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Vol. 35. Issue S2.
The 3rd International Nursing and Health Sciences Students and Health Care Professionals Conference (INHSP)
Pages S348-S359 (January 2021)
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Vol. 35. Issue S2.
The 3rd International Nursing and Health Sciences Students and Health Care Professionals Conference (INHSP)
Pages S348-S359 (January 2021)
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An analysis of pivotal factors in the implementation of occupational health and safety management systems in micro, small and medium enterprises (MSMEs): Literature review
Mila Tejamayaa,
Corresponding author
, Wishnu Puspoprodjoa, Heru Susetyob, Robiana Modjoa
a Department of Occupational Health and Safety, Faculty of Public Health, Universitas Indonesia, Depok 16424, West Java, Indonesia
b Faculty of Law, Universitas Indonesia, Depok 16424, West Java, Indonesia
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In its aim to develop a model of an occupational safety and health management system (OSHMS) for MSMEs in Indonesia, this study seeks to explore crucial factors in relation to the implementation of such a system in MSMEs by conducting a review of previous studies on the topic.


This systematic review is an exploratory study from several online databases our using a combination of two keywords that refer to the population and exposure variables in the PROSPERO Approach by using the “AND” strategy. Each literature goes through selection based on PRISMA flow chart. A Critical Appraisal Skill Programme (CASP) checklist for risk of bias assessment was used for the evidence quality appraisal.


From 37 papers, books, online books and local articles were selected, we identified pivotal factors in the implementation of OHSMS in MSMEs which can be classified into downstream factors (OSH training, commitment, risk management, and communication), middle stream factors (support from the third party), and upstream factors (the role of government).


Various pivotal factors in promoting OSH implementation at MSMEs can be seen as role of MSMEs actors (employer and employee); third party and government.

Occupational Health and Safety Management System
Systematic review
Small and medium enterprises
Full Text

Micro, small, and medium enterprises (MSMEs) plays a dominant role in Indonesian economic. A report on 2013 the number of MSMEs in Indonesia is growing by 13% annually1; followed by the absorption of the labour force in MSMEs, which according to Bank Indonesia (2016) is 7% per year of the total workforce.2

Regardless of the level of work formality, safety is among the pivotal factors in the workplace. Employees’ ignorance about how to perform their job safely, factors causing the occurrence of accidents in the workplace, documentation and reporting systems are problems faced by MSMEs.

Workplace accidents occur at higher rates in small industries than in larger ones.3,4 However, in practice, MSMEs need to pay more attention to the issue, since it has become a centre of attention due to the limited number of human resources and the low level of understanding about occupational health and safety.

Occupational health and safety management systems aim to handle and identify risks related to health and safety at work to prevent accidents.5 The main objective of occupational health and safety management systems is to reduce or prevent accidents that could potentially results in injuries or losses.6 However, these injuries cannot be fully mitigated due to some factors affecting them, such as ways of thinking and behaviour.

The occupational health and safety factors of MSMEs need to be formulated in detail. One way to do this is by studying practices in both developing and developed countries. Therefore, this study aims to analyze factors related to occupational health and safety management systems that can be formulated and developed in the MSME sector.


This systematic review is an exploratory study which aims to describe and analyze previous findings concerning pivotal factors in the implementation of OHSMS in MSMEs. This study was conducted in several steps, which consists of literature search; literature selection; evidence quality appraisal; evidence extraction and synthesis of the higher quality evidence.

In terms of the literature search, several online databases were selected as our literature sources. Google scholar, Science Direct, SpringerLink, JStor, Proquest, Taylor and Francis; as well as hand searching from various local journals; books and e-books which can be fully accessed through the Library of Universitas Indonesia were chosen. Our search strategy used a combination of two keywords that refer to the population and exposure variables in the PROSPERO (Prospective Register of Systematic Reviews) approach by using the “AND” strategy. Those keywords were defined as below:

Population: Micro, Small and medium enterprises; OR, MSMEs; OR Small businesses; OR Informal Sector; OR Small Firms; AND

Exposure: Occupational health and Safety Management System; OR OHS-MS; OR Occupational Safety Management; Occupational Health Management

Each literature goes through a selection stage with the following conditions: first, the inclusion criteria are that the literature has to be written in either English or Bahasa Indonesia; second, the literature must be published between the year 2000 and 2020; and third, the literature must be published as a research article, literature review, research report, article review, or peer-reviewed paper. The exclusion criteria include newspapers, opinions, news from print and digital media, news, editorials, conference info, case reports, and conference articles. In the next selection stage, the literature must go through the title review selection stage, then abstract and full text review for evidence quality appraisal.

