Basic Occupational Health Services - OIC-VET

Report
MINISTRY OF LABOUR & SOCIAL
SECURITY
DIRECTORATE GENERAL OF OHS
Dr. Buhara Önal
OHS INSTITUTE (ISGUM)
May 2010
Ankara - TURKEY
BASIC OCCUPATIONAL HEALTH
SERVICES
CONTENT
• Policy background
• ILO Convention 161
• EU Legislation on OHS
• WHO Worker’s health: Global Plan of Action
• Basic Occupational Health Services (BOHS)
OCCUPATIONAL HEALTH AS A
FUNDAMENTAL HUMAN RIGHT
Every worker has the right to working conditions
which respect his or her health, safety and dignity.
(Art. 31 of the European Charter)
IMPACT OF THE OCCUPATIONAL
ENVIRONMENT ON HEALTH
• 300 000 workers die of work-related
diseases
• 27 000 workers die in occupational accidents
(5% of all deaths due to accidents)
• Loss of 4% GDP
POLICY BACKGROUND
• ILO
• EU
• WHO
ILO
• Joint Committees 1950-2003
• Related Conventions and Recommendations,
Convention 161, Recommendation 171, in particular
• Ethics in workers' health surveillance guidelines
• Numerous Codes of Practice
• Global Strategy
• Promotional Framework for Occupational Safety and
Health Convention 187
• Fair globalization-Decent Work
ILO CONVENTION 161
OH SERVICES
Article 1: For the purpose of this Convention(a) the term occupational health services means services
entrusted with essentially preventive functions and responsible
for advising the employer, the workers and their
representatives in the undertaking on(i) the requirements for establishing and maintaining a safe and
healthy working environment which will facilitate optimal
physical and mental health in relation to work;
(ii) the adaptation of work to the capabilities of workers in the
light of their state of physical and mental health;
(b) the term workers' representatives in the undertaking
means persons who are recognised as such under national law or
practice.
ILO CONVENTION 161(cont.)
Article 2
• In the light of national conditions and practice and in
consultation with the most representative
organisations of employers and workers, where they
exist, each Member shall formulate, implement and
periodically review a coherent national policy on
occupational health services.
ILO CONVENTION 161(cont.)
• Article 3
1. Each Member undertakes to develop progressively
occupational health services for all workers, including those in
the public sector and the members of production cooperatives, in all branches of economic activity and all
undertakings. The provision made should be adequate and
appropriate to the specific risks of the undertakings.
2. If occupational health services cannot be immediately
established for all undertakings, each Member concerned shall
draw up plans for the establishment of such services in
consultation with the most representative organisations of
employers and workers, where they exist.
ILO CONVENTION 161(cont.)
Article 5
• …….occupational health services shall have such of the following
functions as are adequate and appropriate to the occupational
risks of the undertaking:
(a) identification and assessment of the risks from health
hazards in the workplace;
(b) surveillance of the factors in the working environment and
working practices which may affect workers' health, including
sanitary installations, canteens and housing where these
facilities are provided by the employer;
(c) advice on planning and organisation of work, including the
design of workplaces, on the choice, maintenance and condition
of machinery and other equipment and on substances used in
work;
ILO CONVENTION 161(cont.)
(d) participation in the development of programmes for the
improvement of working practices as well as testing and
evaluation of health aspects of new equipment;
(e) advice on occupational health, safety and hygiene and on
ergonomics and individual and collective protective equipment;
f) surveillance of workers' health in relation to work;
(g) promoting the adaptation of work to the worker;
(h) contribution to measures of vocational rehabilitation;
(i) collaboration in providing information, training and education
in the fields of occupational health and hygiene and ergonomics;
(j) organising of first aid and emergency treatment;
(k) participation in analysis of occupational accidents and
occupational diseases.
ILO CONVENTION 161(cont.)
Article 7
1. Occupational health services may be organised as a service for
a single undertaking or as a service common to a number of
undertakings, as appropriate.
2. In accordance with national conditions and practice,
occupational health services may be organised by(a) the undertakings or groups of undertakings concerned;
(b) public authorities or official services;
(c) social security institutions;
(d) any other bodies authorised by the competent authority;
(e) a combination of any of the above.
ILO CONVENTION 161(cont.)
Article 9
1. In accordance with national law and practice, occupational
health services should be multidisciplinary. The composition of
the personnel shall be determined by the nature of the duties to
be performed.
2. Occupational health services shall carry out their functions in
co-operation with the other services in the undertaking.
3. Measures shall be taken, in accordance with national law and
practice, to ensure adequate co-operation and co-ordination
between occupational health services and, as appropriate,
other bodies concerned with the provision of health services.
