Social Performance

 
 
 
 
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Occupational health and employee well-being
   
 

Highlights  

 Solid progress in proactive healthcare strategy, and compliance with DMR standards  
 Among the highest compliance levels in industry for use of personal protective equipment  
 Successful implementation of Target health hub; acclaimed by the DMR as the first of its kind in the mining industry  
 Community clinics in PNG well received  

Material issues  

 Noise-induced hearing loss (NIHL) and use of protective equipment  
 Occupational lung disease, including silicosis  
 Pulmonary tuberculosis and other HIV-related illnesses  
 Heat stress
 Integrating systems and implementing workplace disease management methodologies
 Body mass index (overweight) workers underground.
The section on Harmony’s approach to sustainability details how we identified our material issues.

Harmony values the health and well-being of all its employees and the communities affected by its activities. The company is therefore committed to preventing all illnesses – not only occupational illnesses but other lifestyle diseases such as hypertension, diabetes and HIV – through continued medical surveillance, active case finding, early detection and treatment as part of an integrated managed healthcare system.

Harmony Healthcare provides tertiary, secondary and primary healthcare as well as occupational health services to around 80% of its employees through company-managed healthcare facilities and preferred provider arrangements. Company-owned facilities currently include two private hospitals, two private pharmacies and various shaft-based medical stations. During the year, conversion of the medical station at Target was completed; this is now a health hub providing an integrated, proactive healthcare service. Casualty departments at the private hospitals provide 24-hour emergency services to local communities and to company employees.

The health and well-being of the remainder of Harmony employees, their dependants and contractors is ensured through medical aid membership or third-party service providers, as part of their employment benefits.

In the prior year, Harmony Healthcare began implementing a proactive healthcare strategy, shifting the focus from curative to preventative healthcare. Integrated individual healthcare can now be provided to employees, supported by management information systems that enable the company’s healthcare team to monitor and track the risk profile of individuals in terms of health and well-being. Individual disease management plans are then developed and continually reviewed to assess progress. This initiative is aligned with the company strategy to ensure continued health improvements that will lead to notable improvements in employee attendance and workplace productivity. During the review period, the required training was provided to healthcare professionals and, given the encouraging early results, the long-term benefits of this initiative are expected to be significant.

As part of a R17-million initiative to entrench compliance with DMR standards, the occupational health module of a safety, health, environmental risk and quality assurance system was customised, with staged implementation from August 2011. This will allow health and environmental exposure data to be coordinated, improve medical surveillance data for analysis, improve monitoring and reporting and ensure continued employee health and wellness improvement. The safety phase is scheduled for completion early in 2012.

Absenteeism across the company increased by 5.8% during the year (FY10: 3.4%), while absenteeism due to illness increased by 7.5% at mine level. These indicators missed the 10% improvement target set for Harmony’s health services for FY11, primarily due to the quantum of sick leave granted by external service providers. As it recognised that an increasing absenteeism rate may translate to economic losses to the organisation, making it a priority focal area for the organisation in 2013.

In PNG, medical centres at Hidden Valley, Wafi and Wau provide full-time primary healthcare and occupational health surveillance to employees, dependants and the local community. While the Wau centre is only available to dependants and community members for emergencies, four new community health facilities were built at Babuaf near Wafi and Nauti, Kwembu and Winima near Hidden Valley.

Occupational health in South Africa
Management approach

In compliance with the Mine Health and Safety Act (MHSA), medical surveillance continued at the group’s four medical surveillance centres. A total of 53 412 medical surveillance examinations were conducted in FY11 (FY10: 57 045) including entry examinations (for new employees), annual examinations, exit (end of service) examinations, and out-of-cycle examinations (for transfers, for example).

The group aligns its reporting on occupational health statistics to international standards such as the International Labour Organization (ILO) code of practice on recording and notification of occupational accidents and diseases, as well as the MHSA. Where employees are diagnosed with a compensable occupational illness, Harmony submits details on their behalf to the relevant bodies, depending on the illness and associated legislation. Harmony contributes annually to these bodies:
  • The Medical Bureau for Occupational Diseases – a statutory body responsible for certification and compensation under the Occupational Diseases in Mines and Works Act of 1973
  • Rand Mutual Assurance Company – an industry body providing compensation under the Compensation for Occupational Injuries and Diseases Act of 1993.

The primary occupational health risk areas in FY11 were silicosis, noise-induced hearing loss (NIHL), tuberculosis (TB) and occupational injuries.

