4.2.1. Occupational health services

In 1985 the International Labour Conference adopted the Occupational Health Services Convention (No. 161), providing that occupational health services shall be progressively developed for all workers, and the Occupational Health Services Recommendation (No. 171), specifying as to how this may be done. Both Convention No. 161 and Recommendation No. 171 call for consultation with the most representative organizations of employers and workers on the measures to be taken to give effect to the provisions of these international instruments.

Occupational health services may be organized either by enterprises themselves (or groups of enterprises, as appropriate), public authorities or services, social security institutions, other authorized bodies or a combination of these, depending on national conditions and practices. Their functions vary widely, of course, and include, as appropriate, the identification and assessment of health risks at work, the surveillance of factors in the working environment, and the monitoring of the health of workers and others. Occupational health services participate in the analysis of work-related accidents and diseases and advise on their prevention. Among their functions, the organization of first aid and emergency treatment is listed in Article 5 of Convention No. 161.

Unfortunately, even today, the availability and effectiveness of occupational health services are inadequate in many cases. Even if occupational health services are adequately staffed, their staff may not be on the scene when serious injury or illness occurs. They may arrive too late to intervene in life-threatening situations. Convention No. 161 and Recommendation No. 171 clearly stipulate that the occupational health services have certain roles in the organization of first aid and emergency treatment. First, these services must be a source of advice and technical supervision and, secondly, they must be operationally linked with first aid to:

- provide medical care following first aid;

- make, or help make, referrals to specialized medical care; and

- participate in the post-accident evaluation, which should always include an evaluation of the adequacy and effectiveness of first aid.

When the establishment of occupational health services is promoted at the national level, special attention should be paid to the specific problems encountered by small-scale enterprises. Rigid regulations will not help; flexible solutions exist and are practised in a number of countries. Some examples may be given. In Belgium the occupational health services of large firms may provide assistance as appropriate, including first aid, to the small enterprises which usually work for them (repair workshops, garages, painters, etc.). In Canada occupational health services may be annexed to local hospitals or clinics; the objective is to create a network of occupational health services serving all enterprises, including small ones. In Cuba occupational health centres may be linked to community health centres which serve both large and small enterprises in a given area. In Sri Lanka occupational health care is provided by autonomous services in large enterprises or by the network of public health medical centres for the rest. There are examples of occupational health services which provide services to an industrial estate or which are organized by a national occupational safety and health institute. Innovative approaches exist, and they should be encouraged and more widely applied. Efforts in this respect need to be pursued.