6.2.2. Implementation

Role of occupational health services

The role of occupational health services is considered in the ILO's Occupational Health Services Recommendation, 1959. The following paragraphs take account of the particular features of agricultural work in this connection.

Pre-employment, periodic and special medical examinations (biological, radiological, etc.). Workers should be medically examined on engagement and at yearly intervals thereafter, except for certain classes of workers, such as pregnant women, young persons, workers exposed to special risks and others in special circumstances, for whom the doctor will decide the appropriate periodicity. Examinations should also be made on the resumption of work after an absence due to illness or accident. In this way, the doctor will be able to gain an idea of a person's state of health and, being aware of his working conditions, to advise him as to the kind of work best suited to him. The examinations should make it possible to diagnose troubles in their initial stages, to see whether satisfactory preventive measures have been taken, and if necessary to assign the worker to another job.

However, changes of job, although easy to arrange in large enterprises, are much more difficult in small family undertakings. In such cases, it is advisable to consider carefully the possibility of transferring the worker to another occupation, with due regard being had to his physical and mental aptitudes and the state of the labour market.

Surveillance of the working environment. It is obvious that a doctor who has to judge the aptitude of persons for certain jobs, and to supervise them medically in the light of the risks to which they are exposed, must be familiar with their working conditions. Job analysis is an essential part of the doctor's work, enabling him to advise the technicians on the methods to be employed to avoid risks (handling of poisons, contagion risks, and so on). He should also check that the personal protective measures recommended have been applied (clothing, respirators, and so on).

Prevention of accidents. In agriculture, the proportion of occupational accidents attributable to the human factor is particularly high. It is essential that the agricultural health service should help actively to instil the safety spirit in the workers by seeing that personal protective equipment is properly used and maintained and by encouraging the adoption of appropriate safety measures. first aid. In view of the difficulties of establishing effective first-aid services in a rural environment, the role of the agricultural health service should include initial and regular subsequent training of first-aid personnel.

Health protection measures. The closer the agricultural health service is to the workers, the easier it will be for it to advise on health measures, whether these measures are concerned with investigations or with the organisation of prevention against scourges such as tuberculosis or malaria. The rural doctor can protect people against certain risks by active immunisation (for example, vaccination against tetanus) or by chemotherapy (for example, distribution of quinine derivatives in malarial zones.)

Surveillance of the hygiene of sanitary installations. The doctor must be an adviser in matters of hygiene and health. He should inspect the workers' housing and the various sanitary installations (water supply, shower baths, drains, latrines, and so on). The inspections will also provide opportunities for educating workers in health and hygiene.

Consultations on health problems. In the event of occupational or other disorders, agricultural workers should be encouraged to go to the agricultural health service for information on any questions of health or hygiene. Such personal contacts will increase when the doctor has been able to gain the confidence of those in his care, and they will be extremely useful for the prevention of risks and for the promotion of health education, especially as regards nutrition.

Medical treatment. The rural doctor might participate in the treatment of mild conditions. However, if medical aid is difficult to obtain, the doctor may be allowed to give any necessary treatment to agricultural workers and their families.

Health education. The doctor has a major role to play in educational health programmes, as regards both general health problems (general hygiene, nutrition, and so on) and problems relating to occupational hazards and the protection of workers. He should maintain close contact with all the different bodies concerned with questions of the farmers' health, safety and welfare in rural areas, as well as provide direct advice on occupational health in agriculture.

Co-operation with other medical services. The doctor must not work in isolation from other medical services. He must rather establish contact with other kinds of preventive medical services (health agencies, school and sports medical services, and so on). He must meet other practising doctors and visit hospitals and supervisory medical services (participation in inquiries into occupational accidents and diseases, furnishing opinions on resumption of work jointly with medical inspectors, of insurance institutions).

Agricultural health services must be operated in close co-operation with the local veterinary services, practitioners and/or administrators in order to deal with zoonoses, and with agricultural technicians and labour inspectors.

Records. It is essential that records be kept up to date if the agricultural health service is to function efficiently. This is all the more important if the doctor is to monitor a worker's state of health and to follow its evolution, particularly as regards chronic affections and cumulative poisons.

The statistical processing of records by a central organisation would make it possible to undertake comparative studies at the regional, national and international levels. This is particularly so if the health services are to take part in research (inquiries, specialised examinations) and in education.

Operation

The number of qualified medical personnel available determines the way in which agricultural health services may be operated:

(1) In countries where there are enough doctors (say, one doctor for every 800 inhabitants, with the term "doctor" covering both general and specialist practitioners and supervisory and preventive personnel), provision may be made for occupational health doctors specialising exclusively in agricultural medicine.

(2) In countries where there are not enough doctors but where there is no serious shortage, an agricultural health service may be incorporated in a system of preventive medicine serving the population among which the doctor concerned works (e.g. public health service, industrial medical service).

(3) In countries where there is a chronic shortage of doctors, which unfortunately is the commonest case (it is estimated that about two-thirds of the world's population have no means of obtaining adequate medical treatment), the agricultural doctor may consider participating in the treatment of workers and their families.

Operational conditions

Fixed or itinerant medical installations may be provided, according to the density and the distribution of the population of agricultural workers. Fixed installations are to be preferred, because better health services can be provided than with itinerant installations, with, at the same time, minimal restrictions on the occupational health doctor.

Characteristics of a health service

Two basic conditions are essential for the organisation of a successful health service. First, the doctor must be competent. His competence in handling the problems of occupational health in agriculture can be enhanced through specialised educational programmes that take account of the continuing evolution of agricultural technology. Second, the doctor must have sufficient time in which to practise agricultural medicine. Ideally, the maximum workload for a full-time doctor would be 3,000 workers.

Resources

The doctor must, of course, be provided with the installations and equipment needed for his work, as well as the necessary nursing staff, secretarial staff and possibly social staff in support.

Type of organisation

Agricultural health services can be organised either on a geographical or on an occupational basis. Obviously, the greater the degree of specialisation, the greater the efficacy of the service, since the doctor will not have to be a specialist in so many areas.

However, apart from a few exceptions (large undertakings, single-crop areas), it is practically impossible for an occupational health doctor to specialise in agricultural medicine. Sometimes, even in rural areas, artisans and tradesmen for whom there is no suitable occupational health service available can be cared for by the agricultural health service. Nevertheless, when feasible, specialisation in agricultural medicine is to be preferred.

Finance

In many countries, agricultural workers constitute only a small proportion of the wage-earning population. Farmers may reasonably be asked to help to finance agricultural health services from which they benefit. It is, however, unlikely that agricultural health services would be set up by private initiative.