Albanian legal framework on safety and health at work of health personnel

Background: Work may cause health damage, like accidents at work and occupational diseases. Aim: The aim of this study is to recognize the general information on the impact of work on the employee"s health, and knowledge of the Albanian legal framework on health and safety at work of health personnel. Methods: This is a narrative literature review. Conclusion: Although governments have implemented appropriate legislation for the health protection of their employees, there is evidence of the health damage of their employees at work or due to their work.

Key words: Albania, legislation, health, safety, work, health staff.

Introducction

Work may cause health damage. The social and material conditions in which work is carried out can adversely affect people's well-being. The most obvious and visible health damages are accidents at work and of equal importance are occupational diseases, although less is known about them. Damage to health due to work results from the combination of various factors and mechanisms.

Occupational health deals with all aspects of health and safety in the workplace and has a strong focus on primary prevention of hazards. The health of the workers has several determinants, including risk factors at the workplace leading to cancers, accidents, musculoskeletal diseases, respiratory diseases, hearing loss, circulatory diseases, stress related disorders and communicable diseases and others.

Employment and working conditions in the formal or informal economy embrace other important determinants, including, working hours, salary, workplace policies concerning maternity leave, health promotion and protection provisions, etc.

The health sector includes a wide array of activities developed in hospitals, focusing on diagnostic and medical treatment services of hospitalized patients and health centers and consultants where ambulatory patients are assisted by both medical staff and other healthcare staff.

The health care sector is complex and covers a variety of occupations and jobs, faces various occupational health hazards as well as the health problems that accompany them.

Healthcare workers may be exposed to injuries – needle puncture injuries, to allergy from latex, violence, and stress in an effort to accommodate this large number of special risks, a classification system is recommended. Generally, the risks are classified as biological (as viruses), chemicals (as cytostatics), ergonomics (as patient treatment), organizational (as work-shift) or psychosocial, including labor-related violence (Froneberg, 2006).

In the EU, the health sector employs about 10% of all employees, where over ¾ of them are women.

The working population of the health sector consists in staff of different professional categories, which can be differentiated into two large groups: health personnel and the management and services personnel.

The largest group consists of health personnel, dominating nursing staff numbers (graduate, technical and support staff) and specifically female sex.

The main activity performed in health centers is obviously the provision of health care, and for this the most important risks of the work to which employees are exposed will be the consequence of this activity.

Hospital workers, especially nursing staff, are exposed to a series of risks, such as: exposure to infectious agents, inappropriate postures, weight lifting during manipulation with the patient, multiple displacements, exposure to irritating, allergic and/ or mutagenic chemical substances and to the ionizing radiation, known as causers of employee health injuries.

On the other hand, as the patient is the object of the work of this staff, contact with illness, suffering, and death generates a mental rupture for this group of employees. This load is added to the daily difficulties associated with organizing the work, such as overload, problems of communication between colleagues and in particular doctors, as well as schedules, rounding of tours and night work (Estryn- Behar et al, 1991).

But health activity is not only performance, as management and services personnel perform supporting activities of main activity. These include functions such as administration, hospitality, hygiene and/or technical services.

All this means that, in addition to the health risks deriving from health activity, these work centers are combined with the dangers inherent in these other activities, translating them into a variety of risks that coincide in the same jobs.

"Preventive Hygiene and Preventive Medicine Activities in the Hospitals, Norms and Competencies of General Clinical Services of Preventive Medicine", which includes, among other functions of these services, the realization of medical knowledge, the study of the hazards of each workplace, the processing of work profiles, prophylaxis of occupational accidents and occupational diseases and mental hygiene at work.

Psychosocial and ergonomic factors, however, pose the main problem. As reflected in disease and injury statistics, the number of workers affected by these factors as well as their impact on the health of the worker and the sector as a whole is high. Compared to an average rate of all industries, the health and social sectors have a higher rate of work-related outbreaks, caused mainly by high levels of musculoskeletal work and stress, depression or anxiety.

Risk assessment is the key to preventing and reducing the exposure of health care workers to occupational hazards.

The health sector has a series of specific features that differentiate it from other sectors by organizing workplace risk prevention.

The provision of first aid and emergency assistance is carried out outside prevention services, generally in emergency services (with the exception of biological accidents).

