Helping Bangladesh’s injured workers return to work
Rehabilitation and return to work policies have a huge impact on lives and livelihoods in Bangladesh
The export-orientated garment sector is Bangladesh’s largest employer. Credits: GIZ/Noor Alam
A two-year intervention supported by German development cooperation has been working with employers in the export-oriented garment industry, Bangladesh’s largest employer, to implement voluntary rehabilitation and return to work policies which not only reduce time lost through accidents and disability but also save them money and make them more attractive to overseas buyers.
12th January 2020 started just like any other working day for 19-year old worker Nur Alam at DBL Group’s Matin Spinning Mills, one of the largest and most modern textile factories in Bangladesh. Then, as he was changing a bobbin on one of the 19 giant spinning machines, he suddenly slipped and fell. His hand got stuck in the machine and was almost severed at the wrist. The entire assembly line had to be stopped, and Nur was rushed to hospital in the company’s ambulance, worrying not only about his traumatic injury, but that he might never be able to work again – and how his parents and younger brother would survive without his income.
Impossible to calculate the cost of injuries
Although the accident rate in the export-oriented garment sector has improved by leaps and bounds since the terrible disasters in 2012 and 2013, Bangladesh still has scarce data on workplace accidents and injuries. Apart from trips and falls on the factory floor, such as the one that had such a devastating impact for Nur Alam, other common injuries include needle stick and chemical injuries, heavy objects falling on workers, and muscular-skeleton and respiratory issues which cause long-term disabilities. Given the paucity of accurate data, it is impossible to calculate the cost of such injuries, but according to a recent unpublished study by Bangladesh’s Centre for Disability in Development a worker is off work for an average of 22 days after a major injury – and in Nur’s more extreme case, for almost a year.
Currently, in Bangladesh, although employers are legally obliged to provide medical care, treatment and counselling as well as compensation following an accident, there is no legal provision for rehabilitation services and the law is also a grey area regarding a worker’s rights to get back to work after a lengthy lay-off due to a workplace injury. As a result, for the past two years, a German-supported intervention has been trying to plug this gaping legal gap by persuading employers at factory level that voluntary adherence to pragmatic rehabilitation and return to work (RTW) policies can not only reduce the time lost to accidents and disability but also save them money and make them more attractive to overseas buyers.
Improving employment injury protection for workers
The ‘Employment injury protection scheme for workers in the textile and leather industries‘, a Bangladesh-German cooperation project commissioned by the German Federal Ministry for Economic Cooperation and Development (BMZ) and implemented by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), works with Bangladesh’s Ministry of Labour and Employment to improve access to social protection for textile and leather workers.
This project with the export-orientated garment sector, which is Bangladesh’s largest employer providing jobs to around four million people, mostly women, grew out of and adopted a similar approach to a previous GIZ project to improve occupational health and safety in Bangladesh’s notoriously dangerous shipyards by supporting factories to adopt international standards and certification and implementing preventative health and safety measures to reduce workplace accidents and injuries (see this case study of the German Health Practice Collection for a full account).
‘We were already working on prevention, but we had never worked on rehabilitation,’ says Syed Moazzem Hussain, a senior GIZ Technical Adviser for the project. Bangladesh’s government agrees that the employment injury insurance system it currently works on should be based on the ILO Convention 121, which provides for prevention and rehabilitation as well as financial compensation for work-related injuries. So far, companies had focused on implementation of preventative measures by adopting international standards on health and safety. However, for rehabilitation and return to work there are no globally-accepted standards. As a result, says Moazzem, the project decided to see if factories could be persuaded voluntarily to develop rehabilitation and return to work clauses in their existing human resources policies.
‘Only when a buyer comes in do they really take note’
To do this, they managed to engage 109 textile manufacturers and two leather producers to work with – although initial approaches to persuade factories met with very little success, with only 10 to 15 signing up to begin with. It was only when a major international brand and buyer, Marks & Spencer, expressed an interest, that the initiative really took off and 60 factories signed up. M&S, like many other European companies, are now obliged to ensure that their suppliers provide adequate working conditions for their workers and adhere to international regulations, so was already exploring ways of improving rehabilitation for injured workers. In November 2019, M&S invited all their supplying factories in Bangladesh to a meeting so that GIZ could share ideas on rehabilitation and return to work and explain what the intervention was all about. ‘When there is no legal requirement to do something the factories don’t necessarily see the benefits. Only when a buyer comes in do they really take note. So that’s the main reason why the factories were willing to do it,’ says Moazzem.
Training: A catalyst for change
Factories that agreed to participate were given a two-day face-to-face training course for two employees, with 10 factories taking part in each cohort. After receiving training on return to work policies by international experts, six local institutes, including the Bangladesh Business and Disability Network, the Centre for the Rehabilitation of the Paralysed and the Centre for Disability in Development were asked to conduct 20 training sessions each. The aim of this training was to help the factories to adopt a structured RTW approach that would work better in the event of a worker suffering injury or occupational disease.
