GOAL TO REDUCE THE IMPACT OF TB, HIV, OLDS AND NCDS AS OCCUPATIONAL HEALTH THREATS IN THE MINING SECTOR.

Private Sector Response to HIV and TB: 1 Masoyise Health Programme Acronyms & Abbreviations

AIDS - Acquired Immune Deficiency Syndrome NCD - Non-communicable Disease AMCU - The Association of Mineworkers and Construction Union NDP – National Development Plan ART - Antiretroviral Therapy NEDLAC - The National Economic Development and Labour Council AU – NGO - Non-Governmental Organisation BP – Blood Pressure NHI - The National Health Insurance BRPM - Bafokeng Rasimone Platinum Mine (Anglo Platinum) NIHL - Noise-induced Hearing Loss COIDA - The Compensation for Occupational Injuries and Diseases Act NIOH – The National Institute of Occupational Health COP - Code of Practice NSP – National Strategic Plan CSIR - The Council for Scientific and Industrial Research NUM - National Union of Mineworkers CTF – Culture Transformation Framework ODMWA - Occupational Diseases in Mines and Works Act CVD - Cardiovascular Disease OHS - Occupational Safety and Health DMRE - The Department of Mineral Resources and Energy OLD - Obstructive Lung Disease DOH – The Department Of Health PATHAUT - Pathology Automation DWCP - Decent Work Country Programme PPE - Personal Protective Equipment DWP - The Decent Work Programme RFT - Regional Tripartite Forums ECOSOC - United Nations Economic and Social Council chamber ROI – Return On Investment EOH - EOH Holdings Limited (EOH) is a holding Company SABCOHA- South African Business Coalition on Health and Aids HCT - HIV Counselling and Testing SADC - Southern African Development Community HMIS - Health Management Information System SAMI – South African Mining Industry HIV - Human Immunodeficiency Virus SDG - Sustainable Development Goals HPT - Hypertension SIMRAC - Safety in Mines Research Advisory Committee HTS – HIV Testing Services STI - Sexually Transmitted ILO - International Labour Organization TB - Tuberculosis LGBTIQ+ - Lesbian, Gay, Bisexual, Transgender, Intersex and Questioning TEBA - The Employment Bureau of Africa LTI - Lost Time Injuries UASA - United Association of MASOYISE - Masoyise Health Programme UN – United Nations MBOD – Department of Health Medical Bureau for Occupational Diseases UNAIDS - The Joint United Nations Programme on HIV and AIDS MHSA - Mine Health and Safety Act UNDP - The United Nations Development Programme MHSC - The Mine Health and Safety Council UNESCO - The United Nations Educational, Scientific and Cultural Organisation MINERALS UNFPA - The United Nations Population Fund COUNCIL - Minerals Council South Africa UNHCR - The United Nations High Commissioner for Refugees MITHAC - Mining Industry HIV/AIDS and TB Advisory Committee UNICEF - United Nations International Children’s Emergency Fund MOHAC - Mining Occupational Health Advisory Committee UNODC - United Nations Office on Drugs and Crime MOSH - Mining Industry Occupational Safety and Health learning hub UNOPS - The United Nations Office for Project Services MOU – Memorandum Of Understanding VCT - Voluntary Counselling and Testing MQA - The Mining Qualifications Authority WFP – The United Nations World Food Programme MTSF - The Medium Term Strategic Framework WHO – The United Nations World Health Organisation WIM – Women In Mining

Private Sector Response to HIV and TB: Private Sector Response to HIV and TB: 2 3 Masoyise Health Programme Masoyise Health Programme Acknowledgments

This publication would not have been possible without the contribution and roles played by the many stakeholders who came together to fight the Southern Africa TB crisis in the Mining Sector through Masoyise Health Programme (formerly known as Masoyise iTB).

It is truly a collaborative effort made possible by the generous contributions of many organisations, individuals and companies. The work would not have been as fruitful without everyone’s participation and we give thanks to everyone:

Ms Stella Nongingi – AMCU Mr Matthew Grant - AMCU Mr Charles Mkhumane – NUM Adv. Hanlie van Vuuren – Solidarity Mr Simphiwe Mabhele – ILO Dr. Pride Chigwedere - UNAIDS Dr. Lindiwe Ndelu - DMRE Ms Susan Preller – SABCOHA Dr. Muzimkhulu Zungu – NIOH Mr Johan Kok - UASA Dr. Barry Kistnasamy - DoH Mr Bethuel Dlamini - Harmony Gold

The publication showcases activities, lessons learned and practices, from the Masoyise Health Programme initiative in the Mining Sector that speak to how a multisectoral approach can achieve great results. It has looked at how a collaborative platform can be established and highlights details of how the processes through multiple ministries, sectors, and partners come together to address the factors contributing to TB, HIV and AIDS in the world of work.

Significant progress has been achieved since the launch of the Masoyise iTB Project in 2014 in creating a national platform for addressing TB and HIV/AIDS in the mining sector in South Africa.

