Occupational Health

OCCUPATIONAL HEALTH

 promotion

and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations,

 the

prevention among workers of departures from health caused by their working condition;

 the

protection of workers in their employment from risks resulting from factors adverse to health;

 placing

and maintenance of the worker in an occupational environment adapted to his physiological and psychological

to summarize,  the adaptation of work to man and of each man to work.

 Occupational

health nurse  She functions independently and  caries the responsibility for the administration of the occupational health programmes

 American

Association of Occupational Health Nurse (AAOHN, 1999), occupational health nursing means the specialty practice

 It

is an autonomous specialty, and nurses make independent nursing judgments in providing health care.

The components of the occupational health nursing are:  To carry

on a significant, positive health programmes  To provide therapeutic care for the worker;  To establish meaningful interpersonal relationship  To ensure that nursing activities are compatible

Objectives of occupational health

Function of occupational health  Plans

and develops nursing care  Research to improve delivery of nursing services.

Principles of occupational health  occupational

safety and health.  interdisciplinary team effort.  qualified, professional personnel,  Quality of work environment  Workers participation  Occupational health & community health, they are interrelated and independent.

Scope of Services: Occupational Health Programme  Health/medical

surveillance  Workplace monitoring/surveillance  Health assessments

Scope of Services: Occupational Health Programme Health assessments  Preplacement  Periodic, mandatory, voluntary  Transfer  Retirement/termination  Executive  Return to work

Scope of Services: Occupational Health Programme  Health

promotion  Health screening  Employee assistance programs  Case management  Primary health care for workers and dependents

Legislation related to occupational health

 The

Factories Act, 1948  The Employees State Insurance Act, 1948  The Workman’s Compensation Act, 1923  The Maternity Benefit Act, 1961  The Atomic Energy Act, 1973  The Fatal Accident Act, 1855  The Personal Injuries (Compensation Act), 1963  The Biomedical Waste (Management and Handing) Rules, 1988

Legislation related to occupational health

 The

Mines Act, 1952  The Plantation Labour Act, 1951  The Motor Transport Worker Act, 1961  The Shops and Commercial Establishment Act (State Act)  The Employment of Children Act, 1938  The Bids and Cigar Workers (Condition of employment) Act, 1966

The Occupational Health Team

ERGONOMICS The term “ergonomics” is derived from the Greek ‘ergon’, meaning work and ‘nomos’, meaning law. It simply means: “fitting the job to the worker”.

 designing

of machines, tools, equipment and manufacturing processes,  lay-out of the places of work,  methods of work and environment  For-greater efficiency of both man and machine.

“to achieve the best mutual adjustment of man and his work, for the improvement of human efficiency and well-being”. reducing industrial accidents and to the overall health and efficiency of the workers.

What to do?  Warm

up and stretch before activities  Take frequent breaks  Recognize early signs  Maintain erect position  Keep feet flat on floor, upper body weight resting on “sits bones”  Avoid bending neck forward for prolonged  Avoid repetitive or prolonged grip activities.

 Use

the largest joints & muscles to do the job  Use 2 hands to lift rather than one  Slide or push and pull objects instead of lifting

OCCUPATIONAL ENVIRONMENT

OCCUPATIONAL HAZARDS

 Physical

hazards:  radiation,  electricity,  extreme temperatures, and  noise

 Chemical

hazards:  medications,  solutions,  gases,  vapors,  aerosols, and  particulate matter

 Biological  bacteria,  viruses,  fungi,

or  parasites

and infectious hazards:

 mechanical

hazards:

 accidents,  injuries,  strain,

or  unsafe/inadequate equipment  lifting devices,  slippery floors

 Psychosocial

hazards:

 stress,  emotional

strain,  interpersonal problems.

PHYSICAL HAZARDS Heat  burns, heat exhaustion, heat stroke, heat cramps.  Hot spots – ovens and furnaces  Radiant heat – glass and steel industry  Heat stagnation – jute and cotton textile industry, mines  The indirect effects are decreased efficiency, increased fatigue, enhanced accident rate, stress, impaired health.

PHYSICAL HAZARDS Cold  cutaneous vasoconstriction Light  eye strain, headache, eye pain, corneal congestion , eye fatigue.  Excessive brightness or glare – discomfort, annoyance, visual fatigue, blurring of vision and leads to accident.

