Integrating Occupational Health Services Into Public Health Systems
InternationalLabourOfficeIntegratingOccupational Health Servicesinto Public Health Systems:A Model Developed withThailand's Primary Care UnitsDr. Somkiat Siriruttanapruk and teamMinistry of Public Health, ThailandInformal Economy, Poverty and EmploymentThailand Series Number 2
Informal Economy, Poverty and EmploymentThailand SeriesNumber 2Integrating OccupationalHealth Services intoPublic Health Systems:A Model Developed with Thailand’s Primary Care UnitsDr. Somkiat Siriruttanapruk and teamMinistry of Public Health, ThailandInternational Labour Office
Copyright International Labour Organization 2006Publications of the International Labour Office enjoy copyright under Protocol 2 of the Universal CopyrightConvention. Nevertheless, short excerpts from them may be reproduced without authorization, on condition thatthe source is indicated. For rights of reproduction or translation, application should be made to the ILO Publications(Rights and Permissions), International Labour Office, CH-1211 Geneva 22, Switzerland. The International LabourOffice welcomes such applications.Libraries, institutions and other users registered in the United Kingdom with the Copyright Licensing Agency, 90Tottenham Court Road, London W1P 9HE (Fax: 44 171 436 3986), in the United States with the CopyrightClearance Center, 222 Rosewood Drive, Danvers, MA 091923 (Fax: 1 508 750 4470), or in other countries withassociated Reproduction Rights Organizations, may make photocopies in accordance with the licenses issued tothem for this purpose.Dr. Somkiat Siriruttanapruk and teamIntegrating Occupational Health Services into Public Health Systems:A Model Developed with Thailandís Primary Care UnitsBangkok, International Labour Office, 2006ISBN 92-2-119284-9 & 978-92-2-119284-8 (print)ISBN 92-2-119285-7 & 978-92-2-119285-5 (web pdf)The designations employed in ILO publications, which are in conformity with United Nations practice, and thepresentation of material therein do not imply the expression of any opinion whatsoever on the part of the InternationalLabour Office concerning the legal status of any country, area or territory or of its authorities, or concerning thedelimitation of its frontiers.The responsibility for opinions expressed in signed articles, studies and other contributions rests solely with theirauthors, and publication does not constitute an endorsement by the International Labour Office of the opinionsexpressed in them.Reference to names of firms and commercial products and processes does not imply their endorsement by theInternational Labour Office, and any failure to mention a particular firm, commercial product or process is not asign of disapproval.ILO publications can be obtained through major booksellers or ILO local offices in many countries, or direct from ILOPublications, International Labour Office, CH-1211 Geneva 22, Switzerland. Catalogues or lists of new publicationsare available free of charge from the above address.Printed in Thailand2
Forewordhe Government of Thailand emphasizes that accessibility to health care is afundamental human right that must be available to all citizens. Although allThai citizens are entitled to the State Health Insurance Programme, a number ofservices critical to the prevention of ailments remain out of reach. Workers, forinstance, often suffer from problems associated with bad working conditions andunsafe environments; yet they are not able to receive occupational diagnosis andrehabilitation services from the present health system since the capacities arelimited.Primary care units (PCUs) are in the frontline of Thailand’s healthestablishment and are the most accessible to people working in communities andlocal clusters. Based in villages, PCUs carry out health promotion, prevention,medical treatment and rehabilitation services. They are less trained, however,in detecting and addressing occupational health problems and are dependenton few experts based in the provincial or regional offices. Where working peoplespend more than half of their wake time at work, it is expected that many of theailments and incidences presented to the primary care units are rooted in theworkplace.Following the Ministry of Public Health’s (MoPH) initiative to develop PCUcapacities on occupational health services, the ILO-sponsored Informal Economy,Poverty, and Employment Project supported a one-year pilot programme incollaboration with the MoPH and 15 local health units in five provinces. Thisreport details this experience and draws lessons for its replication in Thailand andin other countries. In particular, it summarizes findings from risk assessments ofagricultural and home workers in the five pilot provinces of Thailand. It describes,based on a survey conducted during this collaboration, capacity and level ofawareness of PCU staff on occupational health services. It also draws lessonsfrom training and outreach activities initiated by the PCUs. It also shows howhealth units are the not the only change agents in communities; rather, localdistrict offices and employers and workers organizations play a critical role inframing real solutions that address root causes of workplace hazards.This initiative was carried out in line with ILO’s priority of addressing decentwork deficits based on the four components that define decent work, namely:rights, employment, social protection, organization and representation. Themandate to extend this priority to the informal economy was reaffirmed in the2002 International Labour Conference. Furthermore, specific ILO conventionsT3
