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Report on
DATA ON WORKERS' HEALTH FOR LATIN AMERICA & THE CARIBBEAN
Prepared For: The Pan American/World Health Organization
By: Mirande Richards
Date August 20, 1997
Table of Contents
1. Data on the Economy
1.2 Total GDP By Economic Activity
1.4 & 1.6 Average Wage By Economic Sectors
2.0 Characteristics of the Workforce
2.1, 2.4, 2.8 Workforce By Sex & Age - Annual Average
2.9 Total Children & Teenage Workers
2.2, 2.3 Workforce - Employed Average
2.7 Workforce - Employed Average By Economic Activity
2.10 Workforce - Employed Average By Size of Companies
2.11 Establishments By Size - Total & Percentage
3.0 Organization of Care in Occupational Health and Coverage
3.1 Structure of Health Coverage for the Whole Country and Percentage
3.2 General Roles in Occupational Health Established by Law
3.3 Bid for Occupational Health Insurance of Company used and Bid amounts & Percentage
Direct and Indirect Beneficiaries
3.5 Description of Existence of Occupational Health Program and Activities
Types of Services and Compensation that Provide Occ. Health Services Providers
4.1 Institutions that offer Services
4.4 Special Regimen of Occ. Health of Occupational Accidents and Diseases
Number of Workers Covered by Occupational Health Insurance
4.6 Types of Recognized Occupational Accidents
Subsidies or Pensions - Employee Injury Benefits
4.9 Number of Workers and Hours/Days of Disability
4.10 Average Days of Disability per Worker
4.11 Average Amount of Subsidies or Pensions per Worker
5.0 Situation of Occupational Accidents and Occupational Diseases
5.1 Registry of Occupational Accidents and Occupational Diseases
Number of Workers and Fatal Occupational Accidents
5.3 Distribution of Compensation Cost, subsidies and administration by Fatal Occupational Accidents
5.6 Number of Occupational Diseases Registered
6.0 Costs of Occupational Accidents and Occupational Diseases
6.1 Direct & Indirect Estimated Costs
6.2 Promoting Prevention of Accidents
7.0 Policies Developed in the Country
APPENDICES
Appendix II Additional Notes On Structure of the National Health Care System
Appendix I List of Occupational Diseases
Appendix II Disability Qualification Table
Appendix III Insurance Coverage for Workers
Appendix V Organizations to which Questionnaires were Distributed
1.3 Minimum Wage
As of July 1, 1996 the national minimum wage was set at JA$800/US$23 per 40-hour work week.
Source : Ministry of Labour, Social Security & Sports - Minimum Wage Section
1.4 & 1.6 Average Wage By Economic Sectors
NB ** Large Establishments are deemed to be companies employing twenty (20) or more persons. However, establishments with as little as ten (10) workers are included in the definition of "Large establishments", in special circumstances. Special circumstances are those instances when an establishment which previously had a workforce of 20 or more persons reduces its numbers without reducing capacity/production load or major activity.
Source: Statistical Institute of Jamaica
1.5 Cost of the home intake (earned salary of one or both head of the family)
Data Not Available
2.0 Characteristics of the Work Force
2.9 Total of Children & Teenage Workers
2.2 & 2.3 EAP By Formal, Informal Sector
2.6 Urban & Rural EAP
Not distinguishable
2.7 EAP by Economic Activity
2.10 EAP By Size of Companies
Data Not Available
2.11 Establishments By Size - Total Number & Percentage
3.0 Organization of Care in Occupational Health and Coverage
3.1 Structure of the Health Coverage for the Whole Country and Percentage
There is no formal organization of occupational health, notwithstanding provisions of the Public Health Act. In Jamaica the main focus has been safety. The general structure is as follows :
SEE ALSO APPENDIX II
3.2 General Roles In Occupational Health Established by Law for :
The Role
The National Insurance Section is one of nine branches in the Social Security Division of the Ministry. The unit manages Employment Injury Benefits, processing claims in relation to work related injuries or illnesses, grouped as follows :
Sections 15 - 20 of the Act addresses "Benefit Attributable to Injury or Disease in Employment". The Act :
* defines employment accident, benefits as a result of employment injury (Section 15)
* prescribes occupational diseases.