Private Sector Response to HIV and TB: Private Sector Response to HIV and TB: 4 5 Masoyise Health Programme Masoyise Health Programme Meet the leading team behind the Masoyise Health Programme

Dr. Thuthula Balfour Elijah Mahlangu Stella Nongingi Simphiwe Mabhele Dr. Pride Chigwedere Dr. Lindiwe Ndelu – MINERALS COUNCIL - Project Manager - – AMCU – ILO – UNAIDS - DMRE SOUTH AFRICA MASOYISE HEALTH PROGRAMME

Matthew Grant Charles Mkhumane Adv. Hanlie van Vuuren Susan Preller Dr. Muzimkhulu Zungu - AMCU – NUM – SOLIDARITY – SABCOHA – NIOH

Private Sector Response to HIV and TB: Private Sector Response to HIV and TB: 6 7 Masoyise Health Programme Masoyise Health Programme Table of Contents PART

Acronyms & Abbreviations 2 Acknowledgments 4 Meet the leading team 6

PART ONE: STAKEHOLDER ROLES 9

Introduction 10 Stakeholders & Partners 13

PART TWO: MASOYISE ITB/HEALTH PROGRAMME IN ACTION 13

Finding missing cases 14 Masoyise in Action 14 Targets And Objectives 16 Table 1: Minerals Council member companies as a proportion of Industry 21 Figure 1: Trend in Percentage of workers counselled for HIV 21 Figure 2: TB diagnoses rates 22 Figure 3: TB Incidence rates 22 TB outcomes: TB Treatment outcomes by year: 23 The Rapid Appraisal initiative 25 Case-Study: Eastern Cape pledge – SABCOHA

Decent Work Country Programmes (DWCP) 28

PART THREE: MASOYISE TRANSITION 31

Transition Masoyise iTB to Masoyise Health Programme 32

PART FOUR: MESSAGES OF SUPPORT 35

Conclusion 36

Stakeholder Roles

Private Sector Response to HIV and TB: Private Sector Response to HIV and TB: 8 9 Masoyise Health Programme Masoyise Health Programme silicosis have been a challenge in the stakeholder initiative. It is made up Introduction South African industry, especially in the of representatives from the Minerals gold sector, for more than a century, Council member companies, trade South Africa has a long history of mining and its mining industry since the link between gold mining and unions (NUM, Solidarity, AMCU, seeks to position itself as a leading industry in all respects. It TB was discovered. The industry thus UASA), government (Department adheres to the set regulations, in so far possible, and adopts has vast experience in the management of Health (DOH) and Department of global of best practices to ensure progress and growth. and control of the disease. Mineral Resources (DMR), the Mine Health and Safety Council (MHSC), In 1995 South Africa became of the nations to adopt the For more than 35 years, the National Health Laboratory Service International Labour Organization’s Safety and Health in Mines organisation and its members have and National Institute of Occupational Convention (C176). Part of the Convention are the Decent Work also been addressing the HIV/AIDS Health), SABCOHA and multilateral Agenda and Decent Future of Work which form part of the challenge in South Africa and southern organisations including UNAIDS, ILO industry’s goals. Africa. Throughout this period, the and WHO. focus has been on prevention initiatives, counselling, testing and treatment for The Masoyise Health Programme was he purpose of this Convention employees, and various services for approved by the Minerals Council is to ensure that protection community members in mining and Board in November 2018 as a three- of the health and safety of labour-sending areas, where possible. year programme that will run till the Temployees and other persons end of 2021 to replace its precursor, at mines with the focus being on the Companies in the mining industry took Masoyise iTB. The programme has precautionary measures that should the lead in South Africa by providing a wider focus beyond TB and HIV. be taken concerning health and safety. “Effective interventions antiretroviral therapies to employees It has adopted a wellness approach It translates what was agreed on at who met the World Health Organization that incorporates non-communicable the annual labour conference, setting in mining require active (WHO) criteria. diseases and occupational lung comprehensive minimum standards collaboration between diseases. that are going to protect both women management, employees and In 2016, the Minerals Council , together and men working in mining from the regulations in order to work with organised labour, government dangers that might occur in the mines, (Tripartite) and other partners, as the nature of the work is hazardous towards the 2024 zero harm launched the Masoyise iTB with the and risky. milestones. This requires an goal of reducing the impact of TB and intensive focus on illnesses HIV as health threats in the mining This helps to implement a risk including tuberculosis (TB) and sector. management approach to safety “As a union we strive that requires risk to be eliminated, HIV/AIDS’’ - Head of Health Part of this goal for Masoyise iTB, which controlled and then minimised by Dr. Thuthula Balfour: Minerals was in line with industry milestones, to empower members a hierarchy of controls through Council was to drop TB incidence in the mines and workplace consultations between representatives to at or below the national average. representatives and of the government, of employers The initiative ran for a period of 3 years being part of Masoyise and of workers with consistency from 2016-2018 and formed part of the while resolving the challenges of The Minerals Council South Africa is an broader national campaign. This goal iTB is an incredible occupational safety and health in the advocacy organisation that represents was achieved in 2018 in the industry experience as it is very industry. Over the years the industry the interests of mining companies that but this was was not without the help close to what we stand has seen improvements in occupational are its members. Occupational lung of many other initiatives around the for.” - Johan Kok: UASA health and safety performance. diseases like tuberculosis (TB) and country and the mining industry.

