This document summarizes discussions from Round Table 1 on universal coverage of a conference on occupational health. [1] Key questions discussed included how to finance universal coverage and ensure equity, essential interventions for preventing work-related diseases, and options when expertise is insufficient. [2] Presentations were given by several representatives on related topics. [3] The group discussed strategies like targeting highest risk populations universally and providing basic occupational health services through primary health care.

1. PARALLEL WORKING SESSIONS
ROUND TABLE 1: UNIVERSAL COVERAGE
Chairs: Prof. Mostafa Ghaffari, Iran; Prof. Frank van Dijk, Amsterdam University
Rapporteurs: Joost van Genabeek, TNO; Julietta Rodriguez-Guzman, WHO/AMRO
1

2. PARALLEL WORKING SESSIONS
ROUND TABLE 1: UNIVERSAL COVERAGE
Objective:
To identify strategies, policy directions and main actions needed to move
towards universal coverage with essential interventions for prevention of
occupational and work-related diseases
Suggested 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

3. Presentations
• Laura Flores, Paraguay
• Hanifa Denny, Indonesia
• Jan De Maeseneer, Belgium
• Jorma Rantanen, Finland
• Joseph Birago, Tanzania
• Z. Leopando, Filipines
• A. Elsharif, Namibia

4. 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

5. Which are the most essential interventions for prevention of
occupational and work-related diseases that need to be
provided to all workers
Essential interventions Conditions, by:
Who How
Hazard identification and risk assessment HRA: job mapping PHC Capacity building
Referral & support
and
support
OHS
Information, education, dissemination and creating awareness to PHC
workers, companies and PHC teams
Education system as a source to incorporate preventive culture in PHC
population &education
sector
Primary prevention: working conditions change; personal PHC / OHS National
protection acknowledgement
Secondary / tertiary prevention: e.g. pesticide control PHC / OHS
Medical complaints –work related?
Recognition diagnosis of common OD, health complaints, etc. by PHC
including work related analysis
Behavioral interventions OHS

6. 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.

7. 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

8. Research and development needed
Research 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