Provision Health Services for Working Little Girls in Small Scale Enterprises of Denizli – FINAL REPORT


Working title: Provision of health services for working little girls in small scale enterprises of Denizli

Location: Denizli, Turkey

Responsible Institution: FISEK Institute on Health Services and Research

IPEC contribution: USD 45,000

Local contribution: USD 35,000

Duration: 12 months

Preparation date: 22.06.97



4.Outputs of the project were as follows: 4.1. Increased awareness among the employers of the small scale enterprises on child labour and the means to improve the working conditions of the child workers 4.2. Obtained support of the owners and workers of the small scale enterprises for the activities of the programme to improve the working conditions for the sustainability of the objectives; 4.3. Collected information on working environment of children in small scale enterprises; 4.4. Reached individual workplaces and child workers under 15. 4.5. Made periodical check-up to each children in the target group.

As it can be observed in our report, the outputs expected from the project has been completely achieved.

5. Input problems: No major problem has been encountered. 6. Budget allocation has been sufficient. INFORMATION ON THE TARGET GROUP

7. Most of the girls under 15, who are the target group of our project, work in the textile sector. Working conditions of the textile factories should be carefully examined for the production rate is high and there are certain risks like noise or work accidents. According to our observations most of the girl labour are transient, as girls quit working when they get married. Their wages are low because they are not qualified, they do not have a union and job security. A great proportion of working girls has been migrated to Denizli and has low economic status. The factor that contribute their relatively low social status are not the ethnic character but poverty.

8. None. 9.Our experience has been considered as being very useful by various groups in the region and it has been enriched by their contributions.

During the 14 months period since the beginning of the project, contacts with the working girls and their employers has been established and their awareness has been raised. Working girls are pleased with the attention that they receive and contribute to our activities. Every new activity and contribution serves to improve the relations.

The “health and social service” theme does not disturb the employers, and they believe that this service should be expanded in order to be permanent. Every employer who has been visited and has participated in the “relations system” praises the service and ties several new relations.

Some experiments like focus groups, implemented to bring together working girls and make them realize their “dreams about future”, are supported by employers. The positive impression that has been created by the personel of the Fisek Institute has a great role in this support, besides the efforts of the employers to please working girls.

INFORMATION ON TARGET GROUP 11. Objectives: 11.1. Development Objective: Elimination of child labour 11.2. Immediate Objective: improve the working conditions of child workers by providing 11.2.1. To improve health services available to small scale workplaces both qualitatively and from the standpoint of increasing accessibility by girl workers; 11.2.2. To evaluate the working environment of children and to use environmental measurement equipment in addition to the observations for this purpose; 11.2.3. To provide social advisorship services to child workers to make them aware of social opportunities, occupational options and leisure-time recreation activities; 11.2.4. To train girl workers in occupational health and safety, thereby increasing their awareness of and demand for better health and social services, thus bringing about their increased participation for the same; 11.2.5. To include employers in the programme through face to face intercourse; 11.2.6. To keep the number of the workplaces and child workers reached and to increase their numbers; 11.2.7. To make a periodical check-up to each children reached. 12.Studies and activities: 12.1. Progress made towards the achievement of the objectives:

Multiple activities have been carried out to implement the project:

12.1.1. Mobile unit has been purchased and furnished.

12.1.2. Meanwhile, Apprenticeship Education Center (AEC) has been contacted and studies have been launched. With the tolerance and assistance of AEC administration, children have been attracted to the heath center and the system has begun to work.

12.1.3. Contacts have been held with local authorities and social leaders since the beginning of the project. Good relations have been set up with the press. Appendix 1 includes some of the articles about the project printed in the press.

12.1.4. Following the completion of mobile unit, workplace visits have been launched. Especially the workplaces employing girls have been selected. Ill girls have been determined, treated and followed up, and sent to a hospital for further examining if necessary. This increased the demand to the service.

12.1.5. Training studies have been conducted in the workplaces and in a common hall. Main training themes include first aid, definition of occupational health and safety, family planning and child health.

