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Healthy working environment is often poorly managed in MSEs, with workers at greater risk of workplace accidents and work-related ill health. This poses challenges in terms of monitoring working conditions, raising awareness and the enforcement of healthy working environment. Various studies, show that the smaller the enterprise the more significant the challenges in handling healthy working environment. This research presents findings by identifying what is currently known and where the gaps are, including the degree of existing healthy working environment arrangements and outcomes, as well as contextual issues such as regulatory environment and available management supports. This study also suggests some policy recommendations and good practices to understand, from the perspective of employers and employees, the problems and concerns associated with healthy working environment at workplace level. In summary, the study explains the rationales, mechanisms and realities shaping the experience of healthy working environment for workers in SMEs.