such as Convention 151, Occupational Safety and Health Convention (1981);Convention 181, Occupational Health Services Convention (1985); Convention187, Promotional Framework for Occupational Safety and Health Convention(2006), mandate governments to promote the right of workers to a safe andhealthy working environment and to establish national policies, programmes andservices on OSH. Convention 187 in particular calls upon governments to establish,through appropriate laws, agencies and mechanisms, a national system of OSHsupport that would involve, among others, information and advisory services; OSHtraining; occupational health services; research, data collection on occupationalinjuries and diseases; collaboration with insurance systems and, notably, “supportmechanisms for a progressive improvement of occupational safety and healthconditions in micro-enterprises, in small and medium-sized enterprises and inthe informal economy.”The task of extending services to the informal economy where peopleare found in non-traditional work places can lie beyond the institutional reachof labour ministries. Collaboration with the health and agricultural ministries, inparticular through village-based health units and agricultural extension workers,are increasingly viewed as an effective way of augmenting the reach of labouradvisory bodies to workplaces found in homes, farms, local markets, streets andmicro enterprises. Their effectiveness is helped in part by their image, not asmonitoring authorities, but as health promoters and farm advisers. Indeed suchan inter-agency collaboration can be part of a national system of OSH promotionthat can potentially cover a wider reach.This documentation is a product of a very extensive collaboration underthe leadership of the Ministry of Public Health and involving the dynamicparticipation of 15 health units throughout the Thailand. Our gratitude goes tothe project leader, Dr. Somkiat Siriratanapluek of the Bureau of Occupationaland Environmental Disease, Department of Disease Control of the Ministry ofPublic Health. Apart from spearheading this initiative, animating public healthpersonnel nationwide, and preparing this report, Dr. Somkiat also collaboratedwith ILO in various knowledge sharing events involving similar projects of the ILOin Asia, Africa, and Latin America.Thanks also goes to Ms. Juraiwan Siriratana, also of the Bureau ofOccupational and Environmental Disease, Department of the Disease Control,Ministry of Public Health, who coordinated the activities under this project and4
helped in monitoring the results. Ms. Pensri Anantagulnathee translated all thereports into English, which was critical to the collaboration with ILO, and so thata wider audience could be reached. Various health officers in the pilot PCUs areresponsible for the experiences reported in this document. Without their creativityand initiative, we would not possibly have such a collection of experiences as wenow have that can form part of a viable national solution.Many thanks go to Dr. Mei Zegers who collaborated with the Ministry ofPublic Health in finalizing this report. Mr. Tsuyoshi Kawakami, Senior Specialiston Occupational Safety and Health of the Subregional Office for East Asia inBangkok, and Mr. William Salter, Director, a.i., of the Conditions of Work andEmployment Programme (TRAVAIL) in Geneva, provided valuable advice andcomments on the design and implementation of this project.The partnership between ILO and MOPH, including the preparation of thisreport, was initiated and overseen by the project team of the Informal Economy,Poverty and Employment in Thailand. It was closely coordinated by Ms. RakawinLeechanavanichpan, the National Project Coordinator, and backstopped byMs. Sandra Yu, Chief Technical Advisor. Ms. Ginette Forgues, Senior Specialiston Local Strategies for Decent Work provided valuable technical support inthis collaboration and in all of the initiatives of the IE Project. Ms. PaveenaEakthanakit provided efficient administrative support and Mr. MatthewHengesbaugh provided editing and logistical support towards the preparationof this publication.We hope that the knowledge and experience gained from this project,as described in this report, can motivate the rest of Thailand as well as othercountries in exploring similar partnerships especially where PCUs or similarbodies might be mobilized to extend critical OSH services.Jiyuan WangOfficer-in-ChargeILO Subregional Office for East AsiaBangkok, Thailand5
