Inequity in occupational health services for government hospital workers in South Africa.

South Africa's inequitable public health system is mainly delivered by provincial health departments, and exemplifies the potential and problems of occupational health services in middle-income countries. The occupational health services for 153 265 employees in all of South Africa's 370 provincial hospitals were described and compared. Information was obtained from 303 (82%) hospitals, using a self-completed questionnaire and telephone interviews. Thirty-two per cent of hospitals had an occupational health clinic, but 61% of employees worked in hospitals with a clinic. Occupational health clinics were more likely to be present in larger hospitals, and were strongly associated with provision of primary care and chronic disease services to workers. Thirty-nine per cent of hospitals had a safety officer, 41% had access to an industrial hygienist or environmental health officer, and 80% had health and safety committees, as required by law. While occupational health services were more likely in larger hospitals, workforce size did not explain the marked differences between provinces. The study shows that substantial occupational health services exist, but that important gaps persist, even in wealthier provinces and especially in provinces without coherent occupational health policies.