CTP: TB Free workplace

What’s inside:

Read this page to learn how TB is a threat to the nation's economy and the role of workplaces in reducing the burden of TB 

Tuberculosis (TB) is one of the top ten deadliest diseases known to mankind and India is accountable for 26% of all TB cases and 31% of all TB-related deaths worldwide.

• TB control and prevention faces daunting challenges in India. A significant proportion of the population is undernourished, which weakens immunity and drives.
• 83% of TB cases come from the most productive age group of 15-60 years in India.
• The public and private sectors in India employ 470 million workers, of which around 80% are from the unorganized sector . [Unlike the organized sector, unorganized sector may not have access to formal mechanisms of regular health check up, insurance etc.]
• It is estimated that around 170 million work days are annually lost due to TB.

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Source:

Global tuberculosis report 2020: executive summary. Geneva: World Health Organization; 2020  * India TB Report 2021

Periodic Labour Force Survey (PLFS) by the National Sample Survey Organization Ministry of Statistics & Programe Implementation, 2017 – 2018

What’s inside:

Read this page to know; how TB could impact the organization & why TB Free workplace is important.

Absenteeism & Productivity Loss related to TB in workplace and its implications:

The success of industries is closely linked to the health and prosperity of the community of workers, services, contractors and consumers. However, India’s response from industries, and business organizations to TB remains minimal and requires scaling up.

TB in Workplace impacts the organization by: Employees may lose 3 – 4 months of work on an average if they are affected by TB. 

• Lost man hours 
• Disruption in workflow 
• Weeks and months of absenteeism 
• Lowered productivity.

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The industries could also incur indirect costs due to, consequent recruitment and training.

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Why TB Free workplaces are important?; Challenges & opportunities:

• Workers spend most of their time at workplaces
• Difficult for the program to reach workers
• Workplaces play a vital role in creating TB awareness and providing necessary support for treatment completion
• Workplaces can promote zero stigma related to TB

What’s inside:

Read this page to learn how stigma & discrimination due to TB can lead to late diagnosis, disease spread and decrease the health & wellbeing of an employee affected with active TB disease.

TB related Stigma & Discrimination at workplaces, and Wage Loss affecting the Employee

People affected by TB lose jobs, go into debt and face considerable stigma from their families, community and employers. Thus, the impact of TB on individuals is often all- encompassing, affecting not only physical health, but also social, economic, and psychological well-being.

If the employer & co-workers are showing stigma and discrimination to the employee diagnosed with TB, it can cause:

• Loss of employment
• Lower Income

Added to the social consequences such as:

• Ostracism from family and community
• Divorce
• Loss of housing
• Depression, Higher levels of anxiety
• Lower Life Satisfaction

Since TB affects the economically productive age group, the social consequences mentioned above will be huge.

Many employees are migrants at their place of work and may be dependent on the employer, and on co-workers, for health care needs.

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To initiate and complete treatment successfully, and to prevent the spread of the disease in the community, TB patients and their families need the understanding, empathy, and support of employers and co-workers.

Four principles to prevent or reduce consequences of stigma:

1. People diagnosed with TB and those who are close to them are able to live and acess TB services without being judged.

2. People in the social circle / members of the community of the person diagnosed with TB do not fear TB but are assured that it is a treatable disease, and that their support of persons with TB will result in early and better recovery, and thus prevent its transmission to others.

3. Community influencers contribute to fostering of safe and acceptable environments towards people diagnosed by TB and thier close contacts.

4. Healthcare providers and health influencers adopt standards for TB care and their capacity in using stigma-mitigating soft-skills and language is built.

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Steps you can take to avoid stigma and discrimination against TB in your community and workplace:

1. Providing awareness:
   1. Against fear of TB.
   2. Regarding the curability of the disease
   3. Need of avoiding stigma and discrimination.
   4. On advantages of early diagnosis and need of treatment adherence
2. Advocating for undergoing periodic TB screening 
3. Providing extensive psycological, economical and nutritional support to TB patients and their family
4. Ensuring that your workplace is having a policy or guidelines against stigma and discrimination especially related to TB and HIV.  