Noise  Auditory effects – temporary or permanent hearing loss.  Non auditory effects – nervousness, fatigue, interference with communication by speech, decreased efficiency, annoyance. Vibration  drills and hammers (10 to 500 Hz).

Ultraviolet Radiation conjunctivitis and keratitis Ionizing Radiation  X-rays, radioactive isotopes (cobalt 60).  Affects bone marrow and gonads.  cancer, leukemia, depilation, ulceration, sterility

CHEMICAL HAZARDS Local Action  Dermatitis, eczema, ulcers, allergic actions, cancer. Inhalation  Dusts  Gases, oxygen, hydrogen, asphyxiating gases  Anesthetic gases – chloroform, ether Ingestion:lead, mercury, cadmium,

BIOLOGICAL HAZARDS  brucellosis,  leptospirosis,  anthrax,  hydatidosis,  tetanus,  encephalitis,  fungal

infections, etc.

MECHANICAL HAZARDS  accidents

PSYCHOSOCIAL HAZARDS  Frustrations,  lack

of job satisfaction,  insecurity,  poor human relationships, and emotional tension

 Psychological

and behavioral changes: including hostility, aggressiveness, anxiety, depression, alcoholism, drug abuse, sickness, absenteeism.  Psychosomatic ill health: including fatigue, headache, pain in the shoulders, neck and back, peptic ulcer, hypertension, heart disease and rapid aging.

OCCUPATIONAL DISEASES AND DISORDERS diseases arising out of or in the course of employment.  Each occupation has its own hazards. 

OCCUPATIONAL DISEASES  Diseases

due to physical agents:  Diseases due to chemical agents:  Diseases due to biological agents:  Occupational cancers:  Occupational dermatosis:  Disease of psychological origin:

         

PNEUMOCONIOSIS: SILICOSIS: ANTHRACOSIS: BYSSINOSIS: BAGASSOSIS: ASBESTOSIS: FARMER’S LUNG: OCCUPATIONAL CANCER RADIATION HAZARDS: LEAD POISONING:

PNEUMOCONIOSIS  It is a lung disease caused due to the inhalation of dust particles (0.5 – 3 micron),  which may gradually reduce the work capacity of a man due to lung fibrosis and other complications.  The important dust diseases are:

Silicosis:  It is caused by inhalation of dust containing free silica silicon dioxide.  The incidence of silicosis depends upon the chemical composition of the dust, size of the particles, duration of exposure and individual susceptibility.  the incubation period vary from a few months to 6 years of exposure.

 mica

mines (34.1%),  ceramic and pottery industry (15.7%),  sand blasting,  metal grinding,  building and construction,  rock mining etc.

 Pathology:  Particles

reach the interior of the lungs are ingested by the phagocytes which accumulate and block the lymph channels.  It is characterized by a dense “nodular” fibrosis ranging from 3 to 4 mm in diameter.

 irritant

cough,  dyspnoea and  chest pain;  finally impairment of total lung capacity (TLC).

 Diagnosis:

Chest X-ray

Silicosis is prone to pulmonary tuberculosis (silicotuberculosis).

Treatment: there is no effective treatment. The control measures are:  Dust control measures – complete enclosure, isolation, hydroblasting, good housekeeping, personal protective measures.  Regular physical examination of workers.

Anthracosis (coal miners pneumoconiosis):  It is caused due to coal dust.  Simple pneumoconiosis – caused due to minimum of 12 years of work exposure which leads to little ventilatory impairment.  Progressive massive fibrosis (PMF) – causes severe respiratory disability.

Byssinosis  It is due to inhalation of cotton fibre dust over long periods of time.  chronic cough and progressive dyspnoea,  ending in chronic bronchitis and emphysema.

 Bagassosis  It

is the disease of lung caused by inhalation of bagasse or sugar cane dust.  sugar cane fibre waste was used in the manufacture of paper, cardboard  breathlessness, cough, haemoptysis, and slight fever further leading to impairment of pulmonary function.

Preventive Measures  Dust control – exhaust ventilation, enclosed apparatus.  Personal protection – mask, respirators with mechanical filters.  Medical control – periodic health check up.  Bagasse control – moisturizing spraying 2% propionic acid, fungicide.

 Asbestosis

Asbestos are silicates of varying composition (magnesium, iron, calcium, sodium, aluminium). Asbestos is used in the manufacture of asbestos cement, fire proof textiles, roof tiling, brake lining, etc.

