Barriers to Occupational Health and Safety Legal Services During Pandemic

Introduction

Occupational health aims to promote and maintain optimal physical, mental, and social well-being for workers in diverse occupational disciplines [1,2]. Its goal is to prevent health problems that may arise for employees as a result of their working conditions, and to protect them from the health risks associated with various workplace hazards [3]. Additionally, occupational health aims to ensure the placement and retention of workers in positions of responsibil- ity [4]. Occupational health and safety (OHS) has become necessary in today’s context as the working population bears a heavy load of OHS hazards [5]. This has raised serious concerns about occupational safety and health, with the conclusion that maintain- ing robust, valid, and essential workplace health and safety measures is necessary to secure workers’ psy- chological and physical health [6]. Statement of Problem and Rationale of Study Annually, an estimated 2.9 million people across the world lose their lives because of accidents and dis- eases related to work [7]. In addition, more than 160 million and 313 million people globally suffer from work-related diseases and non-fatal accidents, re- spectively, on a yearly basis [8]. These alarming fig-

ures underscore the critical need for effective occu- pational health and safety measures to minimise such consequences, particularly in the context of the pandemic, where the accessibility of OHS and legal services may be further constrained. Research Questions This study seeks to address the following questions: (i) What are the primary barriers to seeking and ac- cessing OHS legal services during the pandemic, as perceived by lawyers? (ii) How has the COVID-19 pandemic exacerbated these barriers? (iii) What are the implications of these findings for policymakers and legal professionals in the context of the pan- demic? Policy Context Occupational health and safety (OHS) is recognised as a crucial aspect of labour rights in Nepal, provid- ing for the physical and environmental health of workers as well as other employment conditions. This is reflected in key legal and policy documents, including the Constitution of Nepal (GoN, 2015), the Labour Act (GoN, 2017) and Labour Regula- tions (GoN, 2018), among the country’s other acts, regulations, policies, and guidelines [9-11]. This study aims to contribute to the ongoing efforts to im- prove OHS by identifying and analysing the barriers to seeking and accessing legal services pertaining to OHS, especially in the context of the pandemic. Study Objectives The general objective of this study is to explore the barriers to seeking and accessing OHS legal services in Nepal during the COVID-19 pandemic.

Methods and Materials

Study Context

An exploratory qualitative study was conducted in the Kathmandu Valley of Nepal. Participating law- yers were selected on the basis of their practice at the Labour Court, High Court, and Supreme Court, related to constitutional law and labour laws pertain- ing to OHS issues in the context of the COVID-19 pandemic. This pandemic presented unique chal- lenges to OHS, with factors such as lockdowns,

travel restrictions, and the closure of workplaces all affecting the accessibility of OHS legal services and impacting the enforcement of labour laws. This study focused on exploring the experi- ence of lawyers who handled OHS cases during this period, to understand how the pandemic affected OHS-related legal service-seeking and accessibility and the implementation of OHS rights.

Research Design The study used a qualitative cross-sectional design [12]. Qualitative data were drawn from in-depth in- terviews (IDI) with the lawyers regarding their ex- perience with hundreds of clients.

Sampling Strategy and Rationale Lawyers were purposively selected for the study to capture diverse perspectives on the barriers to seek- ing and accessing OHS legal services. The selected lawyers practiced at various court levels, including the Labour Court, High Court, and Supreme Court. This selection strategy aimed to gather insights into lawyers’ experiences at various stages of the legal process. Potential Sample Bias and Mitigation While purposive sampling can introduce bias, the se- lection of lawyers from different court levels helped to mitigate this by capturing a range of experiences. For instance, lawyers practicing at the Labour Court may have more experience with initial claims and navigating the Department of Labour, while those at the High Court and Supreme Court may provide in- sights into the challenges of appeals and complex le- gal arguments. By including lawyers from all three levels, the study aimed to present a more compre- hensive understanding of the barriers to OHS legal services during the pandemic. Sample Size and Sampling Method Participants were selected using a purposive sam- pling procedure. In-depth interviews (IDI) were con- ducted with 12 lawyers, a sufficient sample size for qualitative research to reach data saturation [13-16]. Inclusion and Exclusion Criteria

The study participants included lawyers who (i) were engaged in OHS legal services, (ii) were ≥18 years old, and (iii) provided consent. Exclusion Criteria: People who (i) were not licensed lawyers, (ii) were minors (<18 years old), or (iii) did not provide consent were excluded from the study.

