5. Workplace occupational health services.ppt

8/10/2019 5. Workplace occupational health services.ppt

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Workplace occupational health

services

Margaret K. Semakula


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Presentation Plan

Introduction

Provision of Occupational Health Services (OHS)

Models of Occupational Health Services (OHS)

Requirements for success in Occupational Health Services

Roles in provision of occupational health services

Organizational Occupational Health Services

Occupational Health Services in the context of PHC

References


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Introduction

Of the total 3 billion workers in the world, more than

80% work and live without having access tooccupational health services (OHS).

This in spite of the fact that several authoritative

bodies, including the ILO, WHO and numerousprofessional organizations and the organizations ofworkers have, already for several decades emphasizedthe need for services.

The coverage, i.e. the proportion of workers andworkplaces with access to services, is todaydiminishing rather than expanding.


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Introduction cond

The ILO Convention No. 161 on Occupational

Health Services and the WHO Global Strategy on OH forall, call for the organization of services to all workingpeople of the world.

We are still far from this goal, and it is not likely that thecoverage will essentially expand without concertedefforts.

To address the new safety and health needs, WHO haslaunched a new Global Plan of Action on Workers' Healthand the ILO has produced a Global Strategy onOccupational safety and Health and the ILO ConventionNo. 187 on Promotional Framework.


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Definition of Occupational Health Services

Occupational health service means a service established

in or near a place of employment for the purposes of

(a) Protecting the workers against any health hazardwhich may arise out of their work or the conditions in

which it is carried on;

(b) Contributing towards the workers' physical andmental adjustment, in particular by the adaptation of thework to the workers and their assignment to jobs forwhich they are suited; and

(c) Contributing to the establishment and maintenance ofthe highest possible degree of physical and mental well-

being of the workers.


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Provision of Occupational Health Services

(OHS)

Occupational health services do not exist as an end inthemselves but as a means to an end.

They are created to prevent an unnecessary interference

with the primary mission of the organization, whetherthat mission is to create wealth, to provide a neededservice, or to protect the interests of a community ofpeople.

All organizations ; small business corporations,government agencies, and the military have similar needsfor effective occupational health services.


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Provision of OHS cond

Occupational health care is a process, not an outcome,

and the success and quality of a service providing suchcare is measured by the absence of problems rather thanby a specific end point.

It therefore follows that a commitment to soundoccupational health practices must be on-going and notlimited to a specific problem-solving exercise.

This fundamental principle must be accepted by thedecision-makers within an organization or by a proprietorof a small business before a commitment to provideoccupational health services begins to make sense and

the value of such services becomes apparent.


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Functions/ activities of occupational

health services

Identification and assessment of risks from healthhazards in the work place

Surveillance of the factors in the working environment

and working practices which may affect workers health,including sanitary installations, canteens and housingwhere these facilities are provided by the employer

Advice on planning/organization of work/ work processes


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health services

Advice/ provision of information/ training onoccupational health, safety and hygiene,ergonomics and examinations.

Surveillance of the workers health in relation towork; pre-employment and periodicexaminations.

Promoting the adaptation of work/environmentto the worker and/or vice versa.


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health services cond

Contribute to rehabilitation of the workers physically ,emotionally or other wise.

Organizing of first Aid/ emergency treatment.

Participation in the analysis of occupational accidentsand diseases

Collaboration in providing information, training andeducation in the field of occupational health and hygieneand ergonomics


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Occupational health services

The decision by management to develop or to

contract for an occupational health service

and how the arrangement shall be structured

must reflect the realities both within the

organization and the community of which the

organization is a part.


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Occupational health services

Among the considerations are the following: Is qualified medical care (i.e., from physicians

knowledgeable about occupational disorders)available in the community and easily

accessible?

Do operations within the organization require

special insight or expertise because of particularhazards, unusual technology, or the potentialfor injuries?


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Considerations cond

What are the pertinent regulations regardingoccupational safety and health?

What has been the past experience of the organizationand what is its expected future growth?

Who are the employees, what is their social, ethnic, and

economic background, and what patterns of disease are

common in their home community?

How much of an investment is the organization prepared

to make?


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Models of Occupational Health

Services (OHS)

1.In-plant (in-company model) of OHS

This is where by some large companies/enterprise have their own, internalmultidisciplinary Occupational Health Services.

The advantage of this model is that there is good

knowledge about the processes in the plant andclose to management and workers e.g. Kakirasugar factory.


