Occupational Health policy and program management in Colombia

Occurrence of social security reforms, free trade agreements and opening free markets caused many changes in the working world in most countries of Latin America, and stimulated reforms in the social security and health systems. Colombia shifted in 1993 to a comprehensive social security reform, within which the OH system and the Worker’s compensation system fused, incorporating new stakeholders to the management and the service provision of both.  A review of the regulation evolvement, the governing bodies, OH National Plans, the affiliation coverage, the registry of occupational illnesses and diseases, and the finances of the WC insurances during these 16 years was carried out through several profiles of working conditions and OH enterprise programs. The transition of a state monopoly to a pluralized structure for the management of the WC and the OH system created market opportunities for insurances, intermediaries and other new stakeholders. Insurance coverage slightly increased, but more than 60% of the economically active population remains uncovered. Injuries and disease continue to increase, and preventive programs are prioritized by the willingness of the ARP, and not workers’ health problems. Regulatory legal bodies have released legal uncertainty with their demands/sues mandates. Working conditions for Colombian workers have not improved as expected. Many investments are done in training, congresses, and other activities under the workers’ health promotion line. But workplace prevention and hazard control are still limited by political will and cost-effectiveness based on profits and market trends. Workers’ health needs and technical solutions for adverse working conditions are still pending. At sectorial levels, OH National commissions have achieved consensus for technical and scientific regulations. Many lighted and showy areas remain to be solved 16 years after their implementation.