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Occupational Health and Primary Health Care NOTICES FOR ROUND TABLE 2: PEOPLE-CENTRED CARE Assoc. Prof. Milan Tuček, M.D., Ph.D. Czech Society of Occupational Medicine Charles University, First Faculty of Medicine, Institute of Hygiene and Epidemiology Prague, Czech Republic e-mail: email@example.com www.pracovni.lekarstvi-czWHO Global Conference on Occupational Health and Primary Health Care, The Hague, Nov.29 – Dec.1, 2011
Occupational health services definition (1)Occupational medicine is a speciality of physicians.Occupational health covers a broader spectrum ofdifferent health protective and promotional services.Modern occupational health is a multidisciplinary expertarea, which consists of several knowledge domainsincludingoccupational medicine (clinical medicine focusing on occupational diseases, their diagnostics, treatment and prevention),occupational health services (protection of workers against hazards at work, protection of their health and promotion of health and work ability),occupational psychology (identification, assessment and prevention of psychological and psycho-social factors at work and their prevention and control),occupational hygiene (measurement of physical, chemical, biological and other hazardous agents at the workplace, risk assessment and advice in preventive actions),ergonomics (identification, assessment and prevention of unphysiological working conditions, such as repetitive movements, their prevention and control),occupational safety including accident prevention and development of safe work environments and working practices
Occupational health services definition (2)Occupational medicine is one of the major disciplines ofoccupational health.Complex of- preventive medical examinations,- workplace inspections/visits,- consultations and recommendationsprovided in the Czech Republic mainlyby medical staff, i.e. by physicians and nurses.
LEGISLATIVE FRAMEWORK (1)ILO ConventionFormer Czechoslovakia ratified the ILO Convention no161 in 1988 and no 155 in 1989.Transformation of medical servicesPrimary occupational medical/health services are a partof special health services (valid Special Health ServicesAct, effective since April 1,2012)
LEGISLATIVE FRAMEWORK (2)Authorized physiciansGeneral practitioners without special postgraduate training/education in occupational medicine!!!!Occupational physicians2009: Certified postgraduate course in OM (2 years) after internal medicine, paediatric medicine, general medicine and hygiene and epidemiology !!!!
DISTRIBUTION AND COVERAGE (1)It is very difficult to estimate the coverage of OHSs in theCzech Republic (no precise statistics are at hand):Controls in enterprises were performed (2010), checkingexistence of a signed contract between an employer and an OHS provider, andprovision of OHS services in the full scope as prescribed by the legislature.2% of employers did not provide OHSs at all33 % of employers did not provide OHS in the scopeprescribed by the legislatureEspecially the workers in SMEs are rarely covered by OHSsbecause of the costs of services ensuing for the employers,the lack of providers of these services or an unfavorablegeographic location of the enterprise.
DISTRIBUTION AND COVERAGE (2)Concerning the quality assurance system, thedevelopment of guidelines and standards in occupationalmedicine is of primary importance. The standards forpreventive examinations define the minimum range andfrequency of medical examinations performed byauthorized occupational physicians and the kind ofconsultations which have to be performed in workers at aparticular workplace. Instructions or Guidelines arepublished by the Society of Occupational Medicine.Currently, there is no specific system for qualityassurance for OHS. The Czech Society of OccupationalMedicine has submitted a project aimed at preparation ofsuch a system in the field of OHS.
MAIN ORIENTATION OF OH (1)Categorization of Work OperationsPublic Health Protection Act No. 258/2000 Dig. and theLabor Code No. 155/2000 Dig. stipulate the obligation ofemployers to perform risk assessment, i.e.to identify all health hazards present at the workplace,andto estimate the level of risk (exposure assessment).According to the level of risk, all working activities areclassified into four categories (category 1 is the safest) .Based on the categorization of work operations in aparticular enterprise, appropriate measures for riskmanagement have to be adopted including frequency andcontent of different health examinations.
