Practical and acceptable OSH programs for SMBs in food and bag manufacturing in Indonesia

Abstract

Background

In the U.S., OSHA and NIOSH have recommended guidelines, called OSHA Core Elements and Total Worker Health^® concepts, to prevent workplace injuries and illnesses and to promote worker health and well-being, respectively. Little is known about how Total Worker Health^® and OSHA Core Elements can be applied to sized businesses (SMBs) in developing countries, including in Indonesia, where health and safety issues are not a priority due to cost, lack of resources, and a lack of national oversight.

Objective

This study aims to better understand which occupational safety and health (OSH) strategies that small and medium sized food and bag manufacturing businesses in Indonesia can reasonably implement to reduce workplace injuries.

Methods

This qualitative study utilized focus group discussions with owners of small and medium sized food and bag manufacturing businesses located in Bogor, Jakarta, and Depok City, and relevant stakeholders that work with SMBs, including governmental and non-governmental organizations.

Results

Business owners and stakeholders were interested in the Basic OSH Program Plan, a guideline discussed in this study, which incorporate components and contents from OSHA Core Elements, Total Worker Health^® concepts, and International Labor Organization (ILO) guidelines. Although some of the OSH strategies in the Program may not be currently feasible to implement, overall, the business owners and stakeholders thought it could be beneficial to address their OSH concerns.

Conclusion

This study shows that there are potential avenues for OSH implementation and enforcement in small and medium sized food and bag manufacturing businesses in Indonesia that can also be expanded to other sectors of SMBs.

Keywords

small business manufacturing health and safety program low-middle income country qualitative Indonesia

Introduction

An occupational safety and health (OSH) program can be defined as any program in the workplace that serves to prevent work-related injuries, illnesses, and deaths.¹ Having an OSH program in place can also help prevent the suffering and financial hardships of employes, their families, and employers that result from these injuries, illnesses, and deaths.¹ In order to be most effective, OSH programs must cover all aspects of prevention to create workplaces and working environments that are safe and healthy.²

In the U.S., OSHA has recommended guidelines, called OSHA Core Elements, to prevent workplace injuries and illnesses.¹ These guidelines can be supplemented with Total Worker Health^® concepts established by the National Institute for Occupational Safety and Health (NIOSH), which also promote worker health and well-being.^3,4 Together, Total Worker Health^® concepts and OSHA Core Elements offer a comprehensive approach to OSH programming that covers the following elements: management leadership in OSH; worker participation in developing and promoting OSH; program designs that consist of hazard identification and assessment and hazard control recommendations; employe education and training; and guidelines for evaluating the OSH program commitment to continuous quality improvements.^5,6 The specific elements that include both the Total Worker Health^® and OSHA Core Elements are summarized in Appendix A.1.

Several studies assessing the implementation of Total Worker Health^® have found strategies to improve worker health and safety. Fundamental Elements can work in small and medium sized businesses (SMBs), as long as there is strong leadership support.^6–8 But most of these studies were conducted in the U.S., where businesses have national guidelines and standards for worker health and safety.^6–8 Little is known about how Total Worker Health^® and OSHA Core Elements can be applied to SMBs in developing countries, including in Indonesia, where health and safety issues are not priority due to costs, lack of resources, and lack of national oversight.⁹

In Indonesia, deaths due to occupational injuries and illnesses accounted for around 2 million cases in 2012 across all industry sectors.¹⁰ Manufacturing industries had the second highest percentage of workplace incidents and injuries at 31.6% in 2010, which is the most recent data available on a national level.¹⁰ A recent annual report from the Indonesia Ministry of Manpower specifically mentions that one of the biggest issues among SMBs is the unavailability of workplace health and safety data and programs.¹¹ The government has recognized the increasing number of occupational injuries and illnesses across all industries, and they believe that the data are under-reported.¹¹ This may be due to the lack of oversight by the government itself, including the local government.¹¹ Indonesia offers national workers’ compensation insurance to cover work related injuries, illnesses, and deaths, known as BPJS Ketenagakerjaan. However, SMB owners rarely register their employes for this insurance because they lack sufficient information from the government.¹²

Existing studies of Indonesian SMBs describe poor working conditions and inadequate use of personal protective equipment (PPE) with little investment of business owners in providing OSH programming,^9,13 but few describe how working conditions could be improved. Among those that do, in-depth interviews with business owners and employes of small and medium sized food and bag manufacturing businesses in Indonesia, and their relevant stakeholders, show that implementation of a comprehensive OSH program is not feasible.^12,14 However, small and medium food and bag manufacturing owners are interested in easy steps and low-cost solutions to prevent injury and illness in their workplaces.¹² Therefore, the purpose of this research is to apply components of the Total Worker Health^® and OSHA Core Elements models that are low-cost, easy to implement, and may be practical and effective for improving worker health and safety in SMBs. This qualitative study aims to answer what OSH strategies small and medium sized food and bag manufacturing businesses in Indonesia can reasonably implement to reduce workplace injuries. The long-term impact for this research is to ultimately improve the health and safety status among workers in SMB food and bag manufacturing businesses.

