environmentalist), Er Anoj Karmcharya, Mr. Rabi Bhattarai (Environmentalist) are highly appreciable, without their valuable comments and suggestions, I could not accomplish the job with quality standards.

Access to data and information provided by the Bir Hospital, Janjagriti High School, Aqua Minerals Nepal Private Limited, Chapter 9 Restaurant and their staffs is highly appreciable.

My special thanks go to Dr. Buland Thapa (Director-Bir Hospital), Er. Mahesh Nakarmi (Health Care Foundation Nepal), Saroj Karki (Headmaster- Janjagriti High School), Mr. Arjun Bhattarai (Production Manager-Aqua Minerals Nepal Private Limited) and Mr. Tara Ratna Sthapit (Manager-Chapter 9 Restaurant) for their valuable support.

[EXECUTIVE SUMMARY]

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EXECUTIVE SUMMARY This study assess the initiatives towards healthy workplace and available legalization in order to know the present situation and what needs to be done for developing Healthy Workplaces in Nepal. After review of the relevant literature, acts, articles, websites, the checklist for field visit were developed. Four work places Bir Hospital, Janjagriti High School, Aqua Minerals Nepal Private Limited and Chapter 9 Restaurant with different work requirements including health service provider, educational enterprises, industrial enterprises, and service-oriented enterprises were taken for case study.

Healthy workplace is a new concept for Nepal. Government of Nepal has started paying attention by enforcing several acts and policies like, Labor act (1992), Trade Union Act (1993), Interim constitution on Nepal (2007), Present three-year interim plan, Environment Protection Act (1997), and conventions like, ILO convention to work for healthy work place. The interim constitution of Nepal incorporates several provisions concerning labor matters as clause 16 clearly states, “Every person shall have the right to live in clean environment”. The present legislation mostly focuses on physical health environment and occupational health and safety. Moreover, the provisions in acts regarding to healthy workplace has disbursed in several headings and responsibilities along with but there is lack of provision of coordination among them. There is need of confined legislative document and, or body to promote the healthy workplace in the nation.

Most of the institutions working in this sector are focusing on physical environment and occupational health and safety only. Department of Labor, Occupational Safety and Health Project, National productivity and Economic Development Centre, International Labor Organization (ILO), World Health organization (WHO), Strengthening of Environmental Administration and Management at the Local Level in Nepal (SEAM- Nepal) ,Trade unions, Entrepreneurs are some major actors playing the roles towards healthy workplace. There is a lack of information sharing and coordination between the stakeholders.

Aqua Minerals Nepal Private Limited, Janjagriti High School, , Chapter 9 Restaurant are observed in seek of healthy workplace basically focused on physical environment, psychosocial environment, personal health resources, participation in the community.

Aqua Hundred has emerged as a trusted name in the market of bottled water in Nepal for the last 17 years. Aqua Minerals has ISO 9001:2008 label. In every unit of productions in Aqua Minerals there is proper housekeeping, light, ventilation, cleanness, floor covering, electric lines, water lines etc. There is provision of separate clean toilets for urine and defecation. Quality control labs are fully equipped with modern equipments with good system of record keeping. The workers works for 8 hours per day with break in between. They have refresher course and training programs, proper personal protective equipments, trolleys to reduce burden due to more load lifting, smoking cessation etc. They have a trade union for collective bargaining. They get free treatment with salary in the case of work life accident. As community responsibility, they supply free water to religious occasion, develop traffic lights and signals to reduce accidents and maintain proper traffic flow and have built garden and grills in Mahankal temple. If they introduce system of being permanent, provision of seating in several compartments, emergency preparedness Aqua will be better work place.

Janjagriti High School is a popular community school of Dhading, about 35 km away from Kathmandu, was established in 1994 AD. The school provides education from playgroup (nursery) to class ten with special provision of blind and open education for older citizens. The school has a proper work place design, basic services, housekeeping, drinking water with taps of different heights, separate toilets for ladies and gents, light etc. Similarly, there are no cases of work life conflict and sexual harassments. Teachers get several refresher course and training programs supported by government and nongovernmental organizations. They also have first aid facility, healthy food, smoking cessation, indoor as well as outdoor games, school day, sports week, parent-teacher games, and scholarships for needy students, water supply in community etc. It would be much better place to work if canteen is improved, class congestion is reduced, cleaning and washing materials are placed in toilets properly, job security, regular health check up programs, safety in roof top is maintained and ergonomic hazards also be taken in consideration.

Chapter 9 restro-bar P. Ltd. was established in 2009 as family restaurant serves Indian, Chinese & Continental food having around 2800 square feet plinth area. There is availability of nice garden for out

[EXECUTIVE SUMMARY]

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side sitting, separate clean toilets for ladies and gents, proper housekeeping, light, electric lines, healthy food and smoking cessation. In dinning and sitting areas there is no congestion, having proper light, ventilation, cleanness, floor covering. In kitchen housekeeping, light, ventilation, electric lines, LP gas pipeline, water lines are in proper condition. The workers of Chapter 9 works for 8 hours per day with break in between. They get salaries from basic salary allocated by government in addition to breakfast, lunch and dinner. They also get service tax collected from customers. They have trade union for collective bargaining. There is a system of WIFI for the consumer so that they could do their work during their lunch, tea and snacks time. They also accept different type of debit and credit cards. They had discount offers for international students and the members of club GUNA. As cleaning area is out of the building there is no problem of ventilation, but it will be too cold in winters of Kathmandu. It may more better place to work if system of permanent staff, use of provided personnel protective equipment, refresher course and training programs, regular health check up programs, , ergonomic hazards also be take in consideration.

Bir Hospital the largest Hospital of Nepal was established around 123 years ago. This is government’s central hospital operating under the management of National Academy of Medical Sciences (NAMS). This hospital has 460 beds and had served 10935 admitted patients as well as 336400 outdoor patients last year. Out of 460 beds, 231 beds are free of cost beds. Patients of kidney, heart, cancer and neurotic also get free treatment. WHO with technical assistance of HCFN has endorsed new system of HCWM in nearly all major wards (20 wards) of this hospital and are planning to cover all wards in near future to reduce risk due to HCW. The hospital is towards movement for safe injection practice and being mercury free. There is high congestion; absence of proper light, ventilation, cleanness, floor covering; lack of proper equipments, proper maintenance of available equipments; lack of sufficient staffs, etc. in most of the departments. However in case of Operation theaters, light and ventilation are in proper condition. The hospital is also in high risk to emergency preparedness like fire hazard, earthquakes etc. The toilets for visitors are not found clean and there is no any provision for wastewater treatment. Proper communication, proper workload, refresher trainings, security, canteen and immunization to protect workers are lacking. Staffs working in the hospital have job security. Bir hospital takes parts in health camp in remote parts of county, organizes seminars, workshops and trainings.

Bir hospital has to manage for several issues raised in above sections to be healthy work place. Bir hospital should raise awareness about the needs and benefits of healthy work place to management and workers of the hospital. After strong commitment from top management and employees / trade unions to find ways to promote hospital as healthy workplace, they have to formulate a HW committee. HW committee in association with staffs of respective departments has to perform workplace need assessment to get proper information on barriers obstructing to make hospital healthy. The assessment assist to identify and priorities the problems, and formulate a local healthy workplace action plan for resolving priority problems. The plan must be focus on the priorities identified with a period, required resources and clear-cut responsibility. According to plan, employees should be encouraged to participate in HW activities. High-level management should encourage HW team by providing supportive environment, necessary resources and follow up to keep track of progress. Implementation process and outcomes should be evaluated in the short and long terms by using indicators with aim to improve workplace and make plan for forward.

Major causes of unhealthy work places in Nepal are unsafe working conditions ,lack of supervision and training ,use of old machinery and equipment ,lack of sufficient maintenance ,bad house-keeping practices. Similarly violation of safety rules , crowded production units, alcohol and drug use, politics of trade unions, work life conflict, use of chemicals in industries, solid waste management, hazardous waste management, dusty worksites, congested and dark workplaces are also responsible.

The promotion towards the sound healthy workplace environment in Nepal is showing disinclination due to lack of clear policy, proper coordination, responsible government agency for healthy work place, knowledge and awareness among workers, awareness and commitment in employers and management. Fear of change and increase in cost, poor consultation system, majority of untrained people in both management and labor, absence of safety-friendly work culture (both workers & management), lack of research and database on healthy work place are also responsible as barriers of health workplace. Entrepreneurs have never taken care of minimum workplace standards provisioned in the law. Weak

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administration and ineffective enforcement mechanism of the government needs a boosting improvement in order to build the capacity to control the situation.

At national level to gain momentum to get healthy workplaces through out the country in all enterprises there need to do a great deal. A healthy work place section/unit should be established under Ministry of Health and Population. For the sustainability; permanent steering committee should be established under the leadership of MoHP and the members should be from Ministry of Industry, Ministry of Environment, Ministry of labor and transportation, Nepal Bureau of standards and metrology, representatives from trade unions, representative of FNCCI, representative of WHO, ILO and other relevant stakeholders. This committee should develop/endorse Healthy Workplace Policy. There should be partnership of all concerned stakeholders to achieve goals at National level.

To achieve goals every enterprise should move towards healthy workplace through raising awareness and creating strong commitment to have change among owners, senior and middle management as well as workers. They have to form a inclusive HW team to perform workplace need assessment and prioritize the problems to develop healthy workplace action plan for resolving them. The employees should be encouraged to participate in HW activities. Implementation process and outcomes should be evaluated in short and long terms. The healthy workplace status should be reviewed annually with the aim to improve workplace and make plan for further.

To build a healthy workplace, it is important to assure that everyone is working towards a common goal. The HW program needs to be supported from all levels of the organization as well as others from community. Employees in Nepal are looking to their employers to provide programs that enrich their work environment and contribute to an overall healthy lifestyle. The program must be supported with appropriate resources material, manpower, and money. It is essential for management to be supportive of the HW program.