In keeping with its mandate the NIS Unit provides the following employment injury benefits for :
* Temporary Incapacity. Benefits are paid up to 52 weeks at 75% of insurable wage.
* Medical Treatment. Fees are paid for treatment received at an approved hospital or medical clinic.
* Disablement. Benefits paid are based on the percentage disablement determined by a medical doctor who is guided by the schedule of Prescribed Degrees of Disablement.
Death Benefits are paid if injuries are fatal, to a spouse or other prescribed persons.
b) Labour Division
The Role
The Industrial Safety Section is responsible for the administration of the Factories Act and Regulations. The section functions through Factories Inspectors who, unlike Public Health Inspectors, have power of entry. The Permanent Secretary, in the Ministry, is the Chief Factories Inspector. The section is headed by a Director who manages the unit.
The Factories Regulations address safety concerns in factories. Part III sections 59 - 77 specifically addresses Health & Welfare requiring managers, inter alia, to :
* implement effective housekeeping (Section 59)
* prevent overcrowding and ensure adequate ventilation and lighting (Section 60 63)
* provision of First Aid (Section 72)
* ensure protection from dust, fume or other "impurity" likely to be injurious Section 74 - 77)
II Ministry of Health
The Role
The Environmental Control Division (ECD), has responsibility for a wide range of environmental activities including sanitation, water quality, food hygiene and building integrity as it relates to health. The division also has responsibility for Occupational Health (OH), hence will have the responsibility of supervising the implementation OH regulations, prescribed by the Public Health Act Sect. 14.1 (f) and monitoring compliance. These regulations are still at the draft stage. Notwithstanding, Public Health Inspectors, currently inspect establishments to identify employment health hazards and recommend corrective measures. Coverage is country-wide.
The Draft Regulations include provisions for:
* notification of Occupational Diseases Section 4 (a), (b)
* establishing standards for ventilation; lighting; control of noise, dust, fumes, etc. Section 6 (a)
* personal protective devices Section 7
The Role
While not explicitly empowered to perform occupational health functions, the inherent of prescribed functions address occupational health concerns. Section 4 of the Act prescribes the functions of the Pesticides Control Authority (PCA) which cover :
* registration of pesticides
* licensing persons who import or manufacture registered pesticides
* licensing pest control operators
Section 14 addresses prohibited pesticides (importation and use) while section 16 prescribes regulations in relation to:
* medical examination for pest control operators and employees
* labelling, packaging, storage, transportation, use and disposal of pesticides and packages
* keeping and provision of records
* protective clothing and the obligations of employers
* prescribing permissible levels
Section 18 prescribes the powers and duties of inspectors including power of entry including premises and vehicles.
The PCA collaborates with existing agencies in fulfilling some of its roles including:
* Rural Agricultural Development Agency (RADA) in collecting data for the evaluation of residue analysis RADA also advises on pesticides to be registered by Pest Control Authority.
* Distributors in educating about the use of products
* Pharmacy Council in licensing Retailers of Hazardous Chemicals (under the Dangerous Drugs Act). The Council currently registers all such chemicals.
* The Jamaica Bureau of Standards in the analysis of pesticide samples.
* Ministry of Agriculture :
Veterinary Division regarding pesticides used in control of pest infestation of animals.