The Masoyise iTB initiative is led by the Minerals Council, but has from the beginning been a collaborative multi-

Private Sector Response to HIV and TB: Private Sector Response to HIV and TB: 10 11 Masoyise Health Programme Masoyise Health Programme Stakeholders & Partners

NATIONAL UNION UASA THE NATIONAL INSTITUTE FOR OF MINEWORKERS UNION OCCUPATIONAL HEALTH

WORLD HEALTH MINERALS COUNCIL SOUTH AFRICAN ORGANISATION SOUTH AFRICA BUSINESS COALITION ON HEALTH & AIDS PART

DEPARTMENT OF INTERNATIONAL LABOUR NATIONAL MINERAL RESOURCES ORGANIZATION DEPARTMENT OF & ENERGY HEALTH

ASSOCIATION OF MINE HEALTH AND THE JOINT UNITED Masoyise iTB/ MINEWORKERS & SAFETY COUNCIL NATIONS PROGRAMME Health Programme CONSTRUCTION ON HIV/AIDS UNION in action

NATIONAL HEALTH LABORATORY SERVICE SOLIDARITY

Private Sector Response to HIV and TB: Private Sector Response to HIV and TB: 12 13 Masoyise Health Programme Masoyise Health Programme Masoyise in Action “Masoyise has given our union a lens that allowed us to zoom into the areas of concern as well as In 2014 Business, Government and Organised labour signed the agreement towards the 2024 milestones with a commitment to plan accordingly in support for in our activities” assist the mining industry in achieving set targets to reduce HIV – Charles Mkhumane: NUM and TB.

he Minerals Council responded South Africa’s TB and HIV challenges An electronic reporting system was put in place as a at a mining industry level, and reduce the high incidence rates, monitoring and evaluation tool and this was a major through the Mine Health and while seeking to ultimately eliminate success. The milestone targets on HIV counselling and TB Safety Council (MHSC) and TB and HIV. screening for 100% of employees annually was monitored T on the system. During this period Masoyise iTB took on committed to meet two milestones on With its inception Masoyise was to TB and HIV by the year 2024. address important pillars of the end- several activities that contributed to reducing TB in the TB Strategy industry, among these were: Masoyise iTB was the vehicle to achieve these milestones , as a multi- • Find missing cases stakeholder initiative that had a key • Early case detection • Monitoring TB outcomes: such as death, loss to follow-up, objective to meaningfully impact on • Early and successful treatment transfer-out, or those for whom the outcome is unknown, contribute to the low threshold level of success • HIV/AIDS reduction • TB contact tracing Early • Lending support to small mines case • Improving communication with mineworkers Early and detection successful treatment “We collect data on diseases and specifically Finding on TB, we as the dept. dealt with all mining missing companies even the smallest ones not, just the cases affiliates.” – Dr. Lindiwe Ndelu: DMRE

These aligned with the South HIV Counselling, Testing (HCT) and African National Strategic Plan TB screening annually, over a 3 for HIV, TB and STIs 2017-2022, year period as mine employees are Masoyise iTB was to offer all classified as a tuberculosis high risk employees in the mining sector group in South Africa.

Private Sector Response to HIV and TB: Private Sector Response to HIV and TB: 14 15 Masoyise Health Programme Masoyise Health Programme Achievements • AngloGold Ashanti • Sibanye-Stillwater Targets and Objectives The core activities undertaken by • Harmony Masoyise iTB were: • Goldfields.

• Monitoring programme Progress in Bojanala performance against TB and HIV targets The Bojanala Masoyise contact • Monitoring TB outcomes tracing task team has been continuing Masoyise iTB subscribed to international and national targets on TB and HIV as set out below: • Supporting small mines to trace contacts to TB index cases • TB contact tracing and in the district. Mining houses such as WHO End TB Strategy - 2025 UNAIDS Fast Track Strategy • Communication Bafokeng Rasimone Platinum Mine • Find at least 90% of people with on HIV -2030 (BRPM), Lonmin, Bushveld Vametco, TB, including key and vulnerable • 90% of people living with Contact tracing Glencore, Sibanye Stillwater, Minopex populations, HIV know their HIV status, and Impala reported on their annual • Place 90% on appropriate • 90% of all people living with 2016 saw a pilot project initiated in contact tracing activities. treatment HIV receive antiretroviral • At least 90% successful the West Rand district of Gauteng therapy and completion. and the main objective was to explore There has been notable progress • 90% of those receiving antiretroviral mechanisms of improving contact and successes in the Masoyise iTB treatment have viral tracing on all index cases identified contact tracing initiative with task suppression. through Masoyise in the mining sector. teams fulfilling their roles. The What the process does is identify, Bojanala team collectively identified diagnose and treat (where applicable) 488 TB indexes in 2018. Through people who have had contact with contact tracingmore cases were • 100% of an individual with a serious . identified, making a notable impact employees This is done so that the spread of an on TB control initiatives in the district. should be offered HIV infectious disease can be controlled Sixteeen (16) new TB cases were counselling and and in the case of the mining industry, diagnosed from the contacts of the testing annually and be tuberculosis (TB). indexes. Companies that had not linked to an antiretroviral Masoyise Targets reported before started to report therapy programme. Identifying TB contacts is valuable fully during the last 2 quarters of • To reduce TB incidence in • To counsel 100% of the mining sector to at or employees for HIV annually. as this is an important tool in TB 2018, indicating that the technical below the South African • To screen 100% of employees management and control. During guidance received from Masoyise rate by 2024. for TB annually using the cough this year the West Rand task team resulted in structural development questionnaire. implemented some of the key action within those companies. Mining industry points of Masoyise iTB, they met milestones regularly to formulate a strategy A significantly major breakthrough that ensured success. They collected that was made with medical aid data and monitored treatment companies linked to some of the outcomes and improved on access to reporting mining houses. Efforts by “The ultimate goal is to reduce TB incidence on diagnostics, treatment and tracing. mining companies ensured that a good working relationship between mines and in mining regions to below the rate This team has been the longest the mining houses and medical aids for the general population. It is hoped that the operating team. It’s been running like was established, and this ensured that national campaign will reduce TB incidence in a well-oiled machine with activities there was better TB control for both carried out smoothly and requiring stakeholders and improved quality of the country as a whole” – Dr Khanyile Baloyi, little to no intervention from Masoyise treatment for miners. Deputy Head of Health, Minerals Council management. The reporting houses are: The working relationship between

