Occupational health and employee well-being

Introduction

Harmony values the health and wellbeing of all its employees and of the communities affected by its activities and the company is committed to the prevention of all illnesses – not only occupational illnesses but others such as HIV and malaria – through increased medical surveillance, management and treatment as part of its managed health care system.

In South Africa, approximately 80% of primary health care and occupational health services are provided to employees and their dependants through company-managed healthcare facilities which include two private hospitals, one mine hospital and three private pharmacies. Casualty departments at these hospitals provide 24-hour emergency services to local communities as well as to the company’s 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 FY10, the company embarked on a pro-active healthcare strategy with a shift in focus from curative care towards preventative healthcare. Integrated individual healthcare was provided to employees with the assistance of management information systems which enable Harmony Healthcare to monitor and track the risk profile of each individual in terms of health and well-being. An individual disease management plan is then developed and continually reviewed to assess progress.

A safety, health, environmental risk and quality assurance system is being adapted for implementation in FY11 to allow for the co-ordination of health and environmental exposure data initially, with safety data to follow in the second phase. This system will improve medical surveillance data for analysis, improve monitoring and reporting and ensure continued employee health and wellness improvement. This first phase is scheduled for completion in September 2011.

Absenteeism increased by 3.4% during the year compared to FY09. However, absenteeism due to illness reduced by 12.3% at shaft level. This is in line with the 10% target Harmony has set for its Health Services for FY10.

In PNG, the medical centres at Hidden Valley, Wafi and Wau provide fulltime primary healthcare and occupational health surveillance to PNG employees, dependants and the local community. The Wau centre, however, is only available to dependants and the community in emergency situations.

Occupational health in South Africa

Management approach

In compliance with the Mine Health and Safety Act, medical surveillance continued at the group’s four medical surveillance centres. A total of 57 045 medical surveillance examinations were conducted in FY10 (FY09: 67 380) 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 occupational health statistics reporting to 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. In the case of an employee being identified as having a compensable occupational illness, the company submits his or her details on the employee’s behalf to the Medical Bureau for Occupational Diseases (MBOD) or to 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.

Harmony has committed to the following industry milestones in respect of NIHL under the auspices of the Mine Health and Safety Council (MHSC):

• the hearing conservation programme implemented by the industry must ensure that there is no deterioration in hearing greater than 10% amongst occupationally exposed individuals after December 2008; and
• 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) by December 2013.

The primary occupational health risk areas in FY10 were silicosis, noise induced hearing loss (NIHL), tuberculosis (TB) and occupational injuries.

Performance

Noise induced hearing loss

The hearing conservation programme in place at Harmony has been intensified to reduce NIHL and includes the issuing of individually-moulded hearing protection devices (HPDs) for working areas where high noise levels have been recorded. The silencing of equipment, such as fans and drilling machines, was completed in FY10. Some 220 (62%) of 357 air-driven mechanical loaders have to date been fitted with silencers as part of the programme.

The early detection of NIHL (between 5 and 10% hearing loss) project initiated at the Ernest Oppenheimer Hospital in the Free State early in FY09, and subsequently introduced at the other health care facilities continued in FY10. This project was monitored through audiograms which are carried out on an annual basis for all employees exposed to noise risk at work.

In FY10, the number of NIHL cases was 442 (12 per 1 000) (FY09: 10 per 1 000 employees), with 452 cases receiving compensation, some of which were from the previous year. The industry target to prevent any hearing loss of more than 10% still remains a challenge for Harmony.

Occupational lung disease

Silicosis and TB are the two primary occupational lung diseases within the gold mining industry in South Africa and remain current and long-term concerns for Harmony.

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:

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

Harmony reduces quartz silica dust levels in its mining environment by using accepted best practice methods including water fogging systems at main dust liberating areas, such as tips and crushers. Personal dust exposure monitoring has been increased from the required DMR minimum frequencies of 5%, 10% and 20% annually for the three different categories of exposure groups – C, B and A Homogenous Exposure Groups – respectively, to 10%, 20% and 40% per annum. Area monitoring has also been implemented for the identification of ‘hot spots’, while dust suppression systems and control measures are being continuously evaluated. All Harmony operations are benchmarked against the same quartz value to obtain a uniform comparison.

