Block 3: Occupational Health Management - Section 1: Occupational Health Service

OHM1.1: Structure and overview

INTRODUCTION:

The aim of the Occupational Health Service is to protect, promote and maintain the health and safety of all employees through a comprehensive and caring service. This is achieved through the provision of medical and technical expertise to achieve improvements in the working environment, adaptation of work to the individual worker, and promotion of the health and welfare of workers. In this way the service should result in a decrease in the incidence of occupational injuries, diseases, deaths and related disability. Article 5 of the ILO Convention on Occupational Health Services outlines a minimum standard for the structure and content of occupational health services agreed internationally by employers, employee organisations and governments.

Occupational health services should be delivered by an integrated team and have five main components.

• Occupational Health (OH) Programme (incorporating Risk Management)
• Health Promotion & Wellness (HP&W) Programme
• Benefit Management & Curative Care 
• Primary Health Care (PHC) Programme
• Employee Assistance Porgramme (EAP)

These core areas function interdependently, often cross-referring and interacting. For example, cases identified in the PHC programme may alert the OH programme that certain adverse health outcomes are suspected from particular parts of the organisation (ie. asthma). This would trigger Safety Hygiene and Medical screening interventions to further characterise the problem. Gaps in the delivery of PHC would indicate a greater need for other Benefit Management options and off-site Curative Care. Boosting the EAP and Health Promotion programmes would spin off by reducing the burden on the Curative Care programme. Social (and psycho-social) problems identified by the OH and PHC programmes would be routed to the EAP. Many problems, including chronic medical diseases, substance abuse and HIV/AIDs exemplify these interactions.

The broad principles that provide the framework within which the occupational health service  functions include:

• Occupational health services are considered as having a preventive orientation that focuses on work-related problems. Nonetheless, the occupational health services should be comprehensive and undertake curative, preventive, promotive, compensation and rehabilitation services; education and training of employees; and maintain an appropriate health information system.
• The governance of the occupational health service should involve participation of both management and employees, in determining the activities of the service.
• The organisational infrastructure of the Occupational Health Services in terms of the facilities, resources and staffing must be appropriate to the needs of the workforce, and aligned with business strategies.
• The services should be easily accessible for use during working hours.

These terms used in the diagram are all defined in the Glossary. It is important to note that all the diagram elements or OHS components  have substantial areas of overlap. 

 The central aspect of the OHS is the Occupational Health Programme consisting of the green blocks in the diagram below.

 The OHS and the OHP constitute the intial material in this Block and will be covered during Day 1.

DEFINITIONS AND OBJECTIVES:

Definitions:

1. Occupational Health (OH) Programme is the application of the science of work-related injury and illness prevention, incorporating the disciplines of Occupational Hygiene, Safety and Medicine, through various strategies, including risk assessment and risk control by means of engineering away hazards, and monitoring for early signs of failure of these controls.
2. The Primary Health Care (PHC) Programme is the delivery of first-level medical interventions, including curative as well as preventive for injured and ill employees at work, and is implied to be an on-site activity.
3. The Employee Assistance Programme (EAP) is the delivery of support services for employees that are functioning sub-optimally due to physical, psychological and social problems, and includes counselling, training, rehabilitation, and the mobilisation of state services where necessary. (I have removed "statutory bodies", as I do not have these at my fingertips. They refer to things like UIF, legal aid, social support structures, etc.)
4. The Health Promotion and Wellness (HP&W) Programme is the term which describes the coordinated activities that aim for a state of health that goes beyond the absence of disease, and seeks to achieve optimal mental, social and physical function. It is strongly linked to prevention, particularly primary prevention, and education, includes issues such as nutrition, mental health, healthy lifestyle, and positive self management.
5. Employee Benefits & Curative Care, includes matters such as pension or provident fund provision, statutory entitlements such as sick leave, perinatal leave, medical aid, hospital insurance and other negotiated benefits.
6. Occupational Health  Practitioner means an occupational  medicine practitioner or a person who holds a qualification in occupational health recognized as such by the South African Medical and Dental Council as referred to in the Medical, Dental and Supplementary Health Service Professions Act, 1974 (Act No. 56 of 1974), or the South African Nursing Council as referred to in the Nursing Act, 1978 (Act No. 50 of 1978).
7. Occupational Medical Practitioner means a medical practitioner as defined in the Medical, Dental and Supplementary Health Service Professions Act, 1974 (Act No. 56 of 1974), who holds a qualification in occupational medicine or an equivalent qualification which qualification or equivalent is recognised as such by the South African Medical and Dental Council referred to in the said Act.
8. Occupational Health  Nurse Practitioner means a registered nurse who holds a qualification in occupational health, recognised as such by the South African Nursing Council as referred to in the Nursing Act, 1978 (Act No. 50 of 1978).
9. Occupational Hygienist means a person who holds a qualification in occupational health recognised as such by the South African Occupational Hygiene Association, and who meets the requirements of an Approved Inspection Authority PUT IN LINK SEE BELOW.  AIAs are prescribed by OHSA.
10. Occupational Hygiene Assistant means a person with suitable training that will conduct the activities required of an Occupational Hygiene Programme, under the supervision and guidance of an Occupational Hygienist.

