Assessment report - UNDP...Assessment report Improving the Health and Safety of Miners in Eastern Ukraine 8 1. IntrodUC tIon Ukraine’s coal mining industry has one of the highest

Assessment reportImprovIng the heAlth And sAfety of mIners In eAstern UkrAIne

published by the United nations development programme (Undp) in Ukraine

Kyiv, Ukraine, November 2012© UNDP, 2012 — All rights reserved

All rights reserved. The views expressed in this publication are the author’s and do not necessarily represent those of the United Nations, including UNDP or its Member States.

The mention of specific companies does not imply that they are endorsed or recommended by UNDP in preference to others of a similar nature.

UNDP does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use.

United Nations Development Programme in Ukraine1, Klovsky Uzviz Str.Kyiv, 01021, Ukraine

Contents

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ContentseXeCUtIve sUmmAry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

key fIndIngs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

1. IntrodUCtIon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81.1 Miners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81.2 Mining Industry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81.3 National Priorities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81.4 Gender Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

2. CommUnIty meetIngs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

2.1 Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102.2 Factors Affecting the Health and Safety of Miners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

3. heAlth dAtA on mIners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

3.1 Key Findings from the Medical Exams of Miners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113.2 Methodology for Conducting and Analysing the Medical Exams . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113.3 Health Data on Miners. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

4. sAfety dAtA on mIners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

4.1 Key Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174.2 Safety Data on Miners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

5. opInIon sUrveys of mIners In rovenky And sverdlovsk . . . . . . . . . . . . . . . . . . . . . . . . . . 18

5.1 Key Findings from Rovenky and Sverdlovsk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185.2 Miners’ Opinions on Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185.3 Miners’ Opinions on Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

6. generAl reCommendAtIons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

7. krAsnodon ACtIon plAn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

7.1 Key Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267.2 Community Health Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267.3 Krasnodonugol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277.4 Priorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287.5 General Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287.6 Action Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297.7 Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

8. rovenky ACtIon plAn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

8.1 Key Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348.2 Community Health Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348.3 DTEK Rovenkiantratsit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348.4 Health and Safety of Miners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368.5 Priorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368.6 General Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378.7 Action Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378.8 Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

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Assessment reportImproving the Health and Safety of Miners in Eastern Ukraine

9. sverdlovsk ACtIon plAn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

9.1 Key Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429.2 Community Health Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429.3 DTEK Sverdlovantratsit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439.4 Health and Safety of Miners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439.5 Priorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449.6 General Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449.7 Action Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 459.8 Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

10. regIonAl ConsIderAtIons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

11. AppendIX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

12. BIBlIogrAphy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

13. endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

EXECUTIVE SUMMARY

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executive summaryThe “Improving the Health and Safety of Miners in Eastern Ukraine” project aims to identify and address the health and safety needs of miners in Krasnodon, Rovenky and Sverdlovsk. This report summarises the results of the first or assessment phase of this project, while the second phase will focus on implementing the recommendations set forth in this report.

To begin, UNDP partnered with DTEK and Metinvest, two of the largest energy and mining companies in Ukraine, to implement this project. UNDP also received endorsements from the mayors of Krasnodon, Rovenky, and Sverd-lovsk, as well as the governor of the Luhansk Oblast State Administration to proceed with the effort.

UNDP then conducted dozens of interviews, focus groups, and community workshops to understand the health and safety needs of miners. UNDP also worked closely with DTEK Rovenkiantratsit, DTEK Sverdlovantratsit, and Metinvest Krasnodonugol to examine the working conditions of miners. Over the course of three months, UNDP had engaged over 250 miners, miners’ spouses, health workers, and government officials to discuss the miners’ needs and priorities.

In addition, UNDP contracted GfK Ukraine, the country’s largest market research firm, to conduct a study on the health and safety of miners based on the medical exams and opinion surveys of 373 miners. The results of this study helped shape the proposed action plans for each of the three target communities.

Overall, UNDP found the most pressing health and safety issues of miners to be respiratory diseases, cardiovas-cular diseases, and occupational traumas. While DTEK and Metinvest have done much to improve the health and safety of miners, there is still much work to be done.

Each community has specific and unique needs, but in general, the proposed action plans focus on upgrading medical equipment, improving emergency transportation, and conducting preventative health work. The follow-ing sections describe the process, results, and proposed actions in greater detail.


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key findingsThe following list summarises the key findings from the health and safety assessment of miners in Krasnodon, Rovenky and Sverdlovsk. Subsequent sections explain the findings in further details.

health Issues• The most prominent health issues of miners in Krasnodon, Rovenky, and Sverdlovsk are respiratory diseases,

cardiovascular diseases, occupational injuries and musculoskeletal conditions.

• More than 37 per cent of miners in Rovenky and Sverdlovsk suffer from respiratory diseases. Chronic bron-chitis alone affects 330 per 1,000 miners—a rate seven times higher than the general adult populations in Rovenky and Sverdlovsk.

• About 18 per cent of miners in Rovenky and Sverdlovsk suffer from cardiovascular diseases. For example, 57.6 per 1,000 miners suffer from ischemic heart disease compared to the national average of 53.1 per 1,000 people or the European average of 36.3 per 1,000 people.1

• In Rovenky and Sverdlovsk, the most common musculoskeletal conditions of miners are osteochondrosis (68 per 1,000 miners) and lower back pain (42 per 1,000 miners).

• The Luhansk Clinic of the Ministry of Internal Affairs classified miners into three health groups: I) generally healthy, II) those who have had acute and/ or chronic disease(s) in the past, and III) those who currently have a chronic disease. Of those who took part in the study, 33 per cent were classified into Health Group I, 13 per cent into Health Group II, and 54 per cent into Health Group III.

• Still, miners are rather optimistic about their heath: 61 per cent are satisfied with it even though 54 per cent are classified in Health Group III. In fact, only 8 per cent are dissatisfied with their health.

• At the same time, 70 per cent of miners worry that their health might deteriorate because of harmful working conditions, and 46 per cent worry that it might deteriorate because of unhealthy habits (e.g., smoking, alco-hol consumption).

• For the most part, miners consult doctors for their health problems (64%). They also consult health profession-als at their enterprise (34%), acquaintances and relatives (27%), pharmacists (23%), and the Internet (10%).

• A large number of respondents prefer self-treatment or to do nothing in treating some of their health issues. For example, only 64 per cent of respondents consulted a doctor to treat bronchitis, 44 per cent for back-aches, and 40 per cent for sore throats over the last 12 months (August 2011-August 2012).

• Fifty-nine per cent of miners (63% of underground workers and 47% among aboveground workers) consider that the health care system in their city satisfies their needs.

• Eighteen per cent of miners are unsatisfied with the quality of medical care, 16 per cent with inconvenient schedules of medical institutions, 15 per cent with expensive medicines, and 12 per cent with expensive medical services.

• Miners’ families and pharmacists play an important role in the health and wellbeing of miners. At least 15 per cent of miners use medical products advised by a pharmacist, 9 per cent use medical products advised by family members or acquaintances, and 8 per cent use folk remedies.

KEY FINDINGS

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safety Issues

• The rates of occupational injuries have decreased at all three enterprises since 2007: by 66 per cent at Krasno-donugol, 21 per cent at Rovenkiantratsit, and 20 per cent at Sverdlovantratsit.

• In 2011, the national average for occupational injuries of miners was 9.3 per 1,000 miners. During the same period, Krasnodonugol, Rovenkiantratsit and Sverdlovantratsit reported 6.87, 12.98, and 7.63 occupational injuries per 1,000 miners, respectively.

• Even though 50 per cent of miners are satisfied with their working conditions, 75 per cent of miners are wor-ried about the possibility of work-related accidents.

• About half of all miners are satisfied with safety conditions at the workplace, 11 per cent are dissatisfied, and 40 per cent are satisfied only partially.

• Miners are generally satisfied with their working conditions, but 75 per cent of miners (79% of underground workers and 65% of aboveground workers) worry that occupational injuries might happen.

• Most miners recognise their enterprises’ efforts to improve occupational safety; only 19 per cent think that existing measures are not effective enough.

• The vast majority of miners (69%), especially underground workers, believe that improving workers’ safety requires tightening control over maintenance of equipment and carrying out timely maintenance and re-placement of equipment.


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1. IntrodUCtIonUkraine’s coal mining industry has one of the highest rates of occupational casualties, injuries and diseases in the world. In 2011, the State Committee on Statistics of Ukraine reported 161 casualties in the mining industry, an average of one casualty every 2-3 days.2 The rate of occupational injuries was 9.3 per 1,000 employees3 — more than five times the rate of the construction indus-try, which had an injury rate of 1.7 per 1,000 employees. In addition, miners suffer unusually high rates of occu-pational health diseases, with one study showing min-ers being seven times more likely to suffer from chronic bronchitis than their adult counterparts.4 Thus, UNDP partnered with energy and mining companies DTEK and Metinvest to improve the health and safety of miners in the mining cities of Krasnodon, Rovenky and Sverdlovsk.

At the project kick-off event, the governor of the Luhansk Regional State Administration, mayors of Krasnodon, Rovenky and Sverdlovsk, executives from DTEK and Metinvest, and UNDP agreed to an approach which would focus more on community health services rather than mining safety standards. The project, which comprises of two phases, first focused on assessing the health and safety needs of miners. This assessment report summarises the results of the first phase and provides a foundation for the upcoming second or implementation phase of this project.

1.1 minersFor this project, the term “miners” includes employees who work in mines, whether it is underground or aboveground. This includes stope miners, sinkers, administrative staff and others. The project only considered current or retired miners in Krasnodon, Rovenky and Sverdlovsk.

1.2 mining IndustryThe mining industry, particularly of coal, plays a central role in Ukraine’s economic and social development. With around 500,000 employees, Ukraine’s mining industry workforce ranks among the biggest in the world.5 In ad-dition, the mining industry is projected to grow by 5.1 per cent to an estimated value of UAH 97.81 billion (USD 14.19 billion) by 2015.6 For mining communities such as Krasno-don, Rovenky and Sverdlovsk, mining activities account for the majority of the communities’ economic activity.

Two energy and mining companies—DTEK and Metin-vest—own the mines in Krasnodon, Rovenky and Sverdlovsk. DTEK is the largest privately owned, verti-cally integrated energy company in Ukraine. The com-pany employs more than 100,000 people, controls about 45 per cent of the country’s mines, and has an annual coal mining capacity of 36.8 million tonnes.7

DTEK’s subsidiary mining companies are DTEK Roven-kiantratsit and DTEK Sverdlovantratsit. Metinvest is the largest company in Ukraine and is an international, vertically integrated steel and mining company with over 635 million tonnes of coal in reserves.8 Its subsid-iary mining company is Krasnodonugol. Both compa-nies are part of Ukraine’s largest financial and industri-al group, System Capital Management (SCM).9

Most of Ukraine’s mining activities take place in the Donetsk coal basin of Eastern Ukraine, where about 225 mines produce 90 per cent of the country’s hard coal.10 The remainder of the hard coal comes from about 18 mines in the Lviv-Volynskiy basin in Western Ukraine.11 Ukraine’s mines are among the deepest in the world with some more than 1,000 metres deep.

1.3 national prioritiesThe Government of Ukraine has reaffirmed its commit-ment to create safer, healthier working conditions for its miners on numerous occasions. In 2010, the Ministry of Coal Industry of Ukraine began a process of restructur-ing its mining industry, citing inefficient production and hazardous working conditions. Subsequently, Ukraine began privatising state-run sites, signing deals with Chi-na to revamp some of them, while also working with the European Union to shut down its non-productive ones.12

In 2011, Ukraine became the 25th country to ratify the International Labour Organization (ILO) Convention 176, the Safety and Health in Mines Convention. Two unions, the Coal Industry Workers’ Union of Ukraine (PRUPU) and the Independent Trade Union of Miners of Ukraine, spearheaded the effort to ratify Convention 176.13 Once enacted, Ukraine’s national laws on mine safety are ex-pected to be updated to comply with international standards. The Convention describes responsibilities for government, mining companies, and miners, and also gives miners the right to report dangerous conditions and accidents, as well as the right to refuse unsafe work.14

The State Service of Mining Supervision and Federa-tion of Trade Unions of Ukraine (FPU) also signed an agreement, in force until 31 December 2015, to joint-ly monitor the implementation of labour protection laws.15 Under the agreement, the parties are required to jointly investigate accidents, work together on im-proving labour laws, and consult each other in matters of labour safety. The parties agreed to revisit and eval-uate their progress on an annual basis.

In addition, Ukraine will begin reforming its health-care sector in 2014, according to the Ministry of Health. Citing lack of funding, equipment and med-ical staff, the Ministry of Health plans to overhaul its healthcare system, including the addition of a unified

INTRODUCTION

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state emergency medical service. The reform process has started with pilot projects in the communities of Donetsk, Dnipropetrovsk, Kyiv and Vinnytsia.

1.4 gender ConsiderationsGender considerations are vital in the mining industry where an overwhelming majority of miners are men. Conversely, the

minority of women who work at mines have specific needs that may be overlooked by managers who are predominantly men. In addition, widowed wives and their children are disproportionately affected when the breadwinner of the family was someone lost in a mining accident. Thus, this project examined the different needs of males and females through gender-sensitive interviews and focus groups.


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2. CommUnIty meetIngs

2.1 methodologyThe assessment process consisted of three main steps: preparation, assessment and agreement. The figure provides an overview of the steps, although the process was not always linear, as steps were rearranged, repeat-ed, and modified as necessary to fit the local context.

Figure 1. Conducting a health and safety risk assessment

preparation •Meetwithkeystakeholders •Collectsecondarydata •Definetheworkplan

Assessment •Collectprimarydata •Examineworkandhealthfacilities •Discussandprioritiseneeds

Agreement •Meetwithkeystakeholders •Discussfindingsanddraftreport •Agreeonwaysforward

First, the preparation process focused on building rela-tionships with local stakeholders and conducting back-ground research. To begin, UNDP partnered with mining companies DTEK and Metinvest to establish the param-eters of the project. This included discussions with key leaders from Krasnodonugol, DTEK Rovenkiantratsit and DTEK Sverdlovantratsit. Then, UNDP, DTEK, and Metinvest met with the governor of the Luhansk Regional State Ad-ministration and mayors of Krasnodon, Sverdlovsk and Rovenky to officially launch the project. In the meanwhile, UNDP collected secondary data, mostly from reports pro-vided by the cities, hospitals and mining companies.

Second, UNDP conducted the health and safety risk as-sessments to examine prevalent health and safety issues, identify barriers to quality health services, and assess the health and safety needs of miners. This was done pri-marily through interviews, focus groups, walkthrough evaluations and community workshops. To ensure a well-rounded perspective, UNDP included a range of participants, including above- and underground work-ers, miners’ spouses, labour unions, and other communi-ty members. The process also included workshops where community members examined data, explored possible solutions, and prioritised community action points mov-ing forward. In total, UNDP engaged over 250 miners, doctors, community, and government representatives to discuss the health and safety problems of miners.

Third, community members reviewed the draft as-sessment report and action plans. During this review

process, community members reaffirmed their com-munities’ needs for upgrading medical equipment, im-proving emergency transportation, and implement-ing public health programmes. They also edited their community action plans, primarily by adjusting the quantity or type of medical equipment needed (see the sections on Action Plans for specific details).

2.2 factors Affecting the health and safety of minersThe main health and safety ailments of miners are respira-tory diseases, cardiovascular diseases, occupational inju-ries (trauma), and musculoskeletal conditions. The reasons miners get sick or get injured include a multitude of fac-tors, including genetics, personal choices, living and work-ing conditions, access to health care, and general social, economic and environmental conditions. The following is a list of the main factors that are affecting the health and safety of miners in Krasnodon, Rovenky and Sverdlovsk:• Health care services: The availability, accessibility

and quality of health care services.• Health care facilities: Staff and resource capacities

to meet the health needs of miners. • Lifestyle and behaviours: Lifestyle choices (e.g.,

eating, exercise, drugs and alcohol) of miners.• Locus of control: The extent to which a person be-

lieves he or she can influence his or her own life.• Mining conditions: Mine depth, methane gas lev-

els, temperature, dust levels and other conditions. • Mining equipment: Quality, quantity and func-

tionality of mining equipment.• Safety regulation compliance: Compliance of safe-

ty regulations by employees.• Safety training programmes: The frequency and

quality of safety training programmes. • Legal frameworks: The implementation of policies,

such as ILO Convention 176. • Governance: Ownership structure and allocation

of subsidies.• Coal pricing: Coal prices affect incentive structures

and pressures to produce. • Pressures of production: Pressures to meet de-

mands of management.• Incentives for profit making: Incentives to make

money, especially when miners are paid by volume of minerals extracted, as opposed to an hourly wage.

• Insurance policies: The availability of adequate policies for miners and their families.

• Unions: The effectiveness of unions to advocate for miners’ health and safety.

More specific findings and recommendations are de-scribed in the individual action plans in subsequent sections.

HealtH data on miners

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3. heAlth dAtA on mIners

3.1 key findings from the medical exams of miners• More than 37 per cent of miners in Rovenky and

Sverdlovsk suffer from respiratory diseases. Chron-ic bronchitis alone affects 330 per 1,000 miners—a rate seven times higher than the general adult populations in Rovenky and Sverdlovsk.

• About 18 per cent of miners in Rovenky and Sverd-lovsk suffer from cardiovascular diseases. For ex-ample, 57.6 per 1,000 miners suffer from ischemic heart disease compared to the national average of 53.1 per 1,000 people or the European average of 36.3 per 1,000 people.16

• In Rovenky and Sverdlovsk, the most common musculoskeletal conditions of miners are osteo-chondrosis (68 per 1,000 miners) and lower back pain (42 per 1,000 miners).

• Fifty-three per cent of miners smoke, close to the average of Ukrainian men aged 18-59.17 In addi-tion, 39 per cent of smokers suffer from bronchitis in comparison to 26 per cent of non-smokers.

• The Luhansk Clinic of the Ministry of Internal Af-fairs classified miners into three health groups: I) generally healthy, II) those who have had acute and/ or chronic disease(s) in the past, and III) those who currently have a chronic disease. Of those who took part in the study, 33 per cent were clas-sified into Health Group I, 13 per cent into Health Group II, and 54 per cent into Health Group III.

3.2 methodology for Conducting and Analysing the medical examsIn addition to meeting with key stakeholders, UNDP contracted GfK Ukraine, the country’s largest market research company, to organise and analyse the medi-cal exams of 373 miners in order to better understand the health needs of miners. The study examined the health of miners in Rovenky and Sverdlovsk (Metin-vest/ Krasnodonugol declined to participate in the study because they did not feel the need to collect more data than they already possessed). The study was aimed to answer the following questions:

• What are the specific health and safety ailments of miners?

• What are the specific health and safety needs of miners?

• How do those problems and needs differ from the rest of the population?

To begin, GfK Ukraine collected secondary data from lo-cal hospitals, DTEK, Metinvest, and the Luhansk Oblast Department of Health. This data included demographic information, as well as health information on the adult populations of Krasnodon, Rovenky and Sverdlovsk.

GfK Ukraine then organised 373 independent medical exams of miners from Rovenkiantratsit and Sverdlovan-tratsit to be conducted at the Luhansk Clinic of the Min-istry of Internal Affairs. GfK Ukraine determined that a research sample of 373 miners was sufficient for pro-ducing a maximum sample error of 5 per cent. Roven-kiantratsit and Sverdlovantratsit helped choose the miners for this study based on four criteria areas: age, gender, place of work, and job position.

Each miner was examined by a physician, otolaryngol-ogist, neurologist, dermatologist and ophthalmolo-gist. Each miner also received a fluorography, electro-cardiogram, and general blood and urine tests. In ad-dition, GfK Ukraine conducted surveys to better un-derstand the opinions of miners regarding their health and working conditions. UNDP shared the final results of this study with key stakeholders to help them guide community planning efforts.

Miners did not receive any compensation, monetary or otherwise, to participate in the study. All parties involved in the medical exams—UNDP, GfK Ukraine, and the Luhansk Clinic of the Ministry of Internal Af-fairs—all guaranteed that individual medical results of miners would remain confidential. The parties also agreed that UNDP would only use medical results in aggregated form to understand the general health trends of miners in Rovenky and Sverdlovsk. The Lu-hansk Clinic of the Ministry of Internal Affairs notified miners about their individual health results in person or by special courier service.

3.3 health data on minersGfK Ukraine’s study shows that miners from Rovenki-antratsit and Sverdlovantratsit suffer disproportionate health problems in comparison to the general popula-tions of Rovenky and Sverdlovsk. In particular, miners suffer disproportionately from respiratory diseases, cardiovascular diseases and musculoskeletal condi-tions. For example, more than 37 per cent of miners in Rovenky and Sverdlovsk suffer from respiratory dis-eases. Chronic bronchitis alone affects 330 per 1,000 miners — a rate seven times higher than the general adult populations in Rovenky and Sverdlovsk. In addi-tion, 57.6 per 1,000 miners suffer from ischemic heart disease compared to the national average of 53.1 per 1,000 people or the European average of 36.3 per 1,000 people.18 The following table shows the compre-hensive results from the medical exams.


