Employment law
Occupational doctor in Mali: what the employer must organise, and what it must do with it
In Kalaban-Coro, cement dust hangs over the block presses at Kalaban Béton. A new labourer starts on Monday, another is returning after a month off sick, and the manager does not know whether they need to see a doctor, which one, or who pays. He thinks a certificate from the local dispensary will do. That shortcut exposes the company to a formal notice, and leaves the question that matters unanswered: can these employees handle this post?
Kalaban Béton is a concrete block and concrete factory with 45 employees, based in Kalaban-Coro. This company and the people mentioned are fictitious: their names are used for illustration only.
1. What exactly are we talking about?
Every company or establishment must provide a medical or health service for its workers, and the Social Security Code sets out how this obligation is to be met (Labour Code, article L.177).
The occupational health service has two missions (Social Security Code, article 36):
- preventing any harm to workers' health caused by their work, by monitoring hygiene conditions, the risk of contagion and workers' state of health;
- providing care to workers and, where applicable, their families, under the conditions and within the limits set, pending the introduction of a health insurance scheme.
The occupational doctor assesses whether an employee's state of health matches the post, and advises the company on hygiene and working conditions.
The most common mistake
Believing that the occupational doctor "does not treat patients". In Mali, the Social Security Code also entrusts care to the doctor: he provides the necessary care to workers and their families, within the limits of the resources provided (articles 52 and 54). The other mistake is to replace the doctor's visits with a certificate from a general practitioner, which does not answer the same question.
The treating doctor looks at an illness. The occupational doctor looks at a post.
2. How the company meets its obligation
The Social Security Code does not leave the company free to choose its arrangement.
| Situation | Arrangement provided for | Text |
|---|---|---|
| Locality where the number of employees allows | The INPS creates an inter-company medical centre; all employers in the locality must join it | Article 37 |
| Geographical isolation or special working conditions | A medical centre specific to certain establishments may be created, after the labour inspector's opinion | Article 38 |
| Funding | The costs of inter-company centres are borne by the INPS, which collects contributions for this purpose | Article 39 |
An inter-company medical centre is a medical service shared by the companies in a locality, run by a chief doctor appointed by the INPS (Social Security Code, article 37). It also serves apprentices, workers on probation, seasonal workers who return regularly and members of the worker's family (article 40).
When an establishment must have its own medical staff, the Code sets minimum numbers: for example one doctor, one state-registered nurse and one first-cycle nurse for 100 to 499 workers, or two nurses for 20 to 100 workers when the workplace is far from any health facility (article 55).
What you need to do
- Check with the INPS which inter-company medical centre covers the locality.
- Keep proof that the company has joined that centre.
- Keep social contributions, which fund the medical service, up to date.
3. Compulsory medical visits
| Visit | When | Purpose | Text |
|---|---|---|---|
| Pre-employment visit | Before hiring, or at the latest before the end of the probation period | Check fitness for the post, the absence of any condition dangerous to colleagues, posts to avoid | Article 43 |
| Periodic visit | At least once a year; every three months for under-18s | Monitor fitness; special supervision of exposed employees, pregnant women, mothers of a child under two, disabled workers | Article 44 |
| Return-to-work visit | After an occupational disease, after more than three weeks off for ordinary illness, or after repeated absences of more than fifteen days in the six-month period | Assess fitness to resume the job or the need for rehabilitation | Article 45 |
| Employee reporting sick | When the employee reports sick | Examination at the inter-company medical centre, at the time set by its rules | Article 50 |
At Kalaban Béton, the new labourer has the pre-employment visit before taking up the post, or at the latest before the end of his probation (Social Security Code, article 43). The employee returning after a month off for ordinary illness must have the return-to-work visit, since the absence exceeds three weeks (Social Security Code, article 45).
Time and documents
Time spent on examinations is taken from working hours without any deduction from pay, or paid as normal working time. Additional examinations for screening occupational diseases are paid by the employer (article 46). At hiring, the doctor draws up a visit record that the employer keeps to show the labour inspector, a medical file covered by confidentiality, and a record given to the worker on request or on leaving (article 43).
The most common mistake
Deducting the time of the visit from pay, or arranging the pre-employment visit after the probation period has ended. In both cases, the company puts itself in breach over a simple formality.
What you need to do
- Schedule the pre-employment visit before the employee starts, and at the latest before the end of probation.
- Arrange each employee's periodic visit at least once a year.
- Trigger the return-to-work visit after more than three weeks off or fifteen days of cumulative absences in the six-month period.