REFERENCES:

1. Occupational Health and Safety Act (OHSA), No 85 of 1993 and Regulations. LINK TO THIS FOR DEFINITIONS

Approved inspection authority

OHSAct Asbestos Regulations: An inspection authority approved by the chief inspector for the monitoring of asbestos concentrations in the air.

OHSAct DR: An inspection authority approved by the chief inspector for the verification, surveillance and certification of the design, construction, manufacture, test, inspection and repair of compression chambers and bells.

OHSAct Lead Regulations: An inspection authority approved by the chief inspector for -

1. the monitoring of lead concentrations in air; or
2. the analysis of blood lead or urinary lead concentrations.

OHS ACT: An inspection authority approved by the chief inspector: Provided that an inspection authority approved by the chief inspector with respect to any particular service shall be an approved inspection authority with respect to that service only.

OHSAct D-Hazardous Chemical Substances: An inspection authority approved by the chief inspector for:

1. the analysis of biological samples; or
2. the examination and testing of engineering control measures.

OHSAct Hazardous Chemical Substances Regulations: An inspection authority approved by the chief inspector for the monitoring of hazardous biological agents substances.

GREG Most of these references are not used in this page.  WE need to shift them out I have highlighted those needing to be removed below.
ADDED MATERIALS IN BLUE HIGHLIGHTS. Agreed. The original document had these in for other reasons. I have edited the blue stuff a little to make the references a little clearer.

1. Compensation for Occupational Injuries and Diseases Act (COIDA), No 130 of 1993 (as amended 1997).
2. The Mines Health and Safety Act (MHSA), No. 29 of 1996 and Codes of Practice.
3. Occupational Diseases in Mines and Works (ODIMWA), Act No. 78 of 1973 and Regulations.
4. Occupational Diseases in Mines and Works Amendment Act (ODIMWA), Act No. 208 of 1993.
5. The Hazardous Substances Act No 15 of 1973 and Regulations.
6. The Health Act No 63 of 1977 and Regulations as amended.
7. The Nursing Act No 50 of 1978 and Regulations as amended.
8. The Nursing Amendment Act No 71 of 1981.
9. The Medicines and Related Substances Control Act, No 101 of 1965, as amended.
10. The Labour Relations Act No 28 of 1956 as amended in 1996.
11. The Basic Conditions of Employment Act No 3 of 1983 as amended - Act 75 of 1997.
12. The Employment Equity Act 55 of 1998.
13. The Codes of Good Labour Practice (including Hours of Work, Pregnancy, HIV & testing, Disability, etc.)
14. The National Road Traffic Act No. 93 of 1996, and Regulations.
15. Convention Concerning Occupational Health Services, Convention 161 of the International Labour Conference, June 1985.
16. ILO Encyclopaedia readings on Occupational Health Services