12

Table 1. Table 1. The differences between weighted and actual samples

Weighted sample Actual sample

rovenkiantratsit

Dzerzhynskogo 33 36

Office Rovenkovskoye 29 42

No. 81 Kievskaya 26 21

M.V. Frunze 50 35

Vakhrusheva 33 28

Kosmonavtov 37 41

sverdlovantratsit

Dolzhanskaya-Kapitalnaya 54 32

Ya.M.Sverdlova 18 35

Tsentrosoyuz 17 37

Kharkovskaya 14 33

Krasnyi Partizan 62 33

Category

Underground worker (not including stope miners and sinkers) 199 191

Aboveground worker (not including administrative personnel) 78 72

Stope miner 47 50

Sinker 32 30

Administrative personnel 16 30

Age

18-30 108 182

31-40 120 111

41-50 76 56

51+ 69 24

gender

Male 299 294

Female 74 79Source: GfK Ukraine, September 2012

Table 2. Results of the medical exams (per 1,000 miners)

Age Category health group

18- 30 31-40 41-50 51+ Underground worker

Aboveground worker І ІІ ІІІ total

Bronchitis 115.80 326.71 444.82 550.68 328.05 337.08 26.11 78.40 573.16 330.33

Presbyopia 0.00 25.19 278.34 326.26 77.02 265.38 32.39 35.92 201.14 124.60

Deviated nasal septum 115.61 156.14 167.53 30.24 142.60 66.52 117.10 129.29 125.75 123.38

Myopia 86.18 68.18 92.71 34.39 66.79 88.06 8.90 192.84 81.42 72.16

Osteochondrosis 6.84 25.57 141.60 159.69 38.40 156.84 8.68 28.19 113.72 68.32

1st degree hypertension 14.89 47.52 141.95 100.03 56.45 97.37 0.00 61.07 108.28 66.79

Ischemic heart disease 0.00 24.18 46.15 219.28 43.23 99.95 0.00 0.00 105.86 57.56

Cholecystitis 10.03 7.77 71.98 134.23 32.65 80.55 0.00 0.00 82.31 44.75

Vertebrogenic lumbalgia 16.10 32.14 50.70 95.71 20.22 110.16 0.00 44.92 68.27 42.94

A slight form of hypermetropia 4.54 0.00 50.74 165.47 37.08 57.04 0.00 69.01 61.02 42.12

Pulmonary fibrosis 0.00 24.35 82.73 79.68 39.24 39.31 0.00 0.00 72.20 39.26

Cardiosclerosis 0.00 0.00 46.15 161.27 32.84 57.58 0.00 0.00 71.90 39.09

Tonsillitis 78.39 10.44 0.00 42.03 35.12 30.69 0.00 141.62 28.79 34.00

Adiposis 0.00 11.16 56.66 97.63 24.63 57.99 0.00 53.23 48.12 33.06


13


18- 30 31-40 41-50 51+ Underground worker


Allergic dermatitis 9.36 27.82 62.89 21.44 31.36 19.43 43.26 0.00 26.14 28.35

Peptic ulcer disease (PUD) 9.10 39.99 0.00 69.23 34.63 9.45 0.00 0.00 51.99 28.27

Neurocirculatory dystonia 55.75 26.51 0.00 0.00 29.84 9.87 0.00 0.00 45.60 24.79

Chronic pharyngitis 0.00 27.01 6.99 69.30 8.27 66.08 0.00 47.70 30.70 22.87

Pollinosis 0.00 16.19 30.21 60.14 18.33 34.48 0.00 22.16 35.93 22.41

Retinal angiopathy 0.00 0.00 18.43 97.63 9.29 58.57 0.00 36.29 31.34 21.74

Myocardiodystrophy 7.50 15.13 70.27 0.00 8.32 59.57 0.00 10.77 36.55 21.27

Groin erythrasma 2.46 13.63 38.28 42.03 16.22 33.53 23.71 5.54 22.31 20.60

Rhinitis 16.04 5.11 42.32 30.24 14.92 36.89 6.21 10.80 31.34 20.47

Pigmented nevus 4.83 3.48 12.05 84.02 25.89 4.42 0.00 38.33 28.51 20.47

Chronic pancreatitis 5.67 0.00 39.84 56.29 23.95 8.71 0.00 0.00 36.97 20.10

Diabetes mellitus 0.00 0.00 0.00 105.50 0.00 77.05 0.00 0.00 35.80 19.46

Angiosclerosis of retinal vessels 0.00 0.00 0.00 98.45 9.29 44.40 0.00 0.00 33.40 18.16

Calculi of the kidney 9.49 14.45 6.92 47.86 2.00 63.91 0.00 10.80 29.87 17.64

Pyelonephritis 9.49 14.45 6.92 47.86 2.00 63.91 0.00 10.80 29.87 17.64

Cochlear disorders 0.00 0.00 0.00 84.02 20.74 0.00 0.00 0.00 28.51 15.50

Atheroma of the auricle (ear) 0.00 0.00 0.00 84.02 20.74 0.00 0.00 0.00 28.51 15.50

Tinea versicolor 12.46 25.37 14.01 0.00 15.77 11.22 0.00 90.99 5.22 14.62

Gastritis 0.00 40.95 0.00 0.00 14.15 10.19 0.00 0.00 24.18 13.15

Otitis 0.00 5.01 42.92 12.94 11.62 15.82 0.00 0.00 23.32 12.68

Diabetic Retinitis 0.00 0.00 0.00 63.47 0.00 46.35 0.00 0.00 21.54 11.71

Vertebrogenic cervicocranialgia 0.00 16.60 28.25 0.00 5.86 26.40 0.00 20.17 15.51 11.05

COPD 0.00 0.00 0.00 53.09 13.11 0.00 0.00 0.00 18.01 9.80

Hypochromic anaemia 21.20 11.16 0.00 0.00 10.19 8.54 0.00 43.29 7.66 9.77

Chronic laryngitis 0.00 9.13 14.01 21.44 3.92 26.89 0.00 22.64 12.49 9.72

2nd degree hypertension 0.00 5.20 0.00 42.03 0.00 37.31 0.00 0.00 17.33 9.42

Fibromatosis of the uterus 0.00 5.20 34.01 0.00 0.00 33.85 0.00 0.00 15.73 8.55

Amblyopia 18.68 8.10 0.00 0.00 10.78 0.00 4.31 10.23 9.79 8.06

Diabetic polyneuropathy 0.00 0.00 0.00 42.03 0.00 30.69 0.00 0.00 14.26 7.75

Hepatitis 0.00 0.00 10.88 30.08 0.00 30.68 0.00 0.00 14.26 7.75

Myopic astigmatism 4.54 19.51 0.00 0.00 8.88 3.77 0.00 41.01 4.19 7.59

Vasomotor allergic rhinitis 0.00 6.07 0.00 30.24 0.00 29.80 0.00 7.22 12.12 7.53

Isolated systolic arterial hypertension 0.00 0.00 0.00 37.65 9.29 0.00 0.00 0.00 12.77 6.95

Iris coloboma 0.00 0.00 0.00 37.65 9.29 0.00 0.00 0.00 12.77 6.95

Psoriasis 0.00 20.75 0.00 0.00 6.76 6.37 15.46 0.00 2.96 6.66

Dyssomnia 7.64 0.00 0.00 21.44 2.98 15.66 0.00 0.00 11.38 6.19

Stomach cancer 0.00 0.00 0.00 30.08 0.00 21.97 0.00 0.00 10.21 5.55

Posttraumatic plexopathy 0.00 16.24 0.00 0.00 6.98 0.00 15.96 0.00 0.00 5.21

Tuberculosis of the lung 5.85 10.44 0.00 0.00 6.77 0.00 0.00 25.87 3.14 5.06

Varicose dermatitis 0.00 15.74 0.00 0.00 6.76 0.00 0.00 0.00 9.29 5.05

Source: Luhansk Clinic of the Ministry of Internal Affairs, September 2012 (calculations by GfK Ukraine)


14

hospital visitsOf the surveyed miners, 48 per cent received treatment at a public hospital during last 12 months (not including for dental issues or preventive medical exams). About 14 per cent received treatment at their enterprise’s medical centre, 3 per cent at a private hospital, 2 per cent at a public hospital in another city, and 1 per cent at a private hospital in another city. It is notable that this rate of hospital visits among underground and aboveground workers is similar, even though the latter group is much

older in age. In addition, 22 per cent said that they were not ill during the last 12 months (27 per cent of underground workers and 9 per cent of aboveground workers) and only 3 per cent did not get treatment even though they knew that they needed it. The survey also showed that miners used medical products and treatments based on the advice of doctors (22%), pharmacists (15%), relatives or acquaintances (9%), and folk remedies (8%). Miners classified in Health Group III and aboveground workers were more inclined to exercise self-treatment.

Table 3. Survey data in response to the question, “Which of the following methods of treatment have you used over the last 12 months apart from dental issues and preventive examinations?”

Category Age health group

totalUndergroundworker

Abovegroundworker 18-30 31-40 41-50 51+ I II III

You visited a public hospital in your city 46% 52% 43% 49% 38% 63% 46% 39% 50% 48%

You exercised self-treatment using medical products advised by a doctor during your previous visit

18% 31% 14% 23% 22% 31% 18% 18% 24% 22%

You exercised self-treatment using medical products advised by a pharmacist at a drugstore

11% 28% 15% 15% 23% 8% 12% 20% 16% 15%

You visited the medical centre of your enterprise 10% 26% 10% 8% 16% 27% 13% 11% 15% 14%

You exercised self-treatment using medical products advised by relatives, friends, or other informational sources

6% 16% 8% 9% 14% 3% 6% 13% 9% 9%

You exercised self-treatment using folk remedies 5% 17% 8% 7% 15% 3% 5% 11% 9% 8%

You visited a private hospital in your city 2% 4% 3% 2% 1% 5% 2% 1% 3% 3%

You consulted a folk healer 3% 0% 2% 3% 3% 0% 3% 5% 1% 2%

You visited a public hospital in another city 1% 2% 3% 0% 1% 2% 0% 4% 2% 2%

You visited a private hospital in another city 0% 5% 0% 1% 1% 5% 0% 2% 2% 1%

You were not ill 27% 9% 26% 25% 16% 18% 30% 16% 19% 22%

You were not treated 2% 5% 2% 1% 3% 6% 1% 2% 4% 3%

Source: GfK Ukraine survey

The following table shows the breakdown of miners who have received outpatient or inpatient hospital care.

Table 4. Survey data in response to the question, “Have you been treated in the past 12 months?” (per cent of miners who received treatment as an outpatient and/or impatient)


totalUnderground

workerAboveground

worker 18-30 31-40 41-50 51+ I II III

Only as an outpatient 63% 59% 76% 69% 66% 33% 81% 46% 56% 62%

Both as an outpatientand an inpatient 21% 21% 10% 16% 23% 37% 3% 34% 27% 21%

Only as an inpatient 16% 20% 14% 15% 11% 30% 16% 20% 17% 17%

Source: GfK Ukraine survey

Aside from general practitioners, miners most commonly receive treatment from otolaryngologists (8%), traumatologists (7%) and neurologists (7%).


15

Table 5. Survey data in response to the question, “What doctors or other healthcare professionals have you visited in the past 12 months apart from dental issues and preventive examinations?”


totalUnderground

workerAboveground

worker 18-30 31-40 41-50 51+ I II III

General practitioner 28% 26% 18% 27% 31% 38% 18% 29% 33% 27%

Otolaryngologist 7% 10% 6% 8% 6% 10% 6% 8% 9% 8%

Traumatologist 8% 2% 5% 7% 8% 7% 5% 8% 8% 7%

Neurologist 5% 10% 5% 7% 8% 8% 5% 6% 8% 7%

Surgeon 5% 4% 3% 5% 3% 12% 4% 6% 6% 5%

Oculist 3% 11% 2% 3% 9% 10% 2% 5% 7% 5%

Urologist 2% 8% 3% 4% 1% 8% 1% 2% 5% 4%

Gastroenterologist 1% 6% 0% 1% 4% 5% 1% 1% 3% 2%

Cardiologist 0% 8% 1% 1% 0% 9% 1% 1% 3% 2%

Dermatologist 2% 2% 1% 2% 0% 6% 2% 2% 2% 2%

Gynecologist 0% 7% 1% 0% 3% 5% 0% 2% 2% 2%

Endocrinologist 0% 6% 0% 1% 0% 6% 0% 0% 3% 1%

Pulmonologist 0% 5% 0% 0% 0% 6% 0% 0% 2% 1%

Allergologist 0% 3% 0% 1% 0% 4% 0% % 2% 1%

Rheumatologist 0% 3% 0% 2% 2% 0% 1% 1% 1% 1%

Psychiatrist 1% 0% 1% 0% 0% 3% 1% 0% 1% 1%

Proctologist 0% 2% 0% 0% 0% 3% 0% 0% 1% 1%

Occupational Physician 0% 2% 0% 0% 0% 2% 0% 0% 1% 0%

Oncologist 0% 1% 0% 0% 1% 0% 0% 0% 0% 0%

Narcologist 0% 0% 1% 0% 0% 0% 1% 0% 0% 0%

Infection disease doctor 0% 1% 0% 0% 0% 0% 0% 0% 0% 0%

Haematologist 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

Venereologist 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

Sexologist, sexual pathologist 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

Other 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

No Answer 8% 3% 18% 6% 0% 0% 15% 3% 3% 7%

Source: GfK Ukraine survey, September 2012

smokingFifty-three per cent of miners smoke, about the same rate as the average of Ukrainian men aged 18-59.19 According to the medical exams, 39 per cent of smokers suffer from bronchitis in comparison to 26 per cent of non-smokers.

Table 6. Survey data in response to the question, “How many cigarettes do you smoke per day?”


totalUnderground

workerAboveground

worker 18-30 31-40 41-50 51+ I II III

Under 5 4% 4% 9% 4% 1% 0% 8% 3% 2% 4%

5-10 23% 8% 22% 25% 16% 9% 22% 24% 16% 19%

11-20 32% 9% 28% 27% 27% 20% 27% 25% 25% 26%

21-40 5% 2% 1% 5% 8% 4% 0% 0% 8% 4%

More than 40 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

I do not smoke 36% 77% 39% 39% 48% 67% 42% 47% 49% 46%



16

health groupsPhysicians of the Luhansk Clinic of the Ministry of Internal Affairs analysed the results of the medical exams and classified the miners into one of three health groups: • Health Group I: The first group includes persons

in good health, who do not have any chronic dis-eases, complaints about their health, or history of dysfunctional organs and systems.

• Health Group II: The second group includes per-sons who have no appreciable diseases but have had an acute or chronic disease in the past.

• Health Group III: The third group includes persons with chronic diseases, who require systematic medical observation.

According to the weighted results of the medical exams, 33 per cent of miners were classified into Health Group I, 13 per cent into Health Group II, and 54 per cent into Health Group III.

Table 7. Classification by health groups

health group

І ІІ ІІІ

Gender Males 36% 13% 51%

Females 17% 13% 70%

Age 18-30 62% 16% 22%

31-40 34% 16% 50%

41-50 18% 15% 67%

51+ 0% 2% 98%

Category Underground workers 37% 14% 49%

Aboveground workers 19% 11% 69%

Work experience Under 5 years 54% 16% 30%

6-10 years 33% 7% 60%

11-15 years 23% 20% 58%

16 year and over 18% 11% 71%

total 33% 13% 54%

Source: GfK Ukraine, September 2012

Safety data on MinerS

17

4. sAfety dAtA on mIners

4.1 key findings• The rates of occupational injuries have decreased

at all three enterprises since 2007: by 66 per cent at Krasnodonugol, 21 per cent at Rovenkiantratsit, and 20 per cent at Sverdlovantratsit.

• In 2011, the national average for occupational inju-ries of miners was 9.3 per 1,000 miners. During the same period, Krasnodonugol, Rovenkiantratsit and Sverdlovantratsit reported 6.87, 12.98, and 7.63 oc-cupational injuries per 1,000 miners, respectively.


• Even though 50 per cent of miners are satisfied with their working conditions, 75 per cent of miners are worried about the possibility of work-related accidents.

• Most miners in Rovenky and Sverdlovsk (59%) be-lieve it is impossible to complete their work (e.g., meeting coal extraction quotas) without deviating from safety and health rules.

4.2 safety data on minersIn 2011, the rate of occupational injuries was 6.87 per 1,000 miners at Krasnodonugol, 12.98 per 1,000 min-ers at Rovenkiantratsit, and 7.63 per 1,000 miners at Sverdlovantratsit, according to statistics from DTEK and Metinvest. In comparison, the average rate of occupa-tional injuries in Ukraine’s mining industry was 9.3 per 1,000 miners.20 Furthermore, the rates of occupational injuries have decreased at all three enterprises since 2007: by 66 per cent at Krasnodonugol, 21 per cent at Rovenkiantratsit, and 20 per cent at Sverdlovantratsit.

Table 8. Factors of occupational injuries at Krasnodonugol, Rovenkiantratsit and Sverdlovantratsit (per 1,000 employees)

krasnodonugol 2007 2008 2009 2010 2011totAl 15.52 10.95 8.33 7.22 6.87rovenkiantratsit 2007 2008 2009 2010 2011Landslides and collapses 5.13 5.44 6.02 5.75 3.32Falls 2.49 4.26 2.54 3.12 2.44Falling objects 1.43 2.08 2.15 1.83 1.71Machine-related 0.46 0.84 0.54 0.84 0.39Underground transport 0.88 0.20 0.44 0.30 0.34Drilling and blasting operations (DBO)

0.00 0.00 0.24 0.00 0.10

Gassing 0.00 0.15 0.00 0.00 0.00Electrocution 0.00 0.00 0.05 0.05 0.00Effects of elevated temperatures 0.00 0.00 0.00 0.00 0.00Cardio vascular insufficiency (CVI) 0.00 0.00 0.00 0.00 0.00Other 6.14 7.28 5.09 4.76 4.69totAl 16.53 20.24 17.08 16.65 12.98sverdlovantratsit 2007 2008 2009 2010 2011Landslides and collapses 3.54 3.66 3.01 1.88 3.06Machine-related 1.59 1.59 1.65 2.23 1.38

Falling objects 1.59 1.77 1.00 1.41 1.14Falls 1.34 1.65 2.42 1.35 1.08Underground transport 0.79 1.04 0.65 0.47 0.60Cardio vascular insufficiency (CVI) 0.00 0.06 0.00 0.06 0.06Drilling and blasting operations (DBO)

0.00 0.06 0.00 0.00 0.00

Gassing 0.00 0.00 0.00 0.00 0.00Electrocution 0.06 0.00 0.00 0.06 0.00Effects of elevated temperatures 0.00 0.00 0.00 0.00 0.00Other 0.67 0.12 0.47 0.18 0.30totAl 9.59 9.94 9.22 7.64 7.63

Source: DTEK and Metinvest (calculations by GfK Ukraine)

According to a GfK Ukraine survey, 2.6 per cent, or 26 per 1,000 miners, at Rovenkiantratsit and Sverdlovantratsit reported an occupational injury during the last 12 months. However, the real number of injured persons could be lower due to sampling errors. Approximately the same number of underground and aboveground workers (2.6% and 2.5% respectively) reported an occupational injury during last 12 months.As for the number of occupational casualties, only Sverdlovantratsit has experienced a decreasing trend in this regard (from 0.18 per 1,000 miners in 2007-2009 to 0.12 per 1,000 miners in 2010-2011). At Krasnodonugol, this rate slightly increased in 2011 due to a mining accident in July. Likewise at Rovenkiantratsit, the rate has fluctuated over the past five years. In comparison, the average rate of casualties in the mining industry in 2011 was 0.34 per 1,000 employees.21

Table 9. Factors of occupation-related casualties at Krasnodonugol, Rovenkiantratsit and Sverdlovantratsit (per 1,000 employees)

krasnodonugol 2007 2008 2009 2010 2011totAl 0.46 0.49 0.23 0.30 1.44rovenkiantratsit 2007 2008 2009 2010 2011Landslides and collapses 0.09 0.15 0.00 0.05 0.15Underground transport 0.05 0.00 0.05 0.00 0.05Machine-related 0.09 0.10 0.05 0.00 0.05Cardio vascular insufficiency (CVI) 0.05 0.20 0.00 0.00 0.05Falls 0.00 0.00 0.00 0.00 0.00Falling objects 0.00 0.00 0.00 0.00 0.00Drilling and blasting operations (DBO)

0.00 0.00 0.00 0.00 0.00

Gassing 0.00 0.05 0.00 0.00 0.00Electrocution 0.00 0.00 0.00 0.00 0.00Effects of elevated temperatures 0.00 0.05 0.00 0.00 0.00Other 0.00 0.00 0.00 0.20 0.00totAl 0.28 0.54 0.10 0.25 0.29 sverdlovantratsit 2007 2008 2009 2010 2011Machine-related 0.06 0.00 0.06 0.00 0.06Cardio vascular insufficiency (CVI) 0.00 0.06 0.00 0.06 0.06Underground transport 0.06 0.06 0.12 0.00 0.00Falls 0.00 0.00 0.00 0.00 0.00Falling objects 0.00 0.00 0.00 0.00 0.00Drilling and blasting operations (DBO)

0.00 0.06 0.00 0.00 0.00

Landslides and collapses 0.06 0.00 0.00 0.06 0.00Gassing 0.00 0.00 0.00 0.00 0.00Electrocution 0.00 0.00 0.00 0.00 0.00Effects of elevated temperatures 0.00 0.00 0.00 0.00 0.00Other 0.00 0.00 0.00 0.00 0.00totAl 0.18 0.18 0.18 0.12 0.12

Source: DTEK and Metinvest (calculations by GfK Ukraine)


18

5. opInIon sUrveys of mIners from rovenky And sverdlovsk5.1 key findings from rovenky and sverdlovskhealth Issues• Miners are rather optimistic about their heath: 61

per cent are satisfied with it even though 54 per cent are classified in Health Group III. In fact, only 8 per cent are dissatisfied with their health.

• Miners stated that their most common health problems are backaches (289 per 1,000), сolds (269 per 1,000), headaches (194 per 1,000), bron-chitis (169 per 1,000) and myalgia (162 per 1,000).

• At the same time, 70 per cent of miners worry that their health might deteriorate because of harmful working conditions, and 46 per cent worry that it might deteriorate because of unhealthy habits (e.g., smoking, alcohol consumption).

• A large number of respondents prefer self-treatment or to do nothing in treating some of their health is-sues. For example, only 64 per cent of respondents consulted a doctor to treat bronchitis, 44 per cent for backaches, and 40 per cent for sore throats over the last 12 months (August 2011-August 2012).

• Fifty-nine per cent of miners (63% of underground workers and 47% among aboveground workers) consider that the health care system in their city satisfies their needs.

• Eighteen per cent of miners are unsatisfied with the quality of medical care, 16 per cent with incon-venient schedules of medical institutions, 15 per cent with expensive medicines, and 12 per cent with expensive medical services.

• For the most part, miners consult doctors for their health problems (64%). They also consult health professionals

at their enterprise (34%), acquaintances and relatives (27%), pharmacists (23%), and the Internet (10%).

• Miners’ families and pharmacists play an impor-tant role in the health and wellbeing of miners. At least 15 per cent of miners use medical products advised by a pharmacist, 9 per cent use medical products advised by family members or acquaint-ances, and 8 per cent use folk remedies.

safety Issues• About half of all miners are satisfied with safety con-

ditions at the workplace, 11 per cent are dissatisfied, and 40 per cent are satisfied only partially. Under-ground workers show higher dissatisfaction with safety than aboveground workers (14% vs. 6%), while younger miners are more satisfied than their older counterparts regarding safety conditions.

• Miners are generally satisfied with their working conditions, but 75 per cent of miners (79% of under-ground workers and 65% of aboveground workers) worry that occupational injuries might happen.

