Twenty years ago, the International Labour Organization (ILO) launched a new strategy, the Decent Work Agenda, to ensure human-oriented development in the globalization of working life and to provide an effective response to the challenges of globalization. We searched for and analysed the origin of the Decent Work concept and identified the key principles in ILO policy documents, survey reports, and relevant United Nations’ (UN) documents. We also analysed the implementation of the Decent Work Country Programmes (DWCPs) and examined the available external evaluation reports. Finally, we examined the objectives of the ILO Decent Work Agenda and the Decent Work targets in the UN 2030 Agenda for Sustainable Development in view of occupational health. In two thirds of the ILO’s Member States, the Decent Work Agenda has been successfully introduced and so far fully or partly implemented in their DWCPs. The sustainability of the Decent Work approach was ensured through the UN 2030 Agenda, the ILO Global Commission Report on the Future of Work, and the ILO Centenary Declaration. However, objectives in line with the ILO Convention No. 161 on Occupational Health Services were not found in the DWCPs. Although successful in numerous aspects in terms of the achievement of the Decent Work objectives and the UN Sustainable Development Goals (SDGs), the Decent Work Agenda and the Decent Work Country Programmes need further development and inclusion of the necessary strategies, objectives, and actions for occupational health services, particularly in view of the high burden of work-related diseases and, for example, the present global pandemic. In many countries, national capabilities for participation and implementation of Decent Work Country Programmes need strengthening. A total of 3.5 billion people—63% of the world’s population—belong to the global workforce. They spend more than one third of their adult life at work and produce a total world gross domestic product (GDP) of US$ 88 trillion , maintaiThere is evidence of the positive impact of globalization on the global economic growth of the world as a whole, particularly on the growth of world trade and the improved distribution of wealth also to the developing world, for example by halving the global poverty rates in the past 20 years. A similar positive impact is seen in the distribution of new technologies and the Internet throughout the continents and enhancement of global connectivity.th International Labour Conference: “Globalization has brought prosperity and inequalities, which are testing the limits of collective social responsibility” [The social impact of globalization, and on occupational health in particular, is, however, not universally positive. The transfer of basic and manufacturing industries to low-wage countries has generated many positive impacts there, but left behind major employment and social problems in the former host countries and communities. Still, most of the two billion workers of the developing world, of whom over 50% are informal, have not benefited from globalization; sometimes quite the opposite. In particular, agricultural and rural populations, family farmers, fishers, and forestry workers, domestic workers, and small and microenterprises in developing countries have been losers in globalization. Several vulnerable groups in both the industrialized and developing countries are also recognized as potential victims. Mr. Juan Somavia, Director General of the ILO, stated before the 87ibility” ,3,4,5.The ILO Decent Work Agenda is a unique global-scale response to the challenges of globalization, employment, economic, social protection policies, and social dialogue. This article describes the origin of the Decent Work concept and analyses its implementation at the national level, and particularly the role of occupational health as a part of the social protection pillar of the Decent Work Agenda .This explorative literature review was drawn up by studying the origin of the Decent Work concept and its key principles in selected and relevant ILO policy documents, survey reports, and relevant UN documents . The selIn the 1980s, the pace of globalization was accelerated by several geopolitical changes  and the increasing wide-scale implementation of new information and communication technologies. Working conditions changed radically; enterprise structures were reorganized ; and working contracts became fragmented .Freedom of association and right to collective bargaining;Elimination of forced or compulsory labour;Abolition of child labour;Elimination of discrimination in employment and occupation.In 1998, a year before launching the Decent Work Country Programme (DWCP) approach, the 86th International Labour Conference (ILC) launched the Declaration on Fundamental Principles and Rights at Work , which wThe eight ILO Fundamental Conventions concern the freedom of association, the effective recognition of the right to collective bargaining, forced labour, the abolition of forced labour, the effective abolition of child labour, the minimum age convention, equal remuneration, and the elimination of discrimination with respect to employment.By ratifying, the countries commit themselves to regulation and implementation in line with the Conventions. This commitment is supported by the ILO Follow-up procedure. The Member States that have not ratified one or more of the ILO Fundamental Conventions are asked each year to report on the status of the relevant rights and principles within their borders and to note any impediments to ratification and areas in which they may require assistance. These reports are reviewed by the Committee of Experts on the Application of Conventions and Recommendations (CEACR). Their observations in turn are considered by the ILO’s Governing Body.As a response to globalization, the ILO developed the Decent Work approach to provide a social dimension to globalization and to initiate an intensive human-oriented approach to the challenges posed by the globalization of working life. In February 1999, the Secretary General of the UN, Mr. Kofi Annan, in introducing the new UN concept of the Global Compact before the World Economic Forum , emphasito promote and implement the standards and fundamental principles and rights at work;to enhance opportunities for men and women to obtain decent employment and wages;to expand the scope and heighten the effectiveness of social protection for all;to strengthen tripartism and social dialogue.The ILO’s Decent Work Agenda promotes a development strategy that recognizes the central role of work in everyone′s life. The Organization provides support in the form of integrated Decent Work programmes developed at the country level with ILO′s constituents. These programmes set priorities and targets within national development frameworks and aim to tackle major Decent Work shortcomings through effective programmes that also meet each of ILO′s four strategic objectives:In addition, Mr. Somavia in his address to the 87th ILC recalled the issues inherent in the concept of Decent Work and outlined the future role of ILO: “The ILO is concerned with Decent Work. The goal is not just the creation of jobs, but the creation of jobs of acceptable quality. The quantity of employment cannot be divorced from its quality. All societies have a notion of Decent Work, but the quality of employment can mean many things. It could relate to different forms of work, and also to different conditions of work, as well as feelings of value and satisfaction. The need today is to devise social and economic systems which ensure basic security and employment while remaining capable of adaptation to rapidly changing circumstances in a highly competitive global market” .Later in 2008, the 97th Session of the ILC adopted the ILO Declaration on Social Justice for a Fair Globalization , which iSince 1999, the ILO has initiated large numbers of DWCPs, which have also been evaluated. The ILO Secretariat regularly reports on the development and implementation of the Decent Work programmes to the ILO Governing Body and the ILC, at which Member States of the ILO meet in June every year in Geneva, Switzerland. This ensures regular follow-up by the highest governance levels of the Organization.In the course of the globalization process, the relevance of and the need for the Decent Work Agenda have become even more important amid the widespread uncertainty in the world of work, from the financial turmoil and economic downturn of the last two decades to growing unemployment, informal employment, insufficient social protection, and labour migration. These have challenged governments and social partners—workers’ and employers’ organizations—to adopt the Declaration on Social Justice  to strengthen the ILO’s capacity to promote its Decent Work Agenda and forge an effective response to the growing challenges of globalization.Both the Decent Work Agenda and its implementation and, at the time, the UN Global Strategy with its Millennium Development Goals (MDGs) aim to eradicate extreme poverty and hunger through achieving full and productive employment and Decent Work for all, including women and young people (MDG Target 1b). This target highlights the fact that, despite progress, almost half of the world’s employed people are still working in vulnerable conditions, especially in Sub-Saharan Africa and Southern Asia. The MDGs succeeded in halving absolute poverty in the target period . In spitIn 2015, the UN launched the new Global Strategy, Transforming our world: the 2030 Agenda for Sustainable Development, which contains 17 Sustainable Development Goals (SDGs) with hundreds of targets and actions addressing people, planet, prosperity, peace, and partnership .The SDG strategy contains several goals, targets, and actions relevant to workers’ health and safety, particularly SDG No. 1 on the Elimination of poverty, SDG No. 3 on Health, and SDG No. 8 on the Promotion of inclusive and sustainable economic growth, full and productive employment and decent work for all. The ILO has been appointed the custodian of 13 different SDG indicators . The UN,The ILO launched the Decent Work concept in 1999, and the first DWCPs were begun in 2000 in the Philippines and the Ukraine. The DWCPs were intended to be well coordinated at the national level with other ILO and UN programmes on the development of working life, in order to make as effective use of scarce resources as possible. The DWCPs aimed at the distinct ILO contribution to UN country programmes and constituting one main instrument to better integrate regular budget and extra-budgetary technical cooperation . The ILOThere has been long-term, logical continuity in the drafting and development of the DWCPs and the coordination, implementation, and independent evaluation of the accomplishments of the programmes. In order to facilitate the preparation of the DWCPs, in 2015, the ILO published a guideline for country-level actors’ support . This guThe country diagnostics provide an overall national development