1. Occupational Health Services Kari-Pekka Martimo Pre-Accession Advisor (PAA)

2. I.Good Occupational Health Practice (GOHP) guideline in Estonia II.Developing the service provision infrastructure of OHS with widened coverage III.Agricultural OHS, making an assessment of the OH&S situation in farms IV.Development of indicators for functioning and status of OHS V.Increasing awareness and disseminating information through networks Five element objectives (EO)

3. Aim was to introduce GOHP guidelines into practice in Estonia Activities: –Principles adopted in all activities since the beginning of the project –GOHP guideline published in January 2004 –Other published guidelines and fact sheets supported the adoption of GOHP –Several seminars and meetings to support the implementation of GOHP EO I: GOHP guideline in Estonia

4. Conclusions: –Guidebook was considered important even if it needs more adaptation to Estonian system –Present legislation supports GOHP –Project supported quality improvement required by Ministry of Social Affairs –Ethics and effectiveness of health examinations need more consideration EO I: GOHP guideline in Estonia

5. Impact: –The wide distribution of guidebooks and popularity of the training events together with perceived needs to develop OHS most likely lead to improvements in the OHS processes EO I: GOHP guideline in Estonia

6. Aim was to link family doctor network to the infrastructure of OHS Activities included –26 days of training on work-related diseases to 1556 participants –Involvement of stakeholders through various meetings and seminars –Study visit of OH physicians and clinical specialists to FIOH on 16-19 March 2004 EO II: Developing OH service provision infrastructure with widened coverage

7. Conclusions: –Other specialists interested in work- relatedness of diseases and in collaboration with OHS –Some employers more interested in OH&S issues than required by law –More flexibility in provision of OHS needed (e.g. SMEs, farmers, self-employed) –Statutory obligations and possibilities of OH physicians collide EO II: Developing OH infrastructure

8. Impact: –63 (+14) OH physicians, 197 family physicians and other specialists and 9 agricultural experts have been informed on OHS system, its strengths and weaknesses, as well as opportunities for development and threats EO II: Developing OH infrastructure

9. Aim was to develop a model for OHS arrangements in agriculture Activities: –Four farms were visited on 4-5 September 2003, and a suggestion for the OH&S model has been made –Study visit of five agricultural experts to Finland on 5- 7 November 2003 –Visit to the Minister of Agriculture on 12 January 2004 EO III: Agricultural OH&S, making the assessment of the situation in farms

10. Conclusions: –Farmers’ associations have been active in promoting OH&S –More research needed on incidence of work accidents and work-related diseases among farmers, as well as more training and information on OH&S issues –Collaboration between public health and OH authorities needed to expand OHS expertise to rural areas EO III: Agricultural OHS

11. Impact: –Project activities have contributed to the initiation of development of occupational health and safety services in agriculture –Practical aids have been produced EO III: Agricultural OHS

12. Aim was to develop models and indicators (quantitative and qualitative) for evaluation of OHS unit’s functions. Planned activity was to instruct OHC on indicators to collect information for the Ministry, and for self-evaluation of the units Several meetings and seminar focused on indicators EO IV: Development of indicators for functioning and status of OHS

13. Conclusions: –At present, the service providers are well documented, but too little information exist on the processes and customers of OHS in Estonia –Registry of W-RDs makes an alternative for that of ODs –Self-assessment of effectiveness and quality was supported with practical aids EO IV: Development of indicators

14. Impact: –Preparedness for use of indicators has increased –Future role of Health Care Board in follow- up of OHS? EO IV: Development of indicators

15. Aim was to increase awareness and information among interest groups in collaboration with network element Activities: –All meetings, seminars and training events have distributed information on OHS –On 12 December 2003 a special seminar was organised to the employers EO V: Increasing awareness and disseminating information through networks

16. Conclusions: –General interest of employer and employee organisations on OH&S issues has been modest –Public interest increased after latest amendment of Act on OH&S and during discussions on insurance of ODs and work accidents –OH&S issues have not been in the agenda of decision makers during the project EO V: Increasing awareness...

17. Impact: –The project has analysed the present situation and produced material for improvement of the OH&S in Estonia EO V: Increasing awareness...

18. Amendments needed in the Act on OH&S: –Employer’s duty to provide continuous access to OH specialist –OH services should be obligations instead of possibilities –Inconsistencies concerning ODs/W-RDs –Good Occupational Health Practice Promotion as well as protection and prevention Follow-up and evaluation at national level Recommendation for future actions

19. Incentives for the employers to improve OH&S –More responsibility for work-related ill- health –Premiums through insurance system –Information on productivity and health and safety at work –Adequate resources for Labour Inspectorate Recommendation for future actions

20. Alternative models for OHS –Profit making enterprises and self- employed do not cover peripheral regions –Large enterprises may prefer in-house OH specialists for closer collaboration –Family physicians should get more involved in OHS but only if adequately trained and supervised by OH specialists –Professional independence is a challenge in every model Recommendation for future actions

21. Strong competent authority needed –Prerequisite for development of OHS –Needed for Training Expert advice Research Information Collaboration For public image of OHS Recommendation for future actions