Informed Consent The purpose of the study and information sought from the participants was explained to them, and their informed consent was obtained before they were interviewed. Participants did not receive mon- etary compensation for their time; however, they were provided with information on OHS services in the area, and the intended use of the collected data was explained. Their privacy was respected, and the interview was conducted in a quiet place. All ques- tionnaires were kept anonymous to protect confiden- tiality, and names and detailed addresses were not recorded.

Interview Guidelines and Interviews Interviews were conducted in the local language (Nepali) by trained researchers, using in-depth inter- view guidelines which had been developed in Eng- lish and translated into Nepali. The translation was reviewed by the researchers as well as by an inde- pendent lawyer fluent in English and Nepali. Quality Control The researchers checked each guideline immedi- ately after the interview to ensure accuracy and com- pletion, and the collected information was reviewed and transcribed on the same day.

Study Period The study was conducted between February and September 2022.

Data Analysis The study used a qualitative thematic analysis ap- proach guided by Braun and Clarke [17]. Interview transcripts and field notes were reviewed and ana- lysed at the time of data collection, which helped the researchers to check data saturation and explore the emerging themes of inquiry in further depth. Theme Selection and Validation

The process of theme selection and validation in- volved several steps to ensure rigour and trustwor- thiness: (i) Inductive coding: The researchers read the transcripts independently for data immersion and developed an inductive coding scheme. This process was repeated twice at different times to refine the codes and capture the nuances of the data. (ii) Code comparison and finalisation: The two sets of codes were then compared to identify areas of agreement and discrepancy. Any discrepancies were discussed and resolved through careful review of the tran- scripts and consensus-building. This iterative pro- cess led to the development of a final coding list. (iii) Double coding: To further enhance the validity of the coding scheme, approximately 10% of the inter- views were double-coded independently. The de- gree of agreement was then examined, and any dis- agreements were resolved through discussion and consultation with the research team. (iv) Theme de- velopment: The final codes were then analysed and sorted to identify overarching themes and sub- themes. This involved grouping similar codes to- gether and identifying patterns and relationships within the data. (v) Data reduction: Data reduction was conducted based on the study objectives to yield critical themes and sub-themes. This ensured that the analysis focused on the most relevant and significant aspects of the data. Coding Process The coding process involved a systematic and itera- tive approach: (i) Initial coding: The researchers be- gan by assigning initial codes to segments of the in- terview transcripts that captured key ideas, concepts, and experiences related to the research questions. (ii) Code refinement: As the researchers progressed through the transcripts, the codes were refined, merged, or split to better reflect the emerging pat- terns in the data. (iii) Codebook development: A codebook was developed to define each code and provide examples from the transcripts. This ensured consistency in coding and facilitated the double-cod- ing process. (iv) Theme identification: The codes were then grouped into themes and sub-themes based on their shared meanings and relationships.

(v) Theme review: The identified themes were re- viewed and revised throughout the analysis process to ensure that they accurately reflected the data and addressed the research questions.

To ensure a broad range of perspectives, our sample included lawyers with diverse expertise and experi- ence; nonetheless, the in-depth interviews revealed a consistent pattern of OHS problems with similar legal contexts and scenarios. This suggests that workers face systematic challenges in seeking or ac- cessing OHS legal services, with most reporting only intermittent and irregular access due to various community and OHS system constraints. We present the following key themes that characterise the chal- lenges faced by workers seeking and accessing OHS legal services services, as perceived by their law- yers: limited awareness about legal provisions and procedures; COVID-19 imposed lockdown; intent to protect oneself and family; influence of partners and significant others; and hiding one’s identity due to potential workplace stigmatisation and threat.