framework with demographics and data related to education, health and human development, the structure and performance of the economy, aspects related to inequality, vulnerability, and poverty in the country, employment and the labour market, the labour force, fundamental principles and rights at work, the implementation of international labour standards, decent working conditions and occupational safety and health (OSH), equal opportunities and treatment in employment, and questions related to social protection and social dialogue, to help identify and recognize the main Decent Work challenges ahead.The logic of the DWCP process of the ILO is described in On the basis of the diagnostics of the country situation, the national stakeholders, in collaboration with ILO experts, will draft a DWCP document to be discussed and agreed on in the tripartite process of the country. The process also serves as a learning cycle for the development of Decent Work. Examples of the main contents of the DWCPs are poverty reduction through the creation of Decent Work opportunities with a focus on young men and women, the reduction of child labour and elimination of its worst forms, or more and better employment for vulnerable groups, and responding to HIV and AIDS challenges in the world of work. The selected priorities depend on the deficits recognized in the Decent Work diagnosis of the country .The DWCP process since the beginning of the DWCP implementation from 2000 to September 2019 is summarized by region in The actual situation in September 2019 shows that Africa has the highest number of ongoing DWCPs, followed by Asia. Africa’s activities are even more prominent if the number of countries and the size of the workforce are considered . A totalThe independent evaluations of the national DWCPs have been carried out at the sub-national, national, and regional levels, and the ILO has published the lessons learned to facilitate the further planning of new programmes. Evaluations have been carried out of both the individual country programmes and the regional programmes, such as those of the Arab Region , North Africa, the Caribbean, the Western Balkans, and Mekong Sub-region. These evaluations have identified success factors and needs for development and provided guidance for further actions .One of the fundamental principles of the ILO Constitution is the “protection of the worker against sickness, disease and injury arising out of his employment” . In adopIn 2003, the 91st ILC adopted the Conclusions of the Global Strategy on Occupational Safety and Health. These Conclusions confirmed OSH as key principles of Decent Work: “Decent Work must be safe work” . The ConIn addition to the DW policy principles, the ILO has also produced legal instruments for the implementation of Decent Work in occupational health practice. Already before the 87th ILC (and Convention No. 161), Recommendation No. 112 (R112) on Occupational Health Services from 1959 guided the Member States in the organization of occupational health services (OHS) for their workers. In 1985, the ILC adopted the Occupational Health Services Convention No. 161 (C161)  and the ILO’s Convention No. 187 on the Promotional Framework for Occupational Safety and Health  emphasizRecently, new evidence on the growing need for occupational health and OHS has accumulated. Globally, occupational diseases, occupational injuries, and work-related diseases (WRDs) are estimated to cause 2.8 million fatalities a year and over 300 million cases of non-fatal health outcomes that affect the health and work ability of workers, leading to a 4% loss of GDPs on average. Occupational injuries lead to 380,500 fatalities annually, whereas the mortality from WRDs is estimated at 2.41 million a year . The cosThe trend of WRDs is expected to grow as working populations are ageing and numerous vulnerable groups such as migrant and refugee workers, several types of workers with vulnerabilities, and workers with partial work ability are recruited into the workforce and the number of informal workers grows. For example, half of the one billion World Health Organization (WHO) Western Pacific Region’s (WPRO) workers are informal. The informal status of workers is the key determinant of the absence of health, safety, and workers’ rights at work. The informal workers work in high-risk jobs, are exposed to high numbers of chemical, physical, biological, and social hazards, and are most vulnerable, for example, to infectious epidemics ,28,29,30The SDGs aim among other things to eliminate poverty. In the long term, the only sustainable way out of poverty for countries, communities, families, and individuals is the gainful employment of working-age people. Successful employment needs job opportunities at the systems level and good employability at the individual level. A prerequisite for individual employability is good work ability , decent working conditions, and safety and health at work. The SDGs cannot be achieved without good health and work ability in working populations, as all the resources available for societies are derived from productive work. Some countries have included or are in the process of including the objectives of the development of occupational health, work ability, and OHS in their National Health 2030 strategies, thus harnessing occupational health for achieving the SDGs.Some countries have achieved reasonably good working conditions and work environments, as well as occupational health, although the majority of countries still face great challenges in meeting the international standards set out in the Occupational Health Services Convention, C161. All countries need to exert a great deal of effort to achieve the UN’s SDGs in the field of health, safety, and work ability of workers. The greatest challenges lie in the improvement of the occupational health and work ability of workers in micro- and small-scale enterprises, the self-employed, and workers in the informal sector, who comprise the majority of the world’s workforce. Today, the majority of the workers of the world are still severely underserved and vulnerable. The gradual extension of the coverage and content of comprehensive OHS, including prevention, protection, promotion of health and work ability, care, rehabilitation, compensation in cases of injuries, and services for return to work is needed for all workers. Workers not yet covered, such as those in agriculture, the informal sector, and the self-employed, have the most urgent need for these services ,27,30.(a)the reduction of economic loss by preventing the loss of work ability through accidents, diseases, presenteeism, disability, and sickness absenteeism and(b)increased productivity derived from better work ability, better motivation, and smoother flow of production .All occupational health and safety hazards can be prevented. Economics researchers have found the control of occupational accidents and diseases and the improvement of working conditions and occupational safety and health to be financially productive and profitable mainly through:The high coverage, comprehensive content, and good functioning of OHS have been positively associated with the human development index (HDI) of the United Nations Development Programme (UNDP), the competitiveness index (World Economic Forum) and GDP per capita of countries, and the success and sustainability of enterprises .Work does not produce only economic and material assets; participation in working life enables important social contacts, support from the work community, opportunities for vocational and professional development, and gives the individual a place and status in working organizations, institutions, living communities, and society at large.Work itself is an important determinant of workers’ health, providing potential enhancement of health and work ability in good jobs and adverse effects in poor working conditions. Workers’ health and work ability also have a crucial impact on the health of families. In many societies, labour participation is the prerequisite for registration in social security schemes, which for their part reduce the risk of poverty. Still today, job opportunities and employment conditions vary greatly between and within countries and between different groups of workers and have great inequities among working people ,32,33.th session in Geneva in June 2019, stated “Safe and healthy working conditions are fundamental to decent work” [OSH has been a central issue for the ILO ever since its creation in 1919 and continues to be a fundamental requirement for achieving the objectives of the Decent Work Agenda. In reaffirming this, the ILO Centenary Declaration for the Future of Work, adopted by the ILO Conference at its 108nt work” .Examination of the DWCPs have revealed that the contributions of occupational health and OHS have not been sufficiently utilized in national programmes. Even the total coverage of OHS in the world has remained low (18.5%). There may be several reasons for this, but the governance model of OHS is likely not the cause, as 73.5% of the respondent countries in International Commission on Occupational Health, ICOH’s OHS survey were governed by the ministry of labour alone or jointly by the ministry of labour and ministry of health .Globally, the majority of work-related loss of DALYs is estimated on the basis of WRDs and only about 11% on the basis of occupational injuries . The manIncluding the development of OHS in the DWCPs would provide a strong substantive and practical contribution to the implementation of the DWCPs and make OHS available for underserved sectors as shown in the needs and provisions analysis in The WHO Global Strategy on Occupational Health for All (1995) called for universal OHS  . The UniThe WHO Regional Office for the Western Pacific has supported the provision of UOHC in the Western Pacific Region ,40. The As stated by the ILO: “Decent Work is safe work” . WorkersThe globalization process has continued over centuries, but during the last 30 years, it has developed and modified working life more intensively and faster than ever before. It is characterized by growing global trade and the movement of capital, materials, services, and people .Globalization exposes all countries and enterprises to challenges and changes. Production structures will be radically modified; some branches of the economy will disappear; and new ones will appear. There will be changes in enterprise structures, their production methods, working practices, and work environments. Enterprises will need to adjust to several new trends; new work organizations, management systems, working contracts, working hours, OSH, and OHS. All of these mean that working life is expected to undergo major changes in terms of employment opportunities and requirements for competence, skills, and work ability ,44,45,46In spite of progress in OSH in developed economies, the global situation is still unsatisfactory, with 2.8 million fatalities from occupational accidents and diseases a year and a manifold