 Asbestos

enters the body by inhalation, and  fine dust may be deposited in the alveoli.  The disease is characterized by dyspnoea, clubbing of fingers, cardiac distress and cyanosis.  It

causes pulmonary fibrosis leading to respiratory insufficiency and carcinoma of the bronchus and gastro intestinal tract, death.

Preventive Measures  Use of safer types of asbestos(chrysolite and amosite)  Substitution of other insulants – glass fiber, mineral wood, calcium silicate, plastic foams.  Dust control and biological monitoring(x-ray, lung function)  Periodic examination of workers and continuing research.

Farmer’s Lung  It is due to the inhalation of mouldy hay or grain dust  The disease is characterized by respiratory symptoms and finally leads to pulmonary fibrosis and pulmonary damage.

LEAD POISONING  manufacture of storage batteries, glass manufacture, ship building, printing and potteries, rubber industry etc.  All lead components are toxic – lead oxide, lead carbonate, lead arsenate, etc.  Mode of absorption is of 3 ways – inhalation, ingestion and absorption through skin.

 abdominal

colic,  constipation,  loss of appetite,  blue-line on the gums,  anemia,  wrist drop and foot drop.  CNS- insomnia, headache, mental confusion, delirium, etc.

Preventive measures:  Substitution of lead with less toxic materials.  Isolation  Local exhaust ventilation.  Personal protection, personal hygiene and good housekeeping  Periodic examination  Medical management- saline stomach washes if ingested

OCCUPATIONAL CANCER  The characteristics of occupational cancer are:  They appear after prolonged exposure  The period between exposure and development of disease may be 10 to 25 years.  The disease may develop even after cessation of exposure.

 Skin

Cancer: gas workers, oven workers, tar distillers, oil refiners, dye-stuff makers, road makers  Lung Cancer: gas industry, asbestos industry, nickel and chromium work  Bladder Cancer: dye-stuffs and dyeing industry, rubber, gas, and the electric cable industries.  Leukaemia

Control of Industrial Cancer  Elimination or control of industrial carcinogens – well-designed building or machinery, closed system of production.  Medical examinations and Inspection of factories.  Notification and licensing of establishments  Personal hygiene measures  Education of workers and management and research.

RADIATION HAZARDS  acute burns, dermatitis malignancies, genetic effects etc. Preventive measures:  Shielding of workers in x-ray field  Suitable protective clothing  Adequate ventilation  Pregnant women should not be allowed to work in risky areas.

OCCUPATIONAL HAZARDS OF AGRICULTURAL WORKERS:  Zoonotic

diseases:brucellosis, anthrax, leptospirosis, tetanus, Q fever.  Accidents:- use of agricultural machinery.  Toxic hazards:- fertilizers, insecticides, pesticides.  Physical hazards:- extremes of climatic conditions, excessive noise and vibration.  Respiratory diseases:- exposure to dusts of grains, rice husks, coconut fibers, etc. The common diseases are byssinosis, bagassosis, occupational asthma.

OCCUPATIONAL ACCIDENTS: 1. HUMAN FACTORS: 2. ENVIRONMENTAL FACTORS:

HUMAN FACTORS: Physical factors :- impaired vision, hearing problems. Physiological factors :- age, sex, fatigue, etc. Psychological factors :- level of confidence, concentration, emotional stress, dissatisfaction, non interestedness etc. 1.

ENVIRONMENTAL FACTORS: extreme temperature, humidity, noise, vibrations, unsafe machines etc. 2.

ACCIDENT PREVENTION – PRINCIPLES:

Adequate preplacement examination and job training.  Continuing examination  Ensuring safe working environment  Establishing a safety department in the organization under a competent safety engineer.  Periodic surveys for finding out hazards.  Careful reporting, maintenance of records and publicity. 

Health Problems due to Industrialization:  Environmental

sanitation problems – housing, water pollution, air pollution, sewage disposal.  Communicable diseases  Food sanitation  Mental health.  Accidents and Social problems.  Morbidity and mortality.

MEASURES FOR HEALTH PROMOTION OF WORKERS  Prevention

and

control

of

occupational

diseases,  disability limitations and rehabilitation

MEASURES FOR HEALTH PROMOTION OF WORKERS  Nutrition  Communicable

Disease Control  Environmental Sanitation  Mental Health  Measures for Women and Children  Health Education  Family Planning

Nutrition  poor health among workers - low work productivity.  Indian Factories Act, canteen -exceeds 250.  education -balanced diet.

