How occupational services are provided in the context of integrated primary health care, case of Benin


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Presentation by prof. Benjamin Fayani of the Faculty of Medicine, Cotonou, Benin at the WHO/TNO/Dutchgovernment Congres 'Connecting Health and Labour' 29 - 1 December 2012

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How occupational services are provided in the context of integrated primary health care, case of Benin

  1. 1. How occupational healthservices are provided in thecontext of integrated primaryhealth care:Case of BéninProfessor Benjamin FAYOMIOccupational and Environnement UnitFaculty of MedecineCotonou, Bénin
  2. 2. Key points Who are the workers in our Context Our experience 1 Our experience 2 Our difficulties Our perspectives
  3. 3. 9 Millions peoples
  4. 4. workers in our Context
  5. 5. The results of the study reveal in 2008 that while the public service hardly offers 29 400 jobs (about 9 % of the working population), and while the modern private sector offers approximately 34 400 jobs (about 11 %) the informal sector occupies the front stage with about 269 800 jobs (that is 80 %) Therefore, this sector is a strategic sector
  6. 6. Example The sector of transport, in particular that of the motorcycle taxis ( zémidjan ) alone offers more than 185 000 jobs to the young Beninese, meaning more than half of formal activities. Based on a daily average profit of fcfa 2500, this sector would generate nearly 46,250 billions fcfa every year. = > 7 000 000 Euro/year
  7. 7. Resources put in place for 10%of workers Existence of legal resources Human resources(doctors, nurses, engineers etc.) Material resources Financial resources, etc.
  8. 8. 90 % of the working population which is part of the informal economy are not surveyConclusion : the health protection in the informal economy workers is not assured
  9. 9. Our FIRST experience of integratedprimary health care in informalsecteur in Bénin was named :Joint "Occupational healthcare program for the Benininformal economy "
  10. 10. Basis for the program: Context and justification Occupational healthcare has at all times been set up to favor the government-regulated) workers (formal Economy). As previously explained, these workers represent only 10 % of the working population
  11. 11. Category of occupation Painters (children) Mechanics Vulcanizers Farmers etc.
  12. 12. Motobycycle repair Washing hand with hydrocarbure productsoil pollution
  13. 13. Our Mission/objectif Reach one of the Millennium objectives which is “the fight against poverty" through Accessibility to quality health care General objectiveContribute to the improvement of the health of the Benin informal economy workers
  14. 14. Specific Objectives Enable access to primary healthcare for all the socio professional sectors of the informal economy Set up a system of health protection and prevention.
  15. 15. Expected results- Ensure accessibility to quality health care- The professional pathologies are detected and taken care of immediately- The statistics of occupational hazards in the informal economy are available.- Local care of nearness are supplied.- Self medication is reduced.
  16. 16. StrategiesTwo types of strategies are combined Active screening Workers’ participation
  17. 17. Strategy 1Active screening consists in: Providing local health care through workplaces visits in order to: Know fields of activity and working conditions Detect the work related diseases Satisfy the expressed needs.
  18. 18. Strategy 2 Workers’ participation meaningMembership to the programCollective choice of the services to be offered
  19. 19. ACTIVITES1- Preventive care activities Systematic medical visits of the workers Additional health assessments (blood, eyes, etc.) Practice of specific vaccinations or not2-Activities of promotional care Communication and raising awareness for a change of behavior (contagious and not contagious Diseases)
  20. 20. ACTIVITIES OF CURATIVECARE Provision of health care on the workplace Refer for specialized care To the medical base the humanitarian Health center Call Holy LEONIE or in case of emergency to the Health center which is closest and well equipped.
  21. 21. FUNCTIONNING A medical team is organized:  A general practitioner  A nurse  A nurses aide  Car driver specially trained for the maintenance and the disinfection of the installations once the medical truck parked This team is supported by an occupational health doctor or Occupational heath student
  22. 22. Hospital truck AIR-CONDITIONED with adequate plugs no matter the type of site electric installation. Truck amenities include:  4 waiting cabins,  2 consultations rooms with at least one equipped with accessories for visual screening (Ophthalmology),  Electrocardiogram ( ECG).
  23. 23. Hospital truck (Cont’d)  Biomedical analyses Laboratory (place for sampling)  Pharmacy.  1 Consultation office  A mapping of the closest Health centers for the cases to refer urgently.
  24. 24. COSTConsultation and medical care: all inclusive of 1000 FCFA / person = 1,5 EuroPharmacy: chargeable to the beneficiaryOccupational health visit : 2.000 FCFA / person = 3 EuroBiological assessment depending on the risk: Chargeable to the beneficiary.
  25. 25. PROGRAM’S POTENTIAL PARTNERS  Occupational Health and Environment training and research university unit (URESTE),  International Labour Organization (regional office of West Africa) NOT ACTIVE SUPPORT  …….etc.
  26. 26. MANAGEMENT OF THE PROGRAM MUSANT, a complementary insurance organization with headquarters at Fidjrossè (Cotonou) FAILURE
  27. 27. CAUSES OF THE FAILURE Management method was not collective Fast deviation towards general healthcare Fast deviation towards government- regulated companies
  28. 28. Other experience (a)
  29. 29. Motocycle taximen inCotonouClinical and biological survey since 2004 Our Others experiences
  30. 30. Métabolites urinaires du benzène et du benzopyrène 10,80,6 Vm benzène Vm PMA/100,4 Vm 1-HOP0,2 0 Taxi-moto Témoin
  31. 31. Adduits et des bases hydroxylées et méthylées d ’ADN54 Témoins3 Conducteurs de2 taxi-moto10 Adduits d’ADN en 8-HO dG /108 dG m 5 dC (%) 10µg fmol/µg ADN X10 ADN /10
  32. 32. Other experience (b)
  33. 33. Use of watering cans to spray pesticides
  34. 34. Our perspectives: Based on our experience
  35. 35. Link Governement health service with informal workersgroup
  36. 36. Concretely Global engagement Re-organisation Training Implementation progressively
  37. 37. Global engagement Regional engagement = ILO/WHO (Thinking about the project called JOINT EFFORT (NO CONCRETE RESULT IN AFRICA) National engagement (different ministery) Workers engagement
  38. 38. 9 Millions peoples
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