Methods

Basic OSH Program Plan for Small and Medium Sized Food and Bag Manufacturing Businesses: A Basic OSH Program Plan for SMB food and bag manufacturing was developed based on results of research conducted with SMBs in Indonesia,^12,14 the OSHA Core Elements, the Total Worker Health^® Fundamentals, existing guidelines written by the International Labor Organization (ILO) for small and medium sized food and bag manufacturing businesses. In the previous research that conducted with SMBs in Indonesia, the perceptions of employers, employes, and relevant stakeholders towards implementing OSH programs in the food and bag manufacturing in Indonesia were identified.^12,14 The strategies suggested by employers, employes, and relevant stakeholders from the prior studies are incorporated in this Basic OSH Program Plan. The goal was to improve workplace safety and health for both the owners and the employes by developing a program that incorporates practical and acceptable strategies. These strategies included: management leadership; worker participation; hazard identification and control; housekeeping; ergonomic hazard mitigation; lighting and electricity; special circumstances for each type of industry (e.g. for bag manufacturing, such as provide needle guards and eye protection for employes working with sewing machines; for food manufacturing, such as use insulated gloves when working with hot surfaces); and additional administrative procedures (e.g. working overtime and night work). The Basic suggested OSH Program Plan is available in Appendix A.2., and the elements are summarized in Table 1. The Basic OSH Program Plan also includes resources for business owners (e.g. contacts of relevant stakeholders that work with SMBs, such as National Insurance Agency (BPJS Ketenagakerjaan), business owners’ association, Local Initiative for OSH Network) and related forms (e.g. employe's report of injury, near miss, or illness form and hazard control plan).

Table 1.

Summary of elements of basic OSH program plan.

Elements	Program Contents
Management leadership	a) Promote a statement of commitment to protect all the employes b) Offer insurance coverage through the national insurance agency scheme (BPJS for employment) c) Assign an employe to be a Person in Charge to ensure employes are following OSH program recommendations d) Have a procedure to report work-related injuries, near misses, and illnesses and respond to the report by making changes to the business e) Post safety signage f) Prepare a written safety slogan
Worker Participation	a) Involve employes in the development of the written health and safety policy b) Encourage employes to inform the owners immediately of any situation which they believe could present a health or safety risk in the workplace c) Arrange regular meeting times with employes to discuss and cooperate with the owners in ensuring health and safety in the workplace d) Involve the experienced employes to train new hires or co-employes about all aspects related to their jobs, including health and safety (e.g. the presence of hazards, the OSH Program, personal protective equipment (PPE) that needs to be used)
Hazard Identification and Control	a) Collect, organize, and review information with the employes to determine what types of hazards may be present and follow-up with employes who have experienced an injury b) Implement administrative controls (e.g. having written health and safety policy, housekeeping rules, working at night guidelines) c) Implement personal protective equipment and engineering controls (e.g. machine guarding)
Housekeeping	a) Assign responsibilities for cleaning-up the workplace during the shift and/or on a day-to-day basis b) Clean up spills immediately c) Remove and dispose of waste d) Clean slippery floors strewn with sand, sawdust, ash, or the like e) Store tools, materials, finished products, packaging materials, and other objects so they do not create a tripping hazard f) Keep general storage areas free from accumulated materials to avoid slips, trips, and falls and to prevent the harborage of insects or rodents g) Remove frequently all sweepings, solid or liquid waste, refuse and garbage to avoid creation of health risks
Ergonomic Hazard Mitigation	a) Employ rest periods for employes during the shift b) Provide drinking water c) Employ job and task rotation routines among employes d) Provide a seat for employes who need to work with machinery e) Have written job descriptions that specify responsibilities, tasks, outcomes, and consequences so employes are aware of the risks if they do not use control measures f) Allow employes to divide the loads into smaller bundles when lifting heavy things g) Encourage employes to report any pain, discomfort, numbness, or tingling to the owners or a supervisor without fear of receiving negative responses
Lighting and Electricity	Lighting: a) Provide adequate lighting around the work area when machinery or guards render normal lighting inadequate for safe operation b) Provide adequate lighting in maintenance areas, such as inside electrical compartments where electrical isolation is necessary for access c) Eliminate glare or disturbing shadows if using artificial lighting Electricity: a) Replace the electric cables that have been damaged b) Provide instructions on how to work with machinery that uses an electrical supply c) Keep electrical plugs or extension cords in good condition d) Maintain electrical circuit with a circuit-breaker and place in a fire-resistant cabinet e) Disconnect the electrical current when the equipment is not in use and ensure the electrical current is not re-connected during maintenance f) Label the electrical equipment when they are disconnected from the electrical current or are in maintenance (LOTO: lockout tagout) g) Shut down all electrical equipment when not in use
Special Circumstances	Food manufacturing: a) Provide PPE for employes who are at risk of falling objects (e.g. rocks used in tofu manufacturing) to ensure that employes have adequate protection, such as providing metatarsal boots b) Install handholds (where appropriate) that are fixed close to the operators to enable them to maintain stability when moving about or standing near parts of machinery c) Use insulated gloves when working with hot surfaces Bag manufacturing: a) Arrange a schedule to inspect the guards, needles, and work areas on a regular basis, including changing the needles b) Switch sewing machine off when replacing the needles or conducting maintenance c) Clearly mark danger areas and use barriers to restrict access especially at cutting tables
Additional protections	a) Arrange rest periods for employes b) Schedule working hours and overtime c) Provide procedure related to night work d) Redistribute work assignments to avoid fatigue

Study Sample: This study included owners of small and medium sized food and bag manufacturing businesses located in Depok, DKI Jakarta, and Bogor City in Indonesia, and stakeholders that work with SMBs. Small businesses were defined as those employing 5–19 workers while medium businesses were those employing 20–99 workers.¹⁵

This study protocol was approved by the Institutional Review Board from X (No. 202112296). Purposive sampling was utilized to identify business owners and other stakeholders. Purposive sampling is widely used in qualitative research to identify and select information-rich, knowledgeable, and experienced individuals when study resources are limited.¹⁶ Using this sampling approach, business owners were identified through existing contacts of the Principal Investigator (PI) in the local office of industry, trade, and small and medium enterprise cooperatives in each city. The inclusion criteria for business owners required that the individual must be over 18 years old and either own the business or be responsible for day-to-day operations. For relevant stakeholders, the inclusion criteria required hands-on experience working with SMBs at their respective institutions and a role related to OSH management in Indonesia. These business owners were contacted by phone for study recruitment. If business owners agreed to participate and were invited to a focus group discussion conducted held in a meeting room at the office complex of the Ministry of Cooperatives and SMBs. This location was chosen as the business owners were already familiar with the place, and it was easy to reach from where they lived.

