Jharkhand Gazette, No. 575, 16 December 2022

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झारखण्ड गजट

असाधारण अंक

झारखण्ड सरकार द्वारा प्रकाशति

10 अग्रहायण, 1944 (०ि)

संख्‍या – 575 रााँची, गुरुवार, 1 दसिम्बर, 2022 (ई०) स्वास्थ्य, चिकित्सा शिक्षा एवं पररवार कल्याण विभाग

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संकल्प

संख्या - 6 /पी० (वविधि)-14/20202- 989(6)--

ववषय- यक्ष्मा रोगगयों को उनके काययस्थल (Workplace) पर यक्ष्मा तथा यक्ष्मा से संलग्न रोगों (कोर्मोबयडडदटस) के रोकथाम तथा मुफ्त ननािन एवं उपचार की समुगचत सुववधा प्रािन करने के उेििश्य से "Workplace Policy on TB and its comorbidities including Occupational Lung Diseases" नीनत के संबध में।

यक्ष्मा अथवा टी0बी0 अथवा क्षय रोग एक प्रमुख लोक स्वास््य समस्या है। यह एक संक्रामक रोग है, जजससे झारखण्ड राज्य में प्रनतवषय लगभग 50 हजार से अगधक लोग प्रभाववत होते हैं। यह मुख्य रूप से जनसमूह के क्रक्रयाीिल अथवा उत्पाकि आयु समूह को प्रभाववत करता है तथा गरीबी, कु पोषण एवं रिीर की कमजोर प्रनतरक्षा प्रणाली से इस रोग का अन्योन्याश्रय संबंध है। यक्ष्मा के साथ अन्य रोगों यथा HIV-AIDS, डायबीटीज (मधुमेह की बीमारी) तथा Occupational Lung Diseases (यथा शसलीकोशसस) एवं तम्बाकू सेवन का घननष्ठ संबंध है। कनतपय रोगगयों में विा प्रनतरोधी टी0बी0 (Drug Resistance TB) ही पाया जाता है, जो इस रोग की रूग्णता, जदटलता एवं मारक क्षमता को बढा ेिता है। यक्ष्मा से ग्रशसत रोगगयों हेतु राष्रीय यक्ष्मा उन्मूलन काययक्रम द्वारा वषय 2025 तक यक्ष्मा उन्मूलन का लक्ष्य ननधाररत क्रकया गया है। झारखण्ड राज्य में खननज पािथय बहुतायात में उपलब्ध है। फलतः यहीं इससे संबंगधत ववववध खनन क्षेत्र तथा औद्यौगगक क्षेत्र क्रक्रयाीिल है जहााँ बहुत अगधक संख्या में कामगार काययरत है। ऐसे काययस्थल पर कायय करने वालों में से क्रकसी एक के यक्ष्मारोग से ग्रशसत होने पर रोग के ूिसरे कामगारों में प्रसार की संभावना अगधक होती है। कई अवसरों पर यक्ष्मा से कामगार को नौकरी से ननकाल भी दयिा जाता है जजससे उनका पररवार संकट में आ जाता है।

2. वतयमान पररप्रेक्ष्य में यक्ष्मा रोगगयों को उनके काययस्थल (workplace) पर यक्ष्मा तथा यक्ष्मा से संलग्न रोगों (comorbidities) के रोकथाम तथा मुफ्त ननािन एवं उपचार की समुगचत सुववधा प्रािन करने के उेििश्य से "Workplace Policy on TB and its comorbidities including Occupational Lung Diseases" नीनत का प्रस्ताव गदठत कर र्मंत्रपररषद् की स्वीकृ नत हेतु भेजा गया। इसके अन्तगयत संभाववत कनतपय रोगगयों में ही एक्स-रे जााँच की आवश्यकता होती है। राष्रीय यक्ष्मा उन्मूलन काययक्रम में बलगम के जााँच तथा आवश्यकतानुसार एक्स-रे जााँच की मुफ्त व्यवस्था प्रावधाननत है । अतएव एक्स-रे इत्यादि पर होने वाले व्यय का अलग से वहन नहीं क्रकया जाना है।

यक्त प्रस्ताव पर दनिांक 3. ववभागीय संलेख संख्या- 847 (6) दनिांक- 11.11.2020 में ननदहत उपयु

23.12.2020 को र्मंत्रपररषि की बैठक में मि संख्या- 36 के रुप में स्वीकृ नत प्राप्त है। आेिि: आेिि दयिा जाता है क्रक इस संकल्प को जनसाधारण की जानकारी के शलए सरकारी राजपत्र के अगले असाधारण अंक में प्रकाशति क्रकया जाय।

अनु0: "Workplace Policy on TB and its comorbidities including Occupational Lung Diseases" नीनत।

