National Institutes for Occupational Health (NIOH)

By Gina Bernhardt

We were warmly welcomed to the National Institute for Occupational Health (NIOH) by David Rees.  He gave us an excellent overview of the purpose and functions of NIOH’s around the world.  Although their value is questioned in some countries, they are beneficial in creating a critical mass of occupational health expertise for the country.  

The South African NIOH adds value by:

·       Knowledge generation, through research, surveillance, and reviews;

·       Developing human resource capacity; eg. occupational toxicologists;

·       Provision of advisory and information service, assisted by collaboration with international agencies;

·       Provision of specialized laboratory services, including toxicological, pathological, microbiological & immunological;

·       Provision of policy support.

Jim Phillips heads up the pathology lab which analyses lung-heart autopsy specimens of ex-miners for the whole of South Africa.  Apart from the benefits at an individual level (for the families of the deceased), this system provides comprehensive surveillance data. Reports include trends in the incidence of occupation lung diseases in miners, as well as other findings such as the incidence of undiagnosed tuberculosis.

Building on a previous study at the NIOH, which found that only around 20% of medium-sized masks fit South Africa faces, Jeanneth Menganyi, in the occupational hygiene section, is involved in a study looking at the fit of facial masks relative to the facial characteristics of an individual.  These findings will potentially influence both mask design and occupational health policy.

The National Cancer Registry’s (NCR) purpose is to identify cancer risk factors in South African populations.  It is currently based within the NIOH and has a surveillance and a research arm.  The surveillance system is pathology based, receiving reports from all labs in South Africa.  However this system results in reporting bias – ie. cancers that are not diagnosed pathologically (such as late stage pancreatic and liver cancers) are not represented.   The registry though will be moving towards case-based surveillance, following legislation in 2011 that makes cancers notifiable.  However this system is struggling as funding to the NCR has shrunk due to financial difficulties in the NHLS.  A case-control study within the research arm of the NCR has been running since 1995, recruiting newly diagnosed cancer patients from Barogwaneth Hospital.  Over 20 000 cases are on their database which contains a wealth of detailed risk information.

http://www.nioh.ac.za/

After lunch, we had a visit to the Medical Bureau for Occupational Diseases (MBOD) and the Compensation Commission for Occupational Diseases (CCOD).  They deal occupational disease claims covered under ODMWA (and not COIDA claims).  The MBOD committee reviews around 60 submissions per day, whereafter cases eligible for compensation are handed over to the CCOD for administration of their lump sum.  Submissions to the MBOD are reportedly processed within 6 months, and the CCOD processes claims 2-3 months after all required documentation is received.

Richard Cooke, a family physician who is passionate about rural-health, joined us for a late afternoon chat under the trees, back at the hotel.  He stimulated discussion on “what is rural?”; “what are some indicators that describe rurality and the quality of services in these areas?”; “ what is “rural-proofing” of policies?” and “what can be done to strengthen health services in rural areas?”  Rural populations are often disadvantaged, even by the health system; if we are to strive for equity, these populations need to be prioritized. He is involved in the Wits department of family physicians and also at Rural Health Advocacy Project (RHAP).  http://www.rhap.org.za/