Communicable Disease Control  immunization program against preventable communicable diseases.  special importance in India - tuberculosis, typhoid fever, viral hepatitis, amoebiasis, intestinal parasites, malaria and venereal diseases.

Environmental Sanitation:  Water supply  Food  Rest rooms  Sufficient space  Lighting , ventilation , temperature  Protection against hazards  Housing

Mental Health  To promote the health and happiness of the workers  To detect the signs of emotional stress and strain and to secure relief  The treatment of employees suffering from mental illness  Rehabilitation of those who become ill

Measures for Women and Children  Expectant mothers are given maternity leave for 12 weeks, of which 6 weeks precede the expected date of confinement they are allowed maternity benefit with cash payment.( ESI act, 1948)  Provision of free antenatal, natal and postnatal services.  Night work between 7 pm to 6 am is prohibited. (Factories Act)

Measures for Women and Children  Provide crèches in factories where more than 30 women workers are employed.  The Indian Mines Act 1923, prohibits work under ground.  No child below the age of 14 shall be employed to work in any factory or mine or engaged in any other hazardous employment.

Health Education  management,  supervisory staff,  workers,  trade union leaders and  community.

Family Planning  quality of life,  small family norm.

PREVENTION OF OCCUPATIONAL DISEASES  Medical

measures  Engineering measures  Legislative or statutory measures

1. Medical Measures  Pre-placement examination  Periodical examination  Medical and health care services  Notification  Supervision of working environment  Maintenance and analysis of records  Health education and counseling

2. Engineering Measures  Design of building  Good housekeeping  General ventilation  Mechanization  Substitution .  Dust  Enclosure

 Isolation  Local

exhaust ventilation  Protective device  Environmental monitoring  Statistical monitoring  Research

3. Legislation  The Factory Act, 1948  The Employees State Insurance Act, 1948  The Mines Act, The Plantation Act, The Minimum Wages Act, The Maternity Benefit Act, etc.

VOILENCE AT WORKPLACE  act

of aggression, physical assault, or threatening behavior that occurs in a work setting and causes physical or emotional harm to customers, coworkers, or managers.

three forms:  Non-physical violence (intimidation, abuse, threats etc)  Physical violence (punching, kicking, pushing etc)  Aggravated physical violence (use of weapons, e.g. guns, knives, syringes, pieces of furniture, bottles, glasses, etc)

Causes of Work Place Violence

Occupational Groups at Higher Risk from Workplace Violence  health

care employees  social services employees  teachers  municipal housing inspectors  public works employees

Measures  Maintain

and disseminate detailed policies on workplace behavior:  Maintain and disseminate workplace violence prevention programs:  Recognize warning signs:  Counseling:  Regular meetings with managers: comment boxes or surveys.

CHILD LABOUR  children

will be forced to work

International labor organization- ILO  Improve

labor conditions and living standards through international action.  Promote economic and social stability.

Factories act-1948  The

Factories Act, is a social legislation which has been enacted for occupational safety, health and welfare of workers at work places.  This legislation is being enforced by technical officers i.e. Inspectors of Factories, Dy. Chief Inspectors of Factories who work under the control of the Chief Inspector of Factories and overall control of the Labour Commissioner, Government of National Capital Territory of Delhi

APPLICABILITY  The

industries in which ten (10) or more than ten workers are employed on any day of the preceeding twelve months and are engaged in manufacturing process being carried out with the aid of power or  twenty or more than twenty workers are employed in manufacturing process being carried out without the aid of power, are covered under the provisions of this Act.

SALIENT FEATURES OF THE ACT ARE :-

 Approval

of Factory Building Plans before construction/extension, under the Delhi Factories Rules, 1950 .  Grant of Licences under the Delhi Factories Rules, 1950, and to take action against factories running without obtaining Licence.  Renewal of Licences granted under the Delhi Factories Rules, 1950, by the Dy. Chief Inspectors of Factories .

SALIENT FEATURES OF THE ACT ARE :-

 Inspections

of factories by District Inspectors of Factories, for investigation of complaints, serious/fatal accidents  inspections to check compliance of provisions of this Act relating to :- Health, Safety, Welfare facilities, Working hours, Employment of young persons , Annual Leave with wages etc.