The unions must enter into the concept of healthy workplace and the benefits of a HW program for its members. It is important to involve employee groups as active partners in the process from the very start. Grass roots involvement and participation is critical to the success of the program. NGOs and INGOs may play catalytic actions in development of Healthy workplaces. Awareness raising, trainings, exposure visits to good practices, social marketing of good practices, provide consultation may be major arena on which NGOs and INGOs can work. Commitment, involvement of workers , vision/policy development , evaluation approach / setting priorities, innovation, learn from others, continual improvement are some fundamental principles to be adopted to have sustainable healthy workplace.

[ACRONYMS AND ABBREVIATIONS]

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ACRONYMS AND ABBREVIATIONS

EIA Environmental Impact Assessment

EPR Environment Protection Rules

FNCCI Federation of Nepalese Chamber of Commerce and Industries

HCW Health Care Waste

HCWM Health Care Waste Management

HW Healthy Workplace

INGO International Non-Government Organization

IEE Initial Environmental Examination

ILO International Labor Organization

MoHP Ministry of Health and Population

NAMS National Academy of Medical Sciences

NGO Non-Government Organization

OHS Occupational Health and Safety

OHSMS Occupational Health and Safety Management Systems

PPE Personal Protective Equipments

QWL Quality of Workplace Life

WHO World Health Organization

[TABLE OF CONTENTS]

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TABLE OF CONTENTS

ACKNOWLEDGEMENTS ..................................................................................................................... ii

EXECUTIVE SUMMARY ..................................................................................................................... iii

ACRONYMS AND ABBREVIATIONS ............................................................................................... vi

CHAPTER 1: BACKGROUND .............................................................................................................. 1 1.1. Introduction ............................................................................................................................ 1 1.2. Objectives ............................................................................................................................... 1 1.3. Methodology and Scope ......................................................................................................... 1

1.4. Health ..................................................................................................................................... 2 1.5. Healthy Workplace ................................................................................................................ 2 1.6. Need of Healthy Workplace ................................................................................................... 2 1.7. Major Factors for Healthy Workplace ................................................................................... 3

CHAPTER 2: LEGISLATIVE PROVISIONS ON HEALTHY WORKPLACE ................................... 5

2.1. Labor act 2048 (1992) ............................................................................................................ 5 2.2. Trade Union Act, 1993 ........................................................................................................... 5 2.3. Interim constitution on Nepal, 2007 ...................................................................................... 6

2.4. Present three-years interim plan 2011 .................................................................................... 6 2.5. Environment Protection Act 1997 .......................................................................................... 6

2.6. ILO convention ...................................................................................................................... 6 2.7. Problems on policies and legislation ...................................................................................... 7

CHAPTER3: MAJOR INSTITUTIONS WORKING IN NEPAL .......................................................... 8 3.1. Department of Labor .............................................................................................................. 8

3.2. Occupational Safety and Health Project ................................................................................ 8 3.3. National productivity and Economic Development Centre ................................................... 8

3.4. International Labor Organization (ILO) ................................................................................ 8 3.5. World Health organization (WHO) ........................................................................................ 9

3.6. Strengthening of Environmental Administration and Management at the Local Level in

Nepal (SEAM- Nepal) ............................................................................................................ 9 3.7. Trade unions ........................................................................................................................... 9 3.8. Entrepreneurs ......................................................................................................................... 9

CHAPTER 4: CASE STUDIES ............................................................................................................. 10 4.1. Three Case Study for Healthy Workplace ........................................................................... 10 4.2. Bir Hospital in line with Healthy Workplace ....................................................................... 15

4.3. Steps for Bir Hospital to be a Healthy Workplace ............................................................... 20

CHAPTER 5: PROMOTION AND ESTABLISHMENT OF HEALTHY WORK PLACE ............... 23

5.1. Major Causes of Unhealthy Situations In Nepal .................................................................. 23 5.2. The Barriers .......................................................................................................................... 23 5.3. The Way Forward in National Level ................................................................................... 24 5.4. Steps for Action at National Level ....................................................................................... 24 5.5. Steps in an Enterprises ......................................................................................................... 24 5.6. Stakeholders and Duties ....................................................................................................... 27 5.7. Fundamental Principles to be Adopted ................................................................................ 28

REFERENCES ....................................................................................................................................... 29

[CHAPTER 1: BACKGROUND]

[Healthy Workplace: Assessment And Case Studies In Nepal] Page 1

CHAPTER 1: BACKGROUND 1.1. Introduction

The healthy workplace has a significant impact on employee’s and service receptors’ health and well-being. Poor management of workplace can lead to various work-related mishaps and a high level of sickness absence. This gives real cause for concern because of the costs involved and the impact on service delivery and the consequences for individual worker as well as their families. Currently, an estimated two million people die each year because of occupational hazards, work-related illnesses or injuries (ILO, Facts on safety at work. April 2005). Another 268 million non-fatal accidents results in an average loss of three workdays per casualty, as well as 160 million new cases of work-related illness evolve each year (ILO/WHO joint press release. Number of work-related accidents and illnesses continues to increase: ILO and WHO join in call for prevention strategies. 28 April, 2005). Additionally, 8% of the global burden of disease from depression is currently attributed to occupational risks (Prüss-Ustün A, Corvalan C. Preventing disease through health environments: towards an estimate of the environmental burden of disease. Geneva: WHO, 2006).

In Nepal, there is lack of proper database as most of the workers are employed informally in factories and businesses, where there are no records of work-related injuries or illnesses. However, the situations are worse than the world scenario. Approximately, thousands of workers meet accidents and hundreds of them lost their lives in vain, annually at workplace. The loss due to workplace accidents and occupational diseases are not merely a loss to industries but also a physical and economic loss to the society and the nation in broader way. To address this huge burden of disease, economic costs and long-term loss of human resources from unhealthy workplaces, it is urgent to move forward to make the work places healthier. As every worker spends most of his/her time in workplace, it is obligatory to protect and promote their health at the workplace. The Seoul declaration on safety and health at work, 2008 also asserts that a safe and healthy work environment is a fundamental human right.

1.2. Objectives

Overall Objective: To carry out an assessment in order to know the present situation and what needs to be done for developing Healthy Workplaces in Nepal is overall objective of this study.

Specific Objective

To study present status of healthy workplace initiatives in Nepal

To document three examples of good practice of healthy workplaces

To perform case study of Bir Hospital in line with healthy workplace

Suggest set of actions to be carried for moving forward on promoting and establishing healthy workplaces in general specifically for hospitals

Suggest set of actions to be carried for moving forward on promoting and establishing healthy workplaces in general

1.3. Methodology and Scope

The following activities were carried out to achieve the set objectives. These were however, indicative of the overall tasks performed.

The Detailed scope includes but not limited to followings:

Review existing relevant documents, web sites and meet officials involved

Locate three healthy workplaces

Develop checklist for field study

Carryout field visits at four work places Bir Hospital, Janjagriti High School, Aqua Minerals Nepal Private Limited and Chapter 9 Restaurant

Meet concern officials, organize meeting in workplaces

Observations



Questionnaire/Interview survey

Analyze information and develop document

Discuss with experts on developed documents

1.4. Health

In 1947, the World Health Organization (WHO) adopted a broad definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. This definition adopts a holistic view of health and addresses all factors that affect human health and relate to the physical, psychological, social and economic development of the individual or society.

1.5. Healthy Workplace

According to WHO, A healthy workplace is the one in which workers and managers collaborate to use a continual improvement process to protect and promote the health, safety and well-being and the sustainability of all workers and the workplace by considering the following identified needs:

Health and safety concerns in the physical work environment

Health, safety and well-being concerns in the psychosocial work environment, including organization of work and workplace culture

Personal health resources in the workplace and

Ways of participating in the community to improve the health of workers, their families and other members of the community.

(Healthy workplaces: a model for action: for employers, workers, policymakers and practitioners, Geneva: WHO, 2010)

This definition had not only focused on physical work environment but had clearly take account of psychosocial and personal health practice too. The healthy workplace is a setting, which encourages health promotion and preventive health activities to prevent occupational injury and to assess and improve people's overall health. The present emphasis is on workplaces that are supportive and accommodative to older workers, women and those with chronic diseases or disabilities that ultimately be able to support to the community level as well. Safe and hazard free work and workplace are needed for higher productivity, quality and efficiency. A sound ergonomic work environment in any enterprises is an important aspect of development. It develops workplaces, where health, safety and well-being off all associates is protected and promoted to ensure access to competent health advice and support. There must be improved access to preventative measures and availability of care for all related health problems.

1.6. Need of Healthy Workplace

Good working conditions and environment are essential for the health and safety of the workers and for better productivity with satisfactory work performance which will acquire the “Fair Trade” labels (ISO, OHSMS etc.). The "fair trade" label can be a trademark for marketing and economic growth of the enterprises and it will increase its faith to the community. It will lower the interruptions in production, work absenteeism, workplace accidents and improve work efficiency as it provides opportunity to work with less risk of injury or illness and more security at respective job.

In Nepalese workplaces, the Quality of Workplace Life (QWL) situation is deteriorating and commitment of the government, employers, and union leaders is required to work on Healthy Workplace initiatives. Healthy Workplace is the integral part of any business that plays crucial role in economical prosperity of the people and country through broadening employment opportunities and sustainable industrial growth. Industrialization at one hand have huge contribution in the development of nation but sometime it may pose the high risk of workplace accidents and occupational diseases due to prevalent inherent sources of workplace hazards generated either or by material, process, technologies or products. Therefore, it is an urgent need to transform our working places to healthy work places. The Enterprises



that maintains healthy workplaces are most successful and competitive in the world. The table below shows the comparative benefits of the healthy work place:

Table: comparative benefits of healthy workplace

Particulates Healthy Workplace Others

Accidents No/Prevented at lower cost Higher cost of treatment and compensation

Human Resources Less chance of loss of trained staffs and speed of work is maintained

More cost and time to recruit and train new staff each time

Disturbances in output

No/Less chances of strikes and closures Higher loss of time and productivity due to strikes and closures

Violation of law Not likely Loss of money and faith of enterprises

Fair trade label More market and profit Not applicable

Absenteeism No/Less chances of leaves Higher rates of sick leaves and disabilities

1.7. Major Factors for Healthy Workplace

According to the WHO model, four key areas those could be mobilized or influenced in healthy workplace initiatives are characterized as follows. (Healthy workplaces: a model for action: for employers, workers, policymakers and practitioners, Geneva: WHO, 2010)

The physical work environment

The psychosocial work environment

Personal health resources

Enterprise involvement in the community

In Nepal physical work environment and occupational health and safety always gets more priority and the rest are rarely counted as shown in the figure below even they are equally important.