Categorization of working operations 2010 (workplace health risk assessment) Number of persons (Source : Czech Ministry of Health)The working population in the Czech Republic : about 5 million employees.Of them, about 8 % are working at high risk of various risk factors ofwork or working environment.
Financing structure(s) (1)At present, OHS is funded partly by Health Insurance,partly by employers and some other subjects.The funding is based on the Act on general health insurance No. 48/1997Dig., and other associated Acts, such as No. 242/1997 Dig.The OHSs paid from the general health insurance includeactivities within the frame of first aid, periodicalpreventive examinations of workers at risk,extraordinary examinations performed for medicalreasons (§11, 12, 13, 14 of the Directive of the Ministry of Health No49/1967 Dig), follow-up examinations of workers withnotified occupational diseases and check-ups ofworkers exposed to hazard factors with long-term ordelayed effects.The pre-employment examinations, some periodicalexaminations (e.g. in drivers and firefighters), andextraordinary examinations performed for non-medicalreasons are paid by employers/employees.
Problems of OHSs in the Czech Republic (1)The main problems in OHSs in the Czech Republic areAt the national level (1):Absence of the effective cooperation between stakeholders in the field of occupational health.Incomplete legislation (full implementation of EU Directive 89/391/EEC in the part relating to preventive and protective services is lagging).Ineffective control of employersThere are two independent bodies in the field of occupational health and safety state inspection:(1) occupational health inspection (which belongs to the Ministry of Health) and(2) labor inspection (which belongs to the Ministry of Labor and Social Affairs).
Problems of OHSs in the Czech Republic (2)The main problems in OHSs in the Czech Republic areAt the national level (2):Lack of well-educated professionals in occupational health,industrial hygiene, safety engineering, occupational healthnurses, etc.Several important enactements have not yet passed,especially Act on Accident Inssurance and OccupationalHealth Services Act.Lack of unified concepts and practical usage of riskassessment methodology.Limited collaboration and mutual exchange of informationbetween occupational health care providers and generalpractitioners or other health care specialists.Gaps in the coverage of OHSs, fragmentation of the OHSssystem, and the real danger of turning OHSs into a plaincommercial business (medical chain services).
Problems of OHSs in the Czech Republic (3)At the enterprise level (1):Safety and health protection at work is not incorporatedinto the enterprise management system.Employers’ limited knowledge of their duties inoccupational health and safetyReduction of an investment in the field of occupationalhealth and safety to the lowest possible level (and itsreplacement by compensation for hazardous work)Use of outdated machinery and equipment; purchase of thecheapest types of personal protective means.Pushing workers into overtime work, often requiring thestaff to take time off.Stress resulting from fear of the staff of losing their job.Consultative functions of OHSs are very limited (moreattention is paid to periodic medical examinations)
Problems of OHSs in the Czech Republic (4)At the enterprise level (2):The limited feedback from employees to OHSs providerhow satisfied they are, and what are their actual needsand problems.If ethical problems in provision of OHS services occur,they should be dealt with in agreement with the ICOHCode of Ethics, which was adopted by the Czech Societyof Occupational Medicine.
Foreseen developments and strategies aiming atdevelopment of OHS (1)Modification of the system of social insurance, healthinsurance and health care, focusing on prevention, andincluding health care of the working population, is needed.Further restructuring, reorientation and renovation of thenational OHSs system should be encouraged, andsufficient resources should be allocated for that purpose.The awareness of policy-makers, employers and workersabout the importance of occupational health as a part ofsocio-economic development should be increased.
POSSIBLE RECOMMENDATIONSAppropriate obligatory postgraduate trainingin occupational medicine of GP´s.Key knowledge of working conditions for medicalaptitude/fitness assessment:Minimum: Hazard identification (risk assessment) duringthe workplace visits.Occupational health/medical services Directive necessity(EU)Independent financing (injury insurance )Liberalization of services (chain of medicalservices) not possible without quality control!