1. MINISTRY OF LABOUR & SOCIAL SECURITY DIRECTORATE GENERAL OF OHS
Dr. Buhara Önal
OHS INSTITUTE (ISGUM)
May 2010
Ankara - TURKEY

2. BASIC OCCUPATIONAL HEALTH SERVICES

3. CONTENT Policy background ILO Convention 161 EU Legislation on OHS
WHO Worker’s health: Global Plan of Action
Basic Occupational Health Services (BOHS)

4. OCCUPATIONAL HEALTH AS A FUNDAMENTAL HUMAN RIGHT
World Health Organization
1 April, 2017
OCCUPATIONAL HEALTH AS A FUNDAMENTAL HUMAN RIGHT
Every worker has the right to working conditions which respect his or her health, safety and dignity.
(Art. 31 of the European Charter)

5. IMPACT OF THE OCCUPATIONAL ENVIRONMENT ON HEALTH
World Health Organization
1 April, 2017
IMPACT OF THE OCCUPATIONAL ENVIRONMENT ON HEALTH
workers die of work-related diseases
workers die in occupational accidents (5% of all deaths due to accidents)
Loss of 4% GDP
In absolute terms, 300,000 deaths per year are attributable to occupational related causes and to occupational accidents, the latter being 5 % of the total deaths due to accidents each year in the Region. Basically, we are losing 1000 workers everyday due to unhealthy and unsafe working conditions. However, the impacts are even more serious than these numbers of death counts.

6. POLICY BACKGROUND
ILO EU
WHO

7. ILO
Joint Committees
Related Conventions and Recommendations, Convention 161, Recommendation 171, in particular
Ethics in workers' health surveillance guidelines
Numerous Codes of Practice
Global Strategy
Promotional Framework for Occupational Safety and Health Convention 187
Fair globalization-Decent Work

8. ILO CONVENTION 161 OH SERVICES
Article 1: For the purpose of this Convention-
(a) the term occupational health services means services entrusted with essentially preventive functions and responsible for advising the employer, the workers and their representatives in the undertaking on-
(i) the requirements for establishing and maintaining a safe and healthy working environment which will facilitate optimal physical and mental health in relation to work;
(ii) the adaptation of work to the capabilities of workers in the light of their state of physical and mental health;
(b) the term workers' representatives in the undertaking means persons who are recognised as such under national law or practice.

9. ILO CONVENTION 161(cont.) Article 2
In the light of national conditions and practice and in consultation with the most representative organisations of employers and workers, where they exist, each Member shall formulate, implement and periodically review a coherent national policy on occupational health services.

10. ILO CONVENTION 161(cont.) Article 3
1. Each Member undertakes to develop progressively occupational health services for all workers, including those in the public sector and the members of production co-operatives, in all branches of economic activity and all undertakings. The provision made should be adequate and appropriate to the specific risks of the undertakings.
2. If occupational health services cannot be immediately established for all undertakings, each Member concerned shall draw up plans for the establishment of such services in consultation with the most representative organisations of employers and workers, where they exist.

11. ILO CONVENTION 161(cont.)
Article 5
…….occupational health services shall have such of the following functions as are adequate and appropriate to the occupational risks of the undertaking:
(a) identification and assessment of the risks from health hazards in the workplace;
(b) surveillance of the factors in the working environment and working practices which may affect workers' health, including sanitary installations, canteens and housing where these facilities are provided by the employer;
(c) advice on planning and organisation of work, including the design of workplaces, on the choice, maintenance and condition of machinery and other equipment and on substances used in work;

12. ILO CONVENTION 161(cont.)
(d) participation in the development of programmes for the improvement of working practices as well as testing and evaluation of health aspects of new equipment;
(e) advice on occupational health, safety and hygiene and on ergonomics and individual and collective protective equipment;
f) surveillance of workers' health in relation to work;
(g) promoting the adaptation of work to the worker;
(h) contribution to measures of vocational rehabilitation;
(i) collaboration in providing information, training and education in the fields of occupational health and hygiene and ergonomics;
(j) organising of first aid and emergency treatment;
(k) participation in analysis of occupational accidents and occupational diseases.