12.2. Major accomplishments:

12.2.1. The first significant achievement is the repetition of the model which has been implemented with the support of IPEC in Ankara-Ostim and Istanbul-Yenibosna since 1992 and 1994. Now Ankara-Ostim and Ýstanbul-Yenibosna could stand up without support. But Denizli project needs time and a support for sustainability.

12.2.2. The model also succeeded in renewing itself. It renewed by adapting itself to the environment, in line with the suggestions of the personnel and the workers, without losing its basic principles.

12.2.3. One of the factors contributed to the achievements was the good relations held with the Denizli Apprenticeship Education School (AES) administration. There is no health officer in the school except us.

12.2.4. Another significant achievement is that Fisek Institute has gradually become an attraction point as an NGO for the people dealing with occupational health and safety in Denizli. These include academicians from the related departments of universities, inspectors from the Ministry of Labor and Social Security and occupational physicians recorded to the local Chamber of Physicians. Particularly occupational physicians contributed to the studies by designing training programs, as they wanted to improve their own knowledge and health services in the workplaces.

12.2.5. The practice of employing a physician in the workplace was launched in 1988 and has been expanded since then, with the efforts of persons now working in Fisek Institute. These persons had an important influence on the success of the studies of Fisek Institute up to now. In addition, Denizli is a province that occupational physicians offer services nearly for 10 years. The field was well known by the physicians and the project was well recognized by the employers, NGOs and physicians; success has been achieved on this background.

12.2.6. Occupational inspections carried out by the Ministry of Labor and Social Security, have an important role in establishing relations with the employers. The interest of the employers increase when they learn that adult workers may also benefit from the services for working girls. They are amazed to learn that environmental measurements, counselling and training are included in the services. They told us that no institution had offered these services until that date.

All of these facts support our opinion that after a period of time, our studies in Denizli will be self sufficient and permanent.

12.3. Drawbacks:

12.3.1. The short background of textile employers was a main drawback. Most of them entered the sector very recently, certainly for profit. They had no opinion about “the problem of child labor” and “occupational health and safety” and not enough time to gain experience on these issues.

12.3.2. Another drawback was the extremely weak “women” movement in Denizli. Traditional approach to woman labor created obstacles in reaching working girls. As they had not met before the messages that we gave, we worked primarily on gaining confidence and friendship in the first period.

12.3.3. An important failure was about the manpower. This failure emerges particularly in two conditions. First one is the approach of physicians and administrators who do not believe changing, confined to the treatment of patients and neglecting the social dimensions of their job. Second one is the lack of trained personnel sensitive to the “dreams” of little girls and that will assist them to build their future. Such a personnel should have distinctive features such as solving his/her internal conflicts and recognizing the importance of women solidarity.

Another problem about the manpower is that the project personnel can not work full time. Thinking of the possibility that financial support from ILO/IPEC may be ceased before the model becomes self sufficient, the personnel do not leave their primary source of imcome. This situation limits the size of the activities.

SPECIAL CONCERNS 13.Our project involves “hazardous conditions & girls”, which is one of the priority groups of IPEC.

14. Our project made contributions to the protection of working conditions. First of all, it brought a permanent model that could reach the children working in industry and providing them a safe working environment besides health and social services. This model is important both for the region and for the country. It claims to be a model not only for offering loyalty service to the working little girls, but offering occupational safety and health services to all the workers in small scale enterprises. It continues to be pretentious with the effects that it created during that limited time.

This special service and communication channel could not be opened even by the universities, public institutions and other NGO’s up to now. Our project is the first communication channel for small and medium size establishments in this field in our country.

A significant difference of Denizli project from the other Fisek projects is the handling of working girls as the main theme. This project is the first systematical study in our country on working girls. Previously, a study has been conducted in this area as a master thesis with our support and interesting results have been obtained (Nazmiye Yeni: A Study on Girls Working in Clothes Workshops. Consultant: Assoc. Prof. A. Gürhan Fisek. Gazi University Health Sciences Faculty, Ankara, 1993). Moreover, the little girl workers had a concept of “rights” in their minds, at least in one aspect, which they had never met before. This is also important for the region and the country.

