Health

HEALTH STRATEGY

Harmony’s proactive health strategy is focused on employee wellbeing, and improving work attendance and individual capabilities. This strategy aims to prevent illness and/or identify disease early through medical surveillance, active case finding, early detection and treatment as part of an integrated management healthcare system.

South Africa

Harmony participated in the World tuberculosis day on 24 March 2014 in Carletonville, hosted by the then Deputy President and the Minister of Health. Harmony also participated in the Regional (Southern Africa Development Community) Ministerial Meeting on tuberculosis in the Mines which was held on 25 March 2014. This interaction influenced Harmony Health Care’s decision to adopt the HATS (human immunodeficiency virus/acquired immunodeficiency syndrome, tuberculosis, and Silicosis) policy as per the Mining Charter and the HATS guidelines, as per the Department of Health.

Our proactive approach to healthcare over the past five years has started delivering the expected benefits. The Harmony healthcare programme provides primary, secondary and tertiary healthcare as well as occupational health services to all employees, through company-managed healthcare facilities and medical aid membership, as well as the use of external providers. Medical surveillance is on-going at dedicated centres where 49 214 examinations were conducted during the year (FY13: 44 321).

Harmony has moved away from the historic mine hospital-centric, health service delivery model which is curative in nature, to a more pro-active, preventative health service delivery model. This decentralised service brings primary care-based services as close as possible to the operations, and will be delivered through seven new health hubs and two medical stations.

Harmony invested around R74 million during phase 1 of the rollout of the strategy on the establishment of the seven health hubs, medical surveillance systems (PIVOT), clinical systems (HEALTHONE & ME+), data warehousing, predictive analytics, research, and service transformation initiatives. Further focus on people-skills development, transformation and service delivery, is expected to have a positive impact on team effectiveness and alignment with the strategy. It is estimated that a further R28 million will be invested during phase 2 of the rollout strategy to enhance the effectiveness of the investment. These health hubs provide an integrated, proactive healthcare service to employees and contractors in close proximity to the mine, improving the quality of health care and decreasing the costs of centralised healthcare services. The benefits of these health hubs include:

• Alignment with proposed national health insurance processes and requirements
• Compliance with the Department of Mineral Resources’ requirements
• Facilitation of individual risk profiling, proactively managed by a significantly enlarged, multi-disciplinary team
• Active case-finding
• Continued surveillance
• A holistic approach to providing healthcare
• Providing a proactive employee assistance programme
• Improved health insurance cover for most employees, which was extended to contractors from FY13
• Improved quality assurance
• A decrease in the fixed costs of healthcare delivery through expensive and under-utilised old mine hospitals
• A decrease in the number of shifts lost per medical visit or time spent at the central medical facilities

This new approach has shown a dramatic decline in levels of sick leave since its implementation in 2010. Over this five year period the following was achieved:

• Sick absenteeism decreased by 17%
• Hospitalisation decreased by 25%
• Medical mortality in service decreased by 35%
• Tuberculosis incidence rate decreased by 44%
• On average 46% of our employees confirmed their human immunodeficiency virus status; this is 6% higher than the National Average of 40%
• The number of employees counselled in terms of Voluntary Counselling and Testing increased by 61%
• The contact rate for acute cases at the hubs and medical stations decreased by 80%

The lag in the certification process of occupational lung diseases by the Medical Bureau of Occupational Diseases is a major challenge in the mining industry and for the Department of Health. The tuberculosis incidence rate in South Africa and Harmony, remains alarmingly high, as per the World Health Organization benchmark. Motivating employees to confirm their status, despite the perceived stigma and confidentiality issues, remain one of the biggest challenges.

In FY13 we set the acceptable sick absenteeism rate within Harmony at 3.5%, based on benchmarking against industry peers. Our sick absenteeism rate remains above the 3.5% benchmark. During FY14 the number of employees being permanently incapacitated increased by 50%, when compared to FY13. This had a negative impact on the number of sick shifts while pending separation, and resulted in an increase of 6.5% across the company (FY13: 4.6% decrease).

