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

Regiane Garcia,Jerry M Spiegel,Annalee Yassi,Rodney Ehrlich,Paulo Romão,Elizabete A Nunes,Muzimkhulu Zungu,Simphiwe Mabhele

doi:10.3390/ijerph17207546

Abstract

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.

Highlights

Throughout the 21st Century, tuberculosis (TB) has continued to be the leading cause of death due to infectious disease globally, killing 1.7 million people in 2018 [1]
We argue that an enabling legal and governance environment is needed if persistent occupational TB transmission in healthcare facilities is to be reduced [20]
These perceptions were explicitly associated with the classical conception of law as command backed by threat [72], rather than “softer” conceptions of law as providing a framework for action, as expressed in the human rights literature [38]

Summary

Introduction

Throughout the 21st Century, tuberculosis (TB) has continued to be the leading cause of death due to infectious disease globally, killing 1.7 million people in 2018 [1]. TB (MDR-TB) further threatens TB control [1,2]. Health workers involved in caring for patients with. TB and MDR-TB have at least a two- to three-fold higher risk of contracting the disease than that. Res. Public Health 2020, 17, 7546; doi:10.3390/ijerph17207546 www.mdpi.com/journal/ijerph

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