In addition, this study is considered as a first step to a “great intervention” that will be conducted with the support of various international agencies.

15. This project has been established on a self-financement basis. Contributions of the employers whose workplaces benefit from the service, will play the major role in this self-dependency. We need some more support.

16.There is no technical and administrative support from ILO/IPEC. 17. RECOMMENDATIONS, FINDINGS AND LESSONS LEARNED 17.1. Main success factors:

17.1.1. First of all, the strong conceptual (theoretical) structure developed before the project, led to carry out the studies rapidly and successfully.

17.1.2. There were children in Denizli, like those in Ostim-Ankara and Istanbul-Yenibosna, who was going to school one day in a week and was working in the rest of the week. General Directorate of Apprenticeship and Widespread Education of the Ministry of National Education enabled us to reach these children easily by giving a “permission”. This also contributed to the success of the project.

17.1.3. It is believed by the public, and expressed by the personnel that, this service would be long-lasting in its field. The community considers this service as unrejectable and sees a team which will not give up offering the service.

17.1.4. Most important factor is the use of community participation. Contribution, continuity and permanence ensured the community to accept the model.

17.1.5. Dynamic character of the model is also a factor contributing to success. It has a flexible structure with the ability of renewing itself continuously.

17.1.6. One important point is the expectation of the community for such a service. They know that healthy people should also be examined as a contemporary principle. This consciousness prepared the community for our model.

17.1.7. People working in the field recognized their ignorance on occupational health and safety during the practical training studies by our industrial hygienist. Even the teachers who give lessons to the working children in Apprenticeship Education Center on this subject told that they had recognized their deficiency. Thus the demand for such trainings have increased.

17.1.8. Another factor that prepared the community for this service is the acceleration of “total quality” practices and the process of attaining Customs Union. The efforts to reach certain production standards that are required by European Union encourage the attempts to improve working environment and to provide health services to the workers.

17.1.9. Another achievement of the project is the approach of Occupational Inspectors from the the Ministry of Labor and Social Security. In Ankara project, some inspectors supported the project while some others hindered it. In Istanbul, almost no inspectors visited the region during the project. Nevertheless, the inspectors visited the workplaces during the project in Denizli as well as they supported the studies of expanding Fisek Model.

17.1.10. An important achievement of Denizli project is the integration of Occupational Safety Exhibition House Project (P.0907.3.442.402). Although it was not mentioned in the manpower planning, occupational safety expert of Fisek Institute began to make regular visits to Denizli in the last month of the project. These visits contributed to increase the awareness of the employers on the improvement of working environment.

17.2. Main risk factors:

17.2.1. Most significant risk factor is the presence of habits and traditional behaviour. A sector of the community is opposed to changes and new initiatives. Their resistance continues until they can not withstand the changes any more. The most important obstacle in front of our project is such people, particularly the employers. We know that we will encounter such preventive behaviours at any stage of the project and get prepared to overcome this.

17.2.2. Another risk factor is the attempt of limiting the service only with the treatment of ill workers. Directing all the energy of the team to ill workers and -although not opposing- responding new initiatives in practice with silence are behaviours that we frequently meet. We tried to overcome this mentality during the project studies.

17.2.3. The role of the women in the community creates a large gap between traditions and common practices. Our intervention aiming to keep the girls in working life after marriage poses an important risk for the future of the project. Poor families migrated from other provinces, force the limits of traditions by sending girls into working life. However, this causes to increase pressure and discipline on working girls.

18. 18.1. Main findings:

The most important finding in this stage is the increasing interest and acceptance towards our project among working children and social partners. Every activity of Fisek Institute is broadcasted in local press and televisions. The local community and large enterprises approve our studies.

We have planned to reach working girls in Denizli in three sites:

1. The first site is small scale enterprises, which have no occupational physician or nurse and can hardly be reached even by the occupational inspectors. These workplaces are usually located in back streets, in the ground floor or basement of the buildings. We reached the workplaces by setting direct or indirect contacts with the employers. These workplaces gain a certain prestige according to the larger enterprises, as they manage to hold a different activity from their counterparts. The visits of the mobile unit draws attention in the neighborhood and contemporary health concepts like mobile unit, the right of health, etc. leave a trace in the minds of workers.