Performance

Noise-induced hearing loss
Harmony is committed to industry milestones for NIHL under the auspices of the Mine Health and Safety Council (MHSC):
  • The industry hearing conservation programme must ensure no deterioration in hearing greater than 10% among occupationally exposed individuals after December 2008
  • Total noise emitted by all equipment in any workplace must not exceed 110dB(A) at any location (includes individual pieces of equipment) by December 2013.

The hearing conservation programme in place at Harmony has been intensified to reduce NIHL. This includes issuing individually moulded hearing protection devices for working areas where high noise levels have been recorded. To date, we are recording a compliance level of 88% for personal protective equipment, one of the highest in the industry and a reflection of Harmony’s effective communication initiatives. Our progress on silencing equipment, such as fans and drilling machines, is shown below.

The project initiated at Ernest Oppenheimer Hospital in the Free State in FY09 for early detection of NIHL (5% to 10% hearing loss) has been introduced at the healthcare facilities. This project is monitored through annual audiograms for all employees exposed to noise risk at work.

In FY11, the number of NIHL cases dropped to 420 (9 per 1 000) (FY10: 11 per 1 000 employees), with 365 cases receiving compensation. The industry target to prevent any hearing loss of more than 10% remains a challenge for Harmony.

Occupational lung disease

Silicosis and TB are the two primary occupational lung diseases in the gold mining industry in South Africa and remain long-term concerns for Harmony. Chronic obstructive airways disease does occur, but less frequently.

Silicosis
Silicosis is linked to long-term exposure to quartz silica dust and can cause increased susceptibility to TB. Under the auspices of the MHSC, Harmony has committed to the following milestones:
  • 95% of all exposure measurement results will be below the occupational exposure limit for respirable crystalline silica of 0.1mg/m3 by December 2008 (individual readings and not average results)
  • Using present diagnostic techniques, no new cases of silicosis will occur after December 2013 among previously unexposed individuals (not exposed before 2008, or someone entering the industry in 2008).

All Harmony operations are benchmarked to obtain uniform comparisons.

The company is steadily implementing a phased strategy to control dust and reduce silicosis:
  • Reducing dust in intake airways
    In line with leading practice (MOSH), Harmony has installed water foggers at station tips and intake shafts, improved maintenance of fogger systems and dust filters, and installed spray cars to reduce dust in intake airways
  • Increased focus on silica dust exposure
    Dust-sampling frequency has been increased from 5% to 10% to improve the confidence level of sampling results and adhere to revised guidelines for airborne pollutants
  • Awareness through formal training on airborne pollutant exposure
    Focused training includes the importance of watering down procedures, good ventilation and wearing respirators/dust masks where required.

In FY11, continuing the gradual downward trend of silicosis in recent years, 747 suspected cases (19/1 000 versus 21/1 000 in FY10) were reported to the Medical Bureau of Occupational Diseases, and 392 cases were certified (10/1 000 as in FY10). A large percentage of submitted silicosis cases are non-compensable, primarily because sensitive digital X-ray technology introduced in FY05 resulted in early over-identification and reporting. There is currently no internationally accepted classification of silicosis on digital X-rays.

Silicosis is receiving heightened attention due to the recent court case against Anglo American by a former employee. Harmony, as a member of the Chamber of Mines, is participating in processes to address issues relating to historical silicosis cases following the Constitutional Court judgement of the Mankayi case.

Tuberculosis

TB continues to hamper the health of workers and affect productivity (absenteeism, treatment costs, compensation, allocated resources, etc). As such, there is increasing pressure on the gold mining industry to reduce TB among its workers. While the gradual downward trend for TB across the industry has resumed, the incidence is still unacceptably high. We are liaising and cooperating with local departments of health on specific TB training for nursing staff, and the additional resources required to improve our collective management of this disease.

In line with the World Health Organization (WHO) and the national TB strategic plan in South Africa, Harmony’s comprehensive TB control programme includes early case findings, directly observed therapy short-course (DOTS), chemotherapy and a radiological TB screening project. Harmony exceeds the national plan in certain respects such as:
  • Testing to identify early TB resistance
  • The number of investigative diagnostic tests conducted for early detection
  • Installing ultraviolet lights for infection control
  • Annual X-rays of employees exposed to dusty work environments for early TB detection
  • Ongoing monitoring and education.

Some 902 ultraviolet lights have been installed to date in a phased programme that is currently targeting risk exposure areas at the mines.

As required by the national plan, the company prepares TB registers, which are regularly inspected by regional health authorities.

Despite high HIV infection levels, the TB rate is gradually declining due to our efforts. A total of 1 201 cases were diagnosed (FY10: 1 302) for an incidence rate of 3 061 per 100 000 employees (FY10: 3 638).