A checklist developed by the Critical Appraisal Skill Programme (CASP) (Fig. 1) for risk of bias assessment was used for the evidence quality appraisal. The checklist consists of 10 questions to investigate the three main issues of a research paper systematically, which are: the validity of the study results, the study results itself and the usefulness of the evidence locally. Only good and moderate quality evidence were included in this study.

Fig. 1.

Risk bias assessment checklist.


√: Yes

?: Can’t tell

×: No

Question 1: Was there a clear statement of the aims of the research?

Question 2: Is a qualitative methodology appropriate?

Question 3: Was the research design appropriate to address the aims of the research?

Question 4: Was the recruitment strategy appropriate to the aims of the research?

Question 5: Was the data collected in a way that addressed the research issue?

Question 6: Has the relationship between researcher and participants been adequately considered?

Question 7: Have ethical issues been taken into consideration?

Question 8: Was the data analysis sufficiently rigorous?

Question 9: Is there a clear statement of findings?

Question 10: How valuable is the research?


From the Google Scholar, Science Direct, SpringerLink, JStor and Proquest databases and additional 45 books, e-books and local journals; a total of 1,708,465 online books and local articles as the initial number of studies were found. The subsequent phase of the study was selection from the databases based on year and language, which resulted in 225,213 articles. This selection was narrowed down to 147 articles which were highly relevant based on the title and research questions. From 147 papers, 23 studies that were found duplicated, leaving 124 articles that were proceeded to the eligibility evaluation.

In the first stage of eligibility evaluation, 40 articles were excluded after screening the accessibility, leaving 84 articles. From these 84 papers, 71 were chosen based on the consistency between the research objectives, methods, and questions. Next, we left out 21 articles that did not correspond to the criteria. Subsequently, a full text review of the 50 articles was conducted to understand the objective and content of the papers (Fig. 2).

Fig. 2.

PRISMA flow chart diagram.


Finally, after the careful and thorough review process, 37 papers, books, online books and local articles were selected which were of sufficiently qualified and with a low level of bias (Fig. 3). The rejected articles demonstrated less or no relevance and did not document factors related to the implementation of occupational health and safety in MSMEs.

Fig. 3.

Study selection results.


The following table presents the results of data extraction from 37 publications that were included in this study (Fig. 4).

Fig. 4.

Data extraction.

From the data extraction, we classified the pivotal factors for OSH implementation MSMEs into three downstream categories, middle stream, and upstream. Downstream factors are classified into several following categories which are awareness on regulation, the involvement of senior management, quality of OSHMS commitment towards safety and health, intervention programme, social relation at work, risk management and risk assessment, OSH structure and policy, knowledge and information, OSH training, technology and communication, human and economic resources, reward, worker involvement, interest, inspection, competition, planning and internal control (Fig. 5). Middle stream factor includes the support from third parties. Upstream factors refer to the support from government.

Fig. 5.

Downstream factors at the enterprise level that need to be stablised to promote OSHMS at MSMEs (extracted from 37 literatures).


As can be found in other studies, implementation of OHSMS at MSMEs can be challenging due to perception that OSH risk at MSMEs are low,7,8 short term benefits are not clear and do not outweigh the invested cost9 which lead to lack of interest and motivation in OSH implementation.10–12 This study aimed to identify pivotal factors in promoting OSH implementation at MSMEs through a systematic literature review.

After the selection and evaluation process, 37 literatures were obtained for this study. The findings from those studies were extracted and synthesized to describe the most important variables in promoting the implementation of OSH at MSMEs. In general, there are 3 inter-dependent parties which all contribute to this common goal, specifically MSME employers and employees, the government and third parties (consultants, associations, unions, etc.). Numerous promoting factors were identified and based on the designated party, these factors were classified as downstream, middle stream and upstream factors. Downstream factors are those which need to be established at the MSMEs, middle stream factors are those which need to be present at third parties and upstream factors are at the government level.