2. The second site is the large scale enterprises. Girls constitute significant manpower in the labor-intensive jobs of textile sector. We have planned to use the occupational physicians, whose employment is obligatory in workplaces that have 50 or more workers, to reach working girls in large enterprises.

It is not possible to say that all of the occupational physicians showed interest to the project. Meetings were held with the contribution of interested physicians to inform them on national and international approaches to working children and on the studies of the Fisek Institute. They were assisted to improve the working environment in their workplaces.

3. The third site is the AEC. Working boys and girls attend this school one day in a week, and they work in their workplaces for the rest of the time. AEC allocated us 2 rooms that were adequate to perform the health examinations of all children and treat ill children. In addition, our institute gave the health lessons in AEC and informed the children on occupational health and safety, general hygiene, family planning, etc. These lessons helped to improve the relations with students and teachers.

Apart from face-to-face studies, some activities were conducted that working girls would benefit indirectly. A course was organized to train workers on first aid and rescue in the workplaces employing girls. According to the law, workers trained on first aid and rescue should be employed in every workplace, but in practice there is generally none. The mannequin in Fisek exhibition house was used for application in this training. Several demands were received for the training to be repeated.

“Occupational health and safety” seminars, which we expect to provide an indirect benefit to working girls, were followed with interest in Denizli. Employers and workers from various enterprises were trained on the prevention of occupational accidents and diseases, prevention of fire, machine protectors, personal protectors, etc. Denizli exhibition house will assist them to apply these principles in their workplaces. The effect of these seminars increased with the participation of the occupational safety expert from Ankara.

Meetings were held for working girls out of working hours and outside the workplace, to maintain solidarity to cope with their problems. 15 girls participated in these meetings. They contributed the discussions actively, expressed that they want to overcome the traditional role that they face and stated their future plans (Box 1).

These 15 working girls took an important step by participating the fair organized by the “Women Solidarity Foundation in Ankara in May 1997. While they could travel outside Denizli with the permission of families who trusted in Dr. Bilgiç, they also met “women solidarity” concept. In addition, they met many women in commercial market and recognized the sector which could be a choice for them in the future.

Most of these girls attend to secondary school graduation courses conducted within our project by Dr. Bilgiç and her colleagues in Denizli. Increasing the formal education levels of these girls may help them to have a different status in the community.



During the studies, psychologists and experts experienced in women issues filled a questionnaire for the working girls to determine their personal characteristics and their expectations about working life and the future.

It was determined that working girls gave most of their income to their families and use the rest as allowance. They said that their families bought goods for them to use after marriage, and expressed their worry that this money could be wasted otherwise.

They usually worked from 8.00 to 18.30 during the week and half day in Saturday, but they worked until 22.00 or until the morning if it is necessary.

The results of the questionnaire can be summarized as follows:

    • Girls want to continue their education and have new knowledge.
    • They do not like their current job and want to deal with more qualified jobs.
    • Managing their own life, living free, attending a computer course, continuing their education and driving an automobile are their main desires.
    • Most of the girls want to continue working after they get married. They state that “contemporary living conditions require this”, they do not want to be oppressed, they will be bored at home, they want to contribute to family income and they like working.

The meetings were fruitful. They decided to take initiatives to “stand” together, to participate in the fair in Ankara and to make studies building self-confidence (body consciousness, family planning, social security, entrepreneurship, etc.).

Social and physical examination results of working girls are as follows:

18.1.1. Besides the general health examination, social characteristics of the working girls have also been determined to define the risk groups.

Age distribution of working girls within the study:



11 years



12 years



13 years



14 years



15 years



16 years



17 years






Particularly the factors influencing the age of girls to start working have been examined. Our previous studies revealed that children started working earlier if their father did not have a regular income. In this study, the mean age of starting working is 13.2 in girls whose fathers do not have a regular income and 13.6 in girls whose fathers have a regular income. These results may be better interpreted after being compared with the data from girls who are not working.