Having proved to be a success, the Target Health hub concept was extended, and six new health hubs were established during FY14, with the Phakisa Health Hub due for commissioning in October 2014. All these hubs are staffed by multi-disciplinary teams that have a holistic approach to health. This includes doctors, occupational healthcare practitioners, case managers, social workers and health educators. A very successful at-work-management programme has been introduced at the hubs in collaboration with other services departments, such as human resources.

This new, preventative, decentralised focus has reduced the fixed costs of healthcare delivery. The Health hub concept of a “one-stop shop” has furthermore decreased the number of shifts lost per acute visit. The examination rate per employee per month, in terms of acute care, has decreased from 1.84%, when primary healthcare was mostly nurse-driven, to 0.38%, with a doctor leading a multi-functional team.

Papua New Guinea

In Papua New Guinea, the provision of full-time primary healthcare and occupational health surveillance to employees, dependants and the local community is provided by medical centres at Hidden Valley, Wafi and Wau. The Wau centre is only available to dependants and community members for emergencies, while four community health facilities provide services at Babuaf (near Wafi) and Nauti, Kwembu and Winima (near Hidden Valley).

Upper respiratory tract infections remain one of Harmony’s main medical issues in Papua New Guinea with nearly 3 000 presentations to the medical centres. In FY14 an occupational hygiene assessment, including respirable dust, respirable crystalline silica and noise monitoring, was conducted at Hidden Valley, and indicated that our activities did not exceed regulatory standards. The assessment was conducted in accordance with the occupational hygiene practice and Australian standards for noise and dust monitoring (AS 2985- 2004 and AS 1269.1-1998).

An integrated business information system provides administrative functions for health, safety, risk management and human resources. Medical registers are used to track and review each patient’s progress from the first visit through to the final treatment.

A total of 15 726 health examinations took place at the Morobe Mining Joint Venture medical centres during FY14, of which 3 584 were random drug and alcohol tests.

HEALTH PERFORMANCE

Healthcare delivery

In South Africa membership of a medical scheme is compulsory for all Category 9(+) employees and is voluntary for Category 4 – 8 employees. Around 6 400 employees participated in medical schemes in FY14, with Harmony subsidising these costs by an amount of R10 million per month.

Around 22 000 Category 4 – 8 employees have so far elected not to join a medical scheme. Instead they receive comprehensive health services from mine medical facilities and associated preferred providers at no cost to themselves.

Harmony undertakes active case-finding and screening for employees not on a medical scheme, as well as active disease management in respect of chronic conditions. Around 10 202 employees are on chronic medication, with around one third of these employees being treated for two or more chronic conditions. Chronic conditions include hypertensions, human immunodeficiency virus/acquired immunodeficiency syndrome, diabetes, asthma and TB.

Tuberculosis

Tuberculosis is recognised as one of the most pressing health concerns in South Africa and the gold mining industry. Harmony’s tuberculosis control programme is in line with the relevant guidelines and prescriptions of the World Health Organization. It is also in line with the national tuberculosis strategic plan in South Africa, which focuses on an integrated approach in addressing human immunodeficiency virus/acquired immunodeficiency syndrome, tuburculosis and sexually transmitted diseases, and the Mining Charter which covers silicosis as part of the human immunodeficiency virus/acquired immunodeficiency syndrome, tuburculosis and silicosis programme in the management approach.

Harmony’s tuberculosis programme focuses on early case findings, directly observed therapy short-course, chemotherapy, radiological tuberculosis screening and hospitalisation until sputum conversion. In addition, various measures are implemented over and above the national tuberculosis strategic plan, such as identifying early tuburculosis resistance through specialised generic and biochemical tests and analysis, and investigative diagnostic tests for early detection.

A total of 1 022 ultraviolet lights for infection control have been installed in areas of high risk for tuberculosis infection, inclusive of the newly established health hubs. Ultraviolet lights sterilise the air and reduce the risks of inhaling micro-organisms, including the tuberculosis germ called mycobacterium tuberculosis that is spread from person to person through the air. Through medical surveillance, employees exposed to dusty work environments are screened annually by means of a chest X-ray in order to detect tuberculosis infection.

