3rd Stop TB Partners Forum

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Tuberculosis care and control at the workplace
3rd Stop TB Partners Forum Rio de Janeiro 23rd-
25th March 2009
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TB is a workplace issue

• 9.27 million new TB cases
• 1.75 million deaths
• Three-quarters of prime
• working age

• Garment workers in Bangladesh 2.4 times more
  likely to develop TB
• TB incidence in miners over 2000 per 100 000 in
  some South African settings

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TB is a workplace issue

• 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
• National loss to GDP per capita 4-7 in Asia,
  16 in SA
• 2500 business leaders reported TB affected their
  business

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Growing concern

• Nearly one-third of over 11,000 respondents from
  over 130 countries to the Forums Executive
  Opinion Survey (2007) expect the disease to
  affect their business in the next five years
• One out of 10 expects the effects to be serious
• Companies in countries hard hit by AIDS are
  particularly worried about TB.
• Firms in sub-Saharan Africa, Asia, and Eastern
  Europe are most concerned

TB and Business Report
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Response from companies in Brazil- TB and
Business Report

• Anxiety has risen steeply in large countries,
  including India, Brazil, Turkey, Korea and South
  Africa and other sub-Saharan African countries

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TB in workplaces Is it being addressed?

• 30 of workplaces do not provide any services to
  facilitate TB diagnosis
• 37 do not provide any services to facilitate TB
  treatment
• 57 of workplaces do not address TB through their
  HIV programs
• 95 of Governments would like TB to be included
  in HIV workplace programmes

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Addressing TB in workplaces Global approach(s)

• WHO-ILO Guidelines
• GBC and WEF
• Interagency taskforce on engaging workplaces
• Self assessment tool
• Survey of businesses
• Documentation of working models
• Global Consultation
• Global Guidance
• Learning projects
• Scale up

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Working model(s)
Government financing and stewardship (national/pro
vincial)
Bangladesh Garment factories pooling resources
Bangladesh Youngone Ltd.
Cambodia Garment factories
Philippines Phil Am Care HMO
Kenya Tea Plantations
Philippines Unorganized sector
Philippines
MOU
NGO
Local PPM DOTS Agency (public/private)
Shared Medical Health Centre
Company medical centre
PPMD Unit
Phil Am Care HMO
Company contributions
WORKERS
Associations
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Company engagement
Anglogold Ashanti educate and counsel- diagnose-
treat employees and contractors, free of charge.
Also addressing MDR-TB. monitoring and evaluation
Ensures that staff wear protective equipment in
highrisk areas found incidence rate of 3.1
among its workforce in 2006, with over 85 of
those infected with TB also HIV-positive

• Gold Fields gt30 yrs of awareness, diagnosis and
  treatment encourage TB patients to test
  voluntarily for HIV and, if positive, option of
  enrolling in the company wellness programme Anti
  discriminatory policy encourage contractors
  reported cure rate 85.

Heineken Test TB patients for HIV and vice
versa, DOTS is provided and closely monitored by
company clinics, with private health providers
used at some sites
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Company engagement
The Hindu Supports the Revised National TB
Control Programme (RNTCP) with a DOTS centre for
employees and the community, runs a Workplace TB
care and control programme works in partnership
with an NGO partner REACH donates advertisement
space, features TB-related stories and covers
related events
Aditya Birla Group workplace and community
programmes covering 3500 villages and nearly a
million people- extended to and around all their
industrial units. Project partners include NGOs
and the Indian government.
Reliance Industries combined HIV/AIDS and TB
control programme covering workers and
communities- awareness programmes, workplace
clinics, medical services set up near
manufacturing sites offering preventive and
curative services for villagers and contract
workers. Project partners include NGOs and the
Indian government
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India Business Alliance
PPP Framework
Partner Companies
Indian Government and technical partners

• Run workplace and community TB and or HIV
  programmes
• Adopt anti- discriminatory policy and activities
• Provide in kind support
• Engaged in R D

• Gives free technical support
• and training
• Provides free diagnostic
• consumables, TB therapy and ART
• Supportive supervision and
• external quality assessment

gt40 Indian companies reach several million
people supporting network of NGOs reaching many
more
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The spectrum of optionsEvery business can
contribute!

