Pan-American Health Organization

World Health Organization

Division of Health and Environment

Workers’ Health Program

LIST OF APPENDICES *

1. INTRODUCTION *

2. WORKSHOP AGENDA *

3. WORKSHOP DEVELOPMENT *

4. DEFINITION OF THE WORK PLAN *

5. UPDATE ON THE COLLABORATING CENTERS NETWORK *

6. CONCLUSIONS, RECOMMENDATIONS AND CLOSURE *

This document summarizes the results, commitments, recommendations and conclusions of the strategic planning workshop, which was organized and convoked by the Pan-American Health Organization/World Health Organization (PAHO/WHO) and the Workers’ Health Program. This Workshop was designed to plan the joint activities of the Occupational Health Collaborating Centers in the American Region based on of the Regional Plan on Workers´ Health, to advance a specific collaborative agenda in this technical area, and to facilitate more effective coordination between PAHO and the Collaborating Centers (CCs).

This report will be presented next June (during the Fourth WHO Occupational Health and Health of Seafarers Meeting) jointly with the America’s Regional Plan on Workers’ Health.

Dr. Tennassee presented the Regional Plan on Workers’ Health (Complete document in Annex No.1 of the Summary), she pointed out its importance within the PAHO strategic and programmatic orientations during the 1999-2002 period and indicated that the Plan is designed to:

• Strengthen the countries’ capabilities to anticipate, identify, evaluate, and control or eliminate risks and dangers in the workplace;
• Promote the updating of workers’ health legislation and regulations and the establishment of programs designed to improve the quality of the workplace environment;
• Foster programs for health promotion and disease prevention in occupational health;
• Promote better health services for the working population; and
• Support programs aimed at protecting child workers exposed to environmental and occupational risks.

To meet these objectives, Dr. Tennassee emphasized the role of the CCs as institutions which have been selected by the PAHO/WHO director. The CCs are expected to support the activities of the international organization within the context of the WHO global CCs network. As such, it is expected that, giving the Regional Plan on Workers’ Health and the activities and capacities of the CCs, the countries would strengthen in four (4) basic areas of collaboration:

• Information
• Research
• Education
• Occupational health services.

Dr. Tennassee emphasized PAHO's commitment to reinforce and enhance the international work of the CCs network within the Americas. She further stated that this Strategic Planning Workshop was convoked to formulate general and specific actions of the CCs over a 10-year period as well as to implement control interventions for the main problems affecting workers’ health in the region.

She also indicated that, this workshop will generate CCs Action Plan which, will be presented during the Fourth WHO Occupational Health and Health of Seafarers CCs Meeting and the Regional Advisors in Occupational Health Meeting, both to be held next June 1999 in Helsinki, Finland, jointly with the Regional Plan on Workers’ Health.

GENERAL CONCLUSIONS:

1. It is evident that the identified problems are very serious. Therefore, an avenue to create and build stakeholder awareness of these problems and their impact should be sought.
2. There is evidence that each stakeholder is over-rated. This limits an objective evaluation.
3. The value assigned to each stakeholder is variable, therefore, it could increase or decrease in the future.

Based on the CCs and observers information, the problem tree and stakeholder analysis, three (3) common work areas were selected for the CCs as follows:

1. Training /research: oriented to postgraduate courses, workers, basic elementary and high school education, curricula development and follow-up.
2. Information and information systems: generation, compilation, processing and distribution of scientific information, strategy for communication with media, and occupational surveillance systems.
3. Sensitization/lobbying/counselling: working forward to build awareness among stakeholders about OH, in such a way that it becomes important and a priority for government, employers, employees and all other actors in the various countries.

To analyze each of these themes, once again three (3) work groups were organized as follows:

1. Excess of poor quality training programs in Latin America.
2. Lack of application of existing regulations (sometimes non-existant) accompanied by lack of research.
3. Lack of risk knowledge and management at various levels.
4. Changes in the working population profile and the organization of work, such as job flexibility.
5. With some exceptions, there is little or no worry among responsible parties within the governments or other authorities about workers’ health.
6. Lack of identification/poor training and research of vulnerable or unprotected populations (children at work, women workers).