EU
• Framework Directive 89/391-preventive and
protective services
• Occupational health and safety strategy 2008-2012
• Workplace health promotion
• Economic loss/productivity
PRINCIPLES OF EU LEGISLATION ON
OCCUPATIONAL HEALTH AND SAFETY
 Prevention
 Hierarchy of prevention measures
 Continuous improvement
 Health and Safety
 Employers’ responsibility
 Social dialogue and participation of employees
 Multidisciplinarity in preventive services & holistic
approach to work
FRAMEWORK DİRECTİVE 89/391/EEC
• Its scope is large: all sectors of activity, both public
and private, with very few clearly described
exceptions.
• Article 5 (1), the Directive's fundamental provision,
states that "the employer shall have a duty to
ensure the safety and health of workers in every
aspect related to the work."
89/391/EHS – Framework Directive
on the introduction of measures to encourage improvements
in the safety and health of workers at work
Using of the work equipment
Specific group of workers
89/655/EEC
Work Equipment (2)
92/85/EEC
Pregnant and breastfeeding
workers and worker who have
recently given birth (10)
Specific activities
90/269/EEC
Manual Handling of Loads (4)
Personal protection
90/270/EEC
Display Screen Equipments (5)
89/656/EEC
Personal Protective Equipment (3)
92/91/EEC
Drilling (11)
Workplace
Exposure to agents
89/654/EEC
Workplace (1)
92/57/EEC
Temporary/Mobile Construction
Sites (8)
90/394/EEC
Carcinogens (6)
92/58/EEC
Safety and/or Health Signs (9)
92/104/EEC
Surface and Underground Mineralextracting Industries (12)
93/103/EC
Fishing Wessels (13)
1999/92/EC
Explosive Athmospheres (15)
2000/54/EC
Biological Agents (7)
98/24/EC
Chemical Agents (14)
2000/44/EC
Vibrations (16)
2003/10/EC
Noise (17)
2004/40/EC
Electromagnetic Fields (18)
2000/39/EC
Indicative
occupational
exposure limit values
OHS directives which
are not directly under
Framework Directive 89/391/EEC
91/383/EEC
Temporary Workers
93/104/EC
2000/34/EC
2000/79/EC
2002/15/EC
Working Time
94/33/EC
Young Workers
1983/477/EC
1999/77/EC
2003/18/EC
Asbestos
WHO
•
•
•
•
•
•
•
•
WHO HFA 2000 and HFA21
Alma Ata: Primary Health Care
Health sector reform
Public health policy: Prevent the preventable
Equity: odd distribution of risks
Social determinants of health
Global Strategy on OH for All
Workers’ Health - Global Action Plan
WHO’S CONCEPT ON WORKERS’
HEALTH AS A PUBLIC HEALTH ISSUE
The Labour Approach
The Public Health Approach
Occupational Health
Workers Health
Labour Contract
All workers beyond the
workplace
Responsibility of
everyone
Employer's
responsibility
Only at the workplace
Only work-related health
Negotiation between
workers and employers
All health determinants
Other stakeholders
Health protection not
subject to collective
negotiation
60TH WORLD HEALTH ASSEMBLY
"WORKERS' HEALTH: GLOBAL PLAN OF
ACTİON"
•The Global Plan of Action
developed by the Member States,
May 2007
•Consensus by all 192 Member
States of WHO
•Global plan of action on workers'
health (2008-2017)
•WHA60 urged Member States to
take an number of measures on
workers' health
OBJECTIVE 1: TO DEVELOP AND
IMPLEMENT POLICY INSTRUMENTS
ON WORKERS HEALTH
•
•
•
•
•
National policy frameworks
– legislation
– intersectoral collaboration
– funding and resource mobilization
– strengthening the ministries of health
National action on workers’ health (taking into consideration also ILO
Promotional Framework for OSH Convention)
– national profiles and priorities for action
– objectives, targets and actions
– mechanism for implementation, monitoring and evaluation
– human and financial resources
National approaches for prevention of priority occupational diseases
and accidents
Minimizing gaps – high risk sectors, vulnerable groups, gender
aspects
WHO assistance to strengthen the capacities of ministries of health;
global campaigns: elimination of asbestos-related diseases and
immunization of healthcare workers against HBV
OBJECTIVE 2:TO PROTECT AND PROMOTE
HEALTH AT THE WORKPLACE
• Improving assessment and management of health risks at workplace:
– Essential interventions for prevention occupational hazards
– Integrated management of chemicals
– Elimination of smoking from all indoor workplaces
– Health impact assessment of new technologies
• Basic set of occupational health standards
– Minimum requirements for health and safety protection
– Enforcement and inspection
• Capacities for primary prevention of occupational hazards, diseases
and injuries: methodologies, training, healthy workplaces
• Health promotion and prevention of noncommunicable diseases at
workplace: diet, physical activity, mental health, family health
• Prevention and control HIV/AIDS, malaria, TB etc. in workplace