• Most miners recognise their enterprises’ efforts to improve occupational safety; only 19 per cent think that existing measures are not effective enough.

• The vast majority of miners (69%), especially un-derground workers, believe that improving work-ers’ safety requires tightening control over mainte-nance of equipment and carrying out timely main-tenance and replacement of equipment.

5.2 miners’ opinions on healthAccording to the results of the survey, miners stated that their most common health problems are backaches (289 per 1,000), сolds (269 per 1,000), headaches (194 per 1,000), bronchitis (169 per 1,000) and myalgia (162 per 1,000). Of the respondents, 22 per cent of miners recognised that they suffered from respiratory diseases during the last 12 months and 4 per cent recognised that they suffered from circulatory diseases.

Table 10. Survey data in response to the question, “What diseases have you experienced in the last 12 months?” (per 1,000 miners)


18-30 31-40 41-50 51+ Underground worker


Backache 175.92 278.07 502.62 254.27 272.98 337.51 225.30 388.40 304.10 289.28

Cold 331.94 276.25 334.79 86.53 270.72 265.35 293.60 274.70 253.50 269.36

Headache 121.42 180.41 324.96 194.12 134.76 373.05 103.20 252.50 236.40 194.96

Bronchitis 103.41 147.80 199.00 277.48 164.93 181.54 118.10 168.90 199.80 169.12

Myalgia 85.30 117.89 246.72 269.44 125.92 270.32 139.10 184.40 171.10 162.40

Painful joints (rheumatism) 26.92 118.08 226.43 316.18 114.85 253.70 87.80 156.40 185.70 149.93

Feeling of fatigue and tiredness 86.58 183.69 257.34 71.92 152.03 142.45 94.30 91.30 196.70 149.61

Toothache 143.31 163.16 156.17 85.51 150.24 116.13 155.00 136.70 134.80 141.62

Heartburn 142.78 148.09 96.88 117.26 131.25 128.24 95.80 188.00 137.60 130.49

OpiniOn surveys Of miners

19


18-30 31-40 41-50 51+ Underground worker


Injuries (outside of work) 165.62 77.59 151.72 125.01 167.05 8.71 146.90 84.50 125.20 127.05

Herpes 81.02 143.47 165.98 30.24 91.01 161.81 77.60 161.50 115.20 108.90

Sore throat 166.95 123.60 94.00 0.00 109.39 101.80 134.20 133.80 85.20 107.47

Flu 80.31 120.31 175.29 47.86 118.70 69.96 72.10 163.80 113.30 106.39

Angina 64.95 136.17 53.15 82.13 87.38 92.21 96.80 97.00 81.70 88.60

Eye diseases 24.92 37.25 131.84 160.32 64.09 109.25 3.10 110.40 110.70 75.50

Chronic respiratory diseases 0.00 43.98 49.21 238.83 56.42 102.83 15.20 40.30 106.60 68.14

Hypertension (high blood pressure) 6.92 35.52 65.17 193.41 15.89 199.58 15.30 79.10 86.50 62.30

Heartache 5.67 81.20 74.84 69.79 21.33 157.57 18.60 56.80 77.80 55.75

Chronic rhinitis 57.87 44.38 28.72 72.27 32.25 103.69 26.90 50.40 64.30 50.30

Diarrhea 42.28 26.69 45.64 104.15 44.41 64.03 45.90 52.40 50.80 49.37

Maxillary sinus 47.27 68.65 52.30 0.00 52.07 29.74 73.10 87.40 20.60 46.43

Insomnia 57.58 23.10 70.95 42.03 37.25 73.24 22.20 69.50 55.30 46.34

Allergy 13.76 41.28 59.57 91.24 15.80 135.97 0.00 65.00 69.40 46.16

Digestive disorder 22.96 36.68 10.88 134.23 36.17 72.89 6.20 45.80 68.90 45.45

Skin diseases 21.85 38.98 99.37 21.94 44.20 39.67 65.90 18.20 35.20 43.05

Overweight 6.84 50.64 29.73 89.89 12.16 125.78 15.20 20.20 61.20 40.86

Prostate diseases 16.00 45.59 20.87 90.23 40.23 40.04 18.00 61.90 48.40 40.18

Kidney stones 14.21 53.77 42.40 47.86 25.38 78.60 0.00 71.60 54.40 38.83

Nervous disorder, depression 35.82 24.83 52.86 42.03 29.24 59.51 12.10 21.40 55.50 36.89

Gastritis 4.37 23.87 71.93 47.86 20.17 68.27 19.20 7.40 46.10 32.33

Varix dilatation 13.55 10.72 40.15 69.79 11.86 77.32 0.00 11.40 49.50 28.40

Cardiovascular diseases 0.00 6.06 10.88 129.99 11.06 78.61 0.00 0.00 51.70 28.13

Occupational injuries 8.28 53.98 0.00 34.39 26.43 25.11 23.40 19.50 29.30 26.09

Pancreatic diseases 0.00 23.69 62.29 30.08 11.43 68.16 0.00 18.80 42.90 25.76

Pneumonia 0.00 10.72 100.51 0.00 26.11 16.90 29.70 33.00 18.00 23.78

Gastric ulcer or duodenal ulcer 0.00 13.63 23.83 43.03 9.12 40.85 7.50 0.00 27.00 17.14

Hearing loss 2.86 0.00 36.17 47.86 7.78 44.21 15.20 6.50 20.50 16.99

Vibration disease 0.00 18.46 14.01 42.03 7.93 41.92 0.00 0.00 30.40 16.52

Liver disease 0.00 11.00 32.14 30.08 12.07 25.98 7.70 0.00 24.00 15.59

Pneumofibrosis 0.00 0.00 38.56 42.03 10.44 30.69 15.20 0.00 19.50 15.56

Potency disorder 20.24 0.00 9.17 42.03 7.91 38.04 11.30 0.00 21.80 15.52

Atherosclerosis 0.00 0.00 10.88 69.79 0.00 59.68 0.00 0.00 27.70 15.08

Thyroid gland diseases 4.54 16.24 32.31 0.00 5.72 34.85 0.00 10.70 21.50 13.08

Diabetes 0.00 0.00 0.00 63.47 0.00 46.35 0.00 0.00 21.50 11.71

Memory impairment 0.00 0.00 14.01 47.86 0.00 46.17 0.00 0.00 21.50 11.66

Constipation 4.29 9.36 14.57 21.94 3.94 32.87 4.90 16.00 13.90 11.25

Psoriasis 0.00 25.70 14.01 0.00 8.89 17.59 20.30 0.00 8.20 11.09

Neurological disorders 3.42 9.82 25.79 0.00 1.34 33.13 8.70 19.20 7.50 9.37

Oral diseases 15.51 14.62 0.00 0.00 5.42 20.47 5.70 11.40 10.80 9.22

Shoulder joint periarthritis 0.00 4.99 36.17 0.00 6.66 15.61 15.20 0.00 7.30 8.92

Gallstone disease 3.33 4.91 28.97 0.00 7.84 10.09 3.00 0.00 13.70 8.41

Hypotension (low blood pressure) 0.00 17.35 8.20 0.00 3.48 18.33 9.10 12.80 4.80 7.23

Chronic obstructive lung disease 0.00 0.00 0.00 37.65 9.29 0.00 0.00 0.00 12.80 6.95

Asthma 0.00 3.48 25.73 0.00 3.78 13.85 0.00 0.00 11.60 6.32

Cystitis 5.12 4.86 0.00 0.00 2.00 6.18 0.00 0.00 5.60 3.05

Coxarthrosis (hip joint arthrosis) 0.00 0.00 12.05 0.00 3.26 0.00 0.00 18.80 0.00 2.44

Migraine 4.83 0.00 0.00 0.00 1.89 0.00 0.00 10.90 0.00 1.41

Tuberculosis 4.78 0.00 0.00 0.00 1.87 0.00 4.30 0.00 0.00 1.40



20

Miners were also asked whether they have chronic diseases connected with their professional activities. Twenty-five per cent of respondents believed that they did, but only 13 per cent had been officially diagnosed by a doctor. Another 8 per cent of respondents thought that doctors did not want to confirm their diagnosis on an official basis. Only 17 per cent of miners recognised that they suffered from bronchitis, even though medical exams showed that 33 per cent of miners actually suffered from bronchitis.

Miners are rather optimistic about their heath: 61 per cent are satisfied with it even though 54 per cent are classified in Health Group III. In fact, only 8 per cent are dissatisfied with their health. Aboveground workers are less satisfied with their health, possibly since they are older on average and thus more susceptible to illness and poor health. At the same time, 70 per cent of miners worry that their health might deteriorate because of harmful working conditions, and 46 per cent worry that it might deteriorate because of unhealthy habits (e.g., smoking, alcohol consumption).

Table 11. Survey data in response to the question, “Do you have any chronic diseases connected with your professional activities?”


totalUndergroundworker

Above groundworker 18-30 31-40 41-50 51+ I II III

No 76% 75% 95% 77% 66% 52% 90% 80% 65% 75%

I believe I do, but doctors have not confirmed my diagnosis officially 8% 9% 1% 7% 9% 22% 3% 6% 12% 8%

Officially diagnosed: Bronchitis 9% 4% 2% 8% 7% 16% 3% 6% 11% 8%

Officially diagnosed: Other 5% 4% 1% 2% 9% 11% 2% 5% 7% 5%

The diagnosis has been confirmed 2% 8% 0% 6% 9% 0% 2% 3% 5% 4%


Table 12. Survey data in response to the statement, “How satisfied are you with your health?”


totalUnderground

workerAboveground

worker 18-30 31-40 41-50 51+ I II III

Completely satisfied 42% 19% 60% 35% 27% 10% 58% 29% 24% 36%

Rather satisfied 27% 19% 29% 26% 14% 27% 24% 32% 23% 25%

Somewhat satisfied, somewhat dissatisfied 27% 41% 11% 35% 45% 39% 16% 39% 38% 31%

Rather dissatisfied 3% 10% 0% 4% 10% 10% 2% 0% 8% 5%

Completely dissatisfied 1% 11% 0% 0% 4% 14% 0% 1% 6% 3%


Table 13. Survey data in response to the question, “Do you agree with the statements given below?”


totalUnder-groundworker

Above-groundworker

18-30 31-40 41-50 51+ I II III

You worry that your health might deteriorate because of harmful working conditions 72% 63% 69% 74% 75% 58% 65% 63% 74% 70%

You worry that your health might deteriorate because of your harmful habits (smoking, alcohol, etc.) 50% 36% 52% 49% 42% 36% 51% 44% 44% 46%

You often feel unwell, experience low energy level, attacks of chronic diseases, etc. that do not require a sickness certificate 17% 36% 2% 21% 31% 44% 9% 22% 30% 22%

You often suffer from stress, anxiety, depression 10% 23% 3% 16% 18% 20% 4% 20% 18% 14%

You often drink more than 50 g of strong alcoholic beverages or half a litre of beer a day 9% 2% 6% 8% 13% 0% 8% 2% 7% 7%

You often have to get a sickness certificate because of different diseases, injuries 2% 12% 2% 1% 7% 12% 2% 3% 7% 5%



21

A large number of respondents prefer self-treatment or to do nothing in treating some of their health issues. For example, only 64 per cent of respondents consulted a doctor to treat bronchitis, 44 per cent for backaches, and 40 per cent for sore throats over the last 12 months (August 2011-August 2012).Fifty-nine per cent of miners (63% of underground workers and 47% among aboveground workers) consider that the health care system in their city satisfies their needs.

Eighteen per cent of miners are unsatisfied with the quality of medical care, 16 per cent with inconvenient schedules of medical institutions, 15 per cent with expensive medi-cines, and 12 per cent with expensive medical services. Despite complaints about the quality of health care, most miners evaluated the work of their doctors pos-itively: 58 per cent were satisfied and only 7 per cent were dissatisfied. Most of those who were dissatisfied complained that the treatment was ineffective and that it was too expensive.

Table 14. Survey data in response to the question, “What conditions of chronic diseases have you experienced in the last 12 months (since August 2011), and how would you describe your usual behaviour when these problems arise?” (per cent of those who suffered from described disease)

I consult a professional

doctor im-mediately

I prefer self-treatment because I’ve already con-sulted a doctor about this problem and know what

they prescribe

I prefer self-treatment and buy medical substances according to friends’ ad-

vice, information from ads, Internet, etc.

I do nothing and wait for

the disease to disappear on

its own

I prefer self-treatment

or treatment by a healer using folk remedies

Toothache 67% 13% 8% 5% 7%

Bronchitis 64% 11% 10% 14% 2%

Backache 44% 21% 9% 18% 8%

Sore throat 40% 28% 20% 4% 7%

Myalgia 33% 19% 21% 20% 7%

Cold 27% 37% 27% 7% 2%

Headache 25% 20% 37% 14% 4%

Feeling of fatigue and tiredness 12% 5% 25% 53% 5%

Heartburn 6% 35% 31% 21% 6%


Table 15. Survey data in response to the question, “Does the existing healthcare system in your city satisfy your needs?”

Category Age health grouptotal

Underground worker Aboveground worker 18-30 31-40 41-50 51+ I II III

Yes 63% 47% 65% 52% 56% 66% 64% 52% 58% 59%

No 37% 53% 35% 48% 44% 34% 36% 48% 42% 41%


Table 16. Survey data in response to the question, “Why does the existing network of medical institutions in your city not satisfy your medical needs?”


totalUnderground worker

Aboveground worker 18-30 31-40 41-50 51+ I II III

Low quality of medical care 16% 22% 16% 22% 21% 8% 13% 25% 18% 18%

It is difficult to get an appointment because of queues, inconvenient schedule 14% 23% 14% 18% 22% 9% 19% 13% 15% 16%

Medicines are expensive 14% 18% 14% 19% 18% 7% 14% 20% 14% 15%

Medical services are expensive 11% 16% 10% 17% 15% 5% 11% 16% 12% 12%

Doctors take bribes 4% 7% 1% 8% 6% 5% 5% 5% 5% 5%

There is no required equipment 3% 2% 1% 4% 2% 6% % 10% 3% 3%

There are not enough beds in in-patient hospitals 3% 1% 1% 3% 5% % 4% 4% % 2%

There are no required specialists 1% 6% 1% 3% 1% 5% 2% % 3% 2%

It is difficult or impossible to get necessary medicines in the city 1% 5% 2% 4% 2% % 4% 3% 1% 2%

Other 4% 10% 5% 5% 2% 9% 5% 6% 5% 5%



22

For the most part, miners consult doctors for their health problems (64%). They also consult health professionals at their enterprises (34%), acquaintances and relatives (27%), pharmacists (23%), and the Internet (10%).

5.3 miners’ opinions on safetyAbout half of all miners are satisfied with safety conditions at the workplace, 11 per cent are dissatisfied, and 40 per cent are satisfied only partially. Underground workers show higher dissatisfaction with safety than aboveground workers (14% vs. 6%),

while younger miners are more satisfied than their older counterparts regarding safety conditions.

Miners are generally satisfied with their working conditions, but 75 per cent of miners (79% of underground workers and 65% of aboveground workers) worry that occupational injuries might happen.

Miners also responded to a series of statements describing various safety issues on a scale from 1 (complete disagreement) to 5 (complete agreement). GfK Ukraine then calculated averages based on these responses.

Table 17. Survey data in response to the question, “How satisfied are you with the medical care provided by the doctor you last visited in your city?” (per cent of respondents who visited a doctor in their city during last 12 months)

Category Age health grouptotal


Completely satisfied 38% 38% 29% 40% 28% 56% 35% 39% 40% 38%Rather satisfied 25% 9% 18% 31% 24% 5% 19% 19% 21% 20%Somewhat satisfied, somewhat dissatisfied 14% 32% 15% 9% 30% 29% 12% 29% 21% 19%Rather dissatisfied 5% 4% 5% 5% 11% 0% 4% 5% 6% 5%Completely dissatisfied 2% 4% 1% 3% 2% 3% 3% 0% 3% 2%


Table 18. Survey data in response to the question, “Whom do you ask advice from most, or what sources of information do you seek in case of health problems?”


totalUnderground worker

Aboveground worker 18-30 31-40 41-50 51+ I II III

Doctor in a hospital 65% 64% 65% 65% 55% 72% 65% 63% 64% 64%Doctor or nurse in a first-aid post of your company 34% 36% 36% 31% 36% 36% 28% 39% 37% 34%Friends, acquaintances, relatives 26% 30% 32% 31% 28% 14% 33% 41% 21% 27%Pharmacist/ chemist at the pharmacy 20% 34% 19% 29% 28% 16% 19% 29% 25% 23%Information from the Internet 9% 12% 6% 12% 16% 5% 10% 14% 9% 10%Press 1% 5% 2% 4% 2% 0% 3% 5% 1% 2%Information from TV 2% 1% 3% 1% 2% 0% 2% 3% 1% 2%Traditional healers, herbalists 1% 1% 2% 1% 1% 0% 2% 2% 0% 1%Information from radio 0% 0% 0% 1% 0% 0% 1% 0% 0% 0%Other 3% 0% 1% 2% 2% 6% 1% 6% 3% 3%


Table 19. Please assess how satisfied you are with the safety levels of your working conditions?

Category Age healthtotal


Completely satisfied 22% 24% 33% 16% 18% 21% 30% 17% 19% 22%Rather satisfied 28% 21% 31% 26% 21% 24% 25% 27% 27% 26%Somewhat satisfied, somewhat dissatisfied 37% 50% 27% 41% 50% 48% 32% 51% 42% 40%

Rather dissatisfied 9% 2% 7% 10% 3% 5% 8% 2% 8% 7%Completely dissatisfied 5% 4% 1% 7% 7% 2% 6% 2% 4% 4%


Table 20. Survey data in response to the question, “Do you agree with the statement given below?”


totalUndergroundworkers

Abovegroundworkers 18-30 31-40 41-50 51+ I II III

Do you worry that there a job-related accident might happen?

79% 65% 78% 77% 70% 73% 76% 69% 76% 75%



23

Table 21. Survey data in response to the question, “How much do you agree with the following statements about adherence to occupational safety and health (OSH) regulations at your enterprise? Write “1” if you completely disagree and “5” if you completely agree.”

Category Age health

totalUnderground workers

Aboveground workers 18-30 31-40 41-50 51+ I II III

Drills on OSH are carried out in a responsible manner. These drills not only explain how to adhere to OSH rules but also why it is vital to

4.3 4.4 4.4 4.5 4.0 4.5 4.3 4.4 4.4 4.4

I understand the OSH goals, regulations, and methods of their implementation 4.3 4.4 4.4 4.2 4.2 4.7 4.4 4.2 4.3 4.3

My manager helps me with choosing safer methods of reaching production targets 4.2 4.4 4.3 4.1 4.1 4.5 4.2 4.2 4.3 4.2

I can easily inform the management on a breach of occupational health and safety regulations if I become aware of them

4.0 4.2 4.0 3.9 4.0 4.4 4.0 4.1 4.1 4.1

OSH system at the enterprise enables me to get new knowledge and skills 4.0 4.1 4.1 3.9 3.9 4.3 4.0 4.0 4.1 4.0

Punishment for breaching OSH regulations is fair and justified 3.8 4.0 3.9 3.8 3.7 4.2 3.8 4.1 3.9 3.9

The enterprise provides opportunities for workers to participate in improving the OSH system 3.7 4.0 3.8 3.6 3.6 4.3 3.7 3.6 3.9 3.8

The enterprise’s health and safety procedures are too strict 3.6 4.0 3.9 3.8 3.4 3.8 3.7 3.5 3.8 3.7

The enterprise values health and safety of workers higher than operating performance 3.4 3.7 3.8 3.1 3.2 4.0 3.5 3.5 3.5 3.5

I am satisfied with the recognition (non-monetary) and commendation by the management, which I get for adhering to OSH regulations

3.3 3.5 3.5 3.2 3.0 4.0 3.2 3.1 3.5 3.4

Bonuses for adhering to OSH regulations are fair and justified 3.3 3.5 3.5 2.9 3.4 4.0 3.2 3.2 3.5 3.4

I am satisfied with material incentives I get for adhering to OSH regulations 2.8 3.3 3.0 2.4 2.6 4.0 2.7 2.8 3.1 2.9


Table 22. Survey data in response to the question, “What are the main reasons for deviating from OSH standards when performing work functions?”


totalUnderground

workerAboveground

worker 18-30 31-40 41-50 51+ I II III

If you follow all the safety standards, it is impossible to perform the tasks you are charged with 65% 43% 64% 62% 57% 50% 58% 52% 62% 59%

Workers can ignore safety standards because of the desire to receive incentives for labor results 28% 16% 26% 28% 18% 27% 28% 21% 24% 25%

Management requires implementation of work plans at any cost 25% 24% 17% 25% 35% 24% 20% 19% 29% 24%

Existing measures are not effective enough and do not guarantee injuries are eliminated 15% 29% 14% 19% 12% 33% 17% 17% 20% 19%

Too many requirements: it is not possible to memorize them all 20% 12% 26% 18% 15% 10% 20% 22% 16% 18%

Reluctance to spend time and efforts on organizing work on a safety basis (laziness) 19% 13% 14% 18% 19% 20% 12% 32% 17% 17%

Poor knowledge of the technological process 16% 12% 11% 13% 13% 25% 13% 14% 16% 15%

Not enough attention is paid to occupational safety training 7% 5% 9% 4% 1% 13% 7% 10% 6% 7%

Other 4% 3% 3% 3% 4% 8% 7% 3% 3% 4%

Don’t know 5% 20% 7% 7% 12% 11% 8% 11% 9% 9%



24

Most miners (59%), especially young underground workers, believe it is impossible to complete their daily work tasks (e.g., meeting coal extraction quotas) without deviating from occupational safety and health (OSH) safety rules. Most miners recognise the efforts of their enterprises in adhering to OSH standards; only 19 per cent think that existing measures are not effective enough. The following table shows what miners think are the main reasons for deviating from OSH standards.The majority of respondents, both aboveground and underground workers, consider the incentives listed

in the table below to be good motivating factors to adhere to OSH rules. It is notable that bonuses for all workers in a division are preferred motivating factors over individual bonuses.Sixty-nine per cent of miners, especially underground workers, believe that improving workers’ safety requires tightening control over maintaining equipment in good condition and carrying out timely maintenance and replacement of equipment. The following table shows what miners believe need to be done to improve workers’ safety.