Looking for alternative solutions to these problems, the group built the following matrix which includes the analyses and selection of target populations for training and/or research when related with the problems.

1. It is recommended to conduct research to determine curricula and the contents of the training programs.
2. The University of Texas is carrying out a global survey with WHO as Dr. Kawamoto in Mexico and Dr. Rudolf Vander Haar in Costa Rica, to determine the number, basic contents and professional profiles of these programs. It was agreed that the survey will be modfied to suit Latin American countries so that curricula guidelines can be built according to regional needs.

Next, discussions were held to determine which interventions can be made by CCs to effectively solve the identified problems:

1.To observe the Basis of collaboration: Convergence of interests and funding that assures sustainability of the programs.

2.To define a Common Plan for training and research . It was felt that this can be done with the existing resources at the centers:

1. Human Capacity: - Creating networks on specific problems

- Providing training

- Collaboration on studies.

2. Collaborating on common areas of interest.
3. Increasing communication among CCs, "talk to each other", in such a way that they can share ideas and resources.

Other resource needs were also considered:

• Financial: to mobilize available capacity. Funding is required for development and sustainability of the collaborative activities.
• Support: to improve the information/ communication network for better cooperation and collaboration.
• Build in activity/program sustainability.

This common plan has a PROJECT vision, with an integrated ecosystemic, multinational, collaborative, multidisciplinary and participative approach. It is designed to develop a common integrated approach to study problems across borders, in which workers’ health promotion and the healthy work centers and workplaces’ approach are included. Risk training and research should be considered from the social, environmental and ergonomical aspects. Neurotoxicology and reproductive health, among others, should also be considered and population groups properly oriented. (Other economic areas also need attention) This model is graphically presented in Diagram No. 1.

Approach: ecosystemic, integrated, TRAINING SOCIAL

multinational, collaborative, ENVIRONMENTAL

multidisciplinary, participative. ERGONOMICAL

NEUROTOXICOLOGY

• Development of a common integrated approach REPRODUCTIVE HEALTH
• Study problems across borders OTHERS RISKS AND HEALTH OUTCOMES
• Workers’ Health Promotion RESEARCH
• Healthy work centers and workplaces

INTERVENTIONS

HEALTHY WORK CENTERS AND WORKPLACES APPROACH

ECOSYSTEM APPROACH TO HUMAN HEALTH WITH COMMUNITY PARTICIPATION AND SUSTAINABILITY ENSURED

3. To define the Specific Plan of each center and identify their Coordinator.

Dr. González informed the meeting about the creation and design of a mailing list to implement a Spanish discussion regional group, aimed to:

1. Build a regular electronic communication space.
2. Promote an agile exchange of information through new electronic information technology.
3. Encourage Spanish cordial communication between participants who are geographically distant.
4. Share experiences and questions about workers’ health.

The list is based at CEPIS/PAHO, coordinated jointly by Dr. Walter Varillas from the Ministry of Health of Peru and has with the support of Duke University.

Dr. González invited all CCs and observers to join the list at the following address:

Dr. Pelegrini

Dr. Pelegrini indicated that the WHO administration is reorienting the CCs’ program policy and several meetings were held in the Americas and other continents. Dr. Peregrini also stated that in the near furure the modifications made to the selection, designation and redesignation criteria and processes to all CCs in the world will be received.

1. The increasing importance of common problems of global and regional magnitude, whose origin and impact go beyond national frontiers require coordinate efforts to be solved;
2. The development of new technologies of communication and information create new opportunities for the establishment of institutional networks for the production, analysis and dissemination of information and knowledge;
3. The rapid dynamism of Science and Technology development requires the identification of centers of excellence that are up-to- date with the new S&T developments and that are able to support other centers at regional and global levels; and
4. The proliferation of themes, areas, disciplines and actors related to health requires the diversification of institutions that are able to contribute to the development of the knowledge and practice of health;
5. The relative and absolute resources constraints of PAHO and WHO.