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Recommendations for the employer:

• Conduct periodic health screening camps specifically for TB in your workplace
• Ensure HR support to employee diagnosed with TB by providing sick leave / paid leave during the treatment period.
• Allot flexible work hours during the recovering period. Consider provision of work from home if the circumstances allow.
• Introduce “TB FREE WORKPLACE” policy in your organization

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TB transmission in Workplaces

What’s inside:

Read this page to learn how TB spreads inside your workplace 

Introduction:

The global spread ofCovid-19 has highlighted the need for implementing standard infection control precautions and to improve preparedness for pandemic respiratory infections. Preparedness means having infection control activities already in place; many of the same infection control activities will help contain TB as well.

Although this chapter focuses on TB as the prototypical airborne disease, the principles also apply to other respiratory infections.  

Dynamics of TB Spread:

The following must be known in order to fully understand TB transmission.

TB is infectious only when it occurs in the lungs or larynx (thought). TB that occurs elsewhere in the body is usually not infectious, unless the person also has TB in the lungs or larynx at the same time.

Tuberculosis is transmitted mainly through the air via droplet nuclei generated when a TB patient coughs or sneezes. 

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Why TB & Workplace ?:

An employee will be spending an average of 8Hrs / day (48 hrs / week) in their work spaces making them vulnerable for contracting diseases like TB and making them a challenging population for the programme (National TB Elimination Program) to reach.

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Added to all of these, Low BMI, Accessibility to Healthcare, Malnutrition, Smoking, Alcoholism and Tobacco usage can also make a person vulnerable to TB.

What’s inside:

Read this page to find out what steps can be taken to tackle the spread of TB and other airborne infections in the workplace (such as COVID-19, Influenza A H1N1, etc.)

Measures for tackling spread of Airborne Infections (TB, Covid-19, Influenza A H1N1, etc.) inside the organization:

Majorly two line of activities are recommended in controlling spread of Air Borne infection inside a work place:

1. Administrative Control
2. Environmental Control

Administrative Control Strategies:

The main objective of this strategy is to reduce the exposure to diseases like TB inside the workplace by:

1. Reduce the delay in diagnosis so that a person with active TB disease or any airborne infections will not spread the disease inside the workplace. 
2. Reducing airborne transmission of disease to other workers / employees by facilitating continues - awareness, early diagnosis and treatment support activities.    

Following, are the activities recommended under administrative control strategies:

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Environmental Control:

Environmental control majorly includes ventilation (natural and mechanical), installation of easily accessible hand wash areas / hand sanitisation dispensing units inside the facility.

Environmental controls work on the basic principle of dilution of infectious particles through real or ‘effective’ air exchange. In the case of ventilation, that dilution occurs through the introduction of fresh, uninfected air and the removal of infected air.

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Types of ventilation: 

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Any of the above ventilations if appropriatly placed can ensure air exchange inside the closed space and can prevent Air Borne infections like TB to a large extend.

High-risk occupational areas / workplaces like cotton mills, glass, chemical manufacturing, healthcare settings, and weaving industries require adequate ventilation systems because workers spend time indoors exposed to harmful substances for their respiratory systems, which can in turn make them susceptible to tuberculosis.

However, all workplaces shall ensure prevention of overcrowding and adequate ventilation in indoor settings for prevention and control of airborne infections such as TB, Covid-19, etc.

In addition to ventilation measures, hand sanitizer and mask dispensing units should be installed at easily accessible areas.

What’s inside:

Read this Chapter to learn - What a TB Free Workplace means and how to implement TB Free workplace.

Page: 1 What is a TB Free Workplace?

An Overview: ‘TB Free Workplace’ is an organization with adequate model and policies for prevention and control of TB by integrating awareness, health education and service delivery with existing systems, structures and resources, and by taking cognisance of their business agendas thus by reducing the burden of TB inside the organization.

