DOTS at the workplace


TB affects people of all ages, but the hardest hit are those between 20 and 45 years of age. These are working men and women in the most economically productive years of their lives. Out of 3 billion people in employment worldwide, nearly 12 million are estimated to be at risk of developing active TB in their lifetime. Studies suggest that on average, an employee with TB loses 3-4 months of work, resulting in potential losses of 20-30% of annual household income, which can push the patient and the family deeper into poverty. Fifteen years of household income is lost in cases of premature death from TB

TB imposes great costs on employers as well due to disruption of work, reduced productivity, high treatment costs, and significant indirect costs (such as replacement and retraining of workers). It is estimated that globally TB is responsible for a decline in worker productivity costing about US$ 12 billion annually

The DOTS strategy is the globally recommended standard of care for TB patients and could be established at all workplaces.

DOTS at the workplace holds the promise of building a healthier and stronger workforce. With the involvement of the government national TB programmes, enlightened and committed workplace management, and dedicated staff and trusting employees, this can become a reality

Benefits of a workplace policy on DOTS

  • Makes the commitment to corporate action explicit
  • Ensures consistency with national laws
  • Sets forth a standard of behaviour for all employees (whether infected or not)
  • Provides guidance to supervisors and managers
  • Enables employees infected with TB to understand what support and care they will receive, so that they will be more likely to come forward for appropriate treatment
  • Helps stop the spread of TB
  • Assists an enterprise in planning for TB control ultimately saving money

Steps to Establish DOTS in the Workplace

  • Situational analysis: This analysis should include – the extent of the TB problem in the workplace, existing services being provided, diagnostic procedures and treatment being practiced, availability of trained health staff and the channels available to collaborate with the national programme
  • Advocacy: To convince all stakeholders – management at various levels, health staff, workers, unions and other interested parties – of the benefit of DOTS
  • Policy formulation: The policy should be based on the principle that workers have a right to work in environments that do not pose undue hazards to health and that employers have the responsibility to implement measures to decrease the occupational risk of TB. The policy should guarantee that no employee will be dismissed for having TB. It should also guarantee a healthy work environment that will prevent the transmission of TB and ensure non-discrimination, confidentiality, equal opportunities for employment, ready access to treatment, permission for time off for treatment, and job modifications, when necessary. The policy must be clearly explained and be applicable to all, regardless of age or gender. Since TB and HIV are so closely linked, the workplace TB control policy should also consider providing integrated TB/HIV services. The policy should be sensitive to the concerns of HIV-infected employees, particularly with respect to testing and confidentiality.
  • Drawing up an action plan: A feasible implementation programme should be planned in collaboration with the health services staff at the workplace and preferably also with the national TB programme staff.
  • Implementing the action plan: The following components should be in place
    • Detecting TB cases in the workplace
    • Treating all detected cases with good quality drugs (DOTS) as per country policy
    • Ensuring that all TB cases adhere to the recommended treatment schedule
    • Guaranteeing an uninterrupted supply of good quality anti-TB drugs
    • Establishing recording and reporting systems
    • Regular review and monitoring

Several countries in the Region are working towards establishing DOTS in the workplace and ensuring standard treatment for all TB patients. Business alliances, such as the Thai Business Coalition and the Business Alliance in India, are emerging as major players from among the non-health private sector for the introduction of TB services. This has resulted in gains for industry in terms of retaining skilled staff, while also helping individuals to continue pursuing their livelihoods, which benefits their families and communities

Success Stories

Bangladesh: Chittagong

Youngone Sports Shoe Industries Ltd. is the largest employer in the Chittagong Export Processing Zone in Bangladesh, with about 22 000 employees, 85% of whom are women between 18 and 30 years of age. In 1996, the Chief Medical Officer identified TB as a serious problem affecting the health of the workers. In partnership with the National TB Programme of Bangladesh, a TB control programme was designed and the WHO-recommended DOTS strategy implemented. A team of 10 doctors, 15 nurses and 40 health counselors received training in the detection and management of TB. Counselors encouraged workers who had a cough of more than three weeks’ duration and loss of appetite to come forward for TB screening. They were then referred to the local government hospital for diagnosis. A workplace laboratory for sputum collection and microscopy was also established. Health education programmes addressed the issues of fear, stigma and discrimination, in addition to other aspects of TB prevention and control. Through home visits, counselors motivated patients to continue their treatment and also referred suspected cases of TB among the patient’s family to nearby government facilities

What is unique about this initiative is the sustained commitment of management to TB control. Company policy clearly states that no employee can be dismissed from service only because of TB. Employees are allowed to return to work in two to three weeks after the initiation of therapy or when their sputum becomes negative. All TB patients are given direct observation treatment at the company’s medical centre, and there has been no case of interrupted therapy

India: Jharkhand

Hindustan Copper Ltd. (HCL) is one of the oldest copper concerns in India. It runs a hospital for its employees and ex-employees with 80 beds, a fully functional lab, an operation theatre and an X-Ray unit. Fourteen doctors including four specialists, 21 nurses and 62 paramedical staff work there. The company is also involved in community outreach programmes as part of its Corporate Social Responsibility and conducts regular health camps in the surrounding villages every month. The hospital is in a remote area and caters to a large rural population. Keeping this in mind, a microscopy centre and DOTS centre were started in the hospital in October 2007. Two doctors, four pharmacists and three lab technicians have been trained in national TB control programme at Jamshedpur. The whole programme is runs under the leadership of the Chief Medical Superintendent, who has encouraged his staff to take an active part in getting trained and following the national TB control programme norms.