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Occupational health in the Philippines

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OCCUPATIONAL HEALTH IN THE PHILIPPINES

Elma B. Torres, B.S.ChE., M.Eng (Environmental)

Consultant
Health Safety and Environmental Management Consultancy Services, Inc.
404 Amberland Plaza, Julia Vargas Ave. Ortigas Center, Pasig City 1600,
Philippines
Telephone No. +632 6317202
Fax +632 7474258
Email Address: ebtorres@starnet.net.ph, elmatorres@edsamail.com.ph

Ian A.Greaves, MB BS, FRACP, FAAAS

Associate Professor, Environmental and Occupational Health, and
Associate Dean for Research, School of Public Health
University of Minnesota, Box 197, 420 Delaware St. S.E.
Minneapolis. MN55455
Telephone No. +612 6246669
Fax +612 6266931
Email Address: igreaves@umn.edu

Joselito L. Gapas, MD, MPH

Chief Medical Officer
Pilipinas Shell Petroleum Corporation
146 Valero St. Salcedo Village, Makati
Philippines
Telephone No.: +632 8166501(loc 6546)
Fax +632 8166218
Email Address: lito.l.gapas@shell.com.ph

Teresita T. Ong, MD, MOH

Assistant Professor, Department of Environmental and Occupational Health

College of Public Health, University of the Philippines Manila
P.O. Box EA 460, Ermita Manila 1000, Philippines
Telephone No.: +632 5247102
Fax +632 5237745
Email Address: tt_ong@lycos.com
Occupational Health in the Philippines

1. Demographic Trends of the Labor Force

The population of the Philippines in 2000 was 75.33M, comprising about 15 M households with an

average of 4.9 persons per household. The average annual growth of the population stands at 2.02

percent from 1995 to 2000, one of the highest growth rates in Southeast Asia (1). Some forty percent of

Filipinos reside in the National Capital Region (Metro Manila Area) and the neighboring regions of Central

Luzon and the Southern Tagalog where economic development is mainly centered. Six out of ten

Filipinos are 15 years or older, however, only 65 percent (31.8M) are participating in the labor force. Of

this number, only 88.9 percent (28.4M) are gainfully employed, and 17 percent (4.8M) of those are

underemployed. A survey of those employed in 2000 indicated half (14.2 M) are wage and salary

workers, 37 percent (8.5M) are self-employed, while a smaller proportion (12% or 3.3M) comprise unpaid

family workers. More than half (54.6%) of those employed live in the rural areas (2).

A considerable change in the share of employment among industry groups has been noted. In 1995, the

agriculture, fishery and forestry sectors had the highest share of employment at 43%. However, the

profile changed in 2000 when the services sector accounted for the bulk of employment of the Filipinos.

Particularly revealing is the educational profile of the labor force: the largest fraction (40 percent or

11.4M) have an elementary school education only; 37 percent (10.8M) have a high school education; and

23% (6.7M) have a college education. This suggests an abundance of unskilled labor in the country (2).

The increasing participation of women and children in the labor force in recent years has been a major

concern in the practice of occupational health and safety (OHS). Thirty-seven percent (28.3M) of those

employed in 2000 are females. There are no official statistics for the number of child laborers in the

country, but children are working in small agricultural plantations, land and sea mining, and small-scale

chemical industries. Of other national concern is the increasing number of Overseas Filipino Workers
(OFW). The OFW serve as a major source of foreign currency in the country. In 1999, 4.6M OFWs were

officially deployed, most of whom were in the Middle East (Saudi Arabia) and Asia (Hong Kong, Japan

and Taiwan) (3). Many OFWs report unsatisfactory working conditions resulting in various occupational

injuries and diseases, as well as psychological stresses from physical and sexual abuse.

Labor statistics in the country suffer from serious deficiencies. Many workers are not duly registered and

therefore are not included in the labor force survey (“informal sector”). Among the “informal” working

groups are jeepney and tricycle drivers, households engaged in street vending and contract growing

(agricultural), and those engaged in small crafts such as dressmaking, fishing, and weaving. It has been

reported that the bulk of the informal sector are found in urban centers of the country and are usually

unprotected from hazards in their workplace.

2. Hazardous industry groups

Considerable health and safety concerns are reported in the construction, agriculture, manufacturing,

transportation and services industries. Based on the limited number of industries (less than 1 percent)

reporting to the Department of Labor and Employment (DOLE) in 1999, ergonomic hazards were the

most common form of hazard in the workplace (4). These ergonomic hazards were thought to arise from

prolonged standing or excessive physical work. The next most common hazards involved excessive

noise, and extremes of temperature and pressure. These health problems are compounded by the hiring

of contractual labor who perform functions similar to regular employees but are usually assigned to the

most hazardous operations. Because casual laborers are not eligible for social security, health

insurance, or other benefits, employers may evade the costs of those benefits by employing casual labor,

and they are not required to report the injuries incurred by casual labor.