झारखण्ड राज्यपाल के आेिि से,

(डॉ0 ननतीन कु लकणी) सरकार के प्रधान सगचव।

Workplace Policy on Tuberculosis (TB) and its Comorbidities including Occupational Lung Diseases

National TB Elimination Programme (NTEP)

Jharkhand

Table of Contents

Abbreviations

ACSM

Advocacy, Communication & Social Mobilization

AFB

Acid-Fast-Bacili

AIDS

Acquired Immunodeficiency Syndrome

ATT

Anti TB Treatment

CSR

Corporate Social Responsibility

DHS

District Health Society

DMC

Designated Microscopy Centre

DOTS

Directly Observed Treatment, Short Course

DR TB

Drug Resistant TB

DS TB

Drug Sensitive TB

DTC

District TB Centre

DTO

District TB Officer

ELM

Employer Led Model

ESI

Employees' State Insurance

HIV

Human Immunodeficiency Virus

HR

Human Resource

IEC

Information, Education & Communication

ILO

International Labour Organization

LoI

Letter of Intent

LTBI

Latent TB Infection

MDR Multi-Drug-Resistant

MoHFW Ministry of Health & Family Welfare

MoLE Ministry of Labour & Employment

MoU Memorandum of Understanding

NACO

National AIDS Control Organization

NGO

Non-Government Organization

NHM

National Health Mission

NSP

National Strategic Plan

NTEP

National TB Elimination Programme

OI

Opportunistic Infection

OPD

Out Patient Department

PHI

Peripheral Health Institution

PPM

Public Private Mix

PSU

Public Sector Undertaking

RNTCP

Revised National TB Control Programme

STC

State TB Cell STO

State TB Officer

TB

Tuberculosis

WHO World Health Organization

XDR

Extensively Drug Resistant

Key Definitions

Worker refers to any person working under any form of arrangement.

Workplace refers to any place in which workers perform their activity.

Stigma means the social mark that, when associated with a person, usually causes marginalization or presents an obstacle to the full enjoyment of social life by the person infected or affected by TB and/or HIV.

Discrimination is the expressed behavior towards a worker based on the individual's perceived TB and/or HIV status or diseased status, including discrimination on the ground of sexual orientation.

Reasonable Accommodation is any modification or adjustment to a job or to the workplace that is reasonably practicable and enables a person living with TB and/or HIV to have access to, or participate or advance in, employment.

Vulnerability refers to socio-economic disempowerment, cultural context and work situations that make workers more susceptible to the risk of infection and situations which put children at greater risk of being involved in child labour.

Tuberculosis and its comorbidities refer to TB, HIV, Diabetes Mellitus, Tobacco Consumption and Silicosis or other Occupational Lung Diseases.

झारखण्ड गजट (असाधारण) गुरूवार, 1 दसिंबर 2022 7 I. Background

India accounts for 27.4 Lakh of the 100 Lakh new Tuberculosis cases globally, according to the WHO Global TB Report 2018. India is a signatory to the WHO's "The End TB Strategy" that calls for a world free of Tuberculosis, with measurable aims of a 50% and 75% reduction in incidence and deaths, respectively by 2025, and corresponding reductions of 90% and 95% respectively by 2035. To meet these targets, India is adopting newer strategies. India is also one of the high HIV burden countries.

Across the globe emergence of Multi-Drug Resistant (MDR) and Extensively Drug Resistant (XDR) TB is proving to be a challenge. World Health Organization (WHO) has quoted, if a country is having 300 cases per One Lakh Population as annual overall TB Incidence rate, out of this 60 cases per year are expected among a workforce of 20,000 (WHO- ILO, 2003). It has been estimated, that a person with infectious diseases could infect about 20 different individuals during their lifetime (Quazi Shafayetul Islam, 2015). A workplace having 20,000 employees could be considered for establishing a Directly Observed Treatment, Short-course (DOTS) program in collaboration with National Tuberculosis Elimination Program (NTEP) (WHO- ILO, 2003).

The National Strategic Plan (NSP) for Tuberculosis Elimination (2017- 2025) has emphasized the role of multi stakeholders towards the elimination of TB by the year 2025. The NSP foresees the role of stakeholders in multiple ways to combat the diseases which is not only having clinical implications but also having financial, social, psychological and other implications. It provides goals and strategies for the country's response to the disease during the period 2017 to 2025 and aims to direct the attention of all stakeholders on the most important interventions or activities that the NTEP believes will bring about significant changes in the incidence, prevalence and mortality of TB. The NSP also emphasizes on addressing the issue of TB along with its comorbidities like HIV, Diabetes Mellitus, Tobacco consumption and Silicosis or other Occupational Lung Diseases.

Further, The National Strategic Plan for TB elimination 2017-2025 (Revised National TB Control Programme i.e. RNTCP, 2017) and RNTCP Technical and Operational Guidelines for India 2016 (CTD- DGHS- MoHFW, RNTCP- Technical and Operational Guidelines for TB Control in India 2016), recommends symptoms screening and periodical health camps in, ''settings like transit camps, night shelters, old age homes, orphanages and de-addiction centres that may have ill ventilated and unsanitary environment''. The NSP further states the need for establishing surveillance system at workplaces and in migrant sites.