Table 23. Survey data in response to the question, “How does each of the following methods encourage you to personally adhere to OSH regulations? On a 5-point scale, write ‘1’ for ‘least encouraging’ and ‘5’ for ‘most encouraging.’”

Category Age health grouptotalUnderground

workerAboveground

worker 18-30 31-40 41-50 51+ I II III

Travel accommodations to sanatoriums and health resorts at discounted prices 4.1 4.6 4.2 4.2 4.3 4.2 4.3 4.2 4.2 4.2

Fear of job loss, reduction in skill-category, re-examination in safety regulations 3.9 3.9 4.1 3.8 4.0 3.9 3.9 3.9 4.0 3.9

Full or partial payment of paid medical services 3.9 3.8 4.0 3.8 4.1 3.6 4.1 3.9 3.7 3.9Denial of a personal bonus (workers are denied their bonus if they do not adhere to OSH regulations) 3.7 4.0 3.9 3.7 4.2 3.4 3.9 4.1 3.7 3.8

Bonus for all the workers of the division for advances in the sphere of OSH 3.6 3.7 3.7 3.4 3.6 3.8 3.7 3.5 3.6 3.6

Valuable presents for advances in OSH 3.6 3.5 3.9 3.4 3.8 3.4 3.6 3.4 3.6 3.6Denial of a bonus for all the workers of the division for non-observance of OSH regulations through the fault of one or several workers of the division

3.2 3.5 3.1 3.1 3.6 3.3 2.9 3.6 3.4 3.3

Personal bonus for observing OSH regulations (the bonus is received by workers themselves not by a division) 3.3 3.0 3.3 3.2 3.2 3.0 3.4 3.4 3.0 3.2

Public recognition of one’s achievements in OSH, commendation by management in front of colleagues (e.g., letters of commendation, awards, honours board, newspaper)

3.1 3.6 3.3 3.2 3.1 3.1 3.2 3.0 3.2 3.2

Competition between divisions for achievements in the sphere of OSH 2.9 3.2 3.2 2.9 2.9 3.1 3.0 2.8 3.1 3.0

Letters to family members stating that a worker strictly follows the regulations 2.6 3.1 2.9 2.5 2.9 2.8 2.7 2.6 2.8 2.7

Letters to family members stating that a worker often breaches the regulations 2.6 2.6 2.6 2.5 2.6 2.8 2.5 2.5 2.7 2.6


Table 24. Survey data in response to the question, “What needs to be done in the first place in order to improve workers’ safety?”

Category Age health grouptotalUnderground

workerAboveground

worker 18-30 31-40 41-50 51+ I II III

To tighten control over maintenance of the equipment in good condition, carry out timely maintenance and replacement of the equipment

71% 64% 68% 64% 78% 70% 73% 55% 71% 69%

To tighten control over maintenance of occupational safety and health regulations by workers 36% 34% 27% 48% 35% 27% 27% 43% 38% 35%

To increase provision of information to workers on occupational safety and health regulations, measures aimed at teaching workers to follow the regulations

26% 34% 27% 31% 25% 29% 32% 27% 27% 28%

To improve living conditions 16% 19% 15% 21% 14% 13% 13% 22% 17% 16%To increase the operating efficiency of rescue services 13% 10% 12% 14% 12% 8% 14% 10% 12% 12%To increase the operating efficiency of a resuscitation-antishock group 4% 9% 6% 6% 4% 5% 5% 3% 6% 5%

To improve ventilation system 1% 1% 1% 3% 0% 0% 1% 4% 3% 1%To improve heating system 0% 0% 0% 0% 0% 0% 3% 0% 1% 0%Other (please explain) 4% 5% 5% 6% 4% 2% 0% 0% 0% 5%No answer 1% 3% 0% 1% 4% 0% 8% 5% 2% 1%


General recommendations

25

6. generAl reCommendAtIonsIn general, the most prominent health and safety problems of miners are respiratory diseases, cardiovascular diseases, occupational injuries (traumas), and musculoskeletal conditions. While the majority of miners expressed satisfaction with their health (61%) and health care options (59%), most of them were diagnosed with a chronic disease (54%). Thus, the following recommendations focus on prevention, diagnosis and treatment of those diseases, as well as improving emergency transportation and medical services.

Improving the health of miners• Train health workers to recognise and treat the most

prevalent diseases among miners (i.e., respiratory and cardiovascular diseases). Also train health work-ers who are most frequented by miners: general practitioners, otolaryngologists, trauma surgeons, neurologists, pulmonologists and cardiologists.

• DTEK and Metinvest should maintain health data of their employees in electronic databases as op-posed to just keeping paper records.

• Provide positive reinforcement for those who comply with OSH rules and regulations. Consider monetary bonuses for meeting certain OSH goals and/or sup-port more visits to sanatoriums and health resorts.

• Implement a public health campaign, including infor-mation about smoking, alcohol, healthy eating and exercise. The campaign should include information on preventing and treating cardiovascular diseases, respiratory diseases and musculoskeletal conditions.

• Include pharmacists and miners’ spouses in discussions about miners’ health.

• Upgrade medical equipment and training for screening services and emergency care.

• Nutritional policies and planning should balance traditional cuisine with nutrition guidelines out-lined in the “Health of the Nation” (2002-2011), which was adopted by the Cabinet of Ministers in 2002, or with World Health Organization guidelines.

• Sports and sports facilities should be included in health planning efforts.

Improving the occupational safety of miners• During safety drills, ask miners to provide exam-

ples of how and when it is impossible for them to follow OSH rules and regulation. Management should implement changes accordingly.

• Ensure timely maintenance and replacement of mining equipment.

• Consider bonuses for teams of workers who meet specified OSH goals (according to survey data, miners stated that they would be more interested in receiv-ing bonuses as a group than on an individual basis).

• Remind miners about the consequences of violat-ing OSH rules, such as rates of injuries and casualties.

• Remind miners that they may be fired, be reassigned, or be denied bonuses if they violate OSH rules.

• Consider involving miners in setting realistic and fair daily quotas for coal extraction.

• Include miners in selecting equipment. In one case, miners complained that newly purchased goggles (protective eyewear) were not compatible with their respirators. Thus, miners had to choose between wearing their goggles or respirators while working.

• Of course, implementing these recommendations depends on changes from both management and miners. True, lasting changes will require time, commitment, and effort from both sides.


26

7. krAsnodon ACtIon plAn

7.1 key findings • In Krasnodon, the top health problems of min-

ers are respiratory diseases, occupational injuries (trauma), heart diseases and musculoskeletal con-ditions. Respiratory diseases account for 74% of all reported occupational diseases (mechanic bron-chitis — 46% and anthracosilicosis — 28%).

• From 2007-2011, occupational injuries at Krasnodon-ugol have decreased by 66 per cent.

• In 2011, Krasnodonugol endured 6.87 occupa-tional injuries per 1,000 miners. In comparison, the national average for occupational injuries was 9.3 per 1,000 miners, while neighbouring Rovenkiantratsit and Sverdlovantratsit endured 12.98 and 7.63 occupational injuries per 1,000 miners, respectively.

• Key stakeholders named the community’s top pri-orities as the need to improve emergency trans-portation and upgrade intensive care units.

7.2 Community health profileKrasnodon, along with its seven neighbouring towns, has a combined population of 117,730 people, whereas the city itself has a population of 49,921 people.22 The city has eight healthcare institutions, including five hospitals, a dental clinic, an ambulance station, and an urban health centre. According to the central hospital, the planned capacity for outpatient care was 2,245 visits/ shift with an actual capacity of 1,933 visits/ shift.

Table 25. Select data from Krasnodon’s central hospital

2010 2011

Patients treated (number) 19,763 17,734

Average length of stay (days) 11.80 11.38

Ambulance outpatients (number) 948,384 912,861

Infectious diseases (cases) 16,588 15,246

As of January 2012, there were 242 physicians or 23.04 per 10,000 people, with 164 vacancies for doctors and 92 vacancies for nurses. While there is no international standard for assessing the sufficiency of a health workforce, the World Health Organization estimates that countries with fewer than 23 healthcare professionals (i.e., physicians, nurses and midwives) per 10,000 people will be unlikely to achieve primary healthcare interventions described by the UN Millennium Development Goals.23

Figure 2. Number of physicians per 10,000 people

2323,04

32

0

5

10

15

20

25

30

35

WHO Minimum Krasnodon Ukraine

The following charts illustrate data regarding hospital beds and hospitalisation rates in Krasnodon.

Figure 3. Hospital beds per 10,000 peopleFigure 3. Hospital beds per 10,000 people

70,86

52,37

98,1789,3

0

20

40

60

80

100

120

2010 2011

City Oblast

Figure 4. Hospitalisation per 100 peopleFigure 4. Hospitalisation per 100 people

18,716,77

25 24,41

0

5

10

15

20

25

30

11020102

City Oblast

The following table shows the rate of registered diseases per 1,000 inhabitants in Krasnodon.

Table 26. Rate of registered diseases per 1,000 inhabitants in Krasnodon

group of diseases 2005 2006 2007 2008 2009 2010 2011

All diseases 1509 1558 1584 1690 1569 1728 1749Diseases of the circulatory system

769 790 799 823 826 841 860

Diseases of the respiratory system

220 212 223 210 210 226 217

Diseases of the musculoskeletal system and connective tissue

47 52 53 51 50 48 48

Diseases of the nervous system 10 12 10 10 10 10 11

Source: Lugansk Oblast Department of Health (calculations by GfK Ukraine)

Krasnodon action plan

27

7.3 krasnodonugolKrasnodonugol is the second largest coking coal producer in Ukraine. It ships coking coal primarily to Avdiivka Coke and Azovstal Iron and Steel Works. Krasnodonugol currently produces coking coal from its underground mines, which are nearly 1,000 metres deep at its deepest point, before processing the coal at its two on-site washing plants. In 2009 Krasnodonugol’s total coking coal output was 5.4 million tonnes.

In 1914, Krasnodonugol started as a group of Sorokino coal mines. These 25 coal mines united in 1935 to establish the Sorokinocoal trust. During its 93 years history (1914-2007) the company mined about 370 million tonnes of coal. In 2007, mine closures (and therefore lack of maintenance) led to major environmental and geological problems. For example, water accumulated in the mines quickly, causing flooding throughout the city. The inactive mines posed a significant disaster risk to Krasnodon.

Today, Krasnodonugol has been reinvigorated ever since it became part of the mining division of Metinvest. Krasnodonugol is now one of the top 10 largest mining companies in Ukraine. The company consists of five coal units, two coal preparation plants, and maintenance, transport and energy divisions. The company has its own medical service, as well as programmes on social development. Krasnodonugol employs about 15,500 people in the mining and service departments.

occupational safetyKrasnodonugol was one of the first in Ukraine to introduce an international standard for the protection and safety of workers (OHSAS 18001). In order to reduce occupational injuries, the company has an occupational health and safety programme, which includes training and funds to purchase personal protective equipment, control devices, and other safety equipment. Miners also are equipped with individual control devices to measure the levels of methane in the mines. Each miner goes underground with an oxygen can, which provides 1-4 hours of oxygen depending on the person’s rate of breathing. Miners are warned by phone, sounds, and lights in case of an emergency. The underground health clinic has been upgraded within the last year with modern first aid kits, inflatable splints, plastic and steel stretchers, defibrillators, and other life-saving equipment. In 2010, the average emergency response time, or the time it took a doctor to arrive at the scene of an accident, was 31 minutes. The range of emergency response time was between 5 and 90 minutes. Minimising response time is invaluable as the percentage of survival goes down dramatically with each passing minute. According to Metinvest, the start

of defibrillation happening in the first minute, gives a survival rate of nearly 100 per cent, whereas the rate drops to about 1 per cent after 10 minutes. Krasnodonugol has a goal of training all medical per-sonnel (about 935 of them) in emergency cardiac and trauma care procedures. As of October 2011, Kras-nodonugol had trained about 109 of these medical professionals. Krasnodonugol also aims to provide at least 8 hours of training to every single miner in first aid support (with defibrillators), advanced cardiac life support and advanced trauma life support, even though the industry standard is only 10 per cent. As of October 2011, some 1,000 non-medical employees had received the one-day training. The company has a goal of under 5-minute response times for adminis-tering first aid, dependable emergency communica-tion, efficient medical transportation, and competent medical personnel.

occupational healthKrasnodonugol’s health clinics keep records of every miner. These records contain information such as whether the miner is medically cleared to work under-ground and past results of blood, hearing, dermatol-ogy, fluorography, and electrocardiogram tests. There are also recommendations for what kind of work each miner is suited to doing in relation to his or her physical health. These health clinics provide therapy, massag-es, and health services to around 200 miners per day. There are also underground health clinics, about 850 metres deep, which provide health care as necessary.According to Krasnodonugol, the top five occupational health ailments of miners are respiratory diseases, trauma, heart diseases, musculoskeletal conditions and skin diseases. Respiratory diseases account for 74 per cent of all occupational diseases (mechanic bronchitis—46% and anthracosilicosis—28%).

Figure 5. Occupational diseases of miners from 2007-2011, as reported by Krasnodonugol, June 2012

98100

121

135

145

60

93

77 74

59

26

18 11

68

13

18

5

8 13

29

61

42

38 33

0

20

40

60

80

100

120

140

160

2007 2008 2009 2010 2011

Mechanic Bronchitis Anthracosilicosis Radiculopathy (Nerve-Related) Vibration Diesease Other

Krasnodonugol sends miners to occupational health centres if further medical analysis is needed. These visits are paid by the company if the ailment is work-related. For non-professional diseases, each miner must pay for his health-related costs through social insurance.


28

Figure 6. Cancer rates per 100,000 people

326,9302,8

318,7 311,8

0

50

100

150

200

250

300

2010 2011

City Oblast

Figure 7. Tuberculosis rates per 100,000 people

108,698,1

82,5 79,9

0

20

40

60

80

100

120

11020102

City Oblast

health and safety effortsKrasnodon has several promising developments in improving its health and safety services. For example, the city provides scholarships to a number of its residents, who study at Luhansk Medical University, in return for a commitment from the students to return to their community as health practitioners upon graduation. As of January 2012, the programme was sponsoring 14 students and 6 interns at Luhansk Medical University, as well as 7 students who are enrolled in biomedical classes. The city also has a programme where it provides housing to young medical specialists. While the programme has not kicked off, it will provide 15 apartments for young medical professionals in the near future.

At Krasnodonugol, the company has implemented a first aid training programme for its employees with great success. As of June 2012, 825 employees (managers and team leaders) have received two-day training courses and over 1,100 miners have received a one-day training course. While industry standards promote at least 10 per cent of its workforce to be trained in first aid, Krasnodonugol is aiming for 100 per cent of its miners to be trained. In addition, Krasnodonugol recently equipped its mines with modern immobilisation devices, automatic external defibrillators, and other life-saving equipment. These aforementioned developments provide a solid foundation to develop further health and safety efforts.

7.4 prioritiesKey stakeholders — miners, doctors, and government officials — discussed the top health and safety issues affecting miners. In particular, the group discussed respiratory diseases, workplace trauma, cardiovascular diseases, musculoskeletal conditions, and skin diseases as the top problems. Then, the group listed five priority areas to address: pre-hospital stage, primary prevention, transportation between home and work, rehabilitation of injured miners, and hygienic conditions in the mines.

1. Pre-hospital stage (high priority)2. Primary prevention (high priority)3. Transportation between home and work (medium priority)4. Rehabilitation of injured miners (medium priority)5. Hygienic conditions in the mines (medium priority)

Among this list, the stakeholders stressed the importance of improving pre-hospital stage and primary prevention efforts. They further explained that that improved emer-gency response vehicles and intensive care units are es-sential in light of recent coal mining accidents.

next stepsThe city of Krasnodon and Krasnodonugol both pro-vide strong leadership to make things happen. Com-bined with support from the central government and international community, Krasnodon has an op-portunity to improve pre-hospital stage and primary prevention efforts. The following is an outline of pro-posed next steps:

Figure 8. Outline of proposed next steps

steps responsible parties

1. Review, adjust, and agree upon the action plan

City of Krasnodon, Metinvest, UNDP

2. Engage the Luhansk Regional State Admin-istration, Ministry of Health, and other govern-ment bodies

UNDP

3. Contact potential financial partners, such as the EU and neighbouring government donors

UNDP

4. Proceed with the implementation plan City of Krasnodon, UNDP

7.5 general recommendationsThe following are general recommendations for the community to consider moving forward. Details for the recommendations are described in more details in the proceeding section.• While the city purchased a new ambulance in Jan-

uary 2011, the city could use an additional two modern ambulances to meet minimum emer-gency response standards (McSwain, N.E. (1991) proposes 1 ambulance per 50,000 residents. Oth-ers argue that this number should be closer to 1


29

ambulance per 10,000 residents. For Krasnodon, with a population over 100,000, the city should have between 1 and 10 ambulances. And since Krasnodon recently received a new, modern am-bulance, two additional ambulances would be a good starting point).

• The city should upgrade its medical equipment (e.g., automated external defibrillators), particular-ly for its intensive care units.

• The Krasnodon City Council should help keep and attract talented medical professionals by pro-viding at least 15 apartments for young me di cal professionals.

• In general, the city could use at least one additio-nal anaesthesiologist, two pediatricians, an urol-ogist, a surgeon, and two general practitioners. The Sukhodolskaya city polyclinic could also use at least one obstetrician and gynaecologist. The Kras-nodon City Council should consider these needs within the context of their scholarship programme.

• Krasnodonskoye, or city hospital number 2, needs 20 nursing care beds.

• Data on the health and safety of miners should be systematised into an electronic database. This will make the data more robust, accessible and usable.

• Krasnodon should conduct a community-wide pub-lic health campaign to promote healthy lifestyles.

• Krasnodonugol should simulate real-life situations in its first aid trainings in both aboveground and underground contexts. The company should con-sider doing the trainings more frequently and in fewer hours.

• Pharmacists should be included in health strate-gies since miners depend on them heavily.

• Likewise, miners’ spouses should be included in health strategies since they play a functional role in the health of miners.

• Sports and sports facilities should be used as a platform to support health planning efforts.


• Miners should have access to 2.0-2.5 litres of clean drinking water every day, as recommended by the European Food Safety Authority (2.0 litres for wom-en and 2.5 litres for men).24 Water intake should be staggered throughout the day, as even one per cent of loss in bodyweight due to fluid deficiency can impair a person’s ability to concentrate.

• Metinvest, Krasnodonugol, and neighbouring communities should consider obtaining an air

ambulance to service mining communities in the Luhansk oblast.

7.6 Action ItemsThe following action items provide the framework for the second phase of this project. These action items focus on pre-hospital care (i.e., ground ambulances, an air ambulance, and intensive care units) and primary (preventative) health (i.e., health promotion and disease prevention programming).

7.6.1 pre-hospital stage

7.6.1.1 ground AmbulancesBackground: Time is a critical factor in saving victims of cardiac arrest, trauma, and other life-threatening health conditions. For example, the survival rate from a cardiac arrest is nearly 100 per cent if defibrillation is started within the first minute of the incident. That rate drops to about 1 per cent after ten minutes. Equipping ambulances with automated external defibrillators (AEDs), oxygen supplies, ventilators, and electrocardiograms (ECGs) can literally mean the difference between life and death. Thus, community leaders stated a need to improve its pre-hospital treatment, or emergency medical response before or during transportation of a patient to the hospital. Other than one fully equipped, modern ambulance acquired last year, 25 Krasnodon’s ambulances are actually old, refurbished military vehicles that lack life-saving medical equipment. Moreover, because of the depths of the mines and poor conditions of the roads, it may take up to 90 minutes to get an injured miner from the bottom of a mine to a hospital. If a patient needs to go to a special care centre (e.g., burn unit) in Luhansk or Donetsk, it would take about 1 hour and 3 hours, respectively. Having fully equipped ambulances for these long rides would be essential to sustain lives en route to the hospital.

recommendation: The community’s rescue services would be greatly enhanced by adding two fully-equipped modern ambulances and upgrading existing ambulances with medical equipment. N.E. McSwain (1991) proposes 1 ambulance per 50,000 residents, while others argue that this number should be closer to 1 ambulance per 10,000 residents. For Krasnodon, with a population of over 100,000 people, this means there should be between 1 and 10 ambulances. And since Krasnodon received a new, modern ambulance in January 2011, two additional ambulances would be a good starting point. In addition, old vehicles should be equipped with emergency medical supplies, including AEDs, intravenous lines and fluids, essential medicines,


30

cervical collars, stretchers, spinal boards, first aid kits, radios and oxygen deployment kits.In the future, the entire fleet of vehicles should be replaced with fully-equipped, modern ambulanc-es. Moreover, according to international standards, ambulances should have three-member crews, all of whom have passed emergency medical technician (EMT) courses. Such a course usually lasts more than 3 weeks and at minimum, teaches how to adminis-ter cardiopulmonary resuscitation (CPR), pass a chest tube, and introduce an intravenous line.

Activity one: The first activity is to procure two ful-ly-equipped modern ambulances, as well as equip-ment to upgrade the existing fleet of ambulances. The steps involved in this activity include:

• Review and revise the proposed procurement list as necessary (Responsible Parties: UNDP, City of Krasnodon, Rescue Services)

• Work with procurement specialists to ensure le-gal compliance and technical specifications of the ambulances and equipment (Responsible Parties: UNDP and Rescue Services)

• Conduct internationally competitive bidding pro-cess to ensure best value (Responsible Party: UNDP)

Activity two: The second activity is to conduct cascade trainings for using the newly acquired equipment. The steps involved in this activity include:• Draft training agenda for members of the Res-

cue Services unit (Responsible Parties: UNDP and heads of Rescue Services)

• Train staff members of the Rescue Service to use new-ly acquired equipment (Responsible Party: UNDP)

• Monitor, review, and adjust procedures as neces-sary (Responsible Party: Rescue Services)

Table 27. Proposed procurement list to improve emergency transport (to be revised with Rescue Services unit)

Item Description Quantity Unit Price Total

Ambulances Modern, fully-equipped ambulance will include defibrillator, intravenous lines and fluids, stretcher, cervical collar, spinal board, first aid kits, oxygen kits, etc.