Multidrug-resistant TB (MDR TB) remains a growing concern for Harmony as it is costly to treat, loses more shifts (eg 18 months’ treatment) and has a higher mortality rate despite treatment. With 63 cases of MDR TB diagnosed in FY11 (FY10: 49), the incidence rate of 181/100 000 (FY10: 133/100 000) has increased. A retrograde study of MDR TB in FY10 has established a baseline for future strategies to reduce incidence.

MDR TB’s association with HIV is almost 100%, further supporting the proactive integration of HIV and TB treatment (and data management) that we are developing in the group. Quality patient and data management and monitoring remain a universal challenge in TB management.

MDR TB cases are treated either at the dedicated ward at Ernest Oppenheimer Hospital in Welkom or in specialised state facilities in Gauteng. This treatment programme falls under the auspices of the specialised MDR TB state hospitals.

One case of extremely drug-resistant TB (XDR TB) was diagnosed in FY10, and this employee is complying with treatment. No new cases were identified in FY11.

In the prior year, Harmony facilitated specific research on TB preventive treatment (TB isoniazid prophylaxis) under the auspices of Aurum Health. Some 20 000 employees from various mining groups were enrolled and data analysis began in the second half of 2011.

Heat stress

Extensive refrigeration and ventilation measures are in place at all operations where temperatures are above normal working ranges. These heat-tolerance testing and acclimatisation programmes support and protect employees exposed to excessive heat in the workplace. In FY11, 26 948 heat tolerance tests were undertaken (FY10: 22 847) and there were no heat stroke cases during the year.

A new heat tolerance screening chamber has been installed at Evander to improve efficiencies and comply with regulations. A new heat tolerance screening centre was commissioned post year end to serve Doornkop and Kusasalethu.

Effective disease management in South Africa

The impact of the HIV/Aids pandemic remains significant on Harmony’s employees, their dependants, and local and labour-sending communities. This effect is evident in absenteeism, reduced performance and loss of skills to the company, and the economic burden on households when the breadwinner becomes ill or dies. There is also an increased financial load on state healthcare facilities.

The group estimates the HIV prevalence level among employees at 27%, based on best available state information and empirical modelling undertaken for the company in 2009. While this modelling suggests prevalence levels will decline over the next ten years, prevalence levels could have increased in the short term as more employees are staying well and employed after the introduction of antiretroviral therapy (ART). No prevalence testing may be undertaken by law.

HIV/Aids is managed at three levels at Harmony:
  • At clinical level – HIV symptoms are managed at our healthcare facilities
  • Company-wide and mine-specific initiatives – shaft-based HIV/Aids committees are an integral part of health and safety committees, which meet monthly
  • Group policy and practice level – monitored by a healthcare specialist.

The programme is undertaken by an external provider using qualified registered professional nurses and protocols aligned with the South African Department of Health, WHO and the HIV Clinicians Society of Southern Africa.

In Harmony’s integrated healthcare approach, the focus on HIV/Aids is not isolated, but an integral part of a wider range of chronic diseases managed by the company. Because the co-infection rate between TB and HIV/Aids is high, the needs of immune-compromised employees require focused attention by all healthcare workers. In FY11, nursing staff and HIV coordinators attended an in-house training programme on HIV clinical skills and basic counselling skills.

Information and education are vital elements of our prevention campaigns, as is providing voluntary counselling and testing (VCT) facilities. The focus on early detection is important as early intervention greatly increases the likelihood of long and healthy lives for employees. Harmony’s approach, that HIV/Aids is a chronic illness that can be managed as such (just like diabetes or hypertension), has had a positive impact on the response to VCT.

HIV-positive employees are encouraged to participate in the company’s wellness programme. This includes counselling on lifestyle choices and nutrition, treatment of opportunistic infections and ART. All Harmony employees have access to ART, either through our healthcare facilities or through private medical aid schemes. State-funded facilities in South Africa also provide ART and some employees may seek treatment there because of the stigma associated with the disease.

Harmony supports the national HIV counselling and testing (HCT) campaign and extended this to include all primary healthcare facilities and occupational healthcare centres as an ongoing service in the prior year.

Over the last 15 months, 26% of employees were tested for HIV and 48% of those tested received counselling. This is in line with the company target of 30%. During the year, 7 009 individuals were tested (FY10: 7 374), a decrease of 5%. The number of employees engaged in VCT has increased, with a current uptake rate of 54%. Over the past three years, a total of 35 617 HIV/Aids tests have been performed in Harmony.

In FY11, 2 902 employees participated in the highly active antiretroviral therapy (HAART) programme (FY10: 3 226). The decrease could be attributed to various factors, including labour movements or patients staying above the CD4 count of 500 for longer by adhering to treatment programmes.

