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Capacity Building for Occupational Health for Workers in South Africa

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Presentation on theme: "Capacity Building for Occupational Health for Workers in South Africa"— Presentation transcript:

1 Capacity Building for Occupational Health for Workers in South Africa
Inakshi Naik OHS Training Department, NIOH 29th October 2013 Hong Kong

2 Overview of the presentation
Overview of the National Institute for Occupational Health (NIOH) SA Training needs assessment Training in different categories and levels Gaps in training – shortage of skills Current initiative to fill in the training gaps Short Courses/seminars/workshops to develop capacity Strengths of NIOH in delivering the programme

3 Johannesburg, SA The City of Gold

4 National Institute for Occupational Health (NIOH)
Established in 1956 (Pneumoconiosis Research Unit) Hopefully by the end of our 50th anniversary, NIOH will all be housed in the Old Medical School building. The NIOH building is also linked to mining. The somewhat decrepit surrounding wall is actually an historic monument. It is part of the original perimeter wall of the police barracks in early Johannesburg which was established in the late 1800s as a gold mining town. History has done a full circle and our new neighbours are the state forensic laboratories or police mortuary where our pathologists perform the whole body autopsies for deceased miners. NIOH is responsible for developing and supporting occupational health initiatives for the South African workforce of about 11.5 million workers. Approximately half a million of these workers or 4.3% of the workforce are in the formal mining industry which continues to be an important focus for NIOH. During its history the National Institute has changed - its name, its affiliations and its functions. The constant in the Institute from past to present has been research and service for miners.

5 Advisory Statutory Service Autopsy Services
Specialized Laboratories These 5 Functions are: * ADVISORY SERVICES * TECHNICAL INFORMATION DISSEMINATION * TRAINING * SPECIALISED LABORATORY SERVICES * RESEARCH ** and a few other services Health Hazard Evaluations Resource Network

6 Services Research Back Office Support Training
Universities and other Institutions Local & International Partnership Trade Unions, NGO and Business Govt. and Public Entities Services Research Back Office Support Training

7 Post Graduate Qualification in OH for Medical Practitioners
Post Graduate Diploma in Occupational Health Part Time: Offered over 2 years in 8-10 weeks one week blocks. Offered by 6 Universities. UCT offers distant learning

8 Post Graduate Qualification for Occupational Health Nurses
Post Basic Nursing qualification 9 Universities and one private Academy offers Masters, B. Tech, Diploma and Certificate courses over one-two years period. B Tech qualifications offered by University of Technology Registration with the SA Nursing Council with minimum DoH nursing

9 Qualification for Occupational Hygienists
Registered Hygienist in 3 different categories with SAIOH in SA Hygiene Assistants Hygiene Technologists Hygienists Education and Training Requirements Occupational Hygienist Post Graduate Qualification 3 Universities offer a Diploma and Masters Degree in and PhD in Occupational Hygiene over two or three years (part time/ full time), Offered as DPH or MPH Occupational hygiene Applicants must have a four-year qualification from a university Being registered with the South African Institute for Occupational Hygiene (SAIOH) at the minimum of the Occupational Hygiene Technologist level. The Wits School of Public Health, in association with the NIOH, offers a Diploma in Occupational Health (DOH) and MPH Occupational Hygiene

10 Weaknesses Identified in the Present System for Training of Different Categories of Hygienists:
In House Training No defined requirements High registration failure rates No mentorship programme Present application form – summary of educational qualification and employment history Assessors lack full understanding of candidate level of competency Little practical and experiential learning Provider also is accreditor

11 New Proposed Training for Occupational Hygienists in SA
Registration model based on competency levels Bench mark proposed skill requirements against international standards Meet IOHA registration requirements Develop a skills matrix Develop detailed skill definitions per grade Mentorship programme support development of practical skills Promote use of Personal Learning Portfolio as part of assessment process Adapted from SAIOH Deon Van Vuuren (Chairperson SAIOH)

12 OHLearning for Occupational Hygienists

13 OH Learning for Occupational Hygiene Qualification
The Occupational Hygiene Training Association (OHTA) was formed to promote better standards of occupational hygiene practice throughout the world.   They develop training materials and make them freely available for use by students and training providers.  Promote an international qualifications framework so that all hygienists are trained to a consistent, high standard, recognized in all participating countries. Three levels of course: Foundation level, and progress through intermediate level to advanced level


15 Downloading of training materials is free of charge but is subject to the Terms of Use of

16 Training for Other Occupational Health Workers Provided at NIOH
Occupational epidemiology (MPH) Information sciences Residency training in Occupational Medicine Partnerships with universities, internship programmes and experiential learning.

