The 2.4 billion working people in the developing countries often have to endure employment conditions, which do not meet even basic occupational safety and health (OSH) standards. The lack of work safety, excessive work loads, and occupational physical, chemical and biological exposures result in occupational diseases, injuries and as many as 1.2 million fatalities each year. Furthermore, as little as 15% of workers in the developing countries have access to occupational health and safety services. Some collaboration between the industrialized and developing countries in the field of OSH has been practiced for 30 years but its volume has been modest compared to other sectors of development assistance. The lessons learned from 30 years of experience are that the most important OSH improving factors in developing countries include legal and policy instruments, national OSH programs, infrastructure for OSH implementation, and OSH services. The establishment of OSH expert human resources, centers serving as engines for research, training, as well as information and registration systems can also be considered as key factors in any such collaboration. A convincing government OSH policy, and close cooperation between social partners and the government are also critical factors that guarantee sustainable OSH programs in a developing country over a long-term basis.