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Home > Vol 14, No 4 (2014) > Sadeghi

JRHS 2014; 14(4): 282-286

Copyright© Journal of Research in Health Sciences

The Effects of Prioritize Inspections on Occupational Health Hazards Control in Workplaces in Iran

Fatemeh Sadeghi (MSc)a, Abdolrahman Bahrami (PhD)b*, Farin Fatemi (MSc)a

a Occupational & Environmental Health Center, Ministry of Health & Medical Education, Tehran, Iran

b Center of Excellence for Occupational Health, Research Centre for Health Sciences, School of Public Health, Hamadan University of Medical Science, Hamadan, Iran

* Correspondence: Abdorrahman Bahrami (PhD), E-mail: bahrami@umsha.ac.ir

Received: 16 June 2014, Revised: 30 August 2014, Accepted: 27 September 2014, Available online: 02 November 2014

Abstract

Background: Iran, a newly industrializing country in Middle East, has a workforce of 25 million people. Most employees are working in agriculture, manufacturing, services, construction, commerce sectors, carpet weaving and mining. This article aims to explore the improvement of occupational harmful agents in workplaces due to implement “prioritize inspections”.

Methods: In 2012, the system of "prioritize inspections "was defined for surveillance on enterprises replace of routine inspection. From this system, the enterprises classified on four groups based on health hazards and enterprises with high risk were under more surveillance. The information about each enterprise was collected by health centers, in five provinces and reported by a recommended form to Centre of Environmental and Occupational Health (CEOH). At this program, the inspections from high and medium hazards were increased in all of provinces.

Results: The results showed there was a significant difference between the control of health hazards in before and after beginning of “prioritize inspections”(P=0.048). The control of noise, fumes and providing of proper illumination increased from 8 to 10%, 9to 9.5%, 12.9 to 15.4%, respectively, at under study provinces in 2012 compared to 2011.

Conclusions: The surveillance based on “prioritize inspections” increased the quality of occupational health inspections that causes to prevent occupational health diseases.

Keywords: Occupational Health Service, Prevention, Control, Education

Introduction

Iran, 18th-largest country, is in Middle East. Iran is an ethnically diverse country and has a population of around 79 million1. As of 2004 the industrial sector, which includes mining, manufacturing, and construction employed 31% of the labor force2. Iran is producing artisanal goods and persian carpets have a good quality and famous in all of the world3.

There are 2.5 million enterprises in Iran, and about 95% of them have less than 50 employees distributed throughout the country 4.

Ministry of Cooperative Labor and Social Welfare and Ministry of Health and Medical Education (MOHME) involve in occupational safety issues in the country such as enforcement of occupational safety standards, inspection and promotion of safe working environment 5.

The Centre of Environmental and Occupational Health (CEOH) at MOHME takes measures to prevent and control health hazards at work. In health system of Iran, the occupational health is integrated in primary health care at 1996 and enterprises are under inspection. Occupational health services include measuring and controlling the harmful agents of workplaces and medical examinations of employees that are provided by private or public sector to employers.

Primary health care in rural areas are provided by health house and at industrial areas for small enterprises is labor health house. Health houses refer to health centers. These cover about 1500 people in rural areas. A rural health center has one to two physicians depending on the population, as well as a number of health technicians. The health centers refer to district general hospitals. These houses, centers, and hospital constitute a network that covers all rural areas 6.

Few studies reported the status occupational health and safety in Iran. Vigeh et al. reviewed occupational health and safety organization activities, also reported research, and occupational health education in Iran 7.

According to regulation, since 2001 it has been compulsory to employ occupational health and safety engineers, by enterprises, depending on the number of workers and the degree of risk by which the plant is classified. Small enterprises, less than 20-49 workers obliged to employ Behgar 8.

There are 1700 occupational health and safety inspectors employed by the MOHME and Ministry of labor at the district and county levels 9.

There is approximately one government inspector for every 1100 workers exposed to occupational hazards 4, 9. However, because of rapid industrialization in urban areas, most township enterprises cannot obtain occupational health services. To compensate for the lack of inspectors a program of “prioritize inspections” was created in 2012.

This study describes the "prioritize inspections" system that has begun from 2012 in whole enterprises in Iran and to evaluate the effects on this program. We compare the control of chemical, physical agents over 2011 and 2012 that is, before and after beginning of priority in inspections.

