Terms of Reference
For the development of a curriculum on identification and treatment of the most common occupational diseases specifically for the export oriented RMG Industries

Client: Bangladesh Business and Disability Network (BBDN)
Consultancy Period: Two (02) Months

Background: 

In Bangladesh, the protection of the textile workers against the risk of a workplace accident or an occupational disease is insufficient thus far. There are individual statutory provisions and first approaches regarding prevention, rehabilitation and compensation. Employers are subject to liability according to civil law and the existing basic approaches are highly fragmented, inefficient and their implementation is not sufficiently monitored. Reimbursements can only be claimed in long and in-transparent procedures. An equal legal claim for all those affected cannot be warranted.

To better assess the rehabilitation and return to work landscape in Bangladesh, the Employment Injury Protection Scheme for workers in the textile and leather industries (EIPS) project of the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) conducted initial key stakeholder consultations to compile a rough structure of a Rehabilitation strategy taking into account the national legal framework, existing rehabilitation and disability assessment proposals compiled by International Labour Organisation (ILO) supported medical experts and renowned academics from Bangladesh’s academia.

The Bangladesh Business Disability Network (BBDN) has developed the national Return to Work (RTW) and Rehabilitation Strategy (Annex-1). The strategy provides a tactical direction for including the rehabilitation agenda especially for the working population. It should be noted that with the feedback of the stakeholders the strategy has been finalised and circulated to key actors. For the concerned actors to dedicate resources for the implementation of the strategy, a close facilitation is required. The strategy emphasized on the need for legal reforms for accommodating RTW and rehabilitation aspects in the current labour law.

In parallel, there are discussion at the policy level to start a Trial on an Employment Injury Scheme (EIS). When agreed, the trial will cover the entire Ready-Made Garment (RMG) workforce (4 million workers) and factories representing 150,000 workers will be actively monitored for collecting data. It is expected that the factories will be nominated by the business associations. The factories nominated will be offered to implement a RTW and an Occupational Health and Safety (OHS) management system programme at the factories.

Further to this, from the past experience of implementing the RTW programme across 111 factories, it has been observed that there is a need for further fine tuning the curriculum on RTW as well as provide training to the medical staff of the factories/physicians at Department of Labour Welfare Centres/ BGMEA appointed physicians on treatment protocols for occupational injuries and occupational diseases.

Context:

A survey of whether industrial leaders fulfil their obligation to set up comprehensive occupational health services is not known. As there are predominantly formal employment relationships in medium to large sized businesses, there is no reason to address significant gaps in the provision of occupational health services to employees in the textile, RMG and leather industries. Based on assumption, the situation is likely to be different in smaller companies and in other sectors with predominantly informal employment, but there is no evidence to that effect. In addition, particularly severe and life-threatening injuries as a result of work-related accidents and occupational diseases which require months of medical treatment and subsequent rehabilitation intervention or even accidents resulting in fatal injuries have been observed to occur in rare cases. This seems understandable because in the textile industry, in general, there are relatively few health hazards; since 2013, occupational safety has been significantly improved. In the case of small and medium-sized workplace accidents, the workers who return to work within a short time, which occurs in about 95% of the cases in the textile industry, will be reintegrated into their work.

For the success of the treatment of workers with chronic injuries and occupational diseases, health professionals require a protocol or guideline to manage cases during the long recovery phase of those affected. In the absence of a protocol there is a risk that the necessary treatments may be discontinued or misguided, leading to a longer recovery period than would otherwise be necessary or the prevalence of other unforeseen complications that may result due to mismanagement of occupational diseases.

Purpose and objectives:
The better the preventive steps taken, the less accidents and occupational diseases that occur and the better the management protocol available, the more appropriate is the treatment provided the less rehabilitation and compensation required.

The standard module on occupational diseases treatment protocol will be a capacity building tool for health professionals devoted to prevention (prevention of occupational diseases) and management of occupational diseases, accidents (Occupational Accidents) and disabilities (occupational disability) and the elimination of occupational factors and conditions that are hazardous to health and safety at work (occupational health and safety); development and promotion of healthy and safe work, work environments and work organizations; enhancement of physical, mental and social well-being of workers and maintenance of their working ability, professional and social development at work, and productivity of workers; and enablement of workers to conduct socially and economically productive lives and to contribute positively to sustainable econonic development.

Scope of Work

The consultant will be supported by two international experts on Occupational Diseases. The international experts will guidethe consultant with regards to key areas of the work. The international experts will support the local consultant with international guidelines and techniques for the deliverables. The consultant is responsible for providing the following services related to the development of a curriculum on identification and treatment of the most common occupational diseases specifically for the export oriented RMG and similar sectors:

• Identify the Occupational diseases as prescribed in the Bangladesh Labour Act that are relevant for the aforementioned sectors
• Upon discussion with employers, researchers, academia, factory personnel, medical professional from Department of Inspection for Factories and Establishments (DIFE), Department of Labour (DoL) and others, develop a comprehensive list of major¹ occupational diseases relevant for the sector.
• Undertake a need assessment for a training on treatment of occupational diseases for the medical staff of factories, DIFE, DoL, and Export Processing Zones (EPZ).
• Based on the need’s assessment, develop a curriculum on “identification and treatment of occupational diseases”
• The curriculum should include classification of diseases as per International Statistical Classification of Diseases and Related Health Problems (ICD) 10 codes.
• The curriculum should include treatment protocols for all the identified occupational diseases in a standardised format.