Families, Communities and beyond
Comprehensive workplace programme
Treatment and care
Diagnosis
Referral
Awareness
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Addressing TB in workplaces Business
contributions

• CSR?...No, CSD Corporate Social Duty !!
• Workplace first !
• Collaborate with national programmes sustainable
  and cost-effective
• Every business counts

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Business Engagement is a Win Win Situation

• For the NTP
• Reaching the unreached- new routes to potential
  new patients, national coverage
• Pooling of resources existing health
  infrastructures, systems and human resource,
  management skills
• Standardisation of quality TB care- can achieve
  shorter diagnostic delays and high treatment
  rates
• For the company
• Through prompt diagnosis and effective treatment
  and by reducing transmission to other workers
• Building healthier workforces
• Save costs by reducing absenteeism, staff
  turnover and re-training
• Save costs of medical insurance and medical costs
• Opportunity for businesses to concretely
  demonstrate their social commitment
• Goodwill and reputation (indirect marketing)

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Business Engagement is a Win Win Situation

• For the worker
• Improved compliance
• No loss of wages
• Saves cost of treatment
• Minimizes the stigma of TB among employers/
  employees
• For communities
• TB management cures people and returns them to
  an active, productive life, which in turn
  benefits their children and other dependants.

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Way forward work together !!

• Greater collaboration and coordination among
  stakeholders
• Interactions among programme managers and
  business leaders
• At least as much focus on action and
  implementation as on advocacy
• Greater attention to informal sector
• Global Subgroup on Public-Private Mix for TB Care
  as a platform for sharing of experiences and
  strategies

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Thank You
For more information contactMonica Yesudian
yesudianh_at_who.intShaloo Puri Kamble
shaloo.puri_at_weforum.org
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Ongoing and future activities

• Self assessment tool Dissemination of tool and
  analysis of results
• Identify best practices and get insights into
  existing approaches
• Documentation Success stories to build evidence
  base
• Implementation of existing tools
• TB Toolkit Chinese, Indian and South Africa
  versions available
• Collaborative Group on TB/HIV ILO, Stop TB,
  UNAIDS, WHO, World Economic Forum and business
  representatives
• Business Coalitions mapping by GHI, build TB
  strategies into Business Coalition mandates
• Continue to use advocacy platforms provided by
  Global Health Initiative, Global Business
  Coalition and others
• Continue to engage the business sector in the
  Stop TB Partnership

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Impact on Economies
Tackling Tuberculosis The Business Response,
David Bloom (Harvard School of Public Health),
2008 519 million cost of TB deaths for
sub-Saharan Africa without DOTS (2006
2015) 3.3 billion - 1.2 trillion estimated
cost to society of TB without DOTS for each of
the 22 high-burden countries (2006
2015) 15-fold estimated return on investment by
investing in DOTS
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Key elements of a successful workplace programme
Management support and employee buy-in
NTP Leadership
Company collaboration
Detect TB cases
Provide treatment
Report cases and track outcomes
Training
Uninterrupted TB drug supply
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Challenges

• Mobilising and sustaining government support-
  Hesitation to engage the business sector ?
  Ignorance of potential of the business sector
  Limited capacity (staff time, motivation)- to
  initiate/sustain quality while expanding a
  challenge
• Balancing ideologies, business interests and
  philosophy of different stakeholders
• Providing practical guidelines and documented
  evidence on potential modes of involvement
• Ensuring effective and efficient utilisation of
  available resources, in a complex situation
  involving multiple partners, each with different
  support needs
• Scaling up to engage larger number of companies,
  supply chains, PSUs, unorganised business sector
• Monitoring the activities without intimidating
  those involved