Table of ContentsExecutive Summary . 11Authors’ Acknowledgements . 14Acronyms . 15Definitions of Selected Terms . 161. Introduction . 192. Overview of the Health Context in Thailand . 222.1 Changes in Thai Society and Impact on ChangingPublic Health Services . 222.2 Occupational and Work-related Illnesses and Injuries . 243. Overview of the Health Service System in Thailand . 263.1 Levels of Health Care Service . 273.2 Primary Care Units: Structure, Functions, and Activities . 303.2.1 Structural Standards of Primary Care Units . 303.2.2 Procedural Standards . 313.2.3 Outcome Standards . 313.2.4 Problems in Management of PCUs . 323.3 Occupational Health and Safety Service System in Thailand . 323.4 Constraints in the Existing OSH Framework in Thailand . 334. Review of International Occupational Health Service Models . 344.14.24.34.44.5Definition of Occupational Safety and Health . 34Objectives of OSH Services . 34Activities of Occupational Health Services. 34Models for OSH services . 35Recommendations for Integrating OSH Services inDeveloping Countries . 364.6 Implementing a Model of OSH Service Integration inPrimary Care Units . 386
5. Orientation Survey on Occupational Health Services inPrimary Care Units . 405.1 Study Design and Methodology . 405.2 Results . 405.2.1 Data from Provincial Health Offices Throughoutthe Country . 405.2.2 Data from Pilot Project Area Respondents. 425.3 Discussion . 446. Training on Occupational Health Services forPrimary Health Care Staff . 456.16.26.36.46.5General objective of the training . 45Specific training objectives . 45Course Methods . 46Description of Participants. 46Evaluation of the Training Programme . 467. Integrating OSH Activities into Primary Care Unit Services . 487.1 Basic Implementation Steps for Pilot Projects . 487.2 Details of Specific Steps in the Development ofCommunity-based OSH services . 507.3 Steps in the development OSH services provision forpatients in PCUs . 517.4 Case Study of OSH Services Provided in Ban Gi,by the Muang District PCU . 517.4.1 PCU Based Pilot Experience: OSH Services forPCU patients . 527.4.2 Community Based Pilot Experience: OSH Services forWood Carvers . 527.4.3 Case Study of Community-based Outreach toAgricultural Workers on OSH . 547
Integrating Occupational Health Services into Public Health SystemsA Model Developed with Thailand’s Primary Care Units8 Lessons Learned, Constraints, and Innovations. 568.1 Observations and Lesson Learned. 568.2 Implementation Constraints . 578.3 Selected Innovative Ideas Implemented in the Project . 599. Conclusions and Recommendations . 619.19.29.39.4Annex 1Annex 2Annex 3Annex 48Key Factors Influencing Implementation Success . 62Expected Expansion and Sustainability of the Project in the Future. 63Recommendations . 64Concluding Remarks . 65Guidelines for Occupational and Environmental HealthServices at the Primary Health Care Unit . 66Details of Project Implementation in Pilot Sites . 69Training for OSH Primary Care Unit Service Providers:Course details . 80References . 85
Integrating Occupational Health Services into Public Health SystemsA Model Developed with Thailand’s Primary Care UnitsList of ResearchersList of researchers from the Bureau of Occupational and EnvironmentalDiseases, Department of Disease Control1.2.3.4.5.6.7.Dr. Somkiat SiriruttanaprukMs. Churaiwan SiriratMs. Orapan UntimanontMr. Kowit BoonmeephongMs. Pensri AnantagulnathiMs. Siriwan ChancharoenDr. Pibool IssarapunList of researchers from Regional Centre for Disease Prevention andControl Zones 2, 4, 6 and 10, Department of Disease Control1. Ms. Kanchana KongsaktrakulRegional Centre for Disease Prevention and Control Zone 22. Ms. Rawinant NuchsilpRegional Centre for Disease Prevention and Control Zone 43. Ms. Simaluck DitheesawaswethRegional Centre for Disease Prevention and Control Zone 64. Ms. Warapan PornwisetsirikulRegional Centre for Disease Prevention and Control Zone 109
Integrating Occupational Health Services into Public Health SystemsA Model Developed with Thailand’s Primary Care UnitsList of researchers from five pilot provincesSuphanburi ProvinceMr. Somporn Sripodoke, Suphanburi Provincial Health OfficeHealth care staff of PCU Suan-Tang, Muang DistrictHealth care staff of PCU Plub-Pla-Chai, U-Thong DistrictNakornpathom ProvinceActing Second Lieutenant Sarayuth SimadamrongNakornpathom Provincial Health OfficeHealth care staff of PCU Klong Chinda, Sam-Pran DistrictHealth care staff of PCU Huay Ta-go, Nakornchaisri DistrictKhon Kaen ProvinceMr. Chamnien Mooltep, Khon Kaen Provincial Health OfficeHealth care staff of PCU Ban-Peu, Muang DistrictHealth care staff of PCU Kao-Ngiew, Phol DistrictLamphun ProvinceMr. Preecha Kreauthong, Lamphun Provincial Health OfficeHealth care staff of PCU Pa-Sang Hospital, Pa-Sang DistrictHealth care staff of PCU Muang-Gie, Muang DistrictPhayao ProvinceMs. Chatsiri Pisitkul, Phayao Provincial Health OfficeHealth care staff of PCU Ban-Tom, Muang DistrictHealth care staff of PCU Yuan, Chieng-Kam DistrictEditor and contributor:Dr. Mei Zegers, consultant.10