Another OHS concern is the presence of working children in many hazardous industry groups such as

agriculture, manufacturing, mining and quarrying sectors. In 1999 about 1.51M or 14.7% of the total

number of families with children 5-17 year old allowed their children to be employed (5). This reflects the
serious poverty experienced by families in the lower 40 percent of annual income; allowing children to

work is the only recourse to augment family income .

For those establishments which reported the occurrence of injuries in the workplace in 1999, the

manufacturing sector prominently topped the list, followed by the agriculture sector and the construction

industry (4). The common injuries reported were contusions, cuts, concussion, and sprains. In the

manufacturing sector, many of the injuries occurred in the food and the leather industries. The common

diseases reported by the manufacturing industries were colds, “tension headaches”, amoebiasis and

diarrhea..

Commonly encountered health hazards in the agriculture sector are ergonomic problems, exposure to

chemical pesticides and other agro-chemicals, and the presence of disease vectors of malaria,

schistosomiasis and filariasis.

Although the mining and quarrying sector presents a relatively low injury rates, occupational diseases

from chronic exposure to chemicals, particularly mercury and cyanide, being used in processing ores are

not recorded and reported. Some small mining enterprises remain to utilize child labor in their operations

3. Specific industries difficult to regulate

The industry structure in the country is dominated by small and medium sized establishments many of

which accord low priority to OHS concerns as these equate to additional costs and investments on the

part of management. In 1995, of the total 494,000 establishments in the country, 90% (or 452,000) had

less than 10 employees (6). However, for this figure, some 20 percent (or 88,000 small-scale

establishments) are in the agriculture, mining and manufacturing sectors. Among industries that are

difficult to regulate are manufacturing sweat-shops, often using hazardous chemicals; small contracted

agricultural plantations with indiscriminate use and disposal of pesticides; and small-scale mining

operations where the use of less polluting technologies presents technical and financial challenges.
Occupational health regulation is basically constrained by the apparent lack of political will on the part of

government agencies at all levels, compounded by the limited availability of capable human resources for

program planning, implementation, monitoring, and regulatory enforcement.

4. History of Occupational Health and Safety (OHS) in the Philippines

The introduction of OHS in the Philippines can be traced to 1903-1913, wherein establishments rendered

medical services to their workers intended for treatment of illnesses and injuries (7). As a consequence,

industrial physicians increased in numbers since they were hired to do the tasks. It was not until 1923 to

1933 when the Section of Industrial Hygiene of the Bureau of Health and the School of Hygiene and

Public Health of the University of the Philippines was established. Legislation in OHS, such as Republic

Act 1054, also known as the Free Medical and Dental Law, provided emergency medical treatment to

laborers; employment of physicians and nurses and the establishment of dispensaries and emergency

hospitals were enforced (8).

People in the field of safety, from both the government and private sectors, formed a new group in 1960 –

Safety Organization of the Philippines, Inc. – in order to disseminate the principles of safety in industries

and other workplaces (9).

As a consequence of RA 1054, a group of company physicians formed the Industrial Medical Association

of the Philippines (IMAP) in 1966 and membership grew to over 300 physicians in the 1970s (10). The

Occupational Health Nurses Association of the Philippines (OHNAP) followed in 1969, but it was not until

1979 when the first basic course in OHS for nurses was offered (8). By the year 1974, the Institute of

Hygiene of University of the Philippines (UP) and World Health Foundation of the Philippines, Inc. jointly

conducted courses on Occupational Health and Safety for physicians, nurses and dentists (8). Two

years later, a Master in Occupational Health degree program was offered at UP College of Public Health

(formerly the Institute of Hygiene). Since 1979, the UP College of Public Health under the Department of

Environmental and Occupational Health is offering Postgraduate Course in Occupational Health and

Safety thrice a year.

In 1976, three occupational health associations merged to form the Philippine Occupational and Industrial

Medical Association (POIMA). These three associations were: the Industrial Medical Association of the

Philippines, the Philippine Association of Occupational Health, and the Philippines Association of

Compensation Medicine. In 1989, POIMA changed its name to Philippine College of Occupational

Medicine to better align its organizational identity to its objectives and activities (10).

Presidential Decree No. 626, otherwise known as the Employees’ Compensation and State Insurance

Fund, was made effective January 1975. This is a compensation package for public and private sector

employees and their dependents in the event of work-related contingencies (11).

