Model gpa objective X working Compendium

2009-2012 Work Plan Number	GPA1.10i Formerly AA3:S1
GPA Objective	GPA Objective 1: To devise and implement policy instruments on workers’ health
CC or NGO Name	National Institute of Occupational Health, Ahmedabad India.
Project title	Development of Risk Management Toolkit for Silicosis in Small Silica Flour Milling Units
Keywords	Silicosis, Silica Flour Mills, Technology, Toolkit
Project leader Email address	Dr L J Bhagia [e-mail] Project Manager NIOH and Dr S K Dave [e-mail] Director, NIOH. Dr Habibullah N Saiyed, (Past Director, NIOH) [e-mail]
Partners (of the CC Network)	CC: Dr Andy Cecala National Institute of Occupational Safety and Health (NIOSH) (Pittsburgh Laboratory) USA. Dr Richard W. Niemeier, Education and Information Division NIOSH (Cincinnati)
Other partners	Prof Scot Clark - University of Cincinnati USA Department of Labour Govt of Gujarat Department of Labour Govt of Rajasthan Association of silica flour manufacturers.
Funding	Ministry of Health Govt of India (First year) Indian Council of Medical Research (2nd and 3rd year) National Institute of Occupational Safety & Health USA (for the visit of US scientists)
Objective of the project	To develop toolkit for control of silica dust for small silica flour mills.
Project outcome(s) and deadline(s) for completion of the project Target group and/or beneficiaries	Development of a toolkit for dust control for small silica flour mill units that will be readily usable by 2008. Disseminate the information to the beneficiaries through pamphlets, internet etc. after successful development of the toolkit, by 2009. Small silica flour mill units in India initially and subsequently similar units in the other developing countries in the region.
Summary of the project (max 100 words)	NIOH studies have shown that about 50% of the young workers develop accelerated silicosis/silico-tuberculosis within 2-3 years of exposure. With the local expertise, we devised dust control techniques which could reduce the airborne silica dust by up to 95%. Under the Indo-US collaborative research programme we are now developing silica control tools which are suitable for the small silica flour mills in India and other developing countries. The intervention measures based on the toolkit will be implemented in a few selected factories. There will be periodic monitoring and modification based on the feedback.
Dissemination	State the method of disseminating the project outcomes. For example: WHO/ILO documents; university studies; worker and enterprise meetings
Impact (global or regional)	Region
Progress on Project (max 100 words)	Indo-US workshop on Practical methods of silica dust Control was organized at Beawar, India from 17-18 January, 2006 where factory owners, supervisors and factory Inspectors from Gujarat and Rajasthan states participated. US team was represented by Dr. Clark, Dr. Rice from Cincinnati and Mr. A Cecala from NIOSH. A workshop was followed by an awareness programme for workers. A booklet giving details of silicosis and its control and general work practices in Hindi was published and distributed to all participants and workers. Later on,CDs of all the presentations and recommendations of the workshop were sent to the participants. After the workshop, one mill owner at Godhra (Gujarat) was encouraged with the help of Director, Industrial Health and Safety (DISH ), Gujarat and he volunteered for new set-up including most of the recommendations of the workshop. New set-up will have ramp, hopper, crusher with dust control, covered conveyor belts. All dust generation points like hammer mill, magnetic separator, rotary screen etc. will be connected to bag filter and fan with duct work. Installation will be completed by September 2007. Dust monitoring will be carried out after September 2007. No report on further progress received by June 2010
List of major outcomes already achieved by this project	There are two types of silica mills in India namely Hammer type and ball mill type. In hammer type of mills product mesh size is less than 100 mesh where as in ball mills product mesh size is 100-500.Ther are 17 hammer type of mills at Godhra (Gujarat). All the mills at Godhra have installed control measures like isolation of processes and dust control devices covering all dust generation points like hammer mill, magnetic separator, rotary screen. Some of the mills have installed ramp, hopper and separate dust control at the crushers while others have isolated crushers. Continuous bagging is stopped in all the units. Instead they have silos where the product is collected. Silo can be unloaded within an hour. Thus, exposure time for bagging is reduced from 6-8 hours to one hour per shift. Dr. Scott Clark, University of Cincinnati, USA, has visited these plants in 2008. There are many ball mills at Beawar (Rajasthan). Exposure occurs while feeding of raw materials and manual bagging of product. Dust control device having hoods at these two points, fan and reverse pulse jet type bag filter has been designed and installed at one of the ball mills. The device was inaugurated on 16^thJune, 2009 in presence of Principle secretary, Labor department, Govt. of Rajasthan and Dr. P. K. Nag, director, NIOH. About 150 mill owners attended the function. Dr. Clark also attended the function. Reduction in the total dust by dust control device is 89.04% to 96.90% and the same for respirable dust varied from 77.50% to 84.91%.
