This document discusses a new concept in occupational health services called Basic Occupational Health Services (BOHS). It aims to provide occupational health services to all workers globally through a stepwise, infrastructure-based approach.
The document outlines 4 stages of occupational health services infrastructure development: Starting level utilizing field workers; Basic Occupational Health Services (BOHS) utilizing trained personnel near workplaces; International Standard Services led by specialists; and Comprehensive Occupational Health Services found in large companies. Stages I and II focus on smallest enterprises and informal sectors.
BOHS were launched in 2003 through collaboration between ILO, WHO, and ICOH to improve global coverage of occupational health services affordably and effectively using primary health care
This document discusses a new concept in occupational health services called Basic Occupational Health Services (BOHS). It aims to provide occupational health services to all workers globally through a stepwise, infrastructure-based approach.
The document outlines 4 stages of occupational health services infrastructure development: Starting level utilizing field workers; Basic Occupational Health Services (BOHS) utilizing trained personnel near workplaces; International Standard Services led by specialists; and Comprehensive Occupational Health Services found in large companies. Stages I and II focus on smallest enterprises and informal sectors.
BOHS were launched in 2003 through collaboration between ILO, WHO, and ICOH to improve global coverage of occupational health services affordably and effectively using primary health care
This document discusses a new concept in occupational health services called Basic Occupational Health Services (BOHS). It aims to provide occupational health services to all workers globally through a stepwise, infrastructure-based approach.
The document outlines 4 stages of occupational health services infrastructure development: Starting level utilizing field workers; Basic Occupational Health Services (BOHS) utilizing trained personnel near workplaces; International Standard Services led by specialists; and Comprehensive Occupational Health Services found in large companies. Stages I and II focus on smallest enterprises and informal sectors.
BOHS were launched in 2003 through collaboration between ILO, WHO, and ICOH to improve global coverage of occupational health services affordably and effectively using primary health care
This document discusses a new concept in occupational health services called Basic Occupational Health Services (BOHS). It aims to provide occupational health services to all workers globally through a stepwise, infrastructure-based approach.
The document outlines 4 stages of occupational health services infrastructure development: Starting level utilizing field workers; Basic Occupational Health Services (BOHS) utilizing trained personnel near workplaces; International Standard Services led by specialists; and Comprehensive Occupational Health Services found in large companies. Stages I and II focus on smallest enterprises and informal sectors.
BOHS were launched in 2003 through collaboration between ILO, WHO, and ICOH to improve global coverage of occupational health services affordably and effectively using primary health care
BOHS Professor Jorma Rantanen International Commission on Occupational Health Introduction Globalization of economies, fragmentation of enterprise structures, introduction of new technologies and new working methods and new types of work organizations, growing transfer of jobs between the countries, growing mobility of people, fragmentation of employment contracts, short-term employment, ageing of the workforce in many coun- tries, constriction of public budgets and the declining role of Government governance set new challenges for the organization and provision of occupational health services (OHS). The needs for OHS have increased rather than decreased during the times of globaliza- tion in both developing and industrialized countries. Both the elimination, prevention, diagnostics and treatment of traditional occupational health and safety problems, occu- pational diseases, injuries and unreasonable work loads call for wider coverage and higher efficiency of OHS. In spite of that, the global coverage of OHS has been on the decline rather than on the growth during the era of globalization. At best only 1015% of the approximately 3 billion workers of the world have access to OHS and in many cases the content and quality, availability and distribution of services do not meet the real needs. The coverage of both the health services and social security has tended to decline rather than grow during the past 20-year period of "new globalization". This is particularly due to two main trends in the national developments: 1. First, some countries have reduced the Government involvement in social schemes as they in the name of the neo-liberalistic policies have reduced tax reve- nues and delegated previously publicly organized tasks and services to the private sector. This has led to the constriction of coverage of services in the areas and sectors, in which the markets have not provided sufficient incentive to deliver ser- vices. 2. The globalization process has expanded the gap between the richest and poorest countries and richest and poorest groups of people within the countries, thus ex- cluding growing numbers of people from service coverage or through increasing the numbers of people in underserved groups. 