Introduction

During the past ten years, Thailand has had one of the fastest growing economies in Asia. Economic expansion has influenced the size of establishments and production amounts, and has brought change and technical development in manufacturing. Thailand produces textiles, garments, electrical and electronic goods, gems, jewels and dozens of other products for both local and world markets.

Successful development of industry requires the appropriate involvement of social, economic and technical factors. However, Thailand as well as other developing countries must still deal with limitations on these factors, especially the technical factor. In order to gain competitive advantages, Thailand has imported many technologies from other countries, without always paying any attention to occupational safety and health measures. This has caused occupational accidents, injuries and diseases. In addition, use of some new, dangerous substances is increasing in Thailand's manufacturing; this can be expected to result in short-term and even long-term health effects.

To protect workers against occupational injuries and diseases and to provide workers with better working conditions and living standards, the Royal Thai Government has established the National Institute for the Improvement of Working Conditions and Environment (NICE) with the assistance of UNDP/ILO. NICE is a division of the Department of Labour Protection and Welfare, Ministry of Labour and Social Welfare. The objective of NICE is to enhance and to improve the protection of workers from occupational injuries and diseases and from unsatisfactory working conditions. Its main activities are:

1. development and implementation of training programmes pertaining to occupational health and safety and to working conditions
2. development and dissemination of occupational safety and health information
3. carrying out research and technical advisory services in the fields of industrial hygiene, toxicology, chemical safety and major hazard control, ergonomics, medicine, safety engineering, and construction safety
4. provision of technical support and assistance as well as laboratory facilities in industrial hygiene, ergonomics, work physiology and the testing of safety equipment
5. development and operation of a management information system to centralize information collected and to provide a basis for planning, evaluating and co-ordinating policies and programmes for improving working conditions and the work environment and 6. development and implementation of the improvement of working conditions and of an occupational safety and health programme for small-scale enterprises.

Ergonomics is playing an increasingly important role in occupational safety and health and also in improving productivity. NICE recognizes the usefulness of ergonomics in improving both safety and health at the same time,and an Ergonomics Section has been set up in NICE. To launch its ergonomicsactivities, NICE has conducted a joint research project, focusing on low-backpain, with the Institute for Science of Labour (ISL), Japan. The second ergonomics-oriented activity wasimprovement of working conditions and the work environment in enterprises where the rate of accidents leading to injury was high, by means of ILO WISE techniques.


Practical approaches to assessing the risk of low-back pain and participatory improvement

A common observation made by occupational health professionals in Thailand is that work-related low-back pain poses an increasing threat to the safety and health of Thai workers. Though it has been said that low-back pain is one of the most common health complaints among the workers in Thailand, the magnitude of the problems has not yet been fully understood. In Thailand's occupational injuries statistics, however, the numbers of the injuries caused by "overexertion or strenuous movement" and "Unnatural working posture" are apparently rising. Workers and managers are filing more and more low-back pain related claims to the Workmen Compensation Office of Thailand's Ministry of Labour and Social Welfare. NICE has often been asked how to reduce the risk of low-back pain at workplaces. It is highly likely that newly transferred production technologies have introduced a large number of factors predisposing Thai workers to the risk of low-back pain. At their workplaces, workers must increasingly handle heavy raw materials and products often in association with awkward work postures. Other widespread features of working conditions in Thailand, such as frequent overtime work or long spells in sitting postures during assembly work, may also increase the risk of low-back pain. These risks of low-back pain are thought to be closely linked with a higher risk of accidents and other work-related health hazards. Factory managers in Thailand, too, are increasingly aware that low-back pain may lead to reduced production and may hamper sound industrial relationships.

There is thus a clear need for practical approaches to reduce the risk of low-back pain. Any approaches that are devised should be widely applicable at many workplaces. The joint research project conducted with ISL was launched with the aim of developing practical approaches for low-back pain prevention which are workable in the local conditions of Thailand.

The research consisted of two essential steps: (1) the field study, conducted at a factory; and (2) group work among workers and managers, to establish a feasible improvement plan. In the field study, direct work observation methods were stressed. The methods applied were: a general questionnaire survey for workers' self-identification of health risks; application of an ergonomic action checklist; a time study for task analysis; and monitoring of subjective fatigue. The group work, which was the second step of the research, took place at the factory premises. The group work processes included: a simplified demonstration of the field study results, presented to the participating workers and management representatives; showing the examples of improvements made at other local factories; group discussion for identifying feasible actions; and group discussion for exchanging ideas on how improvements could be achieved.

A textile mill employing 82 workers in Samuth Prakarn Province was selected as the pilot research site. Field study methods suited to the local conditions were selected to gain an understanding of the actual workplace situation. A questionnaire survey was conducted among all members of a shift team in the weaving section. Direct observation was carried out by using an action checklist developed by the ILO and a time-study method. Subjective fatigue was investigated among workers in the weaving, maintenance and fabrics sections by means of the 30-item fatigue questionnaire developed by the Japan Association of Industrial Health.

Every effort was made to give the factory surveyed rapid feedback concerning the research results. The project team visited the factory again to organize the group work between the workers and managers so that improvement could be discussed. The simplified presentation of the research results was given, and improvement examples found in other smallenterprises in Thailand were described. Following the presentations, a group discussion session for identifying improvement actions feasible at the participants' own worksites was held in collaboration with the workers and managers.

The health complaints most commonly experienced by the surveyed workers within the past month and reported on the questionnaire survey were "low-back pain", "sleep difficulties" and "stiff shoulders". The workers identified "carrying heavy materials" as the most important cause increasing their risk of low-back pain.