• Collect, collate, disseminate information
• Standardize terminology/nomenclature, technology, methods
• Develop and apply appropriate technology
• Provide reference substances, services
• Participate in collaborative research
• Training, including research training
• Coordinate activities carried out by several institutions

• WHO plays the dominant role in decisions regarding the designation of the centers;
• Usually no explicit program of work for the Centers exists;
• When such a program does exist, it has little to do with PAHO priorities;
• Imbalance in the distribution by country and technical area;
• Lack of knowledge of the reality in the countries of the Region;
• Language barriers;
• Lack of financial resources to carry out the activities planned;
• Lack of regular communication among Centers and between them and PAHO.

• PAHO’s Director urged a more proactive approach in the identification of institutions in the Region and in the process of elaboration of working plans, follow-up and evaluation;
• Establishment of an annual evaluation report by the technical areas on the utilization of the collaborating Centers;
• The collaborating Centers located in the Americas were renamed as PAHO/WHO collaborating Centers;
• Recognition of Research Coordination as the focal point for the administration of the Program and creation of a post to deal exclusively with this function;
• Establishment of guidelines and forms for the preparation of a work plan and evaluation;
• Dissemination of all information about Collaborating Centers in the Region through Internet (as a site in PAHO’s Webpage)

1. Increase the percentage of centers from Latin America and the Caribbean which in the two- year period grew from 22% of the total to 29%;
2. Greater involvement of PAHO’s technical areas in the identification of candidate institutions and in the process of designation, follow-up and evaluation;
3. Completion of forms for the elaboration of programs of work and evaluation was enforced;
4. More strict criteria for designation/redesignation were adopted;
5. Each Center received a certificate which showed the period of designation and the new denomination (PAHO/WHO CC) which emphasized its regional commitment;
6. In two years, the time spent for the designation/redesignation was reduced by fifty percent (50).

TABLE No. I

Mrs. Pereira reiterated that in accordance with the planned changes, the new management at WHO is evaluating the whole CCs program including criteria for selection, designation and re-designation. Thus, it is expected that by June, the program modifications, format and procedures will be addressed. She then presented the site at the web page where everybody can locate and consult the program information, described as follows.

The Work Plan consists of three parts:

• Part 1: The actual work plan, the most important part of which is the terms of reference
• Part 2: A description of the collaborating center, and
• Part 3: A description of the activities suggested in the terms of reference

Parts 2 and 3 are optional

The actual work plan of work can be relatively short, prepared as an "executive summary". It should contain:

1. Full name and address of the institution (with telephone, fax and E-mail address if possible).
2. Exact name of that part/unit/department/laboratory, etc., of the institution which, will act as the WHO Collaborating Center;
3. Indication of sphere of activity covered (e.g., PAHO/WHO Collaborating Center for "Research on …", "for reference on …", "for training in …", "for assessing technologies in …" etc)
4. Name of the director of the institution;
5. Name of the head of the WHO Collaborating Center (this may be the director of the Institute or the head of the unit, department, etc., or the principle researcher)
6. Terms or reference (a list of concrete activities to be carried out during the period of designation specifying the person responsible, the expect outcomes and the deadline);
7. Language of correspondence;
8. Reporting;
9. Evaluation.

1. Introduction

This section describes briefly the reasons for the proposed designation of the institution as a PAHO/WHO Collaborating Center and steps which have led to the proposal such as, for example, visits to the institution(s) by PAHO and/or WHO staff and consultants, participation of the institution in PAHO and/ or WHO project, emphasis placed by the national authorities and the institution on activities related to PAHO/WHO’s programs, and discussions which led to the development of the work plan.

2. Background

This section describes the statutory functions and structure of the institution, as well as its links with other institutions or sectors with similar interests.