8 झारखण्ड‍गजट‍(असाधारण)‍गुरूवार, 1 दसिंबर‍2022 The state of Jharkhand is rich in minerals & industries and the history of mining and processing of metallic and non-metallic minerals is approximately 300 years old. There are more than 15,000 mines of different minerals such as coal, copper, iron, quartz, granite, bauxite and uranium and several related industries currently operational. These include several stone crushers, ramming mass units, iron ore crushers, and sponge iron units. There are also presence of Tasar (silk), cotton units & Poultry farms. Many of these production (including construction) units are identified for silica dust emission at workplace. Several such units come under the unorganized sector- in rural and industrial areas of urban localities.

Mineral Map of Jharkhand

झारखण्ड गजट (असाधारण) गुरूवार, 1 दसिंबर 2022 9 Being rich in mines and industries is a boon for the state; at the same time may also result in certain health hazards in the form of "Occupational Lung Diseases" especially varieties of "Pneumoconiosis" such as Silicosis, Asbestosis, Coal worker's pneumoconiosis (Anthracosis) etc., not only in the workers and employees there but also to other people dwelling nearby. As majority of such activities is associated with silica dust, it may be envisaged that presence of persons affected with silicosis forms the bulk of Pneumoconiosis group followed by Coal worker's pneumoconiosis, Asbestosis and so on. The people affected by these are also prone to TB due to bad lung health.

There is a causal relationship between exposure in a specific working environment or work activity and a specific disease. The fact that the specific disease occurs among a group of exposed persons with a frequency above the average morbidity of the rest of the population also substantiates the causal relationship.

II. Goal of the Workplace policy

The overall goal of this policy document is to provide an operational framework to all stakeholders in the "world of work" towards the goal of eliminating tuberculosis (TB) by 2025, by facilitating an enabling environment to prevent new TB infections, early case detection, access to free diagnosis and treatment, adherence to treatment along with focus on its comorbidities like HIV, Diabetes Mellitus, Tobacco consumption and Silicosis or other Occupational Lung Diseases. The policy framework builds on the "Policy Framework to address Tuberculosis, TB related co- morbidities and HIV in the World of Work in India 2019" of Government of India and aims to provide guidance to the Stakeholders of the world of work like Government, Employers, Private Sector, Industries, Mines, Corporate Sectors, Worker's organizations, Civil Society Organizations and all relevant partners.

III. Objective of Workplace policy

➢ To promote awareness on TB prevention, screening, diagnosis and treatment across workplaces in Jharkhand.

➢ To facilitate and advocate for an environment that minimizes and prevents TB transmission at workplaces across Jharkhand.

➢ To support and ensure early and free diagnosis of TB across workplaces in Jharkhand.

➢ To facilitate and ensure access to free TB drugs and adherence to treatment for the entire duration across the Workplaces in Jharkhand.

➢ To ensure care and support services for the workforce, post the completion of treatment.

10 झारखण्ड‍गजट‍(असाधारण)‍गुरूवार, 1 दसिंबर‍2022 ➢ To address TB and its comorbidities in the world of work.

➢ To ensure early identification of workers suspected of suffering from Silicosis or other Occupational Lung Diseases working at Silicosis/Occupational lung diseases prone workplaces and referral of such suspected cases to Certifying Surgeons/higher centers to confirm or rule out silicosis and/or other occupational lung diseases for any other further action needed.

➢ To advocate and facilitate a stigma free environment for assessing TB associated services at the workplaces in Jharkhand.

IV. Workplace settings

All workplaces may not be at increased risk for TB but there are certain workplaces settings with increased TB risk, which are as follows:-

Table – 1: Workplace settings with increased TB Risk (WHO-ILO 2003)

There are other vulnerable populations also for the TB disease which are mainly as follows – Table – 2:

V. Key guiding principles of the Policy framework to address TB & its comorbidities at

the workplace

Following principles have been adopted from various workplace policy documents and these principles will guide the workplace strategies and interventions-

➢ Recognition that workplaces can play a vital role in elimination of TB along with

addressing its comorbidities:

It has been amply demonstrated that TB & its comorbidities can negatively impact work productivity in industrial set-ups through increased absenteeism and turnover of staff due to TB associated morbidity and mortality. Most workers spend most of their working hours at their places of work. In some situations, the workplace may also be where workers live. There is stronger need to introduce access to TB control services in these settings than in any other.

14 झारखण्ड‍गजट‍(असाधारण)‍गुरूवार, 1 दसिंबर‍2022 ➢ Non-discrimination:

A non-discriminatory environment enables the uptake of screening and treatment by employees and hence ensures a healthy workforce. There should be no discrimination against the workers on the basis of TB and/or HIV infection.

