Transcript Tackling Tuberculosis: Engaging the Corporate Sector Fifth PPM Subgroup Meeting Cairo, June 3, 2008

Tackling Tuberculosis: Engaging the Corporate
Sector
Fifth PPM Subgroup Meeting
Cairo, June 3, 2008
The Global Health Initiative is the health expert team
of the World Economic Forum
Our focus is on the role of business in TB, HIV/AIDS and Malaria
Our mission is to catalyze tailor made public private partnerships
Partners
Harvard School
of Public Health
World Bank
Accenture, Adidas, Aditya Birla Group, Bayer, Boston Consulting Group, BHP Billiton, BD
Medical, Chinese National Textile and Apparel Council, Eli Lilly, Eskom, Esquel Group, Exxon
Mobil, GlaxoSmithKline, Heineken, iKANG, Jubilant Organosys, Ketchum Inc, Larsen and
Toubro India, Merck and Co., Modicare, Novartis, Nike, Pfizer, Reliance Industries, Standard
Chartered Bank, Siemens India, Sun International, Tata Steel, Volkswagen South Africa and
Unilever Tea Kenya.
Board Level Participation
Memorandum of understanding
Engaging the Business Sector in TB care
Company
involvement
None
Awareness
adhoc
Awareness
systematic
Referral of
symptomatics
Awareness
Programmes
Diagnosis/
treatment
(workforce)
Diagnosis/
treatment
(workplace &
dependants)
Diagnosis/
treatment
Workforce
Dependants
Community
Treatment
Programmes
NTP Collaboration may vary
Employee Access to Health Services
Company Health Clinics/
Hospitals
Public Sector
Health facilities
Third Party Health Services
(PPs, Panel of doctors, etc)
Case Study
Bangladesh- Partnering with the Garment Industry
DIAGNOSIS
NTP
NGO
M& E
Shared
COMPANY
Corporate
MEDICAL
Health Centre
CENTRE
TREATMENT
COMPANY
CONTRIBUTIONS
Case Study
Bangladesh- Partnering with Garment Industry
Two models:
Shared Corporate Health
Centre
Dhaka EPZ hospital between
2004- 07, around 3000 TB cases
were detected with a cure rate of
92% in 2006.
Partner NGOs
NTP
(supported by
BRAC
Damien Foundation
PSKP
Leeds University)
25 PPPs
BGMEA
Company DOTS Centres
The Youngone DOTS centre in
2001 detected 668 TB cases; cure
rate of 93% achieved in 2006.
Bangladesh
Garment
Manufacturers and
Exporters
Association
Case Study
Philippines Workplace Model
DIAGNOSIS
NTP
M& E
PPMD Unit
Company
clinic
TREATMENT
DOT
Case Study
Philippines Workplace Model
Company A
• Major multinational computer chip
manufacturing
company
(3400
employees)
• Referred 400 employees for sputum
testing to a private PPMD unit in 2007
• 17 were diagnosed with TB (based on
annual physical examination X-ray
results.
DIAGNOSIS
NTP
M& E
PPMD Unit
Company
clinic
TREATMENT
DOT
Case Study
Philippines: Workplace
Model
DIAGNOSIS
NTP
M& E
Company B (Stanfilco)
• Program extends to employee dependents
and the community
• Educated over 3,000 employees, their
families and surrounding community since
2004
• Facilitated the diagnosis and treatment of
100 employees out of 400 referred
• Provided
infrastructure
support
to
establish a DOTS facility
PPMD Unit
Company
clinic
TREATMENT
DOT
Case Study
Philippines: Unorganised Workforce Model
DIAGNOSIS
NTP
Form people
associations
PPMD Unit
Walk in
M& E
TREATMENT
Local
government
support
Case Study
Philippines
PPMD Units: Industrial DOTS Centres
• Advcocacy
• Diagnosis
Our Savior Industrial Clinic
• Caters to patients from 35 companies
surrounding export processing zone (EPZ) area
• In 2006, 187 employees referred to the clinic
• All diagnosed and managed by the clinic
• Treatment success rate of 86%
in
• Treatment
The Makati Medical Center
• In 2006, received about 1300 for TB diagnosis- 153
referrals from the organized workforce (formal
companies); 324 referrals from the unorganized
workforce
• 141 diagnosed with TB- 74 TB cases from the
organized workforce, 67 from the unorganized
sector.