number of non-fatal injuries and diseases (see above). Many of the negative impacts of globalization hit the low-income and low and middle-income countries the worst, but they also affect advanced economies. Digital disruption affects enterprise and institutional structures. Some sectors of traditional economies are dying out, and their workers and professionals are at risk of exclusion from working life. Many traditional jobs are disappearing, and new challenging ones being generated; labour markets are being polarized; and in spite of improving averages, the inequities and gaps between the richest and the poorest are at risk of growing even further. New competence demands require new types of training, and numerous jobs are disappearing virtually overnight in large geographical areas, requiring movement of working populations to seek new job opportunities . Downsizing, outsourcing, and offshoring in industries and services are leading to a new division of work between different countries and continents, which may affect the health and lives of working populations ,48,49. IWith the help of new information and communication technologies, international interactions are being facilitated through ever-growing global connectivity and communication, including social media. Many other technological advancements, the introduction of new substances and materials including nanotechnologies and new e-technologies, digitalization, automation, and robotization in particular, and the use of artificial intelligence and big data are becoming effectively distributed throughout the global world of work. Automation and robotization are expected to eliminate 30–50% of current jobs, but new jobs are also being generated with different competence demands. Earlier, only physical and manual human power was replaced by automation, but the new trend is also partially replacing human intelligence by artificial intelligence: for example, speech recognition, problem-solving, learning, and planning.The national and international division of work has changed due to technology transfer and the outsourcing, downsizing, and offshoring of industries and services. Global giant multinationals will dominate economic activities, exceeding the influence of national governments. Changes in production and in consumer markets will lead to a new division of work; some countries may become primarily producers of materials and producers of goods, others dealers of products only, and others only consumers with no large-scale production. This may result in occupational structures becoming one-sided and even more vulnerable to changes in global markets. National markets will mainly be transformed into global markets.Due to robotization and artificial intelligence, the human role in production has become more one of planning, designing, quality control and services, transport and commercial, and marketing activities. The production of goods and materials will become assigned to automatic systems and robots. Some new branches of the economy will be generated, such as environmental and green economies, new energy economies, and knowledge economies. All these will have an impact on job contents, competences, and work ability profiles. ,50,51,52Major changes have been observed in the demographic structures of the global workforce. Four of these macro trends are ,54,55:The ageing of the workforce in most countries: In both the developing and industrialized countries, this is a dominant trend. Both developing and advanced economies show a comparatively rapid increase in the average age of working populations, known as the global ageing epidemic. This raises numerous challenges: the maintenance of decent employment for ageing individuals, the maintenance and promotion of their competence and work ability, the provision of employment opportunities, social protection, and the prevention of age discrimination. Better use of the competences and experience of ageing workers is warranted.Youth: Some developing and emerging economies are facing challenges in the employment of younger age cohorts, which, particularly in Africa, has led to both internal  and international migration, particularly to Europe, but also elsewhere. The working conditions, OSH, training and education, fair remuneration, social protection, and overall life situation of young migrant workers is a huge international challenge.The feminization of the workforce: In various parts of the world, this is progressing, providing many advantages for female workers, formal jobs, legal and social protection, better income, and more independence. Simultaneously, several jobs may have health hazards, long working hours, several psychosocial risks, reproductive hazards, balance of work and family life, and lack of gender equality and sexual harassment, calling for special protection of female workers at work.Migrants, the handicapped, workers with partial work ability, and informal and domestic workers: These form a vulnerable group of workers and together constitute the majority of the global workforce. Their labour markets and social situation in global working life have not necessarily improved during the era of globalization, often in fact the opposite. International organizations, particularly the ILO, and non-governmental organizations (NGOs) have put great effort into the special protection of vulnerable groups of workers and made it a key element in Decent Work programmes.Global economies are characterized by increased uncertainty of work contracts and employment; sudden changes in employment opportunities due to outsourcing and transfers of industries to new areas; quick, high peaks of employment, which may then dramatically drop; casual and temporary working contracts; and in general, higher risks of unemployment and insecure jobs. Such insecurity together with associated high job demands ,56,57 anGood work ability and psychological and physical functional capacity are key prerequisites for successful and productive employment. In the wider sense of the term, the concept of work ability is multidimensional and complex and includes workers’ personal health, psychological, cognitive, and physical capacity, knowledge, skills, and competence, attitudes and motivation to work, and personal social networks (particularly family). However, good work ability and functional capacity also require a healthy and safe work environment, a conducive working community, a secure labour contract, and social protection. Just and fair management supports work ability, as does the availability of OHS with service modules for work ability ,61.In the course of the development of working life, the challenges related to the occupational health and work ability of workers are gaining more importance. This is due to the growing psycho-social demands of work, the need to address the work ability problems of ageing workers, support and protection of the health of vulnerable groups, and consideration of the numerous health needs of migrant workers and other vulnerable groups. Maintaining and promoting the work ability of all working people requires decent working conditions, a safe and healthy work environment, physiologically and psychologically sound working time schedules, and limits of maximum working hours. This all requires well-functioning OHS for all working people in all types of jobs and enterprises and all modes of working contracts and employment models, i.e., UOHC.The SDGs, particularly SDG 8, Decent Work for All, constitute a global response to the challenges of globalization by all sectors of societies and all regions of the world ,20,46.OSH and labour inspection  have been relatively well introduced as elements of Decent Work and are even further emphasized by Goal No. 8 of the UN Strategy on Sustainable Development, the ILO Global Commission, and the ILO Centenary Declaration . In spitEach year, the ILO’s Evaluation Office holds consultations with senior management, the Evaluation Advisory Committee, and constituents to select topics for future high-level evaluations. The selected topics are then presented to the Governing Body (GB) for approval .A total of 53 programmes of 121 DWCPs have so far been evaluated by external evaluators, as either regional or subregional or individual country evaluations using pre-set criteria ,63,64,65Relevance to the ILO DW agenda, DW/CPO, and country needsDesign, coherence, and validityEffectivenessEfficiencyImpactSustainabilityThe following parameters were standardized for all DWCP evaluations:Data from national DWCP reports were used in regional and sub-regional analyses. Evaluation projects during the period 2006–2018 are presented in The Caribbean region, with twenty countries of diverse sizes, varying from 5900 to three million citizens, is home for a total of approximately 60 million people. It has a young population structure (60% below 30) and is multi-ethnic and multi-lingual, mainly English-, French-, and Dutch-speaking, and its population is highly literate and well-educated.The Caribbean economies are mainly based on agriculture, sugar, and spices and related rum distillation, but are complemented to a growing extent by light industries, electronics, textiles, handicrafts, and tourism. Some countries also have a notable mining industry. Half of the countries belong to the UNEP high human development group and the other half to the medium group. Informal employment is common, making workers vulnerable because of their lack of legal and social protection. The region shows high unemployment rates among youth and women. Increasing migration of female workers and highly educated people in particular to Northern America and partly to Europe is a growing concern. Common natural disasters, tropical storms, floods, earthquakes, and volcanic eruptions are also a major concern.On the basis of high-level political commitments by ministers of labour and other high-level government representatives, and employers’ and workers’ organizations of the English- and Dutch-speaking Caribbean, the DWCPs were launched for 2010–2015 in their respective countries. In collaboration with the ILO, DWCPs have been developed in the Bahamas, Barbados, Belize, Guyana, Suriname, and the member countries of the Organization of Eastern Caribbean States (OECS), comprising the Leeward Islands: Antigua and Barbuda, St. Kitts and Nevis, Montserrat, Anguilla, and the British Virgin Islands, and the Windward Islands: Dominica, St. Lucia, St. Vincent, the Grenadines and Grenada, Martinique, and Guadeloupe. The ILO has also provided technical support to Jamaica and Trinidad and Tobago, where no formalized DWCPs have been launched.The DWCPs were designed to enhance the ratification and reporting of ILO Conventions in order to strengthen tripartism and social dialogue, upgrade legislation, advance OSH policies, tackle discrimination on the basis of HIV/AIDS patients, and eliminate child labour. Through the programmes, measures for equalizing working conditions and formalizing the status of informal workers were