Research & Development Division in the assessment of pesticides
III Companies With Own Service
IV Insurance/Private Services
V Others
3.4 Direct & Indirect Beneficiaries & Number without Coverage
Data Not Available
3.5 Brief description of existence of an occupational health programme and activities
1. Ministry of Health
Not Known
2. Ministry of Labour
Industrial Safety Division
No programme
3. Private Insurance
The companies to which questionnaires were distributed indicated that no Occupational Health Programmes were developed (neither in the capacity as employers nor service providers). However, one company reported activities in relation to disaster preparedness/emergency response
4. Companies (1 subsidiary of a multinational corporation, responded)
Programmes reported were:
a) Health Surveillance - Pre-employment & Periodic Medical Exam
b) Industrial Hygiene - Identification, assessment & reduction of job hazards
c) First Aid & Curative for injury and illness
5. Labour Organizations The Umbrella Organization for Labour Unions reported having Environmental/Occupational Health & Safety Education programme
6. Universities - University of the West Indies (UWI)
a) Academic - Department of Community Health & Psychiatry
Education & Training programme
Health Promotion programmeb) Personnel Department
A programme has been developed and the following activities initiated:- Health & Safety Committee established
- Safety Policy booklet written & circulated
- A lecturer assigned the responsibility for laboratory safety
7. NGOs
a) Occupational Health Nurses Association of Jamaica
Has no programme. However, the association has developed a curriculum for a programme of study in Occupational Health and has had discussions with the Department of Advanced Nursing Education, UWI to have the programme introduced in that Department.
b) Jamaican Association of Safety Professionals
Holds annual conferences and one day seminars for members. Has developed a research project for which funding is being sought.
8. Others
a) Dept. of Mines & Geology
Programmes administered under the Mining (Safety & Health) Regulations
- Reporting
- Inspection
- Investigation
- Incentive Awards
4.0 Types of Services and Compensation that
Provide Occupational Health Services Providers
4.1 Institutions which offer services in relation to Promotion, Prevention, Treatment & Rehabilitation.
Very few institutions provide services specifically for occupational health. The following organizations reported/are known to provide related occupational health services :
a) Promotion - Dept. of Mines & Geology; Industrial Safety Division; University (UWI); Trade Union Centre; CARHEPS Occupational Health & Safety Consultants
b) Prevention - Dept. of Mines & Geology; Industrial Safety Division; University (UWI); CARHEPS Occupational Health & Safety Consultants
c) Treatment Companies that employ nurses, Life & Group Health Insurance Companies; General Insurance Companies; University (UWI)
d) Rehabilitation Not indicated by any of the institutions responding to the questionnaires
e) Compensation Social Security Division of the Ministry of Labour Social Security & Sports; General & Life Insurance Companies; University (UWI)
4.4 Special Regimen of Occupational Health or of Occupational Accidents and Diseases
4.5 Number of Workers Covered by Occupational Health Insurance
4.6 Types of recognized occupational accidents
Data were available for the bauxite industry only.1. Bauxite Mining
Distribution of Injuries By Accident Cause 1994
4.7 Subsidies or Pensions
4.8 Subsidies or Pensions, Employment Injury Benefit
NB
* Paid to the spouse or a dependent mother aged 55 or over or to a person caring for a child/children under the age of 18 years. Maximum payable is JA$735 per week
** That portion of wages on which NIS deductions are calculated e.g. the current ceiling is J$250,000
*** Disability is assessed at 10-100%. The benefit is then calculated at the percent disability times 75% of insurable wage. E.g. For disability of 10% the benefit would be 10% x (75% of insurable wage).
Source: Social Security - Employment Injury Benefit Branch
4.9; 4.10 & 4.11 Number of workers, hours or days of disability, average days of disability per worker,average amount of subsidies/pensions per worker(of three previous years
5.0 Situation of Occupational Accidents & Occupational Diseases
5.1 Registry of Occupational Accidents & Occupational Diseases
5.2 Number of Workers and Fatal Occupational Accidents
5.3 Distribution of the compensating cost, subsidies and administration of fatal occupational accidents (total cost and percentage)
Data were not accessible. Main reason given was that related information was fragmented and/or paper-based and difficult to retrieve.
