The mining sector plays a significant role in the economic growth of Southern Africa. The Republic of South Africa has both the highest number and largest mines in the regions. In South Africa, mining is estimates to a USD1.8 million trillion sector, contributing about 8.6% of South Africa’s total annual gross domestic product (GDP). There are about 2,000 registered mining companies in South Africa, and they employ more than 500,000 mine workers. Approximately 40% of the mine workers come from the neighboring countries of Lesotho, Swaziland, and Mozambique.
Mine workers in the southern Africa sub-region have one of the highest TB incidence rates in the world. In South Africa, TB incidence is 2500- 3000/100,000 among mine workers— more than three times higher than in the general population (948/100,000) and more than ten times higher than the WHO threshold for characterizing a TB emergency (250/100,000). Mine workers are exposed to a multitude of factors that compound their risk of TB infection. These risk factors include their working conditions (prolonged exposure to silica dust, poor ventilation, exposure to occupational injuries); socio-economic factors (migrant status, cramped and unsanitary living conditions, lack of knowledge of the health system or their rights regarding access to care); and their disease burden (co-exposure to HIV, silicosis, or both). Mine workers frequently travel across provincial and national TB infection in labour-sending areas, and also adversely affects mine workers’ adherence to TB treatment, which contributes to the incidence of drug resistant TB.
- a) The World Bank (2014-2015): AQUITY was assigned by the World Bank to conduct training of the healthcare workers on TB in Lesotho, Mozambique, South Africa and Swaziland. This strengthened capacity to implement activities for improved management of TB among miners, ex-miners, their families and surrounding communities. Training emphasis was on infection control, screening, diagnosis, treatment and referral as prescribed by the Framework for Harmonized Management of TB. Among other deliverables, AQUITY:
- Developed the training modules and materials using the Framework for the Harmonized Guidelines for management of TB
- Helped cascade the implementation of the training modules in participating countries and
- Implement the training of existing modules on community- based management of the MDR TB to healthcare workers in participating countries.
b) The World Bank (2014-2015/6): AQUITY Innovations was appointed as a funding recipient of the Development Grant Facility (DGF) funding to support the implementation of a coordinated response to TB in the Mining Sector in 10 Southern Africa countries. The primary objective was to initiate harmonized sub regional action to reverse years if inaction against TB in the mining sector, and to provide valuable proof of concepts from which knowledge, good practices and solutions could emerge and be scaled up across the region. AQUITY Innovations worked through the Ministries of Health, Minerals and Resources and Labour, Employers, Union, Ex-miners Associations and other international and local partners involved in TB initiatives with migrant populations. In addition to holding two regional planning meetings with the Project Implementation Committee (PIC), AQUITY also undertook the following activities:
- An assessment of the cross border referral system across the four countries
- Two pilot border activities were implemented: (a) Mapping of mine workers, ex-mine workers and communities in three out of the four countries; (b) Mapping of health facilities in three of the four countries
- In partnership with Sibanye Gold and Harmony Gold, AQUITY developed an intervention aimed at providing mine workers with continued TB care and treatment during the Christmas holidays. The intervention was implemented in Lesotho, Mozambique and Swaziland to facilitate, with the support of Ministries of Health in the four countries. Referred to as MOLESWASA, this initiate sought to improve cross-border referrals and service delivery to miners when they reached their respective countries.
In 2015 AQUITY Innovations continued implementation of the DGF grant through commissioned research and pilot studies in 10 countries namely Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Zambia and Zimbabwe. The following studies were commissioned.
- An intervention study in Cross-border referral of mineworkers on TB treatment in southern Africa. The intervention study was aimed at designing and implementing a set of interventions to improve adherence among mine workers and ex-mine workers on TB treatment, who travel home from the mines in South Africa during or at the end of their period of employment and to evaluate this in a randomized control trial. The second part was an intervention to “Provide proof of concept on tracking and tracing of ex-mineworkers or their beneficiaries and linking them to the compensation process in any of the targeted countries.
- Survey of human rights and gender barriers related to services for TB,TB/HIV and occupational
lung diseases in the mining sector and mapping of main civil society actors in ten countries in the Southern Africa region. The objective of the survey was to identify human rights and gender barriers to access to TB, TB/HIV and Occupational Health Services, and to compensation for those eligible mineworkers, ex-mineworkers, their families and communities around them the mines as well as those in labor sending areas. The survey would inform the development of appropriate interventions to address the barriers identified.
- Implementation of innovations in delivery of TB screening and case finding, diagnosis and treatment for miners, ex-miners and local mining communities in Southern Africa. The objective was to support the delivery of TB case finding, diagnosis and treatment services for mineworkers, ex-mineworkers and mining communities, with a focus on vulnerable groups who are currently under-served by national and regional TB control efforts.
- Study on Occupational Health Service delivery in the Southern Africa region to establish minimum packages and models for provision of Occupational Health services. The objective of this study was to establish occupational health service packages that can be offered to mineworkers and ex-mineworkers in three countries in Southern Africa, i.e. Zambia, Zimbabwe and Tanzania