developed, as well as for integrating workers with disabilities. Administrative capacities in public sector agencies and judicial capacity in the legal system were strengthened. Other inputs were the promotion of vocational training and education and the enhancement of productivity, competitiveness, employment, and trade.According to the high-level evaluation, the sub-regional and national DW programmes were relevant, particularly in addressing youth employment, child labour, OSH, and HIV/AIDS. The evaluation team rated the overall performance of ILO’s DWCPs, strategies, and actions by triangulating the information and data gathered through desk reviews, surveys, and interviews of staff and constituents, as shown in the overall assessment graph in As a part of the ILO Asia Region, the subregion of the Lower Mekong countries, Cambodia, the Lao People’s Democratic Republic, Thailand, Viet Nam, and Myanmar, constitutes a relatively homogenous and closely collaborating area and one of the most rapidly developing areas in the world. The total population of the sub-region is 241 million and the workforce 130 million. Four of the Lower Mekong sub-region countries were subjected to external high-level DWCP evaluation. Myanmar has not been evaluated yet, due to the short history of DWP in the country. According to ILO reports, the countries are simultaneously experiencing several new challenges due to globalization, climate change, environmental disasters, and several traditional working life problems such as occupational injuries and diseases, hazardous physical, chemical and biological exposures, long working hours, inequalities, and psychological stress. To facilitate the positive development of working life, the ILO initiated and obtained the Lower Mekong countries’ commitment to the Decent Work Decade 2006–2015, focusing on five priority objectives: (a) sustainable productivity, (b) the youth employment challenge, (c) protecting migrant workers, (d) labour market governance, and e) local development for Decent Work. As in all DWCP evaluations, ILO-guided parameters were standardized and used in the evaluation .The overall assessment on the basis of the regional evaluation is presented in In the second decade of the new millennium, working life in the Western Balkan countries of Albania, Bosnia Herzegovina, Croatia, Montenegro, North Macedonia (previously the Former Yugoslav Republic of Macedonia (FYROM)), and Serbia was exposed to several simultaneous pressures: continuing policy and structural adjustment after the socio-economic transition to market economies, the post transition economic recession followed by the 2008 global financial and economic crisis, preparation for the European Union (EU) accession, and the universal pressures of globalization. Despite the efforts of the ILO and others, the post-crisis recovery in the sub-region was considered weak due to three main problems that continued to exist after the transition and the financial crises: persistently weak economic growth, high unemployment, and weak social dialogue. In spite of these challenges, today, all the Western Balkan countries are considered upper middle-income countries according to the World Bank ranking .The Western Balkan countries committed themselves to the DWCP process at different paces: Albania and Bosnia and Herzegovina developed the first generation of DWCPs between 2006 and 2007. The second generation of DWCPs was implemented between 2008 and 2011 in Albania, Bosnia and Herzegovina, Serbia, and at that time, FYROM. From 2012 onward, the third generation of DWCPs was developed in Albania and Bosnia and Herzegovina. Within the framework of the DWCPs, all five countries continued to ratify ILO conventions, which further contributed to improvements of labour or labour-related national legislation.(1)Rights at work: e.g., training and education in the protection of workers’ fundamental rights, introduction of models for peaceful settlements of labour disputes, promotion of gender equality at work.(2)Employment creation and enterprise development: e.g., introduction of models for employment policies and their implementation, development of employment services, local employment development, enhancement of vocational training, promotion of entrepreneurship and SMEs, and the development of labour markets, including markets for vulnerable groups.(3)Social protection: e.g., support of national OSH systems and policies and capacity building of national labour inspections, OSH training of labour inspectors and even doctors, assistance in ratification, implementation of international labour standards, advice on the development of social security, social security, and pension reforms, and capacity building.(4)Social dialogue: e.g., legal advice on and technical assistance for national social dialogue mechanisms and capacity building of social partners.Taking into consideration the whole subregion, the inputs of the DWCPs were directed, in addition to the objectives of the ILO DWCP guidebook, also to recognized national needs. As a whole, the Western Balkans’ sub-regional activities covered all the four pillars of the Decent Work Agenda well, but the programme contents differed between the countries, reflecting their specific needs. Examples of activities of the different Decent Work Pillars were:The overall performance assessment results of the evaluation are shown in The Southern African Development Community (SADC) is well endowed with human and natural resources. Given its economic potential, the SADC is one of the most promising developing regions of the world. The economies of the SADC Member States are at different stages of development, and as a result, the state of industry varies widely throughout the region. In many Member States, agriculture plays a major role in the economy, employing almost half of the total population of the region. Mining employs just 5% of the population, but contributes 60% to the foreign exchange earnings and 10% of gross domestic product for the SADC region. Tourism is growing rapidly, employing about 11% of the workforce and contributing over 12% to GDP.The countries of the region are diverse in their degree of development and living and working conditions. In spite of positive perspectives, the region still faces several challenges, including high levels of poverty (majority of people) and inequality, high unemployment (ranging from 4.5% to 80%) and underemployment, labour migration, and neglect of the application of law and international standards. Other challenges are low productivity and the low coverage of social security among the majority of men and women, youth, and children. For example, in South Africa, HIV/AIDS among the working-age population is high, at 12.5%.The four countries selected for evaluation had different economic and human development indicators: Lesotho and South Africa both have middle-income status in the World Bank ranking, and HDIs of 0.518 (low) and 0.705 (medium), respectively. Madagascar and Tanzania still belong to the low-income group with low HDIs of 0.521 and 0.528, respectively .The regional DWP had the following objectives and expected outcomes:Priority 1. Regional and technical work: The priority areas had the following objectives: (a) harmonization and strengthening of functional SADC labour market information systems (LMIS), (b) development of labour migration system, and (c) elimination of human traffickingPriority 2. Promotional work: (a) Ratification, domestication, and compliance of and compliance with International labour standards, (b) promotion of youth employment strategy, (c) compliance with SADC codes , and (d) promotion of Decent Work in the informal economy in SADC Member States.Priority 3. Information sharing: (a) improving knowledge of best practices in employment and labour policies, legislation, programmes, and social protection floors among Member States and (b) harmonization and development of skills development policies.The inputs of the DWCPs in the four countries varied widely.Lesotho: (a) employment creation for poverty reduction, (b) improvement of social protection coverage, and (c) development of tripartism and social dialogue.Madagascar: The DWCP set out two priorities: (a) to promote access of vulnerable groups to employment by enhancing their employability and boosting employment generating sectors; and (b) to improve labour productivity by promoting social dialogue, fundamental principles and rights at work, as well as social protection.Tanzania: (a) extension of social protection coverage for all; (b) promotion of the creation of productive employment; (c) improvement of compliance with labour standards and rights at work; (d) strengthening of social dialogue mechanisms at national and sectoral levels.South Africa: (a) strengthening of fundamental principles and rights at work; (b) promotion of employment creation; (c) strengthening and broadening of social protection coverage to include vulnerable workers operating in the informal economy and informal employment; (d) strengthening of tripartism and social dialogue.The overall assessment results of the SADC countries’ evaluation are presented in The DWCP content, implementation, and actions varied between the countries, due to differences in the diagnosed country needs, national and regional circumstances, and available resources. Large numbers of region-, country-, and substance-specific conclusions and recommendations for the future development of the DWCPs were made. Some overall conclusions can also be drawn from the evaluation reports by using the ILO DWCP evaluation criteria.The relevance of the Regional and National DWCPs was found to be high, due to the national needs identification diagnosis and participatory principle applied with all constituents’ partners. The ability of the national stakeholders to participate, however, varied widely depending on the national circumstances and resources. The DWCPs were also well synchronized with the other programmes of the UN (MDGs and SDGs) and the programmes of NGOs working for related objectives.The programme design and coherence were ensured through effective and skilful guidance provided by the ILO, based on the ILO Decent Work Agenda, DWCP Guidebook, and guidelines and diagnostic methods prepared for regional and country levels.Where critical conditions for full participation were met, the effectiveness and efficiency were good. In countries with lower interest or capacities for participation, capacities of institutions, national ownership of programmes, and availability of human and financial resources, the need for further development and strengthening of these resources was identified.The impact of DWCPs in most countries was good, due to enhanced awareness of Decent Work and transfer of the DWCP objectives to national strategies.The implementation was critically dependent on national circumstances, on political support, participation culture by stakeholders, on institutional capacities, and on human and financial resources, which in