The Occupational Safety and Health Standards, which is a codification of safety orders and other laws

pertaining to Occupational Health & Safety since 1936, was approved and promulgated on December 8,

1978. Its objective is to protect every working man against the dangers of injury, sickness or death

through safe and healthful working conditions (7). The standard also empowered the Department of

Labor and Employment (DOLE) or its duly authorized representatives to inspect establishments for

compliance with the provisions of the OHS standards.

A major blow was dealt to the effectiveness of the BWC in 1976 when then-President Ferdinand Marcos

abolished the ability of DOLE to fine companies for health and safety offenses. Although criminal

penalties against companies remained on the books, in practice these have been used very rarely. Since

1976, there has been virtually no regulatory enforcement of health and safety regulations in the workplace

through fines or criminal penalties (12).

In November 1987, a presidential fiat Executive Order 307 under President Corazon Aquino was made

wherein the Occupational Safety and Health Center (OSHC) was envisioned as the national authority for

research and training on matters pertaining to safety and health at work. The Center provides the

expertise and intervention mechanism to improve workplace conditions in the Philippines (9). Since

then, there has been an increase in awareness of OHS in the workplaces and as a consequence brought
about the rise of non-governmental organizations (NGOs). Among these is the Institute for Occupational

Health, Safety and Development (IOHSAD) which is a workers’ union-based group. The funding is from

the Australian Union Workers and it provides services including the training of workers, conducting plant

surveys with appropriate recommendations and OHS programs, free health services to the workers and

researches (13). Together with IOHSAD, other known NGOs working together towards the improvement

of OHS and labor’s rights have formed an umbrella organization called PhilOSHNet.

Organized labor is also present in the country, two of the largest of which are the Kilusang Mayo Uno

(First of May Movement) and the Trade Union of the Philippines. However, of the 28 million workers in

the recognized labor force, it is estimated that only 15 percent are organized. Although the main concern

of organized labor remains wages, non-monetary benefits such as health benefits and workers’ safety

have been included lately in collective bargaining agreements (CBA). However, in a 1995 survey of 100

CBA, less than half have included OHS components (12).

5. Regulatory Agencies and Their Effectiveness

5.1 Bureau of Working Conditions , Department of Labor and Employment

Under the structure of Department of Labor and Employment, the Bureau of Working Condition(BWC)

performs primarily policy and program development and advisory functions for the Department in the

administration and enforcement of laws relating to working conditions in all places of employment. Aside

from developing and prescribing OHS Standards, it also conducts inspections for proper observance and

enforcement of the statutory working conditions. The latter also includes technical examination of

equipment, materials and devices for safe use. Other functions of BWC include technical supervision over

its counterpart units in the regional offices of DOLE. Among its programs are the Workplace Initiative on

Safety and Health (WISH), and the Work-Accident and Labor-related Exigencies Response Team (Work-

Alert) (14).
Despite the fact that the BWC has accomplished a number of policy and program developments based on

the agency’s mission, there are some ongoing problems that need to be addressed. The BWC is beset

with major problems in enforcing the OHS standards. First, the number of labor inspectors is too small to

cover the total number of establishments in the country.

Second, only a very small fraction of business establishments report annual statistics on occupational

injuries and illnesses. For example, only a total of 3,028 establishments have submitted their annual

medical report (AMR) for 1999, 753 of which were from the National Capital Region (Metro Manila Area)

(4). Although this was an increase in the number of establishments reporting relative to previous years,
th
this doesn’t even cover (1/8 ) of the total number of establishments in the Philippines.

Third, there is the lack of enforcement powers of the agency. Because the BWC cannot penalize

offending companies, the BWC inspectors are limited to an “advisory” capacity and can only implement

written reminders and warnings for not complying; in effect, this makes compliance voluntary rather than

mandatory. It is believed that voluntary compliance by industrial establishments has remained low for the

past two decades.

5.2 Center for Disease Prevention and Control, Department of Health (DOH)

The Center develops guidelines in the prevention and control of occupational health diseases and training

programs on OH for health personnel of industrial establishments and local government units. The Code

on Sanitation of 1978 provides for the practice and implementation of industrial hygiene practices in the

workplace. However, its regulatory function is limited to recommending revocation/suspension of sanitary

permits of violating establishments to local government units. The DOH can enforce closure of an

establishment when there is a serious threat to the health of the workers and the community and when

the threat is national in scope (15). In practice, this regulatory function seemingly duplicates that of the

Department of Labor and Employment which is mandated by the Labor Code as solely responsible to

enforce OHS standards. However, the DOH and the DOLE have an informal working relationship through

the Interagency Committee on Environmental Health, based at the DOH. Both Departments coordinate in
terms of health research and monitoring in the workplace. However, this relationship may not be

sustained unless an official memorandum of understanding between the two parties is executed.
5.3 Employees Compensation Commission(ECC)

The ECC is a quasi-judicial agency mandated by law to provide meaningful and appropriate

compensation to workers in the event of work-related contingencies. Its main functions are to formulate

policies and guidelines for the improvement of the employee’s compensation program (compensation

package for public and private sector employees and their dependents in the event of work-related

contingencies), and to review and decide on appeals of all compensation claims from the Insurance

Systems (SSS, GSIS) in the country (11). It is estimated that only half of the workforce is included in the

employee compensation system.

