Country PresentationOCCUPATIONAL MEDICINE AND

MEDICAL PRACTITIONERS IN INDIA

Hong Kong, October 28-29, 2013

Jagdish PatelAshish Mittal

Labour Force in the country

• Total Population (2011 Census): 1.21 billion(Rural – 830 Million, Urban – 380 Million)

• Working Population (2001 Census): 402 million (39% of total population)

(Rural ~ 310 Million, Urban ~ 92 Million)Male Workers – 275 millionFemale workers – 127 million

Industry-wise Classification of Workers in India (in millions)

Place of Residence

Total workers (Main + Marginal)

Cultivators Agricultural labourers

Household industryworkers

Other workers

Total 402 127 107 16 151

Rural 310 124 103 11.5 71

Urban 92 3 4 4.5 80

Source: Census of India, 2001

Statistics of Factories (2009)Registered Factories 324,761Working Factories 270,294Employment 13,100,129Safety Officers 2,642Welfare Officers 3,096Factory Med. Officers 6,809Total Injuries 33,093Fatal Injuries 1,509

Data on Burden of Occupational Diseases

Global Indian ProportionTotal Injuries 100 million 17 million (17%)Fatal Injuries 0.1 million 45,000 (45%)Occupational Diseases 11 million 1.9 million (17%)Occ. Disease Death 0.7 million 0.12 million (17%)Economic Burden 2-14 % of GNP for

various countries186 million INR in 1997 (8 million INR in 1961)

Source: NATIONAL PROGRAMME FOR CONTROL & TREATMENT OF OCCUPATIONAL DISEASES, NIHFW Website

No information or breakup on the above categories is available

• Under the Right to Information Act, ESIC gave information in 2010 that it has the reports of 1576 cases of occupational diseases,15 which occurred between 1997 and 2009. Diseases include Silicosis, Asbestosis (Total 47, Maharashtra-36, W.Bengal-10), Byssinosis, other lung diseases (70), Noise-induced hearing loss (total 471, Gujarat 39, Maharashtra 432) and few cases of mercury, lead and chromium poisoning (97 altogether), Dermatitis (7), COPD (6).

• Occupational asthma following exposure to soldering fumes as well as chromium. One case of liver damage due to Chromium.

• Indian Labour Year Book 2005 and 2006 (P.167) reports only 7 suspected cases of occupational diseases.

Data on Burden of Occupational Diseases

Labour laws

• The Factory Act, 1948• Mines Act 1952, and 1957 and Mines Rules 1957. • Dock Workers (Safety, Health and Welfare) Act,

1986,• Building and other Construction Workers

(Regulation and the Employment and Conditions of Service) Act, 1996,

• Child labour (Prohibition and Regulation) Act 1986,• Insecticides Act, 1968

Government institutions and agencies• Ministry Of Labour And Employment• Directorate General Of Factory Advice Service &

Labour Institutes (DGFASLI) / CLI / RLI• Directorate General Of Mines Safety (DGMS)• State Factories Directorates/ Chief Inspector Of

Factories• State Mines Inspectorate• Labour Bureau• Various sectoral Labour Welfare Boards

Government institutions and agencies

• Employee State Insurance Corporation (ESIC)• National Institute of Occupational Health

(NIOH)• National Institute of Miner’s Health (NIMH)• National Safety Council of India (NSC)• Indian Toxicology Research Centre (ITRC)

Inter-sectoral Linkages in Occupational health in India

Ministry of Labour

Corresponding Departments of the respective

State Governments

Ministry of Health and Family

welfare

International Organizations

Ministry of Law

Ministry of AgricultureNGO’s

Ministry of Industries

Ministry of Environment

Workers Union

Industry

Public health, medical and laboratory services overview

• In 335 Medical Colleges ~ 40,000 Graduates are being trained (2011-12) for Primary Health Care.

• 12000 Govt. Hospitals with 0.8 million beds with 72,000 Doctors. 0.8 million registered doctors.