many countries need strengthening.The 2019 ILO Report, Time to Act for SDG 8, urges policy-makers around the world to help speed up progress towards SDG 8 and the implementation of the 2030 Agenda as a whole . AccordiOn the basis of experiences gained and the independent external evaluations performed so far, the following conclusions can be drawn:Globalization shows both positive and negative impacts on the occupational health of working people. These are not distributed equally between the countries with different degrees of development.Workers’ health and work ability and healthy and safe workplaces are factors in productive employment, sustainable economies, and overall socioeconomic development. Globalization challenges all these aspects and calls for proactive occupational health policies and actions.The global analysis of health, safety, and economic burden of occupational and work-related diseases and injuries has been estimated to be at a level of 2.8 million fatalities. The majority (about 89%) of the total burden is attributed to WRDs, and about eleven percent to occupational injuries. The economic loss from such hazards amounts to 4% of GDPs on average. Recently, ILO has predicted a global loss of 25 million jobs by the COVID-19 pandemic.International surveys have shown low coverage of occupational health services (OHS) in the world . OHS are the key partner for the prevention and management of hazards for health and work ability at work and for the promotion of health and work ability. ILO C161 on Occupational Health Services aims to provide OHS for all workers.The COVID-19 pandemic has changed dramatically the perspectives for Decent Work and simultaneously demonstrated the critical value of health and safety, as well as of universal occupational health coverage in the management of the global crisis.The Decent Work Agenda of the ILO was established to equalize the impact of globalization on employment, workers’ rights, conditions of work, OSH, social protection, and social dialogue.In 2000–2019, the ILO launched a total of 121 DWCPs, i.e., in two-thirds of the 187 ILO Member States. So far, 53 DWCPs have been subjected to external evaluation, either as individual country evaluations or as a part of regional evaluations, and were deemed well guided, well documented, and well implemented.The contents of the DWCPs have been drawn up on the basis of the ILO Decent Work Agenda and the diagnosis of countries’ Decent Work needs and deficits, identified with the help of the Decent Work indicators. Thus, the programmes may differ between countries or the weight of the different Decent Work Pillars may vary between the DWCPs.The rapid changes in working life and working conditions and the parallel major demographic trends  mean that OHS must be given more emphasis. For this, the promotion, ratification, and implementation of ILO C161 on Occupational Health Services should be enhanced, aiming for universal occupational health coverage of all workers. The Basic Occupational Health Service approach (BOHS) can serve as an instrument for the implementation of UOHC.In the DWCPs, accidents and safety have been well addressed, but the health dimension and the work-related diseases, WRDs, except for HIV-AIDS at the workplace, are almost non-existent. There is a need to more firmly address the prevention and management of WRDs in DWCPs and ILO policies in general.The Decent Work concept has been deemed timely and feasible at the country level and has been widely adopted by the countries. The DWCPs are effectively guided by the ILO and designed to respond to countries’ needs . They are implemented through national authorities and actors, with technical support from the ILO. The external evaluations collected data on the implementation and country experiences and provided guidance for the further development of the DWCPs.Although effective legal and technical tools, methodologies, and measures to prevent occupational accidents and diseases exist, there is a need for increased general awareness of the importance of OSH and OHS. High-level political commitment is needed for the development of national OSH systems and their effective implementation, including the development of OHS in particular.The ILO Decent Work concept has been adopted as the key content of SDG 8 of the UN 2030 Strategy. The ILO has been assigned as a custodian of 13 SDG 8 targets in the UN Strategy. Thus, the Decent Work Agenda contributes substantially to the implementation of the UN 2030 Strategy, but needs to strengthen the implementation and particularly occupational health dimension. Through the UN SDGs and the Global Commission on the Future of Work Report, the ILO Decent Work Agenda will have a bright future at least up to 2030 and possibly beyond. This brightness is seriously shadowed by the current COVID-19 pandemic. One of the key 2030 objectives should be the UOHC of all working people of the world. This need is even more emphasized by the rapid spread of the COVID-19 pandemic, which demonstrates the unmeasurable value of occupational health and work ability of workers as a critical factor for the maintenance of the whole social fabric, health of the population, national and global economies, employment, and the overall functioning of the national, international, and global systems.Decent Work is a unique social innovation with global coverage. The ILO has promoted and implemented it with its constituents for two decades, respecting the consistency and continuity of the ILO Decent Work Agenda. Over 120 countries have joined the ILO for implementation of the DWCPs and succeeded in integrating the DWCPs into national economic, employment, and social policies and programmes. Occupational safety and health have been included in part of, but not in all DWCPs. The external evaluations found the implementation of DWCPs on average good, but variation was wide. The external evaluation results have been used for continuous learning and improvement by all stakeholders. This has generated opportunities to achieve system-wide impact on the work life of the countries.The sustainability of the ILO Decent Work policy was ensured through the UN 2030 Agenda, the ILO Global Commission Report on the Future of Work, and the ILO Centenary Declaration. The priority given to occupational safety and health in the DWCPs needs, however, enhancement, and the position of occupational health services needs it even more. In view of the evidence on the global burden of work-related diseases the strengthening of the occupational health approach and expansion of the coverage of occupational health services are justified according to the lines of the UN Resolution on Universal Health Coverage, including the call for Universal Occupational Health Coverage (UOHC) and the provisions of the ILO Convention No. 161. The recent pandemic emergencies further emphasize the important role of occupational health.


This research aims at exploring and recognizing the effectiveness of implementing a community-based safety plan on reducing the occurrence of road accidents in the city of Zarand.The research method is descriptive method with analytical approach. To analyze the obtained statistical data, descriptive and inferential statistics were used. For field surveys, a questionnaire was used and for analyzing the data obtained from the questionnaire, the inferential statistics such as Friedman and Measurement tests were used. A paired T-test was used to test the significance of the hypotheses.The research showed the positive effect of the implementation of safe community plan on the reduction of accidents. The main cause of the accidents was human factors, including unauthorized speed and overtaking, left-leaning and rushing. After that, the quality and technical issues of the road have been identified, and according to the interviewees, the main cause of accidents is identified as hazardous route bends, especially in rural areas, poor quality paths and inappropriate signs. The technical and qualitative factors of the car are in the third place and, finally, the environmental and natural factors are the fourth. Also, hypotheses related to the role of the implementation of the safe community plan in reducing mortality, car accidents and pedestrian accidents were confirmed. It was also found that the role of human factors was reduced by implementing strategies such as training and changing the behavior of people, the quality of roads and technical issues. Safe society, Accidents, Human factors, Environmental factors, Road factors, Zarand City


The GSA COVID-19 Task Force developed multiple materials to assist older adults, those who care for them, and policy makers in understanding a variety of topics, including aging and immunity, ageism, the process of developing a vaccine, and how to social distance. Members of the group also undertook development of a decision aid on whether to engage in activities outside the home. The process of developing the decision aid according to Ottawa Research Institute guidelines will be explained.


The present study aimed to propose a model for the national hemovigilance information system with a database approach, considering the importance and necessity of developing an information system for such a network.This is an applied, descriptive, and cross-sectional study, which was conducted in 2018. The research population comprised hemovigilance information systems in advanced countries, including the USA, UK, Australia, and France. Data were collected from library sources and the Internet from 2000 to 2018. The proposed model for the national hemovigilance information system was introduced using comparative tables and based on the similarities and differences of systems in the studied countries. The proposed model was then validated using the two-step Delphi technique through a researcher-made questionnaire whose validity was confirmed, and reliability was approved by a Cronbach’s alpha of 94%.The final model of the national hemovigilance information system comprised five main components: goals, organizations involved in the blood transfusion process, databases of blood transfusion organizations, data transfer flow between the databases of blood transfusion organizations, and transferable datasets, and hemovigilance-related committees. This model was approved by experts with an >85% agreement coefficient.The national hemovigilance information system with a database approach can improve blood transfusion health by providing access to reliable sources on blood transfusion complications to everyone, especially the medical community. Thus, it is essential to implement this standard accurately and precisely control the practical methods of this process based on international guidelines. Blood transfusion is the primary concern for medicine. The advancement in the knowledge and awareness on this topic paves the way for the prevention of diseases and the improvement of the treatment process . In the The process of blood transfusion comprises various clinical