Intervention(s) & Key Activities
Interventions in this module are geared towards mitigating the determinants of TB in the mining sector emanating from working conditions and living conditions of mineworkers, mobility of mineworkers, interaction with communities around the mine and exposure to HIV infection among others. Funds are requested to improve occupational health and compensation systems, mine health and safety SOPs and development of private sector TIMS initiatives.
TIMS 1 supported the review of legislation and systems for compensation for TB and other occupational lung diseases and identified bottlenecks in these systems. TIMS 1 and 2 also supported the linking of migrant ex-mineworkers (who worked in South Africa) to access compensation in South Africa. However, comprehensive approach to addressing the bottlenecks identified has not been put in place. This intervention will target all the 4 countries (Lesotho, Mozambique, Zambia and South Africa) to learn lessons to be shared with other countries. These countries have been selected because they have initiated the process of strengthening TB/OH compensation systems under TIMS 2 and SATBHSS project. TIMS 3 will build on these nascent initiatives to strengthen the compensation systems and document lessons which will be shared with other countries in southern Africa region to take up similar initiatives.
This funding request will support:
- Technical assistance for deeper analysis of compensation systems and identification of solutions to bottlenecks in compensation of TB and other occupational lung diseases and development of country specific action plans
- Sensitization of labour unions and KP organisations on compensation systems to enable them advocate for and participate in efforts to improve these systems in their respective countries
- Technical assistance to support countries to implement the action plans for strengthening compensation systems
- Documentation and sharing of lessons learnt in strengthening of compensation systems at regional level to inform similar initiatives in other countries
Among the southern Africa countries with mining activities, South Africa has a comprehensive TB programmes developed and coordinated by the Mining Council South Africa and implemented by large mining companies. Chambers of mines in other countries have no such programme, although some individual mining companies have their own initiatives.
This funding request will support chambers of mines to develop TIMS initiatives to be implemented by mining companies. 6 countries have chambers of mines (Botswana, Namibia, Tanzania, Zambia, Zimbabwe, DRC) and these countries will learn from the private sector programme in South Africa. A phased approach will be adopted whereby Chambers of Mines for Namibia, Botswana, Zambia will be supported in year 1. Lessons learnt from the phase 1 process will inform the support to chambers of mines for DRC, Zambia and Zimbabwe in year 2. South Africa will provide mentorship to other countries in developing TIMS initiatives.
Funds will be utilized to:
- Convene regional meetings for chambers of mines to advocate for and develop private sector TIMS initiatives
- Support learning tours to South Africa to learn from the South Africa chamber of mines (Mining Council South Africa) “Masoyise” health programme which is a TB in the mines initiatives funded and implemented by mining companies themselves
- Provide technical assistance to the chambers of mines to design TIMS initiatives appropriate to their country context. The initiatives will be developed through a participatory process involving members of the chambers (mining companies and contractors)
- Convene meetings to review progress in implementation of these initiatives, identify challenges and lesson learnt
In order to mitigate TB risk factors in a sustainable manner, funds are requested to strengthen legislation on mine health and safety for formal mining. This intervention will build on the mine health and safety assessment carried out in TIMS phase 1, the mine inspection tool kits developed under TIMS phase 1 and the occupational health code of practice developed under TIMS phase 2. A key lesson from these TIMS 1 and 2 is that mine health and safety legislations and regulations are complex and cover a wide range of issues. The regulations are implemented through standard operating procedures which break down the regulations into implementable actions. Thus, legislation and regulations can be comprehensive, but SOPs determine whether the regulations will have an effect. It also takes time and considerable effort to develop and implement an SOP effectively. Thus TIMS 3 will develop a maximum of 2 SOPs that have direct impact on reducing mineworkers’ exposure to TB infection and support countries to adapt and implement them. This will contribute to reduction of TB cases in large mines. This intervention will target all 9 countries with large mining industry – Botswana, Mozambique, Namibia, South Africa, Tanzania, Zambia, Zimbabwe, Angola and DRC.
Activities to be supported include:
- Technical assistance to update the mine health and safety regulations and SOPs among the targeted countries. This will be a desk review and virtual consultations with country stakeholders to update the mine health and safety regulations situational.
- Technical assistance to develop mine health and safety (MHS) SOPs through a participatory process involving TIMS stakeholders
- Convening of the SADC countries to review the generic MHS SOPs and develop country specific actions plans to adapt and implement the SOPs
- Training KP organisations to effectively participate in the development of the SOPs, advocate for and monitor implementation of the country action plans
- Technical assistance to countries to implement the country specific action plans aimed at improving MHS SOPs
- Review meetings to review progress in implementation of the action plans and learn from each other and adapt innovative solutions
Priority Population(s) and geographical scope
- Mining companies and chambers of mines
- Key populations including ex-mineworker associations and labour unions
- Government departments in charge of mine health and safety and compensation
Barriers and Inequities
Barriers facing TB key populations in accessing TB/occupational health services include ill equipped health facilities and untrained HCWs in the provision of TB and other lung diseases; low knowledge of mining health hazards such as TB and other lung diseases, fear of job loss, misconceptions about TB and stigma and discrimination .
Mineworkers and ex-mineworkers also face bottlenecks in accessing compensation for TB and other lung diseases. These include limited of awareness of the compensation schemes; bureaucratic processes and procedures for accessing compensation required for claim processing, limited access to Benefit Medical Examinations and long distances to compensation authorities especially for migrant mineworkers.
Mineworkers are also exposed to TB risk factors associated with mining including dust, poorly ventilated mining sites, no standardization of appropriate living conditions in some SADC countries or outside the mines and have poor knowledge of health seeking behaviour. This contributes to high TB infections among this population.
At mine level, there is undue influence of mine managers on medical practitioners to perform their duties. Employees would be deemed fit for work when they are not, which raises an issue of medical ethics.
Rationale
Strengthening TB compensation schemes:
Tuberculosis is compensable in South Africa and Zambia. In other 8 countries covered by TIMS 2, tuberculosis is compensable in connection with diagnosed pneumoconiosis or specifically silicosis which hinders access to compensation. Compensation systems also vary from country to country but they all face capacity and bureaucratic constraints. The countries face challenges in compensating ex-mineworkers who develop lung diseases including TB long after employment. All countries apart from Zambia and South Africa have no systems in place to conduct regular medical benefits examination . The intervention to strengthen compensation systems is aimed at addressing the bottlenecks in country systems to improve access to compensation for occupational TB.
Private sector TIMS initiatives:
Mining companies have a key role to play in reducing the TB burden among mineworkers. Lessons learnt from South Africa “Masoyise” health programme shows that mining companies (coordinated by their chambers of mines) can resource and implement TIMS initiatives to reduce mineworker and peri-mining communities’ vulnerability to TB. TIMS 3 therefore proposed to utilize the existence of chambers of mines to galvanize large mining companies to implement TIMS initiatives. Currently this opportunity is not tapped as only South Africa has a compressive TIMS initiative.
Expected Outcome
- 100%of the targeted 4 countries have in place action plans for strengthening compensation systems for TB and other occupational lung diseases
- 100% of the targeted 6 countries with chambers of mines have private sector funded and implemented TIMS initiatives in place by 2023
- 75% (7 out of 9) countries with large mining industry have an action to strengthen selected mine health and safety SOPs by 2023