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GTZ-SPAA
Private Sector Involvement in
National TB Control
Examples in Ghana, Malawi and Namibia
By
Dr Valentine Douala- Mouteng
Chief 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 countries
 Studies 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 huge
 75% 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 shift
 The 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
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
yes/yes
no/yes
No/yes
Notification
of TB cases
yes
yes
yes
Contact
tracing
yes
no
no
Prophylactic
TB treatment
yes
yes
yes
Early and
/adequate
treatment
National Business Coalitions involvement
NAMIBIA
MALAWI
GHANA
COMMENTS
HIV prévalence
rate
13.3% in 2008
12.9% in 2007
2.2% in 2007
TB prevalence
rate
767 per 100 000 346 per 100 000
203 per 100
population per population per year 000 per year
year.
TB detection
rate
87%
MDR TB
3.8% and
2.3% among all new 0.17%
16.5% among
TB cases, and 7.5%
treated patients treated patients
Reduction
of
awareness
in countries
with lower
HIV
prevalence
rate, lower
TB
prevalence
rate
49%
26%
Co infection 71%
47%
22%
Rate of
reduction
6,1%
0,5%
2,6%
National Business Coalitions involvement i
NAMIBIA
MALAWI
GHANA
COMMENTS
Number of
members
60 and 12 have
TB programme
Provision of
training
Yes, peer
educators and
focal person
Yes
90 number of TB
programme not
given
Peer, health care
staff of the
companies
Provision of CPT
(prevention
therapies)
NTP and NACP,
health facility, public
sector, church
38 , TB
programme in
mining sector
no
NTP advocate
at NBC
meetings. ILO
programme
NBCs
awareness
Few
companies
regard TB as
an important
problem.
Measures for
active case
finding
Contact
tracing
Collaboration
with NTB to
be improved
Visit to companies,
Cocktails to
sensitized the
There are
demand
Provision of
information
material
Partnerships
and networking
Agreement with
UNIONS, Royal
Netherlands TB ,
NGO, NTLP
Advocacy,
Advisory
Management of
companies.
no
EXAMPLES OF GOOD PRACTICES
NAMIBIA
MALAWI
GHANA
ETALE FISHING
COMPANY
ILLOVO SUGAR
COMPANY
The ADM Cocoa (Ghana) Ltd.
The company runs an inhouse 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
The company implements a
comprehensive health programme,
which includes HIV/TB, malaria,
hypertension and diabetes.
All identified HIV
positive workers are
screened for TB and
treated, if found
If a person has symptoms suspect for
infected. Contact tracing TB he/she is referred to a public health
in the families is done.
facility for TB screening and an x-ray of
the lung. And treatment
Infected employees are
allowed to collect their
TB treatment is provided free of
drugs and go for
charge in Ghana.
investigations during
their working time.
The company is a member of the NBC
Salary payment
continues.
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