13. ILO CONVENTION 161(cont.) Article 7
1. Occupational health services may be organised as a service for a single undertaking or as a service common to a number of undertakings, as appropriate.
2. In accordance with national conditions and practice, occupational health services may be organised by-
(a) the undertakings or groups of undertakings concerned;
(b) public authorities or official services;
(c) social security institutions;
(d) any other bodies authorised by the competent authority;
(e) a combination of any of the above.

14. ILO CONVENTION 161(cont.) Article 9
1. In accordance with national law and practice, occupational health services should be multidisciplinary. The composition of the personnel shall be determined by the nature of the duties to be performed.
2. Occupational health services shall carry out their functions in co-operation with the other services in the undertaking.
3. Measures shall be taken, in accordance with national law and practice, to ensure adequate co-operation and co-ordination between occupational health services and, as appropriate, other bodies concerned with the provision of health services.

15. EU Framework Directive 89/391-preventive and protective services
Occupational health and safety strategy
Workplace health promotion
Economic loss/productivity

16. PRINCIPLES OF EU LEGISLATION ON OCCUPATIONAL HEALTH AND SAFETY
World Health Organization
PRINCIPLES OF EU LEGISLATION ON OCCUPATIONAL HEALTH AND SAFETY
1 April, 2017
 Prevention
 Hierarchy of prevention measures
 Continuous improvement
 Health and Safety
 Employers’ responsibility
 Social dialogue and participation of employees
 Multidisciplinarity in preventive services & holistic approach to work

17. FRAMEWORK DİRECTİVE 89/391/EEC
Its scope is large: all sectors of activity, both public and private, with very few clearly described exceptions.
Article 5 (1), the Directive's fundamental provision, states that "the employer shall have a duty to ensure the safety and health of workers in every aspect related to the work."

18. World Health Organization
1 April, 2017
89/391/EHS – Framework Directive
on the introduction of measures to encourage improvements
in the safety and health of workers at work
Using of the work equipment
89/655/EEC
Work Equipment (2)
Specific group of workers
92/85/EEC
Pregnant and breastfeeding workers and worker who have recently given birth (10)
Specific activities
90/269/EEC
Manual Handling of Loads (4)
90/270/EEC
Display Screen Equipments (5)
92/91/EEC
Drilling (11)
Personal protection
89/656/EEC
Personal Protective Equipment (3)
Exposure to agents
90/394/EEC
Carcinogens (6)
2000/54/EC
Biological Agents (7)
98/24/EC
Chemical Agents (14)
2000/44/EC
Vibrations (16)
2003/10/EC
Noise (17)
2004/40/EC
Electromagnetic Fields (18)
Workplace
89/654/EEC
Workplace (1)
92/57/EEC
Temporary/Mobile Construction Sites (8)
92/58/EEC
Safety and/or Health Signs (9)
92/104/EEC
Surface and Underground Mineral-extracting Industries (12)
93/103/EC
Fishing Wessels (13)
1999/92/EC
Explosive Athmospheres (15)
2000/39/EC
Indicative occupational
exposure limit values

19. World Health Organization
1 April, 2017
OHS directives which
are not directly under
Framework Directive 89/391/EEC
91/383/EEC
Temporary Workers
94/33/EC
Young Workers
93/104/EC
2000/34/EC
2000/79/EC
2002/15/EC
Working Time
1983/477/EC
1999/77/EC
2003/18/EC
Asbestos

20. WHO WHO HFA 2000 and HFA21 Alma Ata: Primary Health Care
Health sector reform
Public health policy: Prevent the preventable
Equity: odd distribution of risks
Social determinants of health
Global Strategy on OH for All
Workers’ Health - Global Action Plan