Continuous monitoring and education are done at the hubs as well as major campaigns as per the national health calendar. The annual completion of an individual tuberculosis questionnaire has become standard practice in recent years.

Among employees, a total of 353 cases of tuberculosis were certified (FY13: 629) in South Africa. This figure does include contractors, who have been included in the full tuberculosis programme since 1 August 2013. The aim of this inclusion is to proactively contain and prevent any further spreading of tuberculosis, therefore achieving a higher cure rate and lower tuberculosis incidence rate.

There has been a significant decrease in the number of new tuburculosis cases since the inception of the proactive healthcare strategy in FY10. The downward trend is depicted in the graph alongside.

* Evander has been excluded from the FY10 – FY13 figures for comparison

One new tuberculosis case was reported during the year in Papua New Guinea. During the quarter Hard Hat Health (on behalf of the Morobe Mining Joint Venture) had consultations with other companies operating in Papua New Guinea to ensure their learnings with regards to tuberculosis management in Papua New Guinea can be incorporated into the Morobe Mining Joint Venture tuberculosis management plan.

Multidrug-resistant tuberculosis remains of increasing concern to the gold industry and South African population; treatments are expensive and protracted as employees affected are unlikely to return to work. Multidrug-resistant tuberculosis can be identified through sophisticated technology at multidrug-resistant tuberculosis hospitals. Given multidrug-resistant tuberculosis’ close association with human immunodeficiency virus, Harmony has developed an human immunodeficiency virus and tuberculosis treatment which will be integrated into the company’s healthcare management programme.

A total of 25 new cases of multidrug-resistant tuberculosis were diagnosed in FY14 (FY13: 36) and 29 employees are currently on multidrug-resistant tuberculosis treatment (FY13: 68). Employees who are on multidrug-resistant tuberculosis treatment are removed from all risk work as a preventative measure.

human immunodeficiency virus/acquired immunodeficiency syndrome

The human immunodeficiency virus/acquired immunodeficiency syndrome pandemic in South Africa continues to have a significant impact on employees, their dependants, as well as local and labour-sending communities. Illness as a result of human immunodeficiency virus/acquired immunodeficiency syndrome can result in higher levels of co-infections with other diseases, increased absenteeism and reduced performance levels, loss of skills, increased economic burden, and sometimes death.

At the South African operations, human immunodeficiency virus prevalence, as per our actuarial model, is estimated at 22% of the labour force (FY13: 24%). Harmony manages human immunodeficiency virus/acquired immunodeficiency syndrome through its clinics, human immunodeficiency virus/acquired immunodeficiency syndrome committees and healthcare specialists. Our human immunodeficiency virus/acquired immunodeficiency syndrome strategy is based on promoting health through education and awareness programmes, preventative strategies to reduce the number of new cases, evidence-based curative interventions to ensure treatment, and on-going monitoring of compliance.

During the year, 4 640 employees were registered on the antiretroviral therapy programme (FY13: 4 460) at an average monthly cost of R549 per person. Harmony encourages all human immunodeficiency virus-positive employees to participate in the wellness programme, which includes counselling, treatment of infections and antiretroviral therapy, to which all employees have access.

In Papua New Guinea we drafted tuberculosis and human immunodeficiency virus/acquired immunodeficiency syndrome management plans during FY14. These will be reviewed in the next year before being implemented.

Voluntary counselling and testing for human immunodeficiency virus/acquired immunodeficiency syndrome

Pre-counselling and voluntary counselling and testing are offered to all employees through on-going interventions at all Harmony healthcare centres. A total of 33 531 (FY13: 17 849) employees received voluntary counselling and testing during the year and of these, 14 060 employees confirmed their status. This is an increase of 87% in the number of employees counselled and the percentage uptake increased from 36% in FY10 to 42% in FY14.

* Other – includes contractors, service departments and shafts that closed or were sold.

Preventative healthcare

Health promotions and education

Each month Harmony carries out awareness campaigns on various health related topics such as reducing the human immunodeficiency virus infection rate to zero, voluntary counselling and testing, the human immune system, means of infection with a focus on unsafe sex, taking care of your body through a healthy diet and lifestyle, risk factors associated with diabetes and the warning signs of chronic diseases.

