2. Contents
1. Occupational health services
2. Basic occupational health services
3. Objectives of OHS
4. Benefits of occupational services
5. Principles of OHS
6. Development Stage of OHS
7. OHS Characteristics( infrastructure)
8. Flow scheme activities of OHS
9. Global scenario of OHS
10. OHS trends in Nepal
11. Barriers of OHS in Nepal
3. Occupational health services is a multi-prong approach
which requires the availability of services to all working
people but stresses local adaptation measures.
It more over makes necessary arrangements for fostering
basic services, as stipulated by the ILO Conventions161 and
155.
Occupational Health Services
4. More than 80% of the global work force
works and live without adequate access to
OHS.(Joshi,2009)
For the sustainability and continued
development of industrialization, it is
essential to have increased production and
enhanced productivity, for which safe work
and a safe workplace are the
complementary base.
Occupational Health Services
5. The concept for occupational health
and safety is relatively new and very
few industries maintain optimum
occupational standards.
Occupational health and safety, socio
economic development, and the
quality of life and well-being of
working people are interlinked
fabrics.
Occupational health services….
OHS
Occupational
health and
safety
Socio-ecomic
development
Quality of
life
Wellbeing of
workers
6. Basic occupational health Services (BOHS)
The Basic Occupational Health Services are an essential service for the
protection of people's health at work, for promotion of health, well-being and
work ability, as well as for prevention of ill-health and accidents. The BOHS
provide services by using scientifically sound and socially acceptable
occupational health methods through primary health care approach.
The objective of Basic Occupational Health Services is to ensure the provision
of services for all workplaces in the world (in both industrialized and
developing countries).
The BOHS are an effort to provide occupational health services available to
each and every working individual in the world irrespective of sector of
economy, size of company, geographical area, or nature of employment
contract
7. BOHS…..
The Basic Occupational Health Services (BOHS) are an application of the
primary health care principles in the occupational health sector.
The BOHS seek to provide occupational health services for all working people
in the world regardless of mode of employment, size of workplace or
geographic location, that is, according to the principle of universal services
provision.(Pingle, 2019)
The BOHS concept envisages coverage of all workers, and has a strong focus
on prevention.
The BOHS aim at: a) Protection of health at work, b) Promotion of health,
well being, work ability and c) Prevention of occupational diseases and
accidents.
8. Why Occupational health services
Occupational health services are there to support people in the workplace, to
help to ensure that workplaces are safe and healthy and to address health
problems when they arise.
Occupational health and occupational medicine are concerned with the
interaction of health and work, recognizing that work can affect health and
vice versa.
Promoting health and
wellbeing at workplace
Health Work
9. Benefits of occupational health services
Manage minor health-problems in work
Return to work
Avoidance of work-related health problems
High satisfaction
High productivity
Happy employees
10. Principles of BOHS
• Available to all working people
• Addressing to local needs
• Adapted to local conditions
• Affordable to providers and clients
• Organized by the employer for employees
• Provided by the public sector for the self-employed and the informal sector
• Supported by intermediate level services
12. Stage I: Starting level
To the workers and workplaces, which do not have any OHS at all, this is a
reasonable starting point.
The stage is planned to lower the threshold for initiation as much as possible
and still preserve the OHS competence and content.
This is the service utilizing field OHS workers (if possible, a nurse and safety
agent), who have a short training in OHS and who work for a primary health
care unit or a respective grassroots level facility.
The content of the service focuses on accident risks, heavy physical work,
basic sanitation and hygiene, and on the most hazardous chemical, physical
and biological factors (including HIV/AIDS).
Advising the clients to seek help from expert services constitutes an
important part of the service
13. Stage II: Basic Services
This is the infrastructure-based service working as close as possible to the
workplaces and communities.
The service provision model may vary depending on the local circumstances
and needs.
The personnel, usually a physician and a nurse, have a short training (some
10 weeks) in occupational health.
They would benefit from the support of a safety expert who is competent in
accident prevention and basic safety
14. Stage III: International Standard Service
This level is the minimum objective for each country as stipulated by the ILO
Convention No. 161.
The service infrastructure has several optional forms and the content is
primarily preventive, although also curative services may be appropriately
provided.