21. WHO’S CONCEPT ON WORKERS’ HEALTH AS A PUBLIC HEALTH ISSUE
World Health Organization
1 April, 2017
WHO’S CONCEPT ON WORKERS’ HEALTH AS A PUBLIC HEALTH ISSUE
The Labour Approach
The Public Health Approach
Occupational Health
Labour Contract
Employer's responsibility
Only at the workplace
Only work-related health
Negotiation between workers and employers
Workers Health
All workers beyond the workplace
Responsibility of everyone
All health determinants
Other stakeholders Health protection not subject to collective negotiation
Can use the example of Move for Health Day, and initiatives at the work place to support diet and physical activity and sustainable commuting. Recall Move for health day 2007

22. 60TH WORLD HEALTH ASSEMBLY "WORKERS' HEALTH: GLOBAL PLAN OF ACTİON"
The Global Plan of Action developed by the Member States, May 2007
Consensus by all 192 Member States of WHO
Global plan of action on workers' health ( )
WHA60 urged Member States to take an number of measures on workers' health

23. World Health Organization
1 April, 2017
OBJECTIVE 1: TO DEVELOP AND IMPLEMENT POLICY INSTRUMENTS ON WORKERS HEALTH
National policy frameworks
legislation
intersectoral collaboration
funding and resource mobilization
strengthening the ministries of health
National action on workers’ health (taking into consideration also ILO Promotional Framework for OSH Convention)
national profiles and priorities for action
objectives, targets and actions
mechanism for implementation, monitoring and evaluation
human and financial resources
National approaches for prevention of priority occupational diseases and accidents
Minimizing gaps – high risk sectors, vulnerable groups, gender aspects
WHO assistance to strengthen the capacities of ministries of health; global campaigns: elimination of asbestos-related diseases and immunization of healthcare workers against HBV

24. OBJECTIVE 2:TO PROTECT AND PROMOTE HEALTH AT THE WORKPLACE
World Health Organization
OBJECTIVE 2:TO PROTECT AND PROMOTE HEALTH AT THE WORKPLACE
1 April, 2017
Improving assessment and management of health risks at workplace:
Essential interventions for prevention occupational hazards
Integrated management of chemicals
Elimination of smoking from all indoor workplaces
Health impact assessment of new technologies
Basic set of occupational health standards
Minimum requirements for health and safety protection
Enforcement and inspection
Capacities for primary prevention of occupational hazards, diseases and injuries: methodologies, training, healthy workplaces
Health promotion and prevention of noncommunicable diseases at workplace: diet, physical activity, mental health, family health
Prevention and control HIV/AIDS, malaria, TB etc. in workplace

25. World Health Organization
OBJECTIVE 3:TO IMPROVE THE PERFORMANCE OF AND ACCESS TO OCCUPATIONAL HEALTH SERVICES
1 April, 2017
Coverage and quality of occupational health services
Linkage to national health strategies and health sector reforms
Standards for organization and coverage
Mechanisms for resources and financing of the delivery
Sufficient and competent human resources
Quality assurance systems
Basic occupational health services for all workers
Building core institutional capacities – national and local levels
Development of human resources for occupational health
Post graduate training
Capacities for basic occupational health services
workers-’health in training of primary health care
Attracting and retaining human resources

26. World Health Organization
OBJECTIVE 4: TO PROVIDE AND COMMUNICATE EVIDENCE FOR ACTION AND PRACTICE
1 April, 2017
Systems for surveillance of workers' health
National information systems
Capacities to estimate burden of diseases and injuries
Registries of exposures, diseases and accidents
Early reporting and detection
Research
Special agendas
Practical and participatory research
Communication and awareness raising
Workers and employers
Policy makers, media
Health practitioners
WHO action: indicators for workers' health; incorporation of occupational causes of diseases in ICD11; diagnostic and exposure criteria for occupational diseases

27. OBJECTIVE 5: TO INCORPORATE WORKERS’ HEALTH INTO OTHER POLICIES
World Health Organization
OBJECTIVE 5: TO INCORPORATE WORKERS’ HEALTH INTO OTHER POLICIES
1 April, 2017
Economic development policies and poverty reduction strategies
Collaboration with private sectors to avoid international transfer of risks
National plans and programmes for sustainable development
Consider workers' health in the context of trade policies
Assess health impacts of employment policies
Environmental protection in relation to workers' health:
Strategic approach to International Chemicals Management
Multilateral environmental agreements
Environmental management systems
Emergency preparedness and response
Sectoral policies for branches with highest health risks
Primary, secondary and higher level of education and vocational training

