First Consultation to promote the engagement of workplaces in TB care and control

1. WHO / ILO / UNAIDS / GBC / WEF First Consultation to promote the engagement of workplaces in TB care and control Monica Yesudian Mukund Uplekar Supported by the USAID-funded Tuberculosis Control Assistance Program (TBCAP)

2. Objectives • Review ongoing experiences of workplace engagement in TB care and control • Discuss the roles of key stakeholders • Discuss and further develop draft guidance framework • Discuss ways to advocate workplace TB programmes

3. Expected outcomes • A review of and perspectives on workplace TB programmes • Feedback on draft guidance framework • Beginning of an action-oriented, country-focused, collaborative programme on workplace TB control

4. Participants • National TB programme managers and PPM focal points • Businesses • Partners • Business coalition and employer federation representatives • Trade Union representatives

5. Agenda • Present evidence-base and a draft guidance framework • Discuss working models and country experiences on workplace TB programmes • Understand perspectives of business coalitions, employer organizations and trade unions • Group work • Next steps

6. Evidence base &draft guidance framework • 9.27 million new TB cases in 2007 • An estimated three-quarters of those who fall sick or die of TB are aged • 15-54, that is, people of prime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.

7. 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

8. 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

9. 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.

10. 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

11. Site visits • Bangladesh, Cambodia, Kenya and the Philippines • 32 workplace initiatives • Delivery models • Gaps and potential

12. Form people associations COMPANY MEDICAL CENTRE Referral to HC NTP PPMD Unit Delivery models Bangladesh- Partnering with the Garment Industry Kenya – Flower farms Philippines Cambodia Garment Factories Unorganized workforce DIAGNOSIS Shared Corporate Health Centre COMPANY Referral COMPANY CONTRIBUTIONS NGO M & E TREATMENT

13. Directed at NTP-business-partner collaboration to initiate and implement workplace programmes Menu of options Practical steps for implementation Case studies Guidance framework

14. Menu of options Every business counts! Big Companies Identify TB cases among workers and provide diagnosis at workplace Beyond the workplace: Implement comprehensive TB and HIV care programs for workers, families and communities. Support supply chain SMEs Increase awareness among workers, families and community Provide TB treatment and care at the workplace Include TB prevention, diagnosis and treatment in HIV workplace programs Identify TB cases among workers and refer to the public sector Families, Communities and beyond Comprehensive workplace programme Treatment and care Small Companies Referral and Treatment support Diagnosis Awareness

15. Discuss working models and country experiences on workplace TB programmes • Bangladesh, Kenya, India and South Africa

16. Tea Gardens, Jalpaiguri, West Bengal

17. Unilever and James Finlay • Both companies had high cure rates(85-90%) • Very low default rates (close to 0)

18. Roles and perspectives of partners • Business Coalitions • Employer federations • Trade Unions

19. Group Work • Big businesses • Small and medium sized enterprises • Unorganized business sector • Business coalitions and employer federations • Trade Unions

20. Group work outcomes • Strategy and Practical steps • Collaborative team at national level, lead by the NTP • Bringing together unusual partners • Unorganized business sector - important, use civil society voice • Need for Guidance Framework • Integration of TB into package of health interventions • Beyond the workplace

21. Next Steps • Need for a strategic approach to make TB a business issue • Build on existing resources • HIV workplace programmes • PPM programmes • Regulation: TB/HIV workplace policy • Taskforce: Global to national level collaboration