1. Chamber of Mines’ response to the SADC Declaration on TB in the Mines MMPA Conference 30 August 2013 Dr Thuthula Balfour-Kaipa Head: Health Department Chamber of Mines SA

2. Outline Need to act SADC Declaration on TB in the Mining Industry Analysis of declaration Chamber response to declaration Current initiatives Conclusion Need to act SADC Declaration on TB in the Mining Industry Analysis of declaration Chamber response to declaration Current initiatives Conclusion

3. The need to act on TB TB incidence in mining higher that normal SA population rate Significant risks for TB in mining

4. Chamber approach to TB in mining Risks for TB Clinical management Rehabilitation Reduce migrancy Living conditions Nutrition HIV Dust control Active case finding Effective treatment Contact tracing Adequate referral Compensation MHSC Mining charter Company level MOSH MHSC Mining charter Company level MOSH TB Reviews MHSC TB Leading Practices TB Reviews MHSC TB Leading Practices Ex-Mineworker Project Interventions

5. History of the SADC Declaration on TB in the Mines Criticism of industry from 2007 Signing of SADC Declaration by Heads of State in August 2012

6. Elements of SADC Declaration on TB in Mining Industry 1. Accountability and coordination2. Supportive policy and legislative environment3. Strengthen programmatic interventions 4. Disease surveillance 5. Programme monitoring and evaluation6. Financing

7. Chamber response to SADC Declaration Encapsulated in: STRATEGIC FRAMEWORK FOR REDUCING TB, HIV AND SILICOSIS IN THE MINING SECTOR IN THE SADC REGION May 2013 Encapsulated in: STRATEGIC FRAMEWORK FOR REDUCING TB, HIV AND SILICOSIS IN THE MINING SECTOR IN THE SADC REGION May 2013

8. Analysis of requirements from declaration SADC Declaration Priority Area What existsGaps Strengthening accountability, coordination and collaboration for TB, HIV and silicosis at national and regional levels Ministerial Tripartite TB, HIV structures already exist for accountability, coordination and collaboration on TB, HIV and silicosis. Country level task teams that provide oversight do not exist. Independent office of complaints on health related matters in mining industry does not exist.

9. Analysis of requirements from declaration SADC Declaration Priority Area What existsGaps Promoting a supportive policy and legislative environment -Supportive policy and legislative environment already exists. -Legislation for compensation for occupational lung diseases is deficient.

10. Analysis of requirements from declaration SADC Declaration Priority Area What existsGaps Strengthening programmatic interventions for TB, HIV, silicosis and other occupational respiratory diseases control -Programmes exist in companies -Medical costs related to occupational lung diseases are not well regulated -lack of alignment between workplace wellness services provided to employees, services provided to contractors and health- related community initiatives.

11. Analysis of requirements from declaration SADC Declaration Priority Area What existsGaps Strengthening disease surveillance system for TB, HIV, silicosis and other occupational respiratory diseases control -Industry meets all requirement

12. Analysis of requirements from declaration SADC Declaration Priority Area What existsGaps Strengthen programme monitoring and evaluation - Industry meets most requirements - There is no monitoring and evaluation of national budgeting, finance and spending on TB, HIV, silicosis and other.

13. Analysis of requirements from declaration SADC Declaration Priority Area What existsGaps Strengthening financing of TB, HIV, silicosis and other occupational respiratory disease interventions in the mines - Companies currently finance interventions on these diseases. - There are no national partnerships for resource mobilisation to support programmes on these disease.

14. Priority areas in Framework Surveillance and data Access to services for contractors, families and communities Referral systems Compensation

15. Approach to resource mobilisation in Framework Recognition of the SA mining industry’s regulatory framework Positive engagement with all stakeholders Recognition of all contributionsChoice for companies Linking internal capabilitie s to create external value Co-designing with partnersFocus on systems strengthening

16. Current initiatives Mine Health and Safety CouncilChamberCollaborations among companiesIndividual companies

17. MHSC Integrated policy of TB, HIV, silicosis Revision of DOH IPT policy to include silicosis National repository of employee health information Employee awareness of Mining Charter Summit Action Plan R15 m Collation of leading practices Promotion/dissemination of practices Promotion of TB Leading Practices R2 m Health impacts from dust emissions in tailings Reproducibility of digital X-rays Research R7 m

18. Chamber Gold sector – 2011 Platinum sector – 2012 Coal sector - 2013 External TB Reviews Benefit examination sites in Nongoma, Mthatha, North West, Free State Support to CCOD (DOH) Socio-economic projects Ex-Mineworker Project R42m/6years

19. Collaborations among compa nies Intensified case finding in peri-mine communities 5 companies Stop TB Reach Project R12 m Support to Mozambique health dept. TB Pillar 3 Mining companies GBC Health Initiatives

20. Conclusion Industry responding to the SADC Declaration on TB in Mining Sector. Progress being made on TB in mining. Commitment from companies to improve and extend TB services. Collaboration is key to addressing TB in mining and the region.