Case Study
Philippines: Philam ModelOrganised Sector
PhilAm Care currently covers
160,000 employees across the
country.
In 2007, 30 persons referred for TB
diagnosis- 10 diagnosed with TB.
DIAGNOSIS
PhilAm clinic
NTP
(HMO)
M& E
TREATMENT
HMO: Health Management Organisation
Company
clinic
Case Study
Philippines: Philam Model- Unorganised Workforce
DIAGNOSIS
Form people
associations
PhilAm clinic
NTP
(HMO)
Walk in
M& E
TREATMENT
HMO: Health Management Organisation
Key elements of a successful workplace programme
Management support and employee buy-in
NTP Leadership
Company
collaboration
Detect TB
cases
Provide
treatment
Advocacy
Training
Uninterrupted TB drug supply
Report cases and track
outcomes
Potential Roles of Corporate Sector
Supply
Chain
•Develop and implement workplace DOTS
programme
Workplace
(workers)
•Extend reach to dependants, community
and supply chain (vendors, distributors)
Community
•
•
•
•
•
•
Spread awareness and counter stigma
Identify TB suspects and refer them for diagnosis
Help TB patients to complete their treatment
Large-scale employers may set up a workplace DOTS programme
Implement infection control mechanisms
Integrate with HIV (including awareness, diagnosis, treatment, care and
effective cross referrals)
Potential mechanisms to engage the corporate
sector
NTP works directly with companies (signing of MoUs):
• Advocacy (one to one meetings, tools, etc)
• Training
• Diagnostic reagents, microscopes
• Anti TB drugs
• Supervisory support
NTP may work through business associations, NGOs and civil
society
• Global Health Initiative
• Global Business Coalition
• Regional Chamber of Commerce, Business Associations
(Bangladesh, Brazil)
Global Health Initiative: India Business Alliance
Supporting NGO Network
Indian Government
and technical partners
• Gives free technical support
and training
• Provides free diagnostic
consumables, TB therapy and ART
• Supportive supervision and
external quality assessment
Partner
Companies
•Run workplace and community
TB and or HIV programmes
•Adopt anti- discriminatory policy
and activities
•Provide in kind support
•Engaged in R &D
36 Indian companies today reach
several million people with
new TB programmes,
few have expanded to
TB/HIV Coinfections
Challenges to Corporate PPM:
Within the NTPs and policy makers
• Hesitation to engage the business sector
• Lack of policies and practical guidelines to address specific traits and
needs
• Limited capacity (staff time, motivation)- to initiate PPM/sustaining
quality while expanding a challenge
Within the business sector
•
•
•
•
Lack of information on TB and potential engagement
Little documented evidence on potential modes of involvement
Uptake and sustaining of companies’ interest in collaboration
Limited capacity for public health functions: poor patient retrieval,
limited referral links
• Supervision by NTP/ NACP staff not always well received
Business Engagement is a Win Win Situation
For the NTP
– Reaching the ‘unreached’; meeting targets
– Pooling of resources: existing health infrastructures, systems and
human resource, management skills
– Standardisation of quality TB care
– Shorter diagnostic delays
For the company
Through prompt diagnosis and effective treatment and by reducing
transmission to other workers
– Save costs by reducing absenteeism, staff turnover and re-training
– Opportunity for businesses to concretely demonstrate their social
commitment
– Goodwill and reputation (indirect marketing)
Business Engagement is a Win Win Situation
For the worker
–
–
–
–
Improved compliance
No loss of wages
Saves cost of treatment
Minimizes the stigma of TB among employers/ employees
For communities
TB management cures people and returns them to an active,
productive life, which in turn benefits their children and other
dependants.
