An interview with Syed Saad Hussain Gilani, Chief Technical Advisor, ILO, about the importance of health facilities in RMG factories and what benefits they provide.

Can you explain the approach Bangladesh takes in terms of health facilities for factories compared to other countries?
In Bangladesh, the approach to health facilities for factories is quite unique compared to other countries. According to the Bangladesh Labour Rules established (2016), every factory is required by law to have its own health facility rather than relying on external government institutions. This approach ensures that factories provide minimum health services on their premises. The size of the factory determines the level of healthcare provision. For instance, factories with up to 300 workers are required to have basic first aid services, while those with 300 to 500 workers need at least one doctor along with one nurse or paramedic. There are seven different categories, each with specific requirements. The largest category, encompassing factories with 7,500 or more workers, needs a complete small hospital with a minimum of three doctors (at least one woman doctor) with additional doctors and resources for every 1,000 increase in workers.

How has the International Labour Organization (ILO) supported this approach in Bangladesh?
To establish effective enterprise clinics in factories, the International Labor Organization (ILO) has developed a simplified handbook and guidelines in collaboration with the Ministry of Labor and Employment and employers' organizations in Bangladesh, including BGMEA, BKMEA, and BEF. All materials and  documents are developed in close consultation with national tripartite stakeholders, i.e., Government, Employers, and Workers, and are owned by them. Moreover, we organized training sessions for Government Labour Inspectors, employers and workers to help them understand and implement these guidelines effectively. 

Could you elaborate on the materials and tools developed for this purpose?
We have developed comprehensive materials to guide employers through the legal requirements and good practices for establishing and maintaining health facilities. This includes Guidelines on ‘Establishing Model Enterprise Clinics in RMG Industries, a pictorial handbook on ‘Model Enterprise Clinics’ in RMG Industries, a Sustainability Guide for employers and a video tutorial for using handbook with checklist. 

How has the response been from factories and industry associations to these materials and guidelines?
The project collaborated with the Bangladesh Garment Manufacturers and Exporters Association (BGMEA) and Bangladesh Knitwear Manufacturers & Exporters Association (BKMEA), the largest industry associations in Bangladesh.  We initially collaborated closely with industry associations to develop the materials and we imparted a ‘Training of Trainers (ToT)’ for focal persons in both associations. The response from employers and industry associations has been overwhelmingly positive. We initially collaborated closely with industry associations to develop the materials. Their input and scrutiny were crucial to ensuring that the guidelines were both practical and aligned with legal requirements. The associations were committed to making the guidelines feasible for employers while maintaining legal compliance. The approach was piloted within the Bangladesh Garment Manufacturers and Exporters Association (BGMEA), the largest industry association in Bangladesh. The training provided to 30 factories in this pilot phase was highly appreciated, and the feedback was positive. Employers found the materials, including the pictorial content and handbook, to be valuable tools for understanding their legal obligations and implementing good practices.

Is this model of factory health facilities exclusive to Bangladesh, or do you see potential for its adoption in other countries?
The model of factory health facilities is specific to Bangladesh's labor laws, requiring enterprises to establish their own health facilities. However, the approach holds potential to be a good model for other countries to consider. In other nations, social security institutions often handle health services, but Bangladesh's approach places responsibility on the enterprises themselves. This unique model, while tailored to Bangladesh's context, could inspire other countries to explore innovative ways of ensuring adequate health facilities for workers within the workplace.

Could you share some insights into the current state of these health facilities, particularly in different types of factories?
The situation regarding health facilities in factories presents a mixed picture. Export-oriented factories that undergo brand inspections generally have better health facilities and conditions. However, in lower-tier factories within supply chains, the situation is often inadequate. These factories do not face the same scrutiny from brands and labor inspections, which has led to less attention being given to their health facilities. As a result, there are disparities in the quality and availability of health services across different types of factories.

How has the ILO addressed the issue of awareness and compliance among factory inspectors?
To address the issue of awareness and compliance among factory inspectors, we organized a workshop specifically for the Department of Inspection for Factories and Establishments (DIFE) in Bangladesh. This workshop aimed to familiarize inspectors with the checklist of legal requirements and highlight the importance of health facilities within factories. The response from the inspectors was positive, as they expressed appreciation for bringing this issue to their attention. This initiative has contributed to increasing awareness and understanding of health facility regulations among inspectors, which is crucial for ensuring compliance across various factories.

What do you envision for the future of this initiative and its potential impact?
The initiative to promote model health facilities within factories in Bangladesh has the potential to create a significant positive impact. With the comprehensive materials developed by the ILO and in collaboration with industry associations, more factories are likely to understand and adhere to the legal requirements for health facilities. As workers and employers become more informed about their obligations and rights, it is expected that the overall quality and availability of health services within factories will improve. The success of the pilot phase, along with the collaboration with industry associations, lays a strong foundation for the initiative's expansion to other factories and industries, ultimately leading to better health outcomes for workers in Bangladesh. Additionally, the model's uniqueness and success could inspire similar approaches in other countries facing similar challenges.