The service staff should be led by a specially trained expert (usually an
occupational health physician) and the team should preferably be
multidisciplinary or the multidisciplinary content of the service should be
ensured with appropriate support services from specialized units (such as an
institute of occupational health)
15. Stage IV: Comprehensive Occupational
Health Services (COHS)
This level is usually found in the big companies of industrialized countries or
it may be provided by large OHS centers providing services for high numbers
of various types of client companies.
The staff works as a multidisciplinary team often including several specialists
like specialist physician, occupational health nurse, occupational hygienist,
ergonomist, psychologist, safety engineer, etc.
The content of services is comprehensive covering prevention, curative
services, health promotion, promotion of work ability, and development of
healthy work organizations.
16. Steps of OHS contd…
The Stages I and II are primarily designed for the smallest and micro-
enterprises, the self-employed and the informal sector which have no
possibilities to start immediately from the International Standard level three.
Big industries and well organized SMEs should, however, always start to
establish the level three services and that level should be the minimum
objective for each country and each workplace in the long term as stipulated
by the ILO Conventions Nos. 161 and 155
17. OHS Characteristics( infrastructure)
1. Constitutes a part of integrated infrastructure for health and safety
2. Can be carried out by several types of service units
3. Collaborates with and takes support from primary health care
4. Collaborates with safety services
5. Specially tuned to serve the small and underserved workplaces
21. Orientation and planning for OHS
1. Analysis of the type of production indicating the risks and
problems typical of the branch or occupation in concern
2. Review of problems that have been identified previously in
the company
3. Review of the characteristics of the workforce of the
company
4. Available data on occupational diseases and accidents
5. Data on working methods, chemical substances, etc.
6. The knowledge by employers and employees of
occupational health problems
7. Plans for changes in production systems, e.g. installation of
new facilities, machinery and equipment
helps to decide the
types of activities
need to be planned
in more detail
22. Surveillance of the work environment for OHS
1.Identification and evaluation of ergonomic factors which may affect the
workers' health
2. Assessment of conditions of occupational hygiene and factors, such as
physical, chemical, and biological exposures which may generate risks to the
health of workers
3. Assessment, where appropriate, of exposure of workers to adverse
psychological factors and aspects of work organization
4. Assessment of risk of occupational accidents and major hazards
5. Assessment of collective and personal protective equipment
6. Assessment of control systems designed to eliminate, prevent or reduce
exposure
7. Assessment of general hygiene and sanitary facilities
23. Surveillance of workers' health for OHS
The main purpose of health examinations is to assess the suitability of a
worker to carry out certain jobs, to assess any health impairment which may
be related to the exposure to harmful agents inherent in the work process,
and to identify cases of occupational diseases which may have resulted from
exposure at work.
Pre-assignment (pre-employment) health examinations
2. Periodic health examinations
3. Return to work health examinations
4. General health examinations
5. Health examinations at termination or after ending of service
24. Assessment of health and safety risks
1.Identification of occupational health hazards (as a result of surveillances)
2. Identification of workers or groups of workers exposed to specific hazards
3. Analysis of how the hazard may affect the worker (ways of entry and type
of exposure, threshold limit values, dosage/ response relationships, adverse
health effects it may cause, etc.)
4. Determination of intensity (level) and magnitude (volume) of risk
5. Identification of individuals and groups with special vulnerabilities
6. Evaluation of available hazard prevention and control measures
7. Making conclusions and recommendations for the management and control
of risks
8. Documenting the findings of the assessment
9. Periodic review and, if necessary, reassessment of risks
10. The results of risk assessment must be documented.
25. Information and education on risks and
advice on the need for preventive and
control actions
1. The employer and the self-employed have an obligation to know the hazards of the
workplace and works in concern.
2. The workers have a right to know and get continuously information on hazards related to
their own work and the workplace.
3. The employer is responsible for training the workers on safe and healthy work practices.
4. The workers have a duty to follow the safety instructions and safe and healthy work
practices.
5. Confidential health information of an individual worker is subject to special legislation and
practices and to informed consent.
6. The advice provided by OHS personnel must be given in a form which is easily understood by
employers and workers.
7. Information given to various partners should be documented.
26. Preventive actions for the management and
control of health and safety hazards and risks
• Control of hazards at the source
• Ventilation or control technology
• Dust control
• Ergonomic measures
• Use of personal protective equipment
• Regulation of thermal conditions, etc.
