| BACKGROUND AND AIMSOccupational disease is a public health problem seriously harmful to the global working population's health. The data cited from the report of "Occupational Health Planning of WHO" in 2001 pointed that, there are 160 million occupational disease sufferers in the world every year, resulting in 11 million of death and huge economic loss. Occupational disease shows the trends of large number, wide industry involved and rapid growth as the high incidence of occupational disease and group,malignant events in China in recent years. The amount of population suffered from occupational disease in China is the largest one in the world. Because of occupational diseases and occupational accidents, there are direct economic loss of 100 billion yuan and indirect economic loss of 200 billion yuan at least in China every year.It is thought to be effective intervention for occupational disease prevention to supply Occupational Health Services(OHS) for enterprises and workers. And the key points for reliable control of occupational disease proved to be enlargement of the extent and increase the availability of OHS, and make it to be proper services for the most general. Although OHS has got onto the path towards the rule of law and market principle since the PRC Code of Occupational Disease Prevention was enacted and enforced in 2002, and effective network of OHS has been initially shaped, there are still many researchable problems to be solved, such as management mechanism, system, talent workers, raise funds and so on. Although now many research pays attention to OHS, but there are still many weak and bland points to be solved, for example: analysis on the impact factors of OHS in enterprise, the demand of training for facility members of OHS, the satisfaction of workers, raise funds of the facility, management inside the facility, efficiency of the available services in facility and the exterior support for the OHS. There are nearly no systemic and synthetic study on the strategy of the development of OHS in China. It is necessary to get suitable and effective strategy for OHS to improve the sustainable development strategy in China.The main purpose of this study is, finding out the key factors restricting the development of OHS by the analysis on the state of three parts (supply-side, demand-side and external supportive environment) in operating OHS, and researching systematically development strategy of OHS in order to further effectively enhance the coverage and utilization of OHS, control occupational disease, which can also supply scientific interventions and policy recommendations for establishing the mechanism of OHS' sustainable development.CONTENTS OF THE RESEARCH1. Industrial Enterprises' Perception for OHS2. Current situation of the human resource of OHS3. Current Operating situation of the OHS Institutions4. Exterior Environment Supports for OHS5. Sustainable development strategies of OHSOBJECTS OF THE RESEARCHWe carried out related investigations on the people who were selected by using stratified random sampling in 9 enterprises, including 114 business management personnel and 354 workers who are working in the poisonous and harmful workplaces.General survey were presented on current situation of OHS in municipal and county centers for disease control and prevention in Shandong province in our study, including 299 OHS personnel selected from 6 municipal centers and 24 county centers by random cluster sampling method, and leaders of sanitation surveillance institutions which located on the same area of the OHS institutions.METHOD OF THE RESEARCH We carried out the investigation combining the qualitative survey and quantitative survey, using Medline et al for data collection.Qualitative survey: The demand of the OHS for managers and workers of the enterprise, the current situation of the sources and provided services of OHS facility, sample survey of reports documents, the degree of satisfaction, stability and the demand of the training for the workers.Quantitative survey: personal further interview for the managers of enterprises, the leader of the OHS and health supervisor facility, focus group discussion for the medical staff of the OHS facility et al.Both of descriptive and analytical study methods were used for analyzing of data, mainly included descriptive satistics, single factor analysis, multiple factors analysis (such as Non-conditional Logistic Regression, Factor analysis, et al.), SWOT analysis, scenario analysis, qualitative analysis, et al. Among which, the qualitative analysis included reading excessive documents, encoding, attribute sorting, proceeding interpretation and so on.MAIN RESEARCH ACHIEVEMENTSAchievements of five main parts in the paper are presented as follows:1 Evaluation on current situation of industrial enterprises' perception for OHS1.1 The managers didn't pay enough attention to the hazard of the occupational disease. Although the concentration(strength) of risk factors in workplace which can lead to occupational disease are much more severe than common, most enterprise managers always think the conditions in their workplace to be good enough for the health of workers. Managers and workers have strong needs for OHS, which can lay a good foundation for further development of OHS. Legal awareness and knowledge about OHS of managers and workers need to be strengthened and enhanced.1.2 It is the most important reason for the corporation to carry out the OHS that most enterprise managers recognize a good operation environment is