I. Project management:
1. Project approval:
“Worker’s health protection project in stage of 2010” was approved by the Director of General Department of Preventive Medicine and Environment on 27/02/2010.
Contents of Report
Project background
Project Objectives
Direct beneficiaries of the project
Part I: Results of project activities in 2009
Part II: Finance
Part III: The advantages, disadvantages and recommendation
Part IV: Action plan for 2011
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Due to change of organization and personnel of MOH, General Department of Preventive Medicine and Environment has been divided into 02 new departments; namely Health Environment Management Agency and Department of Preventive Medicine since 1/5/2010. Pursuant to function and task assigned by the leader of MOH, “Worker’s health protection project” is managed by Health Environment Management Agency, thus Minister of MOH had decision regarding change of the project’s owner to Health Environment Management Agency on 24 May 2010 and approved Decision on “Worker’s health protection project in stage of 2009-2011” Project Management Unit Re-establishment on 02/6/2010.
Besides the approved members of Project Management Unit, 05 Consultancy Experts are recruited including 02 local consultancy experts for technical support and project management, 01 coordinator, 01 accountant, 01 secretary cum interpreter for the project in accordance with the prevailing procedures.
2. Project execution units in 2010:
In 2010, 05 provinces including Bac Ninh, Thai Nguyen, Thanh Hoa, Thua Thien Hue and Dong Nai deployed a pilot model of basic occupational health services joined with the working conditions improvement methods like WISE and WIND. 03 Institutes including Institute of Occupational Health and Environmental Hygiene, National Institute of Medical Expertise, National Institute of Labor Protection and hanoi School of Public Health focused on deploy activity on basic occupational health service quality investigation, set up asbestos occupational diseases diagnosis and assessment standards; investigate and update data bases for national profile on health related to asbestos and medical worker healthcare. Besides, 06 hospitals (National Lung Hospital, K Hospital, Hospital 103, Cancer Hospital and Cho Ray Hospital, Pham Ngoc Thach Hospital in HCM city) continued to coordinate with Health Environment Management Agency to deploy study on relationship between asbestos contact and asbestos-related diseases. Implement activities on propaganda for project relevant contents along with channel O2TV, Vietnam Television.
As for WHO in Hanoi, some project activities also are implemented like assist project management unit in recruitment of international expertises to help the project to check, determine professional activities contents of all 3 objectives. 04 international expertises for short term (Prof.Ken Takahashi, Dr. Inai, Prof. David Koh, Dr. Seichi Horie) come to Vietnam to consult and assist project activities and had report on results.
3. Project activities principle in 2010:
The units executing the project activities on central line and in provinces as well appointed staffs as the clue to deploy activities in accordance with the approved plan. The activities are executed on principle: Project management unit is responsible for approving draft, content, schedule of each activity made by the partner units and organize acceptance of activity results as specified. The units executing the project activities directly received cost from WHO to their account and executed payment procedures with WHO.
II. Project activities execution results in 2010:
2.1. Project management activities executed by Central Project Management Unit:
To deploy project activities in 2010, Central Project Management Unit organized 01 workshop on project start in Da Nang from 30-31/3/2010. The workshop had successfully been performed with the participant of 05 institutes, colledge; 05 provinces and 06 hospitals, representative of Labor Safety Department under Ministry of Labour, Invalids and Social Affairs, representative of WHO office in Hanoi. The participating units set up execution plan draft and dicussed on detailed activities draft of the year 2010.
On 9/7/2010 in Thua Thien Hue province, Project Management Unit organized 01 training course on project execution and management skill to staffs of 05 provinces and 06 hospitals participating in the project. As result, trainees cought WHO’s project execution procedures such as how to compose draft, report and how to disburse for activities.
On 11/3/2010 and 7/9/2010 MOH coordinated with Ministry of Labour, Invalids and Social Affairs, ILO, WHO and Japanese sponsors to organize the third and the fourth joint steering committee meetings in Hanoi and Ho Chi Minh cities respectively. In these two meetings, 4 parties joinly dicussed on the project results achieved in 2009 and execution schedule till 9/2010, at the same time also discussed on how to coordinate between the 02 branches of the project: Ministry of Health and Ministry of Labour, Invalids and Social Affairs and coordination between 2 ministries in the implementation of national programe on occupational health and safety in the stage of 2011-2015, upto now this program has been approved.