Integrating Occupational Health Services into Public Health SystemsA Model Developed with Thailand’s Primary Care UnitsExecutive SummaryThe development of an occupational and environmental healthservices model that can be integrated into public health systems is animportant step towards improving workers’ physical and mental health.The goals of such a model are to provide primary medical treatmentand/or referral, support rehabilitation, decrease occupational risk factors,promote good health practices, control occupational diseases and itshazards, and track epidemiological data for further analysis of occupationalillnesses and accident rates.Thailand’s Ministry of Public Health (MoPH) developed such a modelwith support from the ILO. The MoPH referred to key ILO standards such asConvention 161 on occupational health services during the development ofthe model.The model discussed in this report was developed, successfully tested,and can serve to inspire other countries to adapt and implement a similarprogramme.The MoPH carried out a research and development project to createthe model in stages:1) Analysis of the existing situation of occupational and environmentaldiseases prevention and control activities of provincial health officesand primary care units (PCUs) in Thailand.2) Data collection to provide baseline data and inform the developmentof an occupational and environmental health services trainingcurriculum for capacity building for the PCU staff.3) Pilot test the provision of occupational safety and health (OSH)services in PCU.4) Monitor the process throughout implementation of all steps andevaluate effectiveness of the model.Data was collected on occupational disease prevention and controlactivities from 75 provincial health offices and from the PCUs in five pilotprovinces: Nakornpathom, Suphanburi, Khon Kaen, Lamphun, andPhayao.11
Integrating Occupational Health Services into Public Health SystemsA Model Developed with Thailand’s Primary Care UnitsThe PCU staff in the five pilot provinces OSH services implementedthe model with technical support from their provincial health office and thePCU network.Analysis of the baseline study results indicated that occupationaldisease prevention and control activities provided at provincial level needto be targeted to underserved populations such as agricultural and informaleconomy workers.OSH services were integrated into existing health services provided bythe PCUs. Specific activities incorporated into the areas of responsibility ofthe PCUs included: collection of patient work history; job characteristics; recording of data on illness/accident information into family recordsfolder; identification of work hazards by using a risk assessment form andhealth record for employees aged 15 years old and over; implementation of activities promoting occupational health in thecommunity through participation of community and workers; collection and analysis of data; prioritisation of problems and problem solving; monitoring of activities at the regional, provincial, and central level.1 (p-value 0.000).12The project included the development of a five-day training course on OSHservices for the PCU staff in five pilot sites. Participants benefited substantiallyfrom the training as indicated by a post-training test.1 The test results indicatedthat the trainees were able to correctly identify occupational health hazards, assessand indicate factors in controlling occupational risks, and provide appropriatehealth services.The pilot project included activities implemented in the community andthrough outpatient services provided in PCUs.Activities implemented in communities included workplace surveys,participatory data analysis, and communication of survey results to workers forjoint problem solving. Workplace surveys and evaluation of the workingenvironment included general health examinations and screening foroccupational diseases such as pesticide poisoning screening tests foragricultural work groups. Specific strategies to solve problems encountered inagriculture were also implemented.The implementation of OSH services in the community was carried outwith agricultural work groups in seven villages and with community workers inthree villages.Occupational disease prevention and control activities provided at thePCUs included primary medical treatment, finger tip screening test for pesticidepoisoning, health education, and surveys. The most common occupationalhealth problems identified were occupational skin diseases caused bychemicals, musculo-skeletal disorders, accidents, and eye-strain.