Private Sector Response to HIV and TB: Private Sector Response to HIV and TB: 16 17 Masoyise Health Programme Masoyise Health Programme • Many contacts were not available higher frequency on Masoyise iTB during the day because of work initiative or other commitments and this is • Provision of better education the time where NGOs can do the to mine workers and members contact tracing should be prioritised because this • Contacts were hard to find/ encourages the identified index locate in the communities due cases to disclose so that treatment to movements from one area to can be offered and decrease the another, e.g. Movement from West number of lost to follow ups. Rand to Labour sending area etc • A very high number of people could not be traced because they Lessons learnt were avoiding healthcare workers, Aurum Institute that was conducting making efforts in improving TB and this could be due to the contact tracing in the communities, prevention There is much confidence • A considerable amount of effort stigma attached, fear or a lack of and mines in the district improved shown by companies in the initiative. went into putting together and understanding the importance of in terms of communication and implementing the Masoyise iTB contact tracing and the positive reporting after a long period of Challenges initiative and its activities by impact it will have to them as misunderstandings that led to low different mining companies. individuals and their families. numbers of people being reached With every new initiative there is • And taking into consideration • Aurum Institute increased working through community contact tracing. bound to be challenges and these are (dependent on) drive and capacity, hours to try and solve the challenge to be expected. These usually come all the companies have somewhat of people that were not available The West Rand Mines community in the form of resistance because reached a level of achievement during the day because of work contact traced through the use of of the adoption to a new program and it did not come without its commitments. NGOs from professionals or from patients challenges. (workers) or funding based. The • The DoH is the country’s custodian All these efforts were primarily aimed at The quality of contact tracing data Masoyise iTB pilot program identified on Healthcare for the general public decreasing the number of people lost to from the mining houses has improved such challenges. Some of these were: and therefore should be playing a follow up. significantly due to improved more active and engaged role at a processes within mines and their • In 2016 not all the employees stakeholders, and this was through a were screened because of slow better understanding of the TB control implementation within individual program goals and activities. mining companies, very few index cases were identified in some A contact tracing reporting tool was companies and therefore resulting developed, and it indicated which in few contacts traced which index case was identified and to which does not give a full picture of TB “We put aside our mining company it was linked to. It incidence or prevalence within the went as far as identifying which peri- companies. ideologies and worked mining community or labour sending • Contact tracing in collaboration towards the benefit area the tracing was done in. with the Department of Health of our members who The tool listed the identified contacts was not as successful. There were to each index case and included mining houses that made use of matter the most. The a section on treatment outcomes the Department of Health (DoH) data collected through e.g. referred to clinic or initiated on for contact tracing in the peri- Masoyise iTB has helped treatment. mining communities, and because the collaboration was weak a big us to plan well for our Tracing contacts within the companies gap was never bridged. activities.” – Charles and the community has been a success • Many index patients gave Mukhumane: NUM through Masoyise iTB with numbers health care providers incorrect increasing every quarter, an indication addresses. that there is an uptake in companies

Private Sector Response to HIV and TB: Private Sector Response to HIV and TB: 18 19 Masoyise Health Programme Masoyise Health Programme Companies submitted their reports In 2018 a total of 32 companies, on TB and HIV via the Minerals representing 370,223 employees Figure 1: Trend in Percentage of workers counselled for HIV Council’s Health Information submitted year-end data. NAME Workers Counselled for HIV - % Management System (HIMS). The system hosted by Healthsource is The total number of employees covered available to all companies, including by the 32 companies represents those that are not members of the about 81% of the estimated 455,226 Minerals Council. employees in the mining industry.

2013 Table 1: Minerals Council member companies as a proportion of Industry 54.2% 2015 2014 79.1% 55.7% 2016 2015 70.6% 62.9%

2017 2016 84.0% 65.7% 2018 2017 72.0% 69.5% STEP 5: STEP 4: 2018 STEP 3: 2017 99.3% The Platinum mines had the highest were screened for TB in 2018 90.3%, STEP 2: 2017 87% percentage number of employees compared to the two previous years of 87% counselled sitting at 95% - but 90% STEP 1: 2017 saw a decline from their previous 87% achievement of 99% in 2017 • TB screening was highest in the 2017 platinum sector sitting at 97% and 87% Coal mines had the lowest percentage saw an improvement from the sitting at 67% though low they showed 94% reported in 2017 a significant increase when compared • Gold improved sitting at 96% as Compliance with reporting requirements improved from 87% of expected reports to their 54.9% reported in 2017 compared to 2017’s 91% finalised in 2017, to 99.3% finalised in 2018 There was no significant change in • Coal reported a screening of the percentage of employees that 74% for TB compared to its 77% achieved in 2017 they had a 3% HIV counselling declined There is clear evidence of TB Incidence The target for HIV counselling: 100% having declined since the 2015 of all employees should be counselled annually and those found eligible must TB Incidence across commodities be linked to an antiretroviral therapy programme (ART) Below is the TB cases and TB incidence across the commodities in 2018 The figure below shows how the • The risks for TB differ across number of employees counselled for commodities, with gold having the HIV improved by 8% reaching 84% in highest risk due to the presence of 2018 silica dust.