One of the major accomplishments of ECC was the establishment of satellite industrial clinics in areas

where occupational health services are not readily available. Since small enterprises are not obliged by

law to provide medical services to their workers, ECC decided to increase the total number of industrial

clinics nationwide to cater to this sector. There are now 33 clinics, serving the small and medium

enterprises for medical examinations for early detection and/or prevention of work-related illnesses. In

2000, it served a total of 62,805 employees representing an increase of 19% over the previous year’s

record of 57,600 employees. Emergency loan assistance was also granted to displaced workers due to

economic crisis, amounting to PHP 600 M (USD 13 M) in 2000 to help alleviate the financial plight of

affected workers while looking for alternative job opportunities. The ECC has also processed 672

appealed compensation cases out of 1,113 cases handled for the year 2000, equivalent to a disposition

rate of 60.45% and target accomplishments of 63.13%. Of these, 84% (564 cases) were adjudicated and

108 cases were remanded to the Insurance System for review and receipt of additional evidence (16).

As with the BWC, the ECC is burdened by some problems. On the average, employees compensation

benefits pay only about 30 percent of medical costs and some cash-income benefits from loss of wages

due to absences. The more commonly claimed occupational problems such as low back pain and

cumulative trauma disorders are not currently listed among the compensable conditions. However, the

ECC is presently reviewing the list to include other work-related injuries and illness among the official list
of compensable conditions. The country’s annual payment in employee compensation benefits in 2000

amounted to only PHP 1.88 billion which is less than one percent of the estimated total cost of PHP 140

billion for occupational injuries and illnesses occurring in the agricultural and non-agricultural sectors (12).

The compensation system is also flawed because it does not hold individual employers accountable for

the costs incurred when their employees are injured or become ill as a result of their work. Unlike

workers’ compensation programs in many parts of the world, which base employers’ compensation

premiums on the injury and illness rates occurring in that industry and company, Filipino employers are

levied a flat rate of 1.0 percent of the gross wages paid to their employees. The rate is the same for

everyone, regardless of the company’s health and safety record. Thus, employers have no financial

incentive under the present system to reduce the injury and illness rates of their employees.

Furthermore, this 1.0 percent tax on wages is collected by the national government and held in general

revenues. As such, the ECC funds can be redirected according to political whim. In recent years, surplus

ECC funds have been mishandled by using them to invest in the private sector, with the result that

substantial reserve funds targeted for compensating workers have been lost through bad investments

(12).

6. Training in Occupational Health and Safety

The critical lack of trained professionals in major disciplines of occupational health is a basic constraint in

addressing OHS concerns in the workplace. A very limited number of highly trained occupational health

physicians, nurses and industrial hygienists are available in the country. Given the magnitude of

workplace health and safety problems, there is obviously a need to increase the numbers of trained

professionals.

The Department of Environmental and Occupational Health of the College of Public Health University of

the Philippines (UP-CPH) has been offering a program in Master of Occupational Health since 1976. This

is intended to prepare students for careers of responsibilities dealing with health and safety problems in
the workplace. Its emphasis is on the principles and methods of occupational health and safety and their

application in the provision of health care to workers in all occupations or workplaces. As of the year

2000, a total of 114 students have graduated from this academic program.

In addition to this graduate degree program, a 60-hour basic training course, Postgraduate Course in

Occupational Health and Safety, is offered thrice a year. The course meets a statutory mandate (Article

159, Chapter 1, Title 1, Book IV of the Labor Code of the Philippines) and provides physicians and other

OHS disciplines the necessary competence to effectively develop and carry out occupational health and

safety programs for the workers in all places of employment. On an annual average, some 200

physicians, nurses, engineers, and other disciplines have completed this basic course since 1996. With

the collaboration of foreign agencies/organizations like the Fogarty International Center (US National

Institutes of Health), WHO, GTZ and SEAMEO-TROPMED, faculty members of the UP-CPH had an

opportunity to train overseas and gain experience in research and policy development. Such fellowships

provide an opportunity to pursue further studies in the specialization of OHS, and the means of acquiring

foreign training materials for local academic and practice-oriented training programs as well as for

dissemination of updated information regarding OHS overseas.