For the purpose of the best effect and obtaining objectives of the project until 15/3/2011, the Project management unit held 10 monitoring trips to the project executing units: monitoring and collecting the cases in Lung Hospital (4/2010), monitoring the project activities in Bac Ninh (02 times in July and October 2010), in Thua Thien Hue (7/2010), Thai Nguyen (11/2010), monitoring the activities in Cancer hospital, Lung hospital in HCM city, K hospital, National Institute of Occupational and Environmental Health, National Institute of Medical Expertise and Institute of Labor protection (8/2010).
During the monitoring trips, project management unit has worked with the executing units to review the progress of each activity; guided, offered/assistance technical solutions, recommended to resolve these difficulties, problems which project implementation unit demanded. Through monitoring activities, project management board has evaluated the quality and progress of each executing unit. Activities of the units achieved the expected objective. The guidances and technical support/intervention of central project management board are effective.
2.2. Professional activities execution result:
2.2.1. Objective 1: Developing basic occupational health service in order to promote activities of occupational accidents and diseases prevention at all levels.
2.2.1.1. Survey quality on basic occupational health service in Vietnam
Survey was performed at 8 units including 04 centers of Preventive Medicine in provinces/cities (Thai Nguyen, Thai Binh, Hai Phong, Quang Ninh), 01 Center of Worker’s health and environment protection (Vinh Phuc) and 03 health centers of ministries/branches (Ministry of Industry and Commerce, Railway branch and Ministry of Construction). The survey result shown:
For quality control system, 88-95,2% of the units built up and building up quality contrrol system for ISO laboratories had relatively good quality control system. However, more detailed analysis on targets of quality control system shown that only 71,2-84,1% of the units well performed targets of management, organization, personnel and equipment; targets on analysis, addition to report on test results only achieved 11,5-19,7%.
For quality of equipment related to service: 100% of the units were equipped with major equipment for measuring occupational environment, health examination, biological/chemical test, blood test to diagnose occupational infection. However, if comparing with the list of equipment in National Standard on Preventive Medicine, equipment for occupational environment measurement only obtained 37,5-64%, equipment for health examination obtained 47,3-79% and equipment for biological/chemical and blood tests to diagnose occupational infection only obtained 12,5-37,5%.
37,5% of the units executed some tests on analysing chemical and toxic gas factors in laboratory and test on dust factors in occupational environment (total dust, respiratory dust, free silic quantitative and technique of counting asbestos fibres by contrast phase microscope).
For quality of health monitoring services: 60,3% of the units established Occupational Disease Clinic which was quite fully equipped with essential equipment for examination, detection and diagnosis of occupational diseases. Almost staffs participating in occupational disease clinic were trained at short term courses on occupational health organized by Institute of Occupational and Environmental Health. 40% of the units had staffs who could take well pneumoconiosis film, the quality of film taken and skill of reading film were relatively good.
2.2.1.2. Organize workshop to introduce on Convention 161 and basic occupational health service in Vietnam.
The workshop was organized in Hanoi on 23/11/2010 with the participant of 03 institutes, 02 medical universities, representatives of 25 provinces; Department of Labor Safety under Ministry of Labour, Invalids and Social Affairs; representative of WHO office in Hanoi and 02 WHO experises (Pro. David Koh and Dr. BS. John Lim). The workshop achieved the expected targets, delegates were provided with basic knowledges on occupational health service to apply to the locality and discuss on the capacity of approving Convention 161 in Vietnam.
2.2.1.3. Build up training frame on basic occupational health service:
Pursuant to documents on basic occupational health service built up in 2009, training document frame on occupational health service has been fully built up to serve for occupational health staffs at provincial level in training on basic occupational health service in their locality.
2.2.1.4. Build up 03 guiding books on deploying basic occupational health service for agriculture, trade village and health workers.
The project has completed building up frame of 03 guiding documents on basic occupational health service and working condition improvement for agriculture, trade village and health workers, it consisted of 7 chapters, each document is approximately 100 pages.
2.2.1.5. Deploy pilot model of basic occupational health service (BOHS)
In 2010, the project executed pilot model of BOHS joined with working condition improvement methods in 05 provinces like Bac Ninh, Thai Nguyen, Thanh Hoa, Thua Thien Hue, Dong Nai, in which BOHS was executed for trade village workers in Bac Ninh; for agriculture workers in Thua Thien-Hue; for workers in the enterprises using asbestos in 03 provinces (Thanh Hoa, Thai Nguyen, Dong Nai). The executed contents included: training organization, health and occupational environment monitoring and working condition improvement assistance.
a/ In Bac Ninh, executed pilot BOHS joined with working condition improvement by WISE method at Doan Ket pottery trade villages and Quang Bo copper cast trade village.
