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

Objectives Review ongoing experiences of workplace engagement in TB care and controlReview ongoing experiences of workplace engagement in TB care and control Discuss the roles of key stakeholdersDiscuss the roles of key stakeholders Discuss and further develop draft guidance frameworkDiscuss and further develop draft guidance framework Discuss ways to advocate workplace TB programmesDiscuss ways to advocate workplace TB programmes

Expected outcomes A review of and perspectives on workplace TB programmesA review of and perspectives on workplace TB programmes Feedback on draft guidance frameworkFeedback on draft guidance framework Beginning of an action-oriented, country-focused, collaborative programme on workplace TB controlBeginning of an action-oriented, country-focused, collaborative 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

Agenda Present evidence-base and a draft guidance frameworkPresent evidence-base and a draft guidance framework Discuss working models and country experiences on workplace TB programmesDiscuss working models and country experiences on workplace TB programmes Understand perspectives of business coalitions, employer organizations and trade unionsUnderstand perspectives of business coalitions, employer 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Evidence base & draft guidance framework 9.27 million new TB cases in 2007 An estimated three-quarters of those who fall sick or die of TB are aged 15-54, that is, people of prime working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 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 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 country experiences on workplace TB programmes Bangladesh, Kenya, India and South AfricaBangladesh, Kenya, India and South Africa YOUNGONE TB DIAGNOSIS & TREATMENT CENTER TREATMENT OUTCOMES YEARTOTAL PATIENT CURE DEFAULTTANSF.OUTDIEDCURE RATE % %

Tea Gardens, Jalpaiguri, West Bengal YearNew S+ TB in the district New S+ TB in the tea estates % contribution by tea estates

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

Roles and perspectives of partners Business CoalitionsBusiness Coalitions Employer federationsEmployer federations Trade UnionsTrade Unions

Group Work Big businessesBig businesses Small and medium sized enterprisesSmall and medium sized enterprises Unorganized business sectorUnorganized business sector Business coalitions and employer federationsBusiness coalitions and employer 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 voiceUnorganized business sector - important, use civil society voice 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 Steps Need for a strategic approach to make TB a business issueNeed for a strategic approach to make TB a business issue Build on existing resourcesBuild on existing resources –HIV workplace programmes –PPM programmes Regulation: TB/HIV workplace policyRegulation: TB/HIV workplace policy Taskforce: Global to national level collaborationTaskforce: Global to national level collaboration