Figure: Imperfect practice for Healthy workplace Figure: Perfect practice for Healthy workplace

I. Healthy Physical Environment

Physical Environment has the highest potentials to face the accidents that may disable or kill workers, so healthy workplace means a sound physical environment only in earliest times. Even in developing countries, like Nepal, the situation has not changed yet. These types of hazards are taking lives of several workers daily in developing and even in developed countries. The physical environment in which people



work has major influence on employee’s health and is the determinant of accidents. Some major aspects are: Work place, workplace design, basic services, guarding of machine and moving parts, housekeeping, material handling, pure drinking water, rest rooms, condition of machines, electricity, light, dust, ergonomics, noise level, air quality, ventilation, heat, safe lifting, waste management, toxic chemicals, hazardous waste handling, and safety guidelines and their use.

II. The Psychosocial Work Environment

Psychosocial Environment has greatest potential to induce depression and other type of mental problems globally. Higher percentage of workforce worldwide is facing these types of problems and is also responsible for global burden of diseases. These factors are responsible for physical hazards and accidents also. Basic human needs such as sense of belonging, purpose and mission, sense of control and freedom from harassment are major concerns for healthy workplace. In this concern, the psychosocial work environment includes organizational culture as well as attitudes, values, beliefs and daily practices in the enterprise that affect the mental and physical well-being of employees.

Some major aspects of psychosocial work environment are: politics, excessive number of trade unions and, or absence of trade union, uncertainty of job, fear of job loss, lack of balance between work and family, employee violence, work-life conflict, staff involvement in decision making , lack of policies , flex time, communication, training and development, reward and recognition, employee satisfaction, positive supervisor communication and feedback , staff morale , social atmosphere, sexual harassment, gender, ethnic or religious discrimination, absenteeism, life satisfaction and depression.

III. Personal health resources

Healthy workplaces should support and encourage healthy behaviors. Personal health resources are the personal protective equipments (PPE), basic health services, information, resources, opportunities, flexibility and supportive environment in workplaces that provides workers to maintain their physical and mental health. Some major aspects are: PPE and their use, regular health checkup, smoking cessation, healthy eating, drinking water, physical activity, hygiene, stress management, women’s health issues, healthy pregnancy, medical services, information, training, financial support, facilities, policy support, flexibility and promotional programmes, cessation in alcohol and drug use.

IV. Enterprise Community Involvement

The environment of communities nearby and Enterprises influences each other. The physical and social environment of the broader community affects physical/social environment within enterprises and workers’ health. Therefore, enterprises should involve in community through the activities that can support the social and physical well being of a community. In Nepal, the enterprises are now responsible for pollution emissions of different types. Enterprises may involve by green production operations, use of clean fuels, supporting community screening and treatment for HIV infection, organizing free health camp, health and sanitation awareness in community, primary health care to community etc.

[CHAPTER 2: LEGISLATIVE PROVISIONS ON HEALTHY WORKPLACE]


CHAPTER 2: LEGISLATIVE PROVISIONS ON HEALTHY WORKPLACE

The concept of healthy working conditions, occupational safety and health of the workers is a new concept for Nepal. Government of Nepal has started paying attention to industrial working conditions and environment after the democratic movement by enforcing the Labor Act, 2048 (1992). Some of the legislative provisions having occupational safety and health as its content that promotes for healthy workplace are mentioned below.

2.1. Labor act 2048 (1992)

The Labor Act and its subsidiary rules are the main legislation in the country that covers the working conditions, welfare of workers, safety and health, and industrial disputes. The Labor Act has provisions on conditions of work, workmen's compensation, leave and holidays, safety and health, minimum wage demarcation and settlement of labor disputes. The coverage of the Labor Act is confined to enterprises employing ten or more workers. As far as industrial estates are concerned, all enterprises, irrespective of the number of workers employed by them, come within the frontier of the Act.

Section 5 of Chapter II of the Labor Act restricts to employ any minor or a woman unless otherwise prescribed during the hours between 6.00 pm and 6.00 am. Chapter III of this Act contains sections 16–20 which provide restrictions on the working hours for the worker. It limits the working hours for adults to no more than eight hours a day or forty-eight hours a week. It obliges for a weekly holiday with pay and compulsory intervals of rest. It also provides overtime payment and restricts to overtime beyond four hours a day or exceeding twenty hours a week.

Chapter V of this Act contains sections 27–36, which entirely pertain to the health and safety of workers in the enterprises. They prescribe arrangements for sanitation and cleanliness, modern lavatories, disposal and destruction of waste, adequate ventilation and lighting, and control of temperature, protection from dust, fumes and other impurities, avoidance of overcrowding in any room of the enterprises, provisions for drinking water and extinguishing fire. The Act also includes the provision for medical examination of workers at least once a year in the enterprises involved in processes, which are likely to cause health hazards. It provides a number of accident preventive measures, such as protection of eyes, protection against chemical hazards and fire, guarding against risky machinery, prohibition on lifting overweight, and safety measures for pressure plants. A provision has been made for compulsory notice of any kind of accident or disease.

This Act empowers Factory Inspector to collect samples of any products and semi-finished products, as well as any material being used that may cause harm to the workers or damage their health. The Labor Act has made it obligatory on the part of the enterprises management to inform the Labor office in a prescribed manner before erecting or establishing or expanding an enterprise on any land or in any house. The Labor office may issue orders to close down unsecured parts of the enterprises, plant or machinery. Factory Inspectors have been assigned with responsibility to ensure that the building, machinery and manufacturing processes are safe for workers. Violations of these provisions are punishable with fines.

2.2. Trade Union Act, 1993

The Act prescribes legal provisions regarding registration, operation of trade union and other necessary provisions for the protection and promotion of professional and occupational rights of the workers of enterprises. Unions are largely successful in improving the quality of work life (QWL) in many countries. A better quality of work life can be ensured by enterprise level unions with a set of human rights conditions and practices such as promotion within policy, democratic supervision, employee involvement, safe working conditions etc. Realizing this fact the Trade Union Act aims to protect and promote the professional and occupational rights of the workers, and self employed workers working inside or outside the enterprise, engaged in various industry, trade, profession or service. The Act clearly states provisions to form enterprise based union in order to protect and promote occupational rights of the workers.



2.3. Interim constitution on Nepal, 2007

The interim constitution of Nepal incorporates several provisions concerning healthy workplace matters, which form the foundation of healthy workplace administration in the country. In clause 16, there is provision about right, regarding environment and health that clearly states that “Every person shall have the right to live in clean environment”. Similarly in Clause 30, right regarding workers, stating “Every employee and worker shall have the right to proper work practice” and “ Every employee and worker shall have the right to form trade unions, to organize themselves and to perform collective bargaining for the protection of their interest in accordance with law”. Similarly, there are provisions, to eliminate slavery and forced labor, freedom of assembly, association and speech, freedom of trade, business, and profession, right of equality, promotion of social justice and economic well- being of the people, and eradication of social evils.

2.4. Present three-years interim plan 2011

Present interim plan has set some strategic programs and visions to make workplace safe, healthy and productive by promoting and developing occupational safety and health as an integral part of all the industrial enterprises and workplaces. It clearly states that “While maintaining cordial industrial relationships, flexible labor policy will be developed and implemented for the investment promotion and increasing productivity and competitiveness ensuring security of both the labor and investor.” The plan has policy to prepare and implement abetments to make necessary changes in labor act for better relations and social security of labors. The plan has given emphasis on cordial relation between labors, entrepreneurs and government. The plan also has policy to prepare necessary provisions to reduce possibility of disasters at different workplaces such as schools, health posts, governmental offices, community buildings etc.

2.5. Environment Protection Act 1997

Environmental Impact Assessment Guideline 1993, Environment Protection Act 1997 and the Environment Protection Rules 1997 have been enforced in Nepal to internalize the environmental assessment system. The process institutionalized the EIA process in development proposals, which makes the integration of IEE and EIA mandatory for the prescribed projects. The projects, requiring EIA or IEE, are included in Schedules 1 and 2 of the EPR, 1997. Small plants and activities have to apply for IEE, while larger plants, industries and activities have to apply for EIA.

For example according to the Environmental Protection Regulation the following activities with relation to HCWM requiring environmental assessment:

Hazardous waste treatment plants, no matter how much waste is treated

Landfilling of hazardous waste, no matter how much waste is land filled

Handling and disposal of radioactive waste

Health Care Facilities with more than 25 beds

Similarly, for different proposals (Industries/ hydropower /Institutions etc) there are provisions in EPR. However, these laws make proponent responsible to come with viable options that can manage negative impacts on the environment, so helping to make healthy workplaces.

2.6. ILO convention

The ILO adopts two main types of standard: Conventions (which are rectifiable and binding) and Recommendations (more detailed, often supplementing a Convention) on safety and health as in other fields. Currently, there are more than seventy ILO Conventions mainly or partly related to questions of health and safety. Many others deal with matters that are also clearly relevant to the health and safety agenda –for example, freedom of association, collective bargaining, labor inspection, gender equality and child labor. Occupational Safety and Health Convention (No. 155) and its accompanying Recommendation (No. 164), prescribe the progressive application of comprehensive preventive measures and the adoption of a coherent national policy on occupational safety and health. They also



establish the responsibility of employers for making work and equipment safe and without risk to health, as well as the duties and rights of workers. Further prominent examples are the Occupational Health Services Convention (No. 161) and its accompanying Recommendation (No. 171), and the List of Occupational Diseases Recommendation (No. 194).

