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

• Main Authors: Regiane Garcia, Jerry M. Spiegel, Annalee Yassi, Rodney Ehrlich, Paulo Romão, Elizabete A. Nunes, Muzimkhulu Zungu, Simphiwe Mabhele
• Format: Article
• Language: English
• Published: MDPI AG 2020-10-01
• Series: International Journal of Environmental Research and Public Health
• Subjects: occupational health; health workers; rights; laws; governance; implementation science
• Online Access: https://www.mdpi.com/1660-4601/17/20/7546
• ISSN: 1661-7827; 1660-4601

Given the very<b> </b>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.