ANNUAL REVIEW MEETING, PUBLIC HEALTH DIV. 2006

1. ANNUAL REVIEW MEETING, PUBLIC HEALTH DIV. 2006 OCCUPATIONAL & ENVIRONMENTAL HEALTH PROGRAM March 2007

2. 3 Sub-Program Areas i. OCCUPATIONAL HEALTH & SAFETY ii. ENVIRONMENTAL HEALTH Iii. POISON INFORMATION CENTRE

3. Occupational Health & Safety • WHO reports • 1.1 million occupational injuries & diseases annually • 300,000 deaths (1997) • Likely higher with increase in industrial processes & range of chemicals (>60,000 in commercial use) • Corresponding figures for Ghana?????? –Poorly developed systems of data collection • <5% have access to O.H. services in developing countries

4. The Ghana Legal Framework of OSH • Labour Act, 2003 (ACT 651) provides legal framework for OSH for all sectors of the Ghanaian economy. • Section 118 : employer to ensure that every worker employed by him works under satisfactory, safe and healthy conditions. • Section 121 empowers Minister to make Regulations by LI providing for specific measures to be taken by employers to safeguard H &S of workers employed by them.

5. Situational Analysis • Min of Manpower lead ministry • 2000: Draft National OSH policy developed in response to heightened public awareness on need for working in healthy & safe conditions: awaiting submission to cabinet • Assigns roles to stakeholder MDAs including MOH: To help in • formulation of policy, training and sensitizing of health professionals to OSH issues and concerns, • the delivery of appropriate occupational health services,

6. OSH Situational analysis • assisting in the design of appropriate OSH databases and information systems, • determination of appropriate exposure standards, • developing biological monitoring procedures, • development of regulations, guidelines and training materials, • and raising awareness of Occupational Health issues

7. participate in the development of the OSH research agenda, and in those research projects in which expertise in occupational medicine and epidemiology is specifically needed. • undertake certain research projects/surveys on behalf of MDA with the direct responsibility. Strengths • Well-trained and highly trainable health professionals: quick mobilization and take-off of OSH management possible.

8. OHS - Objectives Overall Goal : • Contribute to development efforts through facilitating the attainment of the highest level of health standards for workers and promote safety in all sectors of the economy.

9. OHS – Specific Objectives-2002-’06 i. Collaborate with stakeholders within and outside health sector in development of policies and legislations for OHS by 2004 ii. To promote and build capacity for the integration of OHS in the primary health care approach to health care by 2005. iii. To conduct and promote research in the area of occupational and environmental health in major economic sectors by 2005. iv. To facilitate the institutionalization of occupational health services for staff of the GHS by 2006.

10. OHS- Achievements • Draft national policy developed. Awaiting submission to cabinet from Min of Manpower -6yrs + • Little progress on devt of LI on OHS in support of Labour Act, 2003 (Need for intervention by political leadership of MOH) • Curriculum for in-service training in basic OH developed in 2005. To date, no funds for training • Workplace HIV/AIDS Policy and Guidelines for the Health Sector’ was completed and printed - 2004. • Awaiting funds for dissemination

11. OHS -Achievements • Draft policy on OHS for GHS staff has been developed 2005-6. Awaiting approval prior to dissemination • Guidelines on medical surveillance for health workers provided & distributed to regions in 2005 . • Attempt to provide orientation to practitioners halted by non-availability of funds: 2004-2005 • Nomination & training of regional focal persons on basic OSH halted by non-availability of funds?? ??Overstretched staff

12. OHS: Achievements • Studies: • On Child Labour (ILO) – Recommendations to be integrated when OSH training for primary health staff /PHNs takes place.??? • Baseline studies in few economic sectors: health care work, manufacturing (textiles, food & beverage), MSEs, mining, irrigation agriculture, • Development of handbook on OHS for health staff & other workers

13. Environmental Health-Objectives • MOH POLICY: Overall objective of health sector is to reduce risk factors that arise from (among others) ENVIRONMENTAL causes (General Environment and Work Environment).

14. Environmental Health-Objectives • Collaboration: Promoting and facilitating the establishment and implementation of policies and programmes of the Health and other sectors to address priority environmental health issues. • To assist in the investigation and management of (potential) health impacts arising from economic activities, development projects & other activities • To facilitate the establishment of a sustainable waste management system within the health sector.

