1) Nearly two-thirds of Thailand's working population are informal workers who face high risks of occupational diseases and injuries but have difficulty accessing occupational health services. 2) The Bureau of Occupational and Environmental Diseases developed a project to integrate basic occupational health services into primary care units to improve access for informal workers. 3) An evaluation found the primary care units were able to provide some basic occupational health activities and over 700,000 farmers received services, demonstrating the potential of this integrated model.

1. Occupational Health and
Primary Health Care in Thailand
S. Siriruttanapruk
Bureau of Occupational and Environmental Diseases
Ministry of Public health

2. Introduction
In Thailand, half of the total population are
working population (36 millions).
Nearly two-third of the working population
(23 millions) are workers in informal
economy.
They are one of the high risk groups for
getting occupational diseases and injuries
They have difficulty to access occupational
health services (OHS)
This led to the establishment of “BOHS”

3. Introduction (Cont.)
The policy development on BOHS by ILO, WHO,
ICOH, and FIOH
The model of desirable BOHS provided by
governmental sector must be integrated into existing
primary health care services with no need to have
extra investments or develop any new system.
Therefore, the Bureau of Occupational and
Environmental Diseases had developed a project on
BOHS model in Thai primary care units (PCUs) since
2004.
Up to now, the concept model of BOHS has been
expanded into some PCUs in every province
throughout the country.

4. Network of governmental health
care service system
Central level
Bur. of O & E
Office of Permanent
Dis.
Secretariat
Regional level
B. of Dis.
Regional hospital
Control
Provincial
General hospital
level
District level Community hospital
Sub-district Health centre or
level Primary Care Unit
(PCU)

5. Financing of OHS
Type Prevention & Curative &
Promotion Rehabilitation
Government Government Government
officers budget budget
Formal employees Employers Social Security
and Workmen’s
Compensation
Fund
Workers in Health Security Health Security
informal economy Fund Fund

6. Steps of the development
Phase 1: Preparation
Phase 2: Model development
Phase 3: Implementation and
expansion
Phase 4: Quality assurance

7. Preparation phase
The project started with the study of
the situation of OHS in PCUs and
identification of the gap for OH practice
among PCU’s staff.
Development of the guidelines for
BOHS and practice for PCU’s staff
Development of the OH training
curriculum

8. Model development phase
The pilot study had been conducted in 17
Thai primary care units (PCUs) in 8 provinces
from every part of the country.
All pilot activities in the field were also
designed and conducted by co-operation
between research team and the PCUs’ staff
Seminars of all pilot PCUs for sharing
experiences
Evaluation of the model

9. Conceptual framework for BOHS
Integration into existing public health
services
Holistic approach
Pro-active approach
Workers’ participation
Suitable technology (with local wisdom
application and low cost)

10. Guidelines of BOHS activities for
PCUs
1. Outpatient services at the units:
Improvement of simple and common occupational
disease recognition and case management,
OPD card re-arrangement,
Disease reporting system
2. 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.

11. Training curriculum
The capacity building for the PCUs’ staff was also a
key success factor.
The training course focused on occupational risk
assessment and utilization of the information for
planning effective OHS.
The training course combined theory, practical field
and group work. At the end of the course, all trainees
were evaluated by measuring of the extent to which
learning objectives were met.
The capacity building program began with a five-day
training course, followed by pilot activities on the
community level under the supervision of experts.

12. Outcomes of the pilot project
The study showed all PCUs were able to
provide OH services.
The target groups of the OH services were
mainly farmers.
The activities performed included OH
education (100%), first aid and emergency
treatment (77%), working environmental
survey in farms (38%), and health screening
for pesticide exposure (79%).

13. Implementation and expansion phase
Setting up of the national policy and indicator
Target: At least 3 PCUs in every province and at
least 20% of high risk workers are under health
risk assessment by PCUs
Collaboration of relevant agencies at all levels:
National Health Security Office, Local
Authorities, Provincial Health Offices
Development of guidelines, tools, etc.
Capacity building
Supportive teams and resource allocation
Evaluation

14. 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.

15. Results of the project
Almost provinces (74/77) join the project.
1/3 of all PCUs (3,602/9,215) report the BOHS
provision
252,651 Occupational Health volunteers have
been trained.
716,571 farmers access to the services
533,524 farmers are under health screening for
pesticide exposure
173,243 (32%) have the results of high exposure

16. Quality assurance phase
Setting up of the quality assurance
system following the existing Hospital
Accreditation system
Setting up of the teams
Assessment and monitoring

17. Occupational Health Volunteers:
People centered health care
and Participatory approach

18. 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
Training
curriculum Simple risk assessment
Monitoring of working
OH Volunteers environment
Simple health surveillance
Communities
selected
Capacity
building
Healthier and happier

19. Roles and Functions of OH
volunteers
OH 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 measures
Characteristics 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

20. Lessons learned
The project can raise an awareness of the
importance of OH in farmers and other workers in
informal economy among health authorities and
officers at provincial and local levels.
OH services for underserved workers could be
integrated effectively into a general health service
system at the PCU level.
The PCU’s staff increased their understanding and
knowledge on OH services.
The project also affected workers’ belief and attitude
about their health and work.

21. Obstacles
No continuously supportive policy from
the top policy makers
Budgetary constraints
Lack of staff and resources
Lack of advance knowledge on OH
Insufficient law enforcement
Ineffective use of information for
further prevention and control of
occupational diseases.

22. Conclusions
OH services are very important for OH
system.
The suitable OH service model for
underserved workers is necessary
Integration of OH services into the PCUs was
favourable.
Continued capacity building to increase
knowledge and skills for the health care staff
is needed.
Policy support and resource allocation are
essential.