As a result, 04 training classes have been organized for 220 local health staffs and collaborators, labor safety board of districts, communes, householder and workers of the household regarding how to detect and prevent public risk factors in trade village working environment, legal documents on occupational safety and hygiene, relevant occupational diseases, instruct to deploy health and working condition improvement programes. Organized health examination for 600 workers of trade villages, examined and detected silicosis for 50 workers, as a result there were 03 cases having sign of silicosis and 14 cases of hearing capacity down. Furthermore, direct and indirect communication activities have been organized through surveying, monitoring trips at the households; through communication staff of commune with 04 times/week regarding public risk factors which effecting to the health in trade villages, commonly happened labor accidents and preventive methods. Organized 64 times of communication in hamlet through public loudspeaker. Provided with 45 posters communicating on recognition of harmful factors and occupational desease prevention for households and enterprises participating in the project. The project assisted to execute 270 working condition improvements in which there were 68 improvements on arrangement and transport of raw material, 66 improvements on equipment safety, 37 improvements on working place arrangement, 38 improvements on working environment and 39 improvements on working organization.
b/ In Thua Thien Hue, executed BOHS and joined with working condition improvement for agriculture workers by the WIND method at 02 purely agriculture communes as Phong Son and Phong Chuong, Phong Dien district, Thua Thien Hue province.
As a result, organized 03 training classes for 140 workers regarding public risk factors in agricultural working environment, legal documents on occupational safety and hygiene, relevant occupational diseases, instruct to deploy health and working condition improvement programes at the households. Organized health examination for 100 workers. Organized monitoring trips on working condition improvement at the households, as a result there were 548 improvements of working condition executed at 02 communes. Furthermore, equipped 90 medicine boxes for 90 households; provided with 60 anti-toxic masks for insecticide sprayers; provided with insecticide chemical cabinet, agricultural tools for 90 households. The form of providing was gift for effective improvements at the households.
c/ In Thai Nguyen, Thanh Hoa, Dong Nai, executed pilot BOHS at 07 enterprises using asbestos including 02 enterprises in Thai Nguyen (Thai Nguyen Construction Material Roofing Sheet JSC, Roofing Sheet Enterprise under Thai Nguyen Metallurgical Electric JSC), 04 enterprises in Thanh Hoa (Binh Phat Co., Ltd, Quang Vinh Co., Ltd, Thanh Hoa Serpentin and Fetiliser JSC, Tan Duc Phu Co., Ltd) and 01 enterprise in Dong Nai (Dong Nai Construction Material Roofing Sheet JSC).
As a result in 03 provinces, there were 05 training classes organized for 200 workers regarding harmful effects of asbestos to the health of workers contacting to it and preventive method, occupational deseases related to asbestos, working condition and health improvement methods at the enterprises. At the same time, organized monitoring asbestos dust in working environment at 03 enterprises, with 400 samples of measuring environment, the result shown that the asbestos concentration at the measured locations met the allowable standard. Furthermore, organized health examination, examined and detected occupational deseases for 772 workers who directly contacting with asbestos, the result shown that there were 18 cases of silicosis from 0/1p-1/1p (Thanh Hoa), 03 cases of occupational deaf desease, 06 cases of needing to be monitored for occupational deaf desease (Dong Nai), 12 cases of being suspected of having lung and pleura pains related to occupational harmful effects and 19 cases of having signs of trouble with respiratory function (Thai Nguyen). Also assisted with 2.300 anti-dust masks for workers and instructed to organize working condition improvement at 07 enterprises.
* General comment on result of Objective 1:
Generally, activities obtained the expected objective, the project had initial data bases on capacity, quality of basic occupational health service supply in Vietnam, had training documents as assistance tool for health workers and labor capacity improvement. At the same time, health workers at provincial level have been improved their capacity through training courses and 05 provinces where executed pilot BOHS joined with working condition improvement by WISE and WIND methods of International Labor Organization (ILO). However, due to limited cost, thus the pilot BOHS was only executed within narrow limit (1-5 enterprises), the assessment of occupational health service supply quality was only made in 05/63 provinces and 03 centers of occupational health of ministries/branches, not over the country yet.
