OpiniãoThe 17 survey confirmed what had often been noted in qualitative studies consisting of interviews and focus group with worker representatives and unions, namely that compensation systems for workers with HIV and TB have been problematic. Although laws are generally in existence that apply to all workers including health workers, they have been difficult to interpret and implement. Most policies have lacked specific reference and guidance to compensation of health workers with HIV sero-conversion/AIDS and/or TB infection from health care settings. The lack of wide dissemination means that health workers are generally not aware of their rights. Such shortcomings have been noted by Tereskerz and Jagger (1997) with reference to health workers in the United States, but this matter has not itself been the subject of much explicit scholarly review.
A noted consequence of such shortcomings is that associated costs are directly borne by (externalized to) health systems and not attributed to the workplace where their inclusion would contribute to a more balanced consideration of the benefits of prevention. The principle that the employer should finance compensation costs of illnesses caused or aggravated by workplace exposures is well-accepted as illustrated in The ILO Technical and Ethical Guidelines for Workers Health Surveillance (1998), thus proper functioning of such systems can provide a powerful incentive for healthcare employers to invest in the health of the healthcare workforce. The process of appropriately documenting such work-related incidents would also ensure that under-reporting is avoided. From the point of view of the affected worker, furthermore, failure to acknowledge the work-relatedness of the acquired disease could lead to a loss of potentially more attractive compensating benefits for affected workers. However, the difficulty in defining what is and is not occupational in origin remains a potential obstacle. Also, the issue of secondary transmission poses a challenge (i.e. a spouse who becomes infected by a partner who acquired his/her infection from workplace exposures).
Sagoe-Moses et al. (2001) discussed the costs of keeping healthcare workers in developing countries safe from bloodborne pathogens at work. They examined the particular difficulties in circumstances where resources are scare and necessary tools such as gowns and gloves are not available for workers. Whilst there would be a large amount of investment required to ramp up low and middle income countries to use safe needle technology, train healthcare workers and provide the necessary tools for uptake of universal precautions, Sagoe-Moses and colleagues argue that these expenditures should not be viewed as an increase in the cost of health care but, rather as insurance to protect each country's investment in its health care work force. The authors state that the inevitable consequence of continued inattention will be a mounting toll of disease and death among productive healthcare workers in places where their loss can least be afforded.
It can be concluded that while there is rationale that comprehensive workers compensation provisions provide a more stable and economically attractive way to deal with the problems of work-related disease, the inclusion of coverage for occupationally acquired HIV and TB for health workers is largely a rights-based issue. There is, however, evidence that the schemes that do exist require elaboration, clarification and widespread dissemination to the healthcare workforce. The potential for further stigmatizing of health workers who are deemed to have acquired their infection from non-occupational transmission should be considered when developing compensation packages.
The GG stressed that:
- Employers are required to provide compensation for income when it is lost due to time off work as the result of an occupationally-acquired disease.
- Employers are also required to provide psychological services when such incidents occur.
- It must be acknowledged that resources vary from country to country, however, a no fault system should be considered as a key principle.
- Legislation should include expedited adjudication for occupationally acquired disease, where it does not currently exist
- Mechanisms must be consistent with national occupational health and safety regulations.
- It seems unwarranted to require proof of occupational causation in individuals who sustain occupational exposures; a presumption of occupational causation may be appropriate in certain situations (e.g. exposure to TB at work).
• The following are recommended components of compensation package of an occupationally acquired HIV and/or TB: -Immediate PEP
-ART
-Treatment for disease, specifically in the initial period
-Paid leave for periods of sickness and absence (i.e. employers are required to provide compensation when salary is lost due to the disease.)
-Early retirement benefits connected to early resignation or doctor recommendation to stop working.
-Death benefits paid by the employer to survivors who have lost a breadwinner.