June 27, 1991

The following is our response to the ILO questions you requested that the Directorate of Compliance Programs answer.

6.1 Are public health and medical services covered by occupational health and safety legislation and subject to inspection by labor or occupational health and safety inspectorate in the same way as private sector employers?

Answer: The Occupational Safety and Health Act of 1970 excludes public sector employees from federal OSHA coverage. Therefore, in the states which are covered solely by federal OSHA regulations, public sector employees, such as employees in state or municipal hospitals, are excluded from coverage. Twenty-one states have their own state occupational safety and health programs which are overseen, monitored, and partially funded by federal OSHA. Public sector employees in those states are covered by the state occupational safety and health regulations. Two federally covered states, New York and Connecticut, have partial state plans which cover their public service employees only.

6.3 (a) According to statistics of occupational accidents and

diseases, what are the major hazards facing the staff of health and medical services?

Answer: Approximately 12,000 cases of Hepatitis B infections occur annually in health care workers who have occupational exposure to blood or other potentially infectious body fluids. 500-600 hospitalizations and 200 deaths result each year. Other infectious diseases, including exposure to the tuberculosis bacteria, also pose a risk.

Other hazards to the medical profession include ergonomic hazards (eg. back injuries), radiation hazards, exposure to hazardous chemicals such as ethylene oxide and waste anesthetic gases (potential teratogenic hazards) and cytotoxic drugs, exposure to as yet undetermined hazards from a variety of new treatment agents including aerosolized pentamidine for the human immunodeficiency virus, stress resulting from rotating and prolonged work shifts, and electrical hazards.

(b) What measures have been taken to reduce or eliminate these hazards?

Answer: In 1989, OSHA published a proposed rule on occupational exposure to bloodborne pathogens and began applying a number of general industry standards and the General Duty Clause of the OSH Act to the hazards of bloodborne disease. Federal OSHA has conducted approximately 1000 inspections, mostly in health care facilities, to determine compliance with the Centers for Disease Control recommendations, including the use of universal precautions.

In 1988 the National Institute of Occupational Safety and Health (NIOSH) compiled in one volume all guidelines for protecting the safety and health of healthcare workers. For many hospitals this initiated a concerted effort to develop hospital safety and health programs.

Measures are in the developmental stages to establish methods to deal with ergonomic hazards such as back injuries which are prevalent among health care workers.

6.4 What new hazards have appeared in recent years? Describe any preventive measures, including training, already taken or planned in this context.

Answer: The Human Immunodeficiency Virus is a relatively recent hazard to workers occupationally exposed to blood and other body fluids. Both the proposed regulation and the current enforcement under the General Duty Clause include training employees in the epidemiology and symptoms of HBV and HIV, the modes of transmission of the two diseases, the employer's infection control program including engineering controls and work practices that are to be used, proper selection and use of personal protective equipment, the benefits of the hepatitis B vaccine, procedures to follow if an exposure incident occurs, and the meanings of the various signs, labels, tags, and color coding used to denote biohazards.



June 5, 1991

This is to request that you respond to the highlighted sections of the attached ILO questionnaire concerning health and medical services. These responses will be included in a report which will be discussed at a meeting scheduled for 1992 in Geneva.

Please provide your responses to Pat Neale, Room N3641, by c.o.b. June 21. Your assistance is appreciated.

Attachment

Ref. BIT/ILO IC 12-0-7-02-3

Votre ref.

The Director-General of the International Labour Office presents his compliments to the Governments of States Members of the International Labour Organisation and has the honour to request them to be good enough to supply information for inclusion, in summarised form, in the General Report and in the technical report to be submitted to the First Session of the Standing Technical Committee for Health and Medical Services. At its 246th Session (May-June 1990) the Governing Body of the International Labour Office decided to include this meeting in the programme of industrial meetings for the 1992-93 biennium and it is expected to take place at the International Labour Office, Geneva, from 23 September to 1 October 1992.

The agenda, as decided by the Governing Body at the same session, is as follows: 1. General Report.

2. Equality of men and women in health and medical services. In accordance with paragraph 22 of the document entitled "Purposes and Functions of Joint Committees" adopted by the Governing Body at its 235th Session (March 1987), the Office will prepare a report for each item on the agenda of the session. These reports should contain an analysis of the existing situation in the sector or categories concerned and for this purpose the Office is required to address a request for information to the States Members of the International Labour Organisation, asking them to provide as full a reply as possible.

In addition, paragraph 22 of the above-mentioned document states that governments should be requested to consult the national organisations of employers and workers concerned when preparing their reply, to list in their reply the organisations consulted and to transmit any observations made by them.

A questionnaire is enclosed to assist government services, as well as the employers' and workers' organisations to be consulted by them, in providing the information needed.

Bearing in mind the time required for analysing the information received and for the preparation, translation, reproduction and dispatch of the reports, it would be greatly appreciated if governments would ensure that any information that they are good enough to supply in response to this request is forwarded at their earliest convenience, but in any case so as to reach the Office not later than 15 August 1991. Replies should be sent to: The Director, Sectoral Activities Department, International Labour Office, CH-1211 Geneva 22.

The Director-General of the International Labour Office avails himself of this opportunity to renew to the Governments of States Members of the International Labour Organisation the assurances of his highest consideration.

 

The purpose of this questionnaire is to collect information for the preparation of the reports to be submitted to the First Session of the Standing Technical Committee for Health and Medical Services, scheduled to take place in Geneva in September 1992, updating that gathered for the report submitted to the 1985 Joint Meeting on Employment and conditions of Work in Health and Medical Services. At the First Session in 1992 there will be a general report and one technical report on equality of men and women in health and medical services.