• The aim

Recognition of the general information on the impact of work on the employee"s health, and knowledge of the Albanian legal framework on health and safety at work of health personnel.

• The importance of the problem and of the research / study

Damage of health at work has a main importance both in personal, as well as social and scientific aspects.

Already, through many studies carried out around the world, the risk factors in the workplace and their employee"s health injuries (causes and consequences) have been identified, including the search for solutions using different ways of information retrieval since reviewing the literature, finding specific study data on this problem, until reaching a positive solution.

Experience in nursing work allows you to make references based on observations, and although most of the staff seems to be affected by the risk factors at work though it suits the service at certain times, it is likely to suffer damage from them.

Background

In many studies published all over the world, it has been highlighted that work can hurt the health of employees.

• Global data

Every 15 seconds, an employee dies of work-related accidents or illnesses.

Every 15 seconds, 160 employees get a job accident.

Every day, 6,300 people die as a result of an occupational accident or a work-related illness – over 2.3 million deaths per year.

317 million accidents occur every year at work; Some of them result from absences from work.

Half of the world's population and the main contributors to economic and social development are the employees; WHO states in its World Health Care Plan 2008-2017. However, the ONP records annually over 250 million work-related accidents and about 160 million work-related illnesses.

About 2.9 billion employees across the globe are exposed to risk factors in their workplace.

• European data

Every 2-3 minutes a person dies in the European Union (EU) for work-related reasons. Moreover, every year hundreds of thousands of employees are hurt at work; Others are reported as a result of stress, overload, skeletal musculoskeletal disorders (SMD) or other work-related illnesses. And besides the human cost that accidents and illnesses have for their employees and their families, they have a negative impact on the health system's resources as well as on the productivity of the business. Risk analysis is the basis for effective safety and health management, as well as the key to reducing occupational accidents and occupational diseases. If implemented well, it can improve workplace safety and health and can boost business performance in general.

• Albanian data

During January – September 2012 in Albania, 67 cases of injured employees were recorded in all types of activities, out of which 19 were completed with the loss of employees' lives.

During the 9th month of 2011, 93 cases of injured employees were recorded in all types of activities, of which 20 were completed with loss of life. So, there is a decrease in work accident cases for the 9-month period of 2012.

Improving working conditions is one of the main objectives of the ILO.

Lack of conditions and job losses, falling in industrialized countries, are still widespread in developing countries.

In a report of the first session of the ILO and WHO Joint Committee held in 1950, it defined as a workplace health objective "promoting and maintaining the highest level of physical, mental and social wellbeing of employees In all occupations, preventing all their health damages from their working conditions, protecting their work from health hazards by placing and maintaining the employee in a job that suits their physiological and psychological abilities".

Governments create the broader context of employment that influences not only working conditions, but also health inequities. Underlying everything is the way that governments view the health of their population. If governments see differences in health as the inevitable result of individual genetic determinants, individual behaviors, or market conditions, they will respond in one way. If they see inequalities in health as an avoidable outcome that needs to be remedied, they will respond much differently.

Biological justification

Work by caring for others, with the goal of returning, recapturing or maintaining the persons health, is in the center of nursing work. The realization of this activity especially in hospital environment has some characteristics that make the nurse coexist with various dangers, which may ultimately have consequences on their physical and mental health.

Infections and risk factors in hospitals are a worrying motive for nursing staff working in various services and providing direct care to the patient, which means direct or indirect contact, temporarily or permanently with the biological, physical, chemical, ergonomic and psychosocial risk factors.

Legal framework for safety and health at work in Albania

Occupational safety and health is regulated by a general and specific legal framework that is presented below by hierarchy:

• General Labor Legislation in Albania

– First, the Constitution of the Republic of Albania, which contains provisions that emphasize the obligation to protect health and safety at work, in Chapter IV "Economic, social and cultural rights and freedoms" (legal employment, protection of social and health insurance).

– Secondly, Albania has ratified, Convention 155 of the International Labor Organization "On Occupational Safety, Health and the Working Environment" (1981) and its Protocol, ratified by Law No. 9147, dated 30.10.2003. The Convention provides for the obligation to draft policies for the protection of life and health at work and obliges the governments of the ratification states to take measures to improve working conditions in all sectors. Both of these documents are an integral part of Albanian legislation and have the highest rank in the hierarchy of norms.

