การพัฒนารูปแบบการเฝ้าระวังโรคจากการประกอบอาชีพ ของแรงงานนอกระบบ Community Participation in Developing a Model for Occupational Disease Surveillance

บทคัดย่อ

This action research aimed to study the situation of occupational diseases among informal laborand to
develop a model of occupational disease surveillance in Roi-Et Province. By purposive sampling, 42 participants
included 1 7informal labor, 10 community leaders, 10 village health volunteers (VHV) and 5 health care
providersfrom 5 sub-district health promoting hospitals. Research methodology consisted of 2 cycles each of which
followed 4 steps of situation analysis by means of 1) assessment of sickness caused by occupation, work
behaviors, and working environment 2) development of surveillance system via observation and report 3) planned
implementation of role assignment and guidelines for coordination betweeninformal labor and community leaders
and 4) model evaluation using after action review and reflection on practice results. Quantitative data were
collected by occupational risk survey and analyzed by descriptive statistics while qualitative data were collected
by group discussions, brain storming sessions, and participatory observations and analyzed by content analysis.
The study found that communities did not have occupational disease surveillance programs but 40.5% of
informal laborexclusively rice farms and rubber plantations had already experienced occupational disease surveillance.
These two groups watched over 1) symptoms of musculoskeletal system 2) symptoms of using pesticides and
3) accidents andinsect bites and stings. All three categories were associated with work routines and environment.
Through sharing information and experience, the occupational disease surveillance model was developed
and mutually supported by joined forces and party network in the communities. The operational activities can be
divided into two manners: 1) proactive disease surveillance model with 3 steps: 1) watch out –to observe symptoms
using information acquired from workshops together with risk assessment form by VHV and community leaders
2) notify – to report on emergency cases to family, VHV, 1669 hotline or to report at monthly meetings and 3)
manage – to handle minor cases as self-care and get local rescuers. 2) Reactive disease surveillance model is used
when informal laborneed help and show up at the health promoting hospitals where health care providersuses risk
assessment form and conducts additional history taking interviewsfocusing on work routines and environment that
could cause health problems.
After workshops and operational practices, the situation of occupational diseases has improved three parts:
informal labor, community leaders, and health care providersbecame more alert to occupational diseases, community
members pay more attention to occupational diseases surveillance, and community leaders communicate more
with community members on both a prevention note and respond quickly to health incidents. Health promoting
hospitals created networks to work proactively hand in hand and expanded their practice to reach out to all
working-age groups. Therefore, communities should continue practicing the occupational disease surveillance and
include all occupations in their communities in the occupational disease and environment surveillance program.