Private Sector Response to HIV and TB: Private Sector Response to HIV and TB: 20 21 Masoyise Health Programme Masoyise Health Programme Gold mines reported the highest When compared to the South African Figure 2: TB diagnoses rates (Mining industry vs Minerals Council) number of cases and a higher national incidence all commodities, incidence, while diamond mines except for gold, are below the South NAME Number of TB Diagnosed and incidence (per 100 000 pop) reported the lowest cases and African rate. incidence.

TB outcomes: TB Treatment outcomes by YEAR: 1610 435

111 121 Minerals Council COAL 87 197

OTHER

Treatment success Cured Treatment Treatment failed

11 93 completed

Diamond 715 921 Global% 82 Global% - Global% - Global% - 2015 (n=1054) 805 2015 (n=1054) 401 2015 (n=1054) 404 2015 (n=1054) 7 n% 76.4 n% 38.0 n% 38.8 n% 0.6 GOLD 685 475 2016 (n=829) 641 2016 (n=829) 337 2016 (n=829) 304 2016 (n=829) 4 n% 73.3 n% 40.6 n% 36.6 n% 0.5 Platinum 2017 (n=691) 554 2017 (n=691) 267 2017 (n=691) 287 2017 (n=691) 2 n% 80.2 n% 38.6 n% 41.5 n% 0.2

TB Diagonised TB Incidence (per 100,000)

Figure 3: TB Incidence rates (Mining industry vs Minerals Council) Global% - Global% - Global% - Global% - 2015 (n=1054) 158 2015 (n=1054) 76 2015 (n=1054) 158 2015 (n=1054) 1054 NAME TB incidence (per 100,000 population) n% 14.9 n% 7.2 n% 14.9 n% 100 2016 (n=829) 131 2016 (n=829) 49 2016 (n=829) 131 2016 (n=829) 829 n% 15.8 n% 5.9 n% 15.8 n% 100 2017 (n=691) 89 2017 (n=691) 41 2017 (n=691) 89 2017 (n=691) 619 2013 n% 12.8 n% 5.9 n% 12.8 n% 100 849 2015 2014 1068 957 Lost to follow-up Died Not evaluated TOTAL 2016 2015 740 884

2017 2016 548 834

2017 2018 545 435

Private Sector Response to HIV and TB: Private Sector Response to HIV and TB: 22 23 Masoyise Health Programme Masoyise Health Programme TB outcomes from 15,8% to 12.8% and coupled with a high death rate that ranged from The Rapid Appraisal initiative The National Institute for Occupation 5.9% to 7.2% as compared to the Health (NIOH) is part of Masoyise international milestone for death rate The initiative was a study conducted agreements with TEBA to follow up iTB and they were tasked with which sat below 5% to follow-up on mineworkers who left on workers that had gone home, one monitoring TB outcomes as defined the industry while on TB treatment. company had internal mechanisms for by the WHO. They provided results of The results if anything indicated, Eight companies were sampled, and it following up on the workers, while two TB programmes within the selected was found that five had service level had no mechanisms for follow ups. Minerals Council members, covering The results if anything indicated, the years 2015 – 2017. that there is room for improvement in fostering efforts strengthen TB The objectives of the NIOH were programmes and initiatives. to estimate the burden TB has and The data reflected on the outcomes Case-Study: evaluate the performance of the TB report was received from the following programmes across the 26 mines that companies: Eastern Cape pledge were invited to participate. Only 11 • Elandsrand Harmony Mine, accepted the invitation, 3 gold and 8 • Harmony Doornkop Sir Albert platinum. Mine, – SABCOHA • Anglo American Amandebult The findings were that the TB Mine, treatment success rate had been going • African Rainbow Minerals On December 2017, the Minerals carried out in partnership with Africa’s up slowly, moving from 76.4% in 2015 Modikwa Mine, Council announced its support for a largest technology service provide to 80.2% in 2017. • Anglo Platinum Mogalakwena health screening initiative in the OR EOH, together with the South African Mine, Tambo district of the Eastern Cape to Business Coalition on Health and Aids As positive as this is, it was still • Northam Platinum Setaria Mine, mark World Aids Day. The initiative was (SABCOHA). lower than the global treatment • Union Mine Swartklip Mine, success of 82% and the World Health • North West Andrew Safety Mine Organisation’s target of 85% - A Hospital and North West Bafokeng continuing concern was around the Rasemone Platinum Mine Clinic. percentage of employees that were not evaluated. This percentage ranged They all participated in the study

“SABCOHA has been part of Masoyise since the start of the programme providing support through technical input, coordinating contact tracing during the first 3 years of the programme as well as providing programme management and secretarial support.”- Susan Preller: SABCOHA

Private Sector Response to HIV and TB: Private Sector Response to HIV and TB: 24 25 Masoyise Health Programme Masoyise Health Programme The strategic objective here, was to With regards to the culture • Promotion of tripartite vsible felt provide a platform for business to unite transformation framework (CTF) leadership around health and productivity issues promoted by the Council, it was • Mining principals engagement/ in the workplace and beyond, which indicated that by December 2020 there meetings directly or indirectly affected returns on will be 100% implementation of the six • Improvements communications investment (ROI) and economic growth. pillars. During a Summit held on the • Addressing trust deficit The health screening programmes 17 - 18 November 2016, stakeholders • Supervisor and employee included HIV counselling and testing, “Being able to recommitted themselves to the agreed empowerment and; TB screening, glucose (sugar) 2014 milestones and further committed • Annual mining companies health measurement, and blood pressure, participate regularly to the implementation of the following and safety days height and weight measurement. at meetings within the initiatives: tripartite alliance links The campaign was a success with a total number of 7,500 people in deep directly to SABCOHA’s rural areas screened, 7.9% HIV positivity goals and objectives to “Coming from the Masoyise iTB project, we have rate was found with 3,150 people work closely with private direct contact with our union members regarding needing further screening for TB and 1,009 of those having partners that sector, government and all things Masoyise iTB. Having worked closely work in the mines. The Minerals Council labour. This facilitates together with employers, government, other also committed a large sum of funds a cohesive response stakeholders, and organised labour to curb the to the Eastern Cape province to be utilised for tracking and tracing of ex to comprehensive spread of TB and HIV in the South African mining mineworkers with unclaimed retirement wellness across all industry (SAMI), in line with the WHO’ goals funds and compensation benefits. sectors.” - Susan Preller: as well as our own to fight these diseases.” – These funds provided structural support to existing initiatives such as SABCOHA Matthew Grant: AMCU the joint exercise between government, unions and industry, Masoyise iTB initiative.

