The TIMS programme emerged from a recognized need for a regionally coordinated response to the issue of tuberculosis and related illnesses among mineworkers, ex-mineworkers and their families and communities. Regional policies from the Southern African Development Community (SADC) provided the political and policy level commitment of countries to the programme, and galvanized the Global Fund to support a regional TB response in the mining sector. These policies include: (i) SADC Declaration on TB in the Mining Sector (2012); (ii) Framework for Harmonized Management of TB (2014); and (iii) SADC Code of Conduct on TB in the Mining Sector (2015).
The mining industry in Southern Africa attracts mineworkers has a strong reliance on migrant labourers from within countries and across borders. The mining industry is also growing as most countries in the region discover minerals and there is also a huge body of in-country mineworkers. The industry comprises of large scale mining managed by large international mining houses and artisanal and small scale mining. Despite the longstanding history of mining in the region, few regional policies and systems have been implemented to limit the spread of communicable diseases such as TB and HIV and provide continuity of care and compensation support for mineworkers, ex-mineworkers and their families. The industry has for decade’s externalized occupational related illnesses such as TB, silicosis and public health burden such as HIV and other environmental health to the public sector.
Mineworkers are particularly susceptible to occupational lung diseases including TB infection with an incidence of TB three to four times that of the general population. It is estimated that 89% of mineworkers have latent TB infection. Main factors that contribute to the higher risk of TB among mineworkers include exposure to silica dust; crowded living and working conditions with inadequate ventilation; high incidence of silicosis; and HIV/TB co-infection among others.
Silicosis, resulting from exposure to silica dust in the mines, is a chronic condition for which no treatment is available, it contributes to mineworkers’ susceptibility to TB infection and recurrence post-employment. Thus, the TB epidemic in the mining sector affects not only current mineworkers, but ex-mineworkers several years after leaving the mines, posing the challenge of providing post- employment occupational health services and support.
The availability of occupational health services and skilled occupational health professionals in Southern Africa is limited. The public health sector has insufficient capacity to address the complex health needs of mineworkers and ex-mineworkers. While larger mining companies provide health services for their employees, smaller mining operations often rely on the public health sector. Furthermore, mining companies have no system for providing occupational health services to ex-mineworkers and their families post-employment. Although ex-mineworkers are entitled to compensation for occupational related illnesses, access to these funds requires routine screening and assessment, few facilities in the region are equipped to provide these screenings which effectively denies ex-mineworkers’ access to compensation for themselves and their families. Lack of harmonization of regional policies regarding dust control and standardization of mining health and safety also complicate regulatory monitoring and compliance. .
Accessible occupational health services are thus critically needed to ensure appropriate screening, health and support services, including compensation for mineworkers, ex-mineworkers, and their families. Community-based service organizations (CSOs) can also play an important role in linking mineworkers and ex-mineworkers to appropriate information, services and support, including TB screening, case finding, contract tracing and compensation.
The first phase of this grant, running from 01 January 2016 to 31 December 2017, focused on developing infrastructure, processes and systems as part of a regional initiative to address the TB burden. Participating countries are: Botswana, Lesotho, Namibia, Malawi, Mozambique, Tanzania, South Africa, Swaziland, Zambia, and Zimbabwe. This next phase of the grant, from January 2018 to December 2020, will use studies and systems developed in this phase and institutionalize some of these systems; deepen the quality of the services and ultimately integrate them into country systems. The participating countries remain the same. To this end, the following (among others) have been developed/established:
- 11 occupational health service centres in 8 countries
- 4 screening models that define screening, active case finding and contact tracing in several specific context 3 in the region
- 4 evidence generating regional studies
- 3 IT systems addressing continuity of care and compensation
- community systems strengthening has been initiative in all 10 countries
- geospatial mapping