2 $65,000 $130,000

Equipment to upgrade existing ambulances

Automated external defibrillators (AEDs) 7 $1,500 $10,500Intravenous lines and fluids 7 $1,000 $7,000Cervical collars 7 $100 $700Spinal boards 7 $300 $2,100Stretchers 7 $300 $2,100First aid kits (e.g., burn pack, bandages, dressings, gauze rolls, adhesive tape) 7 $200 $1,400Two-way radios to be use between the dispatcher and emergency medical technician 7 $250 $1,750Oxygen deployment kits 7 $400 $2,800Misc. (e.g., stethoscope, thermometer, cold packs, disinfectant, blankets, gloves) 7 $250 $1,750

Total: $160,100

Table 28. Proposed fees for consultant to conduct cascade trainings

Item Description Quantity Unit Price TotalConsul-tant

Fees for 12-day consultation 12 $500 $6,000Travel costs 1 $1,000 $1,000Miscellaneous (e.g., internet, printing) 1 $1,500 $1,500

Total: $8,500

7.6.1.2 Intensive Care UnitsBackground: The standardised death rate in Ukraine due to injuries is almost three times that of countries in the European Union.26 Thus, improving intensive care units makes sense in an injury-prone mining community like Krasnodon. In fact, coal mining traumas represent the most prominent disaster risk in the area, yet Krasnodon and neighbouring Sverdlovsk share a local trauma centre.

recommendation: The following list of proposed trauma care equipment is based on discussions with

doctors in Krasnodon, as well as guidelines set forth by the World Health Organization.27 The list focuses on medical equipment rather than everyday medicines (e.g., antiseptics) or protective clothing (e.g., gloves). The final procurement list will be reviewed and adjust-ed with Krasnodon medical institutions.

Activity one: The first activity is to procure medical equipment for the hospitals in Krasnodon. The steps involved in this activity include:• Review and revise the proposed list of medi-

cal equipment (Responsible Parties: UNDP and Cent ral Hospital)

• Work with Technical Advisor to ensure technical compatibility of new equipment (Responsible Par-ties: UNDP and Central Hospital)



31

• Work with procurement specialists to ensure le-gal compliance and technical specifications of the ambulances and equipment (Responsible Parties: UNDP and Rescue Services)


Activity two: The second activity is to conduct cascade trainings for using the newly acquired equipment. The steps involved in this activity include:• Draft training agenda for members of the Res-

cue Services unit (Responsible Parties: UNDP and heads of Rescue Services)



Table 27. Proposed procurement list to improve emergency transport (to be revised with Rescue Services unit)


Table 29. Proposed procurement list to enhance intensive care units in Krasnodon


Portable ultrasound machine Diagnoses traumas and illnesses (e.g., cardiovascular disease); inclusive of supporting software costs 1 $50,000 $50,000

Electrocardiographs (ECG) Interprets electrical activity of the heart, including the presence of any damage 5 $1,000 $5,000

Heart monitors Tracks heart functions and alerts staff to any sudden changes in vital heart functioning 3 $5,000 $15,000

Defibrillators Electric-shock, life-saving apparatus for victims of heart attacks, for patients in intensive care 3 $3,000 $9,000

Portable x-ray machines Diagnoses conditions in bones and soft tissues 4 $15,000 $60,000

Fluorography machine Diagnoses tuberculosis, lung cancer, etc. 2 $20,000 $40,000

Crash carts Serves in emergency situations with defibrillator, pulse oximeter, etc. 4 $3,000 $12,000

Hospital beds Beds for rehabilitation and acute care patients with attachments for respirator apparatus, oxygenators, and other life-saving devices 6 $500 $3,000

Sphygmomanometer kit with stethoscope Measures blood pressure, heart beat rate 10 $40 $400

Total: $194,400

Activity two: The second activity is to improve the quality of intensive care and maximise the use of the newly ac-quired equipment. International trainings for trauma care exist throughout the European Union and other regions of the world. The Advanced Trauma Life Support (ATLS) pro-gramme, organised by the American College of Surgeons, is one of the longest standing education course in trauma care worldwide.28 However, courses are not currently avail-able in Ukraine or neighbouring CIS countries. Moreover, start-up costs for such trainings would be around $80,000 per country. There are other courses offered through the Primary Trauma Care (PTC) Foundation and the International Association for Trauma Surgery and Intensive Care (IATSIC) as well. However, Ukraine and its neighbouring countries have plenty of individuals who can conduct trainings to improve the level of intensive care in Krasnodon. Thus, individual trainers should be brought in as a cost-effective alternative to improve the quality of intensive care in Krasnodon.

The steps involved in this activity include:• Select hospital staff members to participate in cas-

cade trainings (Responsible Party: Central Hospital)• Conduct cascade trainings for hospital staff (Re-

sponsible Party: UNDP)• Have hospital staff members conduct trainings to

their staff members (Responsible Party: Central Hospital)

Table 30. Proposed fees for consultant to conduct trainings


Consultant Fees for 12-day consultation 12 $500 $6,000Travel costs 1 $1,000 $1,000Miscellaneous (e.g., internet, printing)

1 $1,500 $1,500

Total: $8,500

7.6.2 preventative (primary) health

7.6.2.1 health promotion and disease prevention programmeBackground: In 2011, Krasnodon reported 860 cases of cardiovascular diseases and 217 cases of respiratory diseases per 1,000 inhabitants. These health problems are linked to changeable lifestyle patterns, including smoking, poor diets, stressful working conditions, and alcohol abuse.

recommendation: Half of all deaths before the age of 75 can be prevented through targeted programmes to modify behaviours and improve environmental condi-tions.29 Moreover, the Institute of Occupational Health in Kyiv estimates that compensation costs are approxi-mately six times higher than what it would cost to pro-tect workers or treat them at earlier stages of occupa-tional diseases.30 The European Agency for Safety and Health at Work also states the investments in occupa-tional health and safety have very high returns on in-vestment in terms of earning, improvement of a com-pany’s image, and reducing insurance and compensa-tion costs.31 Thus, Krasnodon needs a comprehensive health promotion campaign to change habits, as well as change the fatalistic mindsets of miners who do not think they can affect their own health and wellbeing.

Activity one: The first activity is to conduct health promotion campaigns and trainings. Such a campaign would focus on the primary health ailments affecting miners: respiratory and cardiovascular diseases. A good model to consider is Krasnodonugol’s train-the-trainers programme, which trained 35 retired miners in occupational health and safety procedures, who in turn trained 6,959 managers and supervisors later on. The steps involved in this activity include:


32

• Conduct tri-annual health promotion meetings and workshops to discuss community-wide strate-gy on health promotion (Responsible Parties: City of Krasnodon, Metinvest, UNDP)

• Select at least 10 participants representing the pri-vate sector, government, education, and other rel-evant sectors for the cascade training (Responsible Party: City of Krasnodon)

• Conduct the cascade trainings on health promo-tion (Responsible Party: UNDP)

• Participants conduct trainings at their place of work (Responsible Party: Participants)

The core curriculum for this health promotion training would include:

• Salutogenesis: Health, Illness and Wellbeing• Determinants of Health

• Principles of Health Promotion• Evidence-based Methods of Health Promotion• Prioritisation and Planning of Interventions• Health Promotion Evaluation• Methods of Structural and Individual Behaviour

Change • Assessment of Health Impact and Investment

Activity two: The second activity is to conduct a diet and nutrition programme for miners. UNDP will exam-ine the diet and nutrition of miners. Nutritional exams would begin by asking miners to keep a “food diary” to understand what miners consume on a daily basis. UNDP will then conduct interviews and focus groups to complement information gathered from the food di-aries. Simultaneously, UNDP will conduct a nutritional analysis of menus from the canteens in the mines. Final-ly, UNDP will provide suggestions for alternative diets.

Table 31. Proposed budget for strengthening primary (preventative) health efforts


Consultant Fees for 12-month health promotion campaign 1 $32,000 $32,000

Fees for diet and nutrition programme 1 $8,000 $8,000

Total: $40,000


33

7.7 BudgetTable 32. Proposed budget to implement Krasnodon’s action plan

ground Ambulances


Ambulances Modern, fully-equipped ambulance will include defibrillator, intravenous lines and fluids, stretcher, cervical collar, spinal board, first aid kits, oxygen kits, etc.

2 $65,000 $130,000


Automated external defibrillators (AEDs) 7 $1,500 $10,500Intravenous lines and fluids 7 $1,000 $7,000Cervical collars 7 $100 $700Spinal boards 7 $300 $2,100Stretchers 7 $300 $2,100First aid kits (e.g., burn pack, bandages, dressings, gauze rolls, adhesive tape) 7 $200 $1,400Two-way radios to be use between the dispatcher and emergency medical technician

7 $250 $1,750

Oxygen deployment kits 7 $400 $2,800Misc. (e.g., stethoscope, thermometer, cold packs, disinfectant, blankets, gloves) 7 $250 $1,750

Sub-total: $160,100

proposed fees for Consultant to Conduct training


Consultant Fees for 12-day consultation 12 $500 $6,000Travel costs 1 $1,000 $1,000Miscellaneous (e.g., internet, printing) 1 $1,500 $1,500

Sub-total: $8,500

Intensive Care Units


Portable ultrasound machine Diagnoses traumas and illnesses (e.g., cardiovascular disease); inclusive of supporting software costs

1 $50,000 $50,000

Electrocardiographs (ECG) Interprets electrical activity of the heart, including the presence of any damage 5 $1,000 $5,000Heart monitors Tracks heart functions and alerts staff to any sudden changes in vital heart

functioning3 $5,000 $15,000

Defibrillators Electric-shock, life-saving apparatus for victims of heart attacks, for patients in intensive care

3 $3,000 $9,000

Portable x-ray machines Diagnoses conditions in bones and soft tissues 4 $15,000 $60,000Fluorography machine Diagnoses tuberculosis, lung cancer, etc. 2 $20,000 $40,000Crash carts Serves in emergency situations with defibrillator, pulse oximeter, etc. 4 $3,000 $12,000Hospital beds Beds for rehabilitation and acute care patients with attachments for

respirator apparatus, oxygenators, and other life-saving devices6 $500 $3,000

Sphygmomanometer kit with stethoscope

Measures blood pressure, heart beat rate 10 $40 $400

Sub-total: $194,400

preventative (primary) health


Consultant Fees for 12-day consultation 12 $500 $6,000Travel costs 1 $1,000 $1,000Miscellaneous (e.g., internet, printing) 1 $1,500 $1,500

Sub-total: $8,500

proposed fees for Consultant to health and nutrition programme


Consultant Fees for 12-month health promotion campaign 1 $32,000 $32,000Fees for diet and nutrition programme 1 $8,000 $8,000

Sub-total: $40,000

totAl: $411,500


34

8. rovenky ACtIon plAn

8.1 key findings • In Rovenky, the top health ailments of miners are

respiratory diseases, occupational injuries (trauma), heart diseases and musculoskeletal conditions.

• More than 37 per cent of miners in Rovenky and Sverdlovsk suffer from respiratory diseases. Chron-ic bronchitis alone affects 330 per 1,000 miners — a rate seven times higher than the general adult populations in Rovenky and Sverdlovsk.

• About 18 per cent of miners in Rovenky and Sverd-lovsk suffer from cardiovascular diseases. For ex-ample, 57.6 per 1,000 miners suffer from ischemic heart disease compared to the national average of 53.1 per 1,000 people or the European average of 36.3 per 1,000 people.32


• In 2011, the rate of occupational injuries at Roven-kiantratsit was 12.98 per 1,000 miners. In compari-son, the national average for occupational injuries of miners was 9.3 per 1,000 miners and was 6.87 and 7.63, respectively, for neighbouring Krasnodo-nugol and Sverdlovantratsit.

• The most common causes of injuries include col-lapses (105.6/ year), falls (61/ year), falling objects (37.8/ year), machine related (12.6/ year), and un-derground transport related (9/ year).


• Most miners (59%) believe it is impossible to com-plete their daily work tasks (e.g., meeting coal ex-traction quotas) without deviating from occupa-tional safety and health (OSH) safety rules.

• Miners’ spouses and pharmacists play an impor-tant role in the health and wellbeing of miners. At least 15 per cent of miners use medical products advised by a pharmacist, 9 per cent use medical products advised by family members or acquaint-ances, and 8 per cent use folk remedies.


• Community members prioritised the following actions: to upgrade medical equipment, prima-ry health prevention efforts, and balance the de-mands of coal production and miners’ safety.

8.2 Community health profile The city of Rovenky has a population of 53,609, whereas the population of the entire municipality is 91,558.33 The municipality’s population receives health services by Healthcare Rovenky, a network of medical institutions, including the central hospital, four city hospitals, and several other specialty clinics. The central hospital has an emergency ward of 345 beds. Rovenky also has an ambulance station that employs five teams per shift. There are also two medical schools within the city limits.

Table 33. Number of beds and visits per shift in Rovenky’s health institutions

Institutions Beds visits/ shift

Central Hospital 345 ---

City Hospital № 2 70 150

City Hospital № 3 70 100

Yasenovskoy Hospital 40 100

City Hospital № 4 Infections 90 ---

St. Michael’s Clinic --- 50

Rural Clinic Blagovskoy --- 15

Dental Clinic --- 150

TB Hospital 90 ---

Bone TB Sanatorium 50 ---

Source: City of Rovenky, June 2012

The city also has multiple sports venues to help promote healthy lifestyles, including Avangard stadium, 2 swimming pools, 7 children’s playgrounds, 58 athletic fields, 1 tennis court, 9 soccer fields, and 27 gyms of at least 162 square meters.

8.3 dtek rovenkiantratsitIn July 2010, DTEK invested in to the state-owned Rovenkiantratsit, an investment approved by the Ministry of Coal Industry of Ukraine. Since then, DTEK has invested in to construction, machinery and technical equipment to improve the company’s operations. Simultaneously, the city of Rovenky joined the DTEK Social Partnership Declaration in order to develop better living and working conditions. DTEK Rovenkiantratsit has six mines and three ore processing plants, and other structural units that cater to coal production. As of August 2012, Rovenkiantratsit employs 13,067 people, or about 19 per cent of the adult population of Rovenky. Of the total, the company has 10,756 male employees (82%) and 2,311 female employees (18%).

Rovenky action plan

35

Table 34. The distributions of miners by gender and age at Rovenkiantratsit

mine totalIncluding:

men Women 18-30 31-40 41-50 51-60 60+Dzerzhynskogo 2058 1679 379 668 691 484 200 15Office Rovenkovskoye 1826 1430 396 526 516 450 302 32

No. 81 Kievskaya 1655 1352 303 440 526 443 221 25M.V. Frunze 3133 2704 429 984 1011 769 344 25Vakhrusheva 2054 1690 364 654 670 440 284 6Kosmonavtov 2341 1901 440 773 739 531 279 19total mines 13067 10756 2311 4045 4153 3117 1630 122

Source: DTEK, August 2012

Figure 9: Distribution of employees by gender, as of August 2012

10 756

1 6791 430 1 352

2 704

1 690 1 9012 311

379 396 303 429 364 440

0

2 000

4 000

6 000

8 000

10 000

12 000

Total Dzerzhynskogo O�ceRovenkovskoye

No. 81“Kievskaya”

M.V. Frunze Kosmonavtov

Men Women

Vakhrusheva

The company has 4,043 workers from 18-30 years old, 4,151 workers from 31-40 years old, 3,116 workers from 41-50 years old, 1,629 workers from 51-60 years old, and 122 workers over 60 years old.

Figure 10: Distribution of employees by age, as of August 2012

0

500

1000

1500

2000

2500

3000

3500

4000

4500

Total Dzerzhynskogo O�ceRovenkovskoe

No. 81“Kievskaya”

M.V. Frunze Kosmonavtov

18-30 years old 31-40 years old 41-50 years old 51-60 years old 60+ years old

Vakhrusheva

Table 35. The distributions of miners by occupation in Rovenkiantratsit

mine stope miners sinkers

Under-ground workers

Above-ground workers

Ad mi ni stra-ti ve sup port

staffDzerzhynskogo 327 211 993 453 74Office Rovenkovskoye 253 147 707 437 282

No. 81 Kievskaya 222 111 900 335 87M.V. Frunze 483 396 1565 556 133Vakhrusheva 231 209 1123 396 95Kosmonavtov 288 373 1060 525 95total mines 1804 1447 6348 2702 766


The company has 6,348 underground workers, 2,702 aboveground workers, 1,804 stope miners, 1,447 sinkers, and 766 administrative support staff.

Figure 11: Distribution of employees by occupation, as of August 2012

0

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3000

4000

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6000

7000

Total Dzerzhynskogo O�ceRovenkovskoe

No. 81Kievskaya

M.V. Frunze Vakhrusheva Kosmonavtov

Stope Miners Sinkers Underground Workers Aboveground workers Administrative

rovenkiantratsit’s health records of minersEmployees of Rovenkiantratsit undergo annual medical exams in accordance with Ukrainian law № 246, “Proce-dure for conducting medical examinations of workers certain categories” (21 May 2007). According to the com-pany, 98.6 per cent of employees have gone through pe-riodic medical exams in accordance with the abovemen-tioned law. Employees undergo exams with neurologists, ophthalmologists, ENT doctors, psychiatrists, as well as specialists in x-rays, laboratory tests, electrocardiography, pneumatic tachometry, and spirography. Based on these exams, the top three health ailments affecting employees in 2011 were respiratory disease (48.37%), trauma (7.98%) and skin and subcutaneous tissue diseases (7.89%). Ex-ams also revealed that alcoholism continues to be prob-lematic as it affects at least 27.16 per 100,000 people.

Figure 12. Total number of occupational diseases at Rovenkiantratsit, 2007-2011

116132

179 178 170

0

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140

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180

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2007 2008 2009 2010 2011

Number of Occupational Diseases

occupational Injuries (traumas) at rovenkiantratsitOccupational injuries represent a serious concern at DTEK Rovenkiantratsit. For 2011, the company averaged 203.6 injuries per 10,000 workers.

Figure 13. Total number of traumas at Rovenkiantratsit, as of June 2012

358

406

352336

266

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2007 2008 2009 2010 2011

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36

Figure 14. Comparison of traumas per 10,000 workers at Rovenkiantratsit and the average of traumas to miners across Ukraine (2011)

203,6

144,8

0

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uarT fo egarevAtistartnaiknevoR mas to Miners Across Ukraine

Rovenkiantratsit Average of Traumas to Miners Across Ukraine

Over the past five years, the most common types of trauma were as follows: 576 “other” cases (115.2 per year), 528 collapses (105.6 per year), 305 falls (61.0 per year), 189 falling objects (37.8 per year), 63 machine-related (12.6 per year), and 45 underground transport (9.0 per year).

Figure 15. Traumas at Rovenkiantratsit by type, as of June 2012

133

147

10496 96

111 110

123116

68

54

86

52

63

50

31

42 4437 35

1017

1117

8

19

49 6 7

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2007 2008 2009 2010 2011

Other Collapses Falls Falling Objects Machine-related Underground Transport

Rovenkiantratsit reported 6 work-related deaths in 2011, an average of about 4.6 deaths per 10,000 workers. Across all of the mines in Ukraine in 2010, there were about 3.9 deaths per 10,000 workers.

Figure 16. Casualties at Rovenkiantratsit as reported by the company in June 2012

0

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12

2007 2008 2009 2010 2011

Casualties

8.4 health and safety of minersAfter conducting medical exams of miners in Roven-ky and Sverdlovsk, the Luhansk Clinic of the Mi nistry of Internal Affairs classified miners into three health groups: I) generally healthy, II) those who have had acute and/ or chronic disease(s) in the past, and

III) those who currently have a chronic disease. Of those who took part in the study, 33 per cent were classified into Health Group I, 13 per cent into Health Group II, and 54 per cent into Health Group III. In Rovenky, the top health ailments of miners are respiratory diseases, cardiovascular disease, occupational injuries (trauma), and musculoskeletal conditions. In fact, more than 37 per cent of miners in Rovenky and neighbouring Sverdlovsk suffer from respirato-ry diseases. Chronic bronchitis alone affects 330 per 1,000 miners — a rate seven times higher than the general adult populations in Rovenky and Sverd-lovsk. Furthermore, about 18 per cent of miners in Rovenky and Sverdlovsk suffer from cardiovascular diseases. For example, 57.6 per 1,000 miners suffer from ischemic heart disease compared to the nation-al average of 53.1 per 1,000 people or the European average of 36.3 per 1,000 people.34 As for musculo-skeletal conditions, the most common conditions of miners in Rovenky and Sverdlovsk are osteochon-drosis (68 per 1,000 miners) and lower back pain (42 per 1,000 miners).The rate of occupational injuries at Rovenkiantratsit in 2011 was 12.98 per 1,000 miners. In comparison, the national average for occupational injuries of miners was 9.3 per 1,000 miners and was 6.87 and 7.63, respectively, for neighbouring Krasnodonugol and Sverdlovantratsit. The most common causes of the occupational injuries include collapses (105.6/ year), falls (61/ year), falling objects (37.8/ year), machine related (12.6/ year), and underground transport related (9/ year). In an opinion survey conducted by GfK Ukraine, 50 per cent of miners from Rovenkiantratsit and Sverdlovantratsit stated that they are satisfied with their working conditions, even though 75 per cent of miners also stated that they are worried about the possibility of work-related accidents.

8.5 prioritiesKey stakeholders — miners, doctors and government officials — prioritised the following as most pressing issues to address. 1. Improvement of medical equipment and emergency transportation (high priority)2. Programmes on health education (high priority)3. Balancing the demands between coal production and miners’ safety (high priority)4. Transportation to mining site (medium priority)5. Quality of underground air (medium priority)

Among this list, stakeholders prioritised improving medical services, programmes on health education, and balancing the demands between coal production and miners’ safety as the most important issues to address.

Rovenky action plan

37

next stepsRovenky has community resources (e.g., health and sports facilities) to help advance health promotion efforts community-wide. Upgrading human and medical capacities, while also improving working conditions, are a step in the right direction for improving the health and safety of miners in Rovenky. This action plan focuses on reducing the risk factors that make miners’ susceptible to cardiovascular disease, respiratory disease and trauma. However, improving the health and safety of miners will require engagement of the public and private sectors. Thus, UNDP has contacted the Ministry of Health, Ministry of Emergencies, and State Committee of Ukraine on Industrial Safety, Labour Protection and Mining Supervision and will seek to engage them in the implementation phase of the project as well.In phase two of the project, UNDP will conduct a roundtable discussion between DTEK, Metinvest, and representatives from government entities, in-cluding the Ministry of Health, Ministry of Emer-gencies, State Committee on Mining Supervision and Industrial Safety. Once representatives are en-gaged, UNDP will facilitate further discussions with the abovementioned ministries and representatives from the Luhansk Regional State Administration and cities of Krasnodon, Rovenky and Sverdlovsk. Con-currently, UNDP will contact potential partners, in-cluding the European Union and interested parties (e.g., neighbouring government donors), about join-ing this effort.