Some of the most hazardous sectors are covered by specific Conventions - for example, mining, construction and dock work. An important recent addition is Convention No. 184 on Safety and Health in Agriculture, adopted in 2001 together with the accompanying Recommendation No. 192. In addition, the ILO has issued more than thirty Codes of Practice on occupational health and safety. These are intended as practical guides for public authorities and services, employers and workers concerned, specialized protection and prevention bodies, enterprises and safety and health committees. Codes of Practice are not legally binding instruments and do not aim to replace the provisions of national laws or regulations, or accepted standards.

2.7. Problems on policies and legislation

The workforce has been recognized as the most important segment of the social structure in national policy and legislation. Stability in the society is possible only when the workforce is given its due attention. Occupational safety and health provisions of the Labor Act do not cover all important sectors of enterprises that pose serious hazards like, agriculture and forestry. These sectors are also substantially labor-intensive.

The legislative measures for occupational safety and health are not applicable to small units employing less than ten workers outside the industrial estates. It has been recognized that the Safety Committee can play a vital role in taking steps to prevent industrial accidents and injuries and promote health and safety in the enterprises. There is the provision of safety committee in enterprises, but in many cases, the committees are not formed and are not even functioning properly where it is formed. Similarly, there is no provision for the appointment of a Safety Officer in any enterprises. There are overlapping responsibilities in implementing the healthy work place provisions, yet there is an urgent need for coordination and cooperation among the concerned line ministries to implement the current healthy work place provisions of the available legislations effectively.

The Labor Act, 1992 spells out various safety measures for the workers of all industrial enterprises, and it vests the Labor office with powers to issue necessary orders for the installation of safety devices against potential hazards, in the concerned enterprises. The law, however, does not stipulate on the identification of the liability of medical treatment.

The present legislation mostly focuses on physical health environment and occupational health and safety. Moreover, the provisions in act regarding to healthy workplace is disbursed in several headings and responsibilities are also disbursed along with but there is lack of provision of coordination among them. There is no any confined legislative document and, or body to promote the healthy workplace in the nation.

[CHAPTER3: MAJOR INSTITUTIONS WORKING IN NEPAL]


CHAPTER3: MAJOR INSTITUTIONS WORKING IN NEPAL Most of the institutions working in healthy workplace are focusing on occupational health and safety. There is a lack of awareness and information sharing between the stakeholders. To improve the situation, some major actors playing the roles are as follows:

3.1. Department of Labor

Under the Ministry of Labor and Transport Management, the Department of Labor is responsible for occupational safety, health and working conditions. This is the apex body in the labor administration and mainly functions in policy level. However, the inspection and regulation of labor offices is not being sufficient for establishing a sound healthy workplace condition in Nepal. Matters relating to the safety and health of workers are the overall responsibility of the Inspection and Manpower Section of the Department of Labor. Under the Director General, Director (Tech) administers the works of occupational safety and health. The safety and health provisions under the Labor Act, 1992 are enforced by the Factory Inspectors of Labor Office.

3.2. Occupational Safety and Health Project

Occupational Safety and Health Project, under Ministry of Labor and Transport Management have following programs to be implemented as the integral part of the project in Nepal.

Training program on occupational safety and health

Capacity enhancement training program for officers affiliated with OSH

Orientation program for employers

Awareness enhancement programs on industrial accidents

Educational program on HIV/AIDS and STDs at work places

Labor education programs

Factory inspection, monitoring and evaluation strengthening programs

3.3. National productivity and Economic Development Centre

National Productivity and Economic Development Centre that is an organ of National Productivity council of Ministry of Industry have taken some initiatives for healthy workplaces. In cooperation with DANIDA, the Environment Sector Program Support Project has gained good momentum and healthy workplace issues under the project and have gained more emphasis in some industries.

3.4. International Labor Organization (ILO)

The ILO activities and programmes are also concentrated on healthy workplace. Some of major concerns of ILO towards healthy workplace are improvement of working conditions, occupational health and safety at work places, promotion of social protection and prevention of HIV/AIDS in Nepal. It is also working on combating child trafficking, labor and sexual exploitation, extending social protection to workers in the informal economy and community action for the elimination of child (bonded) labor from exploitative and hazardous work type of assistance and programming.

ILO provides technical assistance primarily in the fields of vocational training and vocational rehabilitation, employment policy, labor administration, labor law and industrial relations, working conditions, management development, co-operatives, social security, labor statistics and occupational safety and health. It promotes the development of independent employers' and workers' organizations and provides training and advisory services to those organizations. Within the UN system, the ILO has a unique tripartite structure with workers and employers participating as equal partners with governments in the work of its governing organs.

[CHAPTER3: MAJOR INSTITUTIONS WORKING IN NEPAL]


3.5. World Health organization (WHO)

WHO Nepal has established one section for occupational health unit under environment and public health unit. It provides support to different stakeholders like University, Nepal Health Research Council and other related organization for research. WHO help to formulate policy on healthy workplace. Similarly, WHO has supported technically and financially especially in health care waste management in Bir Hospital. WHO has developed different models, guidelines, policies and IEC materials worldwide.

3.6. Strengthening of Environmental Administration and Management at the Local Level in Nepal (SEAM- Nepal)

SEAM–N is working with different industries located in Dharan - Biratnagar corridor through demonstrative OSH model project with the aim of sustainable OSH development. For the sustainable development of OSH in industries and to achieve its goal, SEAM-N works to raise the level of awareness and to make concerned people more competent on OSH and healthy workplace. They have worked together with industry working group and OSH team in Dharan - Biratnagar corridor to improve working condition. For participating industries, they provide trainings, orientation based on OSH issues present in the workplace and their improvement measures at different interval of entire assessment phase.

SEAM-N, in collaboration with the BPK Institute of Health Science (BPKIHS), also organizes interaction on occupational health and safety (OHS) that use to focus on minimization of risk and pollution, healthy and safe workplace and protection of environment. SEAM-N also organizes workshops on Solid Waste Management in five Municipalities.

3.7. Trade unions

Nepal Trade Union Congress (Independent), (NTUCI), General Federation of Nepalese Trade Unions (GEFONT), and Nepal Workers' Association (Revolutionary) are major trade unions in Nepal. Due to level of socio-economic realities, problems to hand to mouth, they are forced to struggle hard even for wages and minimal benefits. Thus, till date the healthy workplace has not become a priority agenda for trade unions in Nepal. From 1994, the trade union confederations of Nepal, has taken the issue seriously and has started awareness campaign on OSH. They are still in the awareness phase and OSH has now become one of the components of Workers Education Program giving emphasis to the issue of healthy workplace basically on the following:

Partnership with employers and government for training programs on OSH

Research for problem identification

Awareness program for safe and clean workplace and healthy life

Partnership with employers for sound workplace management

Pressurising for waste and sewage management

Joining hands with international Agencies and regional and sub regional organizations for works in cooperation on OSH

Cooperation with NGOs on the issue of OSH and environment

3.8. Entrepreneurs

In most of the industrial enterprises, entrepreneurs do not have adequate attention to make the work and workplace safe and healthy, so that huge sum of money was being paid as compensation in the past. Understanding this fact, in search of “Fair Trade labels” and other global scenario entrepreneurs are now keenly interested in healthy workplaces. The companies having or willing to have ISO, OHSMS and other international standard have continual process to improve their workplaces.

[CHAPTER 4: CASE STUDIES]


CHAPTER 4: CASE STUDIES

4.1. Three Case Study for Healthy Workplace

For assessing healthy workplace three sites with different work requirement were identified those are

industrial enterprises, educational enterprises and service oriented enterprises. In case of industrial

enterprises, for the case study, Aqua Minerals Nepal Private Limited was chosen. Similarly, for the

case study of educational enterprises, Jana Jagriti High School and for service oriented enterprises,

Chapter 9 Restaurant were chosen.

A. A Case Study for Healthy Workplace in Industry [Aqua Minerals Nepal Private Limited]

Introduction

Aqua Minerals Nepal Private Limited was established in 1992 with the aim of providing pure drinking water. For the last 18 years, Aqua Hundred has emerged as a trusted name in the market having ISO 9001:2008 label. Reliability of a brand depends upon knowledge and other technicalities associated with the production and purification of water. This was seemed to be fulfilled in this Industry.

The factory is located in Balaju Industrial State within 6 Ropani area. Currently, 21 staffs are working there in production unit. The production rate of the industry is 1200-1500 Jars (capacity-20ltr) and around 350 (Carton- 350*12*1 ltr) water per day.

Figure: ISO Certificate Of Aqua Mineral Water

The industry has an automated plant for water treatment and cleaning jars. Raw water is treated through series of automatic treatment units, sedimentation, aeration, filtration through different media, absorbents, reverse osmosis and ozonization. Similarly, the polycarbonate jars for storing Aqua Minerals is cleaned through a series of automatic cleaning processes that avoids any sort of contamination. At first, manual washing is done externally and internally and after that, jars are sent through a chamber where a high-pressure jet of water rinses the jars moving it into next chamber where specially developed jar washing solutions clean up the jars. Hyperozonation technique is used to sterilize the jars.

Figure: Automatic Jar Cleaning Facilities

Healthy Physical Environment

In Industry housekeeping, electric lines, water lines are in proper condition. There is provision of separate clean toilets for urine and defecation. In every unit of productions in Aqua Minerals there is no congestion and has proper light, ventilation, cleanness, floor covering etc. In quality control labs there is good system of record keeping. The labs are fully equipped with modern equipments to maintain quality.

On over all scenarios, Aqua 100 is healthy work place as it have proper work place design, basic services, housekeeping, material handling, drinking water, electricity, light, noise level, air quality, ventilation, heat.



Figure: Good housekeeping at quality control Testing Lab

Psychosocial work environment

The workers of Aqua Minerals Nepal Private Limited works for 8 hours per day with break in between. They get salaries starting from basic salary allocated by government. In addition to their basic salary, they get dividend from 10% of net benefit of the company each year. However, they have no job security as the industry has no provision of permanent staffs.

Different meetings are held between top management and workers for creating healthy working environment. Biannual meetings are held to resolve problems related to salary and other benefits sharing. The remuneration is not enough to meet international standards but enough for Nepalese socioeconomic standards. They are found highly motivated due to these reasons along with profound name of their brand in market.

