Diverse approaches to preventing occupational tuberculosis in health workers: cross-disciplinary or cross purposes?

Ehrlich, Rodney; Spiegel, Jerry; Yassi, Annalee

doi:10.5588/pha.18.0086

Cited by 5 publications

(10 citation statements)

References 17 publications

(18 reference statements)

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“…Various studies have shown the value of coordinating practice for the benefit of worker and patient health, for example, in addressing threats such as severe adult respiratory syndrome (SARS) in a high-income country setting [28]. Such coordination is likely to be at least equally beneficial in high-risk lowresource circumstances [19].…”

Section: Discussionmentioning

confidence: 99%

“…Several overlapping disciplinary approaches contribute to the prevention of TB transmission and protection and management of affected workers, including infection prevention and control, occupational health, and patientorientated clinical programming such as FAST (Find cases Actively, isolate Safely, Treat effectively) [19]. In this study, interview questions were framed within an occupational health approach that considers the well-being of workers across the spectrum of primary, secondary and tertiary prevention measures.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

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Perceived Health System Barriers to Tuberculosis Control Among Health Workers in South Africa

Adu¹,

Yassi²,

Ehrlich

et al. 2020

Annals of Global Health

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Background: The healthcare workforce in high tuberculosis burden countries such as South Africa is at elevated risk of tuberculosis infection and disease with adverse consequences for their well-being and productivity. Despite the availability of international guidelines on protection of health workers from tuberculosis, research globally has focused on proximal deficiencies in practice rather than on health system barriers. Objective: This study sought to elicit perceptions of informed persons within the health system regarding health system barriers to protecting health workers from tuberculosis. Methods: Semi-structured interviews were conducted with 18 informants active in spheres related to workplace tuberculosis prevention and management in South Africa. Interviews were audio recorded and transcribed verbatim, validated and analysed to derive emergent themes. Responses were analysed using the World Health Organization building blocks as core elements of a health system bearing on protection of its health workforce. Findings: The following health system barriers were identified by informants: leadership and governance were "top-down" and fragmented; lack of funding was a major barrier; there were insufficient numbers of staff trained in infection prevention and control and occupational health; occupational health services were not comprehensively available and the ability to sustain protective technologies was questioned. A cross-cutting barrier was lack of priority afforded to workforce occupational health associated with lack of accurate information on cases of TB among health workers. Conclusions: We conclude that deficiencies in implementation of recommended infection control and tuberculosis management practices are unlikely to be corrected until health system barriers are addressed. More committed leadership from senior health system management and greater funding are needed. The process could be assisted by the development of indicators to characterise such barriers and monitor progress.

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Section: Discussionmentioning

confidence: 99%

Section: Conceptual Frameworkmentioning

confidence: 99%

Perceived Health System Barriers to Tuberculosis Control Among Health Workers in South Africa

Adu¹,

Yassi²,

Ehrlich

et al. 2020

Annals of Global Health

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“…We have previously argued that the worker-centred lens is needed for improved protection of health workers against occupational TB [ 77 ] and have called for greater integration of IPC and occupational health and safety (OHS) [ 77 , 78 , 79 ]. Besides the core components of IPC, the OHS approach includes an emphasis on worker screening, treatment, and disability management; confidential occupational health services; and education about occupational risks and rights [ 78 ].…”

Section: Discussionmentioning

confidence: 99%

“…Besides the core components of IPC, the OHS approach includes an emphasis on worker screening, treatment, and disability management; confidential occupational health services; and education about occupational risks and rights [ 78 ]. It also assumes a legal and political framework for consultation and negotiation with those affected [ 77 ].…”

Section: Discussionmentioning

confidence: 99%

Preventing Occupational Tuberculosis in Health Workers: An Analysis of State Responsibilities and Worker Rights in Mozambique

Garcia

Spiegel

Yassi

et al. 2020

IJERPH

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Given the very high incidence of tuberculosis (TB) among health workers in Mozambique, a low-income country in Southern Africa, implementation of measures to protect health workers from occupational TB remains a major challenge. This study explores how Mozambique’s legal framework and health system governance facilitate—or hinder—implementation of protective measures in its public (state-provided) healthcare sector. Using a mixed-methods approach, we examined international, constitutional, regulatory, and policy frameworks. We also recorded and analysed the content of a workshop and policy discussion group on the topic to elicit the perspectives of health workers and of officials responsible for implementing workplace TB policies. We found that despite a well-developed legal framework and national infection prevention and control policy, a number of implementation barrier persisted: lack of legal codification of TB as an occupational disease; absence of regulations assigning specific responsibilities to employers; failure to deal with privacy and stigma fears among health workers; and limited awareness among health workers of their legal rights, including that of collective action. While all these elements require attention to protect health workers from occupational TB, a stronger emphasis on their human and labour rights is needed alongside their perceived responsibilities as caregivers.

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“…The most commonly cited model for TB-IPC strategies (US CDC, 1994) identifies three main dimensions of IPC: designing health services to anticipate and respond quickly and appropriately to patients with TB in their facilities (administrative controls), improving the circulation and quality of air in a facility (environmental controls), and the appropriate use of masks and respirators (personal protective controls). Other TB-IPC models focus on a smaller set of related strategies (like the 'Find cases Actively, Separate safely and Treat effectivelyor FASTapproach) or situate TB-IPC within broader frameworks such as occupational health and safety (Ehrlich et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

‘It has become everybody’s business and nobody’s business’: Policy actor perspectives on the implementation of TB infection prevention and control (IPC) policies in South African public sector primary care health facilities

Kallon

Swartz

MacGregor

et al. 2020

Global Public Health

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South Africa is increasingly offering screening, diagnosis and treatment of tuberculosis (TB), and especially drug-resistant TB, at the primary care level. Nosocomial transmission of TB within primary health facilities is a growing concern in South Africa, and globally. We explore here how TB infection prevention and control (IPC) policies, historically focused on hospitals, are being implemented within primary care facilities. We spoke to 15 policy actors using in-depth interviews about barriers to effective TB-IPC and opportunities for improving implementation. We identified four drivers of poor policy implementation: fragmentation of institutional responsibility and accountability for TB-IPC; struggles by TB-IPC advocates to frame TB-IPC as an urgent and addressable policy problem; barriers to policy innovation from both a lack of evidence as well as a policy environment dependent on 'new' evidence to justify new policy; and the impact of professional medical cultures on the accurate recognition of and response to TB risks. Participants also identified examples of TB-IPC innovation and described conditions necessary for these successes. TB-IPC is a long-standing, complex health systems challenge. As important as downstream practices like maskwearing and ventilation are, sustained, effective TB-IPC ultimately requires that we better address the upstream barriers to TB-IPC policy formulation and implementation.

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Diverse approaches to preventing occupational tuberculosis in health workers: cross-disciplinary or cross purposes?

Cited by 5 publications

References 17 publications

Perceived Health System Barriers to Tuberculosis Control Among Health Workers in South Africa

Perceived Health System Barriers to Tuberculosis Control Among Health Workers in South Africa

Preventing Occupational Tuberculosis in Health Workers: An Analysis of State Responsibilities and Worker Rights in Mozambique

‘It has become everybody’s business and nobody’s business’: Policy actor perspectives on the implementation of TB infection prevention and control (IPC) policies in South African public sector primary care health facilities

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