Acronyms

AIC                       Air-borne Infection Control
AIOE        All India Organization of Employers
ASSOCHAM     Associated Chamber of Commerce and Industry of India
CII            Confederation of Indian Industry 
CSR         Corporate Social Responsibility 
CTD         Central Tuberculosis Division 
CTP        Corporate TB Pledge 
DR-TB         Drug Resistant Tuberculosis 
DS-TB         Drug Sensitive Tuberculosis 
DTC         District Tuberculosis Centre 
DTO         District Tuberculosis Officer 
DTC         District Tuberculosis Cell 
ELM         Employer Led Model 
EFI        Employers’ Federation of India 
FICCI         Federation of Indian Chambers of Commerce and Industry of India
HIV        Human Immunodeficiency Virus   
IEC         Information, Education and Communication 
ILO        International Labour Organization
LTBI        Latent Tuberculosis Infection 
MDR-TB         Multi Drug Resistant Tuberculosis
MOLE        Ministry of Labour & Employment
MoU        Memorandum of Understanding 
MoH&FW        Ministry of Health & Family Welfare  
NCEUS        National Commission for Enterprises in the Unorganized Sector
NGO        Non-Government Organization 
NTEP         National Tuberculosis Elimination Programme
PHI         Peripheral Health Institute
PSU        Public Sector Undertakings 
PSE        Public Sector Enterprises
SCOPE        Standing Committee of public sector Enterprises 
SDG        Sustainable Development Goal 
STC         State Tuberculosis Cell  
STO        State Tuberculosis Officer 
TPT        Tuberculosis Preventive Treatment 
TB            Tuberculosis 
The Union     International Union Against Tuberculosis and Lung Disease
USAID         U.S. Agency for International Development
WHO         World Health Organization

7.1 Draft Workplace Policy for ending TB
ABC ORGANIZATION

 

 

 

 

Policy Number    
Authorization    
Next Review Date    
Responsible Officer    
Policy Owner    
Total Pages    

INTRODUCTION
In 2022, an estimated 10.6 million people fell ill with TB globally. India carries an estimated 27% of the global TB incidence with an estimated 28.2 lakh people contracting the disease and approximately 3.4 people succumbing to the disease every year. TB is known to cause a decline in workers’ productivity on the order of $13 billion every year.  
It has become essential to create a work environment where TB is addressed and provision of TB services for the workers is made available. A healthy workforce results in higher productivity, making supportive workplace policies mutually beneficial for the industry and its employees. Institutional policies for TB can play a pivotal role in spreading awareness, creating a culture of support and inclusion and helping in the prevention and spread of TB. Every organization assume an accountability to adopt and implement a policy to end TB in their workplace. The following points outline the main pillars that set the standard for TB care at the workplace.

ORGANISATION’S POLICY
•    Organization shall foster a culture of care towards workers who are afflicted with Tuberculosis.
•    Continuous efforts will be made to make workers aware of Tuberculosis. 
•    Pre-employment and periodic screening for Tuberculosis will be done for all workers 
•    Air-borne Infection Control measures will be promoted to prevent transmission of Tuberculosis among the workers.
•    The organization will not discriminate against workers based on known or presumed status of Tuberculosis.
•    The management will respect the right of confidentiality about the health status of workers with respect to Tuberculosis.
•    Counselling services will be ensured for workers and their family members seeking help on issues related to Tuberculosis.
•    Support for adherence and completing treatment will be provided to all workers affected with TB.
•    Employment protection and leave benefits for persons affected with TB will be provided to the best possible extent.
•    Information of all workers diagnosed with TB will be updated in Ni-kshay.
Date    :                        
Approved by :

 

 

 

 

 

 

 

 

 

 

 

 

7.2 Draft Terms of Reference for TB Free Workplace Committee

TB Free Workplace Committee
ABC Organization

Introduction of the ABC Organization
The economic burden of TB in terms of loss of lives, income and workdays is substantial. A large section of the population affected by TB also belong to the economically productive age group that results in a significant loss of working days, pushing people with TB further into the vortex of poverty due to catastrophic costs. Therefore, it is essential to create a work environment where TB is addressed and provision of TB services for the workers is made available. Every organization assume an accountability to adopt and implement a policy to end TB in their workplace. Ongoing efforts are required to engage different departments and individuals for diversified representation. A workplace committee is formed to ensure proper planning, implementation, and monitoring of ending TB interventions in the workplace.
I. The Purpose of TB Free Workplace Committee
The TB Free workplace committee will help the management in planning and implementation of TB and workplace activities. The Committee will ensure equitable and gender sensitive approach to the implementation of TB prevention, treatment and care activities in the workplace.

