Dr Barry Kistnasamy / Dr Nhlanhla Mtshali - PowerPoint Presentation

1. Dr Barry Kistnasamy / Dr Nhlanhla Mtshali 29 November 2017Slide 1Update to Portfolio Committee on Planning, Monitoring & EvaluationThe Compensation Commissioner for Occupational Diseases (CCOD)

2. OutlineOccupational Health & Compensation system in South AfricaServices for current & ex-mineworkersContestation & class actionWay forward

3. ContextMultiple policy and legal frameworks covering health, compensation & other social protection benefits (Labour, Mineral Resources & Health)Migrant / Contract labour / within and cross-borderFragmented services for workers and ex-workers in mines and works (smelters, refineries, foundries)Diverse stakeholders & role-players (government, employers, trade unions, ex-mineworker associations, neighbouring countries, peri-mining communities & labour sending communities)

4. Occupational Health LawsPrevention & EnforcementOccupational Health & Safety Act, 1993 (OHSA)Mine Health and Safety Act, 1996 (MHSA)AdministrationDepartment of LabourDepartment of Mineral ResourcesCoverageAll workers except those under MHSAAll workers in mines except those under OHSAFundingDOL BudgetDMR BudgetOrganisationPretoria and regional officesPretoria and regional offices

5. Workers’ Compensation LawsOccupational Diseases in Mines & Works Act, 1973Compensation for Occupational Injuries and Diseases Act, 1993AdministrationDepartment of Health - R3.9b fund valueDepartment of Labour; Rand Mutual (RMA) & Federated Employers Mutual (FEMA)R53b fund value (~R70b)CoverageMine workers for lung and heart diseases onlyAll workers in formal economy for injuries and diseases except mine workers under ODMWAFundingLevies on employers (risk-rated through Risk Committee) – 495 controlled mines & worksLevies on employers (risk-rated on claims record) – 400 000 employersOrganisationOffice in Johannesburg (Braamfontein) – CCOD, MBOD & NIOH (service delivery); decentralised One Stop Service Centres (Southern Africa)Offices in Pretoria with some decentralisation through Department of Labour regional offices; Rand Mutual and Federated Employees with some decentralised offices

6. Workers’ Compensation LawsOccupational Diseases in Mines & Works Act, 1973Compensation for Occupational Injuries and Diseases Act, 1993StrengthsScreening of ex-mineworkers for occupational lung diseases; post-mortem services; lump sum payments; health & finance inspectorsInjury reporting system; few reports on diseases; lump sum & pension payments with better benefitsWeaknessResources & skills; coverage across borders; controlled mines & works; inferior payments; no link to Mine Health & Safety ActInadequate surveillance system; no independent audits; occupational exposure levels; no link to Mine Health & Safety ActLegalCan sue ownersNo-fault system except in extreme casesFundingDept of Health (voted funds) & leviesLeviesOrganisationDept of Health personnel & infrastructure + partnerships (as of 2008)Rand Mutual – covering mineworkers (independent since 1894)

7. DMR Database of Mines & Quarries (2010)ProvinceCoalDiamondGoldPlatinumOtherTotalEastern Cape0000140140Free State22604061Gauteng63252129167Kwazulu-Natal12010120133Limpopo 30112134156Mpumalanga85014089194North West019962597327Northern Cape01520076228Western Cape02000177197Total10839553451 0021 603495 controlled mines & works

8. ODMWA (DOH)400 000 (R3.9b)COIDA (DOL)11 million (R70b) Demography of Workforce in South AfricaSlide 8

9. Occupational Diseases in Ex-MineworkersLegacy of 120 yearsMining sector + indirect services – almost 20% of economy Mineral wealth of R25 trillionNeglected group of ex-mineworkersChallenge of deadly cocktail of HIV / Silicosis & TuberculosisSome data on injuries (incidence)South Africa mined gold production, 1940-2011*1970 (1000 Metric Tons)https://en.wikipedia.org/wiki/Mining_industry_of_South_Africa#/media/File:S_Africa_Gold_Production.png

10. The Mining Economy18 Trillion Rand sector (net asset value)8% of annual GDP

11. 105 year old History…Miners’ Phthisis Act 19 of 1912Slide 11McCulloch J. 201319301959

12. The Miners’ Phthisis CommissionsMedical Commission 1912Young 1929Stratford 1943Allan 1951Slide 12

13. James Stratford found that occupational disease is a cost of production which should be paid for by industry: “A business conducted upon any other principle is to that extent not self-supporting”.Report of the Miners’ Phthisis Acts Commission, 1941-1943 Pretoria: Government Printer 1943, p.3.Stratford Commission 1943

