Capacity Building for Occupational Health for Workers in South Africa

Inakshi NaikOHS Training Department, NIOH29th October 2013Hong Kong

Overview of the presentation

• Overview of the National Institute for Occupational Health (NIOH) SA

• Training needs assessment• Training in different categories and levels• Gaps in training – shortage of skills• Current initiative to fill in the training gaps• Short Courses/seminars/workshops to develop

capacity• Strengths of NIOH in delivering the programme

Johannesburg, SA The City of Gold

National Institute for Occupational Health (NIOH)

Established in 1956 (Pneumoconiosis Research Unit)

Advisory Statutory Service Autopsy

Services Specialized

Laboratories

HealthHazardEvaluations

ResourceNetwork

6

• Universities and other Institutions

• Local & International Partnership

• Trade Unions, NGO and Business

• Govt. and Public Entities

Services Research

Back Office

SupportTraining

Post Graduate Qualification in OH for Medical Practitioners

• Post Graduate Diploma in Occupational Health • Part Time: Offered over 2 years in 8-10 weeks• one week blocks. • Offered by 6 Universities. • UCT offers distant learning

Post Graduate Qualification for Occupational Health Nurses

• Post Basic Nursing qualification• 9 Universities and one private Academy offers

Masters, B. Tech, Diploma and Certificate courses over one-two years period.

• B Tech qualifications offered by University of Technology

• Registration with the SA Nursing Council with minimum DoH nursing

Qualification forOccupational Hygienists

Registered Hygienist in 3 different categories with SAIOH in SA• Hygiene Assistants• Hygiene Technologists• HygienistsEducation and Training Requirements• Occupational Hygienist Post Graduate Qualification

3 Universities offer a Diploma and Masters Degree in and PhD in Occupational Hygiene over two or three years (part time/ full time),

• Offered as DPH or MPH Occupational hygieneApplicants must have a four-year qualification from a university

• Being registered with the South African Institute for Occupational Hygiene (SAIOH) at the minimum of the Occupational Hygiene Technologist level.

The Wits School of Public Health, in association with the NIOH, offers a Diploma in Occupational Health (DOH) and MPH Occupational Hygiene

Weaknesses Identified in the Present System for Training of Different Categories of Hygienists:

In House Training• No defined requirements• High registration failure rates• No mentorship programme • Present application form – summary of educational qualification

and employment history • Assessors lack full understanding

of candidate level of competency• Little practical and experiential learning• Provider also is accreditor

New Proposed Training for Occupational Hygienists in SA

• Registration model based on competency levels• Bench mark proposed skill requirements against

international standards • Meet IOHA registration requirements• Develop a skills matrix • Develop detailed skill definitions per grade• Mentorship programme support development of

practical skills• Promote use of Personal Learning Portfolio as part of

assessment processAdapted from SAIOH Deon Van Vuuren (Chairperson SAIOH)

OHLearning for Occupational Hygienists www.ohlearning.com

OH Learning for Occupational Hygiene Qualification

• The Occupational Hygiene Training Association (OHTA) was formed to promote better standards of occupational hygiene practice throughout the world.

• They develop training materials and make them freely available for use by students and training providers.

• Promote an international qualifications framework so that all hygienists are trained to a consistent, high standard, recognized in all participating countries.

• Three levels of course: Foundation level, and progress through intermediate level to advanced level

Downloading of training materials is free of charge but is subject to the Terms of Use of OHlearning.com.

Training for Other Occupational Health Workers Provided at NIOH

• Occupational epidemiology (MPH)

• Information sciences

• Residency training in Occupational Medicine

Partnerships with universities, internship programmes and experiential learning.

Laboratory based sciences (Scientists. Technologists & Technicians)

Toxicology Analytic chemistry Pathology Immunology/Microbiology

Students from India trained in the Analytical Laboratories for metals, organic exposures

Developing Capacity for the Government Health System

PHC Training Initiative by the Department of Health, SA

The re-engineered approach to providing PHC services proposes a population based approach for delivering of PHC outreach service

Who is the Training for ?

