Dr Thuthula Balfour-Kaipa Head: Health Department Chamber of Mines of South Africa

1. Presentation to the Parliamentary Portfolio Committee on Health 5 September 2012 Dr Thuthula Balfour-Kaipa Head: Health Department Chamber of Mines of South Africa CHAMBER OF MINES OF SOUTH AFRICA Putting South Africa First

2. Outline • Background to mining industry • Magnitude of occupational diseases • Approach by industry • Tuberculosis • Approach to TB • Challenges • Compensation • Ex-Mineworker Project • Conclusion

3. Background information on mining industry • Chamber members represent: • < 20% of mines • - 85% of employees • - 80% of production • - 80% of gold employees • in three companies

4. Occupational diseases in mining industry

5. Trends for NIHL Marked reductions over time but evidence of plateauing

6. Trends for silicosis No signs of a decline

7. Trends for TB Stabilising and indications of decline

8. Approach Prevention of exposures

9. Tripartite • Mine Health and Safety Council • Established under MHSA to promote health and safety. • Funded through levies from mining companies. • Tripartite representation. • Products include guidelines and audit tools. • Regulation and monitoring by Department of Mineral Resources • Duty of employers under MHSA to review hazards, risks, do occupational hygiene measurements and establish medical surveillance. • Annual and monthly reporting of occupational diseases, inspection of occupational health service. • Censoring where required.

10. Industry Milestones • 2008- Industry milestones for 2013 • Noise • After 2008 - no deterioration in hearing greater than 10% amongst occupationally exposed individuals • 2013 - total noise emitted by all equipment installed in any workplace must not exceed a sound pressure level of 110dB(A) • Dust • 2008 - 95% of all exposure measurement results below OEL for respirable crystalline silica of 0.1mg/m3 • 2013 - no new cases of silicosis will occur amongst previously unexposed individuals

11. 2011 - Summit Commitments • 2011 Industry Summit on Health and Safety recognised progress made and need for accelerate meeting of milestones. New commitments: • Re-examine the return to risk-work of miners with HIV/AIDS, TB and Silicosis. • Investigate the policy and regulatory framework to reduce the silica OEL in line with international benchmarks. • Develop a standard operating procedure for independent verification of dust measurements reported by mines.

12. MOSH Learning Hub • Chamber initiative, established in 2008. • Principle is to promote the adoption of leading practices throughout industry. • Dust and noise teams to address silica dust and noise. • Identify leading practices from companies and disseminate to others.

13. Tuberculosis

14. Risks for tuberculosis

15. HIV a key driver of TB epidemic in SA and mining industry DOH TB Strategic Plan, 2007

16. Response: Tripartite initiatives

17. New Tripartite Summit Commitments • Referral system to ensure access to continued treatment beyond employment. • Establishment of a national repository on employee health information. • Ensure that renewals and new mining licenses have strategic and operational plans for TB, HIV and AIDS. • Promote access for families and immediate communities.

18. Response: Chamber initiatives

19. TB Reviews • Internal reviews by Chamber members: 2010 and 2011 • External reviews in three biggest gold companies :2011 • Report on gold companies submitted to Ministers of Health and DMR. • External reviews of platinum companies in 2012.

20. Results of TB Reviews in gold sector Areas of strength Areas of improvement • DOTS programmes • TB culture • Hospitalisation • Laboratory services • Pharmacy services • Pharmaceutical services • Keeping of TB registers • Patient referral systems • Policies on contractors • Case finding

21. Challenges for TB

22. ODMWA (Dept of Health) Compensation COIDA (Dept of Labour) All occupational diseases except cardiopulmonary organs of mineworkers Administered by Rand Mutual Assurance (RMA) in mining. • Occupational lung diseases in mineworkers (and works) Two compensation systems

23. Constitutional Court ruling on ODMWA Mankayi versus AngloGold Ashanti case: • The issue before court: • Whether section 35(a) of COIDA extinguishes the common law right of mineworkers to claim for occupational injuries or diseases from negligent owners • The judgment • “employee” in section 35(1) of COIDA only applies to those under COIDA, not employees under ODMWA. • Constitutional matter of right to freedom and security under section 12 (1)(c). Extinguishing common law right impinges on this right. This is particularly so if one cannot claim against COIDA but can only get paltry compensation under ODMWA.

24. Differences between COIDA and ODMWA

25. Differences between COIDA and ODMWA

26. Differences between COIDA and ODMWA

27. Challenges with ODMWA • Short-term • Administrative inefficiencies leading to non payment for compensatable diseases (delays and non-nationals), • no adjustment to benefits. • No indemnity for employers. • Medium-term Status of Fund - Liabilities that are accumulating due to: • Non –payment of compensation due to miners • Unclear quantum of deficit as per valuations. • Inadequate benefits, as per Mankayi judgment.

28. Ex-Mineworker Project • Tripartite initiative between DOH, NUM and Chamber to improve access for mineworkers to compensation. • R42 million funding over 6 years from 2007 • Three components • Benefit examination sites • Support to CCOD and MBOD • Socio-economic development • Benefit examination sites set up or strengthened in Nongoma, Mthatha, (Butterworth), North West and Free State.

29. Progress with project • Very slow, dependant on provincial departments of health. • Major blockage in payouts at CCOD.

30. Way forward with compensation • Situation is untenable. • Review of the compensation systems required. • Aim should be better benefits and restoration of “no fault”, functioning compensation system.

31. Conclusion • Occupational diseases in mining are mainly silicosis, NIHL and occupational TB. • Progress is being made in the control of these diseases, but concerns persist around silicosis. • The compensation for occupational lung diseases is inadequate and administrative inefficiencies cause great hardship for mineworkers. • All stakeholders need to work together in preventing occupational diseases and improving the health of mineworkers.