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Occupational health in South Africa

Occupational health management

Harmony provides access to quality health care through company-managed facilities, third-party service-providers or medical aids to all employees, some contractors and many dependents. Harmony’s two private hospitals and one mine hospital, including three private pharmacies, are a world-class health care delivery service providing an extensive range of general and specialist care. Casualty departments at these hospitals provide 24-hour emergency services to local communities as well as to the company’s employees. There were 16 507 in-patient contacts and 477 366 out-patient contacts during the year. Around 73% of these patients were Harmony’s own employees.

In FY09 Harmony revised its integrated health strategy and has begun its implementation in FY10. Key business drivers and health and safety drivers that are behind this new initiative are:

• Business drivers: sick absenteeism that results in lost shifts; work rate requirement, so as to increase face advance; and cost reductions, so as to improve profitability.
• Health and safety drivers: accidents, medical mortality, medical incapacitation, and early retirement owing to poor health and safety.

The new strategic approach is underpinned by a pro-active focus on health care so as to improve:

• the effectiveness of the well-being programme;
• occupational health impact;
• the efficiency of pre-screening;
• emergency preparedness; and
• environmental change readiness (in response to legislative changes, other trends and best practice).

The new strategy will be implemented over a period of 18 months (beginning July 2009) and will review and revise hospital optimisation; the hospital service delivery model; the need for and functioning of a health care hub; information systems; the organisational structure; training, culture and communication; policies, procedures and protocols; and compliance and quality assurance.

Included in the revised strategy is a review of the current centralised health care services provision which inhibits pro-active health care delivery (resulting in high costs and low utilisation of facilities), towards a comprehensive site-based health care service profile. Comprehensive site-based health care services will improve lost shifts, health hub visits, and duplicate referrals, time lost for fitness assessments and sick absenteeism.

A pilot study is to be conducted on a pro-active integrated HIV and TB approach in keeping with current academic thinking, to evaluate the validity of the protocols and parameters for intervention (such as HAART intervention level) that have been set. Both the new health care strategy and the revised TB and HIV & AIDS strategy will support our objectives of reducing absentee rates by 10% in FY10. In FY09, some 1.15 million shifts were lost to absenteeism.

A campaign to administer a flu vaccine prior to winter to employees not covered by medical aid was undertaken at almost all South African sites during the last quarter. Uptake was good, with some 4 658 employees (that is, around 13% of the total work force) having participated.

Health performance

Medical surveillance (in terms of the Mine Health and Safety Act) continued to be conducted at the group’s four medical surveillance centres. In total, 67 380 medical surveillance examinations were undertaken during the year, including initial examinations (for new employees), annual examinations, exit (end of service) examinations, and out-of-cycle (for transfers, for example) examinations for the year (FY2008: 72 547 examinations). The decreased examination figures are due to the reduced number of employees as a result of the sale of Cooke Shafts to Rand Uranium.

The primary areas of concern for the group in respect of occupational health are:

• noise induced hearing loss (NIHL);
• occupational lung disease, of which the two most significant are silicosis and pulmonary tuberculosis (TB); and
• heat stress.

While HIV is not classified as an occupational illness, it is a key priority for Harmony given the impact it has on the company, our employees and their communities. Also, TB is closely associated with HIV, as the weakened immune system increases the likelihood of opportunistic infections.

The group’s occupational health statistics reporting is aligned with international standards such as the International Labour Organization (ILO) Code of Practice on the Recording and Notification of Occupational Accidents and Diseases, as well as the MHSA. If an employee is identified as having a compensable occupational illness, the company submits on the employee’s behalf, his or her details to the Medical Bureau for Occupational Diseases (MBOD) or the Rand Mutual Assurance Company (RMA), depending on the illness and legislation that covers it. The MBOD is a statutory body, responsible for certification and compensation in terms of the Occupational Diseases in Mines and Works Act, 1973, to which Harmony contributes. RMA is an industry body that provides compensation under the Compensation for Occupational Injuries and Diseases Act of 1993.

Noise induced hearing loss

Exposure to noise levels above 85 dB(A) over an extended period of time can lead to loss of hearing in employees. Harmony’s noise management strategy endeavours to limit noise levels through silencing or the installation of equipment that emits lower levels of noise, and the provision of personalised hearing protection devices (HPDs) to employees who are at risk.

Under the auspices of the Mine Health and Safety Council (MHSC), Harmony has committed to the following industry targets in respect of NIHL: after December 2008, the hearing conservation programme implemented by the industry must ensure that there is no deterioration in hearing greater than 10% amongst occupationally exposed individuals; and by December 2013, the total noise emitted by all equipment installed in any workplace must not exceed a sound pressure level of 110dB(A) at any location in that workplace (includes individual pieces of equipment).

The total number of cases of NIHL identified and submitted for compensation in FY09 was 478 (FY08: 732). This is a rate of 10 new cases per 1 000 employees, a significant decrease on the prior year. This decline is thought to be largely due to the hearing conservation programmes that have been implemented, although we need to see a continuation of this downward trend to have greater certainty on this. Note that, as there are delays in the compensation process, the number of cases compensated during the year (447) is not strictly an accurate measure of occurrence. In total, 1 139 diagnostic audiograms were performed during the year.

