New steps in the national rural health policy-Macedonian example

Introduction
Agricultural workers in R.Macedonia ( RM) are recognized by the national public health policy as very important vulnerable groups which need societal and institutional support. This paper is an example of good practice in policy analysis in the process of improving occupational health and safety in agricultural workers.

Methods
In 2009/2010, the Institute of Occupational Health of RM and OHS’ network, realized concrete research activities focused on agricultural workers: the questionnaire-based national survey aimed at identifying vulnerable workers among key informants (N=200) and a cross –sectional, pilot- study (N=200), using specially designed questionnaire and preventive medical check-ups, as a part of the national OH preventive program in agricultural workers (3000 subjects), supported by the Ministry of Health and WHOEuro.

Results
The survey data , indicated that agriculture is one of the sectors with the highest risk for health (81% of responders) because of the low level of education, poor working conditions and lack of workplace hazards’ information; stressed the good availability of primary health care (PHC) services (89% of responders) and poor availability of OHS (81,3%) among agricultural workers. Additionally, the results from the pilot study defined the most often activities ( cultivating vegetables 84%, irrigation 91.6%, pesticide use 76.2%, cattle-breeding 78.3) and exposure (over 80%- inappropriate climate, chemical agents, hard muscular work, loading) among examined. The main self-reported health problems were osteomuscular symptoms (34.6%),while the back pain (54.2%), muscular pain in the extremities (25.6%),were the dominant work-related symptoms. Lung ventilatory disturbances were registered by spirometry in 23.4% , and hypertension in 29.7 % of the examined subjects.

Discussion
The results identified the main occupational health problems and propose specific directions of the health prevention and promotion in agricultural workers, indicating the Basic OHS model at the PHC through public health approach, as a good concept in RM.