The Pan-American Health Organization (PAHO) together with the International Labour Organization (ILO), have defined the workplace as a priority site for health promotion, recognizing that health in the work and healthy workplaces are precious goods among individuals, communities and countries (ref. 1). In this context, PAHO´s Regional Program for Worker Health (RPWH) has promoted and implemented a "Strategy for Developing Healthy Workplaces in Latin America and the Caribbean".
The goal of this strategy is to extend health promotion programs to the workplace and to support those initiatives that are already in progress. In order to make this goal tangible, a Tool Kit has been developed in a Latin American context.
This tool kit is based on a holistic approach proposed by PAHO´s RPWH in May of 1999, which considers not only the control of workplace risk factors and their health effects, but also the economic, organizational, psychosocial and community factors (such as adequate and sustainable living conditions) that affect workers’ wellbeing. (ref. 2). The toolkit is directed toward workers in both the formal and informal sectors of the economy.
The content oriented to the formal sector was developed in Central America, while that of the informal sector was prepared in Bahia, Minas Gerais, Brazil. This paper will focus on the experience of the formal sector. Given the need for participation and consensus to achieve a healthy workplace, a local multisectorial structure has been proposed for developing this initiative. This coordinating body has been named the "Facilitators Team" and the tool kit is the instrument that will guide their work.
The first task was to review and learn from other workplace health promotion experiences. Based on this review, four original modules were prepared by PAHO´s external consultants from Nicaragua and Costa Rica in consultation with colleagues from WHO, Geneva. The modules were presented at a workshop in Nicaragua, where the form, content and vision of the tool kit were discussed and reviewed by 32 participants from different sectors nationwide.
After the modifications proposed during the workshop were added, a second version consisting of eight modules was prepared. This new version was reviewed by 20 male and female workers from the tobacco industry in Estelí, a city 140 Km north of Managua. They were asked to consider the appropriateness of the language and the possibility of implementing the strategy in their workplaces. At the same time, a field test of the methodology proposed in the tool kit was implemented in two tobacco factories in Esteli. This exercise provided a concrete and practical demonstration of the healthy workplace approach. It was carried out by a local, multisectorial team with the participation of officials from the Ministries of Health, Labor, and workers’unions, who became members of the Local "Facilitator Team" of Esteli. The workshop and practical activity were supported by PAHO´s office in Nicaragua and took place between October and November of 2001.
In December 2001, a new eleven module version of the tool kit was presented at an International workshop held during the third international Symposium on Workers Health, sponsored by the "Instituto de Salud de los Trabajadores" (INSAT: Workers Health Institute), in La Habana, Cuba. The revised version contained observations from the workers and an analysis of the practical exercise conducted in Estelí. At the workshop, twenty-nine participants from different disciplines and twelve countries reviewed and commented on the material. The modifications and suggestions have been incorporated in a new version of the kit that will be tested in four Central American work sites over the next twelve months and expanded to other countries in the region at the end of this trial period.
The tool kit consists of eleven original modules, twelve subsidiary manuals and thirteen videos. The manuals and videos are in a CD format and were prepared by the Health and Safety Office of the ILO (Project INT/97/MO/ITA) with Italian financial support. This set of materials should provide guidelines on how to implement a workplace health promotion program. Each Module includes the following sections:
I. The Purpose of the Module
II. How to use the Module
III. The Objectives of the Module
IV. Introduction
V. Content
VI. Appendix
Several cross-cutting issues, such as gender and health promotion, are found in all of the modules.
MODULE ONE
The Tool Kit for Developing a Healthy Workplace
This module describes the background and organization of the tool kit, its conceptual framework and an introduction to the other modules.
MODULE TWO
Guidelines for the Facilitator Team
This module provides guidelines for the Facilitator team on how to implement a healthy workplace initiative. It defines the roles and responsibilities of the team, the teaching materials available for their use and the target population.
MODULE THREE
Building a Healthy Workplace Step-by-Step
This module outlines a step-by-step methodology for how to develop a Healthy
Workplace at the local level for national authorities in Worker Health and Safety
and the Local level Facilitator Team. The module also contains monthly, biannual
and annual evaluation guides for use in measuring progress in each work site.
MODULE FOUR
Training plan for implementing a Healthy Workplace
This module outlines the content of training to be provided by the Facilitator Team for managers and health and safety committees in the workplace. It includes information on the legislative framework for health and safety, potential health risks and how to control or prevent them and participatory strategies for achieving a healthy workplace
MODULE FIVE
Conditions of the work environment Guidelines for conducting a workplace needs
assessment
This module contains technical information on how to describe the work process and identify potential risk factors. It also includes guidelines for assessing the costs and benefits of potential interventions.