The other stakeholders included in the study were from both governmental and non-governmental organizations, and purposively sampled using established connections the Principal Investigator (author CM) had with some of the organizations. For organizations for which the PI had no access, a snowball recruitment approach was used by asking the existing contacts to connect the PI with subsequent respondents. Focus group participants had administrative and/or outreach roles in their organizations related to occupational safety and health.

Data Collection: Focus group discussions with the business owners were conducted in-person by CM and a research assistant who recorded the processes while the focus group with the stakeholders was conducted via Zoom. The focus group discussions averaged approximately 90 min and were conducted in Bahasa Indonesia as the participants only spoke this language. Each participant received $15 which is equivalent to IDR 213,000 at the completion of the focus group. The focus group questions for SMB owners and relevant stakeholders addressed three main themes: (i) Existing OSH concerns, (ii) Evaluation of acceptability and practicality of the Basic OSH Program Plan, and (iii) Evaluation of resources to implement the Program. The appropriateness and clarity of the focus group guide questions and question format were reviewed by two local researchers who had experience working with small and medium sized businesses.¹⁷ Focus groups were utilized as they create interaction between the participants that generate additional ideas through the process of building upon each other's feedback,¹⁸ which was important in this study to collect ideas and perspectives from the participants on acceptable and practical OSH program to improve workers’ health and safety in SMBs.

Participants were provided with printed copies of the Basic OSH Program Plan to review before the focus group discussions began. During the focus group discussions, author CM, who led all sessions, reviewed each component and content of the OSH Program Plan before asking questions to the participants. The detailed questions that guide the focus group discussions with business owners and relevant stakeholders are provided on Appendix A.3.

Data Analysis: The focus group discussions were audio recorded, transcribed verbatim, and then coded. The transcriptions were done by the PI and local independent research assistants. Before the focus groups were conducted, an initial coding plan was developed based on the three main themes included in the focus group guides. Inductive and deductive approaches to data analysis were utilized. An inductive approach uses content-based coding from the verbatim focus groups while a deductive approach uses researcher-driven codes originating from the focus group discussion guides.¹⁹ Utilizing a deductive approach, a codebook was developed prior to data being collected or analyzed.²⁰ We also compared our codes with Total Worker Health^® and OSHA Core Elements models. Throughout the focus groups, the codebook was continuously adjusted and revised.

After that, using the inductive approach, audio recordings of the focus groups were listened to and all of the transcripts were read and re-read to identify repeated patterns of meaning embedded in the data. The PI and research assistants worked systematically through the transcripts to code the data and refine the codebook. Coding was complemented with documentation taken during the focus group meetings, including observational notes on the setting and non-verbal behaviors of the focus group participants. Field notes to document the PI's feelings and assumptions that came out during the focus group discussions, decisions and changes made through the research process as data were collected, and analytical memos documenting insights and interpretations from the transcripts were also recorded. Field notes capturing the settings and non-verbal communications of participants add valuable information in qualitative research to the construction and analysis of the data.¹⁸ Analytical memo writing allows the researcher to articulate, explore, contemplate, and challenge their interpretations when examining data.²¹ Dedoose (SocioCultural Research Consultants, LLC, Los Angeles, CA), a cloud-based software program for management and analysis of qualitative data, was used to code the data. Provisional codes that were developed using the deductive approach were then revised, modified, deleted, and expanded as the data were analyzed. Codes were then sorted and arranged into potential themes and sub-themes, and the themes were reviewed to ensure coherent patterns formed. The codebook was then finalized.

Validity and Reliability: In qualitative research, there are two main types of validity threats: researcher bias and reactivity.²² Researcher bias happens when a researcher's personal values and expectations influence how the study is conducted and how findings are interpreted.²² Reactivity occurs when the researcher influences participants’ responses during interviews.²² To enhance validity and minimize researcher bias, open-ended interview questions were designed to encourage natural conversations and avoid leading questions that might influence the findings toward a preferred outcome.²² All interviews were recorded, and verbatim transcripts, memo writing, and field notes were obtained to ensure data accuracy. Hence, multiple methods were conducted, including observations, field notes, and focus group response to gather data and triangulating them to ensure the consistency in response. To reduce reactivity, leading questions were avoided, and interview questions were pilot tested to ensure clarity, relevance, and eliminate the personal values reflected on the questions. To ensure the interpretation did not reflect preferred outcomes, the researcher had written journals that document their preferred outcomes before the interviews were conducted. Then, after the interviews completed, member checking method was utilized by having an occupational safety and health expert that was not part of the study review the interpretation of the findings. The member checking also involved comparing the interview results with the preferred outcomes written in the journals prior to data collection. Reliability in qualitative research refers to the accuracy and consistency of data extracted from the original source, in this case, the interview participants.²³ To improve the study's reliability, all interviews were recorded and transcribed.

Results

Six focus group discussions were conducted; five with business owners (food manufacturing, N = 3; bag manufacturing, N = 2) and one with the relevant stakeholders. The focus groups with the business owners had between 6 to 8 people in each group. A total of 34 business owners and 5 relevant stakeholders participated. All the participants involved in this study did not participate in previous research conducted by the authors that informed these focus groups.^12,14 All the business owners currently owned and run their business for over 5 years.

The relevant stakeholders who participated in focus group discussion were from the Ministry of Manpower, Ministry of Health, National Agency of Drug and Food Control, Local Ministry of Cooperatives and SMBs, and an independent OSH researcher. All participants from relevant stakeholders have worked in their institutions for more than 10 years. Other stakeholders from the National Insurance Agency, International Labor Organization, and Local Initiatives for OSH Network were also invited but declined to participate. In what follows, main themes from the focus group discussions are described from the perspective of business owners and relevant stakeholders. Exemplar quotes are included to support the themes.