List of additional major outcomes expected from this project by 2012	The tenure of the project expires on 31^st July, 2009.

Area 5: Increase technical knowledge and capacity in industrial hygiene

2009-2012 Work Plan Number	GPA1.10aa
PROJECT Title	Respiratory Protection Program Development
GPA Objective (e.g. GPA5) and GPA Action (e.g. Action 28)	GPA Objective 1: To devise and implement policy instruments on worker health
Priority Number (e.g. 5.3) and Area (if applicable) e.g. Agriculture	Priority 1.2: Develop and disseminate evidence-based prevention tools and raise awareness for the prevention of silica- and other dust-related diseases
Responsible CC or NGO Name	NIOSH
Project leader (contact name and email address)	Heinz W Ahlers, NIOSH [e-mail]
Network partners (CC name, country, email)	Mutual Seguridad, Chile Alejandro Morales, [e-mail] ISP, Chile Manuel Parra IPSC [e-mail]
WHO Regions involved in this CONTRIBUTING project (contact name and email)
Country ministries involved in this CONTRIBUTING project (contact name and email)	Chile ISP, Colombia [e-mail]
External partners for this CONTRIBUTING project (contact name, organization and email)
Summary of the project (max 100 words)	Many industries in the Americas rely on half facepiece particulate respirators to protect the workers from exposures to dust. This is particularly prevalent for silica dust exposures in mining. For the successful use of respirators a respiratory protection program need to be in effect to properly train workers, select respirators, evaluate respirator fit and assure proper respirator maintenance. This program will adapt the current US program covering all respirators to a simple program covering the use of particulate respirators only intended for translation into Spanish and modified for the specific need of the target population.
Target group and/or beneficiaries	Small business operators in the Americas using particulate respirators to protect against toxic dust exposure, especially silica dust
Major Milestones (list up to three dates and milestones)	October 15, 2009: Preparation of Final US draft June 1, 2010: peer review of English version August, 2010: Availability of Spanish version for workplace testing No progress report received by June 2010
Dissemination plan
Funding source(s)	NIOSH, USA
Expected results of this project by 2012 (outcomes)	Respirator programs implemented to prevent toxic dust exposure in mining in at least two South American countries. Current targets are Chile and Columbia.

PRIORITY 1.3: Develop and disseminate evidence-based tools and raise awareness

for the elimination of asbestos-related diseases

FACILITING PROJECT (administrative) Work plan project number	GPA1.3: Asbestos-Related Diseases Global Facilitating Project (with projects organized by area of work)
Facilitating Project title	Strategies and programmes for elimination of asbestos-related diseases (ARDs)
GPA Objective	GPA Objective 1: To devise and implement policy instruments on workers’ health
GPA Action 1.10	WHO will work with Member States to strengthen the capacities of the ministries of health to provide leadership for activities related to workers’ health, to formulate and implement policies and action plans, and to stimulate intersectoral collaboration. Its activities will include global campaigns for elimination of asbestos-related diseases - bearing in mind a differentiated approach to regulating its various forms - in line with relevant international legal instruments and the latest evidence for effective interventions, as well as immunization of health-care workers against hepatitis B, and other actions addressing priority work-related health outcomes.