Flu vaccines

A total of 5 563 employees consented to receive flu vaccinations during the year. This is a proactive measure to prevent employees from falling ill during the winter season. These employees will be monitored in terms of sick absenteeism to measure the effectiveness of this intervention.

OCCUPATIONAL DISEASES

Silicosis

Silicosis is caused by long-term exposure to high quartz silica dust and can cause increased susceptibility to tuberculosis incidences. Silicosis in South Africa, as well as at Harmony, remains a material concern. The integrated Harmony human immunodeficiency virus/AIDS, tuberculosis and Silicosis Policy and Programme was developed to manage the debilitating disease responsibly to minimise the risk and to prevent further deterioration proactively. The trend for silicosis indicates a decline in incidence.

During FY14, 437 cases of silicosis were reported to the Medical Bureau of Occupational Diseases and, of these, 175 cases were certified (FY13: reported 772, certified 185).

Harmony is a member of the Chamber of Mines and is participating in the processes to address issues relating to historical silicosis cases. The legal action against the gold mining companies is in an early stage and it is too early to estimate what the extent of a possible claim would be.

Dust control

In order to decrease exposure to silica dust Harmony uses a range of engineering controls to minimise dust. Mining Industry Occupational Safety and Health leading practices such as the fogger system at strategic underground areas and the implementation of foot- and side wall treatment in identified intake airways to allay dust have been adopted.

In addition, multi-stage dust filtration systems have been installed. We are also in the process of installing winch covers for all of our winches.

The silica quartz content of dust is highly variable; this can pose a challenge when measuring the effectiveness of the engineering controls. Harmony therefore concentrates on controlling the total respirable dust load, in order to reduce the amount of silica quartz exposure. Training and awareness programmes address the concerns of dust control in stoping workplaces and all development ends are equipped with water blasts to settle dust directly after a blast.

The following measures were implemented at our operations during the year to combat silicosis:

• Revision of the airborne pollutant baselines to identify hotspots and to assess the effectiveness of engineering controls is in progress at all operations of which 67% of total samples have been completed. The revision process will come to completion in November 2014. All Harmony operations have received their spot PDR (portable dose rate meter) 1 500 measurement instruments and are being used to identify high dust load areas
• Evaluation of suitable/improved respirators have been completed, of which five different units meet the South African National Standards homologation standard for men. Currently only one meets the standard for women, due to the relatively new standards that have been published on this. A Securities and Exchange Commissionond supplier submitted their two models for homologation testing and it is envisaged that these respirators will become available soon
• Improved training material on dust and the prevention of silicosis has been uploaded onto the e-learning system
• Community of Practice for Adoption meetings to monitor the progress of Mining Industry Occupational Safety and Health initiatives

In Papua New Guinea we experience around 3-4m of rain a year, which is a good dust suppression measure. In addition to this standard dust suppression methods are also used in the open pits and at the crushers and conveyors. Papua New Guinea also has a low respirable silica risk. The combination of these factors means that dust is generally well-controlled in Papua New Guinea.

Noise-induced hearing loss

Harmony embarked on an Oto-Acoustic-Emissions initiative as a measure for early hearing loss detection through the noise clipper technology. The Council for Scientific and Industrial Research has collaborated and analysed this data and confirmed that an Oto- Acoustic-Emissions detects damage two years earlier than the audiogram. We have received a proposal from the researchers at the University of Pretoria to continue with further technical developments that could help prevent noise-induced hearing loss and also to develop leading indicators for the industry.

All Harmony employees who are exposed to high noise levels are issued with personalised hearing protection devices, which reduce the noise level by 25 decibels.

During the year 93.8% of occupationally exposed employees, including contractor employees (62%), were issued personalised hearing protection devices (FY13: 92% and 60%), with a progressive total of 27 238 personalised devices issued in FY14 (FY13: 27 329). Sound attenuators were also fitted on all equipment, resulting in no noise level exceeding 110 A-weighted decibles from any machine, which indicate compliance to the noise milestone.