➢ Rights- based and gender equality:

TB is a disease of poverty and inequality. A number of factors related to human rights and gender can hinder the effectiveness, accessibility and sustainability of TB programs and services.

• Overall, men have

o higher risk of developing TB due to gender specific occupations; and higher risk of occupational lung diseases due to jobs such as mining or blasting with exposure to particulates

o higher TB mortality

• Men may be more likely to migrate for work which may cause interruptions in TB treatment. Migration may also increase risk of contracting HIV.

• Men may also be more likely to smoke or use drugs in many societies both being independent risk factor of TB.

• On the other hand, women may have less access to TB treatment and prevention services than men and in some settings have been less likely to undergo sputum smear examinations. Therefore, more equal gender relations and empowerment of women is vital to successfully prevent the spread of TB infection and enable women to cope up with TB.

➢ Safe and healthy work environment:

The work environment should be healthy and safe for all workers in order to prevent infection of TB along with other occupational lung diseases in accordance with the provisions of international standards. A safe and healthy work environment will keep the workforce healthier and ensure productivity without any delay or discontinuation.

➢ Case finding and diagnosis:

Early identification, of workers and their families with a high probability of having active TB and its comorbidities, is the most important activity of the case finding strategy in the workplace. Screening for TB along with its comorbidities should be voluntary and झारखण्ड गजट (असाधारण) गुरूवार, 1 दसिंबर 2022 15 confidentiality should be ensured. Periodic screening should be extended for an informed voluntary uptake as this will ensure early detection of cases and minimize the period of treatment and further ensure a disease-free environment.

➢ Treatment, Care and Support:

All workers including contractual workers are entitled to affordable health services.

There should be no discrimination against them and their dependents in accessing benefits. There should be proper and adequate rehabilitative measures in place.

➢ Continuation of employment relationship:

Irrespective of the disease status

• The employer should continue to provide employment to the individuals which will facilitate in adherence to the treatment and prevent further transmission.

• There should be psychological support for employers, access to free treatment and services, compensation for loss of income, free transport to health facilities, and motivations to continue treatment.

• Appropriate provision of leave and suitable changes in the work will encourage an employee to complete the treatment.

• The issue of occupational lung diseases should also be dealt with as per the prevailing rules & regulations.

➢ Prevention:

Prevention should be the primary focus and preventive strategies should be focus on behavior change, knowledge, treatment and the creation of a non-discriminatory and safe environment. Workplace preventive interventions should be continuously studied for their effectiveness and to carry out appropriate modifications.

VI. Implementation

There is a need to engage different stakeholders to facilitate implementation of workplace policy and guidelines for TB Control along with addressing its comorbidities. This engagement of the stakeholders could be appropriately instigated for the effective outcome of the program.

The engagement of various stakeholders depends upon different reasons and interest which needs to be identified and addressed appropriately. For TB & its comorbidities interventions at workplace, the stakeholders could be broadly categorized into the following categories:-

16 झारखण्ड‍गजट‍(असाधारण)‍गुरूवार, 1 दसिंबर‍2022 Government (Department of Health, Medical Education & Family Welfare and Department of Labour, Employment & Training):

➢ The Department of Health, Medical Education & Family Welfare and the Department of Labour, Employment & Training should take lead in providing workplace policy guidelines on addressing TB along with its comorbidities. This coherence between these two departments is needed due to Government of India decision to bring TB and its comorbidities programs together and the Ministry of Labor & Employments (MoLE) has already formulated the national policy on HIV/ AIDS in the World of Work in 2009.

➢ The department of Labour should share TB workplace policy framework with employers and workers organizations as this would ensure a healthy workforce besides contribution to the national response on TB.

➢ The department of Labour should also guide employer and workers organizations to extend and adapt their TB prevention programs to the needs of informal workers.

➢ Both departments should ensure periodic review and ensure that the challenges are addressed without hampering the implementation of the workplace intervention for TB along with its comorbidities.

National TB Elimination Program (NTEP):

➢ Ensuring that the TB Control program is in line with national policies and guidelines.

➢ There should be endorsement of the role of employers and workers organizations for implementing workplace measures to address TB and its comorbidities.

➢ There should be up-gradation of facilities (Designated Microscopy Centre (DMC) and/or Treatment Support Centre) for effective response ensuring establishment of appropriate infrastructure facilities for linking and treatment services, wherever required.

➢ Ensuring TB prevention and control programs along with addressing its comorbidities in all workplace settings.

National AIDS Control Organization (NACO):

➢ Implementation of Memorandum of Understanding (MoU) signed between the NACO and MoLE to strengthen workplace program of HIV and TB will pave the way for a robust world of work response for prevention of TB.