5.4 Occupational Accidents
5.6 Number of Occupational Diseases Registered
Data Not Available. No registry.
5.5 Distribution of the cost of treatment, compensation, subsidies, administration of
5.7 occupational accidents & occupational diseases
Sources: Questionnaire (A Bauxite Mining Company & Industrial Safety Division - Ministry of Labour, Social Security & Sports)
5.8 Life Expectance of the country and per economic activity
5.9 General Retirement Age
Appendix I DATA SOURCES
Appendix II ADDITIONAL NOTES ON Structure of the National Health Care System
Jamaica has a relatively well structured national health care system consisting of public and private care providers and institutions.
The public health care system includes Primary Care, Curative & Rehabilitative services with support services at each level. The following exists in terms of public and private health care institutions throughout the country :
Each parish has at least one (1) public general hospital and government health centres are dispersed throughout the country. All persons, including workers in neighbouring establishments, have access to these services. However, neither government nor private health care system is geared towards capturing of data for work related illnesses/ diseases as work history is not, routinely, a part of an individual's case history.
At the Primary Care level, are six (6) Public Health Inspectors, whose responsibility includes occupational health functions and one (1) Occupational Health Nursing Supervisor. The Public Health Inspectors operate at the parish level while the Nurse's sphere of operation is national. The Inspectors and the Nursing Supervisor undertake inspection of facilities in relation to environmental and occupational health.
Health care is also available through private medical clinics, hospitals and allied support services. Workers tend to have access to these facilities through group Health Insurance coverage and would be included among the clientele of these facilities. Work history is not included, routinely, in an individual's case history.
Medical practitioners in both private and public health care sectors are required, by law, to notify the Medical Officer of Health about prescribed diseases. Occupational diseases are not included among the notifiable diseases.
Allied medical services include audiometric testing, spirometry and laboratory analysis of industrial samples are available albeit in limited numbers. Laboratory analyses are limited to tests for micro-organisms such as bacteria. Very limited services are available for analysis of dust usually particulate count. Laboratory analyses of industrial samples for other substances such as VOC, are undertaken mainly in North America.
Occupational Health Consultants. There are two known independent Occupational Health Consultancies, one of which is not active. The consultancy that is operational, provides a wide range of occupational health services including health risk assessments, health and safety audits and industrial hygiene services.
Most establishments have no occupational health or safety programmes (1). However, up to mid July 1996, 66 establishments were known to have employed 89 Registered Nurses and 6 Enrolled Assistant Nurses as is shown below (2). This has been mainly as a result of collective bargaining.
Nurses Employed in Establishments in Jamaica
Nurses in the Bauxite Mining sector and others in small number in the larger establishments, were more actively involved in occupational health activities than were some of their peers. For example, these nurses participated in plant tours, and collaborated with other Safety Officers, and Industrial Hygienists in monitoring the work environment. Many nurses, however, are limited to practice within the clinics, with main responsibility being First Aid and non work related health problems. In the case of those in hotels their main focus are the hotels' guests.
Organization of Services
All the establishments, that employ nursing personnel, have worksite clinics. At least four (4) of the larger establishments have medical doctors who visit at least one half day per week. Others have standing arrangements with medical centres or individual medical doctors to provide emergency services and/or employment medical examinations. The Bauxite companies have medical doctors on staff. One has a team of doctors headed by a Medical Director with one doctor at each of its other two locations, on a part time basis (approx. 4 hours per day). In addition there are two nurses on the morning shift and one on each of the other two shifts, daily at each location. Only two establishments, outside the bauxite mining sector, have nurses on all shifts.
Industrial Hygienists are utilized mainly in the bauxite mining sector. Few are known to be employed in other sectors.
