1. Increase in the Coverage and Effectiveness of Occupational Health Services in Estonia Kari-Pekka Martimo Pre-Accession Advisor (PAA)

2. Milestones Estonian project ficheJuly 2002 launched MS proposal submitted Sept 2002 Letter of acceptance Oct 2002 from the EC Preparation of theSept 2002– Covenant March 2003 Approval of the Covenant April 2003 in EC Steering Committee Starting of the ProjectMay 2003

3. Facts Duration of the Project: 12 months (5.5.2003 – 4.5.2004) Financing: EU Phare (Budget EUR 327,600) Twinning Partners: –Estonian Ministry of Social Affairs (MoSA) –Finnish Institute of Occupational Health (FIOH) Project Leaders: –Mr Tiit Kaadu, Head of the Working Environment Department, MoSA –Prof Jorma Rantanen, Director General of the FIOH Pre-Accession Advisor (PAA): –Dr Kari-Pekka Martimo

4. Objectives To reduce the number of incidences of work-related diseases in Estonia in the long run To increase the coverage of, the availability of and the accessibility to occupational health services throughout Estonia To increase awareness of employers and employees on occupational health and safety issues To support the practical implementation of aquis communitaire

5. Acquis Communautaire underpinning the Twinning Project  Council Directive 89/391/EEC of 12 June 1989 on the introduction of measures to encourage improvements in the safety and health of workers at work  Council resolution 88/C28/01 of 21 Dec 1987 on safety, hygiene and health at work  Commission Decision 88/383/EEC of 24 Feb 1988 providing for the improvement of information on safety, hygiene and health at work  Commission recommendation (OJ L 80, 31.8.1962, p. 2181) to the Member States on company medical services Commission recommendation of 22 May 1990 to Member States concerning the adoption of a European schedule of occupational diseases Commission recommendation 66/464/EEC of 7 July 1966 addressed to Member States and concerning medical control of workers exposed to particular risks

6. INCREASED WELL- BEING AND PRODUCTIVITY OF ESTONIAN EMPLOYEES Effective prevention of work- related diseases Better knowledge, recognition and management of WRDs by Occupational physicians Family physicians Better coverage, quality, effectiveness and network of OHS system Better co-ordination of occupational health and safety issues at the national level

7. Elements Policies and Strategies The MoSA and other relevant authorities will be supported OHS The development of the OHS infrastructure for better coverage and quality in the provision of services. Work-related diseases The development of coverage, quality and effectiveness of recognition of ODs and other WRDs Networking Developing and further strengthening relevant OHS Networks; Preparation of county, community and sectoral OHS profiles Information * Awareness raising * Dissemination of information * Management of information General Informing relevant partners and stakeholders on the project

8. Guaranteed results 1.Strengthened implementation of the Estonian Occupational Health Development Plan and the Ministry of Social Affairs’ Strategy for Occupational Health and safety 2003-7 for development of occupational health services system 2.Administrative structure and institutional capacity for recognizing occupational diseases has been described, discussed and approved as a part of national policy and strategy 3.Occupational health personnel and necessary public health personnel are trained on diagnostics, treatment and prevention of work-related diseases

9. Guaranteed results 4.Guidelines for ”Good Occupational Health Practice” will be distributed and trained to relevant practitioners 5.National, local and subject-oriented OH&S networks are strengthened. Indicators, profiles, research studies, information on the occurrence of work-related diseases and preventive activities of occupational health services are made available in the National Network of Occupational Health for specialists, social partners, and the general public. Up-to-date information on occupational health services and work-related diseases is available and disseminated

10. Key experts Tiit Kaadu Urmas Krass Ülle Sarap Ahe Vilkis Viive Pille Eva Tammaru Jaan Sõrra Ester Rünkla Katrin Lepisk Tanel Tomson Jorma Rantanen Matti Ylikoski Helena Taskinen Kari Kurppa Suvi Lehtinen Kaj Husman Anneli Vartio Taina Pääkkönen

11. Contact Info Pre-Accession Advisor Kari-Pekka Martimo Töötervishoiu Keskus, Hiiu 42, Tallinn Tel. 056 231 344 Email: kari-pekka.martimo@ttk.ee Assistant to PAA Liilika Raudhein Töötervishoiu Keskus, Hiiu 42, Tallinn Tel. 670 0101 Email: liilika.raudhein@ttk.ee

12. Occupational Health Services

13. Element objective I: Good Occupational Health Practice Guideline in Estonia Actions: -GOHP-guideline will be used in training and distributed to OH personnel -Problem-specific guidelines will be selected, translated and modified together with Estonian OH experts (together with the information element)

14. Impact: -OH services will be harmonized in the country -Quality requirements are met better than earlier Element objective I: Good Occupational Health Practice Guideline in Estonia

15. Element objective II: Developing the service provision infrastructure of OHS with widened coverage Actions: -Training of OH system to family physicians and agricultural experts together with OH experts and clinicians (with training element) => 40 OH physicians, 90 family physicians and three agricultural advisers are informed and instructed on the OH system and its activities

16. Element objective II: Developing the service provision infrastructure of OHS with widened coverage Impact: -Family doctor network will be linked to the infrastructure of OHS -All relevant stakeholders and interest groups have a good understanding of the structure of the OHS system and its activities

17. Element objective III: Agricultural OHS, making an assessment of the OH&S situation on farms Actions: -A subnetwork on OHS in agriculture will be established (with network element) -Task force will write a sectoral profile on OHS in Estonian agriculture -A community OHS profile model for rural communities will be developed

18. Element objective III: Agricultural OHS, making an assessment of the OH&S situation on farms Impact: -Recommendations made available for development of OHS services on agriculture -Initiation of development of OHS services in agriculture

19. Element objective IV: Development of indicators for functioning and status of OHS Actions: -OHC is instructed for collecting information on OHS for the Ministry and for the self- evaluation of the units (with policy & strategy element) => Occupational health and safety indicators and models for reporting are made available

20. Impact: -Better management and follow-up of the OHS system -Better quality of OHS services Element objective IV: Development of indicators for functioning and status of OHS

21. Element objective V: Increasing awareness and disseminating information through networks Actions: -Social partners, industries, organizations will be informed on the possibilities to organize OHS => Information will be distributed to work places and employers’ representatives (with information element)

22. Element objective V: Increasing awareness and disseminating information through networks Impact: -Awareness of practical organization of OHS is increased -Coverage of OHS is increased