27. Prevention of accidents
1. Safe planning of facilities, machinery, etc.
2. Good housekeeping, order and cleanliness
3. Making walkways and other structures safe (e.g. scaffolds, fences)
4. Guarding dangerous machines
5. Technical aids for moving and lifting heavy loads
6. Safe tools and safety equipment for workers
7. Analysis of major hazard risks and provision of "redundant safety"
28. The role of BOHS in first aid and
emergency preparedness is:
1.Providing first aid services at the workplace when appropriate
2. Introducing and training first aid practices to workers and supervisors
3. Maintaining and periodically inspecting the first aid readiness and facilities
4. Participating from the health point of view in emergency planning and
organizing the health elements in emergency response
29. General health care, curative and
rehabilitation services
1. Immunizations and other preventive measures
2. Participation in public health actions and programmes
3. GP-level general health services
4. Inspection and advice on canteens, sanitary facilities
5. Advice and education in general personal and community hygiene
6. Actions for rehabilitation and adjustment of work for workers after
injuries, diseases, reduced work ability and on return to work from long sick
leaves
7. General health promotion and introduction of healthy lifestyles
30. Provision of BOHS: In general, numerous models for
the provision of occupational health services are available:
Primary health services model
• Big company model with in-company services
• Group services organized jointly, e.g. by several SMEs
• Social security institution as a service provider
• Private physician who has special competence in occupational health
• Private health centre either providing occupational health services only or
occupational health as a part of its services
• Local or regional outpatient clinic of hospitals
31. The World Health Organization and the
Global strategy for occupational health for all
Strengthening of Occupational Health Services (OHS)
The emerging problems of occupational health call for the development of
OHS for all workers in all sectors of the economy and in all enterprises, as
well as for the self-employed.
- Modern occupational health services should draw from relevant professions,
e.g. occupational medicine and nursing, occupational hygiene, work
physiology and physiotherapy, ergonomics, safety and work psychology.
- The preventive approach should be given the highest priority.
- Due consideration should be given to the needs of OHS for the self-
employed, agricultural workers, persons employed in small-scale enterprises,
migrant workers and those in the informal sector. Sometimes such services
can be provided by primary health care units specially trained in occupational
health.
32. Global scenario of Occupational health
services
in a research: A total of 49 National Secretaries responded (response rate
84.5%), from countries that employ 70% of the total world labor force.
The majority of the respondent countries, 67%, had drawn up an OHS policy and
implement it with the help of national occupational safety and health (OSH)
authorities, institutes of occupational health or respective bodies, universities,
and professional associations. Multidisciplinary expert OHS resources were
available in the majority (82%) of countries, but varied widely in quantitative
terms.
The average OHS coverage of workers was 24.8%, with wide variation between
countries.
In over two thirds (69%) of the countries, the content of services was mixed,
consisting of preventive and curative services, and in 29% preventive only. OHS
financing was organized according to a mixed model among 63% and by employers
only among 33% of the respondents.( Ranten, 2017)
33. OHS concept….
Securing health together 2000
Health care and wellbeing caring for your future.Oct, 2005
The healthy workplace handbook 2007
34. Securing health together 2002
Reduce ill health both workers and public caused or made worse by work
Help people who have bee made ill, whether caused by work or to return to
work
Improve work opportunity for people currently not in employment due to ill
health and disability
Use the work environment to help people maintain or improve health
35. Health care and wellbeing caring for your
future Oct, 2005
Work matters- it can help to improve your health, reduce inequalities, and
offer improve opportunities
36. Occupation health Services in Nepal
The concept of occupational safety and health of the workers is a new
concept even to the oldest industries of Nepal.
The government of Nepal has enforced concepts of OSH through its Labor Act
1992.
It has highlighted a few issues and provisions on working hours, physical
infrastructural setup, yearly medical examination and provisions of safety
measures in work etc.( Joshi, 2018)
37. Trends and Practices of occupational
health services in Nepal
It is in initial stage.
It is guided by Nepal labor act.(provision of workers’ healthcare, factory inspection
and labor inspection)
The Labor Act of Nepal ensures the provision of first aid in industrial enterprises
with more than 50 employees, and an academically trained medical assistant in
the case of industrial enterprises with more than 400 workers.
38. Trends contd…….
If an industrial enterprises has more than 1,000 employees, there should be a
medical doctor and a medical assistant.
The factory inspection functions to promote occupational safety and health
conditions in the assess information on workers’ health conditions.
the establishments and demands for optimum conditions as per the Act.