MODULE SIX
Health promotion in the workplace
This module is prepared for all target populations and explores the implications of implementing workplace health promotion programmes: benefits, obstacles and potential challenges and how to overcome them.
MODULE SEVEN
The important role of decision-makers in workplace health promotion
This module, designed for enterprise decision-makers (e.g. owners and managers), aims to sensitize this audience on the benefits of investing in workplace health promotion, such as financial savings on health care and disability and increased productivity.
MODULE EIGHT
The Investment in Workers Health and
Safety (Aspects related to Cost Benefit Analysis)
This module is designed to gain support among enterprise decision-makers for workplace health promotion. The content includes an exercise that estimates the hidden expenses caused by absenteeism due to illness, disease and workplace accidents.
MODULE NINE
Worker´s Health Brigade in workplace health promotion
This module can be used for all target populations, but it is designed primarily for workers. Since the workers are the main protagonists in this process, it is recommended that worker’s health brigades be established to coordinate their participation.
MODULE TEN
Overview of workplace risk factors
This is a module prepared especially for the workers. It describes the risk factors in different workplaces in simple language. It is recommended that the Facilitator team use this module as a complement to Module FOUR when training workers.
MODULE ELEVEN
Occupational Health Services in the work place
This module aims to guide the Facilitator Team in how to assess the health services in a workplace where the initiative is being implemented. The module proposes a model service for two potential scenarios: presence of an on-site health service or provision of health services by an external service.
In conjunction with the eleven modules outlined above, the tool kit proposes to use twelve educational modules prepared by the ILO and listed below:
Instructor Guide
- An Introduction to Health and Safety in the workplace
- The Body and Work
- Fighting workplace health risks
- Noise at Work
- Chemical compounds in the workplace legislation and its enforcement.
- Workplace legislation and its enforcement
- AIDS in the workplace.
- Ergonomics
- Health and Safety Committees in the workplace.
- Reproductive Hazards among Males and Females in the Workplace
- Health and Safety for Women and Children in the Workplace.
The Facilitator Team should use these materials as a guide on conceptual, technical, methodological and organizational issues in building a Healthy Workplaces. The following three groups are the protagonists in developing the strategy:
1. Managers or Enterprise owners
2. Members of the workplace health and safety committee
3. Workers
The development of a healthy workplace demands the active participation of all sectors, and in this tool kit, the participation of workers and managers in conjunction with government officials is strongly recommended.
The healthy workplace approach has two primary strategies that guide the process:
1. Seek endorsement from enterprise owners and managers by demonstrating that
workplace health promotion is possible, beneficial and sustainable.
2. Promote empowerment of the workers and their active participation in the
development of the initiative.
This Tool Kit provides a comprehensive approach to workplace health promotion, acknowledging the physical, psychosocial and organizational and community issues that impact workers’ health. It also emphasizes the primary role of workers in guiding the process. Workers will take charge of most of the health promotion activities, with the support and supervision of the Facilitator Team.
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With this Tool Kit, it is expected:
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Maritza Tennassee
Regional Advisor in Occupational Health Environmental Quality Program
Division of Health and Environment
Pan American Health Organization
World Health Organization
525 23rd Street, N.W.
Washington, DEC 20037-2895
Telephone:+(202) 974 3307
E-mail: tennassm@paho.org
Rafael Amador R.
External Consultant
Environmental Quality Program
Division of Health and Environment
Pan American Health Organization
World Health Organization.
Nicaragua
Tel:+(505) 277 0456
+(505) 88 6 32 38 (mobile phone)
E-mail: rjamador@hotmail.com
rjamador@cablenet.com.ni
Maria Antonieta López
External Consultant
Environmental Quality Program
Division of Health and Environment
Pan American Health Organization
World Health Organization
Costa Rica
Departamento de Medicina Preventiva
Caja Costarricense de Seguro Social
Promoción de la Salud
Tel:+(506) 223 8948
E-mail:medprev@info.ccss.sa.cr
Rene Mendes
External Consultant
Environmental Quality Program
Division of Health and Environment
Pan American Health Organization
World Health Organization
Federal University of Minas Gerais
School of Medicine
Department of Preventive and Social Medicine
Division Of Occupational Health
Av. Alfredo Balena, 190 — 10th floor
Belo Horizonte-MG-CEP 30130-100- Brazil
Tel +(55)(31)3248-9816
E-mail:rene.mendes@uol.com.br
Merri Weinger
Environmental Health Advisor
United States Agency for International Development
GH/HIDN/EH — RRB, 3rd Floor
Washington, DC 20523-3700
Tel+( 202) 712 4531
E-mail:mweinger@usaid.gov
1) OPS/OMS: Estrategia de Promoción de la Salud en los lugares de trabajo de América latina y El Caribe. San José Costa Rica, Marzo 2000.
2) Idem anterior