28. ESSENTIAL PUBLIC HEALTH FUNCTIONS IN THE AREA OF OCCUPATIONAL HEALTH
Assessment and management of occupational risks
Monitoring and surveillance of workers' health
Workplace health promotion
Participation of workers and employers
Development of policies and institutional capacity
Strengthening of institutional capacity for regulation and enforcement in occupational health
Evaluation and promotion of equitable access to OH services
Human resources development and training in OH
Quality assurance in OH services
Research in OH
Reduction of the impact of industrial accidents and technological disasters on health
WHO PAHO “Public Health in the Americas. Conceptual Renewal, Performance Assessment, and Bases for Action” 2002

29. BOHS
Occupational health services are available to only 10%–15% of
workers worldwide.
In industrialized countries, the coverage varies between 15% and 90% and in developing countries between a few percent and 20%, even where services are available, their quality and relevance may be low.
The needs of occupational health services grow continuously and new challenges are set by the globalization of work life.
To provide a response to such a global challenge the WHO/ILO/ICOH joint effort on the development of BOHS was launched.

30. World Health Organization
COVERAGE OF OHS
1 April, 2017
Workers without OHS
What is the current coverage of occupational health services? There are unfortunately very few data on the percentage of economically active population covered with occupational health services. This figure shows the data available for 21 countries, mostly from the European region. The numbers range from almost universal (95% in Netherlands, 90% in Finland) to a very limited coverage (4% in Slovakia and 5% in Kenya).
On average about 50% of the workers in the 15 Member States of the European Union (prior to 1 May 2004). Though this figure may seem very high compared to the average for the world (15%) it was considered unsatisfactory for the EU. In February 2005, the European Parliament expressed concern that only half of the European workers have access to occupational health services having in mind that the framework legislation of the European Union requires that all workers should have access to preventive services at the workplace. The low access to occupational health services was therefore considered as failure to implement the EU legislation on health and safety at work.
The triangle on the right upper side of the diagram shows the underserved population which is the object of new models for provision of occupational health services, i.e. the basic occupational health services.

31. BOHS
The ultimate objective of the BOHS initiative is to provide occupational health services for all working people in the world, regardless of economic sector, mode of employment, size of workplace or geographic location i.e. according to the principle of universal services provision

32. BOHS There is a challenge to provide good practice guidelines and
toolboxes for service providers on a number of specific activities, such as planning of occupational health services, risk assessment and management, ergonomics and safety, assessment of psychological conditions and stress, and diagnosis of occupational diseases.

33. BOHS
BOHS are most needed for countries and sectors that do not have services at all or which are seriously underserved.
Particularly high-risk sectors such as agriculture, mining, fishery, forestry and construction have to be given priority.
Governments, in collaboration with social partners and with support and guidance by international organizations, should strengthen their policies and clarify priorities with regard to organization and development of service infrastructures.

34. BOHS CYCLE Workers health Work Organization Work environment Worker
Orientation
and planning
Evaluation
Evaluation
Monitoring &
Surveillance of WE
Record keeping
Surveillance of
worker's health
Individual
health record
Worker
Assessing
WE Risk Assessment
General
health service
Assessment of
individual's
health risk
Emergency
preparedness
First aid
Health education
and health
information
Dg of ODs
and WRDs
Action
Information
Accident prevention
Initiatives
Interaction &
Education
Prevention of
OH hazards
Initiatives
Work Organization
Work environment

35. HIERARCHY OF PREVENTIVE MEASURES
World Health Organization
1 April, 2017
HIERARCHY OF PREVENTIVE MEASURES
Structural prevention
Lack of hazard
Engineering controls
Minimising emissions
Control technology
Ventilation, exhaustion
Working practices,
wet processes,
cleanliness, order
Personal protection,
respirators
Preventive power
Limiting exposure
times
Decontamination,
health surveillance,
early diagnosis,
treatment
Burden to health