Audiometric testing during annual medical examinations tests for hearing loss. The early detection of hearing loss is part of Harmony’s hearing conservation programme and this is done at least annually at occupational health hubs by an appointed audiometrist.

Harmony has placed an increased emphasis on the monitoring of employee compliance regarding the use of personalised hearing protection devices in the workplace. An awareness drive was initiated at all operations by supervisors, assistant occupational hygienists and health and safety representatives to ensure employees are aware of the benefits of wearing personalised hearing protection. A monitoring programme was also implemented to measure the actual compliance at the workplace in the use of personalised hearing protection.

Compliance monitoring is done during occupational hygiene routine inspections and was audited ad hoc by the high-level audit team during the year. Workshops with employees exposed to noise have been initiated to create a better understanding of the reasons why people are not wearing noise clippers underground and the benefits of using personalised hearing protection devices are described in the e-learning training material used in employee training courses.

During the year under review an audiometric screening/testing system was acquired in Papua New Guinea to ensure that hearing loss can be measured against a baseline.

Radiation protection

All our operations in South Africa comply with the dose limit of 50 millisievert in a year and 100 millisievert in five years. Operational controls have been established to ensure that elevated monitoring results are investigated and corrected where required.

The radiation quality management system has matured to the extent that Harmony maintained its 100% compliance rating on the radiation quality management system for the third consecutive year.

During FY14, external audits were carried out quarterly by the National Nuclear Regulator and regularly by the Department of Mineral Resources. The Council for Scientific and Industrial Research conducted heat tolerance screening during the year. Other audits took place as arranged by management with external specialists. An in-house function for objective auditing has also been established to assist with standardisation and documentation.

Radiological clearances are conducted at decommissioning sites to ensure the future declassification of these areas. A closure report for the area surrounding Eland shaft has been submitted to the National Nuclear Regulator. The regulator conducted a confirmatory survey at the site during March 2014.

Heat stress

The number of heat illness cases at Masimong remains a concern. It has been identified that ventilation conditions underground deteriorated owing to poor ventilation controls. To improve ventilation at the mine, old worked-out areas are being sealed and compliance with mine standards on in-stope ventilation controls enforced.

Managing chronic diseases

As part of Harmony’s integrated approach to healthcare, specific initiatives have been implemented to manage chronic diseases, with our focus mainly on human immunodeficiency virus, tuberculosis, diabetes, hypertension and silicosis, as well as asthma and epilepsy. In FY14, 42% of our category 4 – 8 employees in South Africa were receiving treatment for chronic conditions (FY13: 40%).

Harmony’s health initiatives focus on the most common diseases and the e-learning module covers these diseases in the induction programme. Other initiatives that have been used are pamphlets, management healthcare memorandums that focus on mine-based health and safety topics, health-worker training to recognise the most prevalent diseases, screening at all medical centres, disease management interventions and quality assurance. In addition, branding on Harmony buses is used to help educate employees on human immunodeficiency virus matters and promote Voluntary Counselling and Testing, as are podcasts and liquid crystal display monitors.

Upper respiratory tract infections

In Papua New Guinea, Hidden Valley is located approximately 3km above sea level and most employees reside in the lower, warmer areas; the regular change in altitude contributes to various respiratory ailments, mostly viral infections. Additional contributing factors include the pollen in the air during peak flowering times (thick rain forest and montane forest) affecting air quality. The heavy rainfall all year round maintains high moisture (around 80-90%) content in the air which creates favourable conditions for fungus (spores), bacteria and viruses to proliferate.

In South Africa, a total of 2 921 employees were treated for respiratory ailments in FY14 (FY13: 5 083). There has been a decreasing trend in the cases of upper respiratory tract infections presentations since FY12, with a decrease of 43% recorded for FY14. Harmony has successfully rolled out a programme to educate employees in the area on respiratory ailments and gastro-intestinal hygiene.

Malaria

Malaria is endemic to many parts of Papua New Guinea, which includes work sites such as Wafi-Golpu and Lae but excludes Hidden Valley. Importantly many employees and contractors working at Hidden Valley reside in areas where malaria is endemic, and this is where our community health projects play a vital role in combatting the disease.

