According to the Global Tuberculosis Report 2021 made by the World Health Organization (“WHO”), tuberculosis (“TB”) is a disease that is one of the leading causes of death worldwide. TB is an infectious disease that can attack the lungs and other organs. According to said report, Indonesia, Philippines, and India had previously been the top three contributors to the global increase in TB notifications between 2013-2019. Indonesia was also on the list of countries with a high risk of TB, HIV-associated TB, and MDR/RR-TB.[1]

With high international pressure to reduce the spreading of this infectious disease, Indonesia released Presidential Regulation No. 67 Year 2021 regarding the Mitigation of Tuberculosis (“PR No. 67/2021”) as a guideline for other regulations regarding TB to follow. As such, the Indonesian Ministry of Health (“MOH”) had also created a National Strategy for the Eradication of TB 2020-2024 as a commitment to reduce the percentage of TB in Indonesia. The aim of the government is to eliminate tuberculosis by 2030 and meet a tuberculosis-free Indonesia by 2050.

According to the MOH strategy report, it is mentioned that one of the root causes of the continuous TB cases in Indonesia is due to the limited ability of healthcare workers to provide sufficient counseling, information, and education in workplaces. Workplaces, where many individuals are gathered, are considered to be a high contributor to the spread of TB in Indonesia.

Since workplaces are considered one of the areas where TB is spreads, the Ministry of Manpower (“MOM”) deemed it necessary to release a regulation as concrete implementation of TB mitigation that must be followed by all employers in Indonesia. The Regulation of the Minister of Manpower No. 13 Year 2022 or “MOM Regulation 13/2022” regarding ‘Mitigation of Tuberculosis in Workplaces’ was recently enforced in 22 September 2022. MOM Regulation 13/2022 is considered to be a furtherance and a clear technical provision of the Occupational Safety and Health efforts in Law No. 1 Year 1970 regarding Occupational Safety or Keselamatan Kerja in regards to TB.

According to Article 2 Paragraph 3 of MOM Regulation 13/2022, the requirement for employers or managers is carried out through 5 (five) steps:

1. Formulation of policies for the mitigation of TB in workplaces;
2. Promotion (sosialisasi), dissemination of information, and education on TB in workplaces;
3. TB case finding;
4. Handling of TB cases; and
5. Restoration of health.

The first and second requirement is considered as precautionary step that should be taken by employers to ensure the preventive action against TB spreading.

Firstly, regarding the formulation of policy for the mitigation of TB in workplaces. According to our discussion with the officer in the K3 Department of MOM, this requirement can be included as a part of the employers’ company regulation (peraturan perusahaan). Article 3 Paragraph 2 of MOM Regulation 13/2022 leaves the discretion to employers to formulate the policy as long as it contains:

1. The commitment of employers in conducting the mitigation of TB in workplaces;
2. Work programs for the mitigation of TB in workplaces; and
3. The elimination of stigma and discrimination towards workers/laborers suffering from TB.

As long as the company regulation includes the three elements above, it is sufficient to deem it as completing the requirement to formulate a policy in regard to TB.

Secondly, Article 4 of MOM Regulation 13/2022 on the promotion, dissemination of information, and education on TB in workplaces. As the confirmation from the K3 Department of MOM, this can be in the form of posters or banners that are displayed the office that can reach to all workers/laborers. The type of promotion, dissemination of information and education can also be in the form of a policy regarding the mitigation of TB, habituating clean and healthy lifestyle, habituating cough etiquette behavior, increasing body resistance through improving nutrition and fitness, education on the impact of comorbidities (penyakit penyerta) on the worsening of TB, and carrying out maintenance and improvement on the quality of workplaces.

The third to fifth requirement is considered as the curative and rehabilitative aspect of TB spreading. This would only become a requirement once there is a suspicion of a worker/laborer infected by TB caused by occupational diseases (penyakit akibat kerja). Occupational diseases are diseases specifically caused by work and/or work environment. This can happen because a certain industry is considered a high risk of TB spreading such as a factory (pabrik) with 100+ workers/laborers. 

Thirdly, Article 5 of MOM Regulation 13/2022 on TB case finding. It is important for employers to be aware of existing TB cases within their respective offices. This can be done by the effort of TB case finding. This would depend on whether employers provide health care programs for their employees, such as an initial and periodic medical examination for workers/laborers; special medical examination for groups with certain risks level (i.e. commodities, exposure to the hazardous work environment, exposure to TB bacteria due to their work) and investigating and examination of close contact cases in workplaces.

If the employers do not provide a health care program, TB case detection can also be from the initiative of workers/laborers by using their Social Security Agency of Health (Badan Penyelenggara Jaminan Sosial or “BPJS”). Then workers/laborers can voluntarily disclose to the employer if there is any indication of TB in order to avoid the spreading of the disease in the workplace.

Fourth, Article 6-8 of MOM Regulation 13/2022 on the handling of TB cases. Employers are obliged to ensure that workers/laborers suffering from TB receive proper treatment. Also, in order to prevent TB cases from spreading employers can also have the discretion to provide sick leave with a minimum of 2 (two) weeks for the initial stage of treatment or based on the recommendation of the assigned doctor. Employers are also required to conduct monitoring of both the TB patients and the rest of the employees within the company towards new arising cases of TB in the workplace.

Lastly, Article 9 of MOM Regulation 13/2022 on the restoration of TB patients’ health. Employers are required to provide support towards rehabilitation needed by the worker/laborer. Bringing the worker/laborer back to work will be based on the assessment of the assigned doctor.

Any kind of supervision regarding the employees’ compliance with the technical requirement in the mitigation of TB in workplaces will be conducted by the Manpower Supervisor. Their assessment would depend on whether the industry environment is a high or low risk of TB and the number of workers/laborers involved. Currently, there is yet a concrete sanction for employers that have not complied with this new regulation. However, during a sudden inspection by the Manpower Supervisor where the employers can provide proof of compliance (i.e. seminar attendance report, a photograph of TB education in the office, email distribution on the TB awareness, posters/banners of TB awareness) it will be considered as a positive remark by the MOM.

A non-compliance can result in the issuance of a notification by the relevant manpower supervisor to comply with this new regulation and requirements. Therefore, we recommend that employers begin to comply with the effort to mitigate the spreading of TB in workplaces in accordance with MOM Regulation 13/2022. Preferably by means of increasing awareness among workers/laborers on the dangers of TB in workplaces.