Results

Participant Demographics A total of 12 participants were included in the study, completed the interview, and were included in the analysis. All were lawyers from Kathmandu Valley; eight were male, and four were female. Participants ranged from 29 to 64 years of age and had legal ex- perience of 5 to 35 years. Barriers to Seeking and Accessing OHS Legal Ser- vices During the Pandemic

sub-themes SN Barrier Theme Barrier Sub-Themes 1 Limited awareness  Lack of knowledge about legal provisions  Unfamiliarity with legal procedures 2 Concerns over job security  Pressure to prioritise job security over OHS  Power imbalances and fear of confrontation  Chances of jeopardising the job over OHS  Prioritising job security for the family over personal well-being 3 Cost of legal services  Financial constraints in pandemic  High cost of legal services  Financial burden on workers 4 Authority and power of service providers

confusion  Authority of lawyers and health workers to postpone services 5 Justice system barriers  Court delay in resolving legal cases  Uncertainty of obtaining favourable outcome/justice 6 Influence of others  Influence of family members  Influence of peers  Influence of employer 7 Fear of stigma, penalisation, and threat

ployers  Fear of employer retaliation  Fear of job loss 8 Pandemic-related challenges  Travel restrictions during lockdown

 Prescriptive authority and power of lawyers and health workers  Different messages from lawyers and health workers, leading to

 Stigma and discrimination at the workplace due to COVID infection  Hesitation to disclose OHS issues to avoid being penalised by em-

services for OHS issues. Whatever hap- pens, it would be an issue for the employer and employees. Employers usually have higher power and recognition than employ- ees. The family members or peers advise them not to risk fighting a legal case with the employer...” (IDI-2, Senior Advocate) 7. Fear of stigma, penalisation, and threat Being employed greatly affected workers’ commu- nication with friends and colleagues regarding their OHS status, mainly due to fear of being stigmatised or even penalised. Most employees would disclose their OHS issues to someone, such as their peers in the same occupation, or, in some cases, to family members. Many workers were likely to work despite poor OHS provisions, in order to earn money. Those workers who concealed their OHS issues did so mostly due to the fear of workplace stigma, potential penalisation, and threat associated with speaking out.

“Employees get jobs against tough compe- tition and with great effort... The COVID- 19 lockdown gave them a harder time, as families were forced to be confined to- gether and depended on the earnings of limited employees. Their family would question them if they risked being penal- ised by raising OHS issues... Obviously, their family members would not believe that OHS takes priority over job secu- rity...” (IDI-6, Advocate) “Workers who chose not to seek OHS legal services did so out of fear of potential re- percussions, such as workplace violence di- rected at themselves, or threats directed at their dependents, due to conflicts arising from the lack of expected OHS provisions at the workplace. This fear of exacerbating a situation was cited as a significant factor influencing their decision to forgo legal services...” (IDI-9, Advocate) 8. Lockdown-imposed challenges to travel and ac- cess services

As reported by the participants, another reason workers did not seek OHS services was the difficulty of leaving their home and finding transport to legal and health facilities during the government-imposed lockdown. A special ‘travel pass’ was required to travel during this time. In addition, legal and health facilities remained closed for several months, pre- venting access to their services. Participants also ex- pressed that workers would have been interrogated in detail by everyone had they tried to leave their homes and travel to legal/health facilities for OHS services during that time.