Mean age of starting working is also examined according to the family size. Girls who have a greater family size (due to multiple siblings) start working younger. The mean age of starting working is 13.6 in girls whose family have 5 or less members while this figure is 13.2 in girls whose family have 6 or more members. If less than half of the family members do not work, this age decreases (Table 1).

Table 1: Mean age of starting working according to family size and the ratio of working members in the family.

Family size

Working members/Family members

General mean

49% or less

50% or more

5 or less



13.562 ?

6 or more




35.4% of the girls has adequate nutrition. 31.7% of the girls does not have any finding in their physical examinations. The main disorders in the rest of the girls are related to teeth and eyes. The distribution of the disorders are shown in Table 2.

Table 2: Distribution of the disorders in working girls according to the organ systems.



1. Eye disorders

– Visual acuity problems



– Color blindness



– Others



2. Decayed teeth

– 2 or less



– 3 or 4



– 5 or more



3. Ear disorders

– Hearing problems



– Others



4. Throat disorders

– Acute tonsillitis



– Thyroidal disorders



5. Skin disorders

– ?



– Allergy



– Others



Total no. of disorders



* A subject may have more than one disorder at one time or may have been examined several times.

** Working girls of 16 and 17 have been also included in this evaluation.

*** Number of girls with normal physical findings is 506 (31.7%) while number of girls with a health problem is 1089 (68.3%).

18.1.2. 350 child workers were provided with counselling. Counselling services were also provided to the above described population during the examinations and interviews. 18.1.3. 250 employers provided with counselling on safety and health. 20 enterprises were visited, and evaluated by industrial hygienist and 230 enterprises were visited and evaluated by occupational physicians. The purpose of that visits was to inform the employers of the workplaces and to encourage them to enter the service network established with mobile unit and industrial hygienist. Employer generally find it hard to understand because they have not seen or even heard of such a service up to now. They believe the benefits of the service after seeing the mobile unit and observing the studies in neighbouring enterprises. Workplaces which share this confidence and contact with our centre are included within the loyalty service. The first one is to perform health checks of all the workers, especially of children; and the second one is to evaluate the working environment by an industrial hygienist and to offer consultation on this matter. Thus, the aim is to promote the health of individuals and to provide them better working environments. 18.2. Main lessons: 18.2.1. Repeatability of the model “offering health services to small scale enterprises employing children” developed in Ankara-Ostim and Istanbul-Yenibosna.Fortunately, we have proved the repeatability of the model in also Denizli. But we need sometime more for sustainability like Ankara & Istanbul. 18.2.2. During the studies in AEC we have the opportunity to interwiev with children longer and to investigate their problems in more detail.. Thus it is a big achievement that the Ministry of National Education opened its doors to our project. 18.2.3. In such a project, success is bound to the ability of the team to establish communication with employers, workers (and working children) of the small scale enterprises.

18.2.4. It has been determined that working children have severe psychosocial problems. Their families have little or no communication with their workplaces or employers. For this reason, their need for a FRIEND who takes care of them is very much. Participation of 15 girls to the meeting, that is organized out of working hours and outside the working place, is an important achievement and promising for the future of the study.

18.2.5. One of the most important risks that can be encountered during the operation of LOYALTY model is the reaction of certain groups in the region due to staying out of the project. This risk had been considered in Ankara-Ostim & Istanbul-Yenibosna, and the service had been designed to cover all the workers in the planning stage. In that model, the missing element was the employer and this had been mentioned in the final report. This time the model had been designed to involve also the employers in preparation and implementation studies in Denizli. This approach has been proved to be beneficial in practice. 18.3. Main recommendations: 18.3.1. Loyalty debt should be well explained to the children in offering health, safety and social services to small enterprises. This provides children with the information about their rights and promotes public opinion on loyalty service. 18.3.2. Health and safety education should be given in enterprises and AEC’s. Working children can be prevented fron accidents and occupational diseases in this way. Moreover, foremen and some selected workers will get more conscious on first aid and occupational safety. 18.3.3. Problems of girls who started working at an early age are different from those of the boys. In addition to the problems that boys meet, they are impeded and sexually bothered. Moreover, gaining money is more important in the employment of girls than learning a job, so they are easily exploited. However, we have an important chance of warning and education in this period so as to break the traditional chain causing inequality. 18.3.4. It is also important to expand this model countrywide, which has been developed to offer loyalty service to working children. To establish implementation fields in collaboration with each other is also important for using education, manpower and laboratory facilities (environmental and biological monitoring) in a feasible way.