Methods        

To make prevention and control of health hazardous and promotion in surveillance, the enterprise inspections for occupational health inspectors were classified based on hazardous agents from 2012. We started this method for inspection at whole of country but the results from five provinces reported at 2013. According to this program, all of enterprises divided in four groups:

Group I: Enterprises with high occupational hazards include agents that can cause serious poisoning, cancer, reproductive or developmental disorders, strong allergic reaction, delayed immunological reaction, and death. These enterprises must be inspected at least three times by occupational health experts in each year until the hazards be controlled otherwise the surveillance should going on.

Group II: Enterprises with moderate occupational hazards include agents that can be controlled and that do not have high effects to human health.

Group III: Enterprises with low occupational hazards include inert agents. The enterprises in groups II and III must be inspected at least, two and one times respectively by occupational health experts.

Class IV: Small enterprises in rural areas, small private factories, downtown and village enterprise inspected and made a training program in primary health care by community health workers that named Behvarz and Behgar.

Behvarz: The community health workers are selected by the community with specific criteria, including the requirement that they are secondary school graduates. Then they are sent for training for two years at the Behvarz Training Centre, which exists in each district.

Behgar is selected among workers at ten to fifteen enterprises with 20-49 workers and have been trained for six months about occupational health.

Deputy of Health in each province, groups all of enterprises for inspection by occupational health experts. They also recognize new industrial and can change the least of enterprises in each groups based on control of health hazards. The inspection to small enterprises was limited to one time in year, and whenever the workers have complained from manufacture owners. In some of small enterprises that are in group I and II, the inspectors at health centers in each province should inspect until the health hazards have been controlled. 

All levels of Health Centre under the CEOH collaborate in the reporting of workplace hazards control and occupational health condition in small and large workplaces. The health inspectors in each health center use a recommended checklist to survey workplace conditions and the data collected in provinces and finally report to CEOH. In order to prepare of data, there are several supervising teams, which are organized in CEOH. These teams include experienced occupational health experts that supervise on the performance of inspectors, registry system and data reporting in different parts of country.

In this study, five health centers were participated and prepared their reports on time. The data were analyzed by using the Statistical Package for Social Science (SPSS). Comparison between the control of chemical and physical agents over 2011 and 2012 was performed by one-way ANOVA test.

Results

Table 1 shows the number of inspections before and after the program of “priority of enterprises inspection” in five provinces. The amounts of inspections at enterprises group I, II, and III were increased about 10 to 50% at different provinces at 2012 compare to 2011.The ratio of inspection to enterprises at 2012 were bigger than 2011. At these provinces, the amounts of enterprises in group I, II and III were 4950, 28170, 11138 respectively at 2012 and workers were in risk and exposed to high occupational hazards and inspection at 2012. The Isfahan Province is an industrial city with 9991workplaces and Ilam with 266 is the lowest in Iran.

Table 2 shows the amounts of enterprises that control concern to physical, chemical agents and apply of ergonomic before and after the inspection priority. There was a significant difference between the control of health hazards before and after the beginning of the new program "prioritize inspections" (P-value=0.048). In all of provinces except Isfahan, we have progress in control of noise pollution. Some states such as Ilam, Fars and Zanjan have better progress in physical and chemical control but in some states such as Isfahan and West Azerbaijan were not any difference between before and after the beginning of priority inspection. In addition, the total compliance rate of work sites regarding chemical agents before was 41%. After the beginning of the program, the compliance rate for chemical agents at work sites increased up to 45%. The noise control the work sites with noise pollution above 85 dB (A) were 23% at 2011 and decreased to 20% at 2012.

The control of ergonomic at workplaces after the implication of "priority inspection" at 2012 was 1.23 more than 2011 and ergonomics posture was made promotion.

Table 1: Number of enterprises, inspections, and criteria (inspection /enterprises) over before and after of prioritize inspection

Table 2: Comparing of control of health hazards at before (2011) and after (2012) of prioritize inspection

Discussion

This study was undertaken to evaluate the effects of “prioritize of inspection” based on the control of occupational health hazards such as harmful physical and chemical agents and apply of ergonomic at workplace. The implementation of prioritize on inspection at workplaces for occupational health hazards cause to more surveillance to high risk jobs and cause to increase control of health hazards. This program was achieved for all of enterprises at Iran. The inspection of enterprises for occupational health was achieved at primary health care in Iran. The Behvarz is responsible at rural area for training occupational health to agricultures, small enterprises such as carpet weavers.

To support the occupational health program for small enterprises, the CEOH gave license to private agencies for foundation centers of occupational health training. The inspection to small enterprises was limited to one time in year and whenever the workers complain from manufacture owners. In some of small enterprises that are in group I and II, the inspectors at health centers in each province should inspects until the health hazards have been controlled. 