The questionnaire covers all health personnel as defined by the World Health Organization (doctors, dentists, nurses, pharmacists, auxiliaries, assistants and technicians) and other personnel employed in medical and health services.

Organisations representing the various categories of personnel should be consulted in the preparation of your reply, as should the health and medical services (or organisations of employers, where appropriate), in order to facilitate the most accurate and complete reporting possible. Any relevant information which may be obtained from departments responsible for health and/or gender equality would also be greatly appreciated.

If you provide legislative texts, statistics or other documents, please indicate to which questions they refer. Your cooperation in sending us your reply in one of the three official languages of the ILO (English, French or Spanish) by 15 August 1991 will greatly assist us in producing comprehensive reports and in ensuring that participants in the meeting receive them in time.

1. Tripartite collaboration

Which workers' and employers' organisations were consulted in the preparation of your reply?

2. Employment

2.1 (a) Please provide data on the numbers employed in the health and medical services over the last ten years, broken down, as far as possible, by occupation, sex, sector of the economy (public or private), contractual status (permanent or temporary), and whether employed full-time or part-time.

(b) What factors underlie the changes observed over the last ten years?

2.2 Please provide any forecasts of future employment trends and comment on the factors underlying the expected changes.

2.3 Please indicate the percentages of men and women in each occupation and, if possible, at each grade within the occupation. What changes have been observed over the last ten years?

2.4 Please provide any comparable data available on career progression of men an women in the various occupations, e.g. the number of years taken on average to gain promotion, the number of promotions obtained over a given number of years.

3. Labour relations and the determination of conditions of employment

3.1 Do all employees in the health and medical services have the right to establish or join organisations of their own choosing? Please give details of any restrictions and of any changes in recent years.

3.2 Please give the names of the main organisations representing employees of the health and medical services, specifying the categories which they cover.

3.3 (a) Please provide any data available concerning the participation of women employees in such organisations.

(b) What have these organisations done to promote equality of opportunity both in the workplace and within the organisations themselves, particularly as regards the status of women in predominantly male occupations?

3.4 Do employees in the health and medical services have the right to take industrial action? Please give details of any restrictions and of any changes in recent years.

3.5 Are conditions of employment in the health and medical services determined through collective bargaining? If so, please provide details. If not, please specify what procedures are used, noting in particular any differences between services in the public and those in the private sector.

4. Working time and the content and organisation of work

4.1 (a) What are the daily and weekly working hours of the various categories of staff and have there been any changes in recent years? Wherever possible, please indicate both the standard hours and the actual hours worked including overtime.

(b) In the case of staff who have periods on call in addition to their regular duties, such as junior hospital doctors, please indicate the total hours they may have to work and, where available, the hours actually worked (the average and, if possible, the frequency distribution).

4.2 Please give details of rest breaks during the working day and of weekly rest periods, both the statutory minima and the actual practice if different.

4.3 What arrangements apply in the case of overtime, shift work, night work, and work at weekends and on public holidays? Are the staff concerned compensated by extra time off or additional remuneration?

4.4 Please give details of paid annual leave and public holidays, indicating any changes in recent years. Do any categories of staff (e.g. temporary employees) receive different treatment? If so, please specify.

4.5 Are there any differences in working time arrangements between men and women in the same occupation? Are there any differences between predominantly male and predominantly female occupations?

4.6 Do any categories of staff enjoy flexible working hours? Please give details.

4.7 Are there any special working time arrangements for workers with family responsibilities, e.g. reduced hours, part-time work, job-sharing, leave to look after a sick child, career breaks for child care? To what extent do men benefit from these arrangements?

5. Remuneration

5.1 For the main categories of staff please indicate minimum and maximum pay rates and, if available, actual average earnings.

5.2 Please provide separate figures for the earnings of men and women in each occupation, commenting on the factors underlying the differences observed. How have these differentials evolved over the past ten years?

5.3 What differences, if any, may be observed between pay in public health and medical services and pay in comparable jobs (both skilled and unskilled), in the private sector? Has the relative position changed in recent years?

5.4 Do the health and medical services suffer from problems such as staff shortages, high turnover, absenteeism, emigration, etc., and, if so, what are the main reasons (conditions of work, remuneration, etc.)?

5.5 What measures have been taken or contemplated to upgrade low-paid jobs in the health and medical services?

5.6 Please give details of housing, transport, canteen, child-care and other welfare facilities provided for staff. To what extent do these facilities promote the equality of men and women in the health and medical services?

6. Occupational health and safety

6.1 Are public health and medical services covered by occupational health and safety legislation and subject to inspection by the labour or occupational health and safety inspectorate in the same way as private sector employers?

6.2 What role do staff and their trade union representatives play in occupational health and safety matters?

6.3 (a) According to statistics of occupational accidents and diseases, what are the major hazards facing the staff of health and medical services?

(b) What measures have been taken to reduce or eliminate these hazards?

6.4 What new hazards have appeared in recent years? Describe any preventive measures, including training, already taken or planned in this context.

6.5 Have staff members disabled by a work-related accident or disease experienced any problems in obtaining the appropriate compensation?

7. Training. retraining and gender equality

7.1 What measures have been taken to increase the number of women entering traditionally male dominated professions in the health sector?

7.2 What opportunities do women in the health and medical services have to upgrade their skills through further training?

7.3 Have new career paths been introduced for occupational groups such as nurses and auxiliaries in order to improve their promotion prospects and to permit moves from one occupation to another?

7.4 Are there special retraining provisions designed to help women returning to employment in the health and medical services after a period of caring for children?

7.5 Please provide information on any issue which you feel is relevant to the equality of men and women in health and medical services.

Please send your reply to this questionnaire to: the Director, Sectoral Activities Department, International Labour Office, CH-1211 Geneva 22, by 15 August 1991.