Private Sector Response to HIV and TB: Private Sector Response to HIV and TB: 26 27 Masoyise Health Programme Masoyise Health Programme Labour Council adopted a roadmap promote gender equality and the Decent Work Country in September 2019 to advocate for mainstreaming of gender within their Programmes (DWCP) the ratification of the ILO Convention trade union structures. Concerning the Elimination of Violence and Harassment in the World of Work The priorities for South (C190). The International Labour Organization South African women played a key Africa’s Decent Work Country (ILO) has had a convention in place role above-ground mining positions The Roadmap includes actions to Programme is to: since 1935 prohibiting the employment long before they were legally allowed sensitise civic and statutory bodies of women in underground mining to work underground from 1996 whose mandate is to promote • To promote more and better jobs; work. However, many countries that onwards. As women have gradually gender equality and the rights of • To broaden social protection initially ratified the convention have ecome formal participants in all women and persons in situations coverage; and since denounced it, including Australia aspects of the industry’s work, they of vulnerability to violence and • To promote strong and (1988), Canada (1978), Chile (1997) and have come up against a range of harassment. Subsequent to the representative employers’ and South Africa (1996). These countries challenges and restrictions. Over the adoption of Convention 190 and its workers’ organisations are now largely signatories to the ILO’s years, the industry has become better accompanying Recommendation 206, Convention 176 (Safety and Health in at identifying and dealing with these the ILO coordinated and facilitated, These priorities align to the national, Mines, 1995), which covers the rights of issues, so creating the conditions for in July 2019, a workshop of the sub-regional, continental and global all workers. more women to work underground. Gender Task Force comprised of frameworks, namely the NDP

gender focal points and male gender 2030, MTSF 2014-2019, the SADC Convention 176 states, “Contrary to Tripartism and social dialogue champions drawn from three trade Industrialisation Strategy and Roadmap the old approach based on the outright continues to be vibrant in South Africa union federations, which represent 2015-2063, the SADC DWP 2013- 2019, prohibition of underground work for and to play a key role in social and organised labour at National the AU Agenda 2063, AU Declaration all female workers, modern standards economic policy processes. At the Economic Development and Labour on Employment, Poverty Eradication focus on risk assessment and risk national level, social dialogue finds (NEDLAC). and Inclusive Development in Africa, management, and provide for sufficient significant expression through the and the 2030 Agenda for Sustainable preventive and protective measures for National Economic Development and The workshop also questioned the Development (SDGs). mineworkers, irrespective of gender, Labour Council (NEDLAC) which is adequacy of existing national policy whether employed in surface or a National Social Dialogue institution on sexual harassment and the need In line with the provisions of the ILO underground sites”. established in terms of the Nedlac Act for policy reform measures to be Declaration on Social Justice for a No.35 of 1994. undertaken parallel to the process Fair Globalization, the programmatic of ratification. The ILO facilitated approach towards implementing the Labour is represented on Nedlac by discussion on required actions by the DWCP will take due account of the the Federation of Unions of South Task Force to lobby for the speedy inseparable, interrelated and mutually Africa, National Council of Trade ratification of the Convention. The supportive nature of the four strategic Unions, and Congress of South Solidarity Centre and the Labour pillars of decent work. And this will African Trade Unions. Business is Research Services have been key necessitate collaborative work across all represented by Business Unity South partners to the ILO in advancing technical sectors of the ILO reflecting “Mainstreaming HIV Africa. The Department of Labour the agenda of the Gender Task the integrated approach required by the leads the government delegation. The and TB response into a Force of the Labour Federations to Social Justice Declaration. fourth constituency – “community” broader Health Workplace – is represented through a variety of Programme in the organisations representing different mining industry is key for interests, namely Disabled People South Africa, South African National achieving decent work.” Civics Organisation, South African - Simphiwe Mabhele: ILO National Youth Council, and the Women’s National Coalition. The Gender Taskforce of three Trade Union Federations represented in the National Economic, Development and

Private Sector Response to HIV and TB: Private Sector Response to HIV and TB: 28 29 Masoyise Health Programme Masoyise Health Programme global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals.