• General Nursing Midwives – 1.2 million, Auxiliary Nursing Midwives – 0.6 million

• Health Visitors/Supervisors – 53,000

Laws related for Occupational Medicine and Medical Practitioners

• Appointment of Certifying Surgeon / Inspector Medical u/s 10 of Factories Act and 11 of Mines Act.

• Any Medical graduate can be appointed without OHS qualification

• Inspector of Factories (Medical)/ Certifying Surgeon, can also suo-moto carry out medical examination of workers engaged in hazardous processes.

Laws related for Occupational Medicine and Medical Practitioners

• NOTICE OF CERTAIN DISEASES (Factories and Mines Act) • If any medical practitioner attends on a person who is or

has been employed in a factory, and who is, or is believed by the medical practitioner to be, suffering from any disease, specified in the Third Schedule the medical practitioner shall without delay send a report in writing to the office of the Chief Inspector.

• If any medical practitioner fails to comply with the provisions of above sub-section, he shall be punishable with fine.

• Similar provisions in BOCW Act. List may be different

Process of Diagnosis for Occupational Disease

• Pre-employment and periodic medical examination of workers under Factories Act and Mines Act

• Workers covered under ESIC Act, ESI dispensaries and Hospitals provide the diagnostic services to the covered employees. Have 4 referral centres for Occ. Diseases, remained non-functional.

• Any qualified medical practitioner can diagnose OD

Current Curriculum – Industrial HealthInstitute Course Duration No. Of Students Eligibility

CLI, Mumbai AFIH 3 months 50 MBBS

RLI, Kolkata AFIH 3 months 25 Do

State Factory Inspectorate, Goa

AFIH 3 months 25 Do

BHEL, Trichy AFIH 3 months 25 Do

LMRC, Pune AFIH 3 months 25 Do

COEH, New Delhi AFIH 3 months 25 Do

NIOH, Ahmedabad AFIHPhD

3 months3 years

15-20 MBBSMD

AIIHPH, Kolkata DIH 2 years 2-3 MBBS

AFMC, Pune Diploma in Industrial Health

2 years 1 MBBS

AIMS, Kochi PhD 3 years - MD

SRMC, Chennai PG Cert. 1 yrs 20 MBBS

Current Curriculum – Industrial SafetyInstitute Course Duration No. Of

StudentsEligibility

RLI, Mumbai Advance Diploma

1 year fulltime 50 Recognized Degree orDiploma in Tech. /Engineering or inPhysics or Chemistry

RLI, kolkata PGD Industrial Safety

1 year fulltime 50 Do

RLI, Chennai Diploma Industrial Safety

1 year fulltime 50 Research, trainingeducation in the field of Industrial Safety

RLI, Kanpur PGD Industrial Safety

1 year fulltime 50 Department inadministration, or inconstruction industry

ITRC, Lucknow Summer Training

3-6 months - M. Sc. Students

SRMC, Chennai M.Sc (Distance) 3 yrs 20 B.E/B.Tech/MBBS

Current Curriculum – Industrial SafetyInstitute Course Duration No. Of

StudentsEligibility

ISTAR, Anand Masters in Industrial Hygiene

2 year fulltime 15 Any Science Graduate

British Safety Council, London

Diploma 1 month - Appropriate role in Health & Safety

NITIE, Mumba1 PEDISEMDErg

2 year 9 months

--

-

AnnamalaiUniversity, Chennai

Diploma inIndustrialHygiene

2 years (distance)

- Any Science Graduate

MahatmaGandhi LabourInstitute,

Diploma inIndustrialSafety

2 y earsFull time

15 - 20 Any Science Graduate

PramukhswamiMedical college

Diploma inIndustrialHy giene

2 y earsFull time

01 MBBS

Expectations from this meeting

• Developing training curriculum for all relevant stakeholders.

• Training for Health Workers at PHC level.• Support for more emphasis on OHS in Medical

graduation. • Support for training of Practitioners in the

endemic area on specific issues.• Developing Orientation training curriculum for

future managers (HR, Engineers, Safety).

Chrome Nasal Perforation

Bilateral Wrist Drop (Lead)

Machine Oil Contact Dermatitis

Awareness Session of Workers

Eye Examination of workers

Thank you