18.3.5. Special social problems of working girls should be emphasized. The roots of gender inequality grow deeper irreversibly with different attitudes in those ages. Every initiative to raise the social status of working girls in the future, is a step towards gender equity and life quality.

19. Activities on working children with the contribution of IPEC have yielded significant outcomes in Turkey. Attitudes of NGOs have been greatly changed by covering large populations and choosing the right targets.

However, one of the most common situations in Turkey is the transient “rising interest”. For this reason, the organizations whose mission is the intervention programs on working children, should be improved. ILO/IPEC has made a significant achievement in this issue and established “working children units” in the Ministry, in the union confederations of workers and employers, and in the Municipality of Ankara.

The support to Fisek Institute should be evaluated in te same context. The institute has organized its activities on working children seperately as “Fisek Institute – Science and Action Center for Child Labor” since the beginning of 1997.

Another common situation in Turkey is that, major changes in policies and implementations of the public sector are encountered with the change of the key administrative staff in times of elections. Thus, the “non-governmental” concept should be carefully preserved in the approach to developing countries. The “governmental” mechanisms have had a major responsibility on young children to start working and not to receive support from any social structure up to now.

Moreover, the decision makers avoid handling the problems in all aspects in our country. They sometimes do not consider civil unrest that may be caused by a governmental intervention. For instance, 8 years of primary education is considered to be a solution to the problem of child labour. 8 years primary education policy is extremely appropriate and necessary, however, measures should be taken against the undesired effects. This policy alone will promote part-time child labor in unsafe conditions, as it will not eliminate the poverty of children that makes them work. Since these children are seen as students and there is no school health units in the schools, the government will not pay attention to their health. NGOs can play an important role in this field. We should make publications, develop models and conduct studies to relieve the problems of these children.

In this context, ILO/IPEC should increase its orientation towards the NGOs and try to leave them out of governmental control. For example, the reference of public institutions is required for NGOs to receive support from ILO/IPEC. Nevertheless, having a tri-partite structure, ILO might have accepted the references of workers” or employers” associations or the background of the NGO beside the reference of public institutions.

Particularly in developing countries, problems of working children and the solution of these problems are very similar. It is very important to explain this to implementators and decision makers. The most efficient way is to implement the models developed in line with ILO activities, in other countries that the project involves. This application will show better the solution and the international character of the problem.

Lastly, organizing an International Congress of Child Labour in 2000 (in Istanbul or Denizli) will be very useful both to constitute public opinion and to make use of previous experiences.


As stated in the previous final reports, Fisek Institute needed a “center” as the projects continued after ILO/IPEC support had ceased. This center will coordinate the existing projects while providing scientific assistance and developing new peojects. An expert institution within the institute is established to achieve this target. Fisek Institute – Science and Action Center for Child Labor launched its activities in May 1997.

Fisek Institute Science and Action Center for Child Labor considers Denizli as a large project area. This giant project will be a combination of “child labor”, “occupational health and safety”, “immigration” and “women studies”.

The model study implemented by Fisek Institute in the short term, proved its validity throughout the country and sustainability. The period of long term studies will be launched by this giant project. Activation of women”s dynamism is considered to be important in overcoming the problem of poverty. This factor is particularly important in countries that are under the influence of fundamentalist islamic approach.

Several actions have been taken by non-governmental workers” and employers” associations and by tradesmen and artisans”associations in our country. This common action has great significance in the improvement of democracy and integrating with the European Union. One of the dimensions of this action should be the elimination of poverty (hence child labor) and passification of women. Fisek Institute plans to use this mechanism to expand its models. Therefore, efforts are made to improve and adopt the theoretical framework by model studies.