“’Our Mandate within Masoyise is the Aids response and that is linked to the TB response which is the biggest killer in South Africa “Masoyise is dealing with the and a large portion of that things that are at the core of TB links back to HIV/AIDS’’ our mandate which makes – Dr Pride Chigwedere: our interest direct given UNAIDS the broader SDG goals and the Global goal’’ – Dr Pride Chigwedere: UNAIDS The Joint United Nations Programme on HIV and AIDS is the main advocate for accelerated, comprehensive and coordinated global action on the HIV/ AIDS pandemic. The aim of UNAIDS The explicit recognition in the 2030 is to help mount and support an Agenda of the central place of decent expanded response to HIV/AIDS, one work as a goal and as an instrument that engages the efforts of many of sustainable development has sectors and partners from government provided the ILO with an unparalleled PART and civil society. Established by opportunity to take a leadership ECOSOC resolution 1994/24 on 26 role in promoting, and cooperating July 1994. not only with constituents in member States but also with a The programme was officially growing number of national and launched in January 1996. It international actors. ILO delivers a is under the guidance of a range of programmes to support programme coordinating board with countries in responding to HIV in representatives of 22 governments the workplace. It has embarked on from all geographic regions, the a series of rights-based initiatives Masoyise UNAIDS Cosponsors, and five for the implementation of ILO representatives of nongovernmental Recommendation No. 200, such as Transition organizations, including associations the VCT@WORK initiative, supported of people living with HIV/AIDS. by UNAIDS launched in 2013.

They unite the efforts of 11 UN Previously AIDS targets sought to organisations; UNHCR, UNICEF, WFP, achieve incremental progress in the UNDP, UNFPA, UNODC, UN Women, response, the aim in the post-2015 ILO, UNESCO, WHO and the World era is nothing less than the end of the Bank working together closely with AIDS epidemic by 2030.

Private Sector Response to HIV and TB: Private Sector Response to HIV and TB: 30 31 Masoyise Health Programme Masoyise Health Programme “Masoyise has provided the monitoring and Transition Masoyise iTB to Masoyise measurement tools for TB in the mining sector. Its expansion to non-communicable and occupational lung Health Programme diseases is welcomed. However there are still gaps in reaching the 90-90-90 targets.”– Dr. Barry Kistnasamy: Masoyise’s success, after it was reviewed in November 2018, gave Compensation Commissioner Department of Health rise to the Masoyise Health Programme. The steering committee decided to extend the initiative’s work over another 3 years (2019 -2021) with a wider focus beyond just TB and HIV. Strategy aligned to National • To put 2 million people on HIV Department Of Health treatment by end of December 2020 The broader focus on leading the What informs the new • To intensify TB case finding to commitments mining industry’s commitment strategy is: identify 80 000 missing TB patients encompasses the fight against • ILO Convention 176 on Safety and in year 1 South Africa’s National Strategic Plan for occupational lung diseases and non- Health in Mines, ratified by South • To intensify non-communicable HIV, TB and STIs 2017 - 2022 (NSP 2017- communicable diseases (NCDs) such Africa diseases (NCD) case finding and 2022) which sets following targets: as cardiovascular diseases (CVDs), • ILO Recommendation concerning screen 7 million people including hypertension (HPT), cancers, HIV and AIDS and the World of • To intensify STIs screening, diagnosis • Reducing TB incidence by at least chronic respiratory disease and Work No.200, noted by the South and treatment 30% from 834/100 000 in 2015, to diabetes, as these are the leading African parliament following its These align to Mine Health and Safety less than 584/100 000 in 2022 causes of mortality and disability adoption. Council’s commitments: (NB) Masoyise’s • Reduce new HIV infections to globally. • The Sustainable Development MOU with Mines Health and Safety less than 100 000 by 2022 (63% Goals (SDG). The relevant goals reduction) through combination are Goal 3 on Good Health and prevention interventions. MASOYISE’S MOU WITH MINE Wellbeing, Goal 5 on Gender • The country has now committed to HEALTH AND SAFETY COUNCIL. Equality and Goal 8 on Decent a National Wellness Campaign 2018 Work and Economic Development – 2020 OF EMPLOYEES • Global Plan to End TB. This calls ANNUALLY AND LINK for 50% reduction of TB incidence THOSE WHO TEST 100% POSITIVE TO AN ART by 2025, compared to 2015. (Stop NATIONAL STRATEGIC PLAN FOR PROGRAMME TB Partnership & UNOPS, 2016) HIV, TB AND STIs 2017 - 2022 “The inclusion of Non- • WHO Global Strategy for the communicable diseases as Prevention and Control of FROM 834/100 000 IN REDUCE Noncommunicable Diseases, 2015, TO LESS THAN one of the focus areas on 2000. TB INCIDENCE IN THE MINING SECTOR TO 30% 584/100 000 IN 2022 OR BELOW THE SOUTH AFRICAN NATIONAL • UNAIDS Fast Track Strategy on Masoyise iTB programme TB RATE BY 2024 proved to the another bold HIV 2030. This calls for a 90% REDUCTION OF TB INCIDENCES step in ensuring holistic reduction in new HIV infections and deaths by 2030, compared TO LESS THAN 100 000 BY DECEMBER 2024 BY 2022 THROUGH approach to health and to 2010 and set the 90-90-90 OF ALL EXPOSURE COMBINATION MEASUREMENT RESULTS WILL BE targets, an ambitious treatment 63% HALF THE LEGISLATED EXPOSURE PREVENTION well-being of the workers.” LIMITS FOR CRYSTALLINE SILICA - Bethuel Dlamini: Clinics target to help end the AIDS INTERVENTIONS. 95% AND COAL DUST epidemic (UNAIDS, 2014) Operational Manager • The impact of HIV and AIDS REDUCTION OF NEW NO NEW CASES OF PNEUMOCONIOSIS Harmony Gold on the world of work: Global HIV INFECTIONS REPORTED AMONGST PREVIOUSLY estimates (May 2018). The ILO UNEXPOSED INDIVIDUALS (PRIOR TO report examines how the evolution DECEMBER 2008) of the HIV epidemic and the scale- The campaign includes all sectors of up of ART have impacted on the Council with the industry setting society and promotes screening for HIV, global labour force, and how it is the following HIV and TB targets / TB, STIs, hypertension and diabetes, projected to do so in the future. milestones to curb TB, HIV and OLDs in with these targets set out below: mines:

