Fifth PPM Subgroup MeetingCairo, June 3, 2008

Tackling Tuberculosis: Engaging the Corporate Sector

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

World Bank

Harvard School of Public Health

Board Level Participation Memorandum of understanding

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.

Company involvement

Treatment Programmes

AwarenessProgrammes

None

Aware-ness

adhoc

Awareness systematic

Referral of sympto-matics

Diagnosis/ treatment

(workforce)

Diagnosis/ treatment (workplace & dependants)

Diagnosis/treatment Workforce

DependantsCommunity

Engaging the Business Sector in TB care

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)

Bangladesh- Partnering with the Garment Industry

Shared Corporate

Health CentreCOMPANY

CONTRIBUTIONSNGONTP

DIAGNOSIS

TREATMENTM & E

COMPANY MEDICAL CENTRE

Ca

se S

tud

y

Ca

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tud

y

Bangladesh- Partnering with Garment Industry

Two models:

NTP(supported by

Leeds University)

Partner NGOsBRACDamien FoundationPSKP

25 PPPs

BGMEABangladesh Garment Manufacturers and Exporters Association

Company DOTS Centres

The Youngone DOTS centre in 2001 detected 668 TB cases; cure rate of

93% achieved in 2006.

Shared Corporate Health Centre

Dhaka EPZ hospital between 2004- 07, around 3000 TB cases were detected with a cure rate of 92% in 2006.

Philippines Workplace Model

PPMD UnitNTP

DIAGNOSIS

TREATMENTM & E DOT

Company clinic

Ca

se S

tud

y

Philippines Workplace Model

PPMD UnitNTP

DIAGNOSIS

TREATMENTM & E DOT

Company clinic

Ca

se S

tud

yCompany 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.

Philippines: Workplace Model

PPMD UnitNTP

DIAGNOSIS

TREATMENTM & E DOT

Company clinic

Ca

se S

tud

yCompany 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

Philippines: Unorganised Workforce Model

NTP

DIAGNOSIS

TREATMENTM & E

Local government

support

Walk in

PPMD Unit

Form people associations

Ca

se S

tud

y

Philippines

Ca

se S

tud

y

• Advcocacy

• Diagnosis

• Treatment

PPMD Units: Industrial DOTS Centres

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.

Our Savior Industrial Clinic • Caters to patients from 35 companies in

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%

Philippines: Philam Model- Organised Sector

PhilAm clinic

(HMO)

NTP

DIAGNOSIS

TREATMENTM & E

Company clinic

Ca

se S

tud

y

HMO: Health Management Organisation

PhilAm Care currently covers 160,000 employees across the country.

In 2007, 30 persons referred for TB diagnosis- 10 diagnosed with TB.

Philippines: Philam Model- Unorganised Workforce

PhilAm clinic

(HMO)

NTP

DIAGNOSIS

TREATMENTM & EWalk in

Ca

se S

tud

y

HMO: Health Management Organisation

Form people associations

Key elements of a successful workplace programme

Management support and employee buy-in

Uninterrupted TB drug supply

Detect TB

cases

Provide

treatment

Report cases and track

outcomes

NTP Leadership

Advocacy

Company collaboration

Training

Potential Roles of Corporate Sector

Supply Chain

Community

Workplace(workers)

•Develop and implement workplace DOTS programme

•Extend reach to dependants, community and supply chain (vendors, distributors)

• 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

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

Supporting NGO Network

36 Indian companies today reach several million people with

new TB programmes, few have expanded to TB/HIV Coinfections

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

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

• 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

Within the business sector

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.

• 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

Ongoing and future activities

Working with Business Coalitions on HIV/AIDS

Source: Business Coalition Report 2007, World Economic Forum

Thank You

For more information contact

Monica Yesudian: yesudianh@who.intShaloo Puri Kamble: shaloo.puri@weforum.org

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 providers-

adapting to needs, perceptions; pre-service training

• Prioritization: which partners to involve and when, to

maximally and rapidly benefit from partnerships

Who is involved?

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

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%.

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 concernNearly 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.

Ca

se S

tud

y

Philippines- Engaging Businesses in National TB Response

Three models:

National TB programme(NTP)

Phillipppines Coalition Against TB(PhilCAT)

PPPs

Industry

Company Health ClinicsReferrals, DOTS provision

Industrial DOTS CentresPublic or private public-private mix for DOTS (PPMD) units

Health Maintenance Organisations Third Party- PhilAm Care/ Private Hospitals

Philippines

Ca

se S

tud

y

• Referal to local PPMD unit for diagnosis

• Provision of DOTS at workplace

Company Health clinic

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

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.

Philippines

Ca

se S

tud

y

Health Maintenance Organisations (HMOs)