36. World Health Organization
1 April, 2017
A STEPWISE STRATEGY
FOR OCCUPATIONAL HEALTH SERVICES
Stage IV
Comprehensive
Service
Stage III
International
Standard Service
In-company or external
special OHS units
Comprehensive content:
prevention, curative and promotion & development services
Continuous development
Objective for all!
Stage II
Basic Service
OHS Infrastructure
ILO No. 161, 155
Multidisciplinary
content
Prevention plus
curative services
Stage I
Starting level
PHC Infrastructure
Basic OHS content
Toolboxes
Advice in OH
Accidents and ODs
Acute ill-health
PHC
Field nurse
Safety agent
Physician and nurse
with short special
training
Multidisciplinary team with special training
Multidisciplinary
specialists' team
Starting point for Big industries and well organised SMEs
SMEs,SSEs,SEs,IFS
SMEs,SSEs,SEs,IFS
Big industries and
Big OHS Centres

37. MODELS OF SERVICES PROVISION
World Health Organization
MODELS OF SERVICES PROVISION
1 April, 2017
Primary health care model
Big company model
Group services
Social security model
Private physician
Private health centre
Local or regional hospitals

38. CONTENT OF BOHS
The content of basic occupational health services includes, as a minimum, the following activities: • surveillance of work environment and risk assessment • health surveillance and health examinations • advice on preventive and control measures • health education and health promotion and promotion of work ability • first aid and treatment of acute illnesses • diagnosis of occupational diseases.

39. World Health Organization
MODERN OCCUPATIONAL HEALTH SYSTEM
1 April, 2017
Competent authority
in central government
labour
health
Secondary support level
LABOUR INSPECTORATE
IOH or RESP OM
OM CLINICS
Hyg, Erg, Psych,
Safety, W-org, OM
Frontline level
GROUP OHS
PHC
Private center
IN-COMPANY OHS
Big
company
SME
Company SE
SME
SSE
SME SE SE SE
IFS
IFS
IFS
IFS
IFS
IFS
IFS
BOHS
IFS

40. World Health Organization
Example: OH service providers in Finland
World Health Organization
1 April, 2017
Räsänen et al 2002
Enterprise
Enterprise
Enterprise
Enterprises 61%
Employees 37%
OHS units 31%
Costs %
MUNICIPAL
HEALTH
Farmers
CENTRE
Self-employed
Enterprises 2%
Employees 25%
OHS units %
Costs %
Satellite
Enterprise
BIG ENTERPRISE
OHS
Enterprise
Enterprises 4%
Employees 6%
OHS units %
Costs %
Enterprise
GROUP OHS
Enterprise
Enterprises 33%
Employees 32%
OHS units %
Costs %
Enterprise
PIVATE OHS
CENTER
Enterprise

41. CONCLUSION Development of the whole occupational health system
(policy, legislation, infrastructures, human resources, information systems and registration)
Occupational health services should be provided by well-established service provision units with a sufficient size to be able to provide multiprofessional services
Training of multiprofessional expert resources for occupational health is recommended by upgrading and re-orienting the existing expert resources and by training new experts for broadening the scope of competence of occupational health services.

42. CONCLUSION
Drawing up a National Policy and Strategy and systematic curricula for training in occupational health and their adjustment to European curriculum systems is recommended.
Utilization of Basic Occupational Health Service (BOHS) model is recommended for expansion of coverage of occupational health services and particularly for serving the small enterprise, self-employed and informal sector workplaces.

43. CONCLUSION
The implementation of existing regulations is recommended to be supported by production of appropriate standards and good practice guidelines for practical implementation of occupational health services.
Infrastructures for occupational health services are recommended to be institutionalized and developed on a multi-model basis: coverage of all working people!

44. CONCLUSION
An important part of infrastructure consists of the Institute of Occupational Health and Safety
A special information strategy on occupational health, including the development of national information service and dissemination system:
- National ILO CIS Center
- Focal Point for EU OSHA
- WHO Collaborating Centre

45. Dr. Buhara ÖNAL bonal@csgb.gov.tr 00 90 312 2571690/200
THANK YOU…
Dr. Buhara ÖNAL
/200