Priority Area	Priority 1.3: Develop and disseminate evidence-based prevention tools and raise awareness for the elimination of asbestos-related diseases (ARDs)
Purpose of Facilitating Project	This Facilitating Project aims to establish synergies between the on-going global, regional and country efforts on elimination of asbestos-related diseases, such as the Asian Asbestos Initiative [AAI] to substantially advance the ILO/WHO Global Campaign to Eliminate Asbestos-Related Diseases (ARDs) as set forth by: i) the 13^th Session of the Joint ILO/WHO Committee on Occupational Health in 2003; ii) WHO Recommendations from 2006 on Elimination of Asbestos-Related Diseases and iii) the WHO/ILO Outline for the Development of National Programmes for Elimination of Asbestos-related Diseases from 2007. The Asian Asbestos Initiative (AAI) is an on-going regional approach to advance the ILO/WHO Campaign. It aims at the sharing and transferring of core preventive technologies among concerned parties, eg, academicians and administrators, for the elimination of ARDs. It strives to develop and augment partnerships with stakeholders including employers, workers, international organizations, ministries, universities, research institutes, and NGOs. All on-going regional projects with similar goals as AAI will be integrated and grouped into four areas, three of which correspond to the three levels of preventive activities, and the fourth of which is designated to monitor progress of the entire spectrum of preventive activities: Area 1: (Primary Prevention) Develop, promote, share and transfer technologies for abatement and substitution of asbestos as well as for reduction of exposure. Core technologies for exposure reduction include measurement of fibre concentration in work environment and asbestos-containing products, and industrial hygienic methods such as containment, local exhaust systems and use of protective masks. Area 2: (Secondary Prevention) Develop, promote, share and transfer technologies for early and effective detection of ARDs combined with an introduction and maintenance of a surveillance system for ARDs. Core technologies for detection of ARDs include: i) chest X-ray and CT techniques to detect asbestosis, pleural plaques and malignancies; ii) pathological diagnosis of mesothelioma; iii) identification and quantification of asbestos fibers and asbestos bodies in lung specimen and broncho-alveolar lavage fluid; iv) biomarkers for early detection of ARDs. Area 3: (Tertiary Prevention) Develop, promote, share and transfer technologies for effective treatment and just compensation of ARDs. Core technologies include new treatment and clinical management options for mesothelioma as well as design and implementation of just compensation schemes. Area 4: (Monitoring Progress) Compile and report NPEAD (ILO/WHO) with periodic review and report.
GPA Manager	Claudina Nogueira – NIOH, South Africa
CC Initiative Leader and contact information	Ken Takahashi; [e-mail] Department of Environmental Epidemiology, IIES, University of Occup & Environ Health, Iseigaoka 1-1, Yahatanishiku, Kitakyushu City JAPAN 807-8555 TEL: [phone] FAX:[phone]
WHO responsible person	Ivan Ivanov [e-mail] Hisashi Ogawa [e-mail]
Collaborating centre partners with separate contributing PROJECTS (List CC, project title, project number, project leader, and email)	Projects are organized by area: Area 1: (Primary Prevention) Develop, promote, share and transfer technologies for abatement and substitution of asbestos as well as for reduction of exposure. Core technologies for exposure reduction include measurement of fibre concentration in work environment and asbestos-containing products, and industrial hygienic methods such as containment, local exhaust systems and use of protective masks. GPA1.10g Establishment of infrastructure to evaluate risk of asbestos exposure. Project Leader: Hyunwook Kim [e-mail] Catholic Industrial Medical Centre (CIMC), Korea GPA1.10o Training on asbestos and its identification. Project Leader: James Ian Phillips [e-mail] National Institute for Occupational Health (NIOH), South Africa GPA1.10q Support in the methodology to train workers involved in asbestos removal activities. Project Leader: Juan Alcaino Lara [e-mail] Instituto de Salud Publica de Chile GPA1.10h Consistency in laboratory analysis of samples to determine airborne concentrations of asbestos and other fibres. Project Leader: Alan Jones [e-mail] Institute of Occupational Medicine, UK GPA1.10w AFRICA [i.e., an international proficiency testing scheme for laboratories that measure airborne asbestos fibre concentrations using the phase contrast optical microscopy counting method] Fibre Counting Scheme. Project Leader: Alan Jones [e-mail] Institute of Occupational Medicine, UK Area 2: (Secondary Prevention) Develop, promote, share and transfer technologies for early and effective detection of ARDs combined with an introduction and maintenance of a surveillance system for ARDs. Core technologies for detection of ARDs include: i) chest X-ray and CT techniques to detect asbestosis, pleural plaques and malignancies; ii) pathological diagnosis of mesothelioma; iii) identification and quantification of asbestos fibers and asbestos bodies in lung specimen and broncho-alveolar lavage fluid; iv) biomarkers for early detection of ARDs. GPA1.10a