 Administrative

Machinery :  The enforcement of this legislation is being carried out on district basis by the district Inspectors of Factories.  After inspection, Improvement Notices are issued to the defaulting managements and ultimately legal action is taken against the defaulting managements.

 Administrative

Machinery :  The Inspectors of Factories file Challans against the defaulters, in the Courts of Metropolitan Magistrates.  The work of Inspectors of Factories is supervised by the Dy. Chief Inspector of Factories on district basis.

 Penalties: This

Act provides for a maximum punishment up to two years and or a fine up to Rs. one lakh or both.



The Act does not permit the employment of women and young in dangerous process or operation.

 Section

11 to 20 deal with provision of environmental sanitation that protect the worker from hazardous environment.  Cleanliness of the working place, privy, benches, stairs, wall etc. is explained.  Disposal of wastes and effluents should be without any risk.

 Ventilation,

temperature inside factory, dust and fumes emission, lighting, artificial humidification, overcrowding (minimum of 50 cubic metres per person) are specified.  There should be a provision for safe and cool drinking water and provision of water in the latrine and urinal.

 One

latrine for 25 female workers but one for 25 male workers up to 100 and one for 50 thereafter.  One urinal for 50 people up to 500 men and after that one for every 100 more.

 Safety

measures like fencing of machines, protection of eyes by use of goggles, precautions against fire, dangerous fumes, etc. are defined.

 Facilities

for washing, and sitting, canteens, creche (one for more than 30 women) and first aid appliances are provided.  One Welfare Officer for 500 or more workers is suggested.

 There

is provision for one weekly holiday, and not more than 48 hours in a week an adult worker should work.  There is at least half an hour rest after a stretch of 5 hours of continuous work.  No women should be employed between 7 p.m. and 6 a.m.  No person less than 14 years of age should work in the factory.

 No

child should work more than 4 hours a day and should not work in the night between 10 p.m. to 6 a.m.  One full wage leave should be given to an adult worker for every 20 days of work and one for every 15 days to the child worker.  12 weeks of maternity leave should be given to a woman.

 If

an accident occurs in any factory causing death or bodily injury or prevents a worker from working for more than 48 hours, the manager must immediately send notice to the prescribed authority (i.e. Labor commissioner).

Following are the Notifiable Diseases:  Lead

poisoning  Phosphorus poisoning  Mercury poisoning  Manganese poisoning  Arsenic poisoning  Poisoning by nitrous fumes  Carbon bisulphate poisoning  Benzene and its derivatives poisoning  Chrome ulceration

Following are the Notifiable Diseases:  Anthrax  Silicosis  Poisoning

by halogens or its derivatives of hydrocarbons  Pathological manifestation due to radium  Toxic anemia  Toxic jaundice due to poisonous substances  Byssinosis  Asbestosis

 Employees’

State Insurance Scheme of India, is a multidimensional social security system tailored to provide socio-economic protection to worker population and their dependants covered under the scheme.

 Besides

full medical care for self and dependants, that is admissible from day one of insurable employment, the insured persons are also entitled to a variety of cash benefits  in times of physical distress due to sickness, temporary or permanent disablement etc. resulting in loss of earning capacity,  the confinement in respect of insured women,

 dependants

of insured persons who die in industrial accidents or because of employment injury or occupational hazard are entitled to a monthly pension called the dependants benefit.

 The

promulgation of Employees' State Insurance Act, 1948(ESI Act), by the Parliament was the first major legislation on social Security for workers in independent India.

A

lighted lamp which is the logo of ESIC truly symbolises the spirit of the Scheme, lighting up lives of innumerable families of workers by replacing despair with hope and providing help in times of distress, both physical and financial.

Coverage under the ESI Act, 1948 APPLICABILITY  Under Section 2(12) the Act is applicable to nonseasonal factories employing 10 or more persons.  Under Section 1(5) of the Act, the Scheme has been extended to shops, hotels, restaurants, cinemas including preview theatres, road-motor transport undertakings and newspaper establishments employing 20* or more persons.

Coverage under the ESI Act, 1948 APPLICABILITY  Further under section 1(5) of the Act, the Scheme has been extended to Private Medical and Educational institutions employing 20* or more persons in certain States/UTs.  The

existing wage limit for coverage under the Act is Rs. 15,000/- per month ( w.e.f. 01/05/2010).