17 Laboratory based sciences (Scientists. Technologists & Technicians)
Toxicology Analytic chemistry Pathology Immunology/Microbiology Students from India trained in the Analytical Laboratories for metals, organic exposures

18 Developing Capacity for the Government Health System

19 PHC Training Initiative by the Department of Health, SA
The re-engineered approach to providing PHC services proposes a population based approach for delivering of PHC outreach service

20 Who is the Training for ? Community Health Workers
Primary Health Care Nurses Family Medicine Doctors Hygienists/Technologist/Technicians/ Environmental Health Officers Health and Safety Representatives Labour Inspectors NGOs, Trade Unions

21 Clinic / PHC Outreach CHW District Hospital
Proposed Training at Different Levels Outreach CHW Short Courses Clinic / PHC District Hospital Regional Hospital Tertiary Hospital CHWs, Nurses, Environmental Health Officers & Hygienists, Doctors OH Learning and other support Academic Learning

22 Ward Based PHC Outreach Programme- CHW
DoH Project: Funded by USAID Ward based PHC Outreach Team CHW trained in phase 1 HIV, TB, ANC, Child nutrition but not OH Introduce OH screening tools 6 CHW 270 Families each Professional Nurse Team Leader EHO Health Promoter Functions stipulated for EHO: Monitor OH and safety in local businesses Manage environmental noise hazards

23 Clinic / PHC Outreach CHW District Hospital
Proposed Training at Different Levels Outreach CHW Short Courses Clinic / PHC District Hospital Regional Hospital Tertiary Hospital CHWs, Nurses, Environmental Health Officers & Hygienists, Doctors OH Learning and other support Academic Learning

24 Statistics of South African Nursing Council - 2012
Over the 9 year period 2003 to 2012, the total number of nurses on the register has grown from to i.e. a net increase of (+40,0% growth). The growth in nursing figures has exceeded that of the population of SA by quite a margin. There is currently a shortage of occupational health nursing practitioners in South Africa (1147 Registered OH Nurses SANC stats) Taken from

25 Motivation for Training PHC Nurses in OH
Where an employee develops ill health due to occupational causation the client may consult a health care worker at a public clinic. PHC nurses are the gatekeepers of the health system They are not taught the basics of occupational health in their training and are thus not skilled in the identification of an occupational disease. Through the early detection of disease the morbidity associated with occupational disease can be reduced thereby decreasing the disease burden in the country.

26 Training of Public Health Care (PHC) Nurses in Fundamentals in Occupational Health- NIOH Initiative
Aim: To equip a PHC nurse with information/skill to be able to take an appropriate occupational history Refer suspected occupational disease cases to the next level of referral, i.e. The Regional/ District hospital. To have a high index of suspicion for work-related problems and identify sentinel events. Knowledge of referral systems that exist within the district. To liaise with the Environmental Health Officer, Labour inspectors

27 Structure of the Course for the PHC Nurses
The course will be five days in duration. A combination of theory and practical teaching methods A site visit and a virtual site visit will be included in the teaching methods. Assessment will be conducted through continuous formative assessment and a summative assessment. Learners will be required to complete 10 health assessments of employees in the PHC setting. On successful completion of assessments a competency certificate will be issued by the NIOH. SANC accreditation of this course will be requested.

28 Current Short Courses Available for Medical Practitioners

29 Global Program in Occupational Health Practice (GPOHP)
What is the GPOHP? The Global Program in Occupational Health Practice is an internet-based, instructor-led distance-learning program for professionals in either occupational health services or occupational hygiene. The program consists of two tracks, the Occupational Health Practice Certificate and the Occupational Hygiene Practice Certificate. Each contains three consecutive courses that build on each other. However, the courses may be taken separately. Courses are ten weeks long. All participants receive a "Certificate of Competency” on completion from UIC. School of Public Health

30 Structure of the GPOHP

31 OHTA Recognition and incorporation of Hygiene Modules in OHLearning

32 Other Short Courses for OHS Workers


34 WHO Modules in Occupational Health, Hygiene and Safety
The WHO Modules in OH were developed by a team of experts from the Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois - Chicago, USA, also a WHO CC in OH. The modules were developed to execute the 49th World Health Assembly Global Strategy for OH The materials are case-based modules in the specific sectors of agriculture, manufacturing, and the health service

35 Aim of the Course The aims of the course were to develop and strengthen the following approaches in OH: Anticipate and recognize workplace hazards Describe exposure to workplace hazards and their health effects Generate recommendations for preventing exposure using available resources and technologies Develop a programme plan for addressing workplace hazards

36 On Completion of the Course
The participants are equipped to: Complete an occupational history Recognize a work related injury or illness Conduct a qualitative risk assessment of a workplace Conduct an incident investigation Categorize exposure groups Complete an exposure and health effect rating chart Develop a strategy for collecting quantitative data Recommend intervention strategies for reducing exposure Begin a programme plan for various workplaces

