occupational and environmental health services in...
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OCCUPATIONAL AND
ENVIRONMENTAL HEALTH
SERVICES IN MALAYSIA
DR. PRIYA RAGUNATH
FFOM(IRE), MPH[OH] (MAL), MPH (MAL), CMIA(MAL),
CAOCH(USA)
SENIOR PRINCIPAL ASSISTANT DIRECTOR
OCCUPATIONAL HEALTH UNIT
MINISTRY OF HEALTH, MALAYSIA
Bangkok, 1 March 2017
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MALAYSIA
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MALAYSIA 14 States
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KEY STATISTICS 2015
Area: 330, 323 km2
Population: 31.0 Million
GDP: RM1,157.1 Billion
Labour Force: 14.1 Million
•SME : 3.6 Million
•Govt Employees 1.6 Million
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MAJOR INDUSTRIES
Manufacturing
Petroleum and LNG
Wood
Palm Oil
Rubber
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OCCUPATIONAL HEALTH SERVICES
NATIONAL COUNCIL OF
OCCUPATIONAL SAFETY AND HEALTH
MIN OF HUMAN
RESOURCES
DEPARTMENT OF
OCCUPATIONAL
SAFETY AND
HEALTH
(DOSH)
OCCUPATIONAL
HEALTH UNIT
MIN OF HEALTH
SOCIAL
SECURITY
ORGANIZATION
(SOCSO)
NIOSH
OTHER
AGENCIES
UNIVERSITIES SOCIETIES
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LEGAL DEVELOPMENTS IN
MALAYSIA
Pre-Independence
1876 1967 1994 2020 2015
Post-
Independence Self-Regulation Preventive
Culture Control by colonial
system (British)
Focus on rubber & tin
industries (immigrant
workers)
First appointed Boiler
Inspector in 1878
In 1913, scope of an
inspector was expand
to other dangerous
machinery
Est. Factory &
Machinery Dept
Est. National Institute
Of Occupational Safety
and Health 1985
Formation of , Major
Hazards Div, Ind. Safety
Div, Ind. Hygiene Div,
Off-Shore Div, Health
Div, Etc.
Est. National
Council for OSH
Developed national
OSH strategy &
program 2011-2015
(OSH MP15)
Developed OSH MS
1722
Conduct
Regulatory Impact
Assessment
Safety
elements
integrate
into daily
business
CONVENTIONAL OSH SYSTEMATIC APPROACH
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LEGISLATION
Occupational Safety and Health Act 1994
Factories and Machinery Act 1967
Social Security Act 1969
Pesticides Act 1974
Environmental Quality Act 1974
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Hotel &
Restaurant
Agriculture,
Storage and
Communicat
ion
Transport, Storage
and Communication
Public
Services
and
Statutory
Authoriti
es
Mining and Quarrying Wholesale
and Retail
Trades
Construction
Finance, Insurance,
Real Estate and
Business Services
Utilities
(Electricity,
Gas, Water &
Sanitary
Services)
Manufacturing
OCCUPATIONAL SAFETY AND HEALTH ACT
1994
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POINTS TO NOTE
• Laws have regulations to address exposure to mineral
dust, asbestos, lead and other substances
• Standard PEL/BEI values have been developed/adopted
• Chemical list
• Medical surveillance requirements
• Health promotion requirements
• Partial ban of asbestos
• Safety and Health Committee
• Workplace Health and Safety Activities
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OH SERVICES PROVIDERS
Occupational Physicians (Overseas Masters)
Public Health Physicians (Local Masters)
Occupational Health Doctors (Short course at NIOSH or
MOH)
Occupational Health Nurses
Health promotion officers
Safety Officers
Chemical Health Risk Assessors
Industrial Hygienists
Hygiene technicians
First responders
Ergonomists
Toxicologists
Safety engineers
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MINISTRY OF HEALTH OH SERVICES
Administrative Level Unit Responsible Person
Ministry of Health Occupational Health
Unit
Public Health
Physician
(Occupational
Health)
State Health
Department
Occupational and
Environmental
Health Unit
Public Health
Physician
( Occupational
Health)
Health Clinics Occupational Health
Services
Occupational Health
Doctor
Hospitals Public Health
Department
Public Health
Physician
(Occupational
Health)
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SERVICES OFFERED (STAFF & PUBLIC)
Preventive programs
Promotive programs
Notification of Occ diseases &injuries
Safety and health audit
Medical surveillance
Compensation : Ex Gratia & SOCSO
Investigations of outbreaks at workplace
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• Pre employment assessment
• Medical surveillance
• Disability assessment
• Promotion of healthy lifestyle
• Monitoring of sickness absenteeism
• Workplace audits
• Investigation of incidents
• Health Education
• Occupational Health Clinic services
• Consultancy and collaborative services
Occupational Health Unit Activities
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CLINICAL SERVICES
Spirometry
Audiometry
X Ray
General Examination
Systemic Examination
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CLINICAL SERVICES
Sector Location Providers Way forward
Government • Primary care
clinics
• Govt
Hospitals
Medical
Officer(OHD)
Occupational
Physicians in
the hospitals
Private • General
Practice
clinics
• In house
clinics
• Private
Hospitals
Medical
Officer(OHD)
Occupational
Physicians in
the private
hospitals
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CLINICAL SERVICES COSTING
Govt clinics:
RM1 : Citizens ( All treatment is free)
RM 5 : Foreigners (Medication has to be
purchased seperately)
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OTHER ACTIVITIES
Health Talks
Healthy Workplace Program
Health Promotion
Risk Assessment
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NCD RELATED ACTIVITIES
1. Screening of all Govt employees over
40 yrs old : Circular 2003
2. KOSPEN Plus Program: NCD screening
program for Government & Public
Organizations
(BMI, HPT,DM,SMOKING,STRESS)
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EH UNIT ACTIVITIES
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ENVIRONMENTAL HEALTH
ACTIVITIES
1. By Environmental Health experts (one per state)
EIA
2. By the health inspectors ( all state health offices and
major hospitals)
Includes food and water sampling
Vector control
Housing and drainage (rural areas)
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OTHER ISSUES
RARE EARTH EXTRACTION NORM WASTE LOW DOSE RADIATION
GOLD MINE USE OF CYANIDE
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COMPENSATION FOR GOVT
EMPLOYEES
Ex Gatia Scheme
1. By the Treasury
2. Medical board conducted
3. Uses criteria similar to the social security organization
(SOCSO)
4. Payment only for permanent disability
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Organization Chart
Occupational Health Division,
Department of Occupational Safety and Health
Director
Deputy Director
Occupational Medicine Section
Deputy Director
Accreditation Section
1 Medical Officer
1 Head Nurse
1 Medical Officer
1 Head Nurse
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Standard Setting
Enforcement
Promotion and Publicity
1
2
3
Role of Department of Occupational
Safety & Health
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Functions of Occupational Health Division
1. Investigating occupational poisoning
and diseases report to DOSH using
JKKP 7 Form based on the
requirements under Occupational
Safety and Health (Notification of
Accident, Dangerous Occurrence,
Occupational Poisoning and
Occupational Disease Regulations -
NADOPOD) 2004
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2. Register and Renew the certificate
of Occupational Health Doctors under the Use and Standards of
Chemicals Hazardous to Health
Regulations 2000 (USECHH 2000).