A TB Free Workplace will have supportive environment and provisions where employees including contractual workers:

• Have easy access to information and services on TB and employees/ worker feel confident to utilize these services;
• Periodic Intensive Case Finding, workers having active TB is identified early and is put on treatment;
• Provisions are in place to support treatment adherence with job security;
• There is no discrimination either based on real or perceived TB status of workers;
• Favourable policy/guidelines are in place to protect rights of TB patients and
• No or Low TB incidence among workers are being report in last one year.

The goal is to implement a comprehensive program on TB prevention and care inside the organization.

Industries can help India's TB outcomes by enabling access to early detection, diagnosis, and high-quality care and treatment services by investing in the health of their own workforce.

Key activities for implementing TB Free workplace:

• Setting up Workplace committee or nominating a focal point 
• Training of master trainers followed by implimenting training on TB to all the employees through the master traininers
• Awareness Generation by circulating communication materials on TB
• Organizing periodic screening for TB
• Facilitating treatment support to identified TB patients, ensuring all the TB patients are put on treatment
• Counselling services for treatment adherence and linkages with government
• Monitoring, Documentation and Reporting
• TB in HR induction

The image below will provide a 360⁰ view of how a TB free workplace should be:

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Read this page to know about the TB Free workplace commitee

Forming a TB Free workplace committee

TB Free workplace committee (Recommendations):

1.For Large scale organizations (with more than 500 employees) - 

Members: TB Free workplace committee is an internal committee formed with the following members:

• Chairperson of the organisation – Chair of the Committee
• Key administration staffs
• Head of HR department
• Medical Officer of the organization
• Representatives from employees
• District TB Officer as the invited member (if necessary)

In case if organization is having a Health committee, TB can be actively integrated into the existing system.

2. For Small scale organizations (less than 500 employees and not having a health commitee)-  Nominate an administrative staff for being the nodal officer, and periodic reporting of TB prevention and control activities that are carried out in the organization to the administrative board of the organization. 

Functions of the TB Free committee: A TB Free committee will be functioning as the pivot point for all the TB related activities of the organization such as:

• Forming and implementing a TB Free workplace policy.
• TB Awareness and Trainings supervision:
  
  • Ensuring TB awareness through the official communications (mails, messages, posters, and other means) to reach all its employees.
  • Identifying employee representatives as master trainers to educate peers on TB
  • Allocating schedules for trainings on TB to its workforce.
  • Workplace against TB related Stigma / Discrimination campaigns. 
• TB Screening and testing supervision:
  
  • Organizing TB screening and diagnosis camps periodically and ensuring the attendance of all its employees in the camp.
• ​​​​​​​TB Treatment & Nutrition support:
• Ensure patient is undertaking prompt treatment.
• Ensuring Zero Stigma and discrimination in the organization.
• Provision of nutrition support to employee from underprivileged category
• Ensure HR support to employee diagnosed with TB by providing sick leave / paid leave during the treatment period.
• Allot flexible work hours during the recovering period. Consider provision of work from home if the circumstances allow.​​​​​​​​​​​​​​​​​​​​​​​​​​​​
• Monitoring and evaluating the TB prevention and control activities.
• Human Resource department: Integrating TB in HR induction

Promoting treatment support groups for physiological support & ensuring zero stigma and discrimination inside the organization

Page 3: Checklist for a TB Free Work Place

The implementation of a checklist will be ensuring that all the TB prevention and control activities are being carried out at the workplace. Following is a TB Free work place checklist model:

TB work place policy by the Corporate Organizations:

Workplace policies should be developed in a participatory manner with the active involvement of senior management and representatives of workers.

Key principles for developing a workplace policy:

• Recognition of TB as workplace issue
• Bipartite approach (working with management and worker’s representatives)
• Gender equality       
• Protection of the rights of workers
• Non-discrimination
• Confidentiality  
• Continuation of employment
• Prevention
• Treatment, care and support

Benefit of an ideal TB Free workplace policy:

• Commitment to corporate action
• Guarantees adherence to pertinent national laws and regulations on TB care
• States a standard of behaviour for all employees (whether infected or not);
• Provides guidance to supervisors and managers;
• Enables workers diagnosed with TB to understand the support and care they will receive, increasing the likelihood that they will adhere to the appropriate treatment.
• Helps to control the spread of TB in the workplace
• Assists the organization in planning for TB prevention and control, which ultimately results in cost savings.