8.6 general recommendations• Rovenky needs at least two modern and ful-

ly-equipped ambulances to meet minimum emer-gency response standards (McSwain, N.E. (1991) proposes 1 ambulance per 50,000 residents. Oth-ers argue that this number should be closer to 1 ambulance per 10,000 residents. Rovenky, with a population of over 91,000 people, should have be-tween 2 and 10 modern ambulances).


• DTEK Rovenkiantratsit should consider installing radiation therapy rooms and aerosol inhalation rooms for their health units.

• DTEK Rovenkiantratsit should purchase washing and drying machines to clean miners’ work clothes on its premises.

• DTEK Rovenkiantratsit should provide workers with sufficient amount of respirators and interchange-able filters. Workers should also be included in

choosing safety equipment so that management understands the workers’ needs.

• DTEK Rovenkiantratsit should consider providing clean and heated means of transportation to and from work.

• The city’s medical equipment and training should be upgraded to improve screening and emergen-cy medical services.

• A comprehensive health education and promo-tion campaign should be advanced within the framework of this project. Sports and sports facili-ties should be used as a platform to launch such an effort. In addition, schools and other educational institutions should be used to promote healthy living.

• Nutritional policies and planning should balance traditional cuisine with nutrition guidelines out-lined in the “Health of the Nation” (2002-2011), which was adopted by the Cabinet of Minis-ters in 2002, or with World Health Organization guidelines.

• Miners should have access to 2.0-2.5 litres of clean drinking water every day, as recommended by the European Food Safety Authority (2.0 litres for women and 2.5 litres for men). Water intake should be staggered throughout the day, as even one per cent of loss in bodyweight due to fluid deficiency can impair a person’s ability to concentrate.

• Promote the use of the prophylactic sanatori-um during miners’ second vacation by allowing miners to bring their families with them to the sanatoriums.



• DTEK, Rovenky, and neighbouring communities should consider obtaining an air ambulance to service mining communities in the Luhansk oblast.

8.7 Action Items8.7.1 Improvement of medical equipmentBackground: Rovenky has a central hospital, four city hospitals, several other specialty clinics, and an am-bulance station. Rovenky also has 755 hospital beds compared to neighbouring Sverdlovsk which has 720 beds. Still, much of the medical equipment in Roven-ky is obsolete and needs to be replaced. Doctors and miners alike know that medical equipment needs to be upgraded throughout Rovenky’s network of health institutions. The following highlights some of the problems with the outdated equipment, as well as


38

recommendations of what purchases should be made moving forward.• diagnostic equipment: Diagnostic equipment

that could have led to early detection (e.g., x-ray machines, spirometers, pulse oximeters, fluorog-raphy machines, ultrasound machines) are mostly outdated and in some cases obsolete. Many pre-ventable diseases have gone undetected or de-tected too late in the process. Last year, respiratory diseases led to 17 per cent of all deaths, and car-diovascular diseases led to 47 per cent of deaths.

recommendation: At least four portable x-ray machines, two fluorography machines, and one portable ultrasound machine are needed based on the number of patients who visit the hospitals. These machines are critical in diagnosing and evaluating respiratory and cardiovascular diseases.

In the future, there should be a gradual shift to digital machines (instead of film-based ones) when the hospital has the technical and staff capacity to absorb the changes. For example, the hospital should be upgraded with computer stations and software programmes in each department to handle the technological shift to digital equipment.• emergency room equipment: Rovenky is lacking

necessary equipment for emergency situations, in-cluding crash carts, electrocardiographs, heart mon-itors and automatic external defibrillators (AEDs). In Rovenky, where heart diseases kill the majority of people (over 47 per cent of deaths last year), equip-ment to monitor heart conditions and to stabilise victims of emergency situations is critical.

recommendation: Proper medical equipment during emergency situations can make the difference between life and death. Thus, minimum additions should be made, including the abovementioned

equipment (i.e., crash carts, electrocardiographs, heart monitors, AEDs). Health consultants determined the numbers of each equipment based on volume of patients and professional opinion.

Activity one: The first activity is to procure medical equipment for the hospitals in Rovenky. The steps involved in this activity include:• Review and revise the proposed list of medical

equipment (Responsible Parties: UNDP and Cen-tral Hospital)

• Work with Technical Advisor to ensure technical compatibility of new equipment (Responsible Par-ty: UNDP and Central Hospital)

• Conduct internationally competitive bidding process to ensure best value (Responsible Party: UNDP)

Activity two: The second activity is to train staff to use the newly acquired equipment. The steps involved in this activity include:

• Select 10 hospital staff members to participate in cas-cade trainings (Responsible Party: Central Hospital)

• Conduct cascade trainings for hospital staff (Re-sponsible Party: UNDP)

• Have hospital staff members conduct trainings to their staff members (Responsible Party: Central Hospital)



Consultant Fees for 12-day consultation 12 $500 $6,000

Travel costs 1 $1,000 $1,000

Miscellaneous (e.g., internet, printing) 1 $1,500 $1,500

Total: $8,500

Table 36. Proposed list of medical equipment to procure (to be revised with the Central Hospital as necessary)



Defibrillators Electric-shock, life-saving apparatus for victims of heart attacks, for patients in in-tensive care 3 $3,000 $9,000



Heart monitors Tracks heart functions and alerts staff to any sudden changes in vital heart func-tioning 4 $5,000 $20,000

Portable ultrasound machine Diagnoses traumas and illnesses (e.g., cardiovascular disease); inclusive of support-ing software costs 1 $50,000 $50,000


Pulse oximeters Measures oxygen levels and diagnoses patients’ breathing and circulatory problems 5 $200 $1,000

Spirometers Diagnoses chronic obstructive pulmonary disease (COPD), a.k.a. chronic obstruc-tive lung disease (COLD) 8 $250 $2,000

Total: $200,000

Rovenky action plan

39

8.7.2 Improve emergency transportBackground: Rovenki’s Rescue Services’ ambulances are actually old, refurbished military vehicles, which lack ba-sic emergency medical equipment. The lack of modern vehicles and equipment severely limits the effectiveness of the Rescue Services. Moreover, because of the depths of the mines and poor conditions of the roads, it may take up to one hour to get an injured miner from the bottom of the mines to a local hospital (15 km drive). If a patient needs to go to a special centre in Luhansk or Donetsk, it will take 2 hours and 4-6 hours, respectively. Poorly equipped vehicles and long commute times to hospitals make it imperative to improve emergency transport ser-vices as medical services provided — or not provided — in the minutes en route to a hospital can be the difference between life and death. In addition, half of the 124.3km of municipal roads in Rovenky are in need of urgent repair.recommendation: Rovenky needs at least two modern and fully-equipped ambulances to meet minimum emer-gency response standards (McSwain, N.E. (1991) propos-es 1 ambulance per 50,000 residents. Others argue that this number should be closer to 1 ambulance per 10,000 residents. Rovenky, with a population of over 91,000 peo-ple, should have between 2 and 10 modern ambulances). In the future, the entire fleet of vehicles should be replaced with modern ambulances. Moreover, according to international standards, ambulances should have three-member crews, all of whom have passed emergency medical technician (EMT) courses. Such a course usually lasts more than 3 weeks and at minimum, teaches how to administer cardiopulmonary resuscitation (CPR), pass a chest tube, and introduce an intravenous line.Activity one: The first activity is to procure two fully-equipped modern ambulances, as well as equipment to upgrade the existing fleet of ambulances. The steps involved in this activity include: • Review and revise the proposed procurement list as nec-

essary (Responsible Parties: UNDP and Central Hospital)• Work with procurement specialists to ensure le-

gal compliance and technical specifications of the ambulances and equipment (Responsible Parties: UNDP and Central Hospital)

• Conduct internationally competitive bidding pro-cess to ensure best value (Responsible Parties: UNDP)

Table 38. Proposed list of equipment to procure to improve emergency transport (to be revised with Rescue Services unit)

Item description Quan-tity

Unit price total

Ambu-lances

Transports patients to health centers; fully equipped ambu-lance will include defibrillator, intravenous lines and fluids, es-sential medicines, cervical col-lar, stretcher, spinal board, first aid kits, radios, oxygen kits, etc.

2 $75,000 $150,000

total: $150,000

Activity two: The second activity is to conduct cascade trainings for using the newly acquired equipment. The steps involved in this activity include:• Draft training agenda for members of the Rescue

Service (Responsible Parties: UNDP and head(s) of Rescue Services)




Item description Quantity Unit price totalConsultant Fees for 12-day

consultation 12 $500 $6,000

Travel costs 1 $1,000 $1,000Miscellaneous (e.g., internet, printing) 1 $1,500 $1,500

total: $8,500

8.7.3 programmes on health educationBackground: The top health problems in Rovenky—cardiovascular and respiratory diseases—are linked to changeable lifestyle patterns, including smoking, poor diets, stressful working conditions, and alcohol abuse. Yet miners in Rovenky suffer disproportionate rates of chronic bronchitis, ischemic heart diseases, and other cardiovascular and respiratory disease. recommendation: Half of all deaths before the age of 75 can be prevented through targeted programmes to modify behaviours and improve environmental conditions.36 Moreover, the Institute of Occupational Health in Kyiv estimates that compensation costs are approximately six times higher than what it would cost to protect workers or treat them at earlier stages of oc-cupational diseases.37 The European Agency for Safety and Health at Work also states the investments in oc-cupational health and safety have very high returns on investment in terms of earning, improvement of a com-pany’s image, and reducing insurance and compensa-tion costs.38 Thus, Rovenky needs a comprehensive health promotion campaign to change habits, as well as change the fatalistic mindsets of miners who do not think they can affect their own health and wellbeing.Activity one: The first activity is to conduct health promotion campaign and trainings. Such a campaign would focus on the primary health ailments affecting miners: respiratory and cardiovascular diseases. A good model for DTEK to consider is Metinvest’s train-the-trainers programme in Krasnodon, which trained 35 retired miners in occupational health and safety proce-dures, who in turn trained 6,959 managers and supervi-sors later on. The steps involved in this activity include:• Conduct tri-annual health promotion meet-

ings and workshops to discuss community-wide


40

strategy on health promotion (Responsible Par-ties: City of Rovenky, DTEK, UNDP)

• Select at least 10 participants representing the pri-vate sector, government, education, and other rel-evant sectors for the cascade training (Responsible Party: City of Rovenky)

• Conduct the cascade trainings on health promotion (Responsible Party: UNDP)


The core curriculum for this health promotion training would include:• Salutogenesis: Health, Illness and Wellbeing• Determinants of Health• Principles of Health Promotion• Evidence-based Methods of Health Promotion• Prioritisation and Planning of Interventions• Health Promotion Evaluation• Methods of Structural and Individual Behaviour


Activity two: The second activity is to conduct a diet and nutrition programme for miners. Canteen supervisors at DTEK Rovenkiantratsit explained that menus were based on high-calorie diets established during Soviet times. After interviews with miners and miners’ wives, it was also clear that miners ate high calorie, high fat diets at home as well. Thus, a diet and nutrition programme would help to keep track of diets, as well as provide guidance for miners to change their eating habits.This activity begins with a “food diary” to keep track of what miners consume on a daily basis. Food diaries help track how many calories one is consuming, as well as if one is consuming enough fruits, vegetables, and whole grains. Participants list their current weight, height, goal weight, and any other health goals the he or she might have (e.g., blood pressure, cholesterol levels). In addition, food diaries allow one to write down how he or she feels after changing his or her diet. UNDP will then conduct interviews and focus groups to complement information gathered from the food diaries. Simultaneously, UNDP will conduct a nutritional analysis of menus from the canteens in the mines. Finally, UNDP will provide suggestions for alternative approaches for meeting their dietary needs.Concurrently, UNDP will facilitate discussions with city officials and DTEK Rovenkiantratsit about how to increase usage of the vast network of sports and health facilities in the area. While DTEK Rovenkiantratsit already organises sports days and programmes for its employees, further health and fitness programmes could be easily developed.

Rovenky has an impressive array of underutilised sports venues, including “Avangard” stadium, 2 swimming pools, 7 children’s playgrounds, 58 athletic fields, 1 tennis court, 9 football fields, 27 gymnasiums, 25 rooms for sports and recreational activities, and other fitness spaces. These resources provide a foundation to develop a comprehensive health promotion programme.

Table 40. Proposed budget for programmes on health education


Consultant

Fees for 12-month health promotion campaign 1 $32,000 $32,000

Fees for diet and nutri-tion programme 1 $8,000 $8,000

Total: $40,000

8.7.4 Balancing the demands between Coal production and miners’ safetyBackground: This is a vital, yet difficult, action item to im-plement. Miners stated that the need to make a living, to-gether with the pressures from management to produce, led to risky behaviour. Thus, this action item is about pro-moting safer working conditions and ultimately, balancing the demands between coal production and miners’ safety.recommendations: This is an enormous task that will take years of persistence and reform to achieve. However, there are intermediate steps that can improve morale and limit risky behaviours by miners.• Include miners in decision-making: Miners know

their working conditions better than anyone else. Including them in decision-making processes will improve efficiency, safety and morale. For example, one miner stated that he appreciated that DTEK Rovenkiantratsit purchased new protective eyewear recently. However, the upgraded eyewear did not fit on their faces with the old respirator masks. Thus, miners had to choose between wearing the eyewear or wearing the respirators. Such a situation could have been avoided if miners were more intimately involved in choosing their own protective gear.

• Conduct Comprehensive risk Assessments: Currently, risk assessments are conducted sepa-rately by different departments at DTEK Rovenki-antratsit. While conducting assessments at each of the mines is helpful, a comprehensive assessment must also be conducted. Again, miners should be included in this process.

• Improve Underground hygienic Conditions: Dust control is a major issue at DTEK Rovenkiantratsit. There are many dust suppression techniques, in-cluding water-based ones that could really decrease dust levels, as well as the risk for getting respiratory diseases. In addition, miners regularly commented about the lack of clean drinking water as a concern.

Rovenky action plan

41

Providing clean drinking water not only improves hy-gienic conditions, it also will improve worker morale.

Activity one: The first activity is to fund an advisor to help guide health and safety procedures at DTEK Rovenkiantratsit. Such an advisor could provide regular advice to DTEK Rovenkiantratsit, while also advocating local and national government bodies to improve and enforce laws that protect miners. The advisor also could conduct trainings on risk assessments, dust control and other best practices in mines, with a goal of training at least 10 per cent of the workforce or about 1,954 employees. These training will not only impart skills to improve safety,

but focus on ways to balance the demands between coal production and miners’ safety.Activity two: The second activity is to establish a health and safety working group to ensure the sustainability of the project.

Table 41. Proposed budget for promoting safer working conditions


Advisor Funding for full-time advisor for 12 months 1 $50,000 $50,000

Project management

Funds to conduct trainings 1 $50,000 $50,000

Total: $100,000

8.8 BudgetTable 42. Proposed budget for Rovenky’s action plan

Action Item 1: Improvement of medical equipment









Pulse oximeters Measures oxygen levels and diagnoses patients’ breathing and circulatory problems 5 $200 $1,000

Spirometers Diagnoses chronic obstructive pulmonary disease (COPD), a.k.a. chronic obstructive lung disease (COLD) 8 $250 $2,000

Sub-total: $200,000

proposed fees for Consultant to Conduct trainings


ConsultantFees for 12-day consultation 12 $500 $6,000Travel costs 1 $1,000 $1,000Miscellaneous (e.g., internet, printing) 1 $1,500 $1,500

Sub-total: $8,500

Action Item 2: programmes on health education


ConsultantFees for 12-month health promotion campaign 1 $32,000 $32,000Fees for diet and nutrition programme 1 $8,000 $8,000

Sub-total: $40,000

Action Item 3: Balancing the demands between Coal production and miners’ safety


Advisor Funding for full-time advisor for 12 months 1 $50,000 $50,000Project management Funds to conduct trainings 1 $50,000 $50,000

Sub-total: $100,000

totAl: $348,500


42

9. sverdlovsk ACtIon plAn

9.1 key findings• In Sverdlovsk, the top health ailments of miners are res-

piratory diseases, occupational injuries (trauma), cardi-ovascular diseases and musculoskeletal conditions.

• More than 37 per cent of miners in Sverdlovsk and neighbouring Rovenky suffer from respiratory dis-eases. Chronic bronchitis alone affects 330 per 1,000 miners — a rate seven times higher than the gener-al adult populations in Sverdlovsk and Rovenky.

• About 18 per cent of miners in Sverdlovsk and Rovenky suffer from cardiovascular diseases. For example, 57.6 per 1,000 miners suffer from ischemic heart disease com-pared to the national average of 53.1 per 1,000 people or the European average of 36.3 per 1,000 people.39

• In Sverdlovsk and Rovenky, the most common musculoskeletal conditions of miners are osteo-chondrosis (68 per 1,000 miners) and lower back pain (42 per 1,000 miners).

• In 2011, the rate of occupational injuries at Sverdlovan-tratsit was 7.63 per 1,000 miners. In comparison, the national average for occupational injuries of miners was 9.3 per 1,000 miners and was 6.87 and 12.98 for neighbouring Krasnodonugol and Rovenkiantratsit.

• In Sverdlovsk, the central hospital treats an average of 201.7 traumas per year. DTEK Sverdlovantratsit’s health clinics report an average of 231.2 injuries per year.

• The most common causes of injuries include col-lapses (105.6/ year), falls (61/ year), falling objects (37.8/ year), machine related (12.6/ year), and un-derground transport related (9/ year).


• Most miners (59%) believe it is impossible to com-plete their daily work tasks (e.g., meeting coal ex-traction quotas) without deviating from occupa-tional safety and health (OSH) safety rules.

• Miners’ spouses and pharmacists play an impor-tant role in the health and wellbeing of miners. At

least 15 per cent of miners use medical products advised by a pharmacist, 9 per cent use medical products advised by family members or acquaint-ances, and 8 per cent use folk remedies.


• Community members prioritised the following ac-tions: upgrade medical equipment, improve emer-gency medical transportation and conduct prima-ry health prevention efforts.

9.2 Community health profileThe city of Sverdlovsk has a population of 72,611 people, whereas the population of the entire munici-pality is 110,107 people.40 The most common diseas-es in Sverdlovsk include cardiovascular diseases and respiratory diseases.

Table 43. Rate of registered diseases per 1,000 inhabitants in Sverdlovsk

group of diseases 2005 2006 2007 2008 2009 2010 2011All diseases 1580 1603 1598 1676 1659 1641 1694Diseases of the circulatory system 710 714 720 730 741 754 781

Diseases of the respiratory system 214 207 204 234 253 218 246

Diseases of the musculoskeletal system and con-nective tissue

68 74 69 67 67 59 61

Diseases of the nervous system 26 25 20 19 20 19 20

Source: Luhansk Oblast Department of Health (calculations by GfK Ukraine)

occupational diseases in sverdlovskAccording to health officials, the top health ailments of the general population of Sverdlovsk include dust bronchitis (48%) and pneumoconiosis (38%). In fact, over the past 10 years, respiratory diseases have accounted for 1,388 of 1,543, or nearly 90 per cent, of all reported cases of occupational diseases.

Table 44. Occupational diseases reported by the Sverdlovsk Central Hospital, June 2012

occupational diseases reported by the Central hospital, 2002-2011occupational disease 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 totalDust Bronchitis (Lungs) 30 36 61 65 19 59 121 105 110 138 744Pneumoconiosis (Lungs) 66 78 64 43 56 40 68 67 54 54 590Vibration Diseases 7 6 10 9 1 4 10 18 6 21 92Nerve-related 1 4 7 4 2 5 8 2 5 8 46Tubercolosis (Lungs) 3 6 4 5 6 3 4 2 2 3 38COPD (Lungs) 0 0 0 0 0 0 0 3 7 6 16Hearing Loss 0 1 0 1 1 0 1 2 0 6 12Joint-related 0 1 0 0 1 0 0 0 1 1 4totAl 107 132 146 127 86 111 212 199 185 238 1543

SverdlovSk action plan

43

traumas in sverdlovskWhile not categorised as an occupational disease, traumas also affect a large number of the general pop-ulation in Sverdlovsk. Since 2002, the central hospital treated an average of 201.7 traumas per year. Over the same period, DTEK Sverdlovantratsit’s health clinics re-ported an average of 231.2 injuries per year. The abovementioned data is complicated, as some of the miners who are injured at the workplace are sent for follow-up visits to hospitals, leading to duplicative data. However, in other cases, miners stated that they are forced by their managers to report workplace inju-ries as household injuries in order to make the compa-ny’s safety statistics look better. Still, the figures below provide a basis to examine traumas in Sverdlovsk.

Figure 17. Traumas reported by the Sverdlovsk Central Hospital and DTEK Sverdlovantratsit, June 2012

377

252224

243

187152

174 164

111133

390

304282 280

218

179 183 179149 148

0

100

200

300

400

500

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Central Hospital DTEK Sverdlovskantratsit

9.3 dtek sverdlovantratsitIn July 2010, DTEK invested in to the state-owned Sverdlovantratsit, an investment approved by the Ministry of Coal Industry of Ukraine. Since then, DTEK has invested in to construction, machinery and tech-nical equipment to improve the company’s opera-tions. Simultaneously, the city of Sverdlovsk joined the DTEK Social Partnership Declaration in order to develop better living and working conditions. DTEK Sverdlovantratsit has five mines and three coal wash-ing facilities. As of August 2012, Sverdlovantratsit employed 10,315 miners or about 12 per cent of the adult population of Sverdlovsk.