14. Mine Dust Exposures ~ Disease BurdenSlide 141 person with TB can infect 15 others

15. Legacy of Neglect / System CollapseMines ? 400k??? Ex-workersNo audited financial statements and annual reports since 2010/11Disclaimers in prior years30% of source documents not foundAntiquated technical resourcesInadequate human resources and infrastructureCentralised services in Johannesburg

16. Legacy ProblemsSlide 16

17. Reform of Compensation SystemDeveloped the evidence base Size, shape, scope & geographic distribution of workersPiloted innovations in service deliveryMobilised ex-mineworkers (outreach & awareness) – Rights Based ApproachMonitored outputsLink with other social protection fundsReform of legislationBuild consensus on approach and interventions (partnership with private sector & social partners – World Bank, UKAID, Global Fund, neighbouring country and provincial Departments of Health)Intervention with gold mining companies and class action lawyers

18. Migrant Mine WorkersYearRSAMozambiqueLesothoSwaziland% Non-RSA192074 45277 92110 4393 449571940178 70874 88352 0447 152491960141 406101 73348 8246 623621980233 05539 63696 3085 050441995122 56255 14087 93515 30458200099 57557 03458 2249 360572010*152 48635 78235 1795 00934* Data from TEBA

19. *Country & #Disease Burden in Ex-Mineworkers19CountryTotal %South Africa922 88874Lesotho143 29511Mozambique104 5328Malawi28 8542Botswana24 9432Swaziland24 4282Other593Total1 249 533Slide 19*TEBA data# Compensation Fund Compensable DiseaseTotalNot PaidAmountSilicosis33 0458 993588mTuberculosis108 88361 310308mAsbestos Related Diseases13 6885 289196mObstructive Airways Disease5 0841 701126mPneumoconiosis10 9141 807126m

20. Ex-Mine Workers by Province (1984 -2013)*20ProvinceTotal %Eastern Cape28155331North West16817118Gauteng16053017Free State11207712KwaZulu-Natal9209210Limpopo755278Mpumalanga272643Northern Cape49871Western Cape687Total922888Slide 20*TEBA data

21. Achievements (2016/17)Increased benefit medical examinations (+21%) – 18145 / 15000Increased certifications (+101%) – 20149 / 10000Increased payments of claims (+59%) – 5249/3300Increased inspections of mines (+ 58%) – 79/50Increased outreach activities (+ 170%) – 27/10Revenue from levies increased by 5% - R15m2270 ex-mineworkers seen at Carletonville & Mthatha One Stop Service CentresAudited financial statements for 2010/11 & 2011/12Raised profile of compensation / social protection reforms in local, national and international forums including Southern Africa Development Community, NEPAD

22. Opened One Stop Service Centres in Mthatha, Carletonville and BurgersfortKuruman on 5 Dec 2017One Stop Service Centres in neighbouring countries (10 functional)Mobile health services 60 000 ex-mineworker or beneficiaries reached over last 18 monthsTEBA record of service (Chamber of Mines)Service DeliverySlide 22

23. Mafiteng (Jan 2017)One Stop Service CentresBurgersfort (Oct 2017)Mthatha (April 2014)

24. Mobile ServicesSlide 24

25. Mobile Services

26. Malawi (Sept 2017)

27. Pongola (Sept 2017)

28. Tracking & Tracing Ex-mineworkersLink with mining companies, SASSA, trade unions, UIF, Home Affairs etcLogistics Coordinating Centre (GWG/Chamber of Mines)Inbound and outbound call centre (GWG/Chamber of Mines)Outreach and awareness campaigns (neighbouring countries, national and provincial departments)Physical track and trace (World Bank / DFID)Pamphlet, data formTraining of fieldworkers

29. Database of ex-workersWeb basedLinked to the TEBA database Pilot link to 4 mining companies for current workersLink to multiple databases (Financial Services Board)www.health/gov/za/ccodPayments Link with banks for improved access of ex-workers to financial servicesLink with Banking AssociationAutomation of calculation of paymentsLinks to social protection (unclaimed pension/provident funds)Geo-locator mappingClaims AdministrationSlide 29

30. Mapcode (Riskcape)30

31. Pilot Registration of Ex-mineworkers31

32. Pilot Registration32

33. Registration33

34. Mapping of MinesSlide 34

35. Transport Corridors of Mineworkers35

36. Corridors of TravelLocation (homes)Route of travelPhysical Barriers – rivers, mountainsMinesHealth Services

37. Mapped Flow of Money

38. Compensation Payments (Nov 14 to Oct 17)Slide 38

39. Comparative Payments (3 years)

40. Mr Thembekile Mankayi versus AngloGold Ashanti20112012 Chamber of Mines versus Compensation Commissioner & Dept of HealthContestation Silicosis settlement 2013 Cape PLC Asbestos settlement 2003 Silicosis / TB Class Action - 2016

41. 50 years (1965 to 2015)Covers Silicosis and Tuberculosis (TB