2.2.2. Objective 2: Improving capacity in monitoring working environment and diagnosis of occupational asbestos-related diseases.:
2.2.2.1. Study asbestos-related diseases at contacting workers
In 2010, the project continued collecting cases of lung cancer in 06 hospitals: National Hospital K, National Lung Hospital, Cho Ray Hospital in Ho Chi Minh city, Pham Ngoc Thach Lung Deseases and Tuberculosis Hospital, Cancer Hospital in Ho Chi Minh city and Hospital 103. The result shown that of 301 cases (including case and control group) there were 172 cases under deseases related to Asbestos including 36 cases defined as mesothelioma in Vietnam. The medical waste of these 34 cases was transferred to Japan to certify and diagnose, until now there were 07 cases diagnosed as mesothelioma.
2.2.2.2. Build up diagnostic standard for mesothelioma due to occupational contact with asbestos.
The project coordinated with National Institute of Occupational and Environmental Health to completely build up draft diagnostic standard of mesothelioma due to occupational contact with asbestos. Now, it is asking comments for final draft before presenting to MOH for issuance.
2.2.2.3. Build up mesothelioma assessment standard due to occupational contact with asbestos.
The project coordinated with National Institite of Medical Expertise and National Institute of Occupational and Environmental Health to completely build up draft assessment standard of mesothelioma due to occupational contact with asbestos. Now, it is asking comments for final draft before presenting to MOH for issuance.
2.2.2.4. Establish system and build up set of monitoring, information updating tools for national profile on health related to asbestos.
Based on the achieved results in 2009, 2010, theproject continued to coordinate with National Institute of Labor Protection to complete update in document of the year 2010 including asbestos data from 1992 to 2010, data on use of asbestos for asbestos roofing sheet manufacturing branch in 2010, data on ship/boiler building/repairing branch. At the same time, builed up a draft mechanism of collecting asbestos information/data and basic indices need to be collected for health document related to asbestos.
2.2.2.5. Training course on mesothelioma diagnosis techniques
On 5/8/2010, 01 training course on mesothelioma diagnosis techniques was organized in Hanoi for 24 cancer and cytology specialists of 06 hospitals participating in desease survey and 08 staffs of 04 institutes. As a result, after the course, participants have been enhanced their knowledge on image diagnosis on CT-Scanner and cytology through the presentation of Japanese experts and also with test reading of mesothelioma template cells of the students and experts.
2.2.2.6. Training course on lung’s Radiographs according to ILO’s classification 2000
Training course has been sucessfully organized within 04 days (from 9-12/8/2010) in Hanoi with the participant of health staffs, occupational health staffs and imaging specialist in examination, diagnosis of 7 pneumonia institutes: National Institute of Occupational and Environmental Health, Institute of Public Health and Hygiene in Ho Chi Minh city, Nha Trang Pasteur Institute, Tay Nguyen Institute of Epidemiology, National Institite of Medical Expertise, National Institute of Labor Protection, 39 Preventive medicine center and Center for Occupational and Environmental Health of provinces/cities and 2 hospitals: Central Lung hospital and 103 Hospital.
Results of training course: teachers had good assessments on the participants through test results before and after training coiurse.
2.2.2.7. Organizing workshop on asbestos related deseases prevention
The workshop was organized on 15/12/2010 in Hanoi with the participation of 70 delegates coming from 03 Institutes, 02 colledges, representatives of 12 provinces (including medical and labor inspector representatives); Department of Labor Safety under Ministry of Labor, Invalid and Social Affairs; Ministry of Construction; Vietnam Labor General Federation, Asbestos Association; representative of WHO office in Hanoi and 01 WHO expert (Pro. Ken Takahashi). As as result, the workshop has achieved the expected objectives, delegates have been provided with and updated relevant information to use of asbestos, legal documents in relation with safe asbestos use, occupational hygiene management and inspection situation at the units using asbestos in Vietnam.
2.2.2.8. Visiting, exchanging diagnosis experience of Asbestos related diseases in Japan.
Procedured for 2 groups (09 people) to attend the conference and training on asbestos in Japan.
01 group (4 people) attended IMIG’s conference in Kyoto, Japan from 31 / 8 - 3/9/2010. The delegation included: Department of Health Environment management (02 persons), Thanh Hoa Preventive Medicine Center (01 person) and National Institute of Medical Expertise (01 person). At this conference, Vietnam delegation had a presentation to share project results in studying relationship between asbestos contact and asbestos related deseases.
01 group (05 persons) attended the training course on diagnostic techniques of mesothelioma and Asbestos-related diseases in Japan from 24-29/12/2010. The delegation included: Department of Health Environment Management (01 person), National Institute of Occupational and Environmental Health (01 person), National Hospital of Tuberculosis and Lung Deseases (01 person), Cho Ray Hospital in Ho Chi Minh city (01 person), National Hospital K (01 person). At this training course, Vietnam delegation had a chance to learn and share soon diagnosis experience of mesothelioma.