Establishment of malignant mesothelioma surveillance system. Project Leader: Hyoung Ryoul Kim [e-mail] Catholic Industrial Medical Centre (CIMC), Korea GPA1.10d Detection of impaired lung function in early stages of asbestosis by means of gas diffusion parameters. Project Leader: Alexandra Preisser [e-mail] Institute of Occupational Medicine and Maritime Medicine, Hamburg, Germany GPA1.10f Lung function reduction associated with different levels of occupational exposure to asbestos particles. Project Leader: Lenka Rychla [e-mail] Center for Occupational Health at the National Institute of Public Health, Prague, Czech Republic Area 3: (Tertiary Prevention) Develop, promote, share and transfer technologies for effective treatment and just compensation of ARDs. Core technologies include new treatment and clinical management options for mesothelioma as well as design and implementation of just compensation schemes. Currently not directly applicable but 1.10c has a component in this area Area 4: (Monitoring Progress) Compile and report NPEAD (ILO/WHO) with periodic review and report. GPA1.10b The national strategic plan and action for prevention and control of asbestos related diseases in Thailand. Project Leader: Somkiat Siriruttanapruk [e-mail] Bureau of Occupational and Environmental Diseases, Ministry of Public Health, Thailand GPA1.10c Asian Asbestos Initiative. Project Leader: Ken Takahashi [e-mail] University of Occupational and Environmental Health, Japan GPA1.10bb Sound management of priority industrial carcinogens, incl. asbestos in Thailand, Indonesia and Sri Lanka. Project Leader: Ivan Dimov Ivanov [e-mail] World Health Organization New - GPA1.10cc Regional Asbestos Atlas of the Americas. Project Leader: Dr Luz Maritza Tennassee [e-mail] PAHO New - GPA1.10dd Epidemiological surveillance system for the ARDS: operative tools for monitoring and prevention. Project Leader: Alessandro Marinaccio [e-mail] and Alessandra Binazzi [e-mail] ISPESL – National Institute for Occupational Prevention and Safety, Italy New – GPA1.10yy Development of toolkit for elimination of asbestos related diseases. Project Leader: Ken Takahashi [e-mail] and Seong-Kyu Kang [e-mail] UOEH – University of Occupational and Environmental Health, Japan
WHO Regional offices actively involved in this project (name and email)	PAHO; Maritza Tennasee [e-mail] EURO: Rokho Kim; [e-mail] SEARO: Salma Burton, [e-mail] WPRO: Hisashi Ogawa [e-mail] AFRO; Thebe Pule [e-mail] ILO; Igor Fedotov [e-mail]
Summary of the facilitating project (max 100 words)	This GPA 1.3 Asbestos-Related Diseases Global Facilitating Project coordinates ongoing efforts in Asia (eg, Asian Asbestos Initiative [AAI]) with projects from Africa, Europe and Americas that will substantially advance the ILO/WHO Global Campaign to Eliminate Asbestos-Related Diseases (ARDs). Academia and administrators will take the lead and collaborate with other concerned parties. Projects include activities within regional and national plans to share and transfer core preventive technologies for the elimination of ARDs at all three levels of prevention, improved estimation of the global burden of ARDs and the active formulation of NPEAD by countries.
Anticipated deliverables by 2012 from contributing projects	Area 1 (Primary Prevention) Develop, promote, share and transfer technologies for abatement and substitution of asbestos as well as for reduction of exposure. Core technologies for exposure reduction include measurement of fibre concentration in work environment and asbestos-containing products, and industrial hygienic methods such as containment, local exhaust systems and use of protective masks. Project GPA1.10g Establishment of infrastructure to evaluate risk of asbestos exposure. Catholic Industrial Medical Centre (CIMC), Korea Support Ministry to create provision, training, etc for asbestos demolition, clearance, etc. In progress. Submit report to Ministry of Labor recommending expertise, guidance, training and ban on use/import of asbestos products. Use and import of all forms of asbestos is now banned in Korea, effective from Jan 2009. Design microscopy course for analysts and establish quality control schemes. Courses have been designed and are being offered by KOSHA and NIER. Quality control schemes are being offered through KOSHA and will be offered by NIER also in the near future. Establish educational institute for asbestos. Educational programs for workers, supervisors and contractors are being offered by two private institutes and KOSHA. Establish training laboratories dealing with asbestos and making accreditation system. There are now over 50 labs participating QC schemes of KOSHA which will be accredited if they pass the QC rounds. Develop substitute for asbestos Collaborate with other WHO partners Project GPA1.10o Training on asbestos and its identification. National Institute for Occupational Health (NIOH), South Africa Develop training materials and training course content (2006) Implement training courses (2007) Establish a regional reference and training centre in conjunction with the Occupational Hygiene Section of the NIOH (2008) Disseminate information to SADC region and associations of occupational and environmental hygienists Project GPA1.10q Support in the methodology to train workers involved in asbestos removal