4. The doctor's opinion and the employer's decision
The occupational doctor advises management, heads of department and staff delegates, in particular on workshop hygiene, protection against dust and dangerous fumes, and adapting workers to their posts. The doctor must be consulted on any new production technique, and the employer must inform the doctor of the composition of the products used (Social Security Code, article 47).
The head of the company must take into consideration the occupational doctor's opinions, in particular on changes of job and post and on improving hygiene, under the supervision of the labour inspector (Social Security Code, article 48).
| Question | The occupational doctor | The employer |
|---|---|---|
| Fitness for the post | Assesses it | Takes it into consideration |
| Adapting the post | Recommends adaptations | Examines and implements them |
| Change of job | Advises on it | Decides it, in line with the contract |
The special case of women and young workers
For women and children, the Labour Code goes further. The labour inspector may have a doctor check that their work is not beyond their strength, and this examination is a right if they request it. If the job is found to be beyond their strength, they must be assigned to suitable work; if that is impossible, the contract is terminated by the employer (Labour Code, article L.188). This rule covers women and children: it does not extend, as it stands, to all employees.
For changes of post, see Redeployment and advancement.
What you need to do
- Give the occupational doctor the composition of the products used, such as cement and additives.
- Record in writing each of the doctor's opinions and the action taken.
- Look for suitable work when a post is found to be beyond the strength of a female employee or a young worker.
5. Accidents, occupational diseases and reporting
The employer must notify the labour inspector within 48 hours of any occupational accident or any occupational disease identified (Labour Code, article L.176). The Social Security Code specifies the form (article 71):
- the report is drawn up in four copies, on the official INPS forms;
- one copy is sent directly to the INPS within 48 hours;
- two copies go, within the same time limit, to the competent regional labour inspectorate, or to the head of the administrative district when the accident occurs outside the district where the inspectorate is based;
- the fourth copy is kept by the employer.
For its part, the occupational doctor reports to the employer any occupational diseases he learns of, and notifies infectious and contagious diseases within 24 hours to the district doctor and the labour inspector (article 49). An employer using work processes likely to cause occupational diseases must declare this before work begins, by registered letter, to the labour inspector and the INPS (article 140).
Finally, when working conditions are dangerous, the inspector may, in an emergency, order work to stop immediately; the hours lost are then paid as actual work (Labour Code, article L.175). See Occupational accidents: regime, benefits and job protection.
What you need to do
- Keep INPS report forms on site.
- Send the accident report to the INPS and the labour inspectorate within 48 hours.
- Check whether the company's processes require a prior declaration to the inspector and the INPS.
6. What the company must be able to show
| Document | Why keep it | Text |
|---|---|---|
| Proof of membership of the inter-company medical centre | To show that the medical service is provided | L.177; Social Security Code, article 37 |
| Pre-employment visit records | They must be available to show the labour inspector | Social Security Code, article 43 |
| Register of visits | It is kept permanently available to the inspector | Social Security Code, article 51 |
| Accident and occupational disease reports | To prove the 48-hour deadline was met | L.176; Social Security Code, article 71 |
| Third part of the employer's register | It contains the inspector's observations and formal notices | L.130 |
These are the documents an inspector consults during a visit. In the event of an accident or a dispute over fitness, they are also the only proof that the company has met its obligations. On hiring formalities, see Recruitment.
A closer look: the occupational doctor also provides care
In Mali, the company's medical service is not only preventive. Pending the introduction of a health insurance scheme, it provides care (Social Security Code, article 36).
- The occupational doctor provides the necessary care to workers and, where applicable, their families (article 52).
- In case of illness of the worker, his wife or his children, the medical centre provides care and medicines free of charge, within the limits of the resources provided (article 54).
- Injured and sick people who cannot be treated on site are evacuated to the nearest medical facility (article 53).
For Kalaban Béton, this means that an injured or sick employee must first be referred to the inter-company medical centre, not sent home with a simple leave of absence.
Key takeaways in 6 points
- Join the inter-company medical centre in your locality and keep proof of membership.
- Have the pre-employment visit carried out before the employee starts, and at the latest before the end of probation.
- Arrange a periodic visit at least once a year, and every three months for under-18s.
- Trigger the return-to-work visit after more than three weeks off or fifteen days of absences in the six-month period.
- Take the occupational doctor's opinions into consideration and record the action you take.
- Report every occupational accident to the INPS and the labour inspectorate within 48 hours.