helpful to enhance the work efficiency. The second reason is that they must comply with national law and regulations. And the last reason is that enterprises hope to protect their public image and reputation. In terms of enterprise managers, the health supervisory institutions do not form a very effective external pressure on them. 1.3 The most important reason restricting the corporation occupational health to get OHS proves to be, the service capability of the country facility which enterprises locate is very weak, and they also lack the qualification of OHS. Service charge is the significant one causing some enterprises not to purchase OHS, especially medium and small enterprises are facing cash flow problem. So, it is very significant for enterprises to acquire external especially government support to carry out necessary OHS.1.4 Through the analysis on impact factors of satisfaction with operation workplace conditions, we can find, workers at toxic and harmful post generally have less satisfaction with their work conditions comparing to enterprise managers. The extent of occupational hazards existed in the industry that enterprises belong to, significantly affect the satisfaction degree of managers and workers. Besides, marital situation and medical expenses payment ways have apparent impact on managers' satisfaction; also the numbers of workers and occupational health workers affect workers' satisfaction.1.5 From our study, poor health situation was identified for enterprise managers and workers. The prevalence rates of various chronic diseases were 39.4% and 45.5% respectively. Besides providing OHS, enterprises also need to provide basic medical health services for their managers and workers.2 Evaluation on the human resource of OHS Institutions2.1 Building OHS talent team has been strengthened and enriched, but there is still a serious lack of professional talents in partial service institutions, especially the county ones. No matter what level the OHS institution is, sanitary engineering people proved to be the most required.2.2 The training strength on OHS resources is not enough. On the whole, almost 50% of professional staff never joined the training in recent three years. 90% are in urgent need of the training to renew knowledge. There are many important factors greatly affect the employees' desire to professional training, including educational background, personnel category, working age, service life at OHS, whether accepting OHS training or not. The personnel who had got professional training about OHS had bad evaluation on the training effect. It's mainly because of less training chance for professional sanitation staff, short training time, and so on. 2.3 It is health care that the employees dissatisfied with at present, such as wage, reward distribution, welfare, working environment, office environment, etc. The key factors to affect the employees' whole satisfaction are the satisfaction on income, reward distribution system, individual promotion and evaluation on job importance.2.4 The work attitude of OHS employees is unreliable, 40.8% of people used to have the idea of abandoning present job. The employees' attitude would be more stable when they are more satisfied on employment mechanism, leadership, social situation, future development, understanding the company's development goal. As the title rises and self-confidence of individual skill increases it's easier to have the idea of leaving present company, especially the men.2.5 There have been some positive changes on the managers and the service personnel about the understanding for OHS, but some of them still didn't break away from the old system of integration of enforcement and service, have the idea of "wait, depend and ask for". It's a common concern about those problems of lacking professional OHS staff, low-quality people, lacking instruments, bad enterprise law-abiding, serious local protectionism and worse supervision on Hygiene Supervision.3 Evaluation on the Operating Situation of OHS Institutions3.1 The OHS system needs to be perfected because the OHS institutions are located mainly in the cities above county level, and there are no professional institutions and professional stuff in the towns, residential districts and villages. In about 15-16% of institutions, there is no matched physical and chemical testing laboratory and quality management departments to carry out OHS. And it is better in municipal institutions than that in country institutions. The providing rates of equipments are not high enough in musicipal and county OHS institutions. The most important is that the phenomenon is much worse in country institutions. Among three kinds of services carried out by OHS institutions, medical check-up and testing service are in a better situation, services evaluation is the weakest part in OHS now. Nearly half of OHS institutions did not have the qualification but still do the relative works, which directly affects the improvement of OHS' quality.3.2 Incentive mechanism of OHS institution mostly focus on wages and bonus, most institutions follow the original management system which is effective in the period of health and epidemic prevention station. OHS's management and incentive mechanism is traditional and simplex, and the institution lacks innovation in OHS's management. It indicates that management level of leadership in OHS institutions needs to be further improved.3.3 Government investment is helpful to carry out OHS, increase the capacity of the institution itself