*Note: 14 State Govts. / UTs have reduced the threshold limit for coverage of shops and other establishments from 20 to 10 or more persons. Remaining State Governments/UTs are in the process of reducing the same.

AREAS COVERED  The ESI Scheme is being implemented area-wise by stages. STATES  All the States except Manipur, Sikkim, Arunachal Pradesh and Mizoram. UNION TERRITORIES Delhi and Chandigarh

Coverage(As on 31st March, 2013)  No. of Insured Person family units-1.85 Crores  No. of Employees-1.65 Crores  Total No. of Beneficiaries-7.20 Crores  No. of Insured women-0.26 Crores  No. of Employers, etc6.66 Lacs

ADMINISTRATION  The

comprehensive and multi-pronged social security programme is administered by an apex corporate body called the Employees' State Insurance Corporation.  It comprises members representing vital interest groups, including, employees, employers, the Central and State Government, representatives of Parliament and medical profession.

 The

Corporation is headed by the Union Minister of Labour, as its Chairman,  whereas the Director General, appointed by the Central Government functions as its Chief Executive Officer.  The broad based corporate body is, primarily, responsible for coordinated policy planning and decision making for growth, development and efficacy of the scheme.

 A Standing

Committee, constituted from among the members of the Corporation, acts as an Executive Body.  The Medical Benefit Council, constituted by the Central Government, is yet another Statutory Body that advises the Corporation on matters related to effective delivery of medical services to the Beneficiary Population.

 Central

Headquarters - New Delhi, operates through a network of 52 Regional, Sub- Regional and Divisional Offices located in various States.  The administration of Medical Benefit is taken care of by the respective State Government except in case of Delhi and Noida  The Corporation has taken over the administration of 23 ESI Hospitals in various States for developing them as ESIC Model Hospitals.

Finance  ESI

Scheme, like most of the Social Security Schemes the world over, is a self financing health insurance scheme.  Contributions are raised from covered employees and their employers as a fixed percentage of wages.  As of now, covered employees contribute 1.75% of the wages, whereas, the employers contribute 4.75% of the wages, payable to their employees.

Finance  Employees

earning upto Rs.100/- a day are exempted from payment of their share of contribution.  The State Governments, as per provisions of the Act, contribute 1/8th of the expenditure of medical benefit within a per capita ceiling of Rs. 1500/- per Insured Person per annum.

Contribution  all

the employees  employer's contribution and employee's contribution at a specified rate.  The rates are revised from time to time.  Currently, the employee's contribution rate (w.e.f. 1.1.97) is 1.75% of the wages and that of employer's is 4.75% of the wages paid/payable in respect of the employees in every wage period.

Contribution  Employees

in receipt of a daily average wage upto Rs.100/- are exempted from payment of contribution.  Employers will however contribute their own share in respect of these employees.

Contribution Collection of Contribution deduct employees contribution from wages bill and shall pay these contributions at the above specified rates to the Corporation within 21 days of the last day of the Calendar month in which the contributions fall due.

Contribution Period and Benefit Period There are two contribution periods each of six months duration and two corresponding benefit periods also of six months duration as under.

Benefits The section 46 of the Act envisages following six social security benefits :(a) Medical Benefit (b) Sickness Benefit(SB) (c) Maternity Benefit (MB) (d) Disablement Benefit (e) Dependants' Benefit(DB) (f) Other Benefits : Funeral Expenses & Confinement Expenses

other need based benefits to insured workers. Vocational Rehabilitation Physical Rehabilitation Old Age Medical Care Rajiv Gandhi Shramik Kalyan Yojana Incentive to employers in the Private Sector

(a) Medical Benefit :  Full medical care is provided to an Insured person and his family members from the day he enters insurable employment.  Medical care is also provided to retired and permanently disabled insured persons and their spouses on payment of a token annual premium of Rs.120/-

          

System of Treatment Scale of Medical Benefit Benefits to Retired IPs Administration of Medical Benefit in a State Domiciliary treatment Specialist consultation In-Patient treatment Imaging Services Artificial Limbs & Aids Special Provisions Reimbursement

System of Treatment  Generally, the allopathic system of medicine is used for providing Medical Benefit.  treatment facilities may be provided under the ISM & H as well.

Scale of Medical Benefit  The beneficiaries are entitled to reasonable medical, surgical and obstetric treatment.  To Insured Persons:- IPs are entitled to avail treatment in ESI Dispensary/Hospital/Diagnostic Centre and recognised institutions  Outpatient treatment  Domiciliary treatment by visits at their residences.

