MODULE ONE:

Developing an Occupational Health andSafety Management System for Health Care Facilities

The health sector is of extraordinary socioeconomic importance in the Americas. It is ahuge source of employment that provides jobs for more than 12 million workers in theUnited States and 10 million in Latin America and the Caribbean (LAC) (PAHOestimates for 1999). Brazil alone employs more than one million persons in its healthservices (Brazil, Ministry of Health, 2003). It is important to note that most healthworkers are women, who suffer not only those risks directly tied to their work in thehealth sector, but also bear the burden that arises from gender inequalities.

Several health sector reforms have been introduced in Latin America and the Caribbeanin the last decade, but they have not considered work conditions as a priority. The labormarket in the health sector has moved toward more flexible models, which has redefinedwork processes, increased job instability, and, in most cases, decreased financialcompensation (1). For example, nurses report that they need to hold two or three jobs tobe able support their families. They also say that new health care models require them toperform more work in a shorter time and with fewer staff, that they care for populationsthat are sicker, and that they do so under greater restrictions in terms of supplies,equipment, and services in the facilities where they work (2).

Substandard working conditions in health care facilities have led to a shortage of trainedprofessionals (3, 4), with serious consequences in health service outcomes. For example,a shortage of nurses in the United States has disproportionately affected developingcountries whose professionals leave their land in search of higher salaries and betteropportunities. This instantly leads to erosion in operational capacity, poorer performance,and lower productivity in health care facilities in the developing countries (5, 6).

Health workers are particularly vulnerable to occupational accidents and illness whenthey work in understaffed units and under precarious working conditions thus creating avicious cycle. Studies in 11 United States cities have shown that nurses working infacilities with a high prevalence of AIDS patients report three times more needle-puncture injuries when they work in undersupplied and understaffed units that have lowernursing leadership and higher levels of emotional exhaustion (7).

Furthermore, technological advances in the health sector are far outstripping thedevelopment of procedures that ensure occupational and environmental safety (8). In theUnited States, occupational-accident rates among health workers rose in the 1990s. Incontrast, that country’s agriculture and construction sectors, which traditionally havebeen two of the most dangerous, are safer today than in the 1990s. In Latin American andCaribbean countries, where there is less available data than in the United States, thesituation may very well be worse for several reasons, including:

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• nonexistent, weak, or non-representative labor unions;

• a high prevalence of preexisting illnesses in the workforce, which increases thevulnerability to exposure to toxic and biological substances;

• a higher workload;

• a higher proportion of the health sector is privately funded (about 54% in 1994); thisfigure is higher than it is elsewhere in the world, except for South Asia;

• infrastructure and equipment tend to be ergonomically inadequate and hazardous;

• the elevation, temperature, and humidity levels in some countries may contribute todevelop physical and biological risk factors; and

• qualified professionals in occupational medicine and safety are scarce. As anywhereelse, general practitioners are not trained to identify occupational problems.

The cost of occupational injuries and illnesses goes well beyond the directly observableexpenditures for treatment, rehabilitation, and pensions. It has been estimated that theindirect costs (absenteeism, loss of productivity, overtime pay) are between two and fourtimes greater than direct costs (10).

Furthermore, it has been demonstrated that deficient occupational health and safetymanagement results in errors that may be subject to legal suits for negligence andincompetence, both against the health services and the health workers themselves (11).Clearly, the development of a management system for occupational health and safety willhelp improve the quality of health care provided and decrease the risk of legal suits.

Patient safety and the output quality of health care have been consistently linked to thepersonnel providing the care and to the characteristics of the organization (12, 13). Thislinkage underscores the extraordinary importance of the human component in theadministration of health care systems (14).

Adequate management of workers’ health and safety ensures:

• a decrease in absenteeism due to illness and lowered costs in health care andsocial security;

• healthy and motivated employees;• better cooperation, organization, and harmony in the workplace;• an increase in productivity; and• better health care provided.

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ADDITIONAL INFORMATION:

(PORTUGUESE)

Portaria 37 -proposta de texto de criação da Norma Regulamentadora No. 32 –

Segurança e Saúde no Trabalho em Estabelecimientos de Assistência a Saúde.http://www/mte.gov.br/Temas/SegSau/Conteudo/941.pdf

Ministério de Saúde do Brasil – Anuário esatístico 2001 –http://portal.saude.gov.br/saude/aplicaçoes/anuario2001/index.cfm

(SPANISH)

NTP 472: Aspectos económicos de la prevención de riesgos laborales: caso prácticohttp://www.mtas.es/insht/ntp/ntp_472.htm

NTP 540: Costos de los accidentes de trabajo: procedimiento de evaluaciónhttp://www.mtas.es/insht/ntp/ntp_540.htm