2.2.2.9. Supporting equipment for sampling and analyzing asbestos dust in working environment.
In 2010, the project supported equipment for sampling and analysing asbestos dust in working environment to 05 units: Institute of Hygiene and Public Health in Ho Chi Minh city, Nha Trang Pasteur Institute, Preventive Medicine Centers of Thanh Hoa, Thai Nguyen, Center of Occupational and Environment Health of Dong Nai. Now, these equipment have been used in monitoring working environment.
* General comment on result of objective 2:
Generally, activities of objective 2 have obtained the expected results, the project built up data bases for national health documents related to asbestos in Vietnam, checked legal documents relating to safe asbestos use, brought out some initial results in studying relationship between asbestos contact and asbestos related deseases in Vietnam and provided some equipment for monitoring asbestos working environment. However, now these equipment at levels are short, thus it made much effect on the implementation of occupational desease examination and detection in the locality.
2.2.3. Objective 3: Promoting occupational risk factors and diseases prevention among health care workers.
2.2.3.1. Organizing 02 training courses on occupational health safety for health care workers.
The project coordinated with Hanoi School of Public Health to sucessfully organize 02 training courses on occupational health safety for health care workers in Hanoi: 01 training course from 2-5/8/2010 and 01 training course from 4/1-8/1/2011 with the participation of 79 health workers under Preventive Medicine Center, Centre for Occupational and Environment Health and labor safety inspectors of 35 provinces/cities. As a result, after the course, all trainees satisfied with the contents of training course and required to expand to other provinces/cities.
2.2.3.2. Printing and allocating training documents on occupational health safety for health care workers.
There were 4.200 document books printed (2.200 books on frame program of occupational health safety and desease prevention at medical units; 2.000 books on basic occupational health service) and allocated to 63 provinces, cities; National Institute of Occupational and Environmental Health, Hanoi School of Public Health.
2.3.3.3. Expanding pilot model of occupational desease prevention for healthcare workers.
The project deployed pilot model of occupational desease prevention for health care workers in 18 district hosiptals of 03 provinces Bac Ninh, Thai Nguyen and Thua Thien Hue (06 hospitals/1 province). The pilot contents included: organizing training course, monitoring health, monitoring working environment, and executing methods to diminish risks of catching desease and prevent blood transmitted desease for health care workers.
As a result, the project organized 02 workshops and 12 training courses for 445 health care workers of 18 hospitals regarding occupational health safety at medical units, legal documents on occupational health safety, regimes/policies for health care workers, risk factors causing occupational deseases in the medical environment and preventive methods. Organized 04 propagandas on occupational risk factors for health care workers through leaflets, posters (516 sheets). Organized health examination and examined to detect occupational hepatitis B and tested 821 health care workers, the result shown that 72 cases had HbsAg(+), 07 cases had HbeAg(+).
Monitored, measured working environment at working places of health care workers of 18 hospitals, the result shown that almost occupational risk factors did not ensure allowable hygiene standard, especially lighting, ionized and UV radiation exceeded the allowable standard holding 34,4 to 73,6%; 76,5% health care workers contacted with risk factors infected by microorganism through blood and air. Inoculated 185 health care workers with hepatitis B vaccine – injection 1 and injection 2 and 3 for 165 health care workers (Bac Ninh).
Furthermore, project provided with 3180 safe syringe and needle boxes; instructed to organize, arrange tools, practise operations for patient care; provided and instructed to monitor exposition with infectious factors in the working environment and necessary procedures to organize occupational desease examination.
2.3.3.4. Editting reportage film on occupational health safety for health care workers.
The project coordinated with channel O2TV of Vietnam Television to complete reportage film on occupational health safety for health care workers.
2.3.3.5. Organizing 01 group attending the International Conference on occupational health for healthcare workers in Casablanca, Morocco from 28-31/10/2010. The delegation members included: 05 persons in which 03 persons of Health Environment Management Agency, 01 person of Tay Nguyen Institute of Epidemiology and Hygiene, 01 person of Hanoi School of Public Health. At this conference, Vietnam delegation had 02 presentations by verbal and poster.
* Comment on result of objective 3:
Generally, activities obtained the expected objective, health care workers have been improved their capacity and knowledge on occupational health safety and occupational desease prevention, the project executed a pilot model of occupational desease prevention for health care workers of 03 provinces participating in the project. However, due to limitted cost, thus pilot model was only executed within narrow scale, not expanding over the country.
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