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Occupational Health Division,
Department of Occupational Safety & Health, Malaysia
The Numbers of Registered Occupational Health Doctor
in Malaysia For The Year 2015
0
17
30 37
61
132
15 21
49
27 22
11
40 50
7
Total: 519 Occupational Health Doctor
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4. Basic Occupational Health
(BOH) Services Programme in the
Industry:
health screening programs to
identify occupational disease
and poisoning among workers.
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Occupational Health Division,
Department of Occupational Safety & Health, Malaysia
0
50
100
150
200
250
300
70
90
72
97 95 91
38 30
47
256
96
119
243
30
THE NUMBER OF WORKERS INVOLVED IN BASIC OCCUPATIONAL HEALTH
SERVICES PROGRAMME FOR THE YEAR 2013
Total Numbers of Workers: 1374
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Occupational Health Division,
Department of Occupational Safety & Health, Malaysia
0
20
40
60
80
100
120
140
160
Occup LungDiseases (OLD)
Occup SkinDiseases (OSD)
Occup NoiseInduced Hearing
Loss (NIHL)
Occup Muscular -Skeletal
Disorders (OMD)
PsychosocialProblem
1
46
15
156
8
TYPE OF OCCUPATIONAL DISEASES IDENTIFIED DURING THE BASIC
OCCUPATIONAL HEALTH SERVICES
PROGRAMMES IN THE INDUSTRY FOR THE YEAR 2013
Total No. of Cases: 226 kes
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OSH STRATEGIC MILESTONE
OSHMP20
20
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APPROACH
OSHMP 2020
OSH policies and legislation
OSH
knowledge and skills
Strategic and
effective enforcemen
t
The involvement
of government
agencies and GLCS
OSH Programs on awareness
and information
Accident data review and
analysis Commitment and
involvement of employers
and employees in OSH program
The
employer and employee
awareness of the
importance of OSH
The involvement of industry and NGOs
Involvement of OSH Training Centre,
TVET and IPT.
Industrial community involvement
Effective
OSH management efficiency
Priority assessment
of risks in the prevention of accidents and occupational
diseases
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SOCIAL SECURITY ORGANIZATION
(SOCSO)
INVALIDITY
SCHEME
EMPLOYMENT
INJURY SCHEME
ALL DECISIONS
REGARDING
IMPAIRMENT &
INVALIDITY MADE BY
MEDICAL BOARD
2 SCHEMES
• Workplace injury • Commuting Accident • Occupational Diseases
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SOCSO SCHEME
1. Contributory scheme
2. Not for Govt employees
3. Employment injury scheme compulsory (Soc Sec Act) for
private sector
4. Invalidity scheme is by choice
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INTRODUCED NEW GUIDELINES
1ST EDITION
2ND EDITION
REVISED 2ND EDITION LATEST 3RD
EDITION
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Employment Injury
Scheme
Invalidity Pension
Scheme
Workplace/Commuti
ng Accidents
Occupational
Disease
Medical Board Special Medical
Board Medical Board
Appellate Medical
Board
Appellate Medical
Board
Appellate Medical
Board
Review Approval Board (Appellate Medical Board)
SOCSO SCHEMES
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Payout (RM) 2010-2014
777,783,78
2
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Number of Cases Referred to the
Medical Board (2010-2014)
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SOCSO HEALTH SCREENING PROGRAM
(HSP)
1. Offered to all private active workers contributing to
SOCSO who attain 40 years of age.
2. Screen Non Communicable Diseases such
cardiovascular diseases, diabetes and cancer (cervical
cancer and breast cancer)
3. Medical examination vouchers given to all contributing
members
4. Vouchers may be used in General Practitioners clinic
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PRIVATE INSURANCE
1. Individual purchase
2. One off payment
3. High premiums depending on health status
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ISSUES
1. Lack of coordination between ministries
2. Lack of collated data
3. Under reporting
3. Feedback to industries
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WAY FORWARD
1. Online collated database
2. Larger pool of OHD’s
3. Coverage of all accidents (including non work related)
4. Coverage of the unemployed and the informal sectors
(taxi drivers)
5. More training is required on the ILO Classification of CXR
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TERIMA KASIH