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Models of Occupational Health

Services (OHS

2. Inter-enterprise or Group Occupational HealthServices/ model

This refers to Sharing of occupational healthservicesby groups of small or medium-sizedenterprises

The advantage is they are well staffed, andmultidisciplinary services are offered. However,the services are far from the enterprises


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Models cond

3. Private health centre OHS

These are organized by the physician or group ofphysicians. Its in some cases more multidisciplinary.

The disadvantage of these is that they are usually run by

general practitioners and thus provide only generalservices. This is a common arrangement with mostcommon workplaces in Uganda

4. Social security model OHS are organized and operated by a social security

system


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Requirements for success in Occupational

Health Services A national policy for OHS

An authority for policy implementation

Legislation

Factory inspection

Incentives/ sanctions

Training and education


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1. Role of Ministry of Gender Labour and Social Development(Uganda)

To formulate and review relevant guidelines, programmes, policiesand laws;

To ensure that occupational accidents, diseases and injuries at the

workplace are minimized;

To promote awareness on occupational safety and health amongstakeholders;

To coordinate and network with stakeholders on occupationalsafety and health concerns;

To ensure that initiatives, programmes, policies and laws address

occupational safety and health concerns.


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2. Roles of the employer Providing medical care to the workers at no cost to

the workers

Establish medical services at the workplace

An employer with more than 20 persons (employees)is required to put in place a health care system

An employer with more than 2000 persons located inone place is required to put in place a competenthospital (Uganda Employment Act)


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Organizational Occupational Health

Services

In developed countries, many organizations have theirown dedicated occupational health services, employing

occupational physicians, hygienists, and occupational

health nurses or use an external service on regular basis.

Settings and scope

Like any other discipline, rapid changes are taking placewith an increasing tendency to contract service providers


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Scope of occupational health services

Preventive (primary, secondary and tertiary)occupational services

Curative services

Rehabilitation

Promotive services

Consultative services


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Scope of OHS cond

Preventive services

1. Primary preventive services: are those intended toprevent illness or injury.

They involve elimination of hazardous exposures and

protection against remaining exposures

2. Secondary preventive services: involves detection ofillness in the early stages before signs and symptoms are

notices.

This makes it possible to reverse disease. Interventionsare both clinical and work based. Ailments are detected

through screening. Its a process of medical surveillance.


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Scope of OHS cond

3. Tertiary prevention: they are curative andrehabilitative services provided after injury orillness.

The purpose of this is to prevent disability orfurther progression of the disease.


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Consultative services

There are different scenarios available for

consultations;

Some physicians offer single consultative visits. They arepaid by the employer to examine workers and prescribe

Independent examiner: e.g. when a worker files forworkmans compensation.

Health risk appraisal and health promotion; these usesurveys, questionnaires and interviews and help patientsto identify aspects of their life styles that are healthrisks.

Ethi l i i i ti l


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Ethical issues in organizational

occupational health services Occupational health workers have a unique obligation.

They work to protect the affected worker, but often undercircumstances in which another party (employer) pays the bills.They must therefore address the conflict of interest. They shouldtherefore;

1. Seek the patients consent

2. Protect patients privacy

3. Be mindful of adverse effects to the patients job status

4. Keep information confident: employers only need to know theability of employees to work or work restrictions needed and notthe underlying chronic diseases the patient may have.

Th i i l f i ti l


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The principal areas of organizational

occupational health practice

Placing people in suitable areas of work

Health surveillance

Providing a treatment service

Monitoring (primary and secondary monitoring)

Avoiding potential risks

Supervision of vulnerable groups like pregnant women,the young etc.


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The principal areas continued

Monitoring for early evidence of nonoccupational disease

Counseling

First Aid and emergency services

Occupational hygiene

Maintenance of health records

O ti l H lth S i i th


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Occupational Health Services in the

context of PHC There is a great diversity among providers

Services are often provided by physicians

Most of whom have been trained in other specialties and manyphysicians and other health worker not specialized in occupationalhealth end up seeing these patients due to inadequacy ofresources

Health care can also be provided by nurses (may be general nursesor occupational nurses). It may also be provided by MedicalOfficers and Clinical Officers especially in developing countries.

In industrialized environments, its provided by occupationalhygienists

Provision of occupational health


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Provision of occupational health

services by health care workers

A primary health care approach is recommended.