As part of this structured approach, each factory was helped to appoint and train two RTW coordinators who could be easily identified by badges and high visibility vests and whose job it would be to act as an interface between an injured employee and his or her employer. These coordinators are responsible for ensuring that adequate medical and rehabilitative care and appropriate support services are delivered as quickly as possible after an accident occurs so that time off work is minimised. They also provide feedback to OHS personnel so that the same kinds of injuries will not occur in the future. Each factory was also encouraged to establish a Disability Management Committee, set up a proper referral procedure and network for rehabilitative services and ensure that RTW clauses were fully embedded in existing human resources polices.
Some of the participating factories quickly understood that quicker responsiveness to accidents and injury leads to shorter times off work and that voluntary rehabilitation and return to work policies could have a beneficial impact on their ‘bottom line’ as well, by saving both time and money. They also grasped that being seen to take action on rehabilitation and RTW could also be a ‘best practice’ selling point to demonstrate to brands and buyers that they are complying with international codes of conduct and thus enhance their competitiveness. A study commissioned by the project in 2020, entitled “Costs and benefits of programmes to prevent occupational accidents and diseases in Bangladesh’s ready-made garment (RMG) sector” further supported this understanding.
Although the face-to-face training programme was disrupted by the COVID-19 pandemic and subsequent factory closures in April 2020, 83 of the 111 factories involved have trained RTW coordinators and implemented a RTW clause as part of their existing HR policy. One of these factories was Matin Spinning Mills, where Nur Alam had his accident.
The role of RTW coordinators
Rafiquel Alam, the factory’s sustainability manager, was one of the two RTW coordinators trained and appointed at Matin Spinning Mills, part of the DBL conglomerate which employs around 39,000 people across Bangladesh. Although the factory already had an injury protection scheme in place, he says the training he received was ‘excellent’ and that he had learned a lot from the two-day sessions. With the RTW coordinators and committee now established, rehabilitation and return to work policies are much more systematic and rigorous in the company. These RTW policies will, he says, also be implemented in new factories as the group expands rapidly. ‘Our workers are most important to us and we believe in human rights in business, not just profits. If they see that we are taking care of them, the workers will be happier and more productive and we will be able to retain skilled workers.’
From helplessness to hope
Nur Alam spent three months in a specialist hospital after his accident. Although the doctors initially thought there was little they could do to save his semi-severed hand, Matin’s management insisted that everything that could possibly be done should be done – and after several operations to reattach the veins and nerves, his hand was eventually successfully saved. Throughout this time, the company paid for all of Nur’s medical and other expenses, as well as his salary. The factory even offered his mother, Lufta Begum, a job in administration so that the family did not suffer from a loss of income. ‘I felt really helpless after my son’s accident,’ she says. ‘But with the factory taking care of the medical expenses and financial side of things, we didn’t have to worry about anything except Nur’s recovery.’
Nur himself finally returned to work on 17th December 2020, eleven months after his accident and now has a new job, instructing other workers how to use the machines. He says he’s immensely grateful to the factory’s RTW coordinator Rafiqul Alam and to Mr. Md. Shamimul Haque, Chief Production Officer and Mr. Md. Golam Kibria, Deputy General Manager Administration, for the rehabilitation services and RTW support he and his family received during this traumatic time.
Enshrining these measures in law
Although this Bangladesh-German cooperation project ended in December 2021, the rehabilitation and RTW policies voluntarily put in place at Matin and elsewhere have largely continued and clearly make a huge difference for injured or disabled workers like Nur. Although a few of the trained RTW coordinators unfortunately lost their jobs as some factories went bankrupt or lost orders during the pandemic, GIZ’s Moazzem Hussain hopes that this momentum to strengthen rehabilitation and RTW measures can now be sustained. Refresher training sessions have already been held for some of the factories.
The next step will be to try to enshrine these measures in law. Before it ended, the project organised a tri-partite consultation between the government and the employers’ and workers’ associations to come up with proposals for amending Bangladesh’s Labour Act to formally include rehabilitation and RTW policies.
A new three-to-five-year pilot project for an employment injury insurance scheme has also just been launched, with support from German development cooperation and the ILO, and funding from international brands and buyers. The pilot is being designed to ensure all five million workers in the export-oriented garment industry will be eligible for payments in accordance to ILO Convention 121 as a top up to the existing entitlement, in case of death or permanent disability, but will initially focus on a sample of 150,000 workers to gather much-needed data on the extent of workplace injuries and disabilities, and the effectiveness of rehabilitation and RTW interventions.
For their part, Nur Alam and his family need no further convincing: They have first-hand experience, literally, of what an enormous impact well-implemented rehabilitation and return to work policies have had on their lives and livelihood.
Ruth Evans, February 2022