Medium enterprises with employees between50-500 employ a part time or full time occupational health expert depend on kind and risk of health ha zards. The large workplaces more than 500 employees were obliged to hire specialized professionals at CLH (Center of Labor Health) in order to provide the necessary occupational health services. CLH should have at least one occupational medicine physician, occupational hygienist, Nurse. There are 317 CLH and 1990 Workers Health House in Iran. There are 1050 occupational health experts inspectors employed by the MOHME Workplace visits by an inspector are typically unannounced and, by law, an inspector must be granted access to enter and access all areas of the workplace. There are about 2.8 million enterprises that 95% of them have less than 50 workers and some are self-owners 4.

The results of current study showed large differences between number of inspections and control of health hazards among five studied provinces. The number of inspectors in Iran are not matched with amounts of large enterprises and industrial state, for instance in some small provinces such as Ilam has 33  inspectors with 284 enterprises(group I,II,IV) but the great industrial provinces such as Isfahan has 96 inspectors with 12445 enterprises(group I,II,IV). Therefore, it was expected that in non-industrial province we have more inspection and get better control of health hazardous.  

At present, many current health hazards in workplaces, such as silica, lead, gases, fume or unsafe work practice, still exist. All of these health risk factors cannot be eliminated or controlled effectively. On top of that, working organizations are also changing from large-scale enterprises to small-scale enterprises and are changing from formal employment to contract or informal employment. All of these kinds of working populations make the management of occupational health and safety more difficult. Through implementing “prioritize inspections” program, we have more surveillance to the mentioned workplaces. Although the active surveillance program has been conducted throughout the country for years, the scheme still faces many problems such as lack of staff and equipment, poor cooperation with employers, and poor coverage of some programs.

Pesticide poisoning among farmers is still one of the major health problems in Iran although MOHME put a lot of effort to control the problem. The Behvarz in rural area is responsible to training of environmental and occupational health to farmers. The implementation of occupational health included health education, alternative methods for pest control, and using of health books for individual self-assessment.

Silica is an important chemical hazard and produce in some mining in different area in Iran using in glass factories, foundry operation, sand blasting, ceramics, water treatment and porcelain articles throughout the country. Silica has been controlled in the most of enterprises with designing of industrial ventilation in Iran but still the concentrations of silica in some workplaces were more than Iranian OEL10. Volatile organic compounds (VOCs) are widely spread in the environment and produced by petrochemical industries and petroleum refineries. Benzene is a carcinogen compound, along with other aromatics is widely used in petrochemical and refinery units and some reports showed that concentrations is more than other compounds 11-12.

The use of different asbestos in Iran began about sixty years ago, and 1970s decade, it was being widely used in manufactures including cement, pipe, brake and clutch industrial. The Iran Environmental Protection Organization tried to ban all major uses of asbestos in 2011, but still the little asbestos use remains in cement sheet 13-14.

In a study by Choobineh et al., the musculoskeletal problems among 454 workers of an Iranian Rubber factory were investigated. The most of workers (73.6 %) had suffered from some kinds of musculoskeletal symptoms over a year. The highest prevalence of the musculoskeletal problems was reported in the lower back (52.2%), knees (48.5%) and upper back (38.1%). Low back pain is a most important problem in the Iranian workers. Age, gender and kind of work physical as well as psychosocial factors have effect to the prevalence of LBP L15-18.

In the Iran, hearing loss is the common occupational disease among workers exposure to hazardous noise. The textile manufacturing industries have noise pollution more than permissible exposure limit in the the workplaces 19 and about 0.5 million workers are exposed to hazardous noise each year and 15-20% of these workers has hearing loss 20.

Iran has a long tradition of producing artisanal goods including, ceramics, brassware, glass, leather goods, textiles, persian carpets, copperware, and wooden artifacts. An estimated 1.2 million weavers in Iran produce carpets for domestic and international export markets 3. Like other informal small-scale industries around the world, this industry also faces occupational health problems and weavers have been an under-served population. Most health problems in this sector originate from ergonomic risk factors. Any improvement program in this industry should therefore focus on the ergonomic aspects of hand-weaving operation.

Conclusions 

This paper has briefly introduced the priority inspection in Iran. This innovative program began in 2011 in Iran. The implication of this program cause to have more surveillance at workplaces and control of chemical, physical and ergonomic in work places increased.

To continue the development of occupational health and safety counter measures in Iran the authorities strengthen the management of occupational hygiene; motivate the government to improve regulation for occupational health program.

Acknowledgements

The authors appreciated to health deputies and the occupational health inspectors that participate in this survey.

Conflict of interest statement

The authors declare that they have no conflicts of interest in the research. All Financial source of the study was provided by Ministry of Health and Medical Education.

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