II. Roles & Responsibilities of the Committee
TB Free Workplace Committee would
1.    Initiate and strengthen organization’s response to TB in the workplace.
2.    Draft organization’s workplace policy/guidelines on ending TB.
3.    Develop annual action plan and mobilize support including required resources for implementation
4.    Organize TB awareness activities at/around the workplace premises 
5.    Address negative attitudes towards people with TB and increase awareness among the workers regarding TB 
6.    Ensure availability and display of relevant IEC materials at strategic locations across the workplace premises. 
7.    Ensure every health facility associated with ABC Organization has a Ni-kshay ID and every TB case detected in the organization to be enrolled in Ni-kshay Portal.
8.    Facilitate linkage with the government’s social protection schemes so that the workers, particularly the contractual workers may avail the benefits.
9.    Conduct periodic TB screening and ensure all workers with presumed TB are tested/evaluated.
10.    Develop linkages with public or private diagnostic centres for referral of workers with presumed TB.
11.    Ensure that list of local testing and treatment services for TB in Government and private sector is made available to all workers and their families. 
12.    Develop a mechanism to monitor the implementation of the policy/guidelines and activities for ending TB.
13.    Document and disseminate good practices and learnings.
14.    Publish a one-page annual report regarding the TB status and efforts to end TB in the workplace. 
III. Proposed Composition of TB Free Workplace Committee
The Committee would have representative from senior management as chair.  Other members include representatives from Human Resource Department, Medical Unit, CSR wing, Welfare Department and representatives of workers. A person cured from TB/TB Champion may also be included in the committee. Additionally, committee’s gender balance may be maintained.
IV. Frequency of meetings
The committee may meet once in a quarter. 
The minutes of the meetings need to be maintained.

_____________                            Date:    ___________ Chair, TB Workplace Committee
ABC Organization

 

7.3 Checklist for implementing TB Free Workplace Interventions

Suggested activity and monitoring framework for workplace response to becoming a ‘TB Free Workplace’:

S. No    
INDICATORS    
MEANS OF VERIFICATION
1.    For smaller workplaces (Up to 100 workers): 
a nodal person from the organization is nominated to oversee planning and implementation of workplace intervention on TB.

For larger workplaces (More than 100 workers): 
TB free workplace committee is established with clear terms of reference     Letter of management/Written document on constitution of committee and/or a nodal person
2    Policy/guidelines on workplace interventions for TB     Written policy/guidelines document 
3    IEC materials are available and displayed    Information, Education, Communication (IEC) materials regarding TB, its prevention, treatment and NTEP facilities for TB, are displayed at strategic locations in the workplace
4    Periodic awareness generation activities on TB is organized with all the workers     Documentation of awareness generation activities (Class/ Seminar/ emails/ social media groups/virtual platform/videos etc.)
5    TB screening may be done at least twice a year for all workers. In case of occupations like mining, textile, glass, TB screening may be done once in every quarter    Documentation of screening process revealing more than 90% of workers screened in the last 6 months
6    Ensure all workers with presumed TB are completely tested/evaluated     Case based documentation of presumed TB with results of test/evaluation (More than 95% of people with presumed TB are tested/evaluated in the last 6 months)
7    Ensuring all workers diagnosed with TB are reported to NTEP and initiated on treatment    Verify in Ni-kshay
8    Welfare mechanism for all workers affected with TB may be introduced (like leave benefits, travel support, nutrition supplements etc.)     Documentation of support provided to workers with TB/ Interviewing workers with TB
9    Airborne Infection Control systems are in place    AIC assessment report and compliance report. 
7.4 Role of ‘NTEP’ at state and district level in implementing workplace intervention 
State and District TB Cells play a crucial role in engaging workplaces to establish a TB free workplace setting. Their role includes:
•    Garnering political and administrative support for collaborating with different workplaces to initiate workplace intervention for TB. 
•    Mapping of key industries and leading business association/s in the state and district.
•    Developing state specific guidelines to influence different workplaces to adopt interventions for establishing a TB Free Workplace.
•    Providing technical support to engage workplaces in the TB space
•    Supporting capacity building of management, workplace committee, peer educators, and health staff of workplace.
•    Ensuring pprovisions for TB evaluation/testing, treatment initiation, and public health actions for the workers in collaboration with the workplace committee.
•    Developing IEC materials and organize awareness generation activities on TB in the workplaces.
•    Documenting and disseminating best practices on workplace interventions for TB. 
7.5 Guidelines and Resources for Workplace TB Intervention

Several guidelines and training modules developed by Central TB Division and partners organization are extremely useful for reference.

