Include all workers exposed to silica dust in anti-TB programme: Govt of India told

Counterview Desk
In a letter, sponsored by well-known civil rights organization, Occupational & Environmental Health Network of India and signed by more than 60 professionals and activists*, Dr Harsh Vardhan, Union Minister of Health and Family Welfare, Government of India, has been told that Indian policy makers shouldn't just acknowledge higher TB risk to mine and stone crusher workers, but also “other silica-exposed workers”.
The letter insists, “Silica-dust exposures among miners, building and construction, stone cutting/crushers, pottery, steel and allied factory, ceramic, thermal power and other workers increases the risk of active TB by three to four times”, adding, “The combination of silicosis and HIV further increases the risk of acquiring active TB by 15 times.”
It says, against this backdrop, it is time the Revised National Tuberculosis Control Programme (RNTCP) should “recognize and prioritize all silica-exposed workers for screening and treatment services”, and not just those that have been listed.

Text:

We are contacting you in regards to the National Strategic Plan for Tuberculosis (TB) Elimination (2017–2025) and associated policies being implemented by Revised National Tuberculosis Control Programme (RNTCP) in regards to targeted screening and interventions. We are a concerned group of health professionals and NGOs working to increase awareness of the opportunities to prevent TB with silica dust controls in the workplace.
For more than one hundred years, silica dust has been linked to higher TB prevalence rates among workers in dusty occupations. Multiple studies from India and abroad have demonstrated that silica-dust exposures among miners, building and construction, stone cutting/crushers, pottery, steel and allied factory, ceramic, thermal power and other workers increases the risk of active TB by three to four times. The combination of silicosis and HIV further increases the risk of acquiring active TB by 15 times.
We note that the National Strategic Plan does acknowledge the risk to mine and stone crusher workers as priorities for active case finding, but it fails to mention other silica-exposed workers and it does not provide any road map for preventing TB among this vulnerable population.

The five prioritized risk groups listed (page 66) mention silicosis patients, but not silica-exposed workers. In addition, we know that informal sector workers tend to have higher silica dust exposures and less access to medical services and therefore this subpopulation should be given greater attention.

The recent UN General Assembly Declaration from the High-level Meeting on TB requires countries to commit to “implementing primary prevention in high-risk occupations by reducing silica dust exposures in mining, construction and other dusty workplaces.” Efforts to target vulnerable workers and communities should incorporate training with strategies to implement silica-dust control measures.
Published studies have demonstrated that the adoption of low-cost wet processing methods in India can reduce respirable silica dust among highly-exposed workers by 80% in these operations. Studies conducted among miners and quarry workers have shown that reducing silica dust can significantly reduce TB incidence. In acknowledging these risks, other national TB programmes have adopted policies calling for increased regulation to improve workplace dust controls.
Therefore, we are requesting the following response on behalf of the RNTCP:

1. Formally recognize and prioritize all silica-exposed workers for screening and treatment services.
2. Expand programmes with NGO partners to include training, capacity building, mapping and in targeting high-risk workers for screening and treatment services. 
3. Initiate inter-ministerial level dialogue to improve regulations and its application on respirable silica dust controls in the workplace and build capacity among the inspectorates to enforce these measures. 
4. Initiate a programme to target informal sector workers for TB surveillance and control in construction, quarries, mining, and other dusty workplaces in particularly for migrant workers.  
5. Increase training opportunities for medical officers in RNTCP programme to improve the diagnoses of silicosis and silico-tuberculosis and in particular, the NIOSH “B” reader certification. 
6. Join in efforts at the Supreme Court and at the National Human Rights Commission to recognize TB and silicosis as compensable diseases for informal sector workers with a history of silica-dust exposures. 

We urge the RNTCP to implement these measures to help achieve its goal of eliminating TB in India by 2030.
Please respond to Jagdish Patel, national coordinator (oehni.del@gmail.com), to inform us on progress with these requests. List of the people who have endorsed this letter is attached herewith which includes luminaries in their own field spreading across the globe.
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*Click HERE for the list of signatories