Workers' compensation claims for occupational Tuberculosis in South African health care workers: A survey of process and outcomes

Background Occupational TB is the most frequently reported occupational disease in health care workers (HCWs) in South Africa. With the emergence of drug resistant strains and their associated health risks, and the associated increased risk for contracting these strains for HCWs, it becomes increasingly important to ensure that the worker’s compensation system is functioning properly for this disease. Whilst many studies have captured the poor functioning of the compensation system for workers in general in South Africa, the closest proxy examining the compensation of HCWs compensation for occupational TB is a study reviewing practices of occupational health nurses responsible for these cases. Whilst examining occupational injuries, workers, in general, report negative experiences with workers’ compensation processes. This study aimed to investigate the experience of health care workers whose cases of occupational TB were reported via the Western Cape Government Health department (WCG:H) to the Compensation Fund of the Department of Labour for compensation claim purposes. Methods This study was a case series with retrospective description, with a qualitative component. Simple random sampling was done on a subset of the population of cases of occupational TB recorded on a database held by the WCG:H administrative office responsible for submitting claims on behalf of WCG:H employees to the Compensation Fund. The study aimed to interview at least 100 HCWs who had reported their occupational TB as per the above mentioned database. In anticipation of a low expected response rate, 300 cases were sampled. Claim status for this sample were evaluated. Utilising general details obtained, an attempt was made to contact each HCW for a telephonic interview consisting of both open and close-ended (qualitative) questions. Fifty-one interviewers were completed. Interviews comprised of a structured telephonic interview carried out by one of three interviewers. The questionnaire consisted of three main sections examining (a) the experience of benefits available for people getting an occupational disease; (b) the experience of the process of reporting a case of an occupational disease to the Compensation Fund and (c) the process of having developed occupational TB as a HCW. Results Nearly half of the 300 cases from the provincial database had no record found on claim status check on the Compensation Fund website (n = 131, 46%). For claims without resolution with either acceptance or repudiation, the median waiting period from date of submission to 31 Dec 2017 was 5.8 years (IQR 3.2 - 9.2). 51 of the 144 cases for which contact attempt was made, gave consent (35% consent rate). Just under one third (n = 15, 31%) of the interviewees did not access occupational leave for their TB. Three quarters (n = 39; 75%) of employees incurred medical costs either personally or by their personal medical aid in relation to their diagnosis and treatment of TB. 21 (42%) of the participants reported ongoing medical problems and one reported being compensated for this. HCWs’ experience of contracting TB was marked by the experiences of stigma, surprise in contracting TB and financial stress as a result of their diagnosis. In addition, the experience of reporting their cases for compensation purposes was marred by poor administration and communication from all parties involved in the process. Conclusion The workers’ compensation system, i.e. the whole process from reporting through to benefit provision, has again been found to have many deficiencies. In this instance, HCWs are not receiving compensation benefits rightfully due to them for occupational TB. The experiences of HCWs contracting TB have been described as mostly being negative. In these negative experiences remedies to the system can be sought. The administrative components of submitting a claim, both by the claimant and by WCG:H to the Compensation Fund, have been found in this study to have a number of obstacles and gaps. Reform in communication, record keeping and timeously checking of claim status and payment of relevant compensation are required from the provincial level. Dedicated occupational health services were recommended by participants as these were expected to improve the service to potential claimants, as well as provide a source of information about the diagnosis and compensation aspects