15. Environmental Health- Achievements Leading in collaborative efforts! • Support to Collaborative study with Minerals Commission & EPA: Environmental Impact Assessment/ Strategic Environmental Assessment – the OSH and Community Health Aspects- on going • Support to EPA Air Quality Monitoring Program: To provide health based evidence on impact of poor air quality to facilitate action by policy makers to improve air quality: • By Monitoring incidence of ARIs in OPDs in Accra: 2005-2006

16. Environmental Health -Achievements • Now monitoring incidence of ARIs in Children under 5years in nursery schools in areas of air quality monitoring – Dec 2006 on going • Study of blood lead levels in exposed persons as part of baseline in support of environmental monitoring towards Phase-out of Lead in gasoline in country. (collab with EPA & Min of Mines & Energy) • Collaborative study on environmental & health impact of ITNs – EPA (under Roll back malaria prog.):

17. Environmental Health-Achievements • Health care waste management policy & guidelines developed for health sector. (MOH/ICD) • Waste management plans developed for 3 levels of health care system, • Dissemination at fora of health service managers, public forum (collaboration with GAC), training for Corridor districts in HCWM. • Steering committee finalising implementation plan • Awaiting official launch by MOH

18. Representation of GHS/MOH on Other sector activities • Committee on Persistent Organic Pollutants (POPS) / Stockholm Convention-EPA • Pesticides Management Committee-EPA • Food Safety Committee – MOFA • Aflatoxin Committee- Ghana Standards Board • Air Quality Monitoring Steering Group- EPA • Review of Water & Sanitation activities – Ghana Water Company / Min of Works & Housing/ Community Water & Sanitation Dept

19. Env Hlth- Representation on Cttees • Civil Aviation Medical Board • Naturally Occurring Radioactive Material Committee (NORM): GAEC • Committee for development of policy & bill on Biotechnology The only fulfilling aspect!

20. Poison Information Centre: Objectives • Provide information service primarily to support health professionals in handling poisoning from Chemicals, toxins & other sources. • Create awareness on availability of poison information service to 50% prescribers by 2006 • Training of 10 % PHC staff in Management of poisoning by 2006 • Improve management and surveillance of poisoning in 20% of GHS institutions by 2006

21. Poison Centre-Achievements • Draft Training Manual on poisoning management developed- awaiting funds for printing • Training for health staff on hold - no funds • Some IE & C materials & developed & distributed • Information pamphlets on centre developed & distributed • Training on prevention of poisoning and first aid to staff of MOFA (Agric Extension)

22. Trend of Poisoning (Sex, Predominant Age Group, Circumstances of Poisoning and Origin of Call)

23. Slight increase in queries to centre - <25 /yr • Origin of calls limited- mainly from Accra • Age < 30 years • Sex: Females> Males; reversed in 2006 • Agents of poisoning – Agrochemicals, drug overdose, venomous bites, food poisoning

24. Strategic Plan -2007-2011 Medium term goal : to ensure that by the year 2011, at least 20% of the working populations have access to basic occupational health and safety services. • Based on WHO guidance from 1982, (Primary health care and working populations, basic occupational health services should meet the following criteria: 1. They must be provided through the existing national health services by a process of integration 2. The primary health care strategy should be the preferred approach for delivery of such services. 3. They must cater for the total health of the workers : prevention, promotion, clinical care, rehabilitation

25. Strategic Objectives: 2007- 2011 • To collaborate with stakeholders within and outside the health sector to develop policies and regulations for occupational safety and health (OSH). • To conduct and promote research in occupational safety and health as well as environmental health. • To promote and build capacity for the integration of OSH into the health service system using primary health care approach to health care delivery.

26. Strategic Objectives: 2007- ’11 • To develop training materials and facilitate the setting up of training programmes for workers’ health and safety needs. • To promote the integration of OSH into work establishments in order to improve the planning for and management of workers’ health. • To support poverty reduction strategies through the implementation of policies to improve the working conditions of vulnerable workers (e.g. pregnant women, young workers) in both the formal and informal sectors.

27. Strategic Objectives • To promote and facilitate the implementation of policies and programmes to address priority health and safety issues e.g. chemical, physical, biological, mechanical, ergonomic, and psychosocial. • To strengthen the poison information center to effectively provide information to health professionals, agricultural sector, industry and the general public. • To establish OSH information centre to provide OSH information to professionals and the general public alike. • To facilitate the institutionalization of occupational health services for staff of the GHS/MOH.

28. Constraints to Unit’s activities • MOST ORPHANED PROGRAM(S): Little sense of support from within GHS / MOH & without • Program area NOT a priority in GHS : • Lack of adequate numbers of technical staff to support program activities: (Problem with establishment in Civil Service) • Little opportunity for Specialist training in Occ Health & Env health GHS • Funding situation precarious : 22m in 2007???

29. Constraints • Non-functioning & broken down office equipment • Inadequate means of transportation • Health information system inadequate to capture & disaggregate occupational injuries & diseases from others

30. PIC - Constraints PIC: • Centre not operating 24 hours due to low utilization • No funds for Mobile phone service to answer queries outside office hours • Antidotes not available in the system to support mgt of poisoning

31. Way forward • Need for decision either to DISSOLVE dept or OWN IT Properly If the latter then: • Political intervention to address issue of having national policy & LI in place • Affirmative action for training sponsorship / recruitment for specialist training in OSH /Env health including in non-typical ‘health disciplines’ eg occupational hygiene, toxicology, ergonomics etc

32. Way forward • Career advancement for nurses should not be advesely affected by specialization in O.H. • Political will on part of our directors to encourage integration: • Appointment of district focal persons • Integration into PHC activities at district level, • Advocacy by technical & political heads to source funding for activities