Malaria: Risk Assessment versus Impact Assessment

Abstract

Some tropical areas are particularly challenging for employers when it comes to deal with both risk assessment and impact assessment of malaria. On our recent operations in Indonesia, we had to cope with health issues related to malaria that raised more questions than we were able to answer regarding occupational health, corporate social responsibility, and legal issues. These questions include: How do we manage malaria prevention and chemoprophylaxis for indigenous people working in highly endemic malaria areas (i.e. Western Papua)? Can we make a distinction between individuals for whom malaria is recorded as an occupational disease and those for whom the illness is not work-related? To cope with this interesting topic, we conducted a case study with the support of the International SOS medical team based in APAC. It consisted of a review of the regulations applicable in Indonesia by taking into account several criteria such as labor laws, occupational/public health, health risk assessment, and health impact assessment. We wanted to learn more about our Duty of Care and how to report or record malaria cases when, as a company, we transfer someone from one Indonesian island to another. We took the case of an employee hired in Jakarta (Java) who travelled to Western Papua for two months and then came back home: Does he require malaria chemoprophylaxis or is he considered semi-immune? Do we record malaria as an occupational disease if he contracts it? What about CSR and company liability if he is infected and becomes a "reservoir" for new Plasmodium falciparum species in his home island where his family and community have no semi-immunity against? The study shows clearly that this issue merits more than just a workplace Health Risk Assessment. Through Health Impact Assessment, knowledge of local regulations, laws, and medical practices is mandatory for understanding and safely managing malaria prevention as well as avoiding litigation or inappropriate actions.