8 The principle for universal service provision in provision of oc- cupational health services The declining trends have called attention in International Organizations leading to call for turning the development to a more positive track (the UN Millennium Objectives, Johannesburg Summit objectives, ILO Commission on Social Development objectives, etc.). In connection of commercialization of other services, such as telecommunication and postal services there has been active discussion in the WTO and in the EU on na- tional and international regulatory actions for ensuring services for all, i.e. Universal Service Provision, USP. In the telecommunication sector the discussion has gone one step further in discussion of Universal Services Obligation as a condition for the liber- alization of market. The ultimate objective of the Basic Occupational Health Services (BOHS) initiative is to provide occupational health services for all working people in the world, regardless of the sector of economy, mode of employment, size of the workplace or geographical location, i.e. according to the principle of universal service provision. The principle of universality is widely applied in the provision of socially important services related to the satisfaction of basic needs and in ensuring the basic rights of the citizens. Occupational safety and health constitute an important part of the basic rights of the working people. In the modern democratic society the basic rights are ensured equally for each and everyone. The principle of equality may be considered as an equality within the whole population if it is the question of services which are needed by each citizen or within a special sub-population as in the case of occupational health services which are relevant only for that part of the population which participates in the work life. The principle of USP in the case of occupational health services can be de- fined as the following. The BOHS should be: Accessible to all working people Available to all according to their needs Equitable in access and relevant in content in view of needs Effective in health provision Acceptable for clients Cost-effective in service provision Guaranteed by public authority An integrated part of the social policy of work life. Stepwise development of infrastructures A sustainable occupational health service requires an infrastructure. To get such a structure developed, a stepwise strategy is recommended. Every country should analyse its prevailing situation in OHS. On the basis of such an analysis, a National Strategy and Action Programme need to be drawn up. The development of occupational health ser- vices is recommended to be made in the following steps: Stage I: Starting level To the workers and workplaces, which do not have any OHS at all, this is a reasonable starting point. This is the service utilizing field OHS workers (if possible, a nurse and safety agent), who have a short training in OHS and who work for a primary health care 9 unit or respective grassroots level facility. The content of services focuses on most im- portant and severe health hazards and on their prevention and control. Stage II: Basic Occupational Health Services (BOHS) This is the infrastructure-based service working as close as possible to the workplaces and communities. The service provision model may vary depending on local circum- stances and needs. The personnel (usually a physician and a nurse) have a short special training in occupational health. Stage III: International Standard Services This level is the minimum objective for each country as stipulated by the ILO Conven- tion No. 161. The service infrastructure has several optional forms and the content is primarily preventive, although also curative services may be appropriately provided. The service staff should be led by a specially trained expert (usually a specialist occu- pational health physician) and the team should preferably be multidisciplinary. Stage IV: Comprehensive Occupational Health Services (COHS) This level is usually found in the big companies of industrialized countries or it may be provided by large OHS centres. The staff works as a multidisciplinary team often in- cluding several specialists like specialist physician, occupational health nurse, occupa- tional hygienist, ergonomist, psychologist, safety engineer, etc. The content of services is comprehensive covering all relevant aspects of occupational health. The Stages I and II are primarily designed for the smallest and micro-enterprises, the self-employed and the informal sectors, which have no possibilities to start immediately from the International Standard level. The strategic paradigm of Basic Occupational Health Services To give a response to the growing and urgent needs of OHS, an ILO/WHO/ICOH global action for Basic Occupational Health Services (BOHS) was launched in 2003 with an aim to improve the global coverage of OHS as soon as possible with reasonable costs and technologies and methods affordable to the companies, employers, self-em- ployed and the countries. The Basic Occupational Health Services are an essential service for protection of peo- ple's health at work, for promotion of health, well-being and work ability, as well as for prevention of ill-health and accidents. The BOHS provide services by using scientifi- cally sound and socially acceptable occupational health methods through primary health care approach. The BOHS are an application of the WHO Alma Ata principles and aim on their part at the implementation of the WHO Global Strategy on Occupational Health for All. The BOHS are simultaneously a step in the way towards the ILO Convention No. 161 on Occupational Health Services and No. 155 on Occupational Safety and Health. BOHS also serve as a response to the priority area set for the ILO/WHO/ICOH collaboration by the 13th ILO/WHO Joint Committee on Occupational Health in 2003. The strategic set-up of BOHS is presented in Figure 1. 10 J.Ra nta ne n/Bor deaux 04 Human resources comptence, skills, ethics Policy Mission Strategy Objectives Infrastructure Service provision Support services WHO Str ategy Good Practices Tools & Methods Knowledge basis Figure 1. The WHO Strategy for Basic Occupational Health Services The content and activities of BOHS The activities of the BOHS are planned as a process approach starting from the identifi- cation of needs, going to information and initiatives for actions for the employers and workers and moving to practical action for prevention, control and correction of condi- tions of work, and finally evaluating the impact of OHS on health and safety. A typical sequence of activities is presented in Figure 2, the so-called BOHS Cycle. Figure 2. The BOHS Cycle Orientation and planning of OHS activities which are feasible to the workplace in concern. This step enables adjustment of the activities of OHS to the special problems and specific needs of the workplace in concern and prioritization of the actions. 