Executive SummaryIn conclusion, results from the pilot model on OSH services from 10 PCUsindicate that the PCU staff now have the capacity to provide OSH servicesand related health promotion activities to workers. Capacity was strengthenedto provide community-based services for workers and outpatients. Provincialhealth personnel capacity was also strengthened to provide better support tothe PCU.Continued capacity building to increase knowledge and skills for the healthcare staff will be needed. Advocacy is necessary to create a national policyto integrate the model into the work of remaining PCUs and will need to besupported by sufficient budget and other resources. Once approved, capacitywill need to be developed in all PCUs throughout the country. Identificationof roles and responsibilities as well as development of implementation networkswill be required. Awareness raising among local authorities with respect tooccupational health issues is necessary so that they can become a majorpartner in supporting PCU activities.13
Integrating Occupational Health Services into Public Health SystemsA Model Developed with Thailand’s Primary Care UnitsAuthors’ AcknowledgementsWe, the researchers, wish to express our gratitude to the InternationalLabour Organization (ILO) and the Bureau of Occupational and EnvironmentalDiseases, Department of Disease Control, Ministry of Public Health, Thailandfor supporting this study. The researchers also wish to thank Dr. SurinthornKalumplakorn from the Faculty of Public Health, Mahidol University;Dr. Kittipong Panomyong from Nopparatrachathanee Hospital; Dr. SasithornTeptagarnporn, Dr. Soisuda Kesornthong, Ms. Rachaneekorn Chomsuan,Ms. Malee Pongsopon, Ms. Suthida U-tapan from the Bureau of Occupationaland Environmental Diseases, Department of Disease Control; Chief MedicalOfficer of Suphanburi, Nakornpathom, Khon Kaen, Lamphun, and the PhayaoProvincial Health Office for working as training lecturers, participating in thisproject, providing recommendations, and for contributing to this project’sachievements.Project researchers14
Integrating Occupational Health Services into Public Health SystemsA Model Developed with Thailand’s Primary Care MoPHContracting Unit for Primary CareGross Domestic Producthealth volunteerMinistry of AgricultureMinistry of LabourMinistry of Public HealthOccupational Medicine Sectionoutpatient departmenoccupational safety and healthprimary care unitWorld Health OrganizationWork Improvement in Neighbourhood DevelopmentMinistry of Public Health15
Integrating Occupational Health Services into Public Health SystemsA Model Developed with Thailand’s Primary Care UnitsDefinitions of Selected TermsHealth education: refers to consciously constructed opportunities for learninginvolving some form of communication designed to improve health literacy,including improving knowledge, and developing life skills which are conducive toindividual and community health.2Health promotion is a strategy for improving the health of the population byproviding individuals, groups and communities with the tools to make informeddecisions about their well-being. Moving beyond the traditional treatment ofillness and injury, health promotion efforts are centered primarily on the social,physical, economic and political factors that affect health, and include suchactivities as the promotion of physical fitness, healthy living and good nutrition.Emphasis is placed on collaborative work with different partners.3Health protection involves the development and implementation of directregulations and other strategies aimed at protecting the health of the people(of a country) against proven health risks over which they, by themselves, havelittle or no control.4Health services refers to services provided to the public that meets their healthneeds and provides solutions to health problems in order to increase quality oflife through improved physical and mental health.Contracting Unit for Primary Care (CUP) is a health service unit that is contractedby the province to be the main deliverer of health care to its registeredpopulation.2 WHO, Health PromotionGlossary, WHO/HRP/98.1; Geneva: 1998.3 Pubic Health Agencyof Canada, lossary.html. accessed 14-052006.4 ibid.5 ibid.16Primary Care Unit (PCU) is a public health service unit that works withcommunities, families, and individuals to identify health needs and assets,and supports individual and community action to prevent illness, protect andpromote health, and achieve well being.Prevention is a method of averting health problems (e.g. disease, injury)through interventions. Preventing and reducing the incidence of illness andinjury may be accomplished through three mechanisms: activities gearedtoward reducing factors leading to health problems; activities involving theearly detection of, and intervention in, the potential development or occurrenceof a health problem; and activities focusing on the treatment of health problemsand the prevention of further deterioration and recurrence.5