OHS as an academic course is now gradually being introduced to different Colleges of the State

University. In the Industrial Engineering program being offered by the National Engineering Center (NEC)

of the University of the Philippines Diliman, a course called Introduction to Ergonomics has been offered

as a core subject since 1996 (17). Under the Special Topic Course, the NEC had offered topics such as

Safety Engineering; Occupational Safety and Health; and Introduction to Biomechanics. The NEC is

proposing to put more emphasis on OHS in their new curriculum. OHS courses are not limited to

graduate students but are also being introduced to the undergraduates of Public Health at the University

of the Philippines.

Other agencies and professional organizations including the Occupational Safety and Health Center of

DOLE, SOPI, PCOM, and OHNAP continue to train and educate interested participants by giving short
training courses in OHS annually. Even NGOs, such as IOSHAD and the Medical Action Group (MAG),

do in-plant training.

7. Personnel Requirements and Training Needs

There is now a growing awareness of OHS among industries. The OHS standards require that in order to

qualify for an occupational health position in industrial establishments, a basic course in OHS is

mandatory. In spite of the various OHS training programs being offered and conducted, there is still a

dearth of OHS specialists in the workplace, in regulatory agencies and in the academe. Based on the

statistics provided by professional societies, and the total number of workforce, recognized and “informal,”

it is estimated that there is nominally one occupational health physician per 30,000 Filipino workers, one

occupational health nurse per 36,000 workers, and one safety specialist per 30,000 (12). There is no

existing professional organization for industrial hygienists, therefore, an objective estimate cannot be

made. By all standards and comparing with developed countries, this personnel profile is found wanting

particularly for those who are responsible for regulatory enforcement and policy development.

8. International Models

Control of workplace exposures is a big challenge in both developed and developing countries like the

Philippines. Highly industrialized nations have developed a mixture of regulations and voluntary

compliance standards. These are based on scientific evaluations of workplace risks, often seeking to

meet exposure guidelines that reflect a very low risk to workers’ health. Emerging nations are faced with

choices about how to regulate their workplaces and what exposure guidelines to use. Experience in

industrialized countries indicates that voluntary compliance by industry does not work unless there are

also regulations, with accompanying penalties for non-compliance to ensure that companies will generally

comply with health and safety guidelines. Regulations and voluntary guidelines both require targets to be

met, and these are usually in the form of exposure limits.

In the Philippines, health issues and concerns in the workplace are generally viewed by a large majority

of establishments as an additional financial burden, without significant contribution to company profits and
performance. Investments in occupational health services are done primarily to meet regulatory

requirements. However, this is complied with by very few industries because enforcement of regulations

is weak and relies on voluntary compliance.

The ability of government in many developing countries to implement health regulatory standards is

extremely limited by a lack of available resources, including trained manpower and experience of

regulators. As such regulation alone, without the ability to remediate problems and to monitor

compliance, will not ensure that workplace exposures are controlled and risks to health are reduced to as

low as reasonably practicable.

The American Conference of Government Industrial Hygienists (ACGIH) publishes annually a list of

“threshold limit values” (TLV). These are the most commonly used set of international guidelines for

workplace exposures in the Philippines. The current exposure standards contained in the Occupational

Safety and Health Guide from the Department of Labor and Employment reflect similar values in most

cases. Standards enforced by the Occupational Safety and Health Authority (OSHA) of the United States

are used less frequently, mainly because the OSHA standards cover far fewer chemical substances than

the TLVs and are not updated periodically.

The International Agency for Research on Cancer (IARC) is another important scientific source of health

information. The IARC provides qualitative information on human and animal carcinogens and classifies

chemicals on their likelihood of causing cancer in humans. However, IARC recommendations and

standards are referred to mostly among academic circles and research activities, and seldom in actual

workplace situations.

The International Standards Organization has proposed the ISO14000, which requires that an employer

develop a plan to reduce workplace injuries and illness, and create a safer environment. In some

companies that underwent ISO 14000 certification in the Philippines the focus was mainly on

environmental issues rather than in the management of occupational exposures. The added value of ISO
14000 to the bottom line of business in developing countries is still being debated. In developing nations

like the Philippines, the price of goods sold remains the single most important determining factor in

consumer patronage. For companies with local markets, ISO 14000 and the cost of its implementation

might not have a significant added market value for the moment. This has become important in

companies engaged in the export markets where clients from developed countries put an added value on

ISO certification.

Multinational companies operating in the Philippines also have standards set by their respective parent

companies. Standards vary depending on the location of the parent company and the region where they

operate. Thus, some multinationals have adopted US standards and operating practices, and others use

a European approach.