Scale of Medical Benefit  Specialists Consultation.  In-patient treatment(Hospitalisation)  Free supply of drugs dressings and artificial limbs, aids and appliances.  Imaging and laboratory services.  Integrated family welfare, immunisation and MCH Programme and other national health programme etc.

Scale of Medical Benefit  Ambulance service or re-imbursement of conveyance charges for going to hospitals, diagnostic centres etc.  Medical Certification and  Special provisions.  To Family Members of Insured Persons:- FULL" Medical Care i.e., all facilities as for IPs including hospitalisation.

(b) Sickness Benefit(SB) :  Sickness Benefit in the form of cash compensation at the rate of 70 per cent of wages is payable to insured workers during the periods of certified sickness for a maximum of 91 days in a year.  Extended Sickness Benefit(ESB)  Enhanced Sickness Benefit

 Extended

Sickness Benefit(ESB) : SB extendable upto two years in the case of 34 malignant and long-term diseases at an enhanced rate of 80 per cent of wages.  Enhanced Sickness Benefit : Enhanced Sickness Benefit equal to full wage is payable to insured persons undergoing sterilization for 7 days/14 days for male and female workers respectively.

(c) Maternity Benefit (MB) :  Maternity Benefit for confinement/pregnancy is payable for three months, which is extendable by further one month on medical advice at the rate of full wage subject to contribution for 70 days in the preceding year.

(d) Disablement Benefit  Temporary disablement benefit (TDB)  Permanent disablement benefit (PDB)

Temporary disablement benefit (TDB) :  From day one of entering insurable employment & irrespective of having paid any contribution in case of employment injury.  Temporary Disablement Benefit at the rate of 90% of wage is payable so long as disability continues.

Permanent disablement benefit (PDB) :  The benefit is paid at the rate of 90% of wage in the form of monthly payment depending upon the extent of loss of earning capacity as certified by a Medical Board

(e) Dependants' Benefit(DB) :  DB paid at the rate of 90% of wage in the form of monthly payment to the dependants of a deceased Insured person in cases where death occurs due to employment injury or occupational hazards.

(f) Other Benefits :  Funeral Expenses : An amount of Rs.10,000/- is payable to the dependents or to the person who performs last rites from day one of entering insurable employment.  Confinement Expenses : An Insured Women or an I.P.in respect of his wife in case confinement occurs at a place where necessary medical facilities under ESI Scheme are not available.

 Vocational

Rehabilitation :To permanently disabled Insured Person  Physical Rehabilitation : In case of physical disablement due to employment injury.  Old Age Medical Care :For Insured Person retiring on attaining the age of superannuation to leave service due to permanent disability insured person & spouse on payment of Rs. 120/- per annum.

 Rajiv

Gandhi Shramik Kalyan Yojana :  This scheme of Unemployment allowance was introduced w.e.f. 01-04-2005.  An Insured Person who become unemployed after being insured three or more years, due to closure of factory/establishment, retrenchment or permanent invalidity are entitled to :-Unemployment Allowance equal to 50% of wage for a maximum period of upto one year.

 Rajiv

Gandhi Shramik Kalyan Yojana :  Medical care for self and family from ESI Hospitals/Dispensaries during the period IP receives unemployment allowance.  Vocational Training provided for upgrading skills - Expenditure on fee/travelling allowance borne by ESIC.

ROLE OF THE OCCUPATIONAL HEALTH NURSE IN WORKPLACE HEALTH MANAGEMENT  several,

inter related and complimentary

Clinician  Primary prevention  Emergency care  Treatment services  Nursing diagnosis  Individual and group care plan.  General Health advice and health assessment

Specialist  Occupational health policy, and practice development, implementation and evaluation  Occupational health assessment  Health surveillance  Rehabilitation  Health and safety  Hazard identification  Risk assessment

Manager  Management  Administration  Budget planning  Marketing  Quality assurance  Professional audit  Continuing professional development

Co-ordinator  Occupational health team  Worker education and training  Environmental health management

Adviser  To management and staff on issues related to workplace health management  to other external health or social agencies

Health Educator  Workplace Health promotion Counselor  Counseling and reflective listening skills  Problem solving skills Researcher  Research skills  Evidence based practice  Epidemiology