– Third, until today, Safety and Health at Work in National Legislation has been implemented in the Labor Code, where for its implementation and the Law on State Labor Inspectorate, have been adopted by the Council of Ministers Decisions aimed at the implementation of safeguards in specific sectors.

• Albanian Medical Labor Legislation

6.2.1. Laws

– Law No. 10237, dated 18.2.2010 "On health and safety at work".

– Law No. 9634, dated 30.10.2006 "On labor inspection and State Labor Inspectorate".

6.2.2. Council of Ministers Decisions

– CMD No. 692, dated 13.12.2001, "On special measures of occupational safety and health protection".

– CMD No. 742, dated 06.11.2003 "Some additions and amendments to decision no. 692, dated 13.12.2001, of the Council of Ministers "On special measures of occupational safety and health protection".

– CMD No. 396, dated 28.06.2007 "On the determination of occupational diseases".

– CMD No. 461, dated 22.7.1998 "On the register kept by the employer for the accident at work and occupational diseases".

– CMD No. 207, dated 9 May 2002 "On the determination of dificult or dangerous works".

– CMD No. 397 .20.5.1996 "On the special protection of pregnant woman and motherhood".

– CMD No. 429 .25.3.1996 "On the regulation of working time and rest in the health system".

– Decision No.107, dated 9.2.2011 "On the composition, rules of organization and functioning of the safety and health council at work and the representatives of the employees".

– Decision No.108, dated 9.2.2011 "On the skills to be completed by employees, persons and specialized services dealing with safety and health at work"

– Decision No. 100, dated 3.2.2008 "On the determination of hazardous substances".

– Decision no. 788, dated 14.12.2005 "On determining an accident at work or due to work".

– Decision no. 594 dated 22.12.1997 "On the register kept by the employer for his employees".

6.2.3. Guidelines and internal regulation of health institutions

– Instruction no. 2, dated 25.06.2004 "On the implementation of the Council of Ministers Decision No.742 dated 09.11.2003" On some additions and amendments to Decision No.692 of 13.12.2001 "On special measures of protection and health safety at work".

Law No. 10237, dated 18.2.2010 On Safety and Health at Work

Today, Albania, the government and all institutions are committed to realizing a great dream, that of Albania's integration into the European Union.

In the framework of the integration process, the improvement of legislation and its approximation with that of the EU remain the main but not the only challenge.

According to the Minister of Labor, Social Affairs and Equal Opportunities of the time, "The Albanian government and its structures have taken a very important action for the country, the approximation of domestic legislation with that of the European Union countries".

The draft law includes provisions of the "acquis communautaires" in the field of occupational safety and health, recent EU recommendations, in particular the European Commission's Framework Directive (89/391 / EEC) "On the implementation of measures aimed at promoting the improvement of occupational safety and health", fulfills the commitments to the International Labor Organization by ratifying Convention No. 155 "On the safety and health of workers and the working environment", but also the positive experiences of the legislation of some European countries, like Macedonia, Romania, Spain.

To complement the legal framework, Albania took the initiative of writing a Policy Document on Occupational Safety and Health, approved by CMD No. 500, dated 6.5.2009, where "Sectoral Employment Strategy and Action Plan" is added in the chapter "Policy Paper on Occupational Safety and Health".

In the framework of the implementation of this document, the Ministry of Labor, Social Affairs and Equal Opportunities undertook the initiative for the first time drafting the draft law "On safety and health at work", which, after the passage of all legal procedures, has already returned to the Law.

The purpose of the law is to ensure the safety and health at work of the employees and the employers' responsibilities to achieve an adequate level of worker health protection against occupational hazards by developing coherent, coordinated and effective measures for the prevention of occupational hazards.

For the first time, this law introduces the notion of the employer's obligation to assess the risks arising from the exercise of the activity at the design stage of the undertaking's project and the taking of preventive measures in accordance with the nature of the risks arising during work, and control the effectiveness of these measures.

Assessing the risks that at the design stage of the enterprise project and the taking of preventive measures and in accordance with the nature of the risks created during the work and the control of the effectiveness of these measures constitute the basic elements of the new concept in preventing the risks at work are defined in the draft law.

