Work-related injury, in general, has never gained priority from any quarter in Bangladesh except by the ready-made garment sector (RMG) thanks to the very unfortunate factory fire and building collapse incidents that cost so many garment workers' lives and maimed many more to let fix some of the sector-specific health and safety issues mostly with the technical and financial assistance from international organizations and western retailers. The International Labor Organization (ILO) states that around 2.3 million people around the world succumb to work-related accidents or diseases annually; this translates to 6000 deaths a day. It also reports that worldwide 340 million occupational accidents occur annually. The lower and middle-income countries (LMIC) certainly contribute to the bulk of these sad incidents and burdens where workplace safety is considered to be a tangential issue; and relevant standards, policies, and programs rarely exist or are enforced to protect the workers. Bangladesh is no exception.
Work-injuries result not only in misery and economic burden for the worker and family but also add to the overall cost to the economy through lost productivity and to society through increased use of health and welfare services. A work-injury is defined as one that arises out of or in the course of employment or is due to the nature of employment. As a consequence of such an injury, impairments, functional limitations, and disabilities may develop in the injured worker. An impairment denotes a physiological or anatomical loss or abnormality; an impairment may or may not develop into a functional limitation, which is defined as a restriction of a person's capacities. Finally, functional limitations may in some cases lead to a disability if they lower the person's ability to engage in home, work, or social activities.
There have been attempts by a very few national organizations including Bangladesh Institute of Labour Studies (BILS) and Bangladesh Occupational Safety, Health and Environment Foundation (OSHE) to come up with national estimates of worker death and injuries in Bangladesh but these are based mostly on news reports in media sources and results of smaller-scale region-level surveys. In absence of an active national-level surveillance system or a government-mandated countrywide program to count these injuries and illnesses, the attempts of these well-meaning organizations while praiseworthy may not be that useful or comprehensive to understand the real and updated risk and burden while at the same time without categorization of these numbers by age, gender, sector of employment, type of job, metropolitan city/rural/district towns work setting, incised or outside an industrial zone, size of the employer, education, and income of the workers, developing and implementing prevention measures will remain to be quite difficult. Identifying high-risk industrial sectors, worker groups, types of work and hazardous materials is a fundamental step that will help in offering and evaluating an intervention. Without granular level investigation and data availability, programs- when and if- offered will remain unfocused and may not yield the desired outcome.
Monitoring and surveillance of work-injury helps to assess the size of the problem; illustrate injury trends; design, implement and evaluate deterrent programs; advance knowledge of injury among safety and health professionals, policymakers and public; and prioritize intervention and research needs. Workers' compensation claims data represents an important source of information on work-injuries in most countries where such compensation systems exist and operate. In those countries, a worker must have been working when injured and the injury must have been caused by something to do with the job in order to obtain compensation. Researchers suggested the use of workers' compensation data for related research as studies based on data extracted from workers' compensation or disability programs were able to generate valuable information.
However, it should not be forgotten that workers' compensation agency reports do not include all workplace injuries: they only include compensated and often more serious injuries that result in time loss from work and are compensated for a loss of wages. Injury cases not reported to or accepted by a workers' compensation agency or injuries among some worker groups that are not covered by the compensation system (such as the self-employed, migrants, day labourers, contract workers) might not be included in the published reports. Previous research points out that workers constantly risk facing adverse consequences for trying to report such injuries.
Work-related injury often remains under-reported in the informal economy. For example, traditional worksite injury surveillance methods are often ineffective for agricultural farms employing seasonal labour or domestic workers like maids and drivers. Even in a country like Canada or USA, many small farms are exempt from mandatory injury reporting and a high proportion of foreign workers and the temporary arrangement of the work further discourage reporting. In Canada, with a high proportion of the immigrant population, many citizens underutilize government-sponsored social services and underreport workplace injuries. Researchers and stakeholders have investigated the use of a variety of data sources including physician reporting systems, hospital records, medical records of treatment, emergency department data, police reports, death certificates, autopsy reports for work injury surveillance. They recommended the use of multiple data sources for making work-injury surveillance comprehensive. All databases have limitations when used to summarise the national scope of workplace hazards and comparison and aggregation of data from multiple sources may produce more credible estimates.
There remains a serious need to enumerate work-related injury and death in Bangladesh and different data sources must be explored. In absence of anything at all, a combination of data sources will provide a more comprehensive, reliable depiction of the hazardous working conditions in Bangladesh.
Dr. Hasnat M Alamgir is a Professor of Public Health.