Existing OSH concerns

Two subthemes emerged related to existing OSH concerns among business owners and relevant stakeholders: the current OSH issues in the workplace and the changes made to address these issues. For the changes made, efforts that have been implemented by both business owners at the business level and relevant stakeholders in relation to national regulations are discussed.

Current OSH issues in the workplace: During all focus group discussions with the business owners, there were several common OSH concerns reported, including hot surfaces, slippery floors, and electrical hazards. “One thing that was really serious was that an employee of mine got electrical-shock, and he bounced really far, but fortunately he is alive. We have no idea why that happened because he was just installing the machine when it happened. So, we just made a quick decision to turn the machine off, and the next day we tried to find the reason for the incident. The next time, what we are going to do is check everything first thing in the morning, before work starts” [Food manufacturing owner]. Common injuries identified were cuts and burns in food manufacturing and needle injuries in bag manufacturing. The focus groups with the bag manufacturing owners also reported that long working hours when demand is high caused their employes to work overnight, which may lead to fatigue. “When demand is high, I meant that happens only once in a while though, I have no choice other than to ask my employees to work overnight. I know they can feel too tired” [Bag manufacturing owner].

When we discussed the current OSH concerns from the SMBs with the relevant stakeholders, most stakeholders mentioned they did not do enough to disseminate OSH information to the business owners, which can result in business owners being unaware of how to identify and address hazardous working conditions. “They have not been exposed to occupational safety and health (OSH) knowledge in general. It is harder to approach them because they are scattered, which is why we need to gather them to make it easier for us to educate and introduce them to OSH. It is different with large industries because they work in one place. That is how I see it. They have not known what OSH is yet, let alone implemented it” [Stakeholder 2]. Some stakeholders also noted how workers in SMBs may be at higher risk of injuries than workers in large businesses. “The concern we have related to OSH is, first, the use of manual and semi-automatic equipment, there is a big potential hazard there. Also, for example, the production process in the small food manufacturing, which includes frying and chopping manually, has a big potential injuries compared in large food manufacturing” [Stakeholder 3].

Changes made to address current OSH issues: Due to existing OSH concerns and injuries that occurred to their employes, business owners reported that they made changes to improve safety and address injuries. The common changes mentioned by most business owners included developing a regular schedule for employes to do the cleaning, providing first aid kits that are easy to access for employes in the workplace, and assigning an employe to supervise the working process or the housekeeping activities. Some bag and food manufacturing owners also had registered their employes with the national insurance agency, known as Badan Penyelenggara Jaminan Sosial Ketenagakerjaan (National Social Security Agency for Employment). “I have registered my employees to the National Insurance Agency after several injuries occurred. They were minor injuries, but still” [Bag manufacturing owner].

Evaluation of acceptability and practicality of the Basic OSH Program Plan

Two subthemes emerged: the acceptability and practicality of the OSH programs and the expected outcomes and challenges in implementing OSH programs. In the acceptability and practicality of the program, elements of OSH programs from Total Worker Health^® and OSHA Core Elements models were discussed.

Acceptability and practicality of the OSH programs: In terms of management leadership, which included the development, existence, and maintenance of a written policy or program to reduce employe injury and illness, most owners mentioned that having signage relaying safety messages in areas visible to employes would be essential and practical. An owner also noted that ensuring employes understood the safety messages would also be necessary. “Signage is necessary and practical to implement as we need to make the employees aware of their surroundings and minimize the likelihood of getting injured… but ensuring the employees understand [what] the signage [means] is also crucial” [Food manufacturing owner].

Most owners also discussed the possibility of registering their employes with the National Insurance Agency. While some owners had already implemented it before the focus group discussions occurred, some did not understand how it worked. Many also learned that the insurance fee is less expensive than the out-of-pocket medical costs they pay when an employe is injured or sick. Many owners expressed they will register their employes to the National Insurance Agency. “I just learned that the insurance is beneficial for all of us, not only the employees, but also for me as the owner in the long run” [Food manufacturing owner].

Some owners suggested assigning an employe to be a person in charge of ensuring other employes are following OSH program recommendations. A few business owners indicated that they had an employe supervising work processes but not OSH strategies. Some owners mentioned that assigning a person in charge would be practical, but that caution was needed. “I think we need to assign an employee who is most experienced to oversee the implementation of health and safety …. But it might cause jealousy among the employees as one person is having more responsibility over the others” [Food manufacturing owners]. Additionally, although most owners did not have written statements of commitment to protect all the employes, some had Standard Operating Procedures (SOPs) related to work processes and expressed interest in having SOPs related to health and safety. “I am interested to have the SOP about health and safety that I can implement in my workplace” [Food manufacturing owner].

Worker participation: Most owners mentioned that holding a regular meeting with employes to discuss health and safety concerns would be practical as most of them already had scheduled time to gather with their employes each week or hold morning briefings before work every day. Most owners also mentioned they have a close relationship with the employes, so they believed encouraging employes to report any health and safety concerns immediately to them would not be an issue. “We often discuss many things with them, I think we can also have discussion about health and safety and their concerns” [Bag manufacturing owner]. However, most owners were not sure about involving experienced employes in training new-hires or co-employes about health and safety as most owners themselves had not received such training. “Well, having the experienced employee to supervise or oversee the other employees are okay, but I am not sure if they need to have responsibility in training other employees. It could be too much as I am as the owner also not feeling confident to train my employees” [Food manufacturing owner].