For the first time, are regulated the obligations of employers to ensure the protection of employees in all aspects related to safety and health at work and take the necessary measures by preventing the risks for occupational accidents and occupational diseases, employee"s information and professional training, organization of collective and individual protection, provision of job organization and necessary tools of activity.

It is envisaged the establishment for the first time and the functioning of the defense and prevention services as well as the Security and Health Council. These structures will serve to implement preventive measures and balanced participation of employees in drafting a document on the assessment and prevention of work-related risks.

Another novelty of this law is the obligation of employers to draft a risk assessment and risk assessment document, which contains measures of a technical, organizational, hygienic-sanitary nature, which will be implemented under specific job conditions.

The establishment and functioning of defense and prevention services as well as the Safety and Health Council at enterprise level, which have not existed as a notion to date in Albanian legislation, are another novelty of the Law.

These structures, which comprise both bilateral business dialogue at enterprise level, will serve to implement preventive measures and ensure the balanced participation of employees in drafting a document for assessing and preventing risks arising from work.

The notion of specialized off-premises services qualified to provide protection and prevention services in the field of occupational safety and health to which the employer is addressed when the capacity of the enterprise is insufficient to organize protection and prevention activities, is introduced for the first time by the Law "On Safety and Health at Work".

Ensuring safety and health at work, protecting employees in labor relations, protecting society and the environment from unfavorable work effects are policy objectives of the Ministry of Labor, Social Affairs and Equal Opportunities.

And it is precisely the minister responsible for safety and health at work, the authority responsible for licensing these specialized services.

In Chapter III, Law No. 10237, dated 18 February 2010 "On occupational safety and health", defines the obligations of employees, the entirety of the rights and obligations arising from or relating to the fundamental right of employees for protection, by specifically regulating the actions to be taken in emergencies or in severe and near-risk, by immediately notifying the employer, the employee in charge of safety and health at work and employee representatives of any defects found in the protection system.

In Chapter IV, the health check summarizes the measures to ensure the health control of the employee in view of the risks related to safety and health at work.

Every employer of a public or private entity, indigenous or foreign, physical or legal person is obliged to provide medical service at work through a occupational physician.

In Chapter V, in the case of occupational accidents as well as occupational diseases, the employer is obliged to notify immediately the Labor Inspectorate, the Social Insurance Institute, the Prosecution authorities, etc.

The law in the field of accident investigation at work for the first time introduces the classification to 4 degrees of accidents, based on the consequences that causes the accident and the number of injured persons.

Chapter VI provides for risk-sensitive groups, specifically the special protection of pregnant women, women with breastfeeding, juveniles, and persons with disabilities and the special measures that the employer must take to adapt the workplace with this category of employees in order to prevent the risks arising from work.

Chapter VII defines the responsible state authorities foreseeing the establishment of an Inter-Ministerial Council on Occupational Safety and Health Issues, which is an advisory body and is established upon the order of the Prime Minister, upon the proposal of the Minister responsible for health and safety issues in work.

Also, are provided the rights and obligations of the responsible state authorities in the implementation of this draft law and the duties of the State Labor Inspectorate, as the institution responsible for controlling its implementation.

Chapter VIII provides for sanctions, where it is foreseen that the State Labor Inspectorate, as the institution responsible for controlling the implementation of this draft law, will impose a fine in accordance with Law No. 9634, dated 30.10.2006, "On Labor Inspection and State Labor Inspectorate".

The adoption of this law puts an end to the lack of a vision in the policy of preventing occupational hazards as a result of a failure to comply with the applicable norms, many of which are promulgated before the Labor Code, to regulate by law the problems that have arisen in the new conditions of economic and social development.

These needs take on importance when dealing with the protection and health of workers at work, the evolution of their conditions requires constant updating of norms and their adaptation to the profound transformations that have taken place.

The implementation of new legislation on safety and health at work is of special importance, which will be achieved also thanks to the collaboration and cooperation of social partners with the State Labor Inspectorate.

Conclusion

Although governments have implemented appropriate legislation for the health protection of their employees, there is evidence of the health damage of their employees at work or due to their work.

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Autor:

Brunilda Subashi

Department of Nursing, Faculty of Public Health, University "Ismail Qemali" of Vlora, Vlor?, Albania