•    Guidance Document on Partnership
(https://tbcindia.gov.in/WriteReadData/l892s/9531588006Guidance%20Doucum…)

•    Policy Framework to address Tuberculosis, TB related co-morbidities and HIV in the World of Work in lndia
(https://labour.gov.in/sites/default/files/framework.pdf)

•    Employer Led Model for Tuberculosis Prevention and Care (https://tbcindia.gov.in/WriteReadData/Reach%20ELM%20Operational%20Manua…)

•    Statement of Commitment of India Employer Organization on addressing TB and HIV in the World of Work
(https://www.ilo.org/wcmsp5/groups/public/---asia/---ro-bangkok/---sro-n…)

•    National Framework for a Gender Responsive Approach to TB in India 
(https://tbcindia.gov.in/showfile.php?lid=3496)

•    Standards for TB Care in India 
(https://tbcindia.gov.in/showfile.php?lid=3061)

•    Training Curriculum for Peer Educators 
Course for Health Volunteers and Treatment Supporters in NTEP | Knowledge Base

7.6 Air-borne Infection Control Check-list

SL No    Workplace checklist for Airborne infection control    Yes    No    Remark
    Administrative            
1    Workers are encouraged to self-screen for cough before entering the workplace.            
2    Signage for cough etiquette are present and adequately displayed across the workplace.            
3    Workers with cough are provided with masks and educated on its correct use & disposal.            
4    Workers affected with TB are reassigned to a more convenient workspace on request.                 
5    Airborne Infection control assessment is conducted at least annually            
6    Facility design and workers seating has been assessed for the best use of space and ventilation            
    Environmental            
7    Hand washing facility with running water and soap accessible to all workers.            
8    Workplace areas have good cross-ventilation in all areas and total areas of windows and doors >20% of floor area in each floor.            
9    Wherever cross-ventilation is not possible, mechanical ventilation (for e.g. exhaust fans) is properly used to ensure minimum six air change per hour            
10    Signages in place to keep doors and windows open when feasible.            
11    Regular cleaning and maintenance of directional and extractor fans is conducted.            
12    Servicing documentation of Air conditioners is maintained and is available for review.            

8.    References

•    India TB Report 2023, CTD, MoH&FW, Govt. of India 
(https://tbcindia.gov.in/WriteReadData/l892s/5646719104TB%20AR-2023_23-%…)

•    Global tuberculosis report 2023 (https://www.who.int/publications/i/item/9789240083851)

•    Guidance Document on Partnership 2019, CTD, MOH&FW
(https://tbcindia.gov.in/WriteReadData/l892s/9531588006Guidance%20Doucum…)

•    Policy Framework to address Tuberculosis, TB related co-morbidities and HIV in the World of Work in lndia, MoLE, Govt. of India.
(https://labour.gov.in/sites/default/files/framework.pdf)

•    National Multi sectoral action framework for TB Free India. (https://tbcindia.gov.in/WriteReadData/l892s/57479351National%20Multisec…)

•    Employer Led Model for Tuberculosis Prevention and Care, CTD, MoH&FW
(https://tbcindia.gov.in/WriteReadData/Reach%20ELM%20Operational%20Manua…)

•    Operational Guidelines for Employer Led Model, Department of AIDS Control 
(http://naco.gov.in/sites/default/files/Operationa_Guidelines_ELM.PDF)

•    Corporate TB pledge: https://www.corporatetbpledge.org/
 

An estimated 10.6 million people fell ill with Tuberculosis (TB) globally in 2022 . India carries an estimated 27% of the global TB incidence with an estimated 28.2 lakh people contacting the disease and approximately 3.4 lakh people succumbing to the disease every year. The economic burden of TB in terms of loss of lives, income and workdays is also substantial. TB usually affects the most economically productive age group of society resulting in a significant loss of working days and pushing people with TB further into the vortex of poverty due to catastrophic costs.
India has more than 500 million workers, majority of whom work in unorganized sector with no or limited access to healthcare and social security. A worker with TB might lose an average of 3–4 months of work and income, resulting in potential losses of 20-30% of their annual household income. The economic burden caused by TB in India has been estimated to be over 13000 crores INR every year.2,3 
 