Likewise, labor inspection is carried out to assess information on workers’
health conditions
39. Labor Act of Nepal
Occupational safety and health-related provisions were discussed in the milieu of the
current Labour Act 19921 and Labour Rules 1993
Labor Act 1992 had highlighted few issues and provisions on working hours, physical
infrastructural setup, yearly medical examination and provisions of safety measures in
work etc
Similarly, the Labour Rules 1993 discussed on the execution of the Labor Act 1992 and
mostly emphasized on the workers’ welfare-related issues, treatment, and compensation
for occupational accidents
The Labor Act, 2017 was passed by the Parliament on August 11, 2017.
40. 7. Occupational safety and health policy
7.1. Formulation of Health and Safety Policy
7.2. Additional duty of the Employer on workplace safety:
7.3. Duties of manufacturer, importer and supplier
7.4. Formation of Safety and Health Committee
7.5. Specific provisions relating to the safety of the works having health hazards:
7.6. General Environment of Work Place
7.7The requirement
7.8. Special provision relating to the Employees performing intellectual work
7.9 Other health and safety equipment's
7.10 Notice of Accidents
7.11. List of occupational disease and compensation:
41. OHS related provisions in the new Labour Act
• Preparation of Safety and Health Policy applicable to each workplace and such policy
should be registered with the Labor Office.
• Formation of Safety and Health Committee where 20 or more workers are engaged
in any workplace. There is provision for the formation of different OHS related
committees as well.
• Employer’s duties towards the workers which include making appropriate safety and
health arrangement, arrangements ensuring no adverse effect on workers from use,
operation, storage or transportation of chemical, physical or biological materials,
disseminating necessary notice, information, and training related to safety and health,
etc
Pregnant women should not be exposed to a hazardous work environment
42. Labor act contd….
Employee’s duties related to safety and health at the workplace which
include abstaining from doing any activities that are likely to affect the safety
and health of any individual in the workplace, cooperate with the employer
for proper implementation of the health and safety arrangements, to use the
personal safety devices provided by the employer, etc.
• Authority delegated to the workers on stopping work anytime, in case of
the immediate threat of any injury or adverse health effect or damage to the
equipment in the workplace.
• Prevention of Communicable Diseases by barring the workers from joining
their regular duty until the treatment is completed.
• All the expenses for the investigation and treatment of any work-related
diseases should be provided by the employer. And where such disease cannot
be cured the worker should be provided with compensation as prescribed
43. Limiting factors to implement the OHS
Significant loopholes in the
existing legal provisions and
failure to act as changes emerge.
Lack of inspecting human
recourses
uneven distribution of inspecting
units
A lack of necessary training and
orientation for surveillance
Incomplete coverage of all
industrial establishments
These conditions have led
to a shortage of ample
information and statistics
on occupational health
and safety practices in the
nation
44. The barriers to OHS
Lack of awareness concerning OHS
at all levels.
Faulty legal systems and lack of
periodic updates
Inability to establish OHS as an
integral component of working life
Lack of professional expertise
Resource constraints
45. Conclusion
Though the Government of Nepal established the Occupational Safety and Health
Project (OSHP) under the Ministry of Labour and Transport Management in 1995 with
the prime objective of improving occupational safety and health in Nepal, it has not
been able to obtain a permanent status for long term sustainability. The major
facade to installing the concept of OSH in Nepal lies in the inability of concerned
stakeholders to grasp the utility and importance of occupational health services.
Major obstacles in enforcing effective OSH practices in Nepal from the nation’s
perspective are least priority of the government, lack of national strategy for OSH
management, legal back up mechanism and focal point at government ministries.
Few industries have taken prudent measures by establishing OSH setups thereby
decreasing vulnerability of hazards
46.
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Canadian center for occupational safety and health 2014, www.ccohs.ca
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Rantanen, J., & Lehtinen, S. (2007). Basic occupational health services.
Rantanen, J., Lehtinen, S., Valenti, A., & Iavicoli, S. (2017). A global survey on occupational health
services in selected international commission on occupational health (ICOH) member countries. BMC
public health, 17(1), 1-15.
Rantanen, J. (2005). Basic occupational health services-their structure, content and
objectives. SJWEH Supplements, (1), 5-15.
Joshi, S. K. (2011). Occupational safety and health in Nepal. International Journal of Occupational
Safety and Health, 1(1), 1-2.
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