Hazard identification and control. All owners agreed that hazard identification and control, particularly related to records and documentation of injuries and illnesses, may not be practical yet for SMBs. Most owners reported anything that related to documentation would be too burdensome. “Documentation is important, but I think it is still too much to do for now. for us with small scale businesses like this. We have a lot of administrative work and this could be too overwhelming for us” [Bag manufacturing owner]. Some owners mentioned the only documentation they did was attendance lists and checklists for housekeeping schedules. However, some owners mentioned checking the safety and functioning of instruments and equipment at the start of the workday would be practical, and some were already doing that. An owner also expressed that they wanted to do it regularly and wanted to have a scheduled time to do it. “It [the machine and tools] also needs to be checked before we are doing the work and I am very interested to make it a regular schedule and to evaluate the workplace an hour before it starts … No matter what, safety is very important. If there is a problem with it, our production will be affected. It is impossible to keep producing while there is an incident in the workplace. That is why we will try to pay attention to employees’ safety” [Food manufacturing owner].

Housekeeping: All owners indicated that housekeeping was one of the most important program elements they should include. Many of them were already implementing some of the suggested strategies, including cleaning up spills immediately; removing and disposing of waste; and storing tools, materials, products, and packaging materials properly so they will not cause any tripping hazard. “I require my employees to clean up spills immediately and put materials and products in a different storage according to their function, so the workplace would be neat, and they [the employees] will not bump or trip” [Food manufacturing owner].

Ergonomic hazard mitigation: Most owners mentioned control measures already in place to reduce the likelihood of musculoskeletal disorders. They included providing rest periods for employes during the shift, providing a seat for employes who need to work with machinery, and allowing employes to divide loads into smaller bundles. “They can rest anytime they want during the shift. Once they feel tired, they can just rest, and we also provide drinking water” [Bag manufacturing owner]. Most owners also described that encouraging employes to report any pain or discomfort would be acceptable and practical. But there were some doubts about implementing written job descriptions that specify the responsibilities, tasks, outcomes, and consequences so employes are aware of the ergonomic hazards. “I do not think the employees will like it if we put too much detail or instructions related to their job” [Bag manufacturing owner: FGD in Bogor City].

Lighting and electricity: Most owners reported that they provide adequate lighting, replace damaged electric cables, keep electrical plugs and extension cords in good condition, and disconnect or shut down all electronic equipment not in use. “I think having adequate lighting and replace the electric cables are essentials in a workplace like ours” [Bag manufacturing owner]. However, most owners were not familiar with the LOTO (lockout tagout) procedures but expressed the procedures would be a good idea to implement. “This [LOTO] is a good one to minimize the likelihood of getting injured” [Food manufacturing owner].

Additional protections: Some food and bag manufacturing owners reported arranging flexible schedules during high demand times, including working night shifts. “I worked with them to arrange the overnight shift so all of them have enough time to rest. It happens only when the demand is so high” [Bag manufacturing owner].

Some owners also had suggestions for additional elements that could be included in the Basic OSH Program Plan, such as a section about conflict resolution between employes because it can affect their ability to work effectively and safely. “Perhaps you need to add about conflict between employees and how to resolve it as it can influence how the employees feel at work and their ability to be productive and work safely” [Food manufacturing owner: FGD in Depok City]. There was also suggestion from some owners to have all of the forms provided in the Basic OSH Program Plan available online so they could fill them out more easily. “It would be great if all these forms [were] available online, so we can easily access them and fill them out” [Food manufacturing owner].

Some food manufacturing owners also suggested that if the government wants to enforce OSH program implementation in food manufacturing, they should consider integrating it in the National Agency of Drug and Food Control's certification program. “So, we [food manufacturing owners] are required to be certified by the National Agency of Drug and Food Control before we can sell our products in the market. If the government wants to enforce us to implement OSH program, they can integrate all these forms [available in the Basic OSH Program Plan] with that certification program” [Food manufacturing owner]. Two owners also suggested adding a waste management program for both manufacturing sectors. They indicated that their workstations are typically not spacious, and employes often put waste inside the workstations, causing odors. The bundles of waste also increase the risk of slips and trips. “Our manufacturing activities produce a lot of waste. I think it will be good to add some strategies on how to handle the waste” [Bag manufacturing owner].

From the stakeholder focus group, all stakeholders mentioned being interested in all aspects of the Basic OSH Program Plan and thought the Program would be very helpful to food and bag manufacturing SMBs. “After I read it [the Basic OSH Program Plan], I thought the explanation was great … We know the leading sector that deals with OSH issues is the Ministry of Manpower, but we have not reached small and medium-sized businesses yet. The program that you designed is good, but one thing that will raise a question in the future is how it can be implemented so that it can reach small businesses” [Stakeholder 4]. None of the stakeholders had suggestions for adding to the program as they felt the program already covered the essential strategies for addressing OSH concerns in SMBs. However, the stakeholders discussed and provided feedback on ways the program could be implemented.

All stakeholders agreed that it would be beneficial for the Basic OSH Program Plan to be integrated into both the existing food certification program required by the National Agency of Drug and Food Control, as well as occupational health unit program offered by the public health center to reach the business owners. “The small and medium sized food manufacturing businesses need to have food certification to get the distribution permit. I think there should be some kind of certification so this can be fully implemented, such as integrating this basic OSH program plan to the existing food certification. If we do not make it an obligation, they [business owners] will never implement it” [Stakeholder 5]. Another stakeholder added, “If we develop something new without any support from the local or city government, it will be a waste. So, in my opinion, integrating this OSH program plan with food certification that has been well implemented would be effective. Either it becomes a part of the training or introduction, or we can discuss it further between the central and local governments” [Stakeholder 3].

