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 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 and Wellness (HP&W) Programme
• Benefit Management and Curative Care
• Primary Health Care (PHC) Programme
• Employee Assistance Programme (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 (e.g. 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 have spin-offs 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, and this will be mostly covered on Day 1 of the Block. The other aspects will be dealt with during the Block.

Definitions and objectives of key components of the Occupational Health Serviceoverall

(See the relationshtips between the overal OHS and its components in these flow charts)

(Strategy for setting up an Organisational Health Service )

(Overall management of the Occupational Health Service for continuous quality improvement - See OHSAS 18001)

1. The Occupational Health (OH) Programme involves the application of the science of work-related injury and illness prevention, incorporating the disciplines of Occupational Hygiene, Occupational Safety and Occupational 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. Three levels of preventive strategies are recognised, including Primary Prevention (prevention of exposure to risk), Secondary Prevention (early identification of exposure effects through screening, enabling early intervention to prevent progression to illness), and Tertiary Prevention (actions that reduce the impact of the occupational event, such as changing occupations, rehabilitation and workmen's compensation.This includes compensation claim processing.
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.
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.
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.

Further definitions

1. 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).
2. 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.
3. 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).
4. 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 (AIA). AIAs are prescribed by the Occupational Health and Safety Act.
5. 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:

PLEASE NOTE THAT FOR UPDATES BEYOND 2008 ON THE LEGISLATION BELOW
and other legislation relevant to Occupational Health
USE EZPROXY (www.ezproxy.uct.ac.za) to access SABINET

This is done by going to Journals via Databases, choosing Sabinet and once in Sabinet
using the "netlaw" option and then searching on the Act number (e.g. 130 for COID Act).

See the powerpoint presentation that explains how to access SABINET

1. Occupational Health and Safety Act (OHSA) , No 85 of 1993 and Regulations.
   This Act contains a number ofimportant definitions.
2. The Mines Health and Safety Act (MHSA), No. 29 of 1996 and Codes of Practice.
3. The Health Act No 63 of 1977 and Regulations as amended.
4. The Nursing Act No 50 of 1978 and Regulations as amended.
5. The Nursing AmendmentAct No 71 of 1981.
6. Convention Concerning Occupational Health Services, Convention 161 of the International Labour Conference, June 1985.
7. ILO Encyclopaedia readings on Occupational Health Services.