The stochastic effect of quartz silica dust may cloud the accurate measurement of new cases. In FY10 there were 881 suspected cases (25 per 1 000 compared with 17 per 1 000 in FY09) reported to the Medical Bureau of Occupational Diseases (MBOD), while 400 cases were certified (11 per 1 000 compared with 12 per 1 000 in FY09). There has been a gradual downward trend of silicosis over the years. A large percentage of the silicosis cases submitted are non-compensable. The introduction of the sensitive digital X-ray technology in FY05 resulted in early, over-identification and reporting as there is currently no internationally accepted classification of silicosis on digital X-rays available yet.

Tuberculosis

Harmony continues to comply with the National Tuberculosis Strategic Plan and exceeds it in certain respects such as the polymerase chain reaction (PCR) testing for early TB resistance identification, the number of investigative diagnostic tests done for early detection, installation of ultraviolet lights for infection control, annual x-rays of employees exposed to dusty work environment for early TB detection ongoing monitoring and education. A total of 750 ultraviolet lights have been installed to date in a phased programme that started at the medical facilities and is currently in the third phase targeting risk exposure areas at the mines. The company prepares TB registers – a requirement of the National Tuberculosis Strategic Plan – which are regularly inspected by the regional health authorities.

In line with World Health Organization (WHO) and the National TB Plan, Harmony has a comprehensive TB control programme that includes early case findings, Directly Observed Therapy short-course (DOTS), chemotherapy and a radiological TB screening project.

Despite high HIV infection levels, the TB rate is in gradual decline. A total of 1 302 cases were diagnosed (1 485 in FY09) resulting in an incidence rate of 3 638 per 100 000 employees (3 628 in FY09). Although 49 cases of Multi Drug Resistant TB (MDR TB) were diagnosed in FY10 (56 in FY09), the incidence rate of 133 per 100 000 (137 per 100 000 in FY09) remains similar to the previous year. A retrograde study of MDR TB was carried out in FY10 as a baseline for future strategies to reduce incidence.

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 is under the auspices of the specialised MDR TB state hospitals.

One case of Extremely Drug Resistant TB (XDR TB) was diagnosed in FY10. This was in an employee staying in his own accommodation away from the mine. No further infectious contact was identified on the mine prior to or after this case was identified.

Harmony has facilitated the Thibela research into Tuberculosis Isoniazid Prophylaxis (TB preventive treatment) research under the auspices of Aurum Health. Some 20 000 employees from various mining groups have been enrolled and analysis of the data is scheduled to begin in the second half of 2011.

Heat stress

Extensive refrigeration and ventilation measures are in place at all operations where temperatures are above the normal working ranges experienced. These heat tolerance testing and acclimatisation programmes support and protect employees exposed to excessive heat in the workplace. In FY10 a total of 22 847 heat tolerance tests were undertaken (FY09: 26 642) and there were no heat stroke cases during the year.

Effective disease management in South Africa

The HIV & AIDS epidemic continues to have a significant impact on the company’s employees, their dependants as well as the local and labour-sending communities. This effect is felt through absenteeism, reduced performance and loss of skills to the company, and the economic burden on individual households when the breadwinner becomes ill or dies. There is also an increased financial load on state health care facilities.

HIV & AIDS is managed at three levels at Harmony:

• At a clinical level, where HIV symptoms are managed at the group’s health care facilities.
• Company-wide and mine-specific initiatives are conducted. Shaft-based HIV & AIDS committees form an integral part of the Health and Safety Committees, which meet on a monthly basis.
• At group policy and practice level which is overseen by a specialist health care professional.

In Harmony’s current integrated healthcare approach, the focus on HIV & AIDS cannot be isolated, but is rather an integral part of a wider range of chronic diseases managed by the company. The co-infection rate between TB and HIV & AIDS is high and therefore the needs of the immune-compromised employee require focused attention by all healthcare workers.

The Harmony medical team is presently adopting the pathogenic, demographic and epidemiological (PADED) approach to HIV & AIDS. As HIV & AIDS presents a myriad of associated illnesses and treatment requirements, this approach looks at HIV and its effects in a more holistic manner. The implementation of the PADED approach will improve HIV & AIDS management and make its monitoring and treatment more cost effective. Nursing staff and HIV co-ordinators attended an in-house training programme on HIV clinical skills and basic counselling skills in FY10.

Harmony supports the national HIV Counselling and Testing (HCT) campaign and extended HCT campaigns to include all primary healthcare facilities and occupational healthcare centres as an ongoing service in FY10. The aim is to achieve 30% employees tested over a 15-month period.