• Community Health Workers• Primary Health Care Nurses• Family Medicine Doctors• Hygienists/Technologist/Technicians/

Environmental Health Officers• Health and Safety Representatives• Labour Inspectors• NGOs, Trade Unions

Clinic / PHC

District Hospital

Regional HospitalTer

tiary

Hospita

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Outreach CHWShort

Courses

Academic Learning

CHW

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Envir

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Office

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Proposed Training at Different Levels

OHLearning

and other support

Ward Based PHC Outreach Programme- CHW• DoH Project: Funded by USAID• Ward based PHC Outreach Team• 10 000 CHW trained in phase 1• HIV, TB, ANC, Child nutrition but not OH • Introduce OH screening tools

6 CHW 270

Families each

Professional Nurse

Team Leader

EHO

Health Promoter

Functions stipulated for EHO:

Monitor OH and safety in local businesses

Manage environmental noise hazards

Clinic / PHC

District Hospital

Regional HospitalTer

tiary

Hospita

l

Outreach CHWShort

Courses

Academic Learning

CHW

s, Nur

ses,

Envir

onm

enta

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lth

Office

rs & H

ygien

ists,

Docto

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Proposed Training at Different Levels

OHLearning

and other support

Motivation for Training PHC Nurses in OH

• Where an employee develops ill health due to occupational causation the client may consult a health care worker at a public clinic.

• PHC nurses are the gatekeepers of the health system

• They are not taught the basics of occupational health in their training and are thus not skilled in the identification of an occupational disease.

• Through the early detection of disease the morbidity associated with occupational disease can be reduced thereby decreasing the disease burden in the country.

Training of Public Health Care (PHC) Nurses in Fundamentals in Occupational Health- NIOH Initiative

Aim: • To equip a PHC nurse with information/skill to be able to take an

appropriate occupational history

• Refer suspected occupational disease cases to the next level of referral, i.e. The Regional/ District hospital.

• To have a high index of suspicion for work-related problems and identify sentinel events.

• Knowledge of referral systems that exist within the district.

• To liaise with the Environmental Health Officer, Labour inspectors

Structure of the Course for the PHC Nurses • The course will be five days in duration. A combination of theory and

practical teaching methods

• A site visit and a virtual site visit will be included in the teaching methods.

• Assessment will be conducted through continuous formative assessment and a summative assessment.

• Learners will be required to complete 10 health assessments of employees in the PHC setting.

• On successful completion of assessments a competency certificate will be issued by the NIOH.

• SANC accreditation of this course will be requested.

Current Short Courses Available for Medical Practitioners

Global Program in Occupational Health Practice (GPOHP)

What is the GPOHP?• The Global Program in Occupational Health Practice is an internet-based,

instructor-led distance-learning program for professionals in either occupational health services or occupational hygiene.

• The program consists of two tracks, the Occupational Health Practice Certificate and the Occupational Hygiene Practice Certificate.

• Each contains three consecutive courses that build on each other. However, the courses may be taken separately. Courses are ten weeks long.

• All participants receive a "Certificate of Competency” on completion from UIC. School of Public Health

Structure of the GPOHP

OHTA Recognition and incorporation of Hygiene Modules in OHLearning

Other Short Courses for OHS Workers

http://www.who.int/occupational_health/publications/whomodules/en/

WHO Modules in Occupational Health, Hygiene and Safety

• The WHO Modules in OH were developed by a team of experts from the Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois - Chicago, USA, also a WHO CC in OH.