and laboratory services; therefore, all the steps in this process must be followed with precision, efficiency, and reliability in order to prevent unwanted complications . Blood tA hemovigilance system is a tool for quality improvement in the blood transfusion process, mainly focusing on safety ,7. This The World Health Organization published in 2007 the standards on the blood transfusion process. Based on this report, the global database on blood safety, 42 countries have implemented national hemovigilance systems under different titles, e.g., the Haemovigilance Advisory Committee (HAC) in Australia in 2008 , the FreAs Iran is a member of the International Haemovigilance Network, due to the importance of designing such an information system for this network, and since no comprehensive study has been conducted  on a natThe present applied, descriptive, and cross-sectional study was conducted in the following three steps:1.Review of the literatureIn this step, the required data were collected based on a review of the literature on a hemovigilance information system and its main components in different countries, including the US, UK, Australia, and France, in Ovid, Scopus, PubMed, ScienceDirect, and Google Scholar databases from 2000 to 2018 using the following keywords: National Hemovigillance System, Hemovigilance System, Hemovigilance Network, Hemovigilance Information System, and Transfusion blood system.2.Developing a model for hemovigilance information system in IranIn this step, organizations in charge of blood transfusion and hemovigilance system in Iran were identified, and their work process was examined. Afterward, based on the results of the literature review and the organization and structure of the Iranian Blood Transfusion Organization (IBTO), a model for the national hemovigilance information system was developed.3.Model validationValidation was performed using the Delphi technique in two steps. First, a researcher-made questionnaire, including the demographic information of system users and the model of axes, was developed. The questionnaire was given to six experts , and their opinions were sought to check the validity. Moreover, Cronbach’s alpha was calculated to determine the reliability of the questionnaire, which equaled 94%. As the value was above 0.7, the questionnaire was found to have high reliability. Then, the final model was given to 13 hematology experts at medical universities in Tehran, as well as the IBTO. Expert opinions on the main components of this model were collected, and the agreement coefficient of 75% was set as the criterion for model acceptance. Next, expert opinions were applied to the proposed model. In the second step of the Delphi technique, an expert panel with six hematology and health information management experts was formed in order to finalize the proposed model. Descriptive statistics were used to analyze the data on the final model confirmation.The review of the literature revealed that the goal shared by all countries with hemovigilance networks or systems included monitoring transfusion-related complications and reactions and enhancing quality and patient safety by improving the reporting system. Accordingly, the most important components of the hemovigilance information system were determined to be the definition and specifications of organizations involving in the hemovigilance system, databases, and data transfer flow in each database of the noted organizations.The proposed model for the national hemovigilance information system with a database approach in Iran comprised five main components:1.Goals of the national hemovigilance information system2.Organizations involved in the blood transfusion process3.Databases of blood transfusion organizations4.Data transfer flow and transferable datasets5.Hemovigilance-related committeesMajor organizations involved in the blood transfusion process included blood donation and transfusion centers, blood transfusion organizations in provinces, the IBTO, and the Ministry of Health and Medical Education (MoHME).Data transfer in the process of blood transfusion has been planned at the city, province, and national levels. There are centers for donating and receiving blood at the city level, including blood transfusion organizations at the province level, blood donation centers, and mobile centers for blood donation. The data transfer process was designed as follows: after blood donation, in case of any complications in the donor, this event is immediately reported to the hemovigilance committees at the province level in the blood transfusion organization. Centers receiving blood donation include hospitals and clinics for special diseases  in which blood is transfused. In hospitals, complications are immediately reported to the hemovigilance chief physician. Using the national hemovigilance information system, a set of data elements  is recorMoreover, a hemovigilance committee is formed in hospitals. If the complication turns out to be related to the transfusion process, this problem is reported to the hemovigilance committee at the province level.Based on organizations and activities related to the blood transfusion process, hemovigilance committees are formed at different levels consist of hospital, provenance, and national level committees.Findings of model validation indicated that all major axes were completely accepted by experts. However, there were some disagreements on several sub-criteria of the major axes. In cases where the agreement coefficient was <75%, those criteria were removed. Furthermore, some sub-criteria were suggested for addition. These suggestions were discussed by experts in the second step of the Delphi technique. The results are presented below.The suggested goals for the national hemovigilance information system, including policy-making and better allocation of financial resources, health planning for blood donors and recipients, evidence-based care planning, monitoring of blood and blood product supply chain, preparing statistical reports on transfusion-related unwanted events, blood processing and transfusion, and measures for preventing complications were agreed upon by all experts (100%).The formation of hemovigilance committees at the city, province, and national level was agreed by all experts. Also, all experts agreed with sending the data online .Findings in this table show that the IBTO, Health Vice-Chancellorship of the MoHME, hospitals, blood and blood product research centers, Iranian Society of Medical Oncology and Hematology, Iranian Scientific Association of Pediatric Hematology & Oncology, Iranian Blood Transfusion Association, and Iranian Laboratory Hematology Association were approved by experts (100%). Nevertheless, the Food and Drug Vice-Chancellorship of the MoHME, Iranian Society of Pathology, Iranian Pediatric Hematology & Oncology Society, and Iranian Scientific Association of Clinical Laboratory were eliminated as they scored below 75% .It is evident that that, except for the head of the information management unit, the operating room supervisor, and a representative from the financial affairs unit, the other members were approved by experts (<92%). Therefore, the remaining sub-criteria were eliminated from the final model. It was also suggested that the following be added to the hospital committee: educational supervisor, head of quality improvement unit, patient safety contact, hemovigilance nurse, treatment deputy, and legal medicine expert.Also, findings show that all members were approved by scores of >84%. It was also suggested that the following should be added to province-level committees: patient safety intermediary, hemovigilance chief nurse, a representative of the province-level laboratory affairs unit, and medical associations  .Based on In the second step of the Delphi technique, the proposed model was finalized, and all experts completely agreed (100%) with the suggestions added to the model .The goal shared by all countries with hemovigilance networks or systems is monitoring transfusion-related complications and reactions and enhancing the quality and patient safety by improving the reporting system. Accordingly, the proposed model for the national hemovigilance information system with a database approach in Iran comprised the five components of goals, organizations involved in the blood transfusion process and their databases, data transfer flow, transferable datasets, and hemovigilance-related committees. Organizations participating in this system included the IBTO, Health Vice-Chancellorship of the MoHME, hospitals, blood and blood product research centers, Iranian Society of Medical Oncology and Hematology, Iranian Scientific Association of Pediatric Hematology & Oncology, Iranian Blood Transfusion Association, and Iranian Laboratory Hematology Association. Similarly, the Australian National Blood Authority cooperates with organizations and committees such as the Peripheral blood mononuclear-stem cell (PBMSC) monitoring committee, the National Immunoglobulin Governance Advisory Committee (NIGAC) and the Australian Haemophilia Centre Directors’ Organisation (AHCDO). Associations cooperating with this system include the Australian Association of Pathology Practices (AAPP), Australia and New Zealand Society of Blood Transfusion (ANZSBT), and Australian Private Hospitals Associations (APHA). It is noteworthy that the Food and Drug Administration (FDA) in the US  and the In the study conducted by Ganz and Wu , the 201In the present study, the following data elements were included: patients’ demographic characteristics, healthcare events and side-events, the intensity of outcome, blood transfusion measures, the examination of results, type of product, transfused volume and time interval since the onset of transfusion until the event, patient’s clinical condition at the onset of transfusion and during the event, ability to trace each part of the transfusion process, examining whether complications are due to transfusion, and the responsibilities of the hemovigilance chief physician.Similarly, the study by Hillis et al.  confirmeMoreover, in the present study, reports are daily and electronically sent, and the method of reporting is based on pre-determined reporting formats  at different levels  based on the information needs of stakeholders. Similarly, in the study by Sandid et al.  and LianInformation is distributed and published using websites, software programs, fax, and automation in the proposed model for the hemovigilance information system in the present study. Consistent with the study by Vanagas et al. , the infThe national hemovigilance information system with a database approach can improve blood transfusion health by providing access to reliable sources on blood transfusion complications to everyone, especially the medical community. Thus, it is essential to accurately implement this standard and precisely control the practical methods of this process based on international guidelines.The authors declare that there is no conflict of interest.


