Factors Accounting for Tuberculosis Stigma and Discrimination among Health Workers. A Study in Korle-Bu Teaching Hospital.

Abstract

Tuberculosis is one of the communicable diseases that infect people across the world. Various drugs are available for the effective management of the disease but most patients default treatment. Defaulting treatment is often attributed to the long duration of treatment and the stigma associated with the disease. Like other stigmatized diseases such as mental illness and HIV/AIDS, patients are discriminated by the family and community members. They are isolated and refused socialization with the family or community members. The stigma and discrimination is extended to health workers in the Tuberculosis unit in health facilities. Health workers in the unit are discriminated against in terms of personal development, distribution of goods, socialization, recognition and respect. This study sets out to investigate the factors accounting for the stigma and discrimination against workers of the TB unit/department by health workers with the aim of making recommendations that will help health facility managers to reduce/minimise the practice of stigmatization and discrimination at workplace. The study was carried out in Korle-Bu Teaching hospital in June 2004, using a mix of qualitative and quantitative data collection methods. The study yielded a number of findings: First, there was general awareness of TB and its management strategy- Direct Observed Treatment Short Course (DOTS) by most of the health workers in the hospital. Majority (68.5%) of the professional groups such as doctors, nurses, laboratory and radiography staff have had refresher training on TB and DOTS within the last eight (8) years. Only the non - professional groups like Ward Aides, Orderlies and Labourers never had any pre-service training or refresher training on TB. Despite this awareness and refresher trainings, the discrimination against the workers of the TB unit was prevalent among all the groups. A second critical finding was the perception of the health workers about the workers of the TB unit/department. The TB department workers are perceived as having TB or are carriers of TB bacilli. For this reason, other workers do not want to socialise with the workers. This was partly due to inadequate knowledge, and largely to the influence of traditional belief and public perception of the disease. Another interesting finding of the study was the discrimination against the workers of the unit by fellow health workers. There was a general belief across the category of workers in the unit that they were being discriminated against by the workers in other units of the hospital. Some workers in the other units of the hospital confirmed the practice of discrimination. The major reasons assigned for the discrimination are fear of contracting TB disease if they socialize with the workers who are believed to have TB and the stigma associated with the disease. Based on these findings certain recommendations are made to reduce or eliminate the stigma and discrimination. First, the management of the hospital should develop a structured In-Service training plan for all categories of workers of the hospital on Tuberculosis with emphasis on effects of stigma and discrimination on TB patients and especially on workers rendering healthcare to the patients. Secondly, the hospital management should set up a committee to campaign against TB stigma in the workplace. Funds should be provided for the production of learning materials for all categories of workers in the hospital. Periodic social mix should be organised in the TB unit environment for all workers in the hospital. These measures may help reduce the stigma and discrimination against TB and the workers in the unit*