11 Surveillance of the work environment is made to analyse the actual safety and health situation of the workplace, to identify the most important health hazards and to identify the exposed workers. Surveillance of worker's health is carried out in the form of health examinations. This is a step focusing on the general health situation of the individual workers and particularly on possible health effects of work and the work environment. Not only are diseases searched for but also early signs of non-clinical effects, levels of physical and psychological work load and ability of the worker to manage the de- mands of his or her job. Assessment of health and safety risks is made on the basis of information obtained in the surveillance of the work environment and workers' health. Special system- atic risk assessment schemes are available. The risk assessment step provides in- formation on priority risks in the workplace and on the needs to undertake control and preventive actions. Information and education on risks and advice on the need for preventive and con- trol actions needs to be provided. The actions for elimination, control and preven- tion of occupational health and safety hazards need to be primarily taken by the employers and workers of the workplace. They need to be informed about the need for actions and advised on how to take such actions. Such interaction should be, if possible, continuous. Prevention of accidents. Accidental injuries are one of the most common adverse health effects of the work environment and a substantial part of them are severe or even fatal. Therefore accident prevention is one of the priority activities of OHS often in collaboration with safety experts, where they are available. Often safety of the workplace can be substantially improved with relatively simple and cheap methods, for example, by introducing better order and cleanliness. Maintaining preparedness to first aid and participation in emergency prepared- ness. As accidents anyway happen an appropriate preparedness for them needs to be established. This includes the organization of first aid facilities, training of first aid to at least a part of the personnel and establishment of the necessary links with the hospital polyclinics, rescue organizations and respective actors. Diagnosis of occupational and work-related diseases. The health surveillance or ad hoc contacts with workers may generate suspicions on occupational diseases. These need to be investigated in more detail to make the proper diagnosis and to do the necessary notification, physician's statements on occupational disease and, if appropriate, the necessary therapeutic or preventive actions. Often the suspected cases need to be referred to occupational medicine clinics for diagnosis of com- plex or otherwise demanding cases. General health care, curative and rehabilitation services are provided in many countries as a part of occupational health services. This activity is usually kept at the general practitioner level. These services may be provided also for family members of the workers. Record keeping by BOHS. Most of the activities that OHS are implementing have a legal dimension either from employer's obligations or from workers' protection and workers' compensation point of view. Therefore, all kind of documentation of activities, findings, measurements, actions for prevention and control and infor- mation on occupational accidents and diseases is of utmost importance. There are stringent regulations on the protection of confidential health information and its transfer to a third party. The records kept by the OHS need to be organized ac- cording to the instructions given by the authorities. 12 Evaluation on OHSs own effects and impacts. It is a general principle in all sec- tors of the society that the operators should regularly evaluate their own activities or to be subjected to an external evaluation. Service provision models Several service provision models are used in different countries and for different enter- prise structures. BOHS are likely to operate in sectors, where the market-based service models do not function and therefore public sector intervention is needed. Whatever model is used the competence and capacity of the services to operate should be ensured. In general, numerous models for the provision of occupational health services are avail- able: Primary health services model Big company model Social security institution as a service provider Group service organized jointly by several small and medium-sized enterprises (SME) Private health centres Private physician who has special competence in occupational health Local or regional outpatient clinic of hospitals. Human resources for BOHS An experience-based estimate speaks for a minimum need of one physician and two nurses per 5000 workers with a great variation depending on the branch of industry and size of workplaces, as well as on their geographical distribution. The public authorities are responsible for ensuring that such a resource is available and its competence is regularly updated in every country. The services will be provided by specialists in occu- pational health where they are available. Where not enough specialists are available, the primary health care personnel may provide services if they have been given an appro- priate training in occupational health. In addition, at the secondary level certain support services are needed for advisory and analytical, diagnostic etc. support services. Such services are usually provided by a Centre of Excellence in Occupational Health, for ex- ample, the Institute of Occupational Health. Numerous good practice guidelines are also needed. Financing According to the ILO Convention No. 161 on Occupational Health Services, the finan- cial responsibility for the provision of occupational health services rests on the em- ployer. As the ability of the small enterprises and the self-employed, and particularly the informal sector enterprises and workers, to buy external services is poor or non-existent, often the only possible provider of services is the public sector, i.e. the primary health care units, public polyclinics or social security organizations. References Rant anen J. Basic Occupat ional Healt h Services. A WHO/ILO/ICOH 2nd revised edit ion. 2 April 2005, Finnish Inst it ut e of Occupat ional Healt h, Helsinki 20 p.