➢ NACO's HIV workplace intervention provides a guidance platform for TB interventions at झारखण्ड‍गजट‍(असाधारण)‍गुरूवार, 1 दसिंबर‍2022 17 ➢ the workplace as well.

Employer's Organizations:

➢ Employers should consult with workers and their representatives to issue guidelines to their members to develop and implement appropriate programs on early detection, prevention, care & treatment of TB and protect all workers from discrimination related to TB.

➢ Employers and their organizations in consultation with workers & their representatives should initiate and support programs at their workplaces to create a pool of resource persons trained in TB and its comorbidities.

➢ Employers should take all measures for risk reduction and management of TB & Occupational Lung Diseases that includes proper ventilation at workplaces, less cramped workplace settings, pre-employment & periodic checkups and regular awareness camps especially in those workplaces where there are high chances of TB infection and/or occupational lung diseases.

➢ Employers and their organizations in consultation with workers & their representatives should take measures to reasonably accommodate workers with TB and related illnesses.

These could include rearrangement of working time, opportunities for rest breaks, time off for medical appointments, flexible sick leaves and return to work arrangement.

➢ In spite of good corporate citizenship, employers and their organizations, should wherever appropriate, encourage fellow employers to contribute to the prevention of TB and occupational lung diseases in the workplace.

➢ Provision of the paid leave for the people affected with TB up to a period of four weeks should be made by the management. The payments could be channelized either through the management or CSR with amendments in the CSR Act if necessary. After paid leave the patients should be given less strenuous works in the establishments so that they can recover fast.

➢ Provision of additional special nutrients to TB sufferers should be made for their speedy recovery through their management or under CSR activity.

Worker's organization (e.g. Trade Unions):

➢ Workers and their representatives should consult with employers to issue guidelines to their members to develop and implement appropriate programs on early detection 18 झारखण्ड‍गजट‍(असाधारण)‍गुरूवार, 1 दसिंबर‍2022 ➢ prevention, care and treatment of TB and protect all workers from discrimination related to TB along with addressing its comorbidities.

➢ Workers and their organizations should use existing union structures and facilities to provide information on TB along with addressing its comorbidities in the workplace, and develop educational material and activities appropriate for workers and their families, including regularly updated information on worker's rights and benefits.

➢ Worker organizations in consultation with employers should take all measures for risk reduction and management of TB & other occupational lung diseases that include proper ventilation at workplaces, less cramped workplace settings, pre-employment & periodic checkups and regular awareness camps especially in those workplaces where there are high chances of TB Infections and/or occupational lung diseases.

➢ Worker Organizations' in consultation with employers and their representatives should take measures to reasonably accommodate workers with TB & other related illnesses.

These could include rearrangement of working time, opportunities for rest breaks, time off for medical appointments, flexible sick leaves and return to work arrangement.

➢ Workers and their organizations should work with employers to develop appropriate strategies to minimize the impact of TB & its comorbidities on workers and their productivity.

➢ Ensuring that the TB Control program, measures for its comorbidities and preventive measures are in line with national policies and guidelines.

Non -governmental organizations (national and international):

➢ Promotion of equitable health services across all levels of employees.

➢ Promoting and ensuring capacity of the government and healthcare providers.

➢ Developing and advocating for evidence based strategies and workplace learning for strengthening government responses.

Social organizations:

➢ Social organizations should be engaged for facilitating resources for welfare of the world of work.

➢ Social organizations should be engaged for volunteerism in implementing workplace interventions and awareness on TB, importance of early detection and treatment झारखण्ड‍गजट‍(असाधारण)‍गुरूवार, 1 दसिंबर‍2022 19 ➢ adherence and role of addressing its comorbidities.

➢ Organizations like Rotary internationals, Lions club, Red Cross Society etc. should be considered as potential stakeholders, as these organizations show interest in serving the interest of the society and nation as a whole.

Community representatives:

➢ Engagement of community such as "Cured TB Patients or TB Champions", "Outreach Workers" etc. will help in creating an environment free of stigma and discrimination in the world of work.

➢ Engagement of community helps in spreading the message on the importance of prevention, early detection and treatment adherence.

Private Practitioners (PPs):

Majority of patients initially seek care from private providers before they turn to public institutions. Therefore, NTEP should try to capitalize on ability of this sector to reach patients who would not or are unable to, access public services.

➢ Treatment regimens under NTEP are efficacious and cost effective compared to the regimens prescribed by PPs. By involving the PPs in NTEP effective & free of cost TB management services could be provided.

➢ Participation of PPs in NTEP would also help in reducing the financial burden on the poor, arising due to cost of drugs in particular.

➢ The Government infrastructure by itself cannot possibly deliver care to all patients because it would mean a substantial increase in infrastructure and personnel in public system.