The workers have a trade union for collective bargaining of labor issues with management. There are no cases of work life conflict as they have clear work policy. There is first aid facility within the industry for treating minor accidents even there is a large hospital nearby. They get free treatment with salary in the case of work life accident. They have regular health check up programs also. Refresher course and training programs are provided to the workers in case of installation of new treatment facilities. These factors show that there is good psychological environment within the industry.


Workers use Proper Personal Protective Equipments like masks, gloves, boots, aprons etc. while working. They use trolleys to reduce burden due to more load lifting. As there is no provision of seating in several compartments, the workers may suffer from ergonomic hazards. They have provision of smoking cessation, physical activity etc. There is no emergency preparedness except provision of fire extinguisher. The industry will be better work place if it incorporates for emergency preparedness and considers ergonomic hazards. Figure: Proper Use Of PPE

Participation in the community

The factory believes in achieving success through trust so they always welcomed consumers to visit the factory. They feel making a good name is not sufficient, carrying over the name and quality for a long time matters the most. They supplies free water to religious occasion like Jatras, Sivratri, Krishna Astami, Saptah, etc. As a community responsibility, they have built garden and grills in Mahankal temple. They as social responsibility help to develop traffic lights and signals to reduce accidents and maintain proper traffic flow.



B. A Case Study for Healthy Workplace in School [Janjagriti High School]

Introduction

Janjagriti High School a popular community school of Dhading, was established in 1994 AD by education devotees of the area. The school is located at Mahadevbeshi in Dhading district. The location of school is about 35 km away from Kathmandu. Currently, the school has 945 students and 26 teachers. The school is operating under the democratically elected management of School Management Committee. The school gets funds from different donors as well as its own resources. The school provides education from playgroup (nursery) to class ten. The school has a provision for educating blind children and open education facility for older citizens those have left their regular classes due to poverty and other reasons.

Figure: Main building of Janjagriti High School


In office, there is no congestion, has proper light, ventilation, cleanness, floor covering as well as

comfortable chairs. In classroom, light and ventilation is in proper condition but a high level of

congestion in some classrooms is observed, as there are around 90 students in a classroom. There is a

seminar hall for special ceremony. Even being community school, it has provision of computers for

the students and teachers and Nursury, KG and UKG students are educated by Monteshwori method.

Figure: unhealthy class environment Figure: Good Computer Lab Facilities

There is provision of separate water supply taps for different height students with adequate supply of water in terms of quality and quantity. There is provision of separate cleaned toilets for boys and girls with proper water supply, light and ventilation. However, cleaning materials like soap, towels are not placed in toilets.



Figure: Urinals for students and teachers at Janjagriti High School Figure: Different height taps for different height students

The school has managed a good system of record keeping in library. There is provision of sitting for small kids also in the library. There are varieties of books but not sufficient according to the number of student. Housekeeping, light, electric lines are in proper condition. The canteen of the school is not found to be hygienic. Housekeeping, cleanness etc. are poor in canteen. They are not only selling junk/colored foods but also increasing the habits of eating these unhealthy foods. Waste management in the school is not found to be well managed. There is no provision of waste segregation. They have been managing their waste themselves simply by burning the waste in a pit. The terrace of roof top is open for students and there is no proper railing. This has probability of students falling from the roof.

In over all scenarios, the school is healthy work place in respect to physical environment as it has a proper work place design, basic services, housekeeping, drinking water, rest rooms, electricity, light, noise level, air quality, ventilation, heat etc. It would be much better place to work if canteen is improved, class congestion is reduced, cleaning and washing materials are placed in toilets properly, safety in roof top is maintained and ergonomic hazards also be taken in consideration.


The teacher’s works for 8 hours per day with break in between. Sometimes they have to work more also. They get salaries in different range as per their post and contract conditions. There are only 9 teachers those get salary from government as compensation post; others are getting salary from private source. The teachers do not have job security, as no one is permanent. There is no any trade union inside the school. There are no cases of work life conflict as they all have friendly behaviors. There are no cases of sexual harassments until date.

Most of teachers are from same community. The teachers are bound to educate their children from the same school and this provision makes them more responsible for quality education. Majority of teachers are working there since its establishment. As a founder, they have pride towards fame of the school in the district and this has been the major cause of motivation. The remuneration is not enough to meet the international standards but enough for average Nepalese socioeconomic standards.

Several refresher course and training programs supported by government and nongovernmental organizations are provided to the teachers for capacity enhancement.

The psychosocial environment in which the teachers are working is in good condition.


Teachers and other staff of the school are prone to inhalation of dust, as they do not use PPE while sweeping. As mentioned above, the canteen of school is not hygienic. Teachers take healthy food from their own houses. There is provision of smoking cessation in school. There are facilities of indoor as well as outdoor games. There is no emergency preparedness for different hazards like fire, earthquake, landslide etc. They have no regular health check up programs but have first aid facility and immunization for students supported by Government of Nepal.



The school can be better work place if they introduce provision of PPE, hygienic canteen, plan for emergency preparedness, regular health checkup etc.


To maintain strong relation with community, different events like school day, sports week, parent-teacher games are organized by school. Similarly, they have provision for scholarships for needy students especially for dalits, ethnic classes as well as low class labors.There is provision of getting education for blind and disabled. There are 4 students who are getting education in Brain script. They are also provided with residential facility within the school. There is a teacher who is blind and he is the resource person for blind and disabled students. The school is providing piped drinking water facility for the community.

Figure: special facility for blind student

C. A Case Study For Healthy Workplace in Restaurant [Chapter 9 Restaurant]

Introduction

Chapter 9 restro-bar P. Ltd. was established in 2009 as family restaurant having menu with starters, snacks, Newari, tanduri items, currys, roti and desserts etc. Chapter 9 serves Indian, Chinese & Continental food. It is located near Pulchowk at Jhamsikhel line having around 2800 square feet plinth area. There is also the option of eating out in the garden as well as home delivery service through Foodmandu. Currently, 22 staffs are working in this restaurant.


There is nice garden for out side sitting. In dinning and sitting areas there is no congestion, has proper light, ventilation, cleanness, floor covering. In kitchen housekeeping, light, ventilation, electric lines, LP gas pipeline, water lines are in proper condition. There is provision of separate clean toilets for ladies and gents with cleaning materials, soap, towels having proper light and ventilation. In store, there is good system of record keeping with proper housekeeping, light and electric lines.

Figure: Nice garden for outside sitting at chapter 9 restaurant Figure: store room of the restaurant

As washing area is out of the building there is no problem of ventilation, but it will be too cold in winters of Kathmandu. In washing area, there is good provision of light, water, cleaning materials, soaps towel etc. There is provision of segregation of bottles and other solid waste. Bottles are sold and other wastes go through municipal collection system. Though gloves are provided in the washing section, workers are not found to use gloves during washing. They are also not using other PPE (like masks) due to which there is increased risk of hazards.

Chapter 9 is healthy work place as it has proper work place design, basic services, housekeeping, material handling, drinking water, rest rooms, electricity, light, noise level, air quality, ventilation, heat, waste



management. It can be made better place to work if PPE and ergonomic hazards are also taken in consideration.


The workers of Chapter 9 work for 8 hours per day with break in between. They get salaries in different range as per their post, starting from basic salary allocated by government in addition to breakfast, lunch and dinner. They also get service tax collected from customers. The remuneration is not enough to meet international standards but enough for Nepalese socioeconomic standards. They are found highly motivated due to these reasons.

They have trade union for collective bargaining. There are no cases of work life conflict as they all have friendly behaviors and clear work policy. They have no job security, as there is no system of being permanent. There are no refresher course and training programs, as they recruited trained staffs only. They have no regular health check up programs but have first aid facility. There are no cases of sexual harassments until date.


Employees take healthy food, as they take meals cooked by them in clean environment from same restaurant. They have provision of smoking cessation in restaurant. There is no emergency preparedness except provision of fire extinguisher. There may be possibilities of inhalation of air contaminants, as they are not using masks in kitchen even it is provided. As there is no provision of seating in kitchen, the workers may have ergonomic hazards, however they are allowed to sit in seating areas at free time.


The restaurant has a system of WIFI for the consumer so that they can do their work during their lunch, tea and snacks time. They also accept different type of debit and credit cards. They have discount offers for international students and the members of club GUNA and provide their own discount card for regular guest.

4.2. Bir Hospital in line with Healthy Workplace

Introduction

Bir Hospital the largest Hospital of Nepal, was established in 1947 Sharawan 12 B.S around 123 years ago in Katmandu. This is government’s central hospital operating under the management of National Academy of Medical Sciences (NAMS). The Hospital gets funds from Nepal government; however, different donors are also supporting it. The hospital provides different types of services in health care sector. National Academy of Medical Sciences has facilities to produce health experts of different disciplines. The hospital has total 1168 staffs in different levels. There are 156 permanent doctors as well as around 200 residence doctors. There are 164 Nurses working at different levels as well as nursing students also. This hospital has 460 beds and last year they had served 10935 admitted patients as well as 336400 outdoor Patients.

Indicators for healthy hospital

To study a hospital as healthy work place following basic indicators or components have been identified and assessed. To transform a hospital in healthy work place these indicators need to be given attention and improved.