Table 45. The distributions of miners by gender and age in Sverdlovantratsit

mine totalIncluding

men Women 18-30 31-40 41-50 51-60 60+

Dolzhanskaya-Kapitalnaya 3364 2614 750 580 1296 460 960 68

Ya.M.Sverdlova 1166 900 266 462 176 250 211 67

Tsentrosoyuz 1043 783 260 480 69 234 202 58

Kharkovskaya 864 585 279 550 19 198 49 48

Krasnyi Partizan 3878 3111 767 712 1795 472 817 82

total mines 10315 7993 2322 2784 3355 1614 2239 323


Figure 18: Distribution of miners by gender, as of August 2012

0

2000

4000

6000

8000

10000

12000

Ya.M.Sverdlova TsentrosoyuzDolzhanskaya-Kapitalnaya

Kharkovskaya Krasnyi Partizan Total

Total Men Women

Figure 19: Distribution of miners by age, as of August 2012

0

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400

600

800

1000

1200

1400

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2000

Dolzhanskaya-Kapitalnaya

Ya.M.Sverdlova Tsentrosoyuz Kharkovskaya Total

18-30 31-40 41-50 51-60 60+

Table 46. The distributions of miners by occupation in Sverdlovantratsit

mine stope miners

sink-ers

Under-ground workers

Above-ground workers

Adminis-trative sup-

port staffDolzhanskaya-Kapitalnaya 353 182 2396 911 57

Ya.M.Sverdlova 184 98 922 211 33Tsentrosoyuz 104 47 806 202 35Kharkovskaya 151 57 784 49 31Krasnyi Partizan 368 180 2968 817 93total mines 1160 564 7876 2190 249


Figure 20: Distribution of miners by occupation as of August 2012

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

Dolzhanskaya-Kapitalnaya

Ya.M.Sverdlova Tsentrosoyuz Kharkovskaya Krasnyi Partizan Total

Stope Miners Sinkers Underground Aboveground Administrative

9.4 health and safety of minersAfter conducting medical exams of miners in Sverd-lovsk and Rovenky, the Luhansk Clinic of the Mi ni-stry of Internal Affairs classified miners into three health groups: I) generally healthy, II) those who have had acute and/ or chronic disease(s) in the past, and III) those who currently have a chronic disease. Of those who took part in the study, 33 per cent were classified into Health Group I, 13 per cent into Health Group II,


44

and 54 per cent into Health Group III. In Rovenky, the top health ailments of miners are respi ratory dise a-ses, cardiovascular disease, occupational injuries (trau-ma), and musculoskeletal conditions.In fact, more than 37 per cent of miners in Sverdlovsk and neighbouring Rovenky suffer from respiratory dis-eases. Chronic bronchitis alone affects 330 per 1,000 miners—a rate seven times higher than the general adult populations in Sverdlovsk and Rovenky. Fur-thermore, about 18 per cent of miners in Sverdlovsk and Rovenky suffer from cardiovascular diseases. For example, 57.6 per 1,000 miners suffer from ischem-ic heart disease compared to the national average of 53.1 per 1,000 people or the European average of 36.3 per 1,000 people.41 As for musculoskeletal conditions, the most common conditions of miners in Rovenky and Sverdlovsk are osteochondrosis (68 per 1,000 min-ers) and lower back pain (42 per 1,000 miners).The rate of occupational injuries at Sverdlovantratsit in 2011 was 7.63 per 1,000 miners. In comparison, the na-tional average for occupational injuries of miners was 9.3 per 1,000 miners and was 6.87 and 12.98, respectively, for neighbouring Krasnodonugol and Rovenkiantratsit. In an opinion survey conducted by GfK Ukraine, 50 per cent of miners from Sverdlovantratsit and Rovenkiantratsit stated that they are satisfied with their working conditions, even though 75 per cent of miners also stated that they are worried about the possibility of work-related accidents.

9.5 prioritiesKey stakeholders—miners, doctors and government officials—prioritised the following as most pressing issues to address. 1. Improve emergency medical transport (high priority)2. Upgrade hospital equipment to better diagnose oc-cupational diseases (high priority)3. Invest in personal and collective safety equipment, including warning signs (medium priority)4. Social services for injured miners (medium priority)5. Underground medical equipment for miners (medi-um priority)Among this list, the stakeholders prioritised upgrading hospital equipment and improving emergency medi-cal transport as the most important issues to address.

next stepsSverdlovsk has strong community leadership and po-litical will to make things happen. Upgrading human and medical capacities will go a long way to improve the health and wellbeing of miners and the commu-nity at-large. This action plan focuses on upgrading both emergency and preventative health services to reduce miners’ susceptibility to cardiovascular disease, respiratory disease and trauma.

However, improving the health and safety of miners will require engagement of the public and private sectors. Thus, UNDP has contacted the Ministry of Health, Ministry of Emergencies, and State Committee of Ukraine on Industrial Safety, Labour Protection and Mining Supervision and will seek to engage them in the implementation phase of the project as well.In phase two of the project, UNDP will conduct a roundta-ble discussion between DTEK, Metinvest, and represent-atives from government entities, including the Ministry of Health, Ministry of Emergencies, State Committee on Mining Supervision and Industrial Safety. Once represent-atives are engaged, UNDP will facilitate further discus-sions with the abovementioned ministries and represent-atives from the Luhansk Regional State Administration and cities of Krasnodon, Rovenky and Sverdlovsk. Con-currently, UNDP will contact potential partners, including the European Union and interested parties (e.g., neigh-bouring government donors), about joining this effort.

9.6 general recommendations• Sverdlovsk needs at least two modern and ful-

ly-equipped ambulances to meet minimum emer-gency response standards (McSwain, N.E. (1991) proposes 1 ambulance per 50,000 residents. Oth-ers argue that this number should be closer to 1 ambulance per 10,000 residents. Sverdlovsk, with a population of over 110,000 people, should have between 2 and 10 modern ambulances).

• The hospitals’ medical equipment and training should be upgraded to improve diagnostic and emergency medical services. At minimum, the hospitals should get a portable ultrasound machine, x-ray machines, and arthroscopic surgery equipment (specific details are outlined in the subsequent section).


• DTEK Rovenkiantratsit should purchase washing and drying machines to clean miners’ work clothes on its premises.

• DTEK Rovenkiantratsit should provide workers with sufficient amount of respirators and inter-changeable filters. Workers should also be includ-ed in choosing safety equipment so that manage-ment understands the workers’ needs.

• DTEK Rovenkiantratsit should consider providing clean and heated means of transportation to and from work.

• A comprehensive health education and promotion campaign should be advanced within the framework of this project. Schools and other educational institu-tions should be used to promote healthy living.

• Nutritional policies and planning should ba-lance traditional cuisine with nutrition guidelines


45

outlined in the “Health of the Nation” (2002-2011), which was adopted by the Cabinet of Min-isters in 2002, or with World Health Organization guidelines.

• Miners should have access to 2.0-2.5 litres of clean drinking water every day, as recommended by the European Food Safety Authority (2.0 litres for women and 2.5 litres for men). Water intake should be staggered throughout the day, as even one per cent of loss in bodyweight due to fluid deficiency can impair a person’s ability to concentrate.

• Promote the use of the prophylactic sanatorium during miners’ second vacation by allowing miners to bring their families with them to the sanatoriums.




• Miners should have access to 2.0-2.5 litres of clean drinking water every day, as recommended by the European Food Safety Authority (2.0 litres for wom-en and 2.5 litres for men).42 Water intake should be staggered throughout the day, as even one per cent of loss in bodyweight due to fluid deficiency can impair a person’s ability to concentrate.

• DTEK, Sverdlovsk, and neighbouring communities should consider obtaining an air ambulance to service mining communities in the Luhansk oblast.

9.7 Action Items9.7.1 Improve emergency transportBackground: Sverdlovsk’s Rescue Services has 10 bri-gades, along with 4 subdivisions, which are led by 2 doc-tors and 8 paramedics. The “ambulances” are actually old, refurbished military vehicles which lack basic emergen-cy medical equipment with only one working automat-ic external defibrillator (AED) among the entire Rescue Service unit. The lack of modern vehicles and equipment severely limits the effectiveness of the Rescue Services.

Moreover, because of the depths of the mines and poor conditions of the roads, it may take up to one hour to get an injured miner from the bottom of the mines to a local hospital (15 km drive). If a patient needs to go to a special center in Luhansk or Donetsk, it will take 2 hours and 4-6 hours, respectively. Poorly equipped

vehicles and long commute times to hospitals make it imperative to improve emergency transport services as medical services provided — or not provided — in the minutes en route to a hospital can be the differ-ence between life and death.

recommendation: Sverdlovsk needs at least two modern and fully-equipped ambulances to meet min-imum emergency response standards (McSwain, N.E. (1991) proposes 1 ambulance per 50,000 residents. Others argue that this number should be closer to 1 ambulance per 10,000 residents. Sverdlovsk, with a population of over 110,000 people, should have between 2 and 10 modern ambulances). In addition, existing vehicles should be equipped with emergen-cy medical supplies, including AEDs, intravenous lines and fluids, essential medicines, cervical collars, stretchers, spinal boards, first aid kits, radios and oxy-gen deployment kits.

In the future, the entire fleet of vehicles should be re-placed with modern ambulances. Moreover, according to international standards, ambulances should have three-member crews, all of whom have passed emer-gency medical technician (EMT) courses. Such a course usually lasts more than 3 weeks and at minimum, teaches how to administer cardiopulmonary resuscitation (CPR), pass a chest tube, and introduce an intravenous line.

Activity one: The first activity is to procure two ful-ly-equipped modern ambulances, as well as equip-ment to upgrade the existing fleet of ambulances. The steps involved in this activity include: • Review and revise the proposed procurement list as

necessary (Responsible Parties: UNDP and Central Hospital)

• Work with procurement specialists to ensure le-gal compliance and technical specifications of the ambulances and equipment (Responsible Parties: UNDP and Central Hospital)

• Conduct internationally competitive bidding pro-cess to ensure best value (Responsible Parties: UNDP)

Activity two: The second activity is to conduct cascade trainings for using the newly acquired equipment. The steps involved in this activity include:• Draft training agenda for members of the Rescue

Service (Responsible Parties: UNDP and head(s) of Rescue Services)




46

Table 47. Proposed list of equipment to procure to improve emergency transport (to be revised with Rescue Services unit)


AmbulancesTransports patients to health centers; fully equipped ambulance will include defibrillator, intravenous lines and fluids, essential medicines, cervical collar, stretcher, spinal board, first aid kits, radios, oxygen kits, etc.

2 $75,000 $150,000


Automated external defibrillators (AEDs) 10 $1,500 $15,000Intravenous lines and fluids 10 $1,000 $10,000Cervical collars 10 $100 $1,000Spinal boards 10 $300 $3,000Stretchers 10 $300 $3,000First aid kits (e.g., burn pack, bandages, dressings, gauze rolls, adhesive tape) 10 $200 $2,000Two-way radio communication between emergency medical technician and dispatcher 10 $250 $2,500Oxygen deployment kits 10 $400 $4,000Misc. (stethoscope, thermometer, cold packs, blankets, towels, masks, gloves, disinfectant) 10 $250 $2,500

Total: $193,000


Item Description Quan-tity

Unit Price Total

Consul-tant

Fees for 12-day consultation 12 $500 $6,000Travel costs 1 $1,000 $1,000Miscellaneous (e.g., internet, printing) 1 $1,500 $1,500

Total: $8,500

9.7.2 Upgrade hospital equipment to Better diagnose occupational diseasesBackground: Most of the medical equipment in Sverdlovsk is from the 1980s and obsolete. Thus, many doctors make diagnoses based on intuition rather than on hard evidence. Upgrading medical equipment would go a long way to improve much needed early detection, prevention and treatment efforts. The following highlights some of the problems with the outdated equipment, as well as recommendations of what purchases should be made moving forward. • X-ray machines: The x-ray department examines

about 30 patients per day, conducting a total of 50-60 x-rays per day. However, two of the four sta-tionary x-ray machines do not function properly. Moreover, other departments (i.e., trauma) do not have working x-ray machines at all.

recommendation: At least five portable x-ray machines are needed to replace outdated equipment and sustain a minimum level of service. In the future, there should be a gradual shift to programmes in each department to handle the technological shift to digital equipment.• Ultrasound machines: The central hospital has

one stationary ultrasound machine for all of its patients. The ultrasound machine, which is used to diagnose traumas and illnesses, is limited in its ef-fectiveness as it cannot be moved to where injured or sick patients are located.

recommendation: At least one portable ultrasound machine is needed to diagnose illnesses and injuries (e.g., abdomen, liver problems). In the future, there should be more than two portable ultrasound

machines in the central hospital, as well as one in each of the surrounding health clinics.• hospital Beds: Sverdlovsk has 720 hospital beds,

or 62 beds per every 10,000 people. This figure is higher than the recommended number of 51 beds per 10,000 people. However, many of the beds in the central hospital need to be replaced, and Ward 2 does not have any functional beds at all.

recommendation: While hospital beds are not a priority, Ward 2 could use five hospital beds at minimum. In the future, at least 20 more hospital beds for rehabilitation and acute care patients, with attachments for respirator apparatus, oxygenators and other vital life-saving devices should be considered to replace older beds.• fluorography machine: Polyclinics do not have

regular access to ultrasound or fluorography equipment — both necessary for making accurate diagnoses for illnesses and injuries.

recommendation: Fluorography machines are a type of x-ray machine that are commonly used to diagnose lung diseases. Considering the high number of miners affected with respiratory diseases in Sverdlovsk, it is crucial to have at least two of these machines to properly diagnose and treat those affected with respiratory diseases.• Arthroscopic surgery equipment: The trauma

department states that over 30 per cent of its cas-es deal with miners. Yet the department is sorely lacking equipment, including arthroscopic sur-gery equipment, and some simple procedures are delayed due to a lack of equipment.

recommendation: Arthroscopic surgery equipment (e.g., cannulae, sterile tubing, arthroscopic resection blades) is used for minimally invasive procedures to examine, diagnose, and treat joint problems. While there are many different types of equipment, five complete kits would greatly boost the department’s efforts. • Intensive Care Units (ICUs): Many wards, includ-

ing intensive care units, lack necessary emergency


47

medical equipment, including crash carts, electro-cardiographs, heart monitors and automatic exter-nal defibrillators (AEDs).

recommendation: Equipment for ICUs is vital, especially when treating heart attacks, strokes or other emergency situations. Thus, minimum additions should be made, including the abovementioned equipment.• diagnostic equipment: The central hospital and

surrounding policlinics lack basic medical equip-ment (e.g., fluorography machines, spirometers, and pulse oximeters) to diagnose diseases, including those for commonly observed respiratory diseases.

recommendation: Equipment for early detection is vital to help prevent respiratory and cardiovascular diseases. Many doctors and nurses are currently using their intuition to make diagnoses when relatively inexpensive diagnostic equipment (e.g., spirometers) can make a big difference.

Activity one: The first activity is to procure medical equipment for the hospitals in Sverdlovsk. The steps involved in this activity include:• Review and revise the proposed list of medical

equipment (see Figure 9) (Responsible Parties: UNDP and Central Hospital)

• Work with Technical Advisor to ensure technical compatibility of new equipment (Responsible Par-ties: UNDP and Central Hospital)


Activity two: The second activity is to train staff to use the newly acquired equipment. The steps involved in this activity include:

• Select 10 hospital staff members to participate in cas-cade trainings (Responsible Party: Central Hospital)

• Conduct cascade trainings for hospital staff (Re-sponsible Party: UNDP)

• Have hospital staff members conduct trainings to their staff members (Responsible Party: Central Hospital)

9.7.3 strengthen preventative (primary) health effortsBackground: While doctors in Sverdlovsk spend 4 hours every week on preventative work, there is no community-wide strategy that involves schools, workplaces, and government entities to promote preventative health efforts. In addition, miners for-go preventative health measures such as sanatorium visits, mostly because they cannot take their families with them. For example, of 1,161 people of a particu-lar mine, only 323 miners went took advantage of the sanatorium in Crimea and only 37 went to the one in Sverdlovsk. DTEK Sverdlovantratsit also provides weekly health courses, but these are not part of a larger, comprehensive effort.

Table 49. Proposed list of medical equipment to procure (to be revised with the Central Hospital as necessary)






Portable x-ray machines Diagnoses conditions in bones and soft tissues 4 $15,000 $60,000Fluorography machine Diagnoses tuberculosis, lung cancer, etc. 2 $20,000 $40,000


Pulse oximeters Measures oxygen levels and diagnoses patients’ breathing and circulatory problems 5 $200 $1,000Crash carts Serves in emergency situations with defibrillator, pulse oximeter, etc. 4 $3,000 $12,000

Arthroscopic surgery kits Tools for minimally invasive surgical procedure to examine, diagnose and treat joint issues (e.g., cannulae, sterile tubing, arthroscopic resection blades) 6 $500 $3,000

Hospital beds Beds for rehabilitation and acute care patients with attachments for respirator apparatus, oxygenators, and other life-saving devices 6 $500 $3,000

Total: $200,000


Item Description Quantity Unit Price TotalConsultant Fees for 12-day consultation 12 $500 $6,000

Travel costs 1 $1,000 $1,000Miscellaneous (e.g., internet, printing)

1 $1,500 $1,500

Total: $8,500

recommendation: Half of all deaths before the age of 75 can be prevented through targeted programmes to modify behaviours and improve environmental conditions.43 Moreover, the Institute of Occupational Health in Kyiv estimates that compensation costs are approximately six times higher than what it would cost


48

to protect workers or treat them at earlier stages of oc-cupational diseases.44 The European Agency for Safety and Health at Work also states the investments in oc-cupational health and safety have very high returns on investment in terms of earning, improvement of a com-pany’s image, and reducing insurance and compensa-tion costs.45 Thus, Sverdlovsk needs a comprehensive health promotion campaign to change habits, as well as change the fatalistic mindsets of miners who do not think they can affect their own health and wellbeing.Activity one: The first activity is to conduct health promotion campaign and trainings. Such a campaign would focus on the primary health ailments affecting miners: respiratory and cardiovascular diseases. A good model for DTEK to consider is Metinvest’s train-the-trainers programme in Krasnodon, which trained 35 retired miners in occupational health and safety proce-dures, who in turn trained 6,959 managers and supervi-sors later on. The steps involved in this activity include:• Conduct tri-annual health promotion meetings

and workshops to discuss community-wide strate-gy on health promotion (Responsible Parties: City of Sverdlovsk, DTEK, UNDP)

• Select at least 10 participants representing the pri-vate sector, government, education, and other rel-evant sectors for the cascade training (Responsible Party: City of Sverdlovsk)

• Conduct the cascade trainings on health promo-tion (Responsible Party: UNDP)


The core curriculum for this health promotion training would include:• Salutogenesis: Health, Illness and Wellbeing• Determinants of Health• Principles of Health Promotion• Evidence-based Methods of Health Promotion• Prioritisation and Planning of Interventions• Health Promotion Evaluation• Methods of Structural and Individual Behaviour


Activity two: The second activity is to conduct a diet and nutrition programme for miners. UNDP will exam-ine the diet and nutrition of miners. Nutritional exams would begin by asking miners to keep a “food diary” to understand what miners consume on a daily basis. UNDP will then conduct interviews and focus groups to complement information gathered from the food di-aries. Simultaneously, UNDP will conduct a nutritional analysis of menus from the canteens in the mines. Final-ly, UNDP will provide suggestions for alternative diets.

Table 51. Proposed budget for strengthening primary (preventative) health efforts


Consult-ant

Fees for 12-month health promotion campaign 1 $32,000 $32,000

Fees for diet and nutrition programme 1 $8,000 $8,000

Total: $40,000


49

9.8 BudgetTable 52. Proposed budget to implement Sverdlovsk’s action plan

Action Item 1: Improve emergency transport


Unit Price Total

Ambulances Transports patients to health centers; fully equipped ambulance will include defibrillator, intravenous lines and fluids, essential medicines, cervical collar, stretcher, spinal board, first aid kits, radios, oxygen kits, etc. 2 $75,000 $150,000

Equipment to upgrade exist-ing ambulances

Automated external defibrillators (AEDs) 10 $1,500 $15,000Intravenous lines and fluids 10 $1,000 $10,000Cervical collars 10 $100 $1,000Spinal boards 10 $300 $3,000Stretchers 10 $300 $3,000First aid kits (e.g., burn pack, bandages, dressings, gauze rolls, adhesive tape) 10 $200 $2,000Two-way radio communication between emergency medical technician and dispatcher 10 $250 $2,500Oxygen deployment kits 10 $400 $4,000Misc. (stethoscope, thermometer, cold packs, blankets, towels, masks, gloves, disinfectant) 10 $250 $2,500

Sub-total: $193,000

proposed fees for Consultant to Conduct Cascade trainings


Unit Price Total


Sub-total: $8,500

Action Item 2: Upgrade hospital equipment to Better diagnose occupational diseases


Unit Price Total

Portable ultra-sound machine

Diagnoses traumas and illnesses (e.g., cardiovascular disease); inclusive of supporting software costs 1 $50,000 $50,000

Electrocardio-graphs (ECG) Interprets electrical activity of the heart, including the presence of any damage 5 $1,000 $5,000

Heart monitors Tracks heart functions and alerts staff to any sudden changes in vital heart functioning 3 $5,000 $15,000Defibrillators Electric-shock, life-saving apparatus for victims of heart attacks, for patients in intensive care 3 $3,000 $9,000Portable x-ray machines Diagnoses conditions in bones and soft tissues 4 $15,000 $60,000



Pulse oximeters Measures oxygen levels and diagnoses patients’ breathing and circulatory problems 5 $200 $1,000Crash carts Serves in emergency situations with defibrillator, pulse oximeter, etc. 4 $3,000 $12,000Arthroscopic surgery kits

Tools for minimally invasive surgical procedure to examine, diagnose and treat joint issues (e.g., cannulae, sterile tubing, arthroscopic resection blades) 6 $500 $3,000

Hospital beds Beds for rehabilitation and acute care patients with attachments for respirator apparatus, oxygen-ators, and other life-saving devices 6 $500 $3,000

Sub-total: $200,000

proposed fees for Consultant to Conduct trainings


Unit Price Total


Sub-total: $8,500

Action Item 3: strengthen preventative (primary) health efforts


Unit Price Total

ConsultantFees for 12-month health promotion campaign 1 $32,000 $32,000Fees for diet and nutrition programme 1 $8,000 $8,000

