Tuberculosis

Guidelines for
workplace control
activities
A social, labour and economic issue
TB is one of the world's leading causes of illness and death. Two million people die
each year and three-quarters of cases are among men and women between the
ages of 15 and 54, the most productive age group. TB is a problem not only for
individuals but also for families, communities, companies and countries. The
AIDS epidemic has fuelled the increase in TB, as people with weakened immune
systems due to HIV are particularly vulnerable to TB.

In high HIV prevalence settings, many workers are vulnerable to TB. Sick workers
mean the loss of skills and experience weeks or months on end, disrupted
production and reduced productivity. There are also the direct costs of treatment.
In Uganda, 80% of wage earners stop work due to TB at some point with the
average time lost from normal activities being 9.5 months. TB is also a major
contributor to ill-health and poverty in the community, affecting both family and
enterprise security. The macroeconomic impact reflects the cumulative loss of
individual and business earnings - it's estimated that productivity losses total
about US$12 billion each year.

Figure 1 - TB incidence in Africa in 2001

per 100 000 pop

< 10
10 - 24
25 - 49
50 - 99
100 - 299
300 or more

A workplace challenge No estimate

Source: WHO

TB is not only treatable, but it can be cured. And the workplace is ideally suited to
Cost effective TB
the prevention and control of TB, a "win-win" situation for both worker and
management at AngloGold
employer. While the individual receives vital information, and treatment where
(South Africa)
necessary, the employer saves costs, disruption and productivity losses.
AngloGold South Africa,
A workplace policy and programme on TB should be linked to other health issues, estimates that each case of TB
especially HIV/AIDS, and should be developed through collaboration between in its operations in the Vaal River
management and workers. The full participation of workers and their and West Vilts regions, cost
representatives helps ensure effective implementation, making it possible to $410 per case in lost shifts
sustain an acceptable level of TB control at a reasonable cost. among unskilled employees.
AngloGold runs a
comprehensive TB management
A workplace policy
programme for the workplace.
• makes an explicit commitment to corporate action;
They have found that an
• ensures consistency with appropriate national laws; effective TB detection and
• establishes the rights of those affected; management programme can
lead to net cost savings.
• gives guidance to managers, supervisors and occupational health services; AngloGold spends about US$90
• helps employees with TB to understand what support and care they will per employee per year and
receive, so they are more likely to come forward for appropriate treatment; benefits US$ 105 through the
prevention of active TB among
• helps to stop the spread of TB through prevention programmes; and HIV-positive employees.
• assists in planning for TB control and impact management.
Source: World Economic Forum
 The basic principles of workplace policy
The ILO and WHO, with the Recognition of TB as a workplace issue
help of other partners in the TB is a workplace issue because it affects the health of workers and the
world of work, have productivity of enterprises. The workplace has a role to play in broader global
collaborated to develop efforts to limit the spread and effects of TB. Workplace programmes should be
international guidelines on TB gender-sensitive, taking into account women’s greater vulnerability to TB and its
management at the impact as a result of higher levels of poverty, the burden of care, and the
workplace. These outline how increasing incidence of HIV among women.
any business, large or small,
or public sector workplace Non-d
discrimination
can make a contribution to TB No one should experience discrimination on the basis of their TB status, whether
management and control. in terms of continuing employment relationships or access to health insurance,
occupational safety, and health care schemes. Employees with TB should be
entitled to work for as long as they are medically fit and appropriate work is
available.

Confidentiality
Neither job applicants nor employees should be asked to disclose information on
the basis of their perceived TB or HIV/AIDS status. Access to personal data should

TB be bound by the rules of confidentiality and be in accordance with the ILO code of
conduct on the protection of worker’s personal data.

management Healthy work environment

at the The work environment should be healthy and safe, as far as practicable, in order to
prevent the transmission of TB. This includes the responsibility for employers to

workplace provide information and education on TB transmission, appropriate environmental

measures, and protective clothing where relevant.

Care and support

Workplaces should provide access to health services that fulfil the needs of male
and female employees with TB and related illnesses, or should refer workers to
treatment and care services in the community. The DOTS approach is preferred
(see below). Measures to accommodate and support workers with TB should be
made through flexible leave arrangements, rescheduling of working times, and
arrangements for return to work.

Social dialogue
Control and management of TB in the workplace is more effective when planned
and implemented on the basis of collaboration between managers and the
workforce. A workplace health and safety committee with broad representation
should be responsible for overseeing implementation.

Implementing DOTS The internationally recognised strategy for the management of TB is DOTS. It
(directly observed requires direct supervision and support for patients, including observation of
treatment strategy) treatment. Daily contact with workers makes the workplace an ideal setting for
implementation.

Because of the close links between TB and HIV/AIDS, work on TB is undertaken

by the ILO's global Programme on HIV/AIDS and the world of work.
Established in 2000, this Programme mobilizes the potential contribution of its
tripartite constituents - governments, employers, and workers - to combat the
spread and impact of the epidemic. It has produced a Code of Practice on HIV/AIDS
and the world of work, and accompanying education and training manual.
The ILO Programme on HIV/AIDS
and the world of work (ILO/AIDS)
International Labour Organization
4 route des Morillons
CH-1211 Geneva 22
Switzerland

tel: +41 22 799 6486

fax: +41 22 799 6349
email: [email protected]

www.ilo.org/aids

Further information
and resources
Global Partnership to Stop TB, Global Drug Facility (GDF)
for projects to fund and useful TB awareness materials
www.stoptb.org

World Health Organization

www.who.int

WHO Africa
www.whoafr.org

Global Fund to Fight AIDS, TB and Malaria

www.globalfundatm.org

Green Light Committee

for improved access to second-line anti-TB drugs
www.who.int/gtb/policyrd/PDF/DOTSGLC.pdf

World Economic Forum - Global Health Initiative

[email protected]

South African Chamber of Mines

www.bullion.org.za

South African Chamber of Business

www.sacob.co.za