Some businesses include the management of occupational health within their work sites. This can be

observed in some American- and European-based companies where health together with safety and

environmental concerns are seen as part of the business, and as important as any other activity of the

company. Even though business models are applied, implementation strategies also vary from the “copy

all” approach (where exact occupational health programs proven to be effective in the parent company

are transplanted to local subsidiaries) to a more “tailor fit” approach (where proven programs are

reviewed and adjusted taking into consideration cultural differences, resource availability, and geographic

characteristics of the country in which they operate). Despite the presence of local and international

standards adopted by many multinational companies in developing countries like the Philippines,

implementation of effective occupational health programs remains extremely limited for the following

reasons.

• The very limited capability of local regulatory agency to implement the requirement either due to

the lack of enforcement powers, resources, manpower, and technical training of designated

factory inspectors.

• No regulatory provision for penalties for violation of occupational standards and exposure limits.
 • High level of graft and corruption.

• The lack of awareness of company management on the nature of occupational health and the

advantages it can bring to the business.

• A limited number of experts in occupational health in the field to service the needs of industry.

• The lack of resources of companies due to the difficult business environment in which they

operate.

A more fundamental challenge faces occupational health practitioners and regulatory agencies in

developing countries. The challenge is for businesses and workers to understand and appreciate the role

of occupational health in the business and to see resources allocated to this not as “expense or added

overhead cost” but more as an investment with substantial health profits both in the short and in the long

term. Only after full appreciation of the role of OHS can companies begin to adopt and implement

occupational health requirements of regulatory agencies and fully implement international standards set

by their Mother Companies as well.

What is more commonly observed among developing countries, including the Philippines, is the old

concept that health is limited to the provision of or access to medical facilities and health personnel. The

role of health is relegated to the treatment of injuries and illnesses once they have occurred. The concept

of prevention and health risk reduction – through engineering and administrative control measures as well

as use of proper personal protective equipment (PPE) – is only beginning to emerge and is mostly driven

by regulatory concerns.

9. Occupational Health: Success and Failures

9.1 Government Initiatives

The establishment of the Occupational Safety and Health Center (OSHC) of the Department of Labor and

Employment (DOLE) in 1987 heralded the first serious attempt by government to understand

occupational health and safety in the Philippines. The OSHC was established through financial
assistance and technical support from the Japanese International Cooperation Agency (JICA), which

provided the resources for the construction of the Center building including equipment and support

facilities. Technical assistance was also provided to include training of local specialists in Japan in the

various fields of occupational health, industrial hygiene and ergonomics.

The OSHC has made available to local industries an opportunity to access training in occupational health

and hygiene, laboratory services to monitor workplace exposures, and access to health promotion

programs like STI/HIV/AIDs in the Workplace; Managing Alcohol and Drugs in the Workplace; and other

health promotion strategies (18).

Its sponsorship of regional and local competitions and various awards scheme in OH amongst companies

such as the ‘Health Workplace Awards” and the “Gawad Kaligtasan and Kalusugan” (Health and Safety

Recognition), has improved the awareness of many companies regarding health and safety at work. It

has provided recognition and encouragement to companies which are already implementing health and

safety programs. The early achievements of the OSHC in improving OH in the workplace have been

severely limited by the following conditions.

• The end of the financial and technical support provided by the JICA and the limited ability of the

Philippine Government to provided adequate resources to ensure continued operations at the

level started.

• The rapid turnover of OSHC staff and the migration of experienced staff to the private sector

where they found higher salaries and greater job security.

9.2. Large-scale Establishments

Large multinational companies generally have better success rate in the establishment and

implementation of occupational health programs in their organizations. This is influenced by the following

factors.
 • Existing corporate polices and culture requiring local companies to meet Philippine regulatory

requirement as a minimum and the company’s OHS requirements as well.

• Regular OHS monitoring and audits conducted by OHS representatives of parent companies

ensuring compliance with local and international standards.

• A higher awareness and strong support from the senior management of these companies.

• A greater premium placed by multinationals on company reputation compared to local and

smaller companies.

• A greater awareness of workers on the role of OHS in the business.

9.3. Small and Medium Enterprises

An emerging trend to establish OHS services and programs is seen among medium scale industries with

well-established trade associations and organizations. This is common among high-risk industries such

as pesticide manufacturing and handling, chemical companies, and semiconductor industries. The

presence of business and trade organizations has enabled these companies to share limited best

practices, pool resources to meet the costs of OHS services, and establish peer pressure among member

companies.

Regulatory agencies, such as the Fertilizer and Pesticide Authority of the Department of Agriculture, have

provided additional pressure for high risk pesticide formulators, distributors, and consumers to implement

health programs to reduce exposures and risk to health in their work sites. However, industry-specific

regulatory agencies, like the FPA, with a strong focus on health and safety are few.