This should be guided by principles like;

Ensure that occupational health services are providedthrough existing National Health Services (a process ofintegration)

The services should be to the total health of the workersand if necessary, their families

The role of an Occupational Health


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The role of an Occupational Health

Professional in the PHC setting

Pre-employment examination of workers Periodical examination of workers

Health education of workers and management

Regular monitoring of the work environment

First aid treatment and rehabilitation services

Administration of health service

Occupational health promotion and public healthmeasures

Specific Personnel Requirements for integrated


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Specific Personnel Requirements for integrated

Occupational Health Services in PHC

At the basic levels of PHC,we need the following personnel;

Nurses, Clinical Officers

Health Educators

Trainers

Environmental Health Inspectors/ Assistants

Medical Officers

District Hospitals, Regional Hospitals and National ReferralHospitals

Occupational Health Physicians

Occupational Health Nurses

Non-physicians providing PHC at workplace


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In industries

Occupational Safety and Health Engineers or Safety Officers

Occupational Hygienists

Orthopaedic Officers, Technologists and Technicians


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The role of Occupational Health Physician

at district levelImportant points to note

Occupational Health Physicianis a professional who carries out

occupational safety activities and provides occupational health

services.

Occupational health clinician is an essential part in the delivery of

occupational heath services.

In developing countries, these specialized personnel are oftenlackinghowever, in PHC setting, the District Health Officer should

put in place mechanisms to offer occupational health services to a

reasonable level, especially in industrial districts.


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Important points to note contd

Occupational health is however a responsibility of everyone

There is shortage of occupational health professionals in

almost all the districts in Uganda, thereforeoccupational health services should be integrated in thegeneral health activities of the district.

Occupational health should be identified as a basichealth activity whose basic concern is the health of aworker.


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Important pints to note cond

The service must therefore be for the total health of the

workers and their families

There is need for collaboration with other stakeholdersat district level

The primary health care approach should be used to

implement the delivery of occupational health services


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Occupational health problems at district level

There are a number of occupationally related problems at districtlevel. Some include;

Agriculture

Fishing: drowning, water borne diseases

Cultivation: cuts, tetanus, snakes etc

Animal husbandry: snakes etc

Industry/ factory

Heavy metal poisoning Injury and cuts

Respiratory tract infections

Hearing impairment

Stress


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Construction sites

Cement and lime dust

Falls and cuts

Paint fumes


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Roles of Occupational Health Physician at the

District contd

Policy formulation and setting guidelines Planning of occupational health services at the district

Training of occupational health personnel

Continuing medical education of workers and otherpersonnel

Recommend pre-employment and periodic examination

of workers

Emphasize prevention of occupational health diseasesand injuries

R l f O i l H l h Ph i i


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Roles of Occupational Health Physician at

the District cond

Treatment of occupational health diseases and injuries aswell as rehabilitation of workers

Resource mobilization

Coordination of various stakeholders involved in theprovision of occupational health services in the district

Health surveillance ie ensure that occupationally relateddiseases and injuries that occur in the district arereported to the competent authority according to the

national laws and regulations

R l f O ti l H lth Ph i i t


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the District contd

Ensure support supervision of cadres involved in theprovision of occupational health services in the district

Promote and participate in occupational health research

at the district level

Multidisciplinary collaboration

This should be both vertical and horizontal ie vertical (withMoH, Ministry of Labour, Agriculture etc) and

Horizontal (with extension staff like hygienists, health

educators, trainers, managers and other employees.

R l f O ti l H lth Ph i i t


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the District cond

Administration; an Occupational Health Physician shouldensure that the administrative process of occupational

health services cover the following areas;

Methods for provision of services

Organization and financing

Legislation and policy

Responsibilities of government and other agencies

Monitoring and evaluation of occupational health

services in the district


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References

http://www-old.itcilo.org/actrav/actravenglish/telearn/osh/legis/r112.htm

Professor Jorma Rantanen (2007), Basic Occupational Health Services

WHO (2001), Occupational health: A manual for primary health care workers

Master of Public Health Distance Manual

Sedlak J. Occupational health organization. Encyclopaedia of Occupational Healthand Safety, ed. Parmeggiani L. Geneva, International Laborer Office

Murray R, Schilling RSF. Functions of an occupational health service. OccupationalHealth

The Occupational Health and Safety Act, 1993Practice
http://www-old.itcilo.org/actrav/actravenglish/telearn/osh/legis/r112.htmhttp://www-old.itcilo.org/actrav/actravenglish/telearn/osh/legis/r112.htmhttp://www-old.itcilo.org/actrav/actravenglish/telearn/osh/legis/r112.htmhttp://www-old.itcilo.org/actrav/actravenglish/telearn/osh/legis/r112.htm

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