activities. Instituto de Salud Publica de Chile. Disseminate training manual in hard copy and CD and conduct phone conferences to support and train workers involved in asbestos removal activities Coordinate efforts between other national and regional institutions responsible for workers health Project GPA1.10h Consistency in laboratory analysis of samples to determine airborne concentrations of asbestos and other fibres. Institute of Occupational Medicine, UK. Standardization of fiber counting methods in Europe Wider application of proficiency testing (PT) across individual analysts and labs Adoption of the WHO all-fibre counting method Improve and maintain consistency in the analysis of airborne concentration of fibers; assess the effect of change to a new method of fibre counting. Coordination with WHO-CCs in Korea (Catholic University) and South Africa (NIOH) Disseminate information on progress and findings to laboratories worldwide by reports and published paper(s). Project GPA1.10w AFRICA Fibre Counting Scheme. Institute of Occupational Medicine, UK [“AFRICA” is an international proficiency testing scheme for laboratories that measure airborne asbestos fibre concentrations using the phase contrast optical microscopy counting method] Enable participating laboratories to compare their counting levels with those of other laboratories with reference counts, for quality control. Regular operation of scheme’s core function of 2009 Formulate reviews of general patterns of international comparability (2010-2012) Increase membership to the scheme especially from developing countries Publish peer review paper on outcome, methodological advances, etc. Publicize proficiency status of participating labs on IOM website COMPLETED Area 2: (Secondary Prevention) Develop, promote, share and transfer technologies for early and effective detection of ARDs combined with an introduction and maintenance of a surveillance system for ARDs. Core technologies for detection of ARDs include: i) chest X-ray and CT techniques to detect asbestosis, pleural plaques and malignancies; ii) pathological diagnosis of mesothelioma; iii) identification and quantification of asbestos fibers and asbestos bodies in lung specimen and broncho-alveolar lavage fluid; iv) biomarkers for early detection of ARDs. Project GPA1.10a Establishment of malignant mesothelioma surveillance system. Catholic Industrial Medical Centre (CIMC), Korea. Support screening system of ARDs in Indonesia [where factories moved to from Japan and Korea] (Dec 2009) Designation of special acts for compensation for environmental ARDs (Dec 2010) Prediction of peak time of the mesothelioma epidemic in Korea (Dec 2012) Development of homepage or blog to assist ARD patient and to communicate with other researchers Project GPA1.10d Detection of impaired lung function in early stages of asbestosis by means of gas diffusion parameters. Institute of Occupational Medicine and Maritime Medicine, Hamburg, Germany. Development of sensitive diagnostic tool for asbestos-induced plaques and asbestosis at early stages as well as evidence-based recommendations for detecting early stages of benign ARDs. Objectify functional impairment of pleural plaques and initial parenchymal fibrosis by means of DL, CO, the new analyzing method DL, NO, and the alveolar-arterial PO2 difference in the exercise test (spiroergometry) Compare data with spirometry, compliance, CXR/CT and estimated cumulative dose of asbestos Dissemination of findings as ISO guidelines, ASTM guidelines, IOHA presentations, NIOSH website, etc. Project GPA1.10f Lung function reduction associated with different levels of occupational exposure to asbestos particles. Center for Occupational Health at the National Institute of Public Health, Prague, Czech Republic. Selection of study subjects from database of former workers occupationally exposed to asbestos (2006) Data-entry and processing of follow-up data from lung function tests and chest films (2007-2009) Statistical analysis of data and final assessment of reduction of selected lung function parameters in study groups. Integration of results to estimate post-exposure progression of lung function damage (2009-2010) Dissemination of findings as meeting reports, publications and WHO documents Area 3: (Tertiary Prevention) Develop, promote, share and transfer technologies for effective treatment and just compensation of ARDs. Core technologies include new treatment and clinical management options for mesothelioma as well as design and implementation of just compensation schemes. Area 4: (Monitoring Progress) Compile and report NPEAD (ILO/WHO) with periodic review and report. Project GPA1.10b The national strategic plan and action for prevention and control of asbestos related diseases in Thailand. Bureau of Occupational and Environmental Diseases, Ministry of Public Health, Thailand. Description of asbestos situation at national and local levels Implementation of control methods, e.g. Labelling of warning signs on asbestos-containing products (2009) Development of ARD surveillance system (2010) Cut use of asbestos by 25% (2012) Project GPA1.10c Asian Asbestos Initiative. University of Occupational and Environmental Health, Japan Sharing and transferring of core technologies in preventing ARDs through development of training tools and organization of