Small-scale industries in the private sector do not enjoy the benefit of an industry organization. Resources

for health and safety remain extremely limited, and management awareness of OHS is minimal. Adverse

business operating conditions have also deprived these companies of financial resources to invest in

measures to promote the health and safety of workers.

9.4 Migrant Sector: Overseas Filipino Workers (OFW)

Many developing countries like the Philippines have a surplus of well-trained labor due to the limited jobs

available in the home country. The Philippines has become one of the top exporters of semi-skilled and

skilled workers to countries lacking these types of workers. Migrant Filipino workers are employed all

over the world in countries such as the United States, Middle East, Europe, Australia, and more affluent

countries in Asia .

Exposure to health hazards at work depends on the available OHS programs and services in their

respective host countries. Standards could vary from very high to extremely low. The limited pre-

departure orientation and preparation of OFW to work in a foreign land has led to an alarming rate of

stress and severe emotional problems. The Philippines government has little influence on the workplace

health and safety conditions in another nation. What often happens, however, is that a Filipino worker

becomes ill and is sent home where his or her work-related illness or injury becomes a problem for the

Philippine health care system and ECC.

Another major area of concern has been physical and sexual abuse of OFW within a host country. While

the worker may heal physically, the emotional scars are severe and often result in serious mental health

problems that again must be dealt with by the Philippine health care system and ECC. Such abuses of

Philippine nationals is something the Philippine government could take up diplomatically with host

countries if it chose to do so.

9.5 The “Informal Sector”

Those who comprise the “informal sector” are a profound expression of poverty within a society. They

can be found to a degree in highly developed nations, but are most prominent in developing countries,

particularly in crowded urban settings. The informal sector comprises people so poor that they do not

appear on any government or property rolls, have no formal employment, pay no taxes, and may never

register to vote. They are often squatters in overcrowded urban areas. Not surprisingly, their health and

welfare suffers from living under such harsh and often unsanitary conditions.
This is the most deprived sector when it comes to occupational health and safety. Businesses in the

informal sector are mainly single person or family-owned affairs that are unregistered. Workers are often

exposed to high levels of chemicals, noise, physical hazards and other health risks. An operator will

immediately replace a worker who becomes ill or injured. This is the business environment that utilizes

the “disposable worker.” Unskilled labor, long hours, and high physical demands are the norm; anyone

who cannot handle the work physically is out of a job. Understandably, there is a serious limitation of

financial resources for operators to spend on health and safety. Regulatory pressure does not exist, as

many of these workplaces are unregistered and unknown to government. There is very low awareness of

OHS, both from the operators and the employees. Workers toil under poor conditions and rock-bottom

wages, barely able to meet the daily needs of families. There is no security of tenure, and any

complaining will put their job on the line.

If injured, a worker in the informal sector has no health insurance or ECC benefits. Social security comes

in the form of help from family and friends, or occasionally from humanitarian or religious organizations.

Access to health care is very limited. The fatality rates of workers in the informal sector are undoubtedly

higher than other segments of society, but mortality and morbidity data are completely lacking.

Despite the desperate lives many of these workers have, their culture is inherently suspicious of

outsiders, particularly government officials. This exacerbates attempts to intervene on behalf of sick or

injured workers and reduce workplace hazards. Some NGOs have had success in Manila and elsewhere

in the Philippines working with squatters and others in the informal sector. These are small efforts,

however, and their effectiveness in reducing occupational injuries and illnesses has not been assessed.

Given the circumstances and culture of the people who make up the informal sector, their workplace

health and safety problems may be insoluble. Those problems are a direct result of their economic

situation, and that requires an economic solution. While education and technical assistance might be

helpful, it is doubtful that meaningful progress can be made in the face of economic pressures created by
serious poverty. It will remain a great challenge for government and non-governmental agencies to

extend OHS services and training to the informal business sector in the Philippines.

10. International Collaboration

Partnership between developed and developing countries is necessary for long term sustainability of the

OHS agenda in the Philippines. This collaboration may come in the form of institutional development

through capacity-building. Developing countries like the Philippines essentially lack a strong-willed

political structure to develop and reform policies, and regulatory bodies able to implement strategies to

improve health in the workplace. Technical assistance should be directed to the Department of Labor

and Employment, the Department of Health, and academic institutions in the form of technical training,

organizational building, and opportunities for staff and faculty to study abroad. Areas of assistance

should cover policy development; program planning, management and evaluation; and regulatory

support.