Some stakeholders also suggested that collaborating at the sub-district government level to monitor OSH program implementation in SMBs would be needed. “It is true that it cannot reach the small and medium sized businesses if we do not make it as a national program. To make it a national program and make it easier to be monitored, we need to collaborate with the sub-district local government regarding this matter” [Stakeholder 4]. Another stakeholder stated, “Providing an assistance for business owners would be helpful and is needed because we know that small business owners have very little understanding about OSH. But I guess it does not have to be done by the governments as the governments have their plates full already. Perhaps having the governments collaborate with the academic institutions will be more practical. We know that the academic institutions in Indonesia are required to have community service program, right? I am worried if the assistance is conducted by the governmental bodies, it will not be sustainable as the governments have a lot of things to do and we need to make priorities” [Stakeholder 4].

Expected outcomes and challenges in implementing OSH programs: Most owners mentioned that their expected outcomes of implementing OSH programming would be to improve productivity. “For me, if something [injuries] happened to my employees, the production process can be disrupted. Hence, I think implement the OSH program is important to improve the productivity” [Food manufacturing owner]. Most of them also mentioned improving the employes’ safety would be important as the employes are their greatest asset, and their safety relates to the business’ profits. “My employees are my biggest asset and if injuries happen to them or they get sick, my business will not run. So, I am hoping the OSH program can protect them as it relates to my business and its profits” [Bag manufacturing owner].

In terms of barriers, most owners reported that their biggest challenges in implementing the Basic OSH Program Plan would be the lack of assistance and information provided by the authorities because they have never received OSH training themselves. “We do not know anything about guidelines or any instruction to implement OSH program, so basically what we do so far [related to health and safety] is based on our instinct or experiences” [Food manufacturing owner]. Other challenges mentioned by some owners were making sure employes adhere to the program, having a limited budget, and not having anyone on site that is knowledgeable in OSH. “The challenge will be my employees. They need to be reminded all the time and I need to be patient with them” [Food manufacturing owner].

Relevant stakeholders identified several challenges to implementing the Basic OSH Program Plan, including lack of OSH knowledge among SMB owners as most of them have not been exposed to OSH information; lack of existing regulation to support OSH implementation in SMBs; costs associated with implementation; and lack of government capacity to disseminate the Basic OSH Program to SMBs. “If we are talking about small and medium sized businesses, resources can become a very sensitive topic, particularly the costs. Owners mainly do not have costs to allocate for something other than production process” [Stakeholder 3].

Evaluation of the resources to implement the OSH program

Three subthemes emerged: resources needed, organization to deliver the program, and prior experience with an OSH program. In terms of resources needed, business owners provided information about the resources required to implement OSH programs. There was also discussion about what organization/stakeholder would be best to deliver the OSH program implementation to the SMBs and prior experiences the business owners and relevant stakeholders had with implementing OSH programs in the past.

Resources needed: Most owners from both manufacturing sectors reported that they would need assistance and information to implement the Program from national or local authorities or related agencies. One business owner stated, “I hope we can have an assistance program to implement this. What I meant with an assistance program is having documented OSH information and regulation for SMBs, distributing the information to us [business owners], and providing consultation about OSH program. They [the authorities] need to make it clear which organization that we need to reach out” [Food manufacturing owner]. Another owner was concerned about SMBs complying with program recommendations. “They need to monitor the implementation of OSH if they want to enforce us to do it” [Bag manufacturing owner].

Organization to deliver the program: Most owners agreed that the Local Ministry of Manpower would be the most suitable agency to deliver the program. However, some owners also mentioned that the sub-district level of government would have an important role in proactively ensuring that the Local Ministry of Manpower could deliver the program effectively to the business owners. “The spearhead of it is the sub-district. So, if the programs need to be disseminated, from the relevant department, communication with the sub-district is essential. I am sure that they have communication right now, but maybe not effective enough. What I mean is that when there are trainings, the sub-district should direct and inform us, as well as encourage us to register for those trainings” [Food manufacturing owner]. There were also a few owners who expressed that the best organization to deliver the program was sector-specific. For food manufacturing, owners mentioned the National Agency of Drug and Food Control as the most suitable to deliver the OSH program.

Aligned with the business owners, some stakeholders also reported the Ministry of Manpower to be the best lead of OSH program implementation in SMBs. However, stakeholders also recognized the importance of local authorities and agencies in implementation. “Small businesses mostly exist in suburban areas, and they are monitored by the local government, either at the city level or at the sub-district level. So, sub-district government also play significant role [Stakeholder 4].” Another stakeholder added, “Some governmental organizations can play role, including the National Agency of Drug and Food Control. But, the one who can closely monitor the implementation is the sub-district government level” [Stakeholder 3].

Prior experience with an OSH program: A food manufacturing owner shared their experience with OSH programming. Their business was certified by the National Agency of Drug and Food Control (BPOM) and they collaborated with a local public health center to give the employes regular medical checkups. “… a program that I think not many people here know Puskesmas (Public Health Center) usually have the Occupational Health Unit or known as Unit Kesehatan Kerja (UKK). It has been helpful for my employees … we can find out that this person has high blood pressure, and this person has low blood pressure. Some people also get vitamins to increase their iron level, and that is all for free. Even the doctors and their team came to us with all the medical tools [to perform medical check-ups]. We do not have to pay for anything” [Food manufacturing owner:]. This owner shared the process on how to register a business to the local public health center so employes could receive regular medical checkups. This food manufacturing owner also shared that they have trainings for employes every three months and sometimes invite guest speakers to talk about health and safety at the workplace. To improve the employes’ motivation to attend trainings, they provide certificates of completion. “In our business, the employees have a three-month contract … every three months, we give training for the employees. The speaker can be me, my husband, the owner, or even an external speaker. We also give them a post-training exam, and if they can pass the training, we also reward them by giving them certificates” [Food manufacturing owner].