Addressing occupational health and safety of allworkers17
Integrating Occupational Health Services into Public Health SystemsA Model Developed with Thailand’s Primary Care UnitsHealth exam in the workplaceFingertip screening test for cholinesterase levelDemonstrating locally made organic pesticidesand fertilizersFarmers look on as their their organicmethods are described to visitorsInternational exchange participants on site visit to understandthe PCU model18
Integrating Occupational Health Services into Public Health SystemsA Model Developed with Thailand’s Primary Care Units1Introduction6 United Nations ThailandWebsite, accessed 31-052006.7 National Statistical Office,Thailand, 2006a.8 National Statistical Office,Thailand, 2006b.9 Economic and SocialStatistics Bureau, 200510 Bundit Thanachaisethavut,200511 Human DevelopmentReport, Thailand 2005.12 Human DevelopmentReport, Thailand 2005;Economist IntelligenceUnit, Fact Sheet, Oct 13th2005.13 Economist IntelligenceUnit, Country Forecast,November 10, 2005.14 World Bank, ThailandCountry Data. 2005.15 World Bank, ThailandCountry Data. 2001.16 Natio
such as Convention 151, Occupational Safety and Health Convention (1981); Convention 181, Occupational Health Services Convention (1985); Convention 187, Promotional Framework for Occupational Safety and Health Convention (2006), mandate governments to promote the right of workers to a safe and
Documentation of occupational therapy services is necessary whenever professional services are provided to a client. Occupational therapists and occupational therapy assistants1 determine the appropriate type of documentation structure and then record the services provided within their scope of practice. This document, based on the Occupational .File Size: 540KBPage Count: 9Explore furtherDocumentation & Reimbursement - AOTAwww.aota.orgNEW OT Evaluation and Reevaluation - AOTA Guidelinestherapylog.typepad.comWriting progress notes in occupational therapy jobs .www.aureusmedical.comDocumentation & Data Collection For Pediatric Occupational .www.toolstogrowot.comSOAP Note and Documentation Templates & Examples Seniors .seniorsflourish.comRecommended to you b
Occupational therapists around the world are obligated to promote occupational rights as the actualization of human rights. This obligation requires addressing occupational injustices, initially named as occupational deprivation, occupational imbalance, occupational marginalisation, and occupational alienation (Wilcock & Townsend, 2000 .
1When the term occupational therapy practitioner is used in this document, it refers to both occupational therapists and occupational therapy assistants (AOTA, 2015b). Occupational therapists are responsible for all aspects of occupational therapy service delivery and are accountable for the safety and effectiveness of the occupational therapy .
403-1 Occupational health and safety management system 403-2 Hazard identification, risk assessment, and incident investigation 403-3 Occupational health services 403-4 Worker participation, consultation, and communication on occupational health and safety 403-5 Worker training on occupational health and safety 403-6 Promotion of worker health
5 .2 To assess compliance with HSE Standards for Occupational Health Services 2018 Research 6 .1 To develop a research plan for Occupational Health Nursing to include data relevant and applicable to occupational health settings 6 .2 To develop a forum for sharing and communication of relevant research and data to the Occupational Health Nursing .
2.14. P ercent of Occupational NYS OHCN Patients, by Major Occupational Group and Patient Type .21 2.15. Percent of Occupational NYS OHCN Patients, by Major Occupational Group and Geographic Region .22 2.16. P ercent of Occupational NYS OHCN Patients,
FAQ 1 - What is occupational health? Occupational Health is a medical specialty that is concerned with the effects of health on work and work on health. It also considers an individual's health, ability and fitness to perform certain jobs/workplace tasks. Occupational Health is a medical advisory service aimed at supporting people in the .
Director of Army Safety Background A rmy motorcycle mishaps are on the rise. Motorcycle mishaps resulted in 155 Soldier fatalities from FY02 through FY06. Collected accident data revealed that over half of motorcycle fatalities were the result of single vehicle accidents that involved riders exercising poor risk decisions and judgment. Males between the ages of 18 and 25 years are historically .