VII. Course of Action

Identification of Presumptive cases and diagnosis

➢ The Department of Labor, Employment & Training should provide district wise line list of factories/mines/industries (workplaces) and establishment wise number of employees to the Civil Surgeon (CS) of the district. The list of available Certifying Surgeons within the state and enlisted/authorized higher level Occupational Diseases referral centres should 20 झारखण्ड‍गजट‍(असाधारण)‍गुरूवार, 1 दसिंबर‍2022 ➢ also be made available to Civil Surgeon (CS).

➢ Pre-employment health checkup & periodic checkups of workers along with maintenance of their Health Cards are responsibilities of owners/authorities of the factories/mines/industries, done by their Health Establishments (HEs) and enforced & monitored by the Factory Inspectorate/DGMS or the concerned department(s).

➢ In case of non-availability of their own HEs, the concerned owners/authorities of factories/mines/industries to coordinate with CS/Program Officer/ Nodal Officer, Department of Health, GoJ of the respective district and finalize date(s) for checkups and send their workers along with their Health Cards on the decided date(s) to identified CHC/Sub-Divisional Hospital/District Hospital/other Hospital.

➢ Health Checkups & necessary investigations to be done in the prescribed manner as per norms. For e.g. for TB as per NTEP guidelines, for Diabetes Mellitus as per Non- Communicable Disease (NCD) program guidelines, for HIV as per the NACO guidelines, for tobacco as per the National Tobacco Control Program (NTCP) guidelines in consultation with the concerned program officers of the respective diseases at district level.

➢ Referral of workers suspected of suffering from TB & any co-morbidities to nearest Designated Microscopy Centre (DMC) & related Health facility respectively. Also referral for doing X-ray of chest shall be done for suspected TB and occupational lung disease cases.

➢ Referral of workers suspected of suffering from Silicosis or other Occupational diseases to Medical Boards of District Hospital/Medical College Hospital, to Certifying Surgeons or to the higher- level Occupational Diseases referral centres as and when needed.

➢ Treatment measures to be undertaken by the concerned programs. ➢ Counseling measures also to be undertaken in above health facilities for diagnostic, treatment, adherence to treatment and preventive measures.

➢ Participation in coordination meeting of the Stakeholders at District.

Training and Sensitization ➢ District level training/sensitization of medics and paramedics by different programs like NTEP, NCD, NACP, NTCP along with in Occupational Lung Diseases.

➢ Training of Certifying Surgeons and members of Medical College/District Hospital level Medical Boards for Occupational Lung Diseases to be facilitated by Department of ➢ Labour/Mines with arranging trainers from Regional Occupational Health Centre (ROHC), Kolkata, National Institute of Occupational Health (NIOH), New Delhi and Factory Advice Service & Labor Institute (FASLI). These shall then function as Master Trainers for all district level trainings.

➢ Developing other Master Trainers at district level for training of medics and paramedics at district level

Recording and Reporting ➢ The owners/authorities of the factories/mines/industries to maintain the Health Card & complete health record of all workers.

➢ The examining Health Facility to also keep the records of such examinations in separate registers and share the data with the District Health Society (DHS) of the district on monthly basis.

➢ Collection, compilation and maintenance of data to be done at District Health society (DHS) which is to be facilitated by Nodal Officers of the concerned program under the supervision of CS in each district and should further be sent to Nodal Officers of the concerned program at State level.

➢ Any diagnosed case of Notifiable disease to be notified to the concerned authority as per the prevailing rules and regulations.

Monitoring and Feedback

➢ The monitoring of the entire activity at state level shall be done by the State TB- Comorbidity Coordination Committee (STCC).

➢ The monitoring of the entire activity at district level shall be done by the District TB- Comorbidity Coordination Committee (DTCC).

22 झारखण्ड‍गजट‍(असाधारण)‍गुरूवार, 1 दसिंबर‍2022 ➢ The feedback from above meetings shall be provided to concerned health officials & related stakeholder(s) and communicated to the Department of Labor, Employment and Training.

Advocacy, Communication and Social Mobilization (ACSM)

1. Workplace ACSM intervention-

➢ Sensitization of Management Officials of the workplace on TB along with its co- morbidities like HIV, Diabetes Mellitus, Tobacco consumption and Occupational Lung Diseases, with support from the District / Sub District level Nodal Officers of respective programs.

➢ Sensitization of Workers (Contractual and Permanent) on TB along with its co- morbidities like HIV, Diabetes Mellitus, Tobacco consumption and Occupational Lung Diseases.

➢ Dissemination of Information, Education and Communication materials in the premises by

o Putting hoardings/ banners/posters etc.

o Using AV materials o Using Social Media tools such as WhatsApp, Facebook, Twitter, SMS wherever suitable.

➢ Observing World TB Day on 24 March every year by involving employees

2. Community level ACSM activities-

➢ Community awareness programs on TB and its co- morbidities can be tagged with other ongoing awareness generation activities of the CSR. A separate plan for sensitization can be done with the support of the District / Sub District level government health facilities.