It remains a cause for concern that HIV & AIDS and HAART may result in hearing damage and that this hearing loss cannot be easily distinguished from NIHL. This and other non-work related hearing loss (noise, barotraumas and ageing) will mitigate against achieving the first MHSC milestone, placing even greater emphasis on the need to achieve the second.

Over the past three years, a total of 5 389 rock drills have been fitted with mufflers. In addition, some 1 800 noisy fans identified have also been fitted with silencers. Around 90% of employees working underground have been issued with Hearing Protection Devices (HPDs) and extensive training is provided on the use of and the need for HPDs. In FY10 Harmony will embark on a programme to install silencers on air-driven mechanical loaders.

An early -NIHL pilot project initiated at the Ernest Oppenheimer Hospital in the Free State early in the year was introduced at the other occupational health centres in the fourth quarter. The detection of early NIHL (between 5 and 9 % hearing loss) has been lower than anticipated, although the project is still at an early stage.

Occupational lung disease

The two primary occupational lung diseases within the gold mining industry in South Africa are silicosis and TB.

Silicosis

Long-term exposure to quartz silica dust – found in the deep-level underground mining environment in South Africa –can lead to silicosis. Silicosis is also linked to increased susceptibility to TB. Silicosis remains a current and long-term concern for Harmony and the industry as a whole.

Harmony has committed to the following milestones under the auspices of the MHSC:

• By December 2008, 95% of all exposure measurement results will be below the occupational exposure limit for respirable crystalline silica of 0.1mg/m³ (these results are individual readings and not average results).
• After December 2013, using present diagnostic techniques, no new cases of silicosis will occur amongst previously unexposed individuals (previously unexposed individuals are individuals unexposed prior to 2008, that is equivalent to a new person entering the industry in 2008).

The first milestone is slightly contentious, as differences exist in opinion on the most accurate and cost-effective dust sampling method. Also, using current technology, the accuracy of measurement decreases as the value decreases. Further, the value of allocating samples from Homogenous Exposure Groups (HEGs) is diminished as these values are then allocated to individuals within that group. The issue is further exacerbated by the time period associated with the development of silicosis by an employee engaged today and who is exposed to unacceptable levels of silica dust; they may only display symptoms of silicosis within a decade.

In total, 808 suspected new cases of silicosis were identified during the year (FY2008: 1 041 cases), which is a rate of 17 per 1 000 employees. The decrease year-on-year may be ascribed to improved mine dust control measures in recent years, as well as to the reduction in the number of long-outstanding (expired) medical examinations over the past two years. Continued delays within the MBOD compensation system means that the number of cases compensated during the year (550) does not reflect occurrence.

Among the measures taken by Harmony to prevent exposure to silica dust are the implementation of sound ventilation principles, designs and practices; comprehensive watering-down procedures; wet-drilling; dust suppression, using equipment such as water spray filters and cyclones; f low-velocity ventilation over conveyor belts and increasing the time between blasting and re-entry to the workplace. Employees at high risk of exposure are issued with dust respirators. Formal training on airborne pollutant exposure and the subsequent associated health effects is provided to all employees on an annual basis.

Tuberculosis

A comprehensive TB control programme that follows the guidelines of the World Health Organization (WHO) and the National TB Plan is in place at Harmony. This programme includes early case findings, Directly Observed Therapy (DOT) and short-course (six-month) chemotherapy. In addition to these requirements, a radiological TB screening programme is in place.

In total, 1 485 new cases of TB were identified during the year (FY08: 1 911). This is a rate of 3 628 per 100 000 employees of new cases identified. The total number of cases of Multi Drug Resistant TB (MDR-TB) remains small, with 56 cases identified during the year. No cases of Extremely Drug Resistant TB (XDR-TB) were identified in FY09. Again, comparison against certified cases (2 218) is not meaningful as there is a backlog in processing by the Medical Bureau for Occupational Diseases (MBOD). Also, the total number of cases submitted for compensation does not accurately reflect the overall TB burden on the company as not all cases are eligible for compensation. Cure rates for TB (88%) are good and in excess of the national target of 85%. Further, around 80% of all new patients with TB are HIV-positive, illustrating the strong relationship between the two illnesses.

A project to introduce ultra-violet lighting (to eliminate bacteria) at high risk areas at the medical facilities has continued. This installation programme is to be further continued at the medical stations and, in the third phase, risk areas at the mines themselves need to be assessed. To date some 340 lights have been installed.

Heat stress

While extensive refrigeration and ventilation arrangements are in place at all operations, there are some operations and areas of work (such as development) where temperatures above the normal working ranges are experienced. Heat tolerance testing and acclimatisation programmes are in place to support and protect those employees who are exposed to excessive heat in the workplace. In total, 22 739 heat tolerance tests were undertaken during the year. There were no cases of heat stroke recorded. A protocol is currently being developed to identify and record cases of heat stress, particularly at the Evander operations.