Accepted paper:

Consumed in care: health workers in India's TB control program - a case study of Mumbai, India


Ramila Bisht (Jawaharlal Nehru University)

Paper short abstract:

Based on newspaper epidemiology and multilevel TB worker ethnography, the paper highlights limitations of proposed biosafety measures of RNTCP in safeguarding its workers assigned to control TB in Mumbai. It argues for attention on embedded determinants of health of these insecurely employed workers.

Paper long abstract:

Based on newspaper epidemiology and multi-level TB worker ethnography, this paper aims at understanding the limitation of the Revised National Tuberculosis Control Programme (RNTCP) in safeguarding its health workers assigned to control tuberculosis in Mumbai. While newspaper stories in general are offered as a 'case by case' basis, the paper attempts to unravel the challenging discourse of embedded determinants of health which applies as much to these health workers as to the poor urban patients they serve. Megapolis of Mumbai represents Indian cities with its huge disparities in economic development and in the quality and quantity of healthcare. Drawing on case studies of healthcare workers infected with TB, from facilities that are sufficiently representative to account for variances in epidemiology, economic development and facility resources, the paper argues that immediate planning on part of the RNTCP to assist in infection control in institutional setting, where it is often encountered and treated, may go some distance in controlling tuberculosis amongst healthcare workers. However any measures aiming to combat the transmission of TB should take into account the health service system as a whole, whether it's a health institution or out-reach locales and workers. Further biosafety measures alone will not suffice to treat and eliminate tuberculosis even among healthcare workers without addressing systemic issues like contractual or temporary nature of job, nutritional problem(not just quantity but also quality), along with addictions and psychological and emotional stress that health workers face today in their increasingly inadequate and alienating form of insecure occupation.

panel P11
Infectious disease and wealth: exploring the links between tuberculosis and the political economy