Models of TB Free Workplace policies:

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 Policies and Guidelines related to TB in Workplace:

From the Government and the ILO :

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TB Free Workplace Strategies Developed by the International Labour Organization (ILO) in partnership with The Union. (2017) (Click here for link) 

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Policy framework released by Ministry of Labour & Employment, Govt. of India (2019).Refer: Policy_Framework_MoLE2019

Supporting an employee diagnosed with TB

What’s inside:

Read this Chapter to learn how an organization can support an employee diagnosed with active TB.

Expressing Solidarity with the TB diagnosed employee

The employers are advised to provide a supportive environment for the TB diagnosed employees by documenting the organisation’s approach on managing TB at the workplace.

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Ensuring a safe workplace:

• Maintain confidentiality
• No tolerance to stigma and discrimination
• Promote peer employees support activities for TB diagnosed employee
• Contact Tracing for identifying cases if any other employees are having TB

Sick leave and flexible workhours:

TB treatment always involves extended sick leave & the intensive phase of the treatment lasts around 2 months

• HR policy needs to be sensitive to the treatment period.
• Work from home for possible cases depending on the health of the employee
• Considering provision of flexible work hours

Support for continuity of Treatment:

TB treatment lasts for minimum of 6 months, and in most cases the employee can join back to work in and around 2 months. The work place shall ensure the employee is continuing the treatment till the completion of the prescribed course.

Return to work:

The organization shall have a clear return to work policy for avoiding:

• Possible anxiety of employee under treatment as well as other employees
• Prevention of hiding of TB or other air borne infection symptoms

The return to work shall be linked to the medical certification that the employee is no longer infectious.

What’s inside:

Read this page to learn how nutrition is linked to TB

TB Nutrition and workplace :

• Under nutrition is a proven risk factor for progression of latent TB into active TB.
• Especially in the context of India, where both women and men in the country are found to be suffering from high levels of moderate to severe malnutrition.
• In the patients with active TB, absence of nutritional support results in a vicious cycle of worsening disease and undernutrition, which can be detrimental and even fatal.
• Undernutrition has also been associated with malabsorption of key anti-TB drugs.

Evidence suggests that nutritional interventions are associated with:

• Better outcomes in TB patients including reduced mortality
• Improved weight gain and body composition
• Earlier stop of infectivity
• Improved effect of key drugs
• Improved functional status and adherence to therapy

Ensuring proper nitrition to the employee diagnosed with TB will be an adequate measure for supporting him / her in recovering from the disease.

Support through provision of Nutrition Kits to underprivileged TB diagnosed Employees /  Patients :

Thus, if the organization if can support the underprivileged TB patients / Employees diagnosed (and family if possible) with TB with Nutrition Kit, the chances of recovery from the disease will be high.

Composition of Nutrition Kits:

Nutrition support could cost around: Rs.1500 (Rs.2500) / patient (Family) / month.

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Supports for TB patient from the Government

The government of India, through the National TB Elimination Programme (NTEP) is providing following support for all the patients diagnosed with TB irrespective of his or her economic status:

• Free of cost Diagnostic Services
  • CB NAAT / True NAAT
  • Liquid Culture & DST (Selected samples)

• Free of cost Treatment
  • TB medications
  • Prophylaxis
• Direct Benefit Transfer (DBT) – Rs.500 / month for all TB patients during treatment period through bank accounts.

• Adherence Support – To prevent drop out during treatment period
• Public Heath Actions- Retrieval, Contact Investigation / tracing
• Support for TB Notification in NIKSHAY portal of the NTEP
• Training and Capacity building for anyone willing to volunteer.