37 WHO Modules in Occupational Health Course in Johannesburg, SA (2009)
This course was directly in line with the overarching aims of the WHO Global Network Plan for Occupational Health ( ), which is driven by the Global Plan of Action (GPA) for Workers’ Health

38 Corse Conducted at NIOH: Team from UIC, SPH, USA and Nayati Int. India

39 The week-long course was attended by close to 90 participants from both public and private sectors.
A certificate of competency (from the University of Illinois - Chicago and the NIOH, Johannesburg) was issued to all participants scoring higher than 70% on post-course performance- and knowledge-based evaluations. A CD of the full course was created as an Integrated E-Learning Platform – essentially a video recording of the presentations, to be used as a training tool by trainers for future capacity building. With the aid of the CD further 330 delegates in 10 centres ( 9 provinces and 1 national centre) were trained within 4 months in 2010. The delegates were HSR, wellness managers, safety officers, nurses The course has a “Train the Trainer” component

40 Field Visit-Hospital Laundry/Kitchen/Laboratory

41 Learners During Lectures and Exercises

42 Training for Medical Officers (Namibia)
WHO: Protection of the Human Environment Worker’s Health Ministry of Health and Social Services. Swakopmund, Namibia 2011 District Health Medical Officials in Namibia Delivered by Dr. Ivan Ivanov (WHO), Dr. Norbert Wagner (UIC, SPH, and Dr. Tony Cantrell (NIOH, SA) 2 weeks course: 1 week Occupational Diseases , 1 week Occupational Hygiene

43 Health and Safety Representatives (HSR) Course for NHLS - online

44 Health and Safety Representative (HSR) in Pathology Laboratories (Course Overview)
We trained 268 HSR countrywide on our intranet in 2012. Current around 170 HSR being trained Course specifically designed to identify hazards and risks associated in pathology laboratories Modified for any environment

45 Stoffenmanager Version 5.1

46 Stoffenmanager: Background and History
Web-based IT-tool (public and freely available) to help small- and medium-sized enterprise (SME) which allows non-expert users in the companies to manage their dangerous substances more efficiently. Developed by consortium: Dutch ministry of social affairs (owner & funding) , BECO , TNO and Arbo Unie (research & development) First development: risk prioritization (control banding) Subsequent: quantification and validation of the exposure process model initially inhalation March 2008: version 4.0  Separate exposure estimation for dermal exposure

47 Changing Focus of Occupational Risk Management for Workplaces Exposure to Chemicals
Traditional Rely on technical experts to evaluate workplace hazards and risks. Carry out exposure monitoring Compare with OELs Recommend controls. Innovative Empower owners/operators to evaluate their own workplaces for hazards and risks. Focus resources on practical control solutions rather than expensive exposure measurements.


49 Stoffenmanager estimation: reasonable worst-case = 90-percentile

50 Other Courses Conducted at NIOH
Biological monitoring of chemical exposures Ergonomics incl. Manual material handling Occupational allergies/asthma Substance abuse in the workplace Chemical and biological hazards for Labour inspectors Personal Protective Equipments ILO-CXR for silicosis Management of Chemical exposures in the workplace Stoffenmanager GHS for chemical communication Continuing Professional Development with HPCSA

51 DVDs and facilitators’ guides

52 Strengths of NIOH NIOH is a WHO CC in OH.
Network with NIOSH, CDC, WHO, FIOH, UIC SPH, USA, etc Linkage with DoH, DoL, DMR, MBOD, CCOD Affiliated with Universities Staff highly knowledgeable and skilled in various fields of OH Infrastructure (lecture rooms, video-conference units New learning technologies (eLearning) National, Regional and International activities Visionary leadership

53 Thank You

54 S A Nursing Council Growth in the Registers 2003-2012
RN / RM = Registered Nurses and Registered Midwives. EN / EM = Enrolled Nurses and Enrolled Midwives. ENA = Enrolled Nursing Auxiliaries.

55 Listed qualification SANC 2012

56 Population Per Qualified Nurse per Province)
Registered Enrolled Auxiliaries Total Limpopo 536:1 1060:1 615:1 226:1 North West 418:1 1269:1 714:1 218:1 Mpumalanga 638:1 1514:1 995:1 309:1 Gauteng 382:1 848:1 726:1 193:1 Free State 353:1 1393:1 845:1 211:1 KwaZulu Natal 380:1 489:1 857:1 171:1 Northern Cape 511:1 2541:1 910:1 290:1 Western Cape 377:1 988:1 695:1 196:1 Eastern Cape 449:1 1486:1 1021:1 258:1 TOTAL 417:1 882:1 785:1 208:1 Population figures - Statistics South Africa (2011 census). (All population figures have been rounded off to the nearest 100.) © 2013 South African Nursing Council

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