Occupational health and primary health care in Thailand
Occupational Health andPrimary Health Care in Thailand S. Siriruttanapruk Bureau of Occupational and Environmental Diseases Ministry of Public health
IntroductionIn Thailand, half of the total population areworking population (36 millions).Nearly two-third of the working population(23 millions) are workers in informaleconomy.They are one of the high risk groups forgetting occupational diseases and injuriesThey have difficulty to access occupationalhealth services (OHS)This led to the establishment of “BOHS”
Introduction (Cont.)The policy development on BOHS by ILO, WHO,ICOH, and FIOHThe model of desirable BOHS provided bygovernmental sector must be integrated into existingprimary health care services with no need to haveextra investments or develop any new system.Therefore, the Bureau of Occupational andEnvironmental Diseases had developed a project onBOHS model in Thai primary care units (PCUs) since2004.Up to now, the concept model of BOHS has beenexpanded into some PCUs in every provincethroughout the country.
Network of governmental health care service systemCentral level Bur. of O & E Office of Permanent Dis. SecretariatRegional level B. of Dis. Regional hospital ControlProvincial General hospitallevelDistrict level Community hospitalSub-district Health centre orlevel Primary Care Unit (PCU)
Financing of OHS Type Prevention & Curative & Promotion RehabilitationGovernment Government Governmentofficers budget budgetFormal employees Employers Social Security and Workmen’s Compensation FundWorkers in Health Security Health Securityinformal economy Fund Fund
Steps of the developmentPhase 1: PreparationPhase 2: Model developmentPhase 3: Implementation andexpansionPhase 4: Quality assurance
Preparation phaseThe project started with the study ofthe situation of OHS in PCUs andidentification of the gap for OH practiceamong PCU’s staff.Development of the guidelines forBOHS and practice for PCU’s staffDevelopment of the OH trainingcurriculum
Model development phaseThe pilot study had been conducted in 17Thai primary care units (PCUs) in 8 provincesfrom every part of the country.All pilot activities in the field were alsodesigned and conducted by co-operationbetween research team and the PCUs’ staffSeminars of all pilot PCUs for sharingexperiencesEvaluation of the model
Conceptual framework for BOHSIntegration into existing public healthservicesHolistic approachPro-active approachWorkers’ participationSuitable technology (with local wisdomapplication and low cost)
Guidelines of BOHS activities for PCUs1. Outpatient services at the units: Improvement of simple and common occupational disease recognition and case management, OPD card re-arrangement, Disease reporting system2. OH services in communities (Pro-active approach) Farm or workplace survey, Participatory data analysis, Health screening, Communication of results with workers for joint problem solving.
Training curriculumThe capacity building for the PCUs’ staff was also akey success factor.The training course focused on occupational riskassessment and utilization of the information forplanning effective OHS.The training course combined theory, practical fieldand group work. At the end of the course, all traineeswere evaluated by measuring of the extent to whichlearning objectives were met.The capacity building program began with a five-daytraining course, followed by pilot activities on thecommunity level under the supervision of experts.
Outcomes of the pilot projectThe study showed all PCUs were able toprovide OH services.The target groups of the OH services weremainly farmers.The activities performed included OHeducation (100%), first aid and emergencytreatment (77%), working environmentalsurvey in farms (38%), and health screeningfor pesticide exposure (79%).
Implementation and expansion phaseSetting up of the national policy and indicatorTarget: At least 3 PCUs in every province and atleast 20% of high risk workers are under healthrisk assessment by PCUsCollaboration of relevant agencies at all levels:National Health Security Office, LocalAuthorities, Provincial Health OfficesDevelopment of guidelines, tools, etc.Capacity buildingSupportive teams and resource allocationEvaluation
Outcomes of the implementation In 2011, MOPH has set up the project to celebrate the 84th years of the King’s birthday The project’s called, “Healthy Farmers, Safety Consumers”. The aim is to protect both farmers and consumers from pesticide poisoning by integrating BOHS for farmers into PCUs.
Results of the projectAlmost provinces (74/77) join the project.1/3 of all PCUs (3,602/9,215) report the BOHSprovision252,651 Occupational Health volunteers havebeen trained.716,571 farmers access to the services533,524 farmers are under health screening forpesticide exposure173,243 (32%) have the results of high exposure
Quality assurance phaseSetting up of the quality assurancesystem following the existing HospitalAccreditation systemSetting up of the teamsAssessment and monitoring
Occupational Health Volunteers: People centered health care and Participatory approach
Capacity Building of Workers’ Representatives for Supportive of Occupational Health Management in Thai Communities Target group: Informal workers Problems identified: Occupational diseases and injuries Reviewing roles & functions Trainingcurriculum Simple risk assessment Monitoring of working OH Volunteers environment Simple health surveillanceCommunities selected Capacity building Healthier and happier
Roles and Functions of OH volunteersOH volunteer is a workers’ representative for collaboration with primary health care staff in provision of some OH activities to their peer group (1volunteer:10-20 workers)Duties: Provision of some basic OH activities e.g. health risk assessment, OH education, and advice on implementation of preventive measuresCharacteristics of OH volunteers: Workers’ leader or representative Currently being Health Volunteer Be voluntary to perform the duty Be able to read or write and communicate to other workers
Lessons learnedThe project can raise an awareness of theimportance of OH in farmers and other workers ininformal economy among health authorities andofficers at provincial and local levels.OH services for underserved workers could beintegrated effectively into a general health servicesystem at the PCU level.The PCU’s staff increased their understanding andknowledge on OH services.The project also affected workers’ belief and attitudeabout their health and work.
ObstaclesNo continuously supportive policy fromthe top policy makersBudgetary constraintsLack of staff and resourcesLack of advance knowledge on OHInsufficient law enforcementIneffective use of information forfurther prevention and control ofoccupational diseases.
ConclusionsOH services are very important for OHsystem.The suitable OH service model forunderserved workers is necessaryIntegration of OH services into the PCUs wasfavourable.Continued capacity building to increaseknowledge and skills for the health care staffis needed.Policy support and resource allocation areessential.