A. Healthy Physical Environment

B. Psychosocial work environment

Component Methodology Resource Also impacts

Buildings-Disable friendly / Earthquake resistant Observation/Interviews Engineer B,C

Rooms- Well ventilated /light/Heat Observation/ Interviews Staffs B,C

Lifts Observation B,C

Walkways/Wheel Chair Observation/Interviews Patients C,D

Canteen Observation/Interviews Staffs/ Patients B, C,D

Drinking Water Observation/Interview Staffs/ Patient B,C,D

Bathroom, restroom Observation/ Interview Staffs/ Patients B,C

Toilet Observation/ Interview Staffs/ Patient B, C,D

Solid Waste management Observation/ Interview Staffs/ Patient B, C,D

Waste water management Observation/ Interview Staffs/ Patient B,C,D

Open space Observation/ Interview Staffs/ Patient B, C,D

Waiting rooms Observation Staffs/ Patient B, C,D

Recreation area Observation Staffs/ Patient B, C

Machines and equipments Observation/ Interview Maintenance B,C,D

Electric lines Observation/ Interview Maintenance B,C

Parking Space Observation/ Interview Security guards B,D

Disaster management Plan Interview BCD

Written procedure posted for emergency preparedness Observation Housekeeping B,C,D

Fire extinguisher Observation/Interview Maintenance B,C

Alarm Observation/Interview Maintenance BC

Emergency door Observation/Interview Maintenance BC

Assembling point Observation/Interview Staffs BC

Emergency and hazard sign are clearly visible Observation BCD

Component Methodology Resource Also Impacts

Communication Interview Staffs C

Regular meetings Interview Staffs A

High work load and demand Interview Staffs C

Verbal abuse from disgruntled or intoxicated patients Interview Staffs D

High expectations from supervisors and management Interview Staffs

Frustrations due to limited resources-staffs Interview Staffs

Availability of security Interviews Security Guards C,D

Preventing overcrowding Observation/Interviews Security /Nursing Incharge

D

Accountability Observation/Interviews Staffs/patient D

Facility distribution Interviews Director/staffs C

Political pressure Interviews Director/staffs

Reward and punishment Interviews Director/staffs C

Union Interviews Staffs D

Human resource mobilization Interviews Staffs C,D

Public relation Interviews Staffs D

Security of staff Interviews Staffs C

Patients load (indoor, outdoor, lab) Observation/ Interview Record section D

Sexual harassment Interviews Staffs C



C. Personal Health resources

D. Participation in the community

Trainings Interviews Staffs C

Minimum wages Interviews Staffs C

Motivation Interviews Staffs C,D

Work hours Interviews Staffs C

Job security Interviews Staffs C

Physical violence/ Conflict Interviews Staffs C,D

Staff coming time arrival time and departure time Observation/ Interview Ward Incharges C

Service delivery with in hospital Observation/Interview Housekeeping/ Staffs D


Healthy food Observation/ Interview Diet Section/ Patient/ Staffs

D,A,C

Personal Protective Equipments for the waste handlers, chemical handlers

Observation/ Interview Housekeeping Incharge B

Use of PPE Observation/ Interview B,D

Availability of Handicapped equipments such as wheel chairs

Observation/ Interview Security Guards B

Hazardous waste management

Health Care Waste Management

Observation/ Interview Housekeeping B,D

Water Quality/ Air Quality Observation/ Interview Housekeeping B,D

Exposure to Heat, Light, Noise, Radiation, Cold, Vibration Observation/Interview Staffs B

Exposure to pollution (air, water, soil, radiation) Observation/ Interview Staffs B, D

Airborne and droplet aerosol exposure Observation/Interview Staffs B

Skin contact exposure Observation/Interview Ward Staffs B,D

Exposure to infectious fluids via broken skin, eyes, mucous

Observation/ Interview Ward Staffs B,D

Cleaning chemicals used by cleaning staff. Observation/Interview Ward Staffs B

Chemical sterilizers used for the sterilization of endoscopes and other equipment

Observation/ Interview Endoscopy unit staffs B

Tissue preservatives used to store and preserve body tissue prior to histopathology.

Observation/ Interview Lab Incharge B

Chemical reagents used in Pathology Laboratory. Observation/Interview Lab Incharge B

Cytotoxic drugs for administering to cancer patients. Observation/ Interview Oncology In-charge B

Processing chemicals for X-ray film development. Observation/Interview X-ray In-charge B,D

Anesthetic gases in the Operating Theatre Observation/ Interview OT In-charge B,D


Available facilities for ultra poor people Observation/Data analysis Account section

Public awareness activities Observation/Data analysis Administration

Participation in health camps Data analysis/ Interview Staffs

Doctor’s patient ratio Observation/Data analysis Record Section B,C

Availability of health service according to level of hospital Observation/ Interview Staffs A

Nurse patient ratio Observation/Data analysis Record Section B,C

Availability of residence for the Emergency staff Observation/Interview Emergency Staff B,C

Total/ average time per patient for health check up Observation/ Data analysis Patients B,C

Availability of privacy for counseling Observation/ Interview Patients B

No. of tussle due to treatment within patient party and doctors

Observation/ Interview Patients/ Nurses/ Doctors

B,C



Assessment of above mentioned indicators in case of Bir Hospital are given below.


Some of the buildings are too old and two buildings have wall-bearing structure. Considering Kathmandu to be an earthquake prone zone, these structures are found to be highly vulnerable. At the time of disaster if these get collapsed, there is no proper facility for treating large number of patents. Considering the fact, it is urgent need for proper maintenance and retrofitting and they are in search for fund.

In several departments of OPD, there is high congestion. Absence of having proper light, ventilation, cleanness, floor covering is common problems. However, in Operation theaters, light and ventilation is in proper condition.

There is lack of proper equipments and there proper maintenance in several departments. The maintenance section is unable to for efficient preventive maintenance, as number of staff is low (7 persons).There is availability of many equipments (like CT scan) but are not functioning well for long time. Now they are performing on demand maintenance only. To perform preventive, regular and emergency maintenance they need at least 20 staffs from biomedical, electrical, mechanical, carpentry, mason, electronics and refrigeration sectors.

For overcoming fire hazard, the hospital has fire extinguishers at different places but is not in sufficient amount. Different sections like medical record sections do not even have fire extinguisher. There is alarm system in new buildings but not in use.

There is provision of treated water supply, but the treatment unit is not functioning properly. Bir hospital is providing bottled water for workers. For workers there is provision of separate cleaned toilets for ladies and gents with adequate supply of water but, cleaning materials like soap, towels is not regular. Toilets for visitors are not found clean in some locations. There was open drain in some places like behind the canteen and adjoining with emergencies. They are discharging their wastewater without treatments in community. There was open electric warring at different wards.

They have managed a good system of record keeping in hospital. Housekeeping, light, electric lines are in proper condition in record section. There are varieties of information’s but not sufficient according to the new systems. The canteen of the hospital is closed recently as it was not found hygienic by observation team of the government. It was abused for poor house keeping, cleanness as well as date expired foods in canteen.

Figure: New HCWM System Figure: HCW came back in the community after Autoclave

The Health Care Waste Management was very poor in the hospital in past. Now World Health Organization with technical assistance of Health Care Foundation has endorsed new system of HCWM in nearly all major wards (20 wards) of this hospital. Health Care Waste Management Center was established there and is working to reduce risk due to this waste. The technology is simple and based on recycle and reuse after autoclave of the waste. Source separation is made compulsion in all departments



but due to lack of knowledge peoples get confused some times. It is suggested that the system should be marketed from television at ticket counter. 95 trained worker in three shifts works for cleanness of the hospital. Most of the workers are pleased to have new system. They are planning to cover all wards in near future.

The hospital has no separate provisions for wheel chair ways for disabled however for patients there is provision of lift. There is now space for ample of parking, however they have managed space for staff parking.

The physical environment of hospital in which the workers are working is not in good condition. Therefore, the hospital has to exercise a lot to be healthy work place in respect to physical environment. It has to manage for proper work place design, basic services, housekeeping, drinking water, rest rooms, electricity, light, noise level, air quality, ventilation, heat etc. It would be better place to work if canteen is improved, congestion is reduced, cleaning and washing materials are placed in toilets properly, safety guidelines and their use and ergonomic hazards also be taken in consideration.

Figure: Possibility of electric hazard Figure: water treatment plant not in proper function


The staffs of Bir works for 8 hours per day with break in between. Some times, they have to work more also but get extra remuneration for that, which is not sufficient. They get salaries in different range as per their post and contract conditions as per government rule. Normally doctors get extra 150% of the salary and other staffs get 50% of salary as Service Development Facility. Pride fame of the hospital through out the nation is also major cause of motivation. The remuneration is not enough to meet in international standards but enough for Nepalese socioeconomic standards. They are found motivated due to these reasons. However, high workload in some departments was observed.

They have 22 trade unions until date. High number of unions shows that the workers are divided into different groups and class. Political affiliation and personal inclination can be the major cause of this diffraction. However, there are no cases of work life conflict as they all are having behaviors as friend.

The workers have job security, as being permanent staff. The management cannot remove even the persons in contract, as trade unions are strong in this respect. There are no cases of sexual harassments until date. There is no proper communication between management and trade unions. Frequent meeting are lacking everywhere.

For security of Bir hospital, workers, patients and visitors there are 16 security personals and they manage duties in three shifts. The security personals are found to be insufficient in number as just 6 personals per shift cannot meet the demand. Hospital has managed rest room, toilet and bathroom for them. Theft of mobiles, money and other logistics is frequent event in Bir Hospital. The hospital will be better workplace if unnecessary politics and high workload can be reduced.


As working in health institution, staffs of Bir Hospital have good knowledge about health issues. Generally, workers use PPE in all departments but their quality sometimes is questionable. The workers of Bir get bottled jar water. They have provision of smoking cessation in Hospital. There is no emergency



preparedness. In front of possibility of electric hazards or mechanical hazards, they have posted CATION. The hospital is in movement of safe injection practice and being mercury free.

Figure: unhygienic toilets for visitors Figure: open drainage carrying hospital waste water

Staff form several department are not getting proper and sufficient refresher trainings. However, this year, enough training on HCWM was conducted. They have rest rooms, changing rooms, tea/coffee rooms with in departments. Though there is high risk of communicable disease, immunization to protect workers is not proper.


Bir Hospital has strong relation with community being first and largest government hospital. Out of 460 beds, 231 beds are free of cost bed and the patient has to pay only for medicines in those beds. Similarly, casuals of National movements, family members of martyrs and Maoist combatants get free treatments in Bir Hospital. Patient from ultra poor families also get free treatment up to 50,000 in recommendations. Patients of kidney, heart, cancer and neurotic also get free treatment as a part of governments national health policy.

Bir hospital takes parts in health camp in remote parts of county also. NAMS as well as Bir hospital organizes seminars, workshops trainings different issues to increase knowledge and awareness in health sector.