OBJECTIVE 3:TO IMPROVE THE
PERFORMANCE OF AND ACCESS TO
OCCUPATIONAL HEALTH SERVICES
•
Coverage and quality of occupational health services
– Linkage to national health strategies and health sector reforms
– Standards for organization and coverage
– Mechanisms for resources and financing of the delivery
– Sufficient and competent human resources
– Quality assurance systems
•
•
• Basic occupational health services for all workers
Building core institutional capacities – national and local levels
Development of human resources for occupational health
– Post graduate training
– Capacities for basic occupational health services
– workers-’health in training of primary health care
– Attracting and retaining human resources
OBJECTIVE 4: TO PROVIDE AND
COMMUNICATE EVIDENCE FOR ACTION
AND PRACTICE
•
Systems for surveillance of workers' health
– National information systems
– Capacities to estimate burden of diseases and injuries
– Registries of exposures, diseases and accidents
– Early reporting and detection
•
Research
– Special agendas
– Practical and participatory research
•
Communication and awareness raising
– Workers and employers
– Policy makers, media
– Health practitioners
•
WHO action: indicators for workers' health; incorporation of
occupational causes of diseases in ICD11; diagnostic and exposure
criteria for occupational diseases
OBJECTIVE 5: TO INCORPORATE WORKERS’
HEALTH INTO OTHER POLICIES
•
•
•
•
•
•
•
•
Economic development policies and poverty reduction strategies
Collaboration with private sectors to avoid international transfer
of risks
National plans and programmes for sustainable development
Consider workers' health in the context of trade policies
Assess health impacts of employment policies
Environmental protection in relation to workers' health:
– Strategic approach to International Chemicals Management
– Multilateral environmental agreements
– Environmental management systems
– Emergency preparedness and response
Sectoral policies for branches with highest health risks
Primary, secondary and higher level of education and vocational
training
ESSENTIAL PUBLIC HEALTH FUNCTIONS
IN THE AREA OF OCCUPATIONAL HEALTH
•
•
•
•
•
•
•
•
•
•
•
Assessment and management of occupational risks
Monitoring and surveillance of workers' health
Workplace health promotion
Participation of workers and employers
Development of policies and institutional capacity
Strengthening of institutional capacity for regulation and
enforcement in occupational health
Evaluation and promotion of equitable access to OH services
Human resources development and training in OH
Quality assurance in OH services
Research in OH
Reduction of the impact of industrial accidents and technological
disasters on health
WHO PAHO “Public Health in the Americas. Conceptual Renewal, Performance Assessment, and Bases for Action” 2002
BOHS
• Occupational health services are available to only 10%–15% of
workers worldwide.
• In industrialized countries, the coverage varies between 15% and
90% and in developing countries between a few percent and 20%,
even where services are available, their quality and relevance may
be low.
• The needs of occupational health services grow continuously and
new challenges are set by the globalization of work life.
• To provide a response to such a global challenge the
WHO/ILO/ICOH joint effort on the development of
BOHS was launched.
COVERAGE OF OHS
100
95
90
90
86
80
80
80
70
70
Workers without OHS
70
60
60
50
50
50
50
50
48
39
40
34
30
30
28
15
20
10
5
10
0
NET
FIN
SVN
BEL
FRA
SWE
JAP
HUN
DEN
NOR
POR
ITA
TUR
POL
UNK
BUL
GRE
EST
CHI
KEN
4
SVK
BOHS
• The ultimate objective of the BOHS initiative is to
provide occupational health services for all working
people in the world, regardless of economic sector,
mode of employment, size of workplace or
geographic location i.e. according to the principle of
universal services provision
BOHS
• There is a challenge to provide good practice guidelines and
toolboxes for service providers on a number of specific
activities, such as planning of occupational health services, risk
assessment and management, ergonomics and safety, assessment
of psychological conditions and stress, and diagnosis of
occupational diseases.
BOHS
• BOHS are most needed for countries and sectors that do not
have services at all or which are seriously underserved.
• Particularly high-risk sectors such as agriculture, mining,
fishery, forestry and construction have to be given priority.
• Governments, in collaboration with social partners and with
support and guidance by international organizations, should
strengthen their policies and clarify priorities with regard to
organization and development of service infrastructures.