The direct observation (time study) revealed that a fabrics section worker spends about 60% of the working time for "handling fabrics" and "carrying materials" work tasks associated with forward bent postures. Observation of maintenance work revealed that a twisting posture was frequently combined with standing, bending and squatting postures. The maintenance worker often took such twisting postures in order to repair mechanical components of the weaving machines, which are positioned in the lower portion of the machines. Their subjective feelings of fatigue increased two hours after starting their work. Low-back pains and shoulder pains were the items most often mentioned in their fatigue complaints.

The group discussion made it easier for the workers and managers to identify feasible improvement ideas. The improvement ideas covered many aspects of their working conditions, such as clear and level passageways, a foot platform for weavers, chairs for inspection workers, and an improved canteen service.

Two months after the group discussion, a follow-up visit was made to the same factory. A wide range of improvements had proved possible, including the introduction of several push carts, improved machine instructions written in Thai, more foot platforms for weavers, provision of seats for standing inspection workers, improved toilets, and an improved canteen.

The present research experiences demonstrated the usefulness of combining a field study with subsequent group work between workers and managers. The field study approach was effective in gathering information about working conditions through direct observation. The action checklist provided a simple, practical tool for identifying many aspects of the work-related risks. The time study method for observing whole shifts assisted the researchers in understanding the work-related health risks in greater detail. The semi-quantitative analysis resulting from observation of the worksites together with the workers' survey and joint discussion made it possible to produce practical recommendations for improvements.

If people at the workplace are to be committed to improving their working conditions, it is imperative that they immediately receive feedback concerning the results of the field study. The field study helped the researchers understand the real working conditions at the workplace, and this understanding in turn provided a firm basis enabling the researchers to take a facilitator role in the group work. The group work methods applied apparently gave the workers and the managers the opportunity for brainstorming and identifying actions of priority. People at the workplace could thus play an active role in improving their existing working conditions, so long as the appropriate supportive measures could be provided.

In conclusion, the combined approach of a practical field study and subsequent group work among the workers and managers facilitated the local action for reducing the risks of low-back pain. The results provided evidence that the local workers and managers had a high potential for sustaining the improvements made to their working conditions. Appropriate approaches supporting local improvements made an active contribution to increasing the improvement dynamism of the local people.

WISE techniques lead to improvement of working conditions and the work environment at high-injury enterprises

The WISE (Work Improvement in Small Enterprises) approaches that have been developed and implemented by ILO and other governments have been found effective in improving working conditions and productivity at many workplaces. WISE experiences in Asian countries have demonstrated that participatory training courses and advisory labour systems can play vital roles in mobilizing managers and workers to take self-help actions that improve working conditions and productivity. Thailand also strives to establish innovative, practical systems for promoting occupational safety and health at work.

WISE techniques were applied to improve the working conditions and the work environment at enterprises having high rates of injury, in two steps:

1. The National Workshop on Intervention Programme for Accident Prevention by Using WISE Techniques.

The goal of this programme is to train our RICE (Regional Centre for the Improvement of Working Conditions and Environment) staff to serve as trainers who can assist managers and workers in implementing occupational safety and health improvements at their workplaces. The objective of this programme is to set up the first six target RICE centres to promote WISE approaches in Thailand, and to conduct workshops to help managers and workers carry out safety and health improvements at their workplaces.

A five-day workshop, supported by ILO, dealt with the following technical topics: materials storage and handling; work-station design; the productive machine; control of hazardous substances; lighting; work-related welfare facilities; premises; and work organization.

2. Training courses for managers and workers

The training course took place within the framework of a series of WISE techniques to improve working conditions, the work environment and also productivity. The training activities were based on a systematic approach designed to encourage and help enterprises to introduce concrete improvements in working conditions and productivity. In this approach, participants learn basic principles of developing and carrying out practical, simple and low-cost improvements that have benefits for both workers and the enterprises.

Follow-up was initiated after the training course. In all, 32 enterprises are participating in this programme, which involves more than 100 improvements. The report includes the details for each improvement measure, one of which is shown below:

Working conditions before improvement: The worker sits on a low stool while welding, and the posture is uncomfortable. He has to bend his body and neck while working. His posture will cause fatigue, low-back pain and muscle pain.

Improvement: Provide a chair with a backrest and of the appropriate height, so that the worker can sit while working.

Benefit: Decreased fatigue, less low-back pain and less muscle pain, which in turn will increase productivity.

Cost: None, because the worker can use the material that is present at the factory but not in use.

References

1. Ministry of Labour and Social Welfare. Yearbook of Labour Statistics, Thailand 1992 1996.

2. Thurman JE, Louzine AE, Kogi K. Higher productivity and a better place to work Practical ideas for owners and managers of small and medium-sized industrial enterprises: Trainers' manual. Geneva: International Labour Office, 1988.

3. Kawakami T, Khai T, Toi L, Sakai K. Workload of rice reapers in the Mekong Delta area in Vietnam. Journal of Science of Labour, 1993;69(Part 2):21 29.

4. Industrial Fatigue Research Committee of Japan Association of Industrial Health. Fatigue Scale by Industrial Fatigue Committee of Japan Association of Industrial Health, In: Kyoto Symposium on Methodology of Fatigue Assessment, Kyoto, 1969.

Sudthida Krungkraiwong
Institute for the Improvement of Working
Conditions and Environment (NICE)
Thaling Chan, Bangkok 10170
THAILAND
Fax: +66-2-448 6509

Updated by PAP/SUT/TRS. Approved by BKL. Last updated on 12 February 2001

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