Workplace occupational health

services
Margaret K. Semakula

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 to
occupational health services (OHS).
This in spite of the fact that several authoritative
bodies, including the ILO, WHO and numerous
professional organizations and the organizations of
workers have, already for several decades emphasized
the need for services.
The coverage, i.e. the proportion of workers and
workplaces with access to services, is today
diminishing 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 for
all, call for the organization of services to all working
people of the world.
We are still far from this goal, and it is not likely that the
coverage will essentially expand without concerted
efforts.
To address the new safety and health needs, WHO has
launched a new Global Plan of Action on Workers' Health
and the ILO has produced a Global Strategy on
Occupational safety and Health and the ILO Convention
No. 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 hazard
which may arise out of their work or the conditions in
which it is carried on;
(b) Contributing towards the workers' physical and
mental adjustment, in particular by the adaptation of the
work to the workers and their assignment to jobs for
which they are suited; and
(c) Contributing to the establishment and maintenance of
the highest possible degree of physical and mental wellbeing of the workers.
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Provision of Occupational Health Services

(OHS)
Occupational health services do not exist as an end in
themselves but as a means to an end.
They are created to prevent an unnecessary interference
with the primary mission of the organization, whether
that mission is to create wealth, to provide a needed
service, or to protect the interests of a community of
people.

All organizations ; small business corporations,

government agencies, and the military have similar needs
for 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 such
care is measured by the absence of problems rather than
by a specific end point.
It therefore follows that a commitment to sound
occupational health practices must be on-going and not
limited to a specific problem-solving exercise.
This fundamental principle must be accepted by the
decision-makers within an organization or by a proprietor
of a small business before a commitment to provide
occupational health services begins to make sense and
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the value of such services becomes apparent.

Functions/ activities of occupational

health services
Identification and assessment of risks from health
hazards 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 housing
where these facilities are provided by the employer
Advice on planning/organization of work/ work processes

Functions/ activities of occupational

health services
Advice/ provision of information/ training on
occupational health, safety and hygiene,
ergonomics and examinations.

Surveillance of the workers health in relation to

work; pre-employment and periodic
examinations.
Promoting the adaptation of work/environment
to the worker and/or vice versa.

Functions/ activities of occupational

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 accidents

and diseases
Collaboration in providing information, training and
education in the field of occupational health and hygiene
and 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.

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 particular
hazards, unusual technology, or the potential
for injuries?

Considerations cond
What are the pertinent regulations regarding
occupational safety and health?
What has been the past experience of the organization
and 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, internal
multidisciplinary Occupational Health Services.
The advantage of this model is that there is good
knowledge about the processes in the plant and
close to management and workers e.g. Kakira
sugar factory.
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Models of Occupational Health

Services (OHS
2. Inter-enterprise or Group Occupational Health
Services/ model
This refers to Sharing of occupational health
services by groups of small or medium-sized
enterprises

The advantage is they are well staffed, and

multidisciplinary services are offered. However,
the services are far from the enterprises

Models cond
3. Private health centre OHS
These are organized by the physician or group of
physicians. Its in some cases more multidisciplinary.
The disadvantage of these is that they are usually run by
general practitioners and thus provide only general
services. This is a common arrangement with most
common 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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Roles in provision of occupational health services

1.

Role of Ministry of Gender Labour and Social Development

(Uganda)

To formulate and review relevant guidelines, programmes, policies

and laws;
To ensure that occupational accidents, diseases and injuries at the
workplace are minimized;
To promote awareness on occupational safety and health among
stakeholders;

To coordinate and network with stakeholders on occupational

safety and health concerns;
To ensure that initiatives, programmes, policies and laws address
occupational safety and health concerns.
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Roles in provision of occupational health services

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 in

one place is required to put in place a competent
hospital (Uganda Employment Act)
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Organizational Occupational Health

Services
In developed countries, many organizations have their
own 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 place
with 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 to
prevent illness or injury.
They involve elimination of hazardous exposures and
protection against remaining exposures
2. Secondary preventive services: involves detection of
illness in the early stages before signs and symptoms are
notices.
This makes it possible to reverse disease. Interventions
are 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 and
rehabilitative services provided after injury or
illness.

The purpose of this is to prevent disability or

further progression of the disease.

Consultative services
There are different scenarios available for
consultations;
Some physicians offer single consultative visits. They are
paid by the employer to examine workers and prescribe
Independent examiner: e.g. when a worker files for
workmans compensation.
Health risk appraisal and health promotion; these use
surveys, questionnaires and interviews and help patients
to identify aspects of their life styles that are health
risks.
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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 under

circumstances in which another party (employer) pays the bills.
They must therefore address the conflict of interest. They should
therefore;
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 the
ability of employees to work or work restrictions needed and not
the underlying chronic diseases the patient may have.
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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 non
occupational disease
Counseling
First Aid and emergency services
Occupational hygiene
Maintenance of health records

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 many

physicians and other health worker not specialized in occupational
health end up seeing these patients due to inadequacy of
resources
Health care can also be provided by nurses (may be general nurses
or occupational nurses). It may also be provided by Medical
Officers and Clinical Officers especially in developing countries.
In industrialized environments, its provided by occupational
hygienists
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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 provided

through existing National Health Services (a process of
integration)
The services should be to the total health of the workers
and if necessary, their families
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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 health
measures

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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 Referral

Hospitals
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 level
Important points to note
Occupational Health Physician is 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 often
lacking however, 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 every
one
There is shortage of occupational health professionals in
almost all the districts in Uganda, therefore
occupational health services should be integrated in the
general health activities of the district.

Occupational health should be identified as a basic

health activity whose basic concern is the health of a
worker.
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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 stakeholders
at district level
The primary health care approach should be used to
implement the delivery of occupational health services

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Important points to note contd

Occupational health problems at district level
There are a number of occupationally related problems at district
level. 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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Important points to note contd

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 other
personnel
Recommend pre-employment and periodic examination
of workers
Emphasize prevention of occupational health diseases
and injuries
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Roles of Occupational Health Physician at

the District cond
Treatment of occupational health diseases and injuries as
well as rehabilitation of workers
Resource mobilization
Coordination of various stakeholders involved in the
provision of occupational health services in the district

Health surveillance ie ensure that occupationally related

diseases and injuries that occur in the district are
reported to the competent authority according to the
national laws and regulations
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Roles of Occupational Health Physician at

the District contd
Ensure support supervision of cadres involved in the
provision 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 (with
MoH, Ministry of Labour, Agriculture etc) and
Horizontal (with extension staff like hygienists, health
educators, trainers, managers and other employees.

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Roles of Occupational Health Physician at

the District cond
Administration; an Occupational Health Physician should
ensure 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 Health
and Safety, ed. Parmeggiani L. Geneva, International Laborer Office

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

Health
The Occupational Health and Safety Act, 1993Practice
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