“We learned informally that many workers were injured following accidents during the lockdown. During COVID-19, all hospitals were closed, so they could not go for a check-up. It has been a long time since COVID-19, when they did not have suffi- cient access to legal/health services...” (IDI-12, Advocate) To protect themselves, the workers had been seeking these (legal) services through local service providers..., but with COVID- 19 and the lockdown, they could not access any legal services related to their work- place health. Many workers could not waste money, almost Rs.2000 per person, to take the COVID test, but wanted to save themselves and their jobs. Many law firms and health facilities were closed because they feared the coronavirus...” (IDI-3, Ad- vocate)

Discussion

This study explored the experience of lawyers with regard to the barriers to OHS legal services in Nepal, in the context of COVID-19. We discuss below the significant gaps and challenges cited by our re- spondents with regard to seeking and accessing these services. Limited knowledge of legal provisions was one bar- rier to seeking OHS legal services. Likewise, limited knowledge about services, limited information as to what to do, and limited expertise about how and where to access services were also reported in other

countries as barriers to seeking and accessing healthcare services during the COVID-19 pandemic [18-22]. Potential confrontation with employers when raising legal issues, and a desire to safeguard their jobs and protect themselves and their dependents, also pre- vented employees from seeking legal services. Con- fronting structural issues [23-24] and personal or collective protection issues have also affected ser- vice-seeking in other contexts [6,25]. The perceived high cost of legal services was an- other barrier hindering workers from seeking such services. This finding was compatible with those of other studies, in which high costs of services and fi- nancial costs to the employee were significant barri- ers to accessing services [26-29].

Differences in information given and referral points suggested by lawyers and health workers with re- gard to OHS services led to confusion for workers as to whether to approach health facilities or the court to ensure OHS services at the workplace. Else- where, different information received from different sources was also reported as likely to create confu- sion and affect the governance of, delivery of, and access to OHS services [30-32]. Potential delays in resolving legal cases and uncer- tainty over obtaining an order in their favour were further challenges faced by workers considering OHS legal services. Procrastination or slow service delivery and long waiting times have often been strongly associated with poor access of clients to health services during the COVID-19 pandemic [33- 36].

Advice from reference people such as family mem- bers, seniors, and friends played a critical role in

Table 2. Implications of barriers for improving OHS during the pandemic SN Barrier Implications for improving OHS during the pandemic 1 Limited awareness  Launch nationwide awareness campaigns  Integrate OHS education in training programs  Disseminate OHS information through various channels 2 Concerns about job security  Enact legislation to protect workers  Establish confidential reporting mechanisms  Promote workplace safety culture

workers’ decisions over whether to seek OHS legal services. This finding aligns with those of other studies that found family, friends, and social support have a huge role in deciding whether, where, and how to seek services [37-39]. Our study found that many workers did not seek OHS legal services due to the fear and perceived threat of stigmatisation or even penalisation by the employer. Other studies have also reported that stigma, discrimination, threats, and penalisation for absence from the workplace deter workers from seeking OHS services [6,26,40,41].

Finally, another reported challenge was leaving home and travelling to legal and health facilities dur- ing the government-imposed COVID-19 lockdown. Other researchers across the globe have frequently reported that COVID-19 and the associated lock- down hindered access to healthcare and legal ser- vices [42-44]. The findings of this study have significant implica- tions for improving OHS during the pandemic, both in Nepal and globally. By highlighting the barriers to seeking and accessing OHS legal services, we em- phasise the need for comprehensive policy interven- tions to strengthen legal service access and ensure the health, safety, and well-being of workers in the face of occupational hazards and public health chal- lenges [45]. The findings contribute to global OHS legal discussions by providing insights into the com- mon challenges faced by workers who choose to seek legal support for OHS concerns, which can in- form policy and practice improvements in diverse contexts [46] .

