Nurses bring primary health care to industrial workers.
A comprehensive approach to worker's health problems involves integration of occupational health services within community health programs. This comprehensive health care concept is basic to the work of the Occupational Health Unit (OHU), in Botswana which was set up in 1982 as a collaborative effort of the WHO Regional Office for Africa and the Ministry of Health using a family nurse practitioner (FNP) for clinical assessment in the place of employment. Botswana has an acute health personnel shortage. Traditionally, nurses have provided primary health care (PHC). In 1980, a 1-year postbasic FNP program was set up at the Botswana National Health Institute (NHI) to prepare registered nurse-midwives (NMs) to treat and diagnose common problems. Family nurse practice includes health assessment, the provision of health education, and counseling. The OHU participates in training nurses who attend the NHI. An instructional unit has been set up for occupational health in which nurses receive field experience. There is a high degree of understanding and acceptance of FNPs by Botswana's physicians. 65 FNPs serve the PHC system--some in remote and some in periurban health facilities. The national manpower development plan says that an additional 20 nurse practitioners should be trained per year. A survey of the health status of industrial workers in Gaborone, the capital of Botswana, was undertaken. It was conducted at places of employment in 30 urban and periurban industries. On-site physical examinations of the workers took place. Diagnosis was based on symptoms and signs. Health problems were managed according to the 1986 "Botswana national drug catalogue and treatment guide." 1007 workers--796 men and 211 women-- were examined. 166 health problems were detected. There were 157 sexually transmitted diseases; 148 low back pain problems; 105 cases of high blood pressure, and 96 workers had eye problems. The health problems affecting Gaborone workers are mostly the same as the PHC problems in the general population. Suspected occupational health and work-related conditions were managed in consultation with the doctor specialist in the OHU. The FNP also provided health education and counseling. One model is to use a centrally located FNP attached to an occupational health team as a source of education and other support for district nurse practitioners and allied health personnel. A team of FNPs could also be used.