income-generating. However, the gap between different industrial areas using total expenses of carrying out OHS is widening year by year. Generally the industrial level in underdeveloped areas is much lower, so the country service institutions there cannot make both ends meet. These institutions can carry out only a few OHS items and the service level is low, which is mainly due to government's fiscal budget not to be in place.3.4 The higher level of service institutions they are in, the easier for them to be apt to serve for big enterprises and state-owned enterprises. Municipal service institutions always serve for state-owned enterprises and collective enterprises. And for the clients of country institutions, foreign-funded and private enterprises account for a larger proportion. Number of OHS and service efficiency provided by municipal institutions are obviously higher than that provided by county institutions. The supply efficiency of OHS in the institutions of low industrial degree areas is only 1/3 of that of high industrial degree areas.3.5 Original record did not written standardized, incomplete archive material about on-site investigation are also problems in OHS, which show some unresolved issues such as the attitude of institution personnel is not serious,low-quality business and management in institutions is not strict. This can all lay a lot of hidden dangers for the future development of OHS institutions.4 Evaluation on Exterior Environment Supports for the OHS.4.1 According to the analysis of policy, the maneuverability of it improved, the guidance effect became clearer. Especially after 2002, the guidance effect proved to be important to introduce market competition mechanism and to pay high attention to social resources joining into OHS. The strategy improved generally, the strategy and the socialist market economy system adapted to each other, developing methods to solve the problem in the development of OHS became available.4.2 There are still many problems when carry out the government policy. Some regulations of the prevention and cure law of the occupational diseases were ignored during execution. Especially the deficiency of service funds for OHS induced the ability of the development of OHS falling behind that of the economy. The government transferred the cost of the detection fee to the enterprise, and the small poor efficient enterprise has no ability to buy the service and this will prevent the development of the health service.4.3 Some supervisors of the OHS institution believe they already fulfill the responsibility they should do, and also induced the development of occupational health services, but there are still many problems: such as no dissection between law execution and services, no enough penalty, advantage between law execution and economic. The relationship between health supervisor institution and OHS facility must be perfectly rationalized.4.4 Multiple conflicts emerged and made the poor development of OHS in other facilities, because the portioning of the advantage and functional authority between health supervisor institutions and the other facilities.5 Study on Strategies for Sustainable Development of OHS5.1 Using SWOT analysis and scenario analysis methods, we analyzed the advantages and disadvantages of OHS institutions, opportunities and threatens from exterior environment, identified 9 key factors affecting OHS: the foundation and development of personnel training system, perfecting and handling of funds collection and reimbursement mechanism, setting up occupational health promotion system in enterprises, setting up coordinating and supporting relationship in multiple supervisory departments, evaluating the degree of OHS strategy enforcing, perfecting OHS system, developing government funds supplement for purchasing OHS in small enterprise, developing effective operating mechanism inside OHS institution, setting up ordered competing mechanism between OHS institutions; and made up 3 scenarios in the future: optimistic scenario, non-mutation scenario and pessimistic scenario.5.2 Made Sustainable development strategy of OHS from the macroscopic and microcosmic angle.Strategy 1: Found training center of OHS, enrich personnel training of OHS, improve the quality of personnel, breakthrough bottle neck problem of talented man.Strategy 2: The health government should cut down the threshold of the experiment equipment reasonably, introduce the public facility, civilian facility and social community into service market, promote variegated competition, and make the 'dealing with health' to be 'administering health.Strategy 3: The health supervisor facility is in responsibility of coordination and supporting system in multiple enterprises to promote the development of OHS.Strategy 4: To avoid the cut-throat competition, the government should change the investments feasibly, realize the purchasing of OHS service, promote effective funds operation and set up price standard for OHS.Strategy 5: Perfect the OHS system, enhance the construct ability of OHS in country hospital and community health center.Strategy 6: Enhance the surveillance of OHS strategy fulfilling, and form available surveillance evaluation mechanism.Strategy 7: Perfect the function of health education and promotion of workplace in OHS facility.Strategy 8: Set up effective operation mechanism inside the OHS facility, using kinds of effective measures to develop the advantage, and using outside opportunity to improve the competition.
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