Bir Hospital has provision of curing patients 24 hour and it has done in its way. Some test would be tested very fast like X ray; Emergency lab etc for emergency patients but there is no practice to serve the patients properly.

Sanjeevani Volunteer Organizations is working there from long time and serving people from deprived community, marginalized people, and street personal. Similarly, volunteers from Sanjeevani guides illiterate/less educated peoples within the hospital. However, their support is not sufficient to meet the demands due to the lack of staff and resources. The needy people were not getting such service in a satisfactory way. Therefore, Bir Hospital itself should initiate this type of service. .

There is high flow of patient in the hospital and they have to wait in a long queue for registration, billing, X-ray, lab etc. This problem can be solved by simple management technique like providing coupon in each department. During the waiting time, they can take some information, education and communication message from the media, newspaper etc. rather than standing in line with distress. Figure: Queue for payment for different tests

4.3. Steps for Bir Hospital to be a Healthy Workplace Bir hospital has to do a lot to be healthy work place. It has to manage for several issues as raised in above sections but it has limited resources. Creating and maintaining a healthy workplace is a continual process and needs to have procedural change. The following steps should be followed to make Bir Hospital a healthy work place.



1. Awareness

It is necessary to create awareness about the needs and benefits of healthy work place to management and all workers of the hospital. Awareness creation in hospital is easier than other enterprises as the management and workers are already aware about health issues. In lower level, there may be need of awareness raising.

2. Build commitment

Healthy workplace program needs commitment from top management (Director Level, In charge level) and employees / labor unions to find ways to promote hospital as healthy workplace. Director/management should get endorsement and employees should be made ready to be involved is next step. A HW program needs noticeable support from Director, senior and middle management. There needs to be a willingness to contribute time, energy and resources to the HW program. For this motivation is necessary. They are motivated by health and economic benefits from healthy workplace and humanity issues.

3. Formulate a Healthy Workplace Team

To formulate a HW committee in Bir hospital, interested people having several qualities and from different departments and levels should be identified. This committee should be inclusive with proper representation of workers with equitable gender representation. A senior level staff responsible for housekeeping or community relation should be nominated as coordinator to make better communication and record keeping. Initially, the involvement of experts from outside as consultant for short term may be more fruitful.

4. Workplace Assessment

HW committee in association with staffs of respective departments to have perform workplace need assessment to get proper information on barriers that are obstructing to make workplace healthy. HW team should gather and analysis the information on all workplaces/departments in the hospital using miscellaneous tools and procedures. The chances of success increase if more employees become involved in this process. This will also help to ensure commitment of all employees.

To find the need HW committee have to

Identify the critical environmental health issues to be solved within the workplace through baseline data. Baseline data on workplace can be achieved through inspections, previous accidents records, rates of sick leave and workplace-related injuries and illnesses, including short and long-term disabilities, union complaint.

Identify the personal health status of workers. This information may be obtained using a confidential survey or simple checklist and/or dialogue between workers and a health professional.

Explore and report on particular problems of interest and roles of different stakeholders.

Define required standard and targets for Bir hospital by looking how other hospitals known as best are doing in this arena or read recommendations or case studies of good hospital.

Define required standard and targets for emergency preparedness in Bir Hospital.

5. Prioritize

For efficient allocation of available limited resources to achieve their best potential and develop actions suited to needs and demand driven, it is essential to prioritize the problems. Identify the priorities of health problems, and formulate a local/healthy workplace action plan for resolving priority problems and get focus on developing activities in problematic areas first. Improved condition on those areas can be taken to demonstrate the benefits. Priority can be fixed with following considerations High exposure to occupational hazards and high risk to workers



Ease of implementation Possibility of making a difference More likelihood of success Low cost solutions High cost of ignorance Preferences of management, workers and trade unions Availability of donors to get fund

In Bir hospital, following may be priority issues Management of queue lines for registration, billing, X-ray etc by providing coupon Immunization to workers towards infectious and lethal communicable disease Wastewater management Improved Canteen with free supply of drinking water Management of volunteers organization and volunteer Retro-fitting of older buildings

6. Plan After prioritization of the issues of hospital, involve the stakeholders to make plan to eliminate/ reduces the barriers at work place. To achieve the improvements on critical places prepare a clear strategy and plan with stakeholders related to that workplaces need to improvement. The plan must be focus on the priorities identified with a period, required resources and clear-cut responsibility. The plan should have long-term goals and objectives and indicators set in order to measure success. After developing the long-term plan, annual plans would be developed to address issues in order of priority. Prepare and adopt a clear statement of the role and responsibility for all stakeholders. Prepare and adopt code of conduct (do/ not to do) for employees for promoting HW. The program needs the involvement and support of senior management, employees, trade unions, and other key stakeholders in order to be successful. These groups need to be working together toward the same goal, so involvement is necessary in planning. Following are basic principles for HW planning.

a. Adapt the program to meet the needs and interests of employees – Different people have different needs and interests. Diverse programs are needed to meet the needs of all employees within the Hospital. It is necessary to take care of age and body limitations, gender equity, as well as cultural differences. It is important to assess needs and interests of employees before developing and implementing activities.

b. Adapt to the special features of each workplace –Programs must recognize the fact that within the hospital each department/ wards are as a unique workplace and be adapted to fit the workplace and as flexible as possible.

7. Action -According to plan employees should be encouraged to participate in HW activities. High-level management should encourage HW team by providing supportive environment, necessary resources and follow up. There should be clear responsibilities for each planned action with necessary resources and time frame to the implementation team.

8. Continuous monitoring and evaluation-It is important for HW programs to collect information in order to keep track of progress and to determine if their goals have been met. Implementation process and outcomes should be evaluated in the short and long terms by using indicators.

9. Provide incentives– It is important to recognize and reward those individuals and wards/ departments that organize and participate in HW initiatives. Incentives encourage participation and demonstrate to employees that the hospital and its senior management value participation in HW.

10. Continuity of HW initiatives Healthy Workplace status should be reviewed annually with the aim to improve workplace and make plan for forward. The HW program must be continuously marketed to make sure employees and management are aware of the program. At the same time others also learn from HW of Bir Hospital.

[CHAPTER 5: PROMOTION AND ESTABLISHMENT OF HEALTHY WORK PLACE]


CHAPTER 5: PROMOTION AND ESTABLISHMENT OF HEALTHY WORK PLACE 5.1. Major Causes of Unhealthy Situations In Nepal

In any workplace, there may be the risks of accidents and diseases due to unsafe work, machine, equipment, materials and work environment. The risk of accidents and diseases present at workplace develops fear, physical and mental stress to workers and are cause of psychosocial hazards, which simultaneously reduces production, productivity and efficiency. Most of the workplace accidents and diseases are avoidable, could be controlled or minimized if appropriate counter measures or safe guards are in place. The measures placed properly minimize workplace accidents and diseases as well as contributes in promotion and protection of health of the workers at workplace. Similarly, it contributes in controlling or minimizing direct or indirect cost related to production and productivity as well as adverse effect on workers health. Major causes of unhealthy work places in Nepal, can be summarized as follows

Unsafe working conditions

Lack of supervision and training

Use of old machinery and equipment

Lack of sufficient maintenance

Bad house-keeping practices

Violation of safety rules

Over crowded production units with very congested space

Alcohol and drug use

Politics of trade unions

Work life conflict

Use of chemicals in industries

Hazardous Waste Management

Solid Waste Management

Dusty worksites

Congested and dark workplaces

5.2. The Barriers

The promotion towards the sound healthy workplace environment in Nepal is showing disinclination because of different barriers as follows:

Lack of clear policy

Lack of proper coordination between different stakeholders

Lack of responsible government agency that only look after healthy work place

Lack of knowledge and awareness among workers

Lack of awareness and commitment in employers and management

Fear of change and of cost increase by Management

Poor consultation system

Majority of untrained people both in management and labor

No safety-friendly work culture (both workers & management)

Lack of research and data-base on healthy work place

There are several provisions related to Healthy Workplace in policy level, but unfortunately, the provisions are not much effective in practice and still need a lot of awareness campaign and effort and single responsible department to coordinate the efforts. Entrepreneurs have never taken care of minimum workplace standards provisioned in the law. Weak administration and ineffective enforcement mechanism of the government needs a boosting improvement in order to build the capacity to control the situation.



5.3. The Way Forward in National Level

Worldwide practices reflect that the effectiveness of healthy workplace could be achieved only by mutual effort and commitment of all stakeholders (management, worker and government) from respective angles rather than any individuals. In national level, healthy work place section/unit should be established under Ministry of Health and Population. For the sustainability; permanent steering committee should be established under the leadership of MoHP and the members should be from Ministry of Industry, Ministry of Environment, Ministry of labor and transportation, Nepal Bureau of standards and metrology, representatives from trade unions, representative of FNCCI, representative of WHO, ILO and other relevant stakeholders.

5.4. Steps for Action at National Level

At national level following are the recommended strategies to gain momentum to get healthy workplaces through out the country in all enterprises.

Formation of Steering Committee at High level

Development of Healthy Workplace Policy

Developing training modules, formal training and orientation

Raising Awareness

Education & Skill Building

Formation and mobilization of HW committees in each workplace and enterprises

Periodic situational survey, hazard analysis and pre-project planning for HW

Approvals of new enterprises only after HW commitment

Nepal Standard(NS label) logo only after HW implementation

Government procurement with HW enterprises

HW incentive program

Involvement of top management in HW issues

Sincere implementation of collective bargaining agreements

Sound inspection form labor administration

Similarly, the concerned stake holders such as government, FNCCI, trade unions and NGOs or INGOs concerning to the Healthy Workplace should be active in the following activities:

Partnership among trade unions, employers and government for training programs on Healthy Workplace.

Research for problem identification

Awareness program for Healthy Workplace and healthy life

Implementing partnership with employers for sound workplace management

Joining hands with international Agencies like WHO, ILO for works in cooperation on Healthy Workplace

Cooperation with NGOs on the issue of Healthy Workplace environment

5.5. Steps in an Enterprises

Creating and maintaining a healthy workplace is a continual process. The best way of achieving healthy workplace is to have a strong and permanent working team responsible for entire issues at enterprises. For this, in any enterprises, should take the flowing steps.