3. Administrative structure

This section should give details of:

1. Organizational chart;
2. Administrative and scientific responsibility for the work or the proposed Center;
3. Establishment of possible national and international advisory boards (composition, periodicity of meetings, terms or reference);
4. List of senior staff of the Center with an indication of their expertise; and
5. Facilities available

For each activity included in the Work Plan, there must be an appendix describing the Activity. The level of details depend on the activity. For all activities the following is required:

• Name of the activity
• Objectives of the activity
• Relevant targets and outputs as well as activities in the PAHO/WHO Programs
• Person responsible for the activity
• Administrative structure for implementing the activity
• Duration of the activity with deadline.

Depending on the nature of the activity (study, course, information collection, provision of services, etc.) the following information may be useful:

• Financial provisions
• Research objectives
• Materials and methods
• Target group
• Educational objectives
• Course contents
• Faculty
• Expected outcome(s) of the activity
• Deadline for delivering the outcome
• Dissemination of the results
• Evaluation of the outcome

Annual Reports for each year of the current designation as a PAHO/WHO Collaborating Center may be submitted to the Research Coordination (see "About this Site").

Before redesignation may be considered, a new 4.year plan of work must be submitted for consideration and approval by the responsible PAHO/WHO Technical Officers.

1. Name of the Center:
2. Address
3. Head of the Center
4. Terms of reference of the Center

For each point on this page and for each activity use a separate sheet.

5. Work performed in relation to the terms of reference:

• Name of the activity
• How the activity was implemented
• Possible publications and other outcomes
• Possible evaluation (e.g evaluation of a course by the participants)
• Possible difficulties
• Possible recommendations for:
• Further implementation of the activity
• Revision of the terms of reference
• Preparation of the terms of reference of the next designated period (4 years)
• Related activities (e.g follow-up and monitoring)

1. Collaboration between the Center and PAHO and/or WHO:

• Visits by PAHO and/or WHO staff to the Center
• Visits by the Center staff to PAHO/WHO
• Use of the Center staff by PAHO/WHO as temporary advisers or consultants
• PAHO or WHO financial support to the Center through Contractual or Technical Services Agreement (including fellowships)
• Provision of Center staff for courses sponsored or organized by PAHO and/or WHO.
• Any other collaboration
• Any difficulties encountered in the collaboration

1. Collaboration with other WHO Collaboration Centers:

• Name(s) of the other WHO Collaboration Center (s) with which Center has collaborated
• Nature of the collaboration
• Outcome of the collaboration
• Suggestions for increased and improved collaboration with other WHO Collaborating Centers.

1. Evaluation:

• Evaluation (strength and weaknesses) of the implementation of the activities included in the terms of reference.
• Impact on the Center’s activities of its designation as a PAHO/WHO Collaborating Center.
• Impact of the activities undertaken by the center as a PAHO/WHO Collaborating Center on the national health development of the country.

Technically, the meeting verified that the CCs can develop joint projects and activities within the context of the Regional Plan on Workers’ Health, because of their convergence of interests and the cooperative will of the centers.

Common problems in workers’ health were also evident. This arose out of the exercises carried out by the CCs from the various countries and coincided with the diagnosis in the Regional Plan. Thus, cooperative actions between the centers and PAHO should be easier.

Based on the defined three main collaboration areas (research & training, information & information systems and lobbying & counseling), the CCs precised with better option of success, the specific activities each one wants to carry out. The summary report draft was sent to them during the week of May 17^th to 20th, and the centers reviewed it to define, modify or add their specific actions. Although not all the centers answered, it was returned on the last week of may to the repporteur, who was responsible for the summary, to finnishthe preparation of the report to be presented at the Helsinki Meeting.

Dr. Tennassee expressed PAHO’s and her gratitude to all participants for their great response to the workshop, as well as for the tough work and dedication by the various work groups, which contributed to the satisfactory achievements of the workshops’ goals. She also expressed her gratitude for the collaboration and support of the administrative,, communications, audiovisual and others from the PAHO team whose work allowed the successful completion of the workshop.She conveyed special thanks to k of Dr. Gerry Eijkmans, Dr. Hernán Rosemberg, Dr. Diego Gonzalez , the CCs participants, the moderators the rapporteur.