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Working together with businesses Guidance on TB and TB/HIV prevention, diagnosis, treatment and care in the workplace
Hannah Monica Yesudian Dias Stop TB Department
World Health Organization Geneva, Switzerland
Global Snapshot
• An estimated three-quarters of those who fall sick or die of TB are aged 15-54, that is, people of prime working age.
The case for engaging businesses
• Reach: 3 billion people in the world of work
• Impact on workers
– A TB patient loses 3-4 months of work time
– 20% to 30% of a patient's annual income lost
– Estimates for India- TB caused a loss of 7.9 million DALYs and a reduction of US$ 23.7 billion in economic wellbeing.
• Impact on economy
– An estimated 4-7% loss in GDP is due to TB in several Asian countries.
– For India, the annual cost to the country's economy - $300 million in direct costs and over $3 billion in indirect costs
• Overcoming barriers
– Working hours
– Job discrimination
– Loss of wages
Rationale for business participation
• Transmission
– TB incidence in miners is over 2000 per 100 000 employees per year in some workforces.
– Garment workers in Bangladesh are 2.4 times more likely to develop active TB than the general population.
• Worker Productivity
– Globally, TB is known to cause a decline in worker productivity to the order of US$ 13 billion every year.
– A gold mining company incurred an estimated cost of $410 in lost shifts for each case of TB among its unskilled employees in South Africa.
Nearly one-quarter of over 10,000 business leaders worldwide reported that TB was affecting their business.
Why this new guidance?
• ILO/WHO guidelines 2003 –updation
• PPM guidelines
• PPM toolkit (specific tool on workplaces)
• Other documents by WEF and GBC
• Meagre evidence base in literature
• Lack of case studies highlighting NTP-workplace collaboration
Development process
• Corporate sector evaluation tool
• Disseminated by ILO, GBC, CII, GHI
and ITGLWF
– 57% of 21,000 workplaces
responded that they do not
address TB within their HIV
workplace programmes.
• Site interviews-Bangladesh,
Cambodia, Kenya and the Philippines
covering 32 workplace initiatives
Unorganized workforce
Bangladesh- Partnering with the Garment Industry
Shared
Corporate
Health Centre
COMPANY
CONTRIBUTIONS NGO NTP
TREATMENT M & E
COMPANY
MEDICAL
CENTRE
Kenya – Flower farms Cambodia Garment Factories
DIAGNOSIS
Referral to
HC
PPMD Unit
Philippines
COMPANY
Referral
Form people
associations
Delivery models
Guidance framework
• Directed at NTP-business-
partner collaboration to
initiate and implement
workplace programmes
• Menu of options
• Practical steps for
implementation
• Case studies
Big
Companies
Menu of options
Increase awareness among workers, families and community Identify TB cases among workers and refer to the public sector
Identify TB cases among workers and provide diagnosis at
workplace
Awareness
Referral
and Treatment
support
Diagnosis
Treatment
and care
Provide TB treatment and care at the workplace Include TB prevention, diagnosis and treatment in HIV
workplace programs
Comprehensive
workplace
programme
Families,
Communities
and
beyond
Beyond the workplace: Implement comprehensive TB and HIV
care programs for workers, families and communities. Support
supply chain SMEs
Small
Companies
Collaboration with NTP
• A National TB Programme (NTP)
has the mandate and responsibility
for coordinating TB prevention,
treatment and care activities.
• Sustainability
• Resources
Key partners
• Trade Unions
• Employers’ Organizations/ Chambers of Commerce
• Labour inspectorate
• Business Coalitions and Associations
• NGOs involved in TB and HIV (International and local)
• ILO Focal Persons and National Project Coordinators, and UNAIDS
Partnership Advisors
Key high-risk sectors
SECTOR Potential Risk Factors
Mining Industry Occupational exposure to silica dust and silicosis
Confined poorly ventilated working environment
Cramped living quarters
High HIV prevalence
Commercial sex workers High rates of HIV
Poor living conditions
Poor access to healthcare
Substance use
Construction Exposure to silica dust
Poor living conditions
Alcohol use
Healthcare centres/ hospitals Occupational exposure to TB
Occupational exposure to HIV
High levels of stress
Oil and Gas Industries and plantations Cramped and congested living area
Poor access to healthcare
Businesses with large migrant workforce High levels of HIV
Poor living conditions
Poor access to healthcare
Overcrowding
Integrating TB in HIV or other workplace health programmes
• Identify all possible entry points in the HIV workplace programme
where TB can be integrated.
• Ensure that integration is built upon what exists and not through
the creation of vertical or duplicate structures which may not be
sustainable in the long term.
Entry points for TB/HIV programming within the workplace
Assess existing HIV/AIDS Workplace programme structures
TB Programmatic Actions
Is there a HIV Focal person/coordinator in the workplace?
Train the HIV focal person to undertake TB activities (TB/HIV focal person) or identify and train another worker to be TB focal person
Have IEC materials been developed for HIV and are some in the process of being developed?
Develop TB IEC material or incorporate TB information in HIV IEC material
Is there a HIV workplace policy? Adapt the HIV policy to address TB (TB/HIV Policy)
Are there trained peer educators and counsellors (from the enterprise and community)?
Upgrade the skills of peer educators and counsellors to include TB education
Have the onsite health workers been trained in HIV/AIDS issues?
Train the onsite workers in TB and related issues
Is VCT undertaken periodically in the workplace for employees?
Encourage passive case finding for TB at the workplace
Are there support groups at the workplace or in the community addressing HIV?
Include TB in the activities of the support groups
Is there a monitoring and evaluation framework for the HIV workplace programme?
Include TB indicators
Steps to initiate TB workplace programmes
• Assessment and planning
• Key tasks as per menu of options
• Allocation of roles
• Launch and roll out
• Monitoring
Capitalizing on untapped corporate sector potential
• Low hanging fruit to increase case detection
• Small number of companies engaged
• Informal sector engagement miniscule
• Targeting key industries, e.g. mining?
• Integration with other workplace programmes key!
• Roll out of guidance framework
• Support from ILO to build in MoL support
• Documenting and sharing more country experiences