The mission of the majority of dental colleges around the world is to provide the high level of education and facilities to learn about the upstream factors that affect the health outcomes, such as personal behaviors, health care quality and access, social, cultural, economic factors, and to graduate dentists with the ability and desire to improve the health of all people by alleviating suffering and eliminating healthcare disparities through their leadership in patient care, research, education, health care administration, and the community , 2.To achieve these missions appropriately, such authorities as to the ministry of health, ministry of higher education, accreditation bodies, etc. which are responsible for supervision and accreditation of dental colleges must have strict rules and regulations for establishment of the new colleges.Unfortunately, in most developing countries such as Iraq, many conflicts of interest exist . These cThe tremendous increase in establishing new private colleges in the same province in Iraq threaten the quality of education mainly due to severe shortage in teaching staff. This, in turn, leads to graduation of unqualified dentists and low-quality oral health care services , 6. Thus


The objective was to identify the presence of the capacity for reflexive-critical thinking or similar, in Nursing Curricula in Iberian America.Strategies to develop reflective and critical thinking in nursing students:Iberian America situation. To achieve this, a descriptive and exploratory research was conducted with qualitative approach. An instrument created for this project was used, along with some guiding questions to focus the information..The article gathers the results of one of the objectives of the macro-project developed by the Iberian American Network on Nursing Education Research, titled Eight countries participated , which contributed information from 189 curricular plans. The R&CT was found in the majority of the curricula, although with diverse denominations. The principal learning strategies used were problem-based learning, group dynamics, reflective reading, clinical practice, and simulation laboratories. The evaluation methods used are the knowledge test, case analysis, and practical exam.Significant stress exists in the discourse and curricular organization. Incongruences were found and a clear inclination toward the formation of professionals with broad technical skills under a traditional, memory, banking and knowledge accumulation education. Currently, the nursing professional’s formation must respond in efficient, integral, timely, assertive, and humanistic manner to the demands required by caring for life and maintenance and reestablishment of human health. This is not an easy task, given that the formal care provided by this professional implies the dynamic of growing changes in the designs and current university methodologies, claim with it the implementation of an integrating vision and transversal of the contents, to deploy effectively the elements necessary to manage to strengthen the skills needed by a graduate from a professional nursing program.., recommend que las higher education institutions (HEI) in Iberian America que offer higher education in Nursing (undergraduate and graduate), form and contribute an interpretative vision in nursing professionals, through an academic curriculum that goes beyond teaching the diverse functions -granting, education, investigation, management, and administration, among others - that will take place around formal or professional nursing care, developing innovative skills. One of t.,3Thinking reflectively and critically permits knowing and discriminating one action from another, in function of priorities established to care for the person, interacting with them in emancipatory manner, where forms or bridges of union must be sought between the most artistic part of nursing and those elements more associated with the field of science, thus, achieving higher quality when providing care. The deveThe critical thinking capacity describes an integral or holistic behavior and it is expected that its promotion and development be cross-sectional, that is, that during each period and in each assignment or unit of learning it is taught by the professor and learnt by the students, as an individual skill, with interpersonal connotations, related with other skills, like analysis and synthesis capacity, critical and self-critical capacity, management of information, decision making, and problem resolution.Since the 1990s, in different national and international institutional documents, the need was established to develop the capacity for R&CT of the nursing staff during their formation and during exercise of their work practice. The scientific literature related with this study object also confirms the importance of developing said capacity.,8 Nevertrd Network Meeting in September 2011, in Coimbra, Portugal, within the framework of the 11th Iberian American Conference on Nursing Education, organized by the ALADEFE. This article describes the presence of the R&CT capacity in curricula of higher level or degree in nursing of educational institutions in Iberian America, as well as the educational approaches, teaching, learning, and evaluation strategies registered in each academic program analyzed.The Iberian American Network on Nursing Education Research  identified as one of its research priorities the “Development of Reflective and Critical Thinking in Nursing Students”, a preference backed by the participation of over 80 nurses from Iberian American countries who attended the 3More frequently, the characteristics that distinguish nursing professionals are cognitive abilities over psychomotor skills that, historically, have been over-dimensioned in the academic curriculum. Reflection and reflective practice are very familiar terms, currently, within the setting of the nursing practice. These are meanings that can generate a broad spectrum of sensations and reactions: from more enthusiastic adhesion to ambiguity and skepticism. In recent decades, ideas related with reflection and the reflective practice have been incorporated in initial and continuous formation programs in the context in which is conducted the research study by the RIIEE.The evolution of nursing degree curricula has crossed continental borders and has homogenized the objectives and las philosophical lines that inspire different curricula aimed, in these moments, at formation through skills, among which are highlighted as vertebral axis of the formation the capacity for critical thinking. This has permitted, saving the cultural, economic, and socioeconomic diversity of the different regions, to undertake an interuniversity and international study of the educational dimensions presented by this research. Given thThis research has considered the paradigmatic visions or positioning of the authors already mentioned, from which was constructed the integrating notion of R&CT by the RIIEE, which alludes to a “Process of complex, systematic, dialogical and deliberate, self-directed and action-oriented reasoning, whose primary purpose is to choose, based on intellectual and affective processes , the best response options that favor nursing problem solving in well-defined contexts and according with the ethical postulates of the profession”. This conThe objective of this study was to identify the R&CT presence or similar , in the different Nursing curricula of higher education institutions in Iberian America.study universe, these were nursing curricula of Iberian America and the study population the nursing curricula from universities that offer the career in Nursing in the regions comprising the RIIEE, independent of their being public or private. A population was chosen through convenience, taking into account the complexity and diversity that exists in a study of these dimensions and areas of influence, as shown in This research was carried out with the participation from research groups from Bolivia, Brazil, Colombia, Ecuador, Spain, Peru, Mexico, and Venezuela. It is an exploratory, descriptive study with mixed approach. This article privileges the presentation of qualitative results. Although the project has a common methodological framework, consensual adaptations have been made, in function of the context in which it has been applied, according to the exploratory methodology adopted, to obtain results more in keeping with the reality in each region and assuming the characteristics and limitations of each context. Regarding the The inclusion criteria were the curricula that had in their academic plan some assignments that included the R&CT capacity or similar words considered synonymous for this study, such as critical thinking, reflexive thinking, analysis and synthesis, critical and self-critical capacity, information management, decision making, problem resolution, among others; the curricula had to of public access or that when required from the respective academic instances, such would be provided.The study categories or nuclei were: (i) presence of the R&CT capacity or similar in the curriculum; (ii) teaching and learning methodologies and strategies suggested in the curricula to develop and promote the R&CT capacity or similar; (iii) forms of evaluations suggested in the nursing curricula linked to achieving the R&CT capacity; and (iv) coherence between the R&CT capacity and the educational methodology used in teaching, learning, and assessment processes. Upon identifying the R&CT presence in the curricula, the study proceeded to review the areas of knowledge or areas of development of the academic offer, which were classified into biomed, public health, nursing, research, and electives.To collect the data, a document was constructed, which in the first instance permitted identifying the type of institution, dependence, and country; thereafter, it was possible to gather elements to characterize R&CT within the curricula, through data related with the presence and denomination of this capacity, where, through consideration of the research team, terms were accepted, like analysis and synthesis, problem resolution, decision making, information management, or critical and self-critical capacity, given that they are all related with this type of thinking. Data was also gathered about the assignments, areas of knowledge, teaching-learning methodologies, and evaluation activities, with these elements being necessary to complement the characterization of the development and positioning of R&CT within the curricula. Lastly, to guide filling out the document, 10 guiding questions were elaborated, which permitted obtaining information on the educational approaches and the curricular theory that support the development of R&CT in nursing education institutions in Iberian America that participated in the research.The empirical or field phase filled out 189 data-collection documents. The results were first grouped into the four regions that participated in the research: Andean, Brazil, Mexico, and Europe, resulting from it a regional analysis to, finally, elaborate a final report that permitted knowing the differences and similarities in the nursing degree academic programs in eight countries and 189 curricular plans; organized based on the four categories or thematic nuclei of study already indicated, deriving from the results some conclusions, reflections, and recommendations, taking as axis the objectives proposed in this research.This project adhered to the Helsinki Declaration and to legislation in effect in each region and country of Iberian America for the regulation of confidentiality and protection of data obtained in the research.formation purpose proposes achieving a professional with integral, reflexive, critical formation, capable of adapting and transforming reality, with critical conscience, entrepreneurial leader, free, critical, and universal. The methodological strategy develops and implements pedagogical methods that promote reasoning and creative critical thought, curricular design through skills, analysis of lectures, group dynamics, individual and group practices, integrates theory-practice and integrates teaching-research and extension, with respect to conducting research, which can transcend at interdisciplinary and transdisciplinary levels. As result: the individual can solve problems, promote critical thinking, generate knowledge, critical analysis, capable of anticipating and visioning the future, and construct viable alternatives to problems.The total of the curricula reviewed, although with different emphasis, contemplate the development of R&CT as priority for all graduates from educational institutions. It was identified that this type of thinking was found in three complementary stages: as formation purpose, as methodological strategy, and as result. The Referring to the curricular theory used in the construction and conduction of the curricula, the study identified diversity of approaches, although in most cases alluding to constructivism, centered on learning (independent learning or self-learning), through skills, flexible or semi-flexible; aimed in inter and/or multidisciplinary manner, favoring, in some cases, accent lines: community, clinical, entrepreneurial, educational and/or research, although it is worth mentioning that, mostly, the skill focuses only on the critical capacity and skill, leaving aside the reflective element. The explicit and implicit R&CT presence was found in all the elements that make up the curriculum, such as mission, vision, objectives, foundation of the academic program, graduation profile, curricular guidelines and evaluation, among others. Although it may be said that great diversity exists of terms that, based on the sense in which they are employed