Private Sector Response to HIV and TB: Private Sector Response to HIV and TB: 32 33 Masoyise Health Programme Masoyise Health Programme • Offer HTS to 100% of employees • SA Decent Work Country annually and link those who test Programme (DWCP) positive to an ART programme • Reduce TB incidence in the mining In addition, Masoyise recognises the sector to or below the South African WHO NCD Global Action Plan and national TB rate by 2024 the Monitoring Framework for NCDs • By December 2024, 95% of all which has set goals for 2025, against a exposure measurement results will baseline in 2010 be half the legislated exposure limits for crystalline silica and coal dust The Framework has nine targets while • No new cases of pneumoconiosis the South African Strategic Plan for the PART reported amongst previously prevention and control of NCDs, 2013 unexposed individuals (previously – 2017 adjusted these for the country unexposed individual is individuals with the following NCD targets being unexposed prior to December 2008 proposed: - 20% relative reduction in Guiding principles: prevalence of raised BP by 2020 - Halt the rise of diabetes and • Masoyise Health Programme must obesity (10% reduction in be more inclusive, i.e. should percentage people that are obese embrace the integration of TB and or overweight, by 2020) HIV into health programmes. The - Increase the number of people programme must include NCDs screened and treated for mental as a comprehensive approach to disorder by 30% by 2030. wellness • Prevention should be the mainstay Priority areas and Target populations of all interventions. The industry for the purposes of implementing and must address and monitor the monitoring a manageable programme, social determinants of disease, e.g. these will be priorities for the Masoyise housing and living conditions and Health Programme: nutrition. Exposure to silica dust must be prevented to reduce TB - TB, • Masoyise will leverage - HIV and AIDS, collaborations and co-funding to - Occupational lung diseases maximise its impact - Hypertension, • The programme will be aligned - Diabetes to international, national and - Mental health industry targets, priorities and interventions. The above conditions affect a large Messages percentage of the population. This warrants that groups that are The existing targets will apply: of support particularly at high risk be identified and targeted in interventions. The focal • Sustainable Development Goals for population groups, depending on the 2030 disease are: • WHO End TB Strategy, 2025 • UNAIDS Fast Track Strategy on - Young women HIV, 2030 - Sex workers, • Department of Health Strategic - LGBTIQ+ Plan for HIV, STIs and TB, 2017 - Men who have sex with men 2022 - Men • MHSC TB, HIV and OLD Milestones

Private Sector Response to HIV and TB: Private Sector Response to HIV and TB: 34 35 Masoyise Health Programme Masoyise Health Programme Conclusion

he Masoyise iTB reflects on limited political will, and limited cross- the significant commitment sectoral engagement. Its proven a of mining companies, collaborative approach can help to set Tgovernments, civil society, aside the key barriers to engagement. and mineworkers to come together and bridge the divides and achieve a consensus on a plan of action to improve occupational health and safety in an industry that remains hazardous.

“Healthy workers are productive and raise healthy families; thus healthy and “We faced a challenge along informed workers are the way with stigma in HIV/ key in ensuring healthy AIDS testing. We received a communities. We believe number of accounts where that every person deserves mining communities, can stimulate a fulfilled life which is why mining companies to look beyond their certain mines conducting own immediate business imperatives. testing and counselling of we care about the health and their employees for HIV wellbeing of our miners.” The general consensus was that – Bethuel Dlamini: Clinics Masoyise iTB was of great value in did not adhere to protocols focusing attention on TB and HIV Operational Manager thereby not ensuring in the mining industry. In line with “Masoyise has helped Harmony Gold national and industry trends, a decision those employees’ right to to extend the scope of the work and with the realisations that confidentiality. In fact, it convert the initiative into a Health when dealing with health, created many challenges of The project has also served as a programme, this should going forward it becomes cumbersome stigma for many employees.” platform to bring the mining industry assist with greater contributions to an together in creating a consensus on increased accountability in the mining to focus on disease – Matthew Grant: AMCU how it can continue to improve and sector that not only includes the specifics. It surely has its strengthen the practices devoted to prospect of safer work environments place and it depends.” defeating TB and HIV/AIDS. but also an enhanced performance that delivers healthcare to its workers – Dr. Lindiwe Ndelu: Masoyise iTB has succeeded in laying Many opportunities have been and ensures that their healthier and DMRE the groundwork for collaboration provide to demonstrate how effective more productive it seeks to give fresh in an environment that was initially collaboration between the health, momentum to the control of TB, HIV, characterised by low levels of trust, labour, and mining sectors, along with NCDs and OLDs in the mining industry.

Private Sector Response to HIV and TB: Private Sector Response to HIV and TB: 36 37 Masoyise Health Programme Masoyise Health Programme Address: 5 Hollard Street, Johannesburg PO Box 61809, Marshalltown 2107

Website link: https://www.mineralscouncil.org.za/ work/health-and-safety/masoyise-health-programme

Facebook page: Masoyise Health Programme https://www.facebook.com/MasoyiseHealthProgramme

Private Sector Response to HIV and TB: Private Sector Response to HIV and TB: 38 39 Masoyise Health Programme Masoyise Health Programme Private Sector Response to HIV and TB: 40 Masoyise Health Programme