 

Case study – from pilot to fully fledged primary healthcare service

The Lesedi-Lechabile Primary Care programme, based at Ernest Oppenheimer Hospital in Welkom, operates around the mining towns of Virginia, Theunissen, Allanridge, Odendaalsrus and Welkom. This is a targeted, three-pronged community-based HIV prevention programme operating mostly within the peri-mines areas of Lejweleputswa District in the Free State. Started as a community intervention in a desperate measure to curb sexually transmitted infections, HIV/Aids in 1996, Lesedi-Lechabile has proven successful in preventing curable sexually transmitted infections.

Lesedi, a Sesotho word that means ‘light’ and signifies hope, started as a pilot study in Virginia 15 years ago. Family Health International’s AIDS control and prevention (AIDSCAP) project and Harmony, in collaboration with the South African Institute for Medical Research (SAIMR), designed an HIV prevention programme that would benefit communities with sexual dynamics peculiar to migrant communities with highly mobile populations. This followed the results of earlier initial studies in Tanzania which had shown that services targeting high-risk groups in peri-mine areas yielded significantly higher reductions in STI/HIV prevalence within those populations.

The success of the 1996 pilot project prompted the national and Free State provincial health departments to join as partners in 1998. By July 2002, Lesedi-Lechabile Primary Care was registered as a section 21 non-profit organisation.

To date, thousands of women, men and youth have been reached with age and gender-appropriate STI, HIV/ AIDS and TB prevention messages delivered by healthcare professionals or trained community-based peer educators through fixed sites, mobile units and during outreach community dialogues.

Services

Between 2004 and 2008, Lesedi-Lechabile Primary Care evolved from being a women’s programme to include youth in or out of school and men. Clinical services are provided by dedicated teams of professional nurses and their assistants. Outreach services in communities and workplaces are driven mostly by trained community-based peer health educators.

Lesedi-Lechabile Primary Care renders preventive, promotive and curative services
Preventive and promotive health services include:
  • Health information, education and communication on HIV prevention; healthy lifestyles including screening tests for cancer, hypertension, etc; promoting safer sex practices and distributing male and female condoms
  • HIV counselling and testing (HCT)
  • Family planning (contraceptive) services
Curative services include treatment of:
  • Sexually transmitted infections
  • Minor illnesses such as mild rashes, headaches, etc
Medical male circumcision

In April 2011, Lesedi-Lechabile Men’s Clinic in partnership with the Ernest Oppenheimer Hospital (Harmony) embarked on a campaign to medically circumcise 3 100 men and boys as part of the Department of Health mandate to circumcise 100 000 males aged between 16 and 49 years in an attempt to manage the spread of the disease.

Other partners and funders include the provincial department of health, Unites States Aid for International Development (USAID), Johns Hopkins Health and Education in South Africa, ANOVA Health Institute and the Centre for HIV/AIDS Prevention Studies (CHAPS).

A team of experienced male medical circumcision clinicians (one doctor and three nurses) from CHAPS joined the Lesedi-Lechabile Primary Care/Ernest Oppenheimer Hospital team to conduct the first training session, and 10 men were safely circumcised on launch day.

On each weekday afternoon, the team conducts 25 to 30 free medical circumcisions. To reach the target of 3 100 by September 2011, Saturdays sessions have been conducted as well.

Learners and students from tertiary institutions are circumcised mostly during holidays to avoid disrupting their schooling. During the June school holidays alone, 380 learners/students were circumcised. Between mid-April and end-July, the team has conducted 1 538 medical male circumcisions.

In July 2011, the Free State provincial department of health launched the circumcision campaign at a local stadium in Thabong, Welkom. To contribute to this launch, the Ernest Oppenheimer Hospital/Lesedi-Lechabile Primary Care team conducted a mini session at which 107 medical male circumcisions were done.

Prince, a young man from Thabong (Welkom), summed up the benefits of this programme, saying: “A close friend of mine was abducted and taken to a non-medical circumcision school. He never came back and, sadly, I later discovered he had died from circumcision-related complications. After this I was scared and wanted to do medical circumcision although I knew I could not afford it. It was sometime in April 2011 when I discovered that the Ernest Oppenheimer Hospital and Lesedi-Lechabile Primary Care were offering free medical circumcisions for men and boys in my area – Thabong. I was among the first ones who got circumcised at the hospital. Having lost a friend who died after non-medical circumcision, I am grateful to Harmony Mine, for giving me the opportunity to undergo ‘mahala’ (free) medical circumcision using resources of the Ernest Oppenheimer Hospital.”