TB epidemic leads to substantial economic repercussions for both individuals and organizations due to lost productivity, worker absenteeism and employee turnover. The world of work can play a critical role in ending TB in India. Employer need to assume an accountability to adopt and implement a TB Free Workplace intervention. A healthy workforce results in higher productivity making supportive workplace policies mutually beneficial for the industry and its employees.
Government of India has developed and released a ‘Policy Framework to address Tuberculosis, TB related co-morbidities and HIV in the World of Work in India’ in 2019. The overall goal of this policy framework is to provide an operational framework to all stakeholders in the world of work towards the goal of ending TB by 2025.

Air-borne Infection Control (AIC): Air-borne Infection Control (AIC) measures are a set of practices that minimizes the spread of airborne transmission of infections. These precautions are generic for all airborne infections but they also contribute to reduce the spread of TB.

Corporate TB Pledge: The Corporate TB Pledge (CTP) is a joint initiative of Ministry of Health and Family Welfare, Government of India and US Agency for International Development (USAID) with an objective of galvanizing corporates to jointly work towards a shared vision of eliminating TB from the country.

Formal Sector: The formal sector, also known as the organized sector, consists of non-agricultural establishments in the private sector that has 10 workers or more and all establishments, irrespective of size, in the public sector (NCEUS, 2009).

Industry: An industry is a branch of an economy concerned with the processing of raw materials & manufacturing of goods in factories. For e.g., textile industry, mining industry etc.

Informal Sector: The informal sector, also known as the unorganized sector, consists of all unincorporated private enterprises owned by individuals or households engaged in the sale and production of goods and services, operated on a proprietary or partnership basis, and with less than a total of 10 workers (NCEUS, 2009).

Organization: An organization is an entity such as a company, an institution, or an association comprising  of one or more people and having a particular purpose. There are a variety of legal types of organizations, including corporations, governmental and non-governmental organizations, political organizations, international organizations, armed forces, charities, not-for-profit corporations, partnerships, cooperatives, and educational institutions, etc. The organization may have either/both permanent and contractual workers.

Peripheral Health Institute: A Peripheral Health Institute (PHI) is a health facility under the National TB Elimination Program (NTEP), manned by at least a Medical Officer (MO), where diagnosis and management of TB are done. It can be a public or private health facility.

Private Sector: The private sector or enterprise refers to the businesses that are owned by a private group or an individual. 

Public Sector Undertakings (PSUs): Public Sector Undertaking (PSU) means any corporation established by or under any Central, State or Provincial Act, which is owned, controlled or managed by the Government.

Stigma: A set of negative and often unfair beliefs that a society or group of people have about something. Stigma is considered to be a social mark, which when associated with a person, usually causes marginalization or presents an obstacle to the full enjoyment of social life by the person.

Workplace Policy for Ending TB:  Workplace Policy for ending TB refers to the document published by State Government/ institution/ enterprises in sync with national policy document ‘Policy Framework to address Tuberculosis, TB related co-morbidities and HIV in the World of Work in lndia’.

TB Free Workplace: A TB Free Workplace is defined as a workplace where systems are in place to protect the workforce from TB and sufferings due to TB and it includes provisions for-
-    Generating awareness about TB among all workers
-    Early & complete diagnosis of TB among the workers 
-    Supporting correct & complete treatment for all workers affected with TB
-    Linkage of workers affected with TB to social welfare schemes and other public health actions
-    Preventing transmission of TB in the workplace
-    Ensuring a stigma free environment for all workers affected with TB

TPT: Tuberculosis Preventive Treatment (TPT) consists of a course of one or more anti-tuberculosis medicines given with the intention of preventing the development of TB disease. TPT is given to people who are infected with TB bacteria or have been exposed to it and are at a higher risk of developing TB disease.

Worker: Worker refers to any person working under any form or arrangement. An employee, a contractual worker etc. can all be referred as workers.

Workplace: Workplace refers to any place in which workers perform their activity.