Key Deliverables

• Conduct necessary stakeholder consultations, literature review and work closely with guidance of BBDN, GIZ and DGUV (German Social Accident Insurance).
• Develop the list of major occupational diseases in the export oriented RMG industries
• Develop curriculum on “identification and treatment of occupational diseases”

Profile / Consultancy Requirements:

We are expecting application from any reputed farm, agency, institute or team of expart pool.

• Expert combination: The team must consist of at least two experts who are a Medical Doctor and a Rehabilitation Professional (OT/PT).
• Education/training: Medical Doctor / Rehabilitation expert with specialization or similar qualification on occupational injuries and diseases.
• Experience: At least 10 years of demonstrated experience in the context. Currently or previously connected with academia, highly qualified academician, with previous experience in curriculum development, research & training.
• Mandatory skills: Proven excellent writing (in English) and facilitation skills (in Bangla).
• Highly motivated and committed to the values of transparency and integrity.

Jurisdiction:
The place of assignment is Dhaka and surrounding vicinity.

Budget:
The Consultant shall propose an amount for the total fee, considering 160 hours (20 working) days; including VAT and Tax as per NBR rules.

Duration of the assignment
The assignment is scheduled for the period from 15th June  to 14th August 2021.

Applications:
Interested parties should e-mail their proposals to pmbbnd@bbdn.com.bd by 12th  June 2021 

Annex 1:

Brief summary of the Medical rehabilitation and Return to Work (RTW) Strategy

The strategy starts with an introduction of socio-economic and political rights of all citizens and its shortcomings for citizens with disabilities by highlighting the gaps in policies, infrastructure, services, social protection and other relevant areas. To overcome the gaps, the following strategies are outlined:
Strategy 1: Effective Execution of Policy & Regulatory Framework and Redressing the Existing Gaps by Amendments

1. Places emphasis on the amendment of section- 22 where the law addresses the issue of discharging a disabled worker by paying regular compensation; if this section is followed, many other rights of a worker namely, rights of appropriate treatment, rehabilitation, re-training as well as re-appointment are all currently unaddressed.
   
2. The definition and assessment procedure for disabilities as described in the BLA 2006 is insufficient. It is heavily misleading in terms of determining the compensation rates. Actuarial present value of different types of injury and disability is not yet established, and currently in the process of assessment. Once, the actuarial basis is established and accepted, the rates for disability compensation and pension will be more market-oriented and risk-based.
3. Flag the requirement of coordination among the implementing agencies for effective enforcement of various provisions based on the Rights and Protection Acts-2013 and Bangladesh National Building code 2008. In this regard, the strategy has proposed a periodic review at the National Coordination Committee of the National Social Security Strategy, spearheaded by the Ministry of Social Welfare.

Strategy 2: Enhancement and Decentralization of Medical Care Capacity:

4. Strategy addresses the need for Long-Term Capacity Building initiatives including DIFE, DoL and other stakeholders, Short-Term Capacity Expansion in Public Hospitals, the need for Small-Scale Facilities near Industry Clusters under the Directorate General of Health Services and Care facilities at Export Processing Zones and Special Economic Zones.

Strategy 3: Human Capital Development- Improvements in Rehabilitation Skills and Knowledge

5. a) Operationalize the National Occupational Safety and Health Institute with appropriate courses, curriculum and faculty members. b) Better compliance in Accident Reporting, Capacity Building of DIFE inspection and Academia-Industry-DIFE linkages and introduce need-based curricula for OSH education offering certificate, and diploma courses of different durations on major OSH disciplines, such as, ergonomics, chemical safety, fire safety, bio-safety, etc. c) Mandatory employment of Certified OSH and rehabilitation professional at every enterprise for each 500 employees.
   

Strategy 4: Scaling up Preventive Measures at Enterprise Level: Enforcing safety measures, as per BLA-2006.

6. Proposed to be done by continuing periodic and regular inspection by the Remediation Co-ordination Cell set up by the RMG trade bodies and the Ministry of Labour and Employment in close collaboration with the DIFE, ensuring the provisions stipulated in Chapters V, VI, VII, and VIII.
   

Strategy 5: Training and Re-Skilling of Persons with Disabilities

7. a) Introduction of re-skilling courses under existing TVET institutions. b) Facilitating Access for persons with disabilities to TVET Education by Creating Accessible Curriculum c) Introduction of Disability Inclusion Agenda for National Skills Development Authority.
   

Strategy 6: Incentive Framework including Cost Sharing and Risk Coverage

8. Introduction and Streamlining of Fiscal Incentive for the use of CSR Funds and Perquisites.
   
9. Modification of the tax rebate provision for employing persons with disabilities to qualify for a 5% tax rebate, to make it more attainable for employers.
   
10. Dissemination and promotion of the incentive framework to the employers
    
11. Introduction of Cost Sharing Program between the Government and the Employers.

For the full strategy please click:      RTW and Rehabilitation Strategy