6.0 Costs of occupational accidents and occupational diseases
The cost was estimated by the Industrial Safety Division to be :
7.0 Policies developed in the country
1. Ministry of Health
The Ministry of Health has drafted a National Action Plan for Workers' Health. Elements of the plan address:
- Political Will
- Legislation
- Research
- Occup. Health & Safety Programmes
- Education & TrainingSource: Draft National Action Plan For the Development of Workers' Health
2. Industrial Safety Div. - Ministry of Labour, Social Security & Sports
Draft Occupational Safety & Health Act, soon to be enacted. The cost for developing and implementing the policy has been estimated at J$2.5 million/US$71,429.
Source: Questionnaire completed by the Dept.
3. Dept. of Mines & Geology
Policies developed in relation to the following at an estimated cost of J$2.6 million/US$74,286
- Reporting format and frequency - Investigation & Enquiry of specified accidents
- Inspection - Annual Incentive Awards
Source: Questionnaire completed by the Dept.
4. University of the West Indies
Policy developed re training for Health practitioners, Safety personnel and Managers in industry.
Source: Questionnaire completed by the Dept.
5. Joint Trade Union Research Development Centre
Policy statement developed regarding "The Environment and Sustainable Development". The statement includes social issues such as health and will form part of the ILO's Caribbean Policy Statement. The cost of developing and seeking concensus has been estimated at J$200,000/US$5,715.
Source: Questionnaire completed by the Centre
6. Company in the Bauxite Sector
This company reports having developed policies including those for :
- No Smoking - Hazard Communication
- Respiratory Protection - Hearing Conservation
- Disability Management
Source: Questionnaire completed by one company in the Sector
Prescribed Degrees of Disablement
Prescribed Degrees of Disablement Description of Injury Degree of Disablement B. Toes of Right or Left Foot - Great Toe % Through metatarso-phalangeal joint 14 Part, with some loss of bone 3 Any Other Toe Through metatarso-phalangeal joint 3 Part, with some loss of bone 1 Toes of One Foot excluding Great Toe Through metatarso-phalangeal joint 5 Part, with some loss of bone 2 Three Toes of One Foot, Excluding Great Toe Through metatarso-phalangeal joint 6 Part, with some loss of bone 3 Four Toes of One Foot, Excluding Great Toe Through metatarso-phalangeal joint 9 Part, with some loss of bone 3 Source: Ministry of Labour, Social Security & Sports Appendix III(cont'd) Insurance Coverage for workers 1994 - 1996
1995NB
** Total Premium Income/Sum Assured - includes basic & ad&d # Data provided for Government workers only. Data for other workers not available ad & d = accidental death and dismemberment Prem Inc = Premium Income N/A = Not Available/Information Not Provide bil = billion Rate of Exchange US$1 = J$35 Appendix III(cont'd) Insurance Coverage for workers 1996NB
** Total Premium Income/Sum Assured - includes basic & ad&d # Data does not include workers covered by one company ad & d = accidental death and dismemberment Prem Inc = Premium Income N/A = Not Available/Information Not Provide bil = billion Appendix III(cont'd) Insurance Coverage for workers 1994 - 1996 - TotalNB
ad & d = accidental death and dismemberment # Data does not include some workers covered by one company Prem Inc = Premium Income bil = billion US$1 = J$33 (1994 & 1995); US$1 = J$35 (1996)Appendix IV DATA ON WORKERS' HEALTH FOR LATIN AMERICA AND THE CARIBBEAN QUESTIONNAIRE Please respond to all items that apply to your organization. I Organizational Profile 1. Tick [] the option which best describes your organization [ ] Ministry of Health [ ] Labour Division [ ] Social Security Division [ ] Private Insurance [ ] Company [ ] Labour Organization [ ] University [ ] NGO [ ] Other (Please specify) II Occupational Health (OH) coverage
4. Which of the following categories best describe the occupational health or related services offered/provided by the organization? [ ] Promotion (specify) [ ] Prevention (specify) [ ] Treatment (specify) [ ] Rehabilitation (specify) [ ] Compensation (specify)
