Most of the factories, workshops and workplaces in Bangladesh are unhealthy and overcrowded, as a result, a large number of factory workers and day labourers have been suffering from TB and infectious diseases. In Bangladesh, there are numerous brickfields, tannery factories, battery industries and construction sites where a large number of men and women work in most pitiable environment. Industries like readymade garments, hotel, shrimp, medicine, jute, poultry etc. are dominating the labour markets at the moment but the atmosphere of the workplaces are not in favour of these workers.

The problems are further aggravated by the increasing population density, rapid urbanisation, overcrowding, poverty, malnutrition and illiteracy.

In the developed countries, employers are usually cordial and have legal obligation to protect health of the labourers. The workers of such countries are also aware of their health. But in the developing countries like Bangladesh, most of the employers are profit mongers and as a result the poor workers are bound to do their duties in unhealthy and unsafe conditions. But it’s the right of the labourers that they will work in a healthy place.

Tuberculosis is a contagious, airborne infection. A patient with pulmonary tuberculosis can spread bacilli when exhaling, coughing, sneezing, talking or spitting. Infection occurs when these bacilli are inhaled by a susceptible human. A person infected with TB bacilli incurs a 10% risk of developing active TB. Though most can carry TB bacilli without becoming sick, any weakening of the immune system, e.g. caused by HIV infection or malnutrition, increases the chance that the TB bacilli will become active. On average, TB spreads easily when an infected case is in close contact with others, as is often the case in ill-ventilated, closed workplaces. It has been estimated that the most infectious form of TB will infect about 20 others in his or her lifetime. So, the crowded workplaces are more risky to spread bacilli.

Directly Observed Treatment Short-course (DOTS) is a WHO recommended proven system for TB treatment, and is based on accurate diagnosis and patients taking a full course of a combination of anti-TB drugs. DOTS hinges on government commitment, case detection, treatment, uninterrupted supply of anti-TB drugs and a monitoring and reporting system to evaluate treatment outcomes for each patient.
Since TB is an airborne contagious disease, providing DOTS at the workplace is essential. Through timely and supervised attention to all suspected and suffering from TB, the employers, employees, families, communities and the entire nation may be benefited.

The illness of a worker impacts on the person, family, society, economy and nation. TB implies prolonged illness, frequent periods of absenteeism from work, loss of wages, sometimes even loss of job and other forms of discriminations. Family members also suffer. Apart from being at a higher risk of getting infected due to close contact with the infected case at home, a reduction in household income adversely affects the health and well-being of the family.

When TB affects women workers, the impact is even more severe. In Bangladesh, women generally have poorer accessibility to health services, face boundless discriminations and get lesser family support in times of illness especially when they suffer from diseases like TB and HIV/AIDS.

A well-planned DOTS at the workplace programme provided with empathy and concern is a dignified way of letting people know that employers care for the health and welfare of their staff. Apart from its health benefits, it also boosts the morale of the workers when they are made to realise that having TB is not the end of a working life. The disease can be completely cured with the worker going back to normal duties after a couple of weeks. There is no shame or stigma attached to the disease. When employers spread the message of non-discrimination and back it with their workplace policies, the impact is even greater. The company gets the opportunity to enhance its image and show that it cares for the workers.
Families benefit from the decreased risk of the spread of TB among family members. They also benefit from the undisrupted household income, allaying their fears of deprivations associated with a long drawn out illness in an earning member.

Employers benefit from greater work productivity and profit as an outcome of a healthier workforce. Communities benefit from a healthier and therefore, a more prosperous environment, vital elements necessary for building harmony and peace.

The national TB programme benefits through enlisting the business sector to extend the reach of its DOTS.
Commitment must come from all levels—top management to the ill-paid worker, from workers’ unions and even from workers’ families. This is important when establishing a new programme that relies heavily on management and union support, skills of health personnel, workers’ compliance and family cooperation.
Commitment of the management’s part must be real and reflected adequately, not merely in budget allocations, but also in their endorsements and approvals of policies related to TB control at the workplace and in the statements they make that express the value they place on the health and well-being of their workers.

A workplace policy on TB is essentially based on national policy and legislations if such exist. The policy should be developed and formalised in consultation with all stakeholders including officials of the national TB programme, corporate management, departments of trade and labour, industrial health professionals, employees unions and communities. It 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 that decrease the occupational risk of TB.

The policy should guarantee that no employee would be dismissed on account of having TB. It should also guarantee a healthy work environment that will prevent the transmission of TB, ensure non-discrimination, confidentiality, equal opportunities for employment, ready access to treatment, and permission for time off for treatment and job modifications, when necessary. The policy must be clearly explained to all TB patients and 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 instead of separate services, which in the long run, will be more expensive to operate. The policy should be sensitive to the concerns of HIV-infected employees, particularly with respect to testing and confidentiality. HIV testing should only be done after informed consent has been obtained and include pre and post test counselling by trained counsellors.

The introduction of DOTS services into the various workplace settings should as much as possible, utilize or build on existing facilities or arrangements that are already in place to provide healthcare to employees in their respective workplaces. These services must be easily accessible to all workers during their various shifts. Employers must allow employees time to seek care for their ailments and also facilitate the process of their diagnosis. It is important that the staffs are fully aware of both the workplace policy and guidelines of the country’s national TB control programme. Adequate training must be provided to the health staff on how DOTS should be implemented, including the procedures on recording and reporting.

DOTS at the workplace must work in close collaboration with the national TB programme, ensuring that national policies and guidelines are followed with respect to both diagnosis and treatment. Collaborations with employees’ associations are most useful for getting the needed support for the programme and feedback on its implementation. As most workplaces may not have well established medical services on site, collaborations with nearby government health facilities must be sought and formalised. All such partnerships must be based on mutual trust and understanding.

TB is a chronic disease which involves taking daily medicines for at least six months. Even if the drugs are provided free of cost, there are often other expenses incurred due to loss in wages as the result of absenteeism from work, transportation costs and money spent on nutritional supplements. These are often deterrents to successful compliance of treatment regimens. Social welfare benefits like free treatment, maintaining salary during treatment, free transportation to health facilities and food support are important incentives to help workers complete the treatment.

Workers who have successfully completed their treatment and have been declared cured must be suitably rewarded. This can be done either privately or publicly, depending on whether the worker wishes to make his or her identity known. When it is done publicly, the opportunity must be taken to further educate employees on TB.