Ongoing and future activities
• Self assessment tool: Dissemination of tool and analysis of results
• Mapping Exercise of ACSM WG: identify best practices and get
insights into existing approaches
• Documentation: Success stories to build evidence base
• Adaptation of existing tools
• TB Toolkit: Indian and South Africa versions available; China in the
pipeline
• Collaborative Group on TB/HIV: ILO, Stop TB, UNAIDS, WHO, World
Economic Forum and business representatives
• Business Coalitions: mapping by GHI, build TB strategies into
Business Coalition mandates
• Continue to use advocacy platforms provided by Global Health
Initiative, Global Business Coalition and others
Working with Business Coalitions on HIV/AIDS
Source: Business Coalition Report 2007, World Economic Forum
Thank You
For more information contact
Monica Yesudian: [email protected]
Shaloo Puri Kamble: [email protected]
Proposed strategies
• Establishing interfaces, common forums with an inclusive
approach to resolve issues, build mutual trust, share
information and improve service delivery
• Well defined transparent mechanisms for dissemination of
experiences
• Strong leadership, flexible support by national
programmes
• Systematic approach, learning from pilots, revision of
strategies, repackaging communication and advocacy
messaging
• Sustained efforts to train and orient different providersadapting to needs, perceptions; pre-service training
• Prioritization: which partners to involve and when, to
maximally and rapidly benefit from partnerships
Who is involved?
Anglogold Ashanti: found incidence rate of 3.1% among its
workforce in 2006, with over 85% of those infected with TB also
HIV-positive; also addressing MDR TB. Based on transmission
control, Effective disease management, research, monitoring
and evaluation and information, education and communication
Gold Fields: >30 yrs of awareness, diagnosis and treatment;
encourage TB patients to test voluntarily for HIV and, if positive,
option of enrolling in the company wellness programme; Anti
discriminatory policy; encourage contractors; reported cure rate
85%.
Heineken: Test TB patients for HIV and vice versa, DOTS is
provided and closely monitored by company clinics, with private
health providers used at some sites
Corporate Response: Context
• .
For the company, TB management can
• save costs by reducing absenteeism, staff turnover and re-training costs
– through prompt diagnosis and effective treatment
– and by reducing transmission to other workers
• provides an opportunity for businesses to demonstrate their social
commitment
Corporate Response: Opportunities
Growing concern
Nearly one-third of over 11,000 respondents from over 130
companies to the Forum’s Executive Opinion Survey (2007) expect
the disease to affect their business in the next five years
One out of 10 expects the effects to be serious.
Firms in sub-Saharan Africa, Asia, and Eastern Europe are
most concerned.
Companies in countries hard hit by AIDS are particularly
worried about TB
TB management cures people and returns them to an active, productive life,
which in turn benefits their children and other dependants.
Case Study
Philippines- Engaging Businesses in National TB
Response
Three models:
Company Health Clinics
Referrals, DOTS provision
Phillipppines
Coalition
Against TB
(PhilCAT)
National TB
programme
(NTP)
PPPs
Industrial DOTS Centres
Public or private public-private
mix for DOTS (PPMD) units
Industry
Health Maintenance
Organisations
Third Party- PhilAm Care/
Private Hospitals
Case Study
Philippines
Company Health clinic
• Referal to local
PPMD unit for
diagnosis
• Provision of
DOTS at
workplace
Company A
• Major multinational computer chip manufacturing
company (3400 employees)
• Referred 400 employees for sputum testing to a
private PPMD unit in 2007,
• 17 were diagnosed with TB (based on annual physical
examination X-ray results.
Company B (Stanfilco)
• "TB DOTS in the workplace" program extends to
employee dependents and the community.
• Educated over 3,000 employees, their families and
surrounding community since 2004
• Facilitated the diagnosis and treatment of 100
employees out of 400 referred
• Provided infrastructure support to establish a DOTS
facility
Case Study
Philippines
Health Maintenance Organisations (HMOs)