 

Occupational health and disease management in PNG

In Papua New Guinea, the joint-venture partners have developed an integrated business information system, a web-based application that provides numerous health, safety, risk management and human resource administrative functions as a foundation for sustainable business management. This includes a medical register that tracks and reviews each patient’s progress from initial health contact throughout the treatment process.

In FY11, 15 216 health contacts were made at all MMJV medical centres (FY10: 19 389).

An occupational hygiene assessment conducted at the Hidden Valley operation in 2009 spanned respirable dust, respirable crystalline silica and a noise monitoring survey. It was conducted according to occupational hygiene practice and Australian standards for noise and dust monitoring (AS 2985-2004 and AS 1269.1-1998), the methods for quartz measurement. Based on these results, activities at Hidden Valley do not exceed regulatory standards.

The primary health risks in FY11 at Hidden Valley were upper respiratory tract infections (URTIs) and malaria, neither of which are occupational illnesses.

Most URTIs are due to viral infections. As Hidden Valley is roughly 3 000 metres above sea level and the majority of employees are from warmer, lower areas, the regular change in altitude contributes to respiratory infections. Some 4 605 employees were treated for URTI in the period (FY10: 3 936).

PNG is a high-malaria zone with around 1.6 million cases identified annually by the World Health Organisation (WHO). We support the Morobe provincial health authority’s malaria-eradication programme by regularly fogging sites below 2 000 metres, distributing treated mosquito nets and mosquito repellents, conducting malaria education programmes, advocating the availability of prophylaxis, and introducing early-detection programmes and an effective treatment regime. In FY11, 1 466 employees were treated for malaria (FY10: 2 049).

Over 16 000 new cases of TB are detected in PNG every year (WHO), although only one case was identified at the MMJV medical centres. Communities in PNG are vulnerable to TB given the cramped living conditions in many settlements and villages, exacerbated by lack of access to health facilities, poor transport infrastructure, poverty and poor TB awareness. We support the Morobe health authorities by conducting TB community awareness programmes with health NGO World Vision throughout the province for more effective prevention of this infectious disease.

Australian government statistics forecast that 208 000 people in PNG will be living with HIV by 2012. In partnership with government and other stakeholders, including the PNG Business Coalition Against HIV/AIDS (BAHA), we are actively supporting HIV/Aids management and prevention initiatives at MMJV. Condoms are distributed free at PNG operations and to surrounding communities. MMJV also conducts regular HIV education training, distributes relevant material to employees and the community, and sponsors and organises World Aids Day activities in its areas of operation.

Access to clean water is key in combating community health issues in PNG. In FY11, working with local faith-based organisations, we completed 20 water and sanitation projects in Watut River and Hidden Valley area communities. Another 20 projects are planned to be completed in FY12.

Another area where MMJV has led the way has been in training village birth attendants. In FY11, the company partnered with the Morobe health authorities, World Vision and Zonta International to conduct two training courses for 56 village-based health volunteers who assist with local deliveries. More courses are planned for FY12 to assist in reducing local infant mortality.

After proposing a public-private partnership to provide health services in Morobe province in the prior year, this was approved by the national and provincial government, as well as the community, and a programme to support community health services across the province is being developed.

Objectives in FY12

  • Develop an integrated strategy, aligned with the Millennium Development Goals, on TB, malaria and HIV – building on systems already in place

 

Case study – developing healthcare skills in PNG

To address the unique needs of communities near Harmony’s operations in Papua New Guinea, the company and its joint venture partner have a memorandum of agreement with national, provincial and local government in terms of which the parties will establish family development programmes to advance the aims and aspirations of family life, women and youth. These initiatives span life skills training programmes, micro-credit programmes, and agriculture, health and literacy programmes.

PNG has a population of just over 6 million, predominantly in rural areas (over 80%). Given the rugged terrain that characterises the island, access to infrastructural services is challenging. Key among these challenges is health and sanitation facilities – reflected in relatively high infant mortality rates and over two-thirds of the population only having access to unimproved drinking water sources.

Accordingly, we are concentrating on these areas – with an almost immediate impact on quality of life.

In the review period, MMJV and Bulolo District health division ran two courses to train women in basic first-aid and midwifery skills to enable them to deal with common health issues and birthing in rural areas.

To date, 56 women have been trained as village birth attendees, which should help reduce infant and maternal mortality, especially in remote rural areas. These women will also be able to assist in areas where there are good health facilities but no health workers to provide services.

Basic first-aid training for 25 women will enable them to deal with a range of issues to avoid possible life- threatening complications later.
 
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