GTZ-SPAA

Private Sector Involvement in

National TB Control

Examples in Ghana, Malawi and Namibia

By

Dr Valentine Douala- MoutengChief Executive Officer, PABC

INTRODUCTION• In 2008, 9.4 million newly infected with TB. Asia (55%)

and Africa (30%). • The situation worsened due to the dual infection with

HIV and TB and of multi and extremely-drug resistant tuberculosis (MDR-TB) and (XDR-TB).

• The direct and indirect costs of tuberculosis and the social consequences are often catastrophic for the individual, the family and the wider community.

• Tuberculosis affects the business of companies• Private sector have introduced TB workplace

programmes . But are they geared to contribute towards eradication of the disease?

THE STUDY • Study performed by SPAA project and the PABC, to provide

information about:• the transmissibility of TB and the implication for the

workplace• Existing TB control activities at the workplace• The existence of legislation for infection control relevant

for workplaces METHODOLOGY• A review of literature and publications (not complete)• Interview with key informants: National Business Coalitions

(NBCs) , National TB program, companies, ILO, GTZ representatives.

LIMITATIONS: only 3 countries; few informants,

Workplaces: environment with high level of disease transmission

Infectiousness starts before onset of symptoms (up to 3 months)

Treatment delay increases transmission to close contact in households and workplaces.

A long delay is common in African countriesStudies report high numbers of transmission in workplace

settings (34% – 39% infection rates of contacts)Poorly ventilated areas, share car rides to and from work

and joint lunches identified as factors contributing to transmission .

PLWHA are very vulnerable to TB transmission

The economic impact of TB is huge75% of people infected are between 15 and 54 years of age.Estimation: TB reduces workers’ productivity by as much as

US$ 13 billion annually. A large gold mining industry in S. A. estimated that each case

of TB among its unskilled employees cost US$ 410 in lost shiftThe disease causes severe losses through absenteeism,

reduced productivity, need for replacement of lost workers. On average, an employee with active TB will lose up to nine

months of work. With treatment infected employees take up work again after

two to four weeks.

TB legislation•Protect uninfected persons against TB infection

•Detect cases of infectious TB as early as possible and to initiate treatment

•Notify and report TB cases•Perform screening in close contacts of the index case

•Ensure that persons with TB receive adequate treatment•Provide prophylactic treatment to certain groups of people

•Protect TB-infected persons from stigma and discrimination

In the workplace• Education

programme• Screening, for TB and

referral for diagnosis and treatment

• Prevention of discrimination and stigmatization

• measure such as improving the ventilation

´Namibia Ghana Malawi

Protection of the general population yes no no

Intensive active case detection yes no no

Early and /adequate treatment

yes/yes no/yes No/yes

Notification of TB cases

yes yes yes

Contact tracing

yes no no

Prophylactic TB treatment

yes yes yes

National Business Coalitions involvement

National Business Coalitions involvement iNAMIBIA MALAWI GHANA COMMENTS

Number of members

60 and 12 have TB programme

90 number of TB programme not given

38 , TB programme in mining sector

NBCs awareness Few companies regard TB as an important problem. Measures for active case finding Contact tracingCollaboration with NTB to be improved

Provision of training

Yes, peer educators and focal person

Peer, health care staff of the companies

no

Provision of information material

Yes Provision of CPT (prevention therapies)

no

Partnerships and networking

Agreement with UNIONS, Royal Netherlands TB , NGO, NTLP

NTP and NACP, health facility, public sector, church

NTP advocate at NBC meetings. ILO programme

Advocacy, Advisory services

Management of companies. Linking with services providers

Visit to companies, Cocktails to sensitized the management

There are demand from the companies

NAMIBIA MALAWI GHANA

ETALE FISHING COMPANY

ILLOVO SUGAR COMPANY

The ADM Cocoa (Ghana) Ltd.

The company runs an in-house clinic where an average 20 TB patients per year are treated . Workers suspected to be TB infected are sent to the public health facility for testing. Treatment is provided in the company owned clinic with drugs of the public sector,.

5000 employers

All identified HIV positive workers are screened for TB and treated, if found infected. Contact tracing in the families is done.

Infected employees are allowed to collect their drugs and go for investigations during their working time. Salary payment continues.

The company implements a comprehensive health programme, which includes HIV/TB, malaria, hypertension and diabetes.

If a person has symptoms suspect for TB he/she is referred to a public health facility for TB screening and an x-ray of the lung. And treatment

TB treatment is provided free of charge in Ghana.

The company is a member of the NBC

EXAMPLES OF GOOD PRACTICES

CONCLUSION/RECOMMANDATIONS

• Increase awareness on the importance of combined TB and HIV control among national business coalitions, the private sector and public partners

• Increase the support for NBCs to respond to the demand of the companies and the need to mobilize more companies to implement TB programmes as NBCs play a critical role.

• Perform contact tracing systematically at company level• Expand collaboration between NBCs and the NTBP

(including re- assessment of the policy)• Realise research on the financial impact of TB on

companies in different economic sectors

THANK YOU FOR YOUR ATTENTION

MERCI