Figure: Steps for Healthy Workplace

1. Awareness

In developing and under developed countries it is necessary to create awareness about need and benefit of healthy work place. Normally due to lack of knowledge and willingness to see direct benefits only, managers do not show interest on Healthy Workplace Initiatives.

2. Build commitment

Healthy workplace program starts with commitment and attention to people’s health and well-being. It needs commitment of top management and interested employees or labor unions in finding ways to promote workplace as healthy workplace. To get senior management endorsement and make employees ready to be involved is the next step. A HW program needs noticeable support from owners, senior and middle management. There needs to be a willingness to contribute time, energy and resources to the HW program. For this motivation is necessary. Different things like, economic benefits from healthy workplaces, market benefits, humanity issues, conscience or religious beliefs motivate them.

3. Formulate a Healthy Workplace Team

To formulate a HW team, it is needed to include interested people having several qualities and from different departments and levels. This committee should be inclusive with proper representation of workers with equitable gender representation. Any staff could be nominated as a coordinator who is responsible for health or environment or community development to make better communication and record keeping. If there is an existing safety committee, that may also be able to take on this additional role. In a small enterprise, there may be involvement of experts from outside as consultant for short term can be a better step.

4. Workplace Assessment

Perform workplace need assessment to get proper information on barriers that are abstracting workplace health. HW team should gather and analysis the information on different workplaces/departments in the business using diverse tools and measures. The chances of success increase if more employees are involved in this process to ensure commitment of all employees.

To find the need



Identify the critical environmental health issues of the component to solve within the workplace through baseline data. Baseline data on workplace can be achieved through inspections, previous accidents records, rates of sick leave and workplace-related injuries and illnesses, including short- and long-term disabilities, safety committee minutes, employee demographics, turnover and productivity statistics, union complaint.

Identify the personal health status of workers. This information may be obtained through a confidential survey, or in smaller business settings, a walk-through with a checklist and/or dialogue between workers and a health professional.

Explore and report on particular problems of interest and roles of different stakeholders.

Define required standard and targets for enterprise by looking how similar companies known as best are doing in this arena or read recommendations or case studies of good practice.

Define required standard and targets for emergency preparedness.

5. Prioritize

For efficient allocation of available resources to achieve their best potential and develop actions suited to needs and demand driven, it is essential to prioritize the problems. Identify the priorities of health problems, and formulate a local/healthy workplace action plan for resolving priority problems and get focus on developing activities in problematic areas first. Improved condition on those areas can be taken to demonstrate the benefits. Priority can be fixed with following considerations

High exposure to occupational hazards and high risk to workers

Ease of implementation

Possibility of making a difference

More likelihood of success

Low cost solutions

High cost of ignorance

Preferences of managers, workers and trade unions

6. Make plan together

The stakeholders should be involved to make plan to eliminate/ reduces the barriers at work place. To achieve the improvements on critical places prepare a clear strategy and plan with stakeholders related to that workplaces need to improvement. The plan must focus on the priorities identified with a period, required resources and clear-cut responsibility. The plan should have long-term goals and objectives and indicators set in order to measure success. After developing the long-term plan, annual plans should be developed to address issues in order of priority. A clear statement of the role and responsibility for all stakeholders and code of conduct (do/ not to do) for employees for promoting HW should be prepared and adopted.

The program needs the involvement and support of senior management, employees, unions, and other key stakeholders in order to be successful. These groups all need to be working together toward the same goal, so involvement is necessary in planning. Following are the basic principles for making plans.

a. Adapt the program to meet the needs and interests of employees – Different people have different needs. Diverse programs are needed to meet the needs of all employees within the organization. The plan should be sensitive to age and body limitations, gender equity, as well as cultural differences. It is important to assess needs and interests of employees before developing and implementing activities.

b. Adapt to the special features of each workplace – Each workplace has a unique workplace character and employee culture. The programs must recognize this and be customized to fit the workplace. The programs should be as flexible as possible.

c. Strategies need to be inclusive – Healthy Workplace initiatives must complete three tasks in order to be successful.

Create awareness Build employee skills



Create a supportive work environment

7. Action

The employees should be encouraged to participate in HW activities. The HW team can assist by providing necessary resources and follow up. Responsibilities for each planned action should be assigned with necessary resources and time frame to the implementation team.

8. Continuous monitoring and evaluation – It is important for HW programs to collect information in order to keep track of progress and to determine that their goals have been met. Evaluating how well the activities met the needs of employees is important to the success of HW program. Implementation process and outcomes should be evaluated in the short and long terms.

9. Provide incentives–

It is important to recognize and reward those individuals that organize and participate in HW initiatives. Incentives encourage participation and demonstrate to employees that their participation is valued by the organization.

10. Continuity of HW initiatives

The healthy workplace status should be reviewed annually with the aim to improve workplace and make plan for further. The HW program must be continuously marketed to make sure that the employees and management are aware of the program, its benefits and opportunities to participate.

5.6. Stakeholders and Duties

To build a healthy workplace, it is important to assure that everyone is working towards a common goal. The HW program needs to be supported from all levels of the organization as well as others from community. At present context, several countries has given due attention in improving safety, health and environment, realizing the requirement of introducing changes in the workplace. Active participation, cooperation and commitment from concerned stakeholders (management, workers and government) are duly important to find the practicable solutions for the sustainable development of healthy workplaces.

Top Management

Employees in Nepal are looking to their employers to provide programs that enrich their work environment and contribute to an overall healthy lifestyle. The program must be supported with appropriate resources material, manpower, and money. It is essential for management to be supportive of the program and be prepared to:

Adopt healthy workplace policy and show the commitment

Respond to the issues identified by employees and HW committee

Support the development of a comprehensive healthy workplace strategy

Provide appropriate resources.

Trade Unions / Employee Associations

The unions must enter into the concept of healthy workplace and the benefits of a HW program for its members. It is important to involve employee groups as active partners in the process from the very start.

Employees

Grass roots involvement and participation is critical to the success of the program. Commitment and actively involving key employees are heart of successful implementation.

Other key stakeholders

This includes staff from occupational health, health and safety, human resources, benefits, and / or training and development departments, and family members of employees.

Government Departments

Provides necessary supports, monitor the programs, develop policies, reward good practices and punish the entrepreneurs those are not following the laws and guidelines.

[REFERENCES]


NGOs and INGOs

NGOs and INGOs may play catalytic actions in development of Healthy workplaces. Awareness raising, trainings, exposure visits to good practices, social marketing of good practices, provide consultation may be major arena on which NGOs and INGOs can work.

5.7. Fundamental Principles to be Adopted

Following are some fundamental principles to be adopted to have sustainable healthy workplace.

a) Commitment

HW initiatives need commitment and support for the development and implementation of activities from the top-level management. These commitments with a written policy statement strengthen effective implementation of HW in any enterprises. This policy makes easier to get necessary permissions, resources and support from owners and senior managers and clearly indicates that healthy workplace initiatives are part of the organization’s business strategy.

b) Involvement of workers

The workers from different levels and departments (with gender equity) must be involved in every step of the process from planning to evaluation. There should not be top down communication about what is going to happen but they should actively involve in decision-making. Trade union leader or representative system from departments can increase collective means of expression and bargaining than individual worker due to the inherent dynamics of relations between labor and management.

c) Vision/Policy development

HW initiatives should promote long-term strategy for health promotion that is reflected in the programs and policies to create healthy workplaces. For this, workplace assessment is done to find current situation and vision if ideal best situation is set.

d) Evaluation approach / Setting priorities

HW initiatives identify the priorities of health problems, and formulate a local/healthy workplace action plan for resolving priority health problems. HW initiatives focus on developing activities in different key areas to improve the situation regards to problematic areas to improve conditions. This adopts a participatory process involving all stakeholders for evaluation. The areas with improved condition can then demonstrate the benefits and methods of effective planning.

e) Innovation

HW initiatives encourage for new ideas and methods by sharing information, creating incentives for innovation and recognizing the achievements of those who experiment with new policies and programmes. Innovation provides the base for shaping new healthy public policies and analyzes the impact of present policies.

f) Learn from others

In absence of ideas and tools to resolve the problems it is important to learn from others. Experts or researchers can be out sources. Visiting enterprises having good practice is another way to learn from others. Websites of ILO, WHO, UNEPA and OHSP may also provide valuable information in this regard.

g) Continual Improvement Healthy Workplace status should be reviewed annually with the aim to improve workplace and make plan for ahead. The HW program must be continuously enforced and monitored to make sure employees and management are aware of the program, its benefits, and opportunities to participate. It also ensures that the healthy workplace initiatives are integrated into the enterprise’s overall strategic business plan.

[REFERENCES]


REFERENCES

1. Facts on safety at work, International Labour Organization, Geneva. April 2005.

2. Healthy workplace, healthy workforce, better business delivery ,Health and Safety Executive

3. Healthy workplaces: a model for action: for employers, workers, policymakers and practitioners.

World Health Organization 2010, Geneva

4. ILO/WHO joint press release. Number of work-related accidents and illnesses continues to

increase: ILO and WHO join in call for prevention strategies. April 2005.

5. Interim Constitution of Nepal, Government of Nepal, 2063

6. Joan Burton, Healthy Workplace Framework and Model: Background and Supporting Literature

and Practices. World Health Organization

7. Occupational safety and health situation in industrial sector in Nepal, Er. Khumraj Pun

8. Plan of Action (2010-2016) to achieve widespread ratification and effective implementation of

the occupational safety and health instruments .International Labour Organization ,March 2010,

Geneva

9. Prüss-Ustün A, Corvalan C. Preventing disease through health environments: towards an

estimate of the environmental burden of disease. World Health Organization 2006, Geneva

10. Role of Trade Unions in Micro and Small Enterprises in Nepal [A Case Study of Small Restaurants]

Prepared by Dinesh P. Chapagain for International Labour Office, Geneva

11. Three-year interim plan, National Planning Commission, Government of Nepal, 2011

Documents

Healthy Workplace in Nepal