Occupational Health and

Primary Health Care in Thailand

S. Siriruttanapruk

Bureau of Occupational and Environmental Diseases

Ministry of Public health

Introduction

In Thailand, half of the total population are working population (36 millions).

Nearly two-third of the working population (23 millions) are workers in informal economy.

They are one of the high risk groups for getting occupational diseases and injuries

They have difficulty to access occupational health services (OHS)

This led to the establishment of “BOHS”

Introduction (Cont.) The policy development on BOHS by ILO, WHO, ICOH, and FIOH

The model of desirable BOHS provided by governmental sector must be integrated into existing primary health care services with no need to have extra investments or develop any new system.

Therefore, the Bureau of Occupational and Environmental Diseases had developed a project on BOHS model in Thai primary care units (PCUs) since 2004.

Up to now, the concept model of BOHS has been expanded into some PCUs in every province throughout the country.

Network of governmental health

care service system

Central level

Regional level

Provincial

level

District level

Sub-district

level

Office of Permanent

Secretariat

Regional hospital

General hospital

Community hospital

Health centre or

Primary Care Unit

(PCU)

Bur. of O & E

Dis.

B. of Dis.

Control

Financing of OHS

Type Prevention &

Promotion

Curative &

Rehabilitation

Government

officers

Government

budget

Government

budget

Formal employees Employers Social Security

and Workmen’s

Compensation

Fund

Workers in

informal economy

Health Security

Fund

Health Security

Fund

Steps of the development

Phase 1: Preparation

Phase 2: Model development

Phase 3: Implementation and expansion

Phase 4: Quality assurance

Preparation phase

The project started with the study of

the situation of OHS in PCUs and

identification of the gap for OH practice

among PCU’s staff.

Development of the guidelines for

BOHS and practice for PCU’s staff

Development of the OH training

curriculum

Model development phase

The pilot study had been conducted in 17

Thai primary care units (PCUs) in 8 provinces

from every part of the country.

All pilot activities in the field were also

designed and conducted by co-operation

between research team and the PCUs’ staff

Seminars of all pilot PCUs for sharing

experiences

Evaluation of the model

Conceptual framework for BOHS

Integration into existing public health

services

Holistic approach

Pro-active approach

Workers’ participation

Suitable technology (with local wisdom

application and low cost)

Guidelines of BOHS activities for

PCUs

1. Outpatient services at the units:

Improvement of simple and common occupational disease recognition and case management,

OPD card re-arrangement,

Disease reporting system

2. OH services in communities (Pro-active approach)

Farm or workplace survey,

Participatory data analysis,

Health screening,

Communication of results with workers for joint problem solving.

Training curriculum The capacity building for the PCUs’ staff was also a key success factor.

The training course focused on occupational risk assessment and utilization of the information for planning effective OHS.

The training course combined theory, practical field and group work. At the end of the course, all trainees were evaluated by measuring of the extent to which learning objectives were met.

The capacity building program began with a five-day training course, followed by pilot activities on the community level under the supervision of experts.

Outcomes of the pilot project

The study showed all PCUs were able to

provide OH services.

The target groups of the OH services were

mainly farmers.

The activities performed included OH

education (100%), first aid and emergency

treatment (77%), working environmental

survey in farms (38%), and health screening

for pesticide exposure (79%).

Implementation and expansion phase

Setting up of the national policy and indicator

Target: At least 3 PCUs in every province and at least 20% of high risk workers are under health risk assessment by PCUs

Collaboration of relevant agencies at all levels: National Health Security Office, Local Authorities, Provincial Health Offices

Development of guidelines, tools, etc.

Capacity building

Supportive teams and resource allocation

Evaluation

Outcomes of the implementation

In 2011, MOPH has set up the project to

celebrate the 84th years of the King’s

birthday

The project’s called, “Healthy Farmers,

Safety Consumers”.

The aim is to protect both farmers and

consumers from pesticide poisoning by

integrating BOHS for farmers into PCUs.

Results of the project

Almost provinces (74/77) join the project.

1/3 of all PCUs (3,602/9,215) report the BOHS

provision

252,651 Occupational Health volunteers have

been trained.

716,571 farmers access to the services

533,524 farmers are under health screening for

pesticide exposure

173,243 (32%) have the results of high exposure

Quality assurance phase

Setting up of the quality assurance

system following the existing Hospital

Accreditation system

Setting up of the teams

Assessment and monitoring

Occupational Health Volunteers:

People centered health care

and Participatory approach

Capacity Building of Workers’ Representatives for Supportive of

Occupational Health Management in Thai Communities

Problems identified: Occupational

diseases and injuries

Target group: Informal workers

OH Volunteers

Reviewing roles

& functions

Training

curriculum

Communities

selected

Capacity

building

Simple risk assessment

Monitoring of working

environment

Simple health surveillance

Healthier and happier

Roles and Functions of OH

volunteers OH volunteer is a workers’ representative for collaboration

with primary health care staff in provision of some OH activities to their peer group (1volunteer:10-20 workers)

Duties: Provision of some basic OH activities e.g. health risk assessment, OH education, and advice on implementation of preventive measures

Characteristics of OH volunteers:

Workers’ leader or representative

Currently being Health Volunteer

Be voluntary to perform the duty

Be able to read or write and communicate to other workers

Lessons learned The project can raise an awareness of the

importance of OH in farmers and other workers in

informal economy among health authorities and

officers at provincial and local levels.

OH services for underserved workers could be

integrated effectively into a general health service

system at the PCU level.

The PCU’s staff increased their understanding and

knowledge on OH services.

The project also affected workers’ belief and attitude

about their health and work.

Obstacles

No continuously supportive policy from the top policy makers

Budgetary constraints

Lack of staff and resources

Lack of advance knowledge on OH

Insufficient law enforcement

Ineffective use of information for further prevention and control of occupational diseases.

Conclusions

OH services are very important for OH system.

The suitable OH service model for underserved workers is necessary

Integration of OH services into the PCUs was favourable.

Continued capacity building to increase knowledge and skills for the health care staff is needed.

Policy support and resource allocation are essential.