within the curricula, these may be considered synonyms of R&CT. Thus, the following can be stated: critical knowledge, reflexive thinking, analysis and synthesis, clinical practice, problem solving capacity, critical and self-critical capacity, critical and/or reflective attitude, critical and/or reflective skill, critical and/or reflective capacity, clinical judgment or clinical method, critical spirit, problem resolution, information management and decision making; all imply a self-directed, complex, systematic, and deliberate reasoning process aimed at action.Social-humanist, which included assignments, like sociology, values, ethics, among others, many of them of elective nature; in contrast to those of greater curricular weight, like that of disciplinary-medical-technical knowledge - integrated by assignments, like anatomy, physiology, genetics, pharmacology, and nursing . Other assignments in which the capacity appears are Communication skills, Foreign languages, Research, Information management, Workshops, Informatics and Technology. In Spain (European region), this capacity is specified predominantly in areas of disciplinary knowledge, like Nursing models and theories, Nursing process, Practicum, Anthropology of Health, and Epistemology of Nursing.Within the Latin American RIIEE setting , R&CT presence is mostly consigned to areas of lower curricular weight, like the st century, making broad specifications on the Being, Knowing and Doing of the nursing professional. An example of this is the following manifestation: “the Nursing degree graduate will be able to …solve problems, followed by decision-making professionals, with critical thinking, creative, participant, enterprising, productive, reflective and self-critical, capable of making clinical judgments, researcher, capable of business creation and engaging in independent practice, with autonomy, creativity, and self-realization, competent for intersectoral, multidisciplinary work, with effective communication and oral and written expression. Capable of providing integral care, conducting continuous and permanent learning, according to personal and professional needs…” (C-32).It was common to find in the graduation profile of the Nursing Curricula, belonging to the different institutions studied, the following statements: “train higher-level professionals committed with the population’s health, development of their discipline, with capacity to construct from their own knowledge, take initiative and solve problems; competitive and with aptitude for team work, assuming responsibly the risks involved in disciplinary and interdisciplinary professional practice, capable of applying knowledge based on scientific evidence to care for human health, with humanistic and bioethics sense”; additionally, attributes are expressed on knowledge, skills, attitudes, and values to meet the needs, demands, and conditions of the nursing labor market for the 21formal or written curriculum, which may not necessarily be congruent between the real and the hidden curriculum, an aspect that in this study exceeds those comparisons. Hence, this section only accounts for what was found in most of the curricula reviewed. In all the regions studied, the academic programs make explicit the teaching-learning strategies and evaluation of the capacity for critical thinking, supported by the literature. Nevertheless, the lack of linearity in the application of these strategies is also common. These are not enunciated in the curricula or in the teaching plans, at least with sufficient clarity to determine that, effectively, the teaching activity is being guided toward acquiring the R&CT capacity. The principal teaching and learning strategies made explicit in the curricula were: Portfolio of evidence, analysis of lectures, group dynamics, individual and group practices, research, problem-based learning (PBL), brainstorming, analysis and synthesis, conceptual maps, analogies, case studies, experiential workshops, nursing process, panel, forums, seminars, reflective diary, critical incident, essays, fieldwork, socio-drama, debate, dialogue, summaries, simulation laboratories, supervised clinical practice, among others.Each curriculum analyzed consigns onto the “teaching and learning activities” section a range of actions the curricular program suggests, but it should be mentioned that this is only the so-called etc., which is not congruent with the didactic-pedagogic techniques of transmitting knowledge, generally evaluated to pass a course and promote students to the next academic level.The evaluation activities identified in the curricula reviewed were: portfolio of evidence, field diaries or logbooks, knowledge test, practical exam, elaboration of research work, essays, as well as case studies, elaboration of the nursing process, clinical case, written exam, oral exam, and self-evaluation. Regarding the evaluation, it was found that know-how is mainly evaluated. There is a message/discourse on constructivism, capacities, flexibility, self-learning, The teaching and learning strategies enunciated in the curricula reviewed are diverse. It is common to denominate active, creative, reflective, and critical or innovative methodologies. Most of the teaching plans gather the emerging tendencies having to do with learning and evaluation activities, although full coherence is not observed in them among the learning results expected, the teaching-learning activities developed and those activities to be evaluated by said results. Most of the curricula reviewed in this study do not make explicit the linearity between skill and the teaching-learning-assessment activities (T-L-E).The R&CT capacity is currently a necessary capacity highlighted, explicitly and narratively, in all the Nursing Curricula reviewed in this research; although it must be specified that they must be expressed through diverse nominations, which permits concluding that the term can be seen as multi-voiced. LikewiseIt is interesting to find in the graduation profile of the curricula analyzed statements that describe the formation of nursing professionals committed with the health of the population, development of their discipline, with capacity to construct their own knowledge, take initiative, and solve problems; this implies collecting, interpreting, evaluating, and selecting information for the purpose of making timely decisions  on the fThe social, cultural, health, and educational needs, to mention some, of the person, family, and society together are based on all the curricula reviewed, an aspect not reflected in the internal congruency of the study plan; particularly, in the profession’s object of study, its objectives, and the graduate’s profile, still privileging a biological, ahistorical, and individual education, although enunciating an integral or holistic formation of the graduate. We belieMoreover, the gap is often observed between the curricular theory and the pedagogical practice consigned in the majority of the curricula studied. Adaptation of the traditional nursing curriculum to a skills-based curriculum has assumed an important advance for the nursing formation. In the first place, it has mean tan effort of reflection shared by the faculty to become conscious of the new approaches the nursing career must assume, in order to reduce the gap between theory and practice. Integration of contents, coordination among faculty staff, and transversality, as well the orientation toward the professional practice, have been elements present in the reflection carried out. Change is evident in the elaboration of the curriculum, above all in that referring to the orientation by skills and to more creative and innovative teacher methodologies. However, these changes are only evident at explicit curriculum level. When delving into the study of the curriculum, many questions remain unsolved, especially regarding the implicit or hidden curriculum. This poses the question of whether the nursing teachers in the study field are actually carrying out the pedagogical and didactic practices that the new curricular approach suggests in the academic program.st century, formation of nursing professionals must respond in efficient, integral, timely, assertive, and humanistic manner to the demands required by caring for life and maintenance and reestablishment of human health. This is not an easy task, given that the formal care provided by this professional implies the dynamic of growing changes in current university designs and methodologies claim with it implementation of an integrating version and transversal of the contents to deploy effectively the necessary elements to achieve strengthening the skills a nursing degree graduate must have.With respect to the teaching, learning, and evaluation strategies, it may be said that these are not only multiple and diverse, but that they do not present full congruence, such is the case, for example, of the “teaching and learning strategy” used by the evidence portfolio and where the “evaluation” section specifies that the activity and the assignment will be graded through a written test of knowledge. We deem it important to reiterate that, during the second decade of the 21Although it is true that the curriculum orientation is perceived inserted onto the constructivist current, prevalence is still noted in the curricula of technical-instrumental formation characteristic of the positivist biomedical paradigm, known for high percentages of contents with disease-focused biologic clinical character in detriment of contents oriented at health and social critique. The paradigm of the transformation in which we are immersed and which promotes the emancipation of the professionals, is scarcely supported on the formation of new professionals, which proceed and continue to form in a context marked by the repetitive and anachronistic practice of the traditional health culture, where medical paternalism continues expressing the power they maintain in healthcare structures. Nevertheless, it is necessary to highlight the effort by nursing education institutions to adjust the curricula to this new transforming paradigm, in spite of the cultural barriers instituted and which, in many cases is maintained by the care professionals themselves.knowing, know-how, and knowing-being, as general consideration of the curriculum, and knowing to coexist for nursing.(objectification only of knowledge, many times of memory type, where we believe that the principal results are limitation of the students’ creativity, autonomy, and self-criticism to measure and assess their academic performance and achievement.It is prudent to remember and recognize that the evaluation should be diagnostic, formative and summative or final, which seeks to use instruments that enable feedback from the educational process, preserving respect for the academic freedom of teachers, by these being autonomous institutions, through traditional evaluation techniques or assignment of research work, essays, case study, elaboration of the nursing process, clinical case, oral exam, self-evaluation, among other forms and strategies, which will grade the domain of  nursing. In spiteDevelopment and promotion of reflective and critical thinking in nursing professionals is currently essential, given that the epistemological and sociological growth of the nursing profession require professionals with permanent discernment, supported on scientific, ethical, aesthetic, and personal knowledge. Reflection and critique, as learning tools, must be incorporated into the formation of nursing professionals. If learning based on life experiences is so important in nursing, reflection is vital to avoid repeating practices that hinder professional development and affect the quality of service provided by the nursing staff. This type of multi-referred thinking must be one of the essential axes that transform the professional formation and practice and with it the quality of care to users, family, and society, besides achieving higher professional status in nursing.The results previously indicated permit stating that it is fitting to review and reorient institutional development plans, programs and academic plans, or study plans, fundamentally in what refers to the curricular contents, to develop and promote in the students and future graduates the practice of R&CT, diminishing existing gaps among theoretical formation, professional practice, and care requirements, reestablishing and maintaining health, favoring individual and collective wellbeing indices, especially if the aspiration of public and private universities that offer the nursing degree in Iberian America, consists in forming and contributing an interpretive vision to nursing professionals, through an academic curriculum that goes beyond teaching the diverse functions -granting, education, research, management, and administration, among others, which will take place around formal or professional nursing care, developing innovative skills. One of the cross-sectional-type curricular axes that must be considered, based on our point of view, is development, implementation, and promotion of R&CT in academic programs and their respective assignments or learning units, which provide nursing professionals the theoretical-practical tools necessary to use this type of thinking in any setting of the labor market they enter, which will enhance their vision, leadership, decision making, autonomy, and social and professional recognition.The principal limitation noted in a multicenter research of this nature was the collection of information in the different participating countries, to the extent in which, although a document was constructed to obtain data, the interpretations made difficult some aspects of analysis and construction of analysis categories.