Activities of occupational physicians for occupational health services in small-scale enterprises in Japan and in the Netherlands

Occupational health service (OHS) for small-scale enterprises (SSEs) is still limited in many countries. Both Japan and the Netherlands have universal OHS systems for all employees. The objective of this survey was to examine the activities of occupational physicians (OPs) in the two countries for SSEs and to investigate their proposals for the improvement of service. Questionnaires on types and sizes of the industries they serve, allocation of service hours (current and desired), sources of information for occupational health activities etc. were mailed in 2006 to 461 and 335 Japanese and Dutch OPs, respectively, who have served in small- and medium-scale enterprises. In practice, 107 Japanese (23%) and 106 Dutch physicians (32%) replied, respectively. Total service time per month was longer for OPs in the Netherlands than OPs in Japan. Japanese OPs spent more hours for health and safety meetings, worksite rounds, and prevention of overwork-induced ill health (14-16% each). Dutch OPs used much more hours for the guidance of absent workers (48%). Thus, service conditions were not the same for OPs in the two countries. Nevertheless, both groups of OPs unanimously considered that employers are the key persons for the improvement of OHS especially in SSEs and their education is important for better OHS. The conclusions should be taken as preliminary, however, due to study limitations including low response rates in both groups of physician

Development and preliminary validation of a questionnaire to measure satisfaction with home care in Greece: an exploratory factor analysis of polychoric correlations

<p>Abstract</p> <p>Background</p> <p>The primary aim of this study was to develop and psychometrically test a Greek-language instrument for measuring satisfaction with home care. The first empirical evidence about the level of satisfaction with these services in Greece is also provided.</p> <p>Methods</p> <p>The questionnaire resulted from literature search, on-site observation and cognitive interviews. It was applied in 2006 to a sample of 201 enrollees of five home care programs in the city of Thessaloniki and contains 31 items that measure satisfaction with individual service attributes and are expressed on a 5-point Likert scale. The latter has been usually considered in practice as an interval scale, although it is in principle ordinal. We thus treated the variable as an ordinal one, but also employed the traditional approach in order to compare the findings. Our analysis was therefore based on ordinal measures such as the polychoric correlation, Kendall's Tau b coefficient and ordinal Cronbach's alpha. Exploratory factor analysis was followed by an assessment of internal consistency reliability, test-retest reliability, construct validity and sensitivity.</p> <p>Results</p> <p>Analyses with ordinal and interval scale measures produced in essence very similar results and identified four multi-item scales. Three of these were found to be reliable and valid: socioeconomic change, staff skills and attitudes and service appropriateness. A fourth dimension -service planning- had lower internal consistency reliability and yet very satisfactory test-retest reliability, construct validity and floor and ceiling effects. The global satisfaction scale created was also quite reliable. Overall, participants were satisfied -yet not very satisfied- with home care services. More room for improvement seems to exist for the socio-economic and planning aspects of care and less for staff skills and attitudes and appropriateness of provided services.</p> <p>Conclusions</p> <p>The methods developed seem to be a promising tool for the measurement of home care satisfaction in Greece.</p

Stakeholders' role in improving Ghana's construction safety

Health and safety (H&S) management has traditionally been the responsibility of the contractor. Most often, contractors are blamed for the accidents and other ill health that occur on their construction sites. H&S performance is, however, enhanced when there is effective collaboration between those involved in the construction process. This paper therefore explores the role of stakeholders in promoting construction H&S in Ghana through public works procurement. The four main stakeholders identified and evaluated in this study are the government, the client (employer), the contractor and the employee(s). Seven interviewees (comprising procurement managers, consultants and quantity surveyors) from public institutions in Ghana participated in the research. Data were collected using semi-structured interviews and were thematically analysed. Results indicate a conflict in the perceived functions and relation of these stakeholders in the construction process. To address the constraint to improving construction H&S, certain recommendations are offered. These include the identification of specific individuals responsible for supervision and employee training, the development of H&S policies by the government and contracts that clearly outline the contractual obligations of all parties involved. Additionally, the specific roles and involvements of other stakeholders in the procurement process in improving construction H&S are also outlined

Circumventing 'free care' and 'shouting louder':Using a health systems approach to study eye health system sustainability in government &amp; mission facilities of north-west Tanzania.

BACKGROUND: Little is known about the contributions of faith-based organisations (FBOs) to health systems in Africa. In the specialist area of eye health, international and domestic Christian FBOs have been important contributors as service providers and donors, but they are also commonly critiqued as having developed eye health systems parallel to government structures which are unsustainable. METHODS: In this study, we use a health systems approach (quarterly interviews, a participatory sustainability analysis exercise and a social network analysis) to describe the strategies used by eye care practitioners in four hospitals of north-west Tanzania to navigate the government, church mission and donor rules that govern eye services delivery there. RESULTS: Practitioners in this region felt eye care was systemically neglected by government and therefore was 'all under the NGOs', but support from international donors was also precarious. Practitioners therefore adopted four main strategies to improve the sustainability of their services: (1) maintain 'sustainability funds' to retain financial autonomy over income; (2) avoid granting government user fee exemptions to elderly patients who are the majority of service users; (3) expand or contract outreach services as financial circumstances change; and (4) access peer support for problem-solving and advocacy. Mission-based eye teams had greater freedom to increase their income from user fees by not implementing government policies for 'free care'. Teams in all hospitals, however, found similar strategies to manage their programmes even when their management structures were unique, suggesting the importance of informal rules shared through a peer network in governing eye care in this pluralistic health system. CONCLUSIONS: Health systems research can generate new evidence on the social dynamics that cross public and private sectors within a local health system. In this area of Tanzania, Christian FBOs' investments are important, not only in terms of the population health outcomes achieved by teams they support, but also in the diversity of organisational models they contribute to in the wider eye health system, which facilitates innovation

Special Education Today in Ghana

The Ghana chapter on special education begins with the history of service provisions for persons with disabilities. It includes information on educational and rehabilitation services, special schools and integrated education. Detailed data is related concerning prevalence and incidence rates and special needs among the Ghana population. This is followed by a comprehensive section on regular and special education teacher roles, expectations, and training. An important aspect of Ghana's special education is its movement towards inclusive education. The support for this movement comes from the Ministry of Education's policy, namely, The Education Strategic Plan (ESP), which adopts inclusive education and promotes it as the future special education direction for the country. The chapter provides detailed information on the issues related to the implementation of the ESP plan, four models that have been developed for inclusive education, the progress and effort that Ghana has made towards inclusive education as well as significant challenges that are present