international seminars Development of training tools for expert training on prevention of ARDs, e.g. video COMPLETED Elaboration of national profiles on asbestos use and ARDs (2010) Initiate surveillance system of asbestos exposure and ARDs (2011) Organization of annual international seminars (2008 completed, 2009 scheduled in Thailand, 2010 scheduled in Japan) Project GPA1.10bb Sound management of priority industrial carcinogens, including asbestos in Thailand, Indonesia and Sri Lanka. WHO Global Occupational Health Programme, Bureau of Occupational and Environmental Diseases, Ministry of Public Health of Thailand, Directorate for Occupational Health, Ministry of Health of Indonesia, Department of Public Health Services, Ministry of Health of Sri Lanka. Draft national programme on elimination of ARDs prepared in Thailand COMPLETED National programme on elimination of ARDs finalised in 3 countries by 2012 Development of national profiles of industrial carcinogens (May 2010); Priority setting (September 2010); Development of national report on proposed preventive interventions (May 2011) NEW - Project GPA1.10cc Regional Asbestos Atlas of the Americas. PAHO Individual countries need to inventory their use of asbestos and asbestos products: Contact the key people who will write the history (e.g., on asbestos use as well as recognition and management of ARDs) of their countries Submit letters to the Ministries of Health, Labour and Economy to inform about the project and to facilitate the gathering of information Follow up on progress during the process It is hoped that this project will contribute to the Global Elimination of ARDs by overcoming known barriers such as: In some of the countries, the access to asbestos data is very challenging and difficult Asbestos must be given a higher profile on the regional health agenda Coordination of efforts with diverse regional stakeholders will contribute to the elimination of ARDs across the Americas Region as well as global partners in other Regions NEW - Project GPA1.10dd Epidemiological surveillance system for the ARDS: operative tools for monitoring and prevention. ISPESL - National Institute for Occupational Prevention and Safety, Italy Review of existing ARDs surveillance systems worldwide [2010] Comparison of methodologies applied and standardisation of procedures [2010] Availability of tools from the Italian mesothelioma surveillance system (territorial organization of the Register, national guidelines establishing standardised methods of cases collection and diagnostic criteria, standardised questionnaire for retrieving occupational and residential histories and lifestyle habits, catalogue of economic sectors with asbestos exposure) [2011] Development of methodologies and procedures for ARDs surveillance to be applied in developing countries [2012] NEW – Project GPA1.10yy Development of toolkit for elimination of asbestos related diseases. UOEH - University of Occupational and Environmental Health, Japan Compilation of collected and newly developed information and technical materials into a comprehensible and usable toolkit The toolkit will be developed as a joint effort of concerned partners collaborating on the existing platform of the Asian Asbestos Initiative (AAI) Submission of toolkit product to a funding agency, after completion Strengthening of networks and promotion of the application of the toolkit
Critical Gaps to be filled by 2012 in order to fulfil GPA priorities (these lead to deliverables desired by 2012)	Additional projects are needed in the area of tertiary prevention, i.e. effective treatment and just compensation of ARDs Formulate a regional model based on accomplishments in Asia (i.e. priority region in terms of needs) to translate and implement in other regions Develop practical tools for control of exposure to asbestos Assess health and environmental impacts of continuing use of asbestos Collect evidence on the effectiveness of asbestos substitution
Examples of deliverables desired by 2012 to adequately assist countries to substantially reduce silica and other dust-related diseases. It is these deliverables for which we will seek projects from CCs	Complete and update NPEAD for representative countries Construct and maintain specific website for NPEAD for other countries to follow Improve estimation of global burden of ARDs Compile good practices for substitution and exposure reduction Review national status on health surveillance of exposed in combination with early detection of ARDs Promotion by ILO and WHO of model national programs (e.g. Thailand, Vietnam) Electronic library of tools and information for the elimination of ARDs Involve international organizations in addition to WHO/ILO, e.g. UNU, UNEP Increase number of countries adopting: i) ILO Asbestos Convention; ii) ban on asbestos use; iii) roadmap towards ban
Barriers to success that must addressed	Account for differences in national/regional phases on use of asbestos and status of ARDs Give the issue a higher place on the global health agenda and acquire grants for global projects from a wider range of funding organizations, including those dealing with global health Coordinate efforts with on-going activities by grass-roots and other organizations Insufficient national capacities for sound management of hazardous chemicals and substances