3 Cost of legal services  Expand legal aid programs  Offer alternative dispute resolution mechanisms  Subsidise legal services 4 Authority and power of service providers

 Develop clear guidelines and protocols  Establish and strengthen a centralised referral system  Implement training programs for service providers 5 Justice system barriers  Streamline legal processes  Establish specialised labor courts  Implement case management systems 6 Influence of others  Launch awareness campaigns for influencers  Develop open communication policies  Establish support groups or peer networks 7 Fear of stigma, penalisation, and threat

 Strengthen anti-discrimination policies  Implement confidential reporting mechanisms  Conduct workplace inspections and audits 8 Pandemic-related challenges  Utilise telehealth platforms and digital technologies  Establish alternative service delivery models  Develop contingency plans for public health emergencies

This study provides valuable insights into the barri- ers to seeking and accessing OHS legal services dur- ing the pandemic, but it is essential to acknowledge its limitations. First, the study relied on the perspec- tives of lawyers, which may not fully capture the lived experiences and challenges faced by workers themselves. Second, the qualitative nature of the study limits the generalisability of the findings to a broader population [47,48]. Finally, the small sam- ple size of lawyers involved in the study may not be sufficient to capture the full range of perspectives and experiences related to seeking and accessing OHS legal services, from a quantitative viewpoint. To address the limitations of this study, future re- search could directly involve workers to understand their first-hand experiences and challenges in seek- ing and accessing OHS legal services. This could in- volve interviews, focus groups, or surveys with workers from diverse sectors and backgrounds. Ad- ditionally, a larger and more representative study could be conducted to estimate the prevalence of barriers to seeking or accessing these services, as well as the associated factors and determinants. Combining qualitative and quantitative methods could provide a more comprehensive understanding of these barriers [49]. Longitudinal studies could

track workers’ experiences over time to understand how OHS legal service-seeking evolves, and the long-term impacts of these services on workers’ health and well-being [50]. Comparing the experi- ences of workers in different regions of Nepal or across different industries could shed light on the specific challenges faced by various worker popula- tions. Finally, intervention research could explore and evaluate interventions designed to improve the process of seeking and accessing OHS legal ser- vices, such as legal aid programs, educational cam- paigns, and policy changes.

Conclusion

This study explored the barriers to seeking and ac- cessing legal services related to occupational health and safety (OHS) in Nepal, as perceived by lawyers, during the COVID-19 pandemic. The findings high- light critical challenges faced by workers who choose to seek legal support for OHS concerns, in- cluding limited awareness of legal provisions, per- ceived high costs, fear of stigma and job loss, influ- ence of family and employers, and difficulties im- posed by pandemic-related restrictions. These chal- lenges underscore the need for comprehensive pol- icy interventions to strengthen access to OHS legal

services in Nepal and other countries with similar re- source constraints. Based on our findings, several policy recommenda- tions can be proposed. First, governments should prioritise educational campaigns to raise awareness among workers about their OHS rights and the legal resources available to them. Second, financial sup- port mechanisms, such as legal aid programs or sub- sidised legal services, should be established to ad- dress the cost barriers faced by workers. Third, pol- icies should be implemented to protect workers from stigma and job loss when they seek legal redress for OHS concerns. Fourth, legal professionals, includ- ing lawyers and judges, should receive specialised training in OHS laws and regulations to ensure ef- fective representation and adjudication of OHS cases. Fifth, digital technologies and telehealth plat- forms could be leveraged to facilitate remote access to legal services, particularly in pandemic contexts or geographically isolated regions. These policy interventions should be considered not only in the context of the COVID-19 pandemic, but also any public health crisis that may disrupt access to OHS legal services. By addressing the identified barriers and implementing these recommendations, policymakers can create a more supportive legal en- vironment for workers, ensuring their health, safety, and well-being in the face of occupational hazards and public health challenges. CONFLICT OF INTEREST None. ACKNOWLEDGEMENTS We would like to acknowledge all of the lawyers who participated in the interviews and shared their perspectives. We also thank Kat Kamstra, English language editor at JMLPH, for her valuable feed- back and assistance throughout the review process, which significantly improved the clarity and quality of this manuscript. FUNDING None.