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