Sub-total: $40,000

totAl: $450,000


50

10. regIonAl ConsIderAtIons

10.1 Air AmbulanceBackground: Throughout Ukraine, most special care centres (e.g., burn units) are located in major ur-ban hospitals. For miners in Krasnodon, Rovenky and Sverdlovsk, this means that some life-saving servic-es can only be obtained in large cities like Luhansk or Donetsk, which are 50km and 190km away, respective-ly. These distances, combined with the area’s notori-ously poor road conditions, make emergency medical transportation very difficult (for example, the city of Krasnodon has 50.3km of roads, 29.8km of which are in disrepair). Still, travel time to specialised centres must be somehow decreased or medical services in Krasno-don, Rovenky and Sverdlovsk must be improved.To address the former point, some communities are obtaining air ambulances (e.g., helicopters) to reduce the time required to transport a victim to a special care centre and increase the patient’s chances for a successful recovery. Air ambulances not only avoid traffic and bumpy roads, they also travel much faster than land vehicles, flying at about 220-270km/ hour. They also can take off from the ground within 2-5 minutes of receiving an emergency request. This all equates to response times that are 3-5 times faster than traditional land-based ambulances, possibly the difference between life and death for some patients.Still, air ambulances are popular within health systems despite inconsistent evidence to support their use. Some scholars state that air ambulances are both cost-effective and life-saving.46 Others argue that the health outcomes and costs of air ambulances are unclear; suggesting that what is important is early advanced life support (ALS), not the mode of transportation.47 There are also studies that suggest that air ambulances make sense in the right location under the right circumstances.48 Before investing in an air ambulance, Krasnodon, Rovenky, and Sverdlovsk should carefully consider the financial and logistical requirements of owning one. financial Considerations: An air ambulance can cost over $1.5 million, not including operational, maintenance, or training costs. Each mission may cost up to $2,000 with annual maintenance fees possibly costing over $165,000, although some operational costs may be reduced by securing VAT exemptions on gas, for example. In addition, the air ambulance will require trained pilots and should be staffed with an emergency medical technician (EMT), nurse and/or trauma doctor. The actual cost of each mission will vary based on the distance flown, number of medical

personnel required, airport landing fees, and distance ground ambulances need to travel.In some cases, air ambulance services are provided on a fee-for-service basis. In others, companies may choose to fund local air ambulance services as a donation to the community. In the United Kingdom, Santander Corporate Banking and Virgin Group sponsor London’s Air Ambulance (LAA) operations.49 In New Zealand, several companies co-sponsor the Westpac Waikato Air Ambulance service.50

recommendation: An air ambulance makes sense considering the number of miners who require special care following a coal mine explosion or cardiac arrest. However, representatives from the cities of Krasnodon, Rovenky, and Sverdlovsk, hospital officials, DTEK, Metinvest, and UNDP should meet to discuss the feasibility of such a decision. Purchasing and maintaining an air ambulance will take community commitment, as well as solid financial and logistical planning. The group should also consider getting an air ambulance that covers the entire Luhansk region, or possibly the Luhansk and Donetsk regions, to increase the feasibility and practicality of such a plan. The group might also consider talking to the Government of Ukraine about purchasing an entire fleet of air ambulances for the entire country, similar to what Romania’s Ministry of Health has done.51

Activity one: The first activity is to consider the procurement of an air ambulance.• Discuss the interest of procuring and maintaining

an air ambulance (Responsible Parties: UNDP, Cen-tral Hospital, Luhansk Hospital, Metinvest)

• Consult local authorities of Krasnodon, Rovenky, and Sverdlovsk about their interest of joining the effort (Responsible Parties: Local authorities, DTEK, Metinvest, UNDP)

• Consult air ambulance companies about financial and logistical procedures (Responsible Parties: UNDP, Central Hospital, Luhansk hospital, DTEK, Metinvest)

• Consult the Luhansk and Donetsk oblast adminis-trations about supporting the efforts (Responsible Parties: Local authorities, DTEK, Metinvest, UNDP)

• Discuss preliminary plans of whom and how the air ambulance would be sustained after the pur-chase. (Responsible Parties: Local authorities, DTEK, Metinvest, Luhansk State Regional Adminis-tration, UNDP)

• Pursue potential donors about contributing to the effort (Responsible Parties: UNDP, local authorities, DTEK, Metinvest)

Regional consideRations

51

Activity two: If the aforementioned parties agree, the second activity will be to procure an air ambulance.

• Work with procurement specialists to ensure legal compliance and technical specifications of the air ambulance (Responsible Parties: UNDP and Cen-tral Hospital(s))

• Conduct internationally competitive bidding process to ensure best value (Responsible Parties: UNDP)

Table 53 Proposed procurement list to improve emergency transport


Air ambu-lance

Modern, fully-equipped dou-ble-engine ambulance with defibrillator, intravenous lines and fluids, stretcher, cervical collar, spinal board, first aid kits, oxygen kits, etc.

1 $1,500,000 $1,500,000

Con-sult-ant

Fifteen-day consultation on maintaining an air ambu-lance service

1 $12,000 $12,000

Total: $1,512,000


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11. AppendIXAppendix: extended lists of officially registered diseases among the population of surveyed cities

Table 54. Rate of registered diseases per 1,000 inhabitants in Krasnodon

diseases 2005 2006 2007 2008 2009 2010 2011

All diseases 1508.6 1557.9 1584.4 1690.3 1569.0 1727.8 1749.2

Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism 17.4 17.4 17.5 17.7 17.8 17.9 18.0

Endocrine, nutritional and metabolic diseases 36.5 38.1 37.6 40.2 41.0 43.0 45.7

Diseases of the nervous system 10.4 11.8 9.7 10.0 9.8 10.1 10.5

including diseases of peripheral nervous system 1.9 2.1 2.4 2.0 2.1 2.1 2.1

Vegetovascular dystonia 3.9 4.4 4.2 4.4 4.6 4.8 5.1

Diseases of the eye and adnexa 50.9 63.6 68.5 56.2 50.7 58.7 50.4

Hearing loss 6.0 5.2 6.5 5.9 5.3 4.9 4.9

diseases of the circulatory system 768.7 789.8 799.3 822.9 825.5 840.6 859.8

Hypertensive diseases (all forms) 277.0 400.4 406.5 419.7 425.1 433.1 440.6

Other heart diseases 1.8 1.9 1.9 2.0 2.0 2.0 2.1

Paroxysmal tachycardia and heart arrhythmia 0.0 0.7 1.1 1.4 1.7 1.9 1.9

Cerebrovascular diseases 82.8 83.3 85.3 85.5 83.5 82.9 30.6

Strokes (all forms) 3.9 3.2 3.2 3.3 3.4 3.1 3.1

Atherosclerosis 1.4 1.4 1.6 1.6 1.5 1.4 1.5

Other peripheral vascular diseases 0.3 0.3 0.4 0.4 0.4 0.4 0.4

Phlebitis, thrombophlebitis, varicosity 0.6 0.8 0.9 3.6 3.1 3.0 2.9

diseases of the respiratory system 219.8 211.9 222.8 210.1 209.9 225.6 217.2

including acute pharyngitis and acute tonsillitis 3.5 4.0 3.3 2.6 2.6 2.3 2.5

Acute laryngitis and tracheitis 1.9 2.5 2.4 5.3 3.3 4.6 4.3

Pneumonia 3.1 2.4 2.9 2.9 3.2 3.3 2.8

Allergic rhinitis 0.4 0.5 0.3 1.3 1.3 2.6 3.1

Chronic rhinitis, nasopharyngitis and pharyngitis 0.8 1.1 0.6 0.7 0.5 0.7 1.1

Chronic diseases of tonsils and adenoids 3.8 3.7 3.3 3.0 3.6 3.6 4.2

Chronic laryngitis and laryngotracheitis 0.5 0.7 0.6 0.6 0.6 0.6 0.7

Chronic bronchitis 59.2 58.8 57.5 57.2 42.0 42.1 43.3

Other chronic obstructive pulmonary diseases 0.0 0.0 0.0 0.0 16.5 17.1 17.3

Bronchial asthma 4.5 4.7 4.7 4.7 4.6 4.8 4.9

Pneumonomycosis 30.7 30.1 29.5 29.3 28.8 29.0 28.5

diseases of the digestive system 176.5 173.9 179.6 180.2 184.4 187.9 191.5

including peptic ulcer 41.9 41.8 41.0 41.1 41.4 41.3 41.9

Gastritis and duodenitis 65.4 63.6 64.6 66.0 69.1 71.0 71.4

Gallstone disease 1.0 1.1 1.4 2.0 2.1 1.8 2.3

Diseases of the pancreas 9.6 10.4 11.1 11.8 12.3 12.7 13.2

diseases of the skin and subcutaneous tissue 5.4 4.4 8.2 37.8 7.3 38.3 35.6

diseases of the musculoskeletal system and connective tissue 47.1 52.1 53.1 50.8 49.8 47.6 47.5

Including rheumatoid joint inflammation and other inflammatory polyarthropathies 5.7 6.4 5.4 7.5 7.6 6.4 5.8

Arthrosis 22.6 23.3 23.6 23.7 24.4 24.1 24.9

Systemic lupus erythematosis 0.2 0.2 0.1 0.2 0.2 0.2 0.2

Ankylosing spondylitis 0.1 0.2 0.2 0.2 0.2 0.2 0.3

Cervical and other intervertebral disc disorders 0.0 0.0 0.0 0.0 0.0 0.0 0.1

Other specified dorsopathies, spondylopathies 12.8 13.1 15.1 12.7 10.8 9.9 9.6

diseases of the genitourinary system 50.2 50.7 50.0 47.2 45.9 47.3 54.6

Renal and ureteral calculi 1.3 0.0 1.8 1.4 1.5 1.3 1.2

Cystitis 1.0 1.3 1.4 0.9 0.8 0.6 0.7

Prostatic diseases 1.6 2.4 4.0 2.9 2.9 2.0 1.8

Injury, poisoning and certain other consequences of external causes 49.9 52.9 51.6 48.2 43.2 41.3 34.1

Source: Luhansk Oblast Department of Health, September 2012

Appendix

53

Table 55. Rate of registered diseases per 1,000 inhabitants in Rovenky

diseases 2005 2006 2007 2008 2009 2010 2011

All diseases 1489.8 1474.7 1475.5 1467.7 1574.4 1572.6 1613.4

diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism 6.8 6.3 6.6 7.3 7.1 8.3 8.5


diseases of the nervous system 14.6 13.0 12.8 11.2 12.4 14.2 15.6



diseases of the eye and adnexa 73.2 80.3 71.2 80.6 87.5 108.1 114.7

Hearing loss 4.5 4.5 3.2 3.2 2.7 3.2 4.4




Paroxysmal tachycardia and fibrillation atrial 0.0 1.0 1.9 1.3 1.3 1.0 0.9


strokes (all forms) 5.1 4.8 4.3 4.6 4.7 4.4 3.9


other peripheral vascular diseases 0.2 0.2 0.2 0.2 0.3 0.6 0.2

phlebitis, thrombophlebitis, varicosity 0.3 0.4 0.5 2.2 3.0 4.4 3.5




Pneumonia 7.6 6.4 6.7 5.2 5.3 7.9 7.7


Chronic rhinitis, nasopharyngitis, pharyngitis 2.7 2.7 2.6 2.9 2.6 2.3 2.4


Chronic laryngitis, laryngotracheitis 0.3 0.3 0.4 0.3 0.3 0.4 0.3


Other chronic obstructive pulmonary disease 44.1 0.1 0.2 0.2 10.9 4.7 15.2


Pneumoconiosis 45.1 42.1 40.0 39.9 38.9 36.6 36.0


including gastric ulcer and duodenal ulcer 21.9 21.8 21.2 19.7 15.8 17.8 17.3


Cholelithiasis 1.7 1.9 2.1 2.1 2.6 2.9 2.4




including rheumatoid arthritis and other inflammatory polyarthropathies 4.3 4.3 5.3 5.1 3.0 4.3 4.7

Arthrosis 21.9 21.0 20.9 20.3 20.5 17.7 21.5

Systemic lupus erythematosus 0.2 0.1 0.1 0.1 0.1 0.1 0.1



Other specified dorsopathies, spondylopathy 6.7 5.8 4.6 5.7 4.6 5.5 4.9


Calculi of kidney and ureter 4.1 4.2 3.8 4.5 6.0 5.3 5.8

Cystitis 2.2 2.9 2.3 1.9 2.7 2.0 2.1

Prostate gland diseases 5.0 4.6 5.9 5.6 5.1 7.2 4.6




54

Table 56. Rate of registered diseases per 1,000 inhabitants in Sverdlovsk

diseases 2005 2006 2007 2008 2009 2010 2011

All diseases 1579.7 1603.4 1597.8 1675.5 1658.6 1640.6 1693.7

diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism 6.7 8.0 9.3 9.5 10.3 11.1 11.4


diseases of the nervous system 25.5 25.1 20.0 19.3 19.7 18.6 20.3



diseases of the eye and adnexa 47.9 50.3 42.2 40.4 38.4 34.3 31.7

hearing loss 1.2 1.2 1.2 1.1 2.1 2.1 2.2




Paroxysmal tachycardia and fibrillation atrial 0.0 1.2 1.2 1.2 1.3 1.3 1.3


Strokes (all forms) 3.7 3.6 2.8 3.9 3.6 3.8 3.9


Other peripheral vascular diseases 0.3 0.3 0.3 0.3 0.4 0.4 0.4

Phlebitis, thrombophlebitis, varicosity 2.5 2.7 3.3 6.6 6.5 6.6 6.0




Pneumonia 5.5 5.0 4.6 5.0 7.1 9.7 13.6


Chronic rhinitis, nasopharyngitis, pharyngitis 1.4 1.2 1.2 0.8 0.9 1.0 0.9


Chronic laryngitis, laryngotracheitis 0.4 0.4 0.3 0.4 0.5 0.4 0.3


Other chronic obstructive pulmonary disease 0.2 0.1 0.2 0.0 21.0 22.8 24.3


Pneumoconiosis 46.3 45.5 44.1 43.8 43.2 41.6 40.0


including gastric ulcer and duodenal ulcer 36.6 36.9 36.8 36.9 36.4 36.5 36.8


Choleithiasis 2.1 2.2 2.5 2.4 2.5 2.7 3.0




including rheumatoid arthritis and other inflammatory polyarthropathies 7.6 8.0 7.4 7.1 7.8 7.7 7.1

Arthrosis 27.6 28.1 27.9 28.9 28.8 28.9 29.8

Systemic lupus erythematosus 0.1 0.1 0.2 0.2 0.2 0.2 0.2



Other specified dorsopathies, spondylopathy 22.8 27.2 24.5 22.1 22.0 13.7 15.2


Calculi of kidney and ureter 4.0 3.7 4.9 6.2 6.7 6.5 7.0

Cystitis 5.5 5.2 4.0 4.1 3.0 2.1 2.3

Prostate gland diseases 6.8 6.4 5.7 6.9 5.6 4.8 4.9



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58

13. endnotes1. World Health Organization. “1o Health Questions about the new EU Neighbours—Ukraine.” World Health Organization. Accessed 30 July 2012, http://www.euro.who.int/en/where-we-work/member-states/ukraine/publications3/10-health-questions-about-the-new-eu-neighbours-ukraine. 2. State Committee on Statistics of Ukraine. “Infor-mation on the status of occupational injuries for 12 months in 2011 by industry.” Last modified 25 June 2012, http://dnop.kiev.ua/index.php?option=com_content&task=view&id=7446&Itemid=225. 3. State Statistics Service of Ukraine, “Industrial Trauma-tism in 2011.” Bulletin of State Statistics Service of Ukraine.4. GfK Ukraine, “Study on the Health and Safety Needs of Miners in Eastern Ukraine.” August-September 2012.5. US Energy Information Administration. “Ukraine: Coal.” US Energy Information Administration website, undated. Accessed on 1 May 2010.6. Business Monitor International. Ukraine Min-ing Report 2011. 4 August 2011. Accessed on 1 October 2011: http://www.marketresearch.c o m / B u s i n e s s - M o n i t o r - I n t e r n a t i o n a l - v 3 0 4 /Ukraine-Mining-6485942/.7. DTEK, http://www.dtek.com/en/about-us.8. Metinvest. http://www.metinvestholding.com/en/about/structure.9. System Capital Management. http://www.scm-holding.com/en/about-us/scm/.10. U.S. Geological Survey. 2006 Minerals Yearbook: Commonwealth of Independent States. November 2009. Accessed on 1 October 2011: http://minerals.usgs.gov/minerals/pubs/country/2006/myb3-2006-am-aj-bo-gg-kz-kg-md-rs-ti-tx-up-uz.pdf.11. Ibid.12. Business Monitor International. Ukraine Min-ing Report 2011. 4 August 2011. Accessed on 1 October 2011, http://www.marketresearch.c o m / B u s i n e s s - M o n i t o r - I n t e r n a t i o n a l - v 3 0 4 /Ukraine-Mining-6485942/.13. ICEM. “Ukraine Ratifies ILO Convention 176, the Safety and Health in Mines Convention.” 21 February 2011. Accessed on 1 October 2011, http://www.icem.org/en/77-All-ICEM-News-Releases/4263-Ukraine-Ratifies-ILO-Convention-176-the-Safety-and-Health-in-Mines-Convention.14. Ibid.15. Government of Ukraine website. 11 April 2011. Accessed on 2 October 2011, http://www.d n o p. k i e v. u a / i n d e x . p h p ? o p t i o n = c o m _ c o n -tent&task=view&id=6130&Itemid=1.

16. World Health Organization. “1o Health Questions about the new EU Neighbours—Ukraine.” World Health Organization. Accessed 30 July 2012, http://www.euro.who.int/en/where-we-work/member-states/ukraine/publications3/10-health-questions-about-the-new-eu-neighbours-ukraine. 17. GfK Ukraine, “Omnibus Data.” July 2012.18. World Health Organization. “1o Health Questions about the new EU Neighbours—Ukraine.” World Health Organization. Accessed 30 July 2012, http://www.euro.who.int/en/where-we-work/member-states/ukraine/publications3/10-health-questions-about-the-new-eu-neighbours-ukraine. 19. GfK Ukraine, “Omnibus Data.” July 2012.20. State Statistics Service of Ukraine, “Industrial Trauma-tism in 2011.” Bulletin of State Statistics Service of Ukraine. 21. State Statistics Service of Ukraine, “Industrial Trauma-tism in 2011.” Bulletin of State Statistics Service of Ukraine. 22. Parliament of Ukraine, “City of Krasnodon, Luhansk Oblast.” Accessed 03 September 2012, http://w1.c1.rada.gov.ua/pls/z7502/A005?rdat1=16.06.2012&rf7571=18967. 23. World Health Organization, “World Health Statis-tic 2009.” World Health Organization. 195. Accessed 10 July 2012, http://www.who.int/whosis/whostat/EN_WHS09_Table6.pdf. 24. EFSA Panel on Dietetic Products, Nutrition, and Aller-gies (NDA). “Scientific Opinion on Dietary Reference Val-ues for water.” EFSA Journal, 8(3):1459. Accessed 10 July 2012, http://www.efsa.europa.eu/it/scdocs/doc/1459.pdf. 25. City of Krasnodon. “В Краснодоне появился свой ре-анимобиль.” Accessed 15 July 2012, http://tut.krasnodo-na.net/page/v-krasnodone-poyavilsya-svoj-reanimobil. 26. Anderson, Gerard F, et al. “Non-Communicable Diseases and Injuries in Eastern Europe and Eurasia.” USAID and Johns Hopkins Bloomberg School of Public Health. p. 25, 25 October 2006.27. Mock, Charles, Lormand, Jean-Dominique, Goos-en, Jacques, and Joshipura, Manjul. “Guidelines for Es-sential Trauma Care.” World Health Organization. (Ge-neva: WHO, 2004): 19-57, http://whqlibdoc.who.int/publications/2004/9241546409.pdf.28. Ibid.29. World Bank, “Combating Ukraine’s Health Cri-sis: Lessons from Europe.” World Bank. Last mod-ified 29 January 2010, http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/ECAEXT/0,,-contentMDK :22456440~pagePK :146736~piP-K:146830~theSitePK:258599,00.html.30. Billig, Patricia, Daane, Janelle, and Dobrovolsky, Leondard. “An Assessment of Environmental and Oc-cupational Health Activities Conducted for the USAID Mission to Ukraine.” (Washington, DC: USAID, 2000): 62, http://pdf.usaid.gov/pdf_docs/PNACH064.pdf.

EndnotEs

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31. European Agency for Safety and Health at Work. “Annual Report 2011.” (Bilbao: EU-OSHA, 2012), https://osha.europa.eu/en/publications/annual_report/2011full. Accessed 3 July 2012. 32. World Health Organization. “1o Health Questions about the new EU Neighbours—Ukraine.” World Health Organization. Accessed 30 July 2012, http://www.euro.who.int/en/where-we-work/member-states/ukraine/publications3/10-health-questions-about-the-new-eu-neighbours-ukraine. 33. Parliament of Ukraine, “City of Rovenky, Luhansk Oblast.” Accessed 3 September 2012, http://w1.c1.rada.gov.ua/pls/z7502/A005?rdat1=20.10.2003&rf7571=18997.34. World Health Organization. “1o Health Questions about the new EU Neighbours—Ukraine.” World Health Organization. Accessed 30 July 2012, http://www.euro.who.int/en/where-we-work/member-states/ukraine/publications3/10-health-questions-about-the-new-eu-neighbours-ukraine. 35. EFSA Panel on Dietetic Products, Nutrition, and Al-lergies (NDA). “Scientific Opinion on Dietary Reference Values for water.” EFSA Journal, 8(3):1459. Accessed 10 July 2012, http://www.efsa.europa.eu/it/scdocs/doc/1459.pdf. 36. World Bank, “Combating Ukraine’s Health Cri-sis: Lessons from Europe.” ECA Knowledge Brief. Accessed 1 July 2012, http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/ECAEXT/0,,-contentMDK :22456440~pagePK :146736~piP-K:146830~theSitePK:258599,00.html.37. Billig, Patricia, Daane, Janelle, and Dobrovolsky, Leondard. “An Assessment of Environmental and Oc-cupational Health Activities Conducted for the USAID Mission to Ukraine.” (Washington, DC: USAID, 2000): 62, http://pdf.usaid.gov/pdf_docs/PNACH064.pdf.38. EU-OSHA: Annual Report 2011. Accessed 3 July 2012, https://osha.europa.eu/en/publications/annual_report/2011full. 39. World Health Organization. “1o Health Questions about the new EU Neighbours—Ukraine.” World Health Organiza-tion. Accessed 30 July 2012, http://www.euro.who.int/en/where-we-work/member-states/ukraine/publications3/10-health-questions-about-the-new-eu-neighbours-ukraine. 40. Parliament of Ukraine, “City of Sverd-lovsk, Luhansk Oblast.” Accessed 3 Septem-ber 2012, http://w1.c1.rada.gov.ua/pls/z7503/A005?rdat1=11.02.2012&rf7571=19031.41. World Health Organization. “1o Health Questions about the new EU Neighbours—Ukraine.” World Health Organization. Accessed 30 July 2012, http://www.euro.

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Assessment report - UNDP...Assessment report Improving the Health and Safety of Miners in Eastern Ukraine 8 1. IntrodUC tIon Ukraine’s coal mining industry has one of the highest