GTZ-SPAA
Private Sector Involvement in
National TB Control
Examples in Ghana, Malawi and Namibia
By
Dr Valentine Douala- MoutengChief Executive Officer, PABC
INTRODUCTION• In 2008, 9.4 million newly infected with TB. Asia (55%)
and Africa (30%). • The situation worsened due to the dual infection with
HIV and TB and of multi and extremely-drug resistant tuberculosis (MDR-TB) and (XDR-TB).
• The direct and indirect costs of tuberculosis and the social consequences are often catastrophic for the individual, the family and the wider community.
• Tuberculosis affects the business of companies• Private sector have introduced TB workplace
programmes . But are they geared to contribute towards eradication of the disease?
THE STUDY • Study performed by SPAA project and the PABC, to provide
information about:• the transmissibility of TB and the implication for the
workplace• Existing TB control activities at the workplace• The existence of legislation for infection control relevant
for workplaces METHODOLOGY• A review of literature and publications (not complete)• Interview with key informants: National Business Coalitions
(NBCs) , National TB program, companies, ILO, GTZ representatives.
LIMITATIONS: only 3 countries; few informants,
Workplaces: environment with high level of disease transmission
Infectiousness starts before onset of symptoms (up to 3 months)
Treatment delay increases transmission to close contact in households and workplaces.
A long delay is common in African countriesStudies report high numbers of transmission in workplace
settings (34% – 39% infection rates of contacts)Poorly ventilated areas, share car rides to and from work
and joint lunches identified as factors contributing to transmission .
PLWHA are very vulnerable to TB transmission
The economic impact of TB is huge75% of people infected are between 15 and 54 years of age.Estimation: TB reduces workers’ productivity by as much as
US$ 13 billion annually. A large gold mining industry in S. A. estimated that each case
of TB among its unskilled employees cost US$ 410 in lost shiftThe disease causes severe losses through absenteeism,
reduced productivity, need for replacement of lost workers. On average, an employee with active TB will lose up to nine
months of work. With treatment infected employees take up work again after
two to four weeks.
TB legislation•Protect uninfected persons against TB infection
•Detect cases of infectious TB as early as possible and to initiate treatment
•Notify and report TB cases•Perform screening in close contacts of the index case
•Ensure that persons with TB receive adequate treatment•Provide prophylactic treatment to certain groups of people
•Protect TB-infected persons from stigma and discrimination
In the workplace• Education
programme• Screening, for TB and
referral for diagnosis and treatment
• Prevention of discrimination and stigmatization
• measure such as improving the ventilation
´Namibia Ghana Malawi
Protection of the general population yes no no
Intensive active case detection yes no no
Early and /adequate treatment
yes/yes no/yes No/yes
Notification of TB cases
yes yes yes
Contact tracing
yes no no
Prophylactic TB treatment
yes yes yes
National Business Coalitions involvement
National Business Coalitions involvement iNAMIBIA MALAWI GHANA COMMENTS
Number of members
60 and 12 have TB programme
90 number of TB programme not given
38 , TB programme in mining sector
NBCs awareness Few companies regard TB as an important problem. Measures for active case finding Contact tracingCollaboration with NTB to be improved
Provision of training
Yes, peer educators and focal person
Peer, health care staff of the companies
no
Provision of information material
Yes Provision of CPT (prevention therapies)
no
Partnerships and networking
Agreement with UNIONS, Royal Netherlands TB , NGO, NTLP
NTP and NACP, health facility, public sector, church
NTP advocate at NBC meetings. ILO programme
Advocacy, Advisory services
Management of companies. Linking with services providers
Visit to companies, Cocktails to sensitized the management
There are demand from the companies
NAMIBIA MALAWI GHANA
ETALE FISHING COMPANY
ILLOVO SUGAR COMPANY
The ADM Cocoa (Ghana) Ltd.
The company runs an in-house clinic where an average 20 TB patients per year are treated . Workers suspected to be TB infected are sent to the public health facility for testing. Treatment is provided in the company owned clinic with drugs of the public sector,.
5000 employers
All identified HIV positive workers are screened for TB and treated, if found infected. Contact tracing in the families is done.
Infected employees are allowed to collect their drugs and go for investigations during their working time. Salary payment continues.
The company implements a comprehensive health programme, which includes HIV/TB, malaria, hypertension and diabetes.
If a person has symptoms suspect for TB he/she is referred to a public health facility for TB screening and an x-ray of the lung. And treatment
TB treatment is provided free of charge in Ghana.
The company is a member of the NBC
EXAMPLES OF GOOD PRACTICES
CONCLUSION/RECOMMANDATIONS
• Increase awareness on the importance of combined TB and HIV control among national business coalitions, the private sector and public partners
• Increase the support for NBCs to respond to the demand of the companies and the need to mobilize more companies to implement TB programmes as NBCs play a critical role.
• Perform contact tracing systematically at company level• Expand collaboration between NBCs and the NTBP
(including re- assessment of the policy)• Realise research on the financial impact of TB on
companies in different economic sectors
THANK YOU FOR YOUR ATTENTION
MERCI