There has been an 80% decrease (when compared to FY13) in the presentation of patients with malaria-like symptoms to the clinics in Papua New Guinea in FY14. This is primarily as a result of the following:

• Continued support for provincial programmes to eradicate the disease by the use of residual spraying and fogging
• Standardised testing, that allows a more consistent testing of malaria. The turnaround time of the blood tests have been increased, meaning that patients are tested twice before receiving treatment, allowing the treatment provided to be appropriate
• The distribution of treated mosquito nets and treatment regimes
• On-going malaria awareness education is provided to employees, contractors and communities
• Morobe Mining Joint Venture has been issuing treated mosquito nets as standard personal protective equipment to all employees and contractors on site, as part of the malaria awareness campaign. In addition, work clothes issued at sites like Wafi-Golpu are impregnated with in Securities and Exchange Commissionticides, and in Securities and Exchange Commissiont repellents are issued to all employees and contractors

The Morobe Mining Joint Venture malaria programme is under the new management of the General Manager: Health and Safety. An action plan was implemented in consultation with Hard Hat Health (see below), with a focus on the following:

• Review and update of the Morobe Mining Joint Venture malaria policy and guidelines
• Establishing a single-point accountability for public health issues within Morobe Mining Joint Venture in line with the restructuring of the business
• Establishing regular malaria surveillance reporting from each site to a central location for monitoring purposes
• Ensuring that diagnosis for malaria includes both the rapid detection test (RDT) and blood slides for microscopy
• Standardising treatment across Morobe Mining Joint Venture
• Ensuring that vector-control activities are consistent across sites and documented for audit purposes – this includes fogging, residual spraying, the issue of treated protective equipment and treated mosquito nets
• Establishing a day clinic at Valley View Estate (9 Mile) to treat Lae-based staff and families
• Institute a comprehensive treatment reporting regime including treatment failures or relapses, rock drilling tools, microscopy results and type of malaria

Hard Hat Health

During the year under review, in Papua New Guinea, the Morobe Mining Joint Venture contract with the International Organization for Standardisation expired and a new contract with Hard Hat Health became effective. Hard Hat Health, an Australian-owned company based in Sydney, is owned and managed by three senior executives in the medical services industry. Hard Hat Health provides the following services to Morobe Mining Joint Venture:

• Supply of qualified staff – paramedic at Hidden Valley (1 position)
• Co-ordination of both international and domestic medical evacuations
• Restructuring of the medical staff in the Morobe Explorations, Hidden Valley and Wafi-Golpu joint ventures which will include updating of job descriptions, integration of standards and procedures, among others
• Staff training
• Reviewing and updating the clinical governance framework for the joint ventures
• General corporate medical support

Once the emergency protocols and governance structures are updated and embedded in the organisation, the scope of work of the contractor and the joint venture medical staff will change to focus on the pro-active health care management of our employees.

MANAGEMENT INFORMATION

With regard to having an Individual Risk Profile per employee, we have made significant progress since FY10. During the past year Harmony Healthcare successfully implemented a new clinical and billing system at all the health hubs, medical stations and Ernest Oppenheimer Hospital and Pharmacy. In collaboration with the Harmony Business Intelligence Team, the healthcare team successfully managed to deposit data into the Harmony Data Warehouse that will assist to holistically determine individual risk, through predictive analytics. This will form the base for individual treatment plans and health risk assessments for future health and safety decision making.

HEALTH OBJECTIVES FOR 2015

Harmony’s healthcare strategy is aimed at improving the wellbeing of every employee. Targets for FY15 include:

• Continued improvements in sick absenteeism rates; specifically a target of 3.50%
• Continued improvement of PIVOT data availability. In the long-term, data from sources such as PIVOT and clinical data will be combined in an integrated approach that will assist doctors and healthcare workers in making holistic, informed decisions about a person’s health; on-going regulatory and legislative compliance
• Standardisation of medical surveillance processes to continue with a revamp of the written procedures scheduled for FY14