Browsing by Author "Yassi, Annalee"

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    Preventing Occupational Tuberculosis in Health Workers: An Analysis of State Responsibilities and Worker Rights in Mozambique
    (2020-10-16) Garcia, Regiane; Spiegel, Jerry M; Yassi, Annalee; Ehrlich, Rodney; Romão, Paulo; Nunes, Elizabete A.; Zungu, Muzimkhulu; Mabhele, Simphiwe
    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 Utility of Length of Mining Service and Latency in Predicting Silicosis among Claimants to a Compensation Trust
    (Multidisciplinary Digital Publishing Institute, 2022-03-17) Williams, Haidee; Ehrlich, Rodney; Barker, Stephen; Kisting-Cairncross, Sophia; Zungu, Muzimkhulu; Yassi, Annalee
    In the wake of a large burden of silicosis and tuberculosis among ex-miners from the South African gold mining industry, several programmes have been engaged in examining and compensating those at risk of these diseases. Availability of a database from one such programme, the Q(h)ubeka Trust, provided an opportunity to examine the accuracy of length of service in predicting compensable silicosis, and the concordance between self-reported employment and that officially recorded. Compensable silicosis was determined by expert panels, with ILO profusion ≥1/0 as the threshold for compensability. Age, officially recorded and self-reported years of service, and years since first and last service of 3146 claimants for compensable silicosis were analysed. Self-reported and recorded service were moderately correlated (R = 0.66, 95% confidence interval 0.64–0.68), with a Bland–Altman plot showing no systematic bias. There was reasonably high agreement with 75% of the differences being less than two years. Logistic regression and receiver operating characteristic curve analysis were used to test prediction of compensable silicosis. There was little predictive difference between length of service on its own and a model adjusting for length of service, age, and years since last exposure. Predictive accuracy was moderate, with significant potential misclassification. Twenty percent of claimants with compensable silicosis had a length of service <10 years; in almost all these claims, the interval between last exposure and the claim was 10 years or more. In conclusion, self-reported service length in the absence of an official service record could be accepted in claims with compatible clinical findings. Length of service offers, at best, moderate predictive capability for silicosis. Relatively short service compensable silicosis, when combined with at least 10 years since last exposure, was not uncommon.
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    Workers' compensation claims for occupational Tuberculosis in South African health care workers: A survey of process and outcomes
    (2018) van de Water, Nicholas; Ehrlich, Rodney; Yassi, Annalee
    Background Occupational TB is the most frequently reported occupational disease in health care workers (HCWs) in South Africa. With the emergence of drug resistant strains and their associated health risks, and the associated increased risk for contracting these strains for HCWs, it becomes increasingly important to ensure that the worker’s compensation system is functioning properly for this disease. Whilst many studies have captured the poor functioning of the compensation system for workers in general in South Africa, the closest proxy examining the compensation of HCWs compensation for occupational TB is a study reviewing practices of occupational health nurses responsible for these cases. Whilst examining occupational injuries, workers, in general, report negative experiences with workers’ compensation processes. This study aimed to investigate the experience of health care workers whose cases of occupational TB were reported via the Western Cape Government Health department (WCG:H) to the Compensation Fund of the Department of Labour for compensation claim purposes. Methods This study was a case series with retrospective description, with a qualitative component. Simple random sampling was done on a subset of the population of cases of occupational TB recorded on a database held by the WCG:H administrative office responsible for submitting claims on behalf of WCG:H employees to the Compensation Fund. The study aimed to interview at least 100 HCWs who had reported their occupational TB as per the above mentioned database. In anticipation of a low expected response rate, 300 cases were sampled. Claim status for this sample were evaluated. Utilising general details obtained, an attempt was made to contact each HCW for a telephonic interview consisting of both open and close-ended (qualitative) questions. Fifty-one interviewers were completed. Interviews comprised of a structured telephonic interview carried out by one of three interviewers. The questionnaire consisted of three main sections examining (a) the experience of benefits available for people getting an occupational disease; (b) the experience of the process of reporting a case of an occupational disease to the Compensation Fund and (c) the process of having developed occupational TB as a HCW. Results Nearly half of the 300 cases from the provincial database had no record found on claim status check on the Compensation Fund website (n = 131, 46%). For claims without resolution with either acceptance or repudiation, the median waiting period from date of submission to 31 Dec 2017 was 5.8 years (IQR 3.2 - 9.2). 51 of the 144 cases for which contact attempt was made, gave consent (35% consent rate). Just under one third (n = 15, 31%) of the interviewees did not access occupational leave for their TB. Three quarters (n = 39; 75%) of employees incurred medical costs either personally or by their personal medical aid in relation to their diagnosis and treatment of TB. 21 (42%) of the participants reported ongoing medical problems and one reported being compensated for this. HCWs’ experience of contracting TB was marked by the experiences of stigma, surprise in contracting TB and financial stress as a result of their diagnosis. In addition, the experience of reporting their cases for compensation purposes was marred by poor administration and communication from all parties involved in the process. Conclusion The workers’ compensation system, i.e. the whole process from reporting through to benefit provision, has again been found to have many deficiencies. In this instance, HCWs are not receiving compensation benefits rightfully due to them for occupational TB. The experiences of HCWs contracting TB have been described as mostly being negative. In these negative experiences remedies to the system can be sought. The administrative components of submitting a claim, both by the claimant and by WCG:H to the Compensation Fund, have been found in this study to have a number of obstacles and gaps. Reform in communication, record keeping and timeously checking of claim status and payment of relevant compensation are required from the provincial level. Dedicated occupational health services were recommended by participants as these were expected to improve the service to potential claimants, as well as provide a source of information about the diagnosis and compensation aspects.