Private sector assistance from developed countries has proven to be effective in pushing for an OHS

agenda. Private businesses are direct beneficiaries of health programs in the workplace, are less

encumbered by bureaucracy, and have the necessary resources to implement the standards through self-

regulation and setting of health standards specific for groups of industries. Improvement in awareness of

senior management can lead to strong support for implementing health programs and standards in

workplaces. Collaboration is specially needed for small- and medium-scale industries, particularly local

companies that do not have access to OHS resources or have limited financial capability to implement

programs in their workplaces.

10.1 Collaboration with Academe and Local Training Institutions

OHS training is often limited in many developing countries like the Philippines. Local specialists in the

field are few and those with good experience are even fewer. It is a continuing challenge to attract good

candidates for training considering the relatively low prospect of satisfactory employment after graduation

from school. Training institutions are few. In the Philippines, formal training in OHS can only be obtained
from the College of Public Health of the University of the Philippines. This academic institution is still

finding difficulty to recruit sufficient number of enrollees to its Masters in Occupational Health program.

Faculty members with good experience often are recruited into the private sector or to international

agencies where better working conditions and financial rewards are available.

Collaboration should include continuing assistance to develop technical expertise in the field of OHS that

will supplement the existing academic pool. Training should be followed up by continuing technical

support to conduct research and develop specialty courses.

10.2 Collaboration with Regulatory Agencies

Further training support and exposure opportunities should be provided to regulatory agencies involved in

setting-up and implementing OHS standards. Regulatory agencies are often ill-equipped and lack the

necessary training to develop appropriate policies and strategies to ensure OHS standards are currently

appropriate and well implemented. Regulatory agencies include Department of Labor and Department of

Health, and other agencies that regulate specific industries and business organizations.

Screening of candidates for training should be well implemented to ensure only relevant people are sent

to these training opportunities. A deeper review of the re-entry plan after training should be done to

ensure that training is put to good use. Opportunities to attend conferences and meetings at the

international level should be extended to ensure best practices are learned and transferred, as well as

common problems discussed.

11. Future of Occupational Health in the Philippines

Industrial growth is inevitable over the next decade. Whether OHS resources, policies, services and

practice can catch up and adapt to that growth will depend on some major changes occurring. These

changes range from the political structure and its will to reform and enforce policies (particularly on

regulatory and workers’ compensation issues); to the economic environment wherein the “informal” work

sector and child labor are addressed appropriately; to the empowerment of organized labor to recognize
not just wages but health concerns in its collective bargaining agreements; and to building the capacity of

small-scale establishments to address OHS concerns. Based on the prevailing conditions in the country,

the following general comments are offered about the future of OHS in the Philippines.

• Growth of industrial activities will continue as the country pursues its goal of sustainable

economic development. Consequently, workers’ exposure to health hazards will likely increase

unless specific policy changes are instituted, particularly those relating to regulatory compliance

of OHS standards and to workers’ compensation.

• Regulating OHS will essentially remain weak and limited unless corrective measures address (i)

the failure of the public sector to enforce regulatory standards and (ii) the failure of the private

sector to self-regulate its problems. Among these measures include capacity-building of

institutions mandated to regulate OHS; setting policy directions; and strengthening operational

research.

• Industrial enterprises need to recognize the beneficial impact of rationally investing in OHS

programs in the workplace. A revision of the workers’ compensation schemes to include risk-

rating is mandatory and will begin to provide financial incentives for employers to reduce health

risks in the workplace. Employers need to realize that providing safe working conditions is

equated to healthy productive workers, and minimal costs to workers’ compensation. In addition,

this would foster a stronger employee-employer relationship and public relations.

• On the other side of the equation, organized labor needs to realize that occupational health

issues should be made part of the collective bargaining agreements. Its inclusion wold reassure

workers of having better and safe working conditions. The continued active participation of NGOs

involved in OHS in this endeavor will prove to be very useful.

• Particularly vulnerable to health risks in the workplace are those employed in small-scale

enterprises, contractual workers, and the “informal” labor sector. Enforcement of OHS standards

in these sectors will entail policy changes ranging from investing in health protection, to workers’

health insurance schemes and workers’ compensation.

 • Policies to further protect the welfare of migrant workers must be developed. For example,

strengthening foreign relations with countries where OFWs are employed is urgently needed.

Among its policy directions would be for host countries to strictly enforce internationally

recognized labor standards to protect local and migrant workers equally.

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 rd
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 ACKNOWLEDGEMENTS

This work was funded in part by a grant from the Fogarty International Center, US DHHS (Grant No.

5D43-TW00814-03). Dr T. Ong was a trainee in Environmental and Occupational Health supported by

this grant. The authors also acknowledge the support of staff of the College of Public Health, University of

the Philippines–Manila who assisted with the preparation of this manuscript.

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