Tuberculosis and mining

A CHALLENGE TO A KEY SOUTHERN AFRICAN ECONOMIC SECTOR

Photo: David Rochkind/International Reporting Project

Implementing best practice interventions could yield a financial benefit of US$ 783 million a year for mines and miners

Mine workers in South Africa have the highest rate of tuberculosis (TB) in the world, with an estimated 3 to 7 percent of miners becoming ill with the disease each year. The issue is regional. The mining industry in South Africa is heavily dependent on migrant workers from surrounding countries, particularly Lesotho, Mozambique, Swaziland and Zimbabwe. Each migrant worker who returns home with TB spreads the disease to an estimated 15 people in their community. An estimated one third of TB infections in sub-Saharan Africa are linked to mining activities.

BAD FOR COMMUNITIES, BAD FOR THE ECONOMY

In addition to the human toll, TB in the mining sector results in huge healthcare costs and greatly reduced productivity. The current cost of the TB epidemic in the South African mining sector is estimated at US$ 886 million per year. However, implementing activities to tackle TB in mines would eliminate these costs and bring about increased productivity, resulting in a total financial benefit of US$ 783 million per year. (See section Why invest in TB and mining on the next page.)

WHAT DRIVES THE TB EPIDEMIC IN MINES?

The TB epidemic in South African mines is driven by high levels of HIV-infection in mining communitiespeople living with HIV are 20-30 times more likely to develop TBcrowded living conditions and exposure to silica dust, which can lead to silicosis and a three-times greater chance of becoming ill with TB. Men travelling to work in the mines from neighbouring countries are at the greatest risk of getting TB, but their partners, children and friends are also at risk when these miners travel back and forth to work, often many times a year.

ELIMINATING TB FROM THE MINING SECTOR

The issue of TB and mining crosses national boundaries and affects both the public and private sector. To free mine workers and their communities from TB, governments across Southern Africa need to work together with private companies, civil society, labour unions and mineworkers themselves. World Bank analysis on the South African mining sector identifies five interventions required to address TB among mine workers, former mine workers, their families, and communities: Improve TB detection actively find people with TB and provide them with treatment early Eliminate the factors which lead to high rates of TB in the mines Improve TB treatment Actively seek former mine workers who could have developed TB and silicosis Create a legal and regulatory framework that provides appropriate compensation for occupational disease

and other partners, allowed representatives from governments, trade unions, the private sector, nongovernmental organizations and donors to provide their input to a declaration and code of conduct on TB in the mining sector. This declaration was endorsed by SADC health and labour ministers in April 2012 in Luanda, Angola. The ministers also agreed on the need for: The development of a regional action plan to implement the declaration The development of a single unified employment database and health information system to record workers, enable patient tracking and to improve cross-border medical referral Further economic analysis of TB in the mining sector across the 15 SADC states

The 15 SADC countries

WHY INVEST IN TB AND MINING?

THE COST OF TB*
Annual cost of the TB epidemic in the South African mining sector $886 million Annual cost of implementing bestpractice interventions $570 million

WHAT IMPLEMENTATION OF BESTPRACTICE INTERVENTIONS COULD SAVE SOUTH AFRICA

Annual savings as a result of implementing best-practice interventions $316 million Annual productivity increase from implementing interventions $467 million Total annual benefit $783millio
*Source: preliminary analysis performed on behalf of SADC.

NEXT STEPS
To maintain momentum, SADC countries need support to deliver the three priority tasks identified above. In addition, it is clear that action will require strong publicprivate partnerships which welcome the corporate sector as a key partner, and a coordinated response across sectors.

For more information, please contact Judith Mandelbaum-Schmid: schmidj@who.int

BUILDING POLITICAL MOMENTUM FOR CHANGE: FROM PROBLEMS TO SOLUTIONS

The Ministers of Health for Lesotho, South Africa and Swaziland - who also serve as ministerial TB champions on the Stop TB Partnership Coordinating Board - have shown extraordinary leadership in putting the issue of TB and mining on both the regional and global agenda. The three ministers raised the issue of TB and mining to the Southern African Development Community agenda (SADC) in November 2011. In March 2012, SADC convened a stakeholders meeting in Johannesburg. The meeting, which was supported by the Stop TB Partnership, World Bank, the International Organization for Migration

Photo: Stephenie Hollyman