➢ Sensitization of the volunteers of the CSR on TB along with its co-morbidities like HIV, Diabetes Mellitus, Tobacco consumption and Silicosis or other Occupational Lung Diseases.

➢ Dissemination of Information, Education and Communication materials in the field.

o Putting hoardings/ banners/posters etc.

o Nukkad Natak (Street Plays)

o Sensitization of PRI members and SHGs of the Industries and the mining villages.

➢ Observing World TB Day on 24th March every year by involving communities The prototypes of IEC materials for above-mentioned workplace & community level ACSM activities shall be made available by the concerned District Nodal Officers. The activities may be undertaken under CSR activity by the concerned workplace authorities.

VIII. Inclusion of Employer Led Model (ELM)

In order to facilitate, the effective implementation and course of action, a model named as "Employer Led Model (ELM)" is to be incorporated. The ELM is a comprehensive strategy to reach out people working in industries and mines for integrating awareness and care on TB and its co-morbidities with existing system and structure of establishments.

Under this model a letter of Intent (LoI) is to be signed between the designated officials of District Health Society (DHS) and the PSU /Private Mines & Industries for effective implementation. The format for LoI is attached as Annexure-I.

After signing the LoI, the designated official of the Industry/Mine shall do its facility assessment & submit the Facility Assessment Checklist (FAC) to the designated official of DHS.

The format for FAC is attached as Annexure-II.

The designated official of the Industry/Mine shall submit its monthly report to its higher official and the designated official of DHS. The DHS shall submit this report to the state nodal officers of concerned programs. The Monthly Reporting Format for this purpose is attached as Annexure-III.

IX. Mechanism to review implementation of the policy framework

At national level, in 2009 Ministry of Labor & Employment (MoLE), Government of India had formulated a policy on prevention of HIV/ AIDS in the world of work in India. A national steering committee (NSC) was formed by the ministry with representatives from Employers' and workers' organizations, institutions of the MoLE, NACO, ILO and People Living with HIV/ AIDS (PLHIV) for effective implementation of the policy. In 2017, the NSC was expanded to include the Central TB Division, Ministry of Health. The TB workplace policy framework could also be implemented in and integrated manner and governed by the same NSC to ensure smooth implementation without creation of multiple structure. Considering the growing changes in health care provisions and the TB situation in the country, the TB workplace policy framework could be revisited on appropriate time and interval.

At state level, in September, 2019 the Department of Health, Medical Education & Family 24 झारखण्ड‍गजट‍(असाधारण)‍गुरूवार, 1 दसिंबर‍2022 Welfare, Government of Jharkhand has constituted a State level Committee named as State TB- Comorbidity Coordination Committee (STCC) to ensure smooth implementation and regular review of all TB comorbidity collaborative activities. Representatives from the Department of

Labour, Employment & Training, Department of Industry and Department of Mines & Geology shall be included in the STCC. Then, this workplace policy framework could also be implemented in an integrated manner and governed by the same STCC to ensure smooth implementation without creation of multiple structures.

Considering the growing changes in health care provisions and the TB & its comorbidities situation, this workplace policy framework could be revisited by the STCC, for incorporation of any modification, on appropriate time and interval.

References-

1. "Policy Framework to address Tuberculosis, TB related comorbidities and HIV in the world of

work in India 2019" by Government of India dated - 10th April 2019.

2. National Strategic Plan for TB Elimination 2017-2025 (RNTCP, 2017)

3. RNTCP Technical and Operational Guidelines for India 2016 (CTB-DGHS-MoHFW, RNTCP-

Technical and Operational Guidelines for TB control in India – 2016).

4. WHO Global TB Report - 2018.

5. Standard Operating Procedure on Silicosis, Department of Health, Government of Jharkhand.

XXXXXXXXXXXXXXXXXX

Annexure – I

Letter of Intent (LoI)

Signed on

Date………………………….

Between

……………..………………………………………………………………………………… (Name of Workplace),

Jharkhand &

……………………………………………........................................................District Health Society, Jharkhand

This letter of Intent is being signed to achieve followings through Employer Led Model (ELM):

Goal: The overall goal is to provide an operational framework to all stakeholders in the "world of work" towards the goal of eliminating tuberculosis (TB) by 2025, by facilitating an enabling environment to prevent new TB infections, early case detection, access to free diagnosis and treatment, adherence to treatment along with focus on its co-morbidities like HIV, Diabetes Mellitus, Tobacco consumption and Silicosis or other Occupational Lung Diseases.

Objectives:

26 झारखण्ड‍गजट‍(असाधारण)‍गुरूवार, 1 दसिंबर‍2022 • To promote awareness on TB prevention, screening, diagnosis and treatment across workplaces in Jharkhand.

• To facilitate and advocate for an environment that minimizes and prevents TB transmission at workplaces across Jharkhand.

• To support and ensure early and free diagnosis of TB across workplaces in Jharkhand.