• The modules were developed to execute the 49th World Health Assembly Global Strategy for OH

• The materials are case-based modules in the specific sectors of agriculture, manufacturing, and the health service

Aim of the CourseThe aims of the course were to develop and strengthen

the following approaches in OH:• Anticipate and recognize workplace hazards

• Describe exposure to workplace hazards and their health effects

• Generate recommendations for preventing exposure using available resources and technologies

• Develop a programme plan for addressing workplace hazards

On Completion of the CourseThe participants are equipped to:• Complete an occupational history• Recognize a work related injury or illness• Conduct a qualitative risk assessment of a workplace• Conduct an incident investigation• Categorize exposure groups• Complete an exposure and health effect rating chart• Develop a strategy for collecting quantitative data• Recommend intervention strategies for reducing

exposure• Begin a programme plan for various workplaces

Corse Conducted at NIOH: Team from UIC, SPH, USA and Nayati Int. India

• The week-long course was attended by close to 90 participants from both public and private sectors.

• A certificate of competency (from the University of Illinois - Chicago and the NIOH, Johannesburg) was issued to all participants scoring higher than 70% on post-course performance- and knowledge-based evaluations.

• A CD of the full course was created as an Integrated E-Learning Platform – essentially a video recording of the presentations, to be used as a training tool by trainers for future capacity building.

• With the aid of the CD further 330 delegates in 10 centres ( 9 provinces and 1 national centre) were trained within 4 months in 2010.

• The delegates were HSR, wellness managers, safety officers, nurses

• The course has a “Train the Trainer” component

Field Visit-Hospital Laundry/Kitchen/Laboratory

Learners During Lectures and Exercises

Training for Medical Officers (Namibia)• WHO: Protection of the Human Environment

Worker’s Health• Ministry of Health and Social Services.• Swakopmund, Namibia 2011• District Health Medical Officials in Namibia • Delivered by Dr. Ivan Ivanov (WHO), Dr. Norbert

Wagner (UIC, SPH, and Dr. Tony Cantrell (NIOH, SA)• 2 weeks course: 1 week Occupational Diseases , 1

week Occupational Hygiene

Health and Safety Representatives (HSR) Course for NHLS - online

Health and Safety Representative (HSR) in Pathology Laboratories (Course Overview)

We trained 268 HSR countrywide on our intranet in 2012.

Current around 170 HSR being trained

Course specifically designed to identify hazards and risks associated in pathology laboratories

Modified for any environment

Stoffenmanager Version 5.1www.stoffenmanager.nl

Stoffenmanager: Background and History

• Web-based IT-tool (public and freely available) to help small- and medium-sized enterprise (SME) which allows non-expert users in the companies to manage their dangerous substances more efficiently.

• Developed by consortium: Dutch ministry of social affairs (owner & funding) ,

BECO , TNO and Arbo Unie (research & development)

• First development: risk prioritization (control banding)

• Subsequent: quantification and validation of the exposure process modelinitially inhalation

• March 2008: version 4.0 Separate exposure estimation for dermal exposure

Changing Focus of Occupational Risk Management for Workplaces Exposure to Chemicals

Traditional• Rely on technical

experts to evaluate workplace hazards and risks.

• Carry out exposure monitoring

• Compare with OELs • Recommend

controls.

Innovative• Empower

owners/operators to evaluate their own workplaces for hazards and risks.

• Focus resources on practical control solutions rather than expensive exposure measurements.

Stoffenmanager estimation: reasonable worst-case = 90-percentile

Other Courses Conducted at NIOH• Biological monitoring of chemical exposures• Ergonomics incl. Manual material handling• Occupational allergies/asthma• Substance abuse in the workplace• Chemical and biological hazards for Labour inspectors• Personal Protective Equipments• ILO-CXR for silicosis• Management of Chemical exposures in the workplace• Stoffenmanager• GHS for chemical communication • Continuing Professional Development with HPCSA

DVDs and facilitators’ guides

Strengths of NIOH• NIOH is a WHO CC in OH. • Network with NIOSH, CDC, WHO, FIOH,

UIC SPH, USA, etc• Linkage with DoH, DoL, DMR, MBOD, CCOD• Affiliated with Universities• Staff highly knowledgeable and skilled in various

fields of OH• Infrastructure (lecture rooms, video-conference units • New learning technologies (eLearning)• National, Regional and International activities• Visionary leadership

Thank You