SOUTHERN African countries could realise savings 40 times what they would otherwise spend if they were to test and treat all mineworkers in the gold and platinum group metal industries for tuberculosis (TB), according to the preliminary findings of a World Bank study released on Tuesday.
It found it would cost about R330m a year to test and treat mineworkers in South Africa, Lesotho, Swaziland and Mozambique, but that this would result in savings of about R13bn a year in increased productivity and a reduced spread of the disease.
"The study shows the returns on investment are very high and it makes good business sense to do so," said Asad Alam, the World Bank’s country director for South Africa, Lesotho, Namibia, Botswana and Swaziland.
While significant sums were being spent by mines, governments, and nongovernmental agencies on TB programmes, their efforts had been fragmented, he said in an interview. "The question is how the public and private sector can work more closely with development partners."
Mineworkers are three times more likely to have TB than the general population in South Africa, as the conditions in which they live and work increase their risk of infection. The TB incidence rate, which measures the number of new infections per year, is 943 per 100,000 among the general population in South Africa, but between 2,500 and 3,000 per 100,000 for mineworkers in South Africa, according to the World Bank study.
Mineworkers are at high risk of contracting TB for several reasons: many are exposed to silica dust, which increases the risk of lung diseases; they live and work in crowded and poorly ventilated conditions; and they are separated from their families for long periods and have high levels of HIV infection, which increases susceptibility to infection with TB. Around 70% of the mineworkers in South Africa who are diagnosed with TB are also infected with HIV.
The World Bank’s preliminary findings were released on Tuesday at a ministerial meeting on TB and mining in the Southern African Development Community (Sadc), hosted by Deputy President Kgalema Motlanthe. The meeting was supported by the World Bank, the Stop TB Partnership, and the Global Fund to fight AIDS, Tuberculosis and Malaria.
"Given the sobering fact that Africa is the only continent unlikely to achieve the Millennium Development Goals target of halving TB-related mortality by the end of 2015, the urgency of developing and implementing region-wide programmes is self-evident," Mr Motlanthe said in a prepared speech. TB was "not just a health matter, but also an economic, social and development issue, especially for Southern Africa".
"This disease — which is the leading cause of death in our country, has a huge impact on workforce productivity and operational costs in an industry that contributes almost 20% to South Africa’s GDP (gross domestic product)."
Sadc heads of state signed a declaration on TB in the mining sector in August 2012, recognising the vulnerability of mineworkers to TB and HIV/AIDS and highlighting the challenges facing the region. Last night, health ministers from South Africa, Lesotho, Swaziland and Mozambique signed an agreement to harmonise the treatment protocols of their countries. Work is under way to improve patient referral systems, and develop a regional patient database.
Anglo American’s chief medical officer, Brian Brink, said reaching small mining companies and contract workers was likely to prove the biggest challenge in attempts to test and treat all current mineworkers for TB. Anglo is the biggest investor in South Africa’s mines, and the first miner to provide HIV/AIDS treatment to workers.
"If you really want to bring down TB, you have to get everything right … HIV, living conditions, exposure to silica ," Dr Brink said. The TB incidence on Anglo ’s mines ranged from about 330 per 100,000 population in its coal mines to about 1,400 per 100,000 in its platinum operations, he said.
The National Union of Mineworkers, which was represented at the ministerial meeting, said TB levels in the industry were "10 times higher than the level the World Health Organisation classifies as an emergency".
"We appreciate and support the call for this regional meeting by our government to fight TB. We have noted a number of challenges experienced by current and ex-mineworkers their families, as well as communities affected by migration, which need to be urgently addressed," said the union’s health and safety secretary, Erick Gcilitshana.
"This should not be a talk show. It should come up with tangible solutions that everybody will be able to commit and implement. The meeting should also come up with solutions for the ex-miners so that they can get … treatment."