Downstream factors

According to the extracted data, there are 19 factors which need to be established at the enterprise level. The top six factors which are most commonly deemed as important for OSH implementation are OSH training; Commitment, Quality of OHSMS, Resources, Risk assessment and management; Communication.

  • OSH training aims to improve the level of knowledge and awareness on OSH for both the employee and employer. P33 found that training and coaching where direct and face-to face interaction occurs are more effective, though other studies suggested online training instead.12,13

  • Commitment could motivate the implementation of OSH in its presence or hinder it in its absence.14,15 OSH policy or lack thereof can be a major indication of commitment.16,17

  • The quality of OSHMS is another major factor in MSMEs. The OSHMS which are found in small businesses are usually formulated by third parties.18 The most important thing when developing an OSHMS for a small business is to consider its various internal characteristics19, including the risks associated with its line of work, while at the same time, it should be as simple and cost effective as possible.20

  • Risk Assessment and Management affects the quality of the OSHMS21 and safety performance of small businesses.22 Hence, it is crucial to create tailored risk assessment tools which are suitable for the type of MSMEs.

  • Communication, both verbal and non-verbal, inter-organization and intra-organization, is found to influence the OSH performance at MSMEs. Adequate communication between related parties e.g. government to company, employer to employee, etc. is essential to ensure effective flow of information.

Middle stream factors

The support from third parties (associations, trade unions, consultants) is hugely beneficial in promoting OSH implementation at MSMEs. A study from Arocena (2010) found that businesses not involved in any union are less likely to implement any OHS systems.23 Consultation with third parties has also become a driving factor for OSH implementation at small businesses.15,24 Trade unions and associations have become important drivers for OSH implementation, as well as sharing and harmonizing OSH practices.9,25 Since third parties play an important role in supporting OSH at MSMEs, consultants should be competent and qualified on OSH.18

Upstream factors

The role of the government to encourage OSH implementation at MSMEs is vital. Due to the informal characteristics of MSMEs, simple, proactive and functioning OSH regulation for MSMEs need to be established.14,25,26 Caparros, et al. (2020)27 and Masi and Cagno (2015)28 recommends guidance for compliance rather than bureaucratic and stringent regulations. A computational experimental study29 showed that punishment strategies, formulation of OSH standards and supervision of service agencies are recommended interventions which can be adopted by government. The role of the local government in terms of regulation enforcement and training provision are also key factors in promoting OSH implementation at MSMEs.30

Model of OSHMS at MSMEs

The establishment of an integrated management system for OSH implementation in MSMEs was proposed. This system allows for more efficiency in terms of avoiding redundant similar procedures.20 However, the certification for IMS implementation is opposed by small businesses due to its excessive capital requirement.7,9 The adoption of IMS in Thailand MSMEs requires extensive support from the government and third parties, especially to communicate its benefits, organize OSH education and awareness sessions and financial assistance.31

In Bouan China, a model of Basic Occupational Health and Services (BOHS) has been successful and well accepted by society, employee, employers and government.32 Involvement of the local government, including Bureau of Health, Finance, Industry, Labour, Human Resources, Administration of Work Safety, Social Security and trade union showed a significant improvement in the implementation of OSH programmes such as training and education, workers and workplace health surveillance, risk assessment and control, and inspection of occupational health. The cost from the BOHS was borne partly by the employer and partly by the government.


Various pivotal factors in promoting OSH implementation at MSMES were shown by literatures. Those factors are inter-related and can be seen as role of MSMEs actors (employer and employee); third party and government. Reinforcing those factors is proposed to be able to enhance the implementation of OSH-MS at MSMEs.

Conflicts of interest

The authors declare no conflict of interest.


This study was made possible through the support of the Ministry of Reearch and Higher education of Republic of Indonesia for funding this study through Penelitian Dasar Unggulan Perguruan Tinggi (PDUPT) Grant (Contract number: NKB-1581/UN2.R3.1/HKP.05.00/2019). The author would also like to thank Ms. Astuti and Ms. Amelia Anggarawati Putri who contributed to this study.

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