Harmony’s HCT programme is undertaken by an external provider (Careways) using qualified registered professional nurses and protocols aligned with the South African Department of Health, the World Health Organization (WHO) and the HIV Clinicians Society of Southern Africa. During the year, a total of 18 971 individuals were tested (FY09: 22 806 tests) a decrease of 17%. The decrease is because the initial HCT campaigns targeted a broader spectrum of candidates and included the community as well as dependants.

Anti-retroviral therapy (ART) has been introduced at a CD4 count of 350 (previously 250) to curb the impact of HIV and its progression to AIDS, and specifically to influence TB prevalence in the group positively by reducing the number of TB susceptible individuals within Harmony’s employee population. This has resulted in a significant increase in employees enrolling onto the treatment programme although the effects will only be visible in the long term. When several ARTs, typically three or four, are taken in combination, the approach is known as highly active antiretroviral therapy (HAART). Access to HAART is available to all company employees, either through the company’s health care facilities or through private medical aid schemes where appropriate. Due to the stigma associated with HIV, some employees may seek treatment at state-funded facilities in South Africa.

In FY10, a total of 3 226 employees participated in the HAART programme, compared with 4 255 in FY09. Fluctuations in the population figures possibly contributed to this decline.

Occupational health and disease management in PNG

MMJV has developed an integrated business information system (IBIS), a web-based application that provides a variety of health, safety, risk management and human resource administrative functions as a foundation for sustainable business management. This resulted in the development of a medical register to track and review each patient’s treatment progress from the initial health contact all through their treatment process.

In FY10, a total of 19 389 health contacts were made at all the MMJV medical centres (FY09: 23 055). The decrease was because the Hidden Valley mine went into production in October 2009 which saw a reduction of staff and contractors on site from approximately 2 500 to 1 200. The primary health risk areas in FY10 at MMJV were upper respiratory tract infections (URTIs) and malaria, neither of which are occupational illnesses.

An occupational hygiene assessment was conducted at the MMJV Hidden Valley operation in October 2009 by consultants from Australia. This evaluation consisted of a respirable dust, respirable crystalline silica and noise monitoring survey. It was conducted according to occupational hygiene practice and Australian standards for noise and dust monitoring (AS2985-2004 & AS1269.1-1998), the methods for quartz measurement. Based on results from this assessment, the activities at the operation do not exceed the standards.

Most URTIs are due to viral infections. As Hidden Valley is located approximately 3 000m above sea level and the majority of employees are from warmer, lower areas, the regular change in altitude is a contributing factor for respiratory infections. Approximately 3 936 employees were treated for URTI in FY10.

PNG is a high malaria incidence zone with approximately 1.6 million cases identified annually (WHO). MMJV continues to support the Morobe Provincial Health Authority (MPHA) in its malaria eradication programme by regularly fogging sites below 2 000m, 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. Over 2 000 mosquito nets were distributed in FY10 by Harmony and non-governmental organisations (NGOs) in the MMJV area, and approximately 2 049 employees were treated for malaria.

A total of 16 000 new cases of tuberculosis (TB) are detected in PNG every year (WHO), although no cases have been identified at the MMJV medical centres. Communities within PNG are vulnerable to TB, an infectious disease, due to the cramped living conditions common to many settlements and villages. A lack of access to health facilities, poor transport infrastructure, poverty and a lack of TB awareness also contribute to high infection levels. MMJV supports the MPHA by conducting TB community awareness programmes throughout the Morobe Province for the effective prevention of TB.

Australian government statistics report that over 500 new cases of HIV were identified in PNG in FY10 and predict that 208 000 people in PNG will be living with HIV by 2012. MMJV, in partnership with government and other stakeholders, actively supports HIV & AIDS management and prevention initiatives at MMJV. Condoms are distributed free of charge at PNG operations as well as to the contiguous communities. MMJV also conducts regular HIV education training and distributes HIV material to employees and the community. In addition, MMJV sponsors and organises the World Aids Day activities within its areas of operation.

In FY10 the PNG national department of health confirmed cases of cholera and dysentery in Port Moresby, Morobe province, Madang province, East Sepik province, West Sepik province, Southern Highlands province and the National Capital District. The MMJV government declared a state of emergency in September 2009 to prevent the spread of the disease. PNG undertook a cholera vaccination programme to high risk staff at all its operations as well as an education programme for employees and the surrounding communities. No cases of cholera were identified at the MMJV medical centres.

MMJV proposed a public private partnership for the provision of health services in the Morobe province. This was approved by the national and provincial government as well as the community and a programme to support community health services across the Morobe province will be further developed in FY11.