A stakeholder shared their experience in providing OSH trainings, which are no longer being conducted due to leadership changes in the Local Ministry of Manpower. “I have worked with small businesses for around 20 years. Back then, I knew there were some programs related to OSH for SMBs in the Local Ministry of Manpower in (city), such as trainings about hygiene and fire extinguisher used. But it was not continued when the leaders were moved into other departments in the Ministry” [Stakeholder 5]. Another stakeholder also shared their experience with an occupational health unit program in the local public health center. “Occupational Health Unit program is initiated by the Ministry of Health to reach the small and medium sized businesses. This program is designed to promote injury and illness prevention. However, what has already been done is mostly providing curative care, such as providing medication for injured employees in SMBs and conducting medical checkup for SMBs employees” [Stakeholder 2].

Discussion

Results of this study indicate that both business owners and stakeholders are interested in the Basic OSH Program Plan. Although some of the OSH components and content in the Program may not be currently feasible to implement, overall, the business owners and stakeholders thought it could be beneficial to address their OSH concerns. Business owners had concerns with the injury occurrences in their workplaces, and stakeholders also acknowledged that the SMBs commonly had a higher risk of injuries compared to large businesses. Both business owners and stakeholders also discussed ways the Basic OSH Program Plan could be implemented into practice. They had agreement that enforcement is needed to make OSH programming sustainable. Additionally, to reduce costs and improve the effectiveness of implementing OSH programming into SMBs, both business owners and stakeholders suggested that components of the Basic OSH Program Plan could be integrated into programs already in place, including the food certification program required by the National Agency of Drug and Food Control, and the occupational health units of local public health centers.

Focus groups with the business owners indicated that some components and content of the Basic OSH Program Plan would be practical and acceptable, including registering the employes with the national insurance agency, improving worker participation, and practicing good housekeeping. In terms of worker participation, business owners suggested that having scheduled check-in meetings with employes and encouraging employes to report health and safety concerns in the workplace would be feasible especially since many owners already convened employes on a regular basis to discuss work processes. Many business owners already prioritized housekeeping, which has been shown in prior research to be one of the most important aspects of improving productivity, safety, and product quality in small businesses.²⁴ In addition, research in Australia reported that good housekeeping can improve water efficiency in food manufacturing plants.²⁵ Overall, implementing housekeeping strategies often cost very little, but can have huge impacts on worker safety and on environmental and waste minimization.²⁵

Consistent across both owners and stakeholders was the concept of integrating the Basic OSH Program Plan with the existing food certification program required by the National Agency of Drug and Food Control (NADFC). This program integration will ensure that training occurs for business owners. The food certification program is a requirement of the NADFC where all food manufacturing owners must be certified before they can sell their products to the market. Certification includes participating in food safety training, having the food tested in the lab for ensuring the food does not contain any harmful ingredients, having the workplace checked for its hygiene by the agency, obtaining health and hygiene certification from the local public health center, and providing the details of ingredients of the food being produced.²⁶ It is possible that some components and content from the Basic OSH Program Plan could be integrated into the certification program. For instance, requiring business owners to have written OSH commitment, register their employes to the national insurance agency, have safety signage and scheduled meetings with employes, and practice good housekeeping. When all the OSH requirements are fulfilled, the food manufacturing owners can receive the certificate and sell their products.

In addition, occupational health units initiated by the Ministry of Health through local public health centers can play a role in OSH programming. The occupational health unit aims to educate the SMB owners and employes on how to prevent injuries and illnesses in the workplace, as well as provide free and regular medical checkups for the SMB employes.²⁷ But, based on the focus group with owners and stakeholders, OHU services have mainly focused on providing medical checkups and not necessarily OSH education. By integrating components of the Basic OSH Program Plan with occupational health units, the local public health center can educate SMB employes about OSH during the scheduled medical checkups. For instance, the local public health center can talk with SMBs owners and employes about the insurance and ways to have the employes registered, provide emergency contact to business owners if any of their employe experience injuries at the workplace, and provide first aid training for SMBs owners.

In 2006, Hasle and Limborg introduced an OSH program dissemination model to small businesses in the US, and concluded that OSH interventions should be simply designed, meaning that OSH programs and information should be incorporated into small business practices at a low-cost and be practical and acceptable to the business owners to implement.²⁸ Based on the dissemination model, the integration of basic OSH program plan to the food certification program and occupational health unit will provide a program that is simply designed, low-cost, practical, and acceptable to implement. Additionally, as the integration of basic OSH program plan to the occupational health unit will provide the SMBs owners a free medical checkup for their employes, it is expected that the owners will be more willing to participate. Then, the integration of basic OSH program plan to the food certification program will enforce the food manufacturing owners to implement the OSH.

In addition to knowledge, business owners in the study discussed how enforcement of OSH program compliance would be important for sustainability. Stakeholders specifically mentioned the importance of having oversight from local entities. For example, the sub-district government commonly has connections to small businesses as they are the first called when business owners need support from government organizations. Focus groups with owners and stakeholders suggested that the national Ministry of Manpower could lead OSH dissemination efforts, while the sub-district governments could interact with the businesses for training, materials, and technical support. Based on the OSH dissemination model proposed by Sinclair et al. the Ministry of Manpower would be an “initiator” organization while the sub-district government would be the “intermediary” organization that reaches small businesses and connects them to OSH resources offered at the national level.²⁹

OSH dissemination models provide frameworks for reaching small businesses with occupational safety and health information and have been shown to be effective approaches in disseminating OSH Program to SMBs.^28–31 However, further translation efforts are needed to identify effective methods of introducing and sustaining a Basic OSH Program Plan in food and bag manufacturing SMBs in Indonesia. The OSH field recognizes the importance of protecting workers from injury and illness but also recognizes the unique challenges that small businesses face in adopting OSH strategies, including costs, limited human resources, and lack of affiliations with organizations that serve OSH business interests.³²

Our study with Indonesian business owners and stakeholders shows that OSH is important but that infrastructures for dissemination, enforcement, and continued support need to be established. This study also demonstrates that the Basic OSH Program Plan (Appendix A.2.) can be used by Indonesian SMBs owners and relevant stakeholders for implementing practical programs. In addition, obvious partners were identified through the focus groups, providing a starting place for next efforts in reaching food and bag manufacturing SMBs with a Basic OSH Program Plan. However, there are some expected challenges that can inhibit the integration of basic OSH program plan with the occupational health unit and how it will be implemented. While it is true that occupational health unit is run through the local public health center, there is no existing data to determine how many local public health centers still run the program. Additionally, to receive the services from the occupational health unit, the SMBs owners need to register their businesses to the local public health center. Unfortunately, SMBs owners commonly do not know that such program exists, unless the sub-district government inform them.