• To facilitate and ensure access to free TB drugs and adherence to treatment for the entire duration across the Workplaces in Jharkhand.

• To ensure care and support services for the workforce, post the completion of treatment.

• To address TB and its comorbidities in the world of work.

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Annexure–I

Letter of Intent (LoI)

• To ensure early identification of workers suspected of suffering from Silicosis or other Occupational Lung Diseases working at Silicosis/Occupational lung diseases prone workplaces and referral of such suspected cases to Certifying Surgeons/higher centers to confirm or rule out silicosis and/or other occupational lung diseases for any other further action needed.

• To advocate and facilitate a stigma free environment for assessing TB associated services at the workplaces in Jharkhand.

Execution

• The Letter of Intent shall become effective upon signatures by both parties.

• Both Parties agree to collaborate and work together for the fulfilment of the Goal & Objectives as per the clause II & III of the Policy document named "Workplace Policy on TB, its Comorbidities including Occupational Lung Diseases – Jharkhand".

• Both Parties agree to collaborate and work together for the fulfilment of the Course of Action as per the clause VII of the Policy document named "Workplace Policy on TB, its Comorbidities including Occupational Lung Diseases – Jharkhand".

• Both parties agree to collaborate with each other and review the progress of implementation at least on quarterly basis.

Signed on behalf of Signed on behalf of

District Health Society I/C of the Workplace

(Name of Signing Authority) (Name of Signing Authority)

(Stamp/Seal) (Stamp/Seal)

Page 2 of 2

Annexure–II

28 झारखण्ड‍गजट‍(असाधारण)‍गुरूवार, 1 दसिंबर‍2022

Facility Assessment Checklist

A. General Information

1. Name of the Establishment :

2. Sector of the Establishment : PSU Private

3. Nature of Work:

4. Address:

5. Name of the Manager / Designated officer for ELM:

a. Contact Number:

b. E-Mail Address:

6. Name of the Chief / In-charge Medical Officer:

a. Contact Number:

b. E-Mail Address:

c. Staff Details:

Total Male Female i. Number of Permanent Employees

ii. Number of Contractual Employees

iii. Number of Daily wages Employees

B. Health Facility Information

झारखण्ड‍गजट‍(असाधारण)‍गुरूवार, 1 दसिंबर‍2022 29 1. Facilities Available: (Y / N)

a. IPD

If Yes then, No. of Beds

b. OPD

If Yes then, Avg. OPD/Day

c. Pathology Lab Sputum Microscopy Blood sugar HIV d. Radiology X-Ray X-Ray capacity USG CT e. NTEP - DMC f. NTEP - DOT centre

2. Health Staff:

a. Number of Doctors

b. Number of Nurses

c. Number of Lab Technicians

d. Number of X-Ray Technicians

e. Number of Paramedics & health workers

Page 1 of 2

30 झारखण्ड‍गजट‍(असाधारण)‍गुरूवार, 1 दसिंबर‍2022

Annexure-II 3. Training:

a. Number of Doctors trained in NTEP

b. Number of Nurses trained in NTEP

c. Number of Lab technicians trained in NTEP

d. Number of Paramedics & health worker trained in NTEP

C. Activities done at Health Facility level during the last one year

a. No. of orientation / Sensitization meetings on TB organized in the

companyby State / District TB cell or by the company

b. No. of awareness activities on TB

c. No. of persons with symptoms of TB (Presumptive TB) Screened

d. No. of persons referred to Govt. Health Facility for CBNAAT Test

e. No. of persons diagnosed with TB and put on treatment

f. No. of persons diagnosed with TB and notified to NTEP

g. No. of TB patients successfully completed treatment

D. Activities done at Community/Field level under CSR during last one year

a. No. of awareness activities on TB

b. No. of any other activity related to benefit of TB

Patients(If yes, Please attach details)

E. Workplace Policy

Does your organization have a defined workplace policy for health

includingTB and its co morbidities: Y / N

(If yes, Please Attach Details)

Official Seal

Signature of Designated Officer

Page 2 of 2 Annexure–III

Monthly Reporting Format

Name of the establishment :

Sector (PSU/Private) :

Nature of work

:

Address

:

:

District

:

Reporting Month and Year :

Date of Reporting :

Page 1 of 2 Annexure–III 32 झारखण्ड‍गजट‍(असाधारण)‍गुरूवार, 1 दसिंबर‍2022

A. Awareness activities (conducted in this reporting month)

Page 2 of 2 Annexure–III

Monthly Reporting Format

B. Referral, Diagnosis and Treatment (for this reporting month)

Official Seal

Signature of Designated Officer

___________________________________________________________________ झारखण्ड राजकीय‍मुद्रणालय, रांची‍द्वारा‍प्रकाशत‍िएवं‍मुदद्रत झारखण्ड‍गजट‍(असाधारण)‍575 - 50

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