BOHS CYCLE
Workers health
Orientation
and planning
Evaluatio
n
Surveillance of WE
Record keeping
Individual
health record
Surveillance of
worker's health
Worker
General
health service
Emergency
preparedness
Accident prevention
Assessment of
individual's
health risk
First aid
Dg of ODs
and WRDs
Health education
and health
information
Informatio
n
Education
Prevention of
OH hazards
Work environment
WE Risk
Assessment
Initiative
s
Work Organization
HIERARCHY OF
PREVENTIVE
MEASURES
Structural prevention
Lack of hazard
Engineering controls
Minimising emissions
Preventive power
Control technology
Ventilation, exhaustion
Working practices,
wet processes,
cleanliness, order
Personal protection,
respirators
Limiting exposure
times
Burden to health
Decontamination,
health surveillance,
early diagnosis,
treatment
A STEPWISE STRATEGY
FOR OCCUPATIONAL
HEALTH SERVICES
Stage IV
Comprehensive
Service
•In-company or
Stage III
external
International
special OHS units
Standard Service
•Comprehensive
content:
prevention,
Stage II
curative and
Basic Service
promotion &
•OHS Infrastructure development
services
•ILO No. 161, 155
Objective for all!
Stage I
Starting level
•PHC Infrastructure
•Multidisciplinary
content
•Basic OHS content
•Prevention plus
•Advice in OH
•Toolboxes
curative services
•Accidents and ODs
•Acute ill-health
•PHC
Field nurse
Physician and nurseMultidisciplinary
Safety agent
with short special team with
special training
training
SMEs,SSEs,SEs,IFSSMEs,SSEs,SEs,IFS
Starting point for
Big industries and
well organised
SMEs
Multidisciplinary
specialists' team
Big industries and
Big OHS Centres
MODELS OF SERVICES PROVISION
1. Primary health care model
2. Big company model
3. Group services
4. Social security model
5. Private physician
6. Private health centre
7. Local or regional hospitals
CONTENT OF BOHS
The content of basic occupational health services
includes, as a minimum, the following activities:
• surveillance of work environment and risk assessment
• health surveillance and health examinations
• advice on preventive and control measures
• health education and health promotion and promotion
of work ability
• first aid and treatment of acute illnesses
• diagnosis of occupational diseases.
MODERN OCCUPATIONAL HEALTH SYSTEM
labour
Competent authority
in central government
health
Secondary support level
IOH or RESP
OM
LABOUR
INSPECTORATE
OM
CLINICS
Hyg, Erg, Psych,
Safety, W-org, OM
Frontline level
IN-COMPANY OHS
Big
company
PHC
GROUP OHS
SME
Company
SE
SME
Private center
SSE
SE
SE
IFS
IFS
IFS
IFS
BOHS
SME
IFS
IFS
IFS
SE
IFS
Example: OH service providers in Finland
Räsänen et al 2002
Enterprises 61%
Employees 37%
OHS units 31%
Costs
16%
MUNICIPAL
HEALTH
CENTRE
Enterprise
Enterprise
Enterprise
Farmers
Self-employed
Enterprises
Employees
OHS units
Costs
2%
25%
38%
43%
Enterprises
Employees
OHS units
Costs
4%
6%
7%
2%
GROUP
OHS
33%
32%
24%
39%
PIVATE OHS
CENTER
Enterprises
Employees
OHS units
Costs
BIG ENTERPRISE
OHS
Satellite
Enterpris
e
Enterprise
Enterprise
Enterprise
Enterprise
Enterprise
CONCLUSION
•
Development of the whole occupational health system
(policy, legislation, infrastructures, human resources,
information systems and registration)
•
Occupational health services should be provided by wellestablished service provision units with a sufficient size to
be able to provide multiprofessional services
•
Training of multiprofessional expert resources for
occupational health is recommended by upgrading and reorienting the existing expert resources and by training new
experts for broadening the scope of competence of
occupational health services.
CONCLUSION
•
Drawing up a National Policy and Strategy and systematic
curricula for training in occupational health and their
adjustment to European curriculum systems is recommended.
•
Utilization of Basic Occupational Health Service (BOHS)
model is recommended for expansion of coverage of
occupational health services and particularly for serving the
small enterprise, self-employed and informal sector
workplaces.
CONCLUSION
–
The implementation of existing regulations is recommended
to be supported by production of appropriate standards
and good practice guidelines for practical implementation
of occupational health services.
–
Infrastructures for occupational health services are
recommended to be institutionalized and developed on a
multi-model basis: coverage of all working people!
CONCLUSION
•
An important part of infrastructure consists of the Institute
of Occupational Health and Safety
•
A special information strategy on occupational health,
including the development of national information service and
dissemination system:
- National ILO CIS Center
- Focal Point for EU OSHA
- WHO Collaborating Centre
THANK YOU…
Dr. Buhara ÖNAL
[email protected]
00 90 312 2571690/200

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