To our knowledge, this is the first study that simultaneously examined SMB owners’ and stakeholders’ perspectives on the acceptability and practicality of small and medium sized food and bag manufacturing businesses in Indonesia implementing a Basic OSH Program Plan. We found that OSH was important to business owners and relevant stakeholders but that implementing even a Basic OSH Program Plan will need a coordinated effort from national and local stakeholders, local organizations that may not be traditional OSH stakeholders but who are influential to SMB owners, and the business owners themselves and their employes. Furthermore, although the business owners indicated that they are interested in improving employes’ safety and health through the Basic OSH Program Plan, it may not be how employes feel that makes it more important to have a national program with enforcement component. Understanding how the Basic OSH Program Plan can be feasible for other industry sectors will be important for future studies. Furthermore, once Indonesia has surveillance data to provide detailed information about SMBs, as well as the occupational injuries and illnesses that occurred to the SMBs employes, additional studies can utilize quantitative methods (e.g. surveys) with larger samples to provide a more complete overview of current OSH program implementation and its potential improvements among SMBs in the country.

This qualitative study is not intended to be generalizable; although, some themes may resonate in similar contexts to other manufacturing sectors or SMBs in general, particularly those in low- and middle-income countries. However, caution should be made when applying findings to SMBs that operate as franchises or are part of big chain companies, where more resources are available. Additionally, purposive sampling was used to identify participants. The perceptions shared by these individuals might be different from others who work in different regions in the country or work for different types of manufacturing businesses. Additionally, there were some stakeholders who were invited to participate in the focus groups but did not. These stakeholders had significant roles in relation to the components and contents on the Basic OSH Program and their potential implementation. They included the International Labor Organization, Local Initiatives for OSH Network, and the National Insurance Agency.

Conclusion

This study shows that there are potential avenues for OSH implementation and enforcement in small and medium sized food and bag manufacturing businesses in Indonesia, the methods of which may be expanded to other sectors of SMBs. Although a comprehensive OSH program, as suggested by the NIOSH Total Worker Health^® Fundamental Elements and OSHA Essential Elements, could not be adopted as designed by Indonesian food and bag SMBs, components of these programs are feasible, such as registering the employes with the national insurance agency, having safety signage, improving workers’ participation in routine OSH practices, and practicing good housekeeping. It is recommended that the Indonesian SMBs and relevant stakeholders can adopt the recommendations in the Basic OSH Program Plan that is available in this study.

Supplemental Material

sj-docx-1-wor-10.1177_10519815251320270 - Supplemental material for Practical and acceptable OSH programs for SMBs in food and bag manufacturing in Indonesia

Supplemental material, sj-docx-1-wor-10.1177_10519815251320270 for Practical and acceptable OSH programs for SMBs in food and bag manufacturing in Indonesia by Cynthia Febrina Maharani, Carri Casteel, Diane Rohlman, Rima Afifi, Kelly Baker and Nathan Fethke in WORK

Footnotes

Acknowledgements

Support from this project comes from the Healthier Workforce Center of the Midwest (CDC/National Institute for Occupational Safety and Health; U19 OH008868) and the Injury Prevention Research Center at the University of Iowa (CDC; R49 CE003095). We also thank Fiori Amelia Putri for the help in taking notes and documentations on several focus group discussions. Cynthia Maharani as the Principal Investigator of this research was supported by the Fulbright Doctoral Degree Scholarship, American Association of University Women, and the International Peace Scholarship to accomplish the doctoral training. Cynthia Maharani is the one who contributed most to the work by developing the ideas, concepts, collecting and analyzing the data, and including writing the manuscript. Carri Casteel and Diane Rohlman are Cynthia Maharani's faculty advisors who provided guidance on ideas and concepts development, advised Cynthia during the data collection and analysis, and reviewed the manuscript. Rima Afifi also had significant contribution in providing guidance during the data collection and analysis, advised for the interpretation of the data and reviewed the manuscript. Kelly Baker and Nathan Fethke also had substantial contribution in providing feedbacks during the data collection and analysis and manuscript writing. All the focus group interviews’ recordings and transcripts are available in Bahasa Indonesia (the primary language of the study participants).

Author's note

Cynthia Febrina Maharani is also affiliated at Public Health Graduate Program, College of Health Sciences and Technology, Binawan University, Jakarta, Indonesia

ORCID iD

Cynthia Febrina Maharani

Ethical consideration

This study protocol was approved by the Institutional Review Board from the University of Iowa (No. 202112296). The study participants were contacted through phone call and if the participants agree to participate, verbal interest is shown.

Informed consent

Not applicable. If the participants agreed to be interviewed, verbal consent was achieved.

Funding

This research was funded by several grants from the University of Iowa, including Center for Asian and Pacific Studies (CAPS) Dissertation Research Grants for Graduate Students, Advancing Graduate Student Success Award, GPSG Research Grants, Global Public Health Student Travel Grant, and T. Anne Cleary International Dissertation Research Fellowship.

Declaration of conflicting interests

None declared. The authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Supplemental material

Supplemental material for this article is available online.

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