Tuberculosis in health workers as an occupational disease

Tuberculosis in health workers is legally accepted as an occupational disease in South Africa in settings where there are infectious tuberculosis patients. This commentary draws on the authors’ previous work and the voices of health workers to consider the implications of this legal status for the experience of health workers and their protection from occupational tuberculosis. Despite compensation and prevention legislation and numerous guidelines on protective practices, occupational tuberculosis is undercounted and the implementation of control measures inadequate. Important contextual causes are budgetary, staffing and managerial constraints in public sector facilities, and the limited ability of the state to deliver effective enforcement and compensation services. These factors shape the responses of health workers, such as lack of awareness of their rights as workers; and if diagnosed, fear for confidentiality, reluctance to disclose their illness and a sense of abandonment by the system and colleagues. Mobilisation of health workers for greater involvement in tuberculosis control practices is clearly needed. However, also needed is mobilisation of health workers to understand their rights and responsibilities as workers, despite the many burdens on health care delivery and vocational pressures to accept risk, and to demand both practical and psychosocial support if diagnosed.