Monica Yesudian Mukund Uplekar First Consultation to promote the engagement of workplaces in TB care and control WHO / ILO / UNAIDS / GBC / WEF Supported.

Monica Yesudian Mukund Uplekar

First Consultation to promote the engagement of

workplaces in TB care and control

WHO / ILO / UNAIDS / GBC / WEFWHO / ILO / UNAIDS / GBC / WEF

Supported by the USAID-funded Tuberculosis Control Assistance Program (TBCAP)

ObjectivesObjectives

• Review ongoing experiences of workplace Review ongoing experiences of workplace

engagement in TB care and controlengagement in TB care and control

• Discuss the rolesDiscuss the roles of key stakeholders of key stakeholders

• Discuss and further develop draft guidance framework Discuss and further develop draft guidance framework

• Discuss ways to advocate workplace TB programmesDiscuss ways to advocate workplace TB programmes

Expected outcomesExpected outcomes

• A review of and perspectives on workplace TB A review of and perspectives on workplace TB

programmesprogrammes

• Feedback on draft guidance frameworkFeedback on draft guidance framework

• Beginning of an action-oriented, country-focused, Beginning of an action-oriented, country-focused,

collaborative programme on workplace TB controlcollaborative programme on workplace TB control

Participants

• National TB programme managers and PPM focal

points

• Businesses

• Partners

• Business coalition and employer federation

representatives

• Trade Union representatives

AgendaAgenda

• Present evidence-base and a draft guidance frameworkPresent evidence-base and a draft guidance framework

• Discuss working models and country experiences on Discuss working models and country experiences on

workplace TB programmes workplace TB programmes

• Understand perspectives of business coalitions, Understand perspectives of business coalitions,

employer organizations and trade unionsemployer organizations and trade unions

• Group workGroup work

• Next stepsNext steps

Evidence base &draft guidance framework

• 9.27 million new TB cases in 2007• 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– 15 years of income are lost from premature death– 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

Need for guidance framework

• ILO/WHO guidelines 2003 –

updation

• PPM guidelines

• Meagre evidence base

• Lack of case studies highlighting

NTP-workplace collaboration

• Interagency task force

Evidence base

• Literature review– the impact of TB on businesses; – the impact of TB on workers; – cost and quality of TB service provision in the workplace and advantages for patients and governments; – the risk factors for TB in the workplace; – the occupational sectors where TB is most prevalent;– the special risk of TB for migrant workers; – the importance of TB care, control and follow up activities in the workplace; – and other benefits of partnering with businesses.

The literature did not yield any articles discussing implementation or evaluation of TB programmes in

the workplace.

Survey

• Corporate sector evaluation tool

• Field tested

• 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

Site visits

• Bangladesh,

Cambodia, Kenya and

the Philippines

• 32 workplace initiatives

• Delivery models

• Gaps and potential

Unorganized workforce

Bangladesh- Partnering with the Garment Industry

Shared Corporate

Health CentreCOMPANY

CONTRIBUTIONSNGONTP

TREATMENTM & E

COMPANY MEDICAL CENTRE

Kenya – Flower farmsCambodia 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 sectorIdentify 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 workplaceInclude 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

Discuss working models and Discuss working models and country experiences oncountry experiences on workplace TB programmes workplace TB programmes

• Bangladesh, Kenya, India and South AfricaBangladesh, Kenya, India and South AfricaYOUNGONE TB DIAGNOSIS & TREATMENT CENTER

TREATMENT OUTCOMES

YEAR TOTAL PATIENTCURE

DEFAULT TANSF.OUT DIED CURE RATE

2007 3433

1 0 0 97.05%

2008 4133

5 3 0 80.48%

Tea Gardens, Jalpaiguri, West Bengal

Year New S+ TB in the district

New S+ TB in the tea estates

% contribution

by tea estates

2005 3112 1390 44.6

2006 3018 1342 44.4

2007 3228 1457 45.1

2008 3392 1480 43.6

Unilever and James Finlay

0

50

100

150

200

Unilever James Finlay

TB Cases detected

HIV Coinfection

•Both companies had high cure rates(85-90%)

•Very low default rates (close to 0)

Roles and perspectives of partners

• Business CoalitionsBusiness Coalitions

• Employer Employer

federationsfederations

• Trade UnionsTrade Unions

Group Work

• Big businessesBig businesses

• Small and medium sized Small and medium sized

enterprisesenterprises

• Unorganized business Unorganized business

sectorsector

• Business coalitions and Business coalitions and

employer federationsemployer federations

• Trade UnionsTrade Unions

Group work outcomes

• Strategy and Practical stepsStrategy and Practical steps

• Collaborative team at national level, lead by the NTPCollaborative team at national level, lead by the NTP

• Bringing together unusual partnersBringing together unusual partners

• Unorganized business sector - important, use civil society Unorganized business sector - important, use civil society

voicevoice

• Need for Guidance FrameworkNeed for Guidance Framework

• Integration of TB into package of health interventionsIntegration of TB into package of health interventions

• Beyond the workplaceBeyond the workplace

Next StepsNext Steps

• Need for a strategic approach to make Need for a strategic approach to make

TB a business issueTB a business issue

• Build on existing resourcesBuild on existing resources

– HIV workplace programmesHIV workplace programmes

– PPM programmesPPM programmes

• Regulation: TB/HIV workplace policyRegulation: TB/HIV workplace policy

• Taskforce: Global to national level Taskforce: Global to national level

collaborationcollaboration