PARALLEL WORKING SESSIONSROUND TABLE 1: UNIVERSAL COVERAGEChairs: Prof. Mostafa Ghaffari, Iran; Prof. Frank van Dijk, Amsterdam UniversityRapporteurs: Joost van Genabeek, TNO; Julietta Rodriguez-Guzman, WHO/AMRO 1
PARALLEL WORKING SESSIONSROUND TABLE 1: UNIVERSAL COVERAGEObjective: To identify strategies, policy directions and main actions needed to move towards universal coverage with essential interventions for prevention of occupational and work-related diseasesSuggested questions:• How to finance universal coverage and ensuring equity, the role of social security and insurance• Which are the most essential interventions for prevention of occupational and work-related diseases that need to be provided to all workers• What are the options for moving towards universal coverage when expertise is insufficient?• What actions should be undertaken to move to universal coverage at the local, national and international level, including research to fill knowledge gaps? 2
Presentations• Laura Flores, Paraguay• Hanifa Denny, Indonesia• Jan De Maeseneer, Belgium• Jorma Rantanen, Finland• Joseph Birago, Tanzania• Z. Leopando, Filipines• A. Elsharif, Namibia
How to finance universal coverage and ensuring equity, the role of social security and insurance• Insurance mostly limited to the formal work and excluding informality• Highest risk populations should be targeted universally• Basic level of OHS should be in the primary health care and governement should ensure universal coverage and appropriate mechanisms to financing it.• Coverage for the informal sector with primary care is limited, so other funding systems should be putted in stake eg associations / corporations or other collective organisations for groups of informal workers• State supporting PHC including OHS for all• Selected coverage seems to be inequitable vs universal coverage although it might be a transitional situation to limited and poor countries
Which are the most essential interventions for prevention of occupational and work-related diseases that need to be provided to all workersEssential interventions Conditions, by: Who HowHazard identification and risk assessment HRA: job mapping PHC Capacity building Referral & support and support OHSInformation, education, dissemination and creating awareness to PHCworkers, companies and PHC teamsEducation system as a source to incorporate preventive culture in PHCpopulation &education sectorPrimary prevention: working conditions change; personal PHC / OHS Nationalprotection acknowledgementSecondary / tertiary prevention: e.g. pesticide control PHC / OHSMedical complaints –work related?Recognition diagnosis of common OD, health complaints, etc. by PHCincluding work related analysisBehavioral interventions OHS
What are the options for moving towards universal coverage when expertise is insufficient?Take into account the different contexts (legal, social, work, etc.) of each country to apply the following as needed:• Be sure to have a first response facing critical situations. Then approach should change with needs, in a progressive scaling up.• Community and volunteer empowerment to create awareness, identify hazards and control risks by self asessments.• WISE / WIND adopted by ILO through safety and health committees.• Develop and train basic expertise HHRR in work related issues: in community levels competences in midcare health worker or OH medical specialist in PHC. This should encompass with different levels of competency according to the complexity of the needs.• Training primary health care providers (nurses, hygienists, etc.) will be strongly appreciated as they can act also in occupational health interventions.• Strenghen referral systems and networking with special units, including IT, telemedicine, telecare and mobile phones and systems.• Resource sharing between services and specialized units.
What actions should be undertaken to move to universal coverage at the local, national and international level, including research to fill knowledge gaps?• WHA resolution 62.12 and WHA 60.26• WHR 2010 on universal coverage• Financial crisis might affect expectations
Research and development neededResearch and sharing experiences needs:• A platform to share experiences on the matters we have discused• Studies that describe evidence based data for decision making• Conceptual work on the focus of chronic conditions (ICF)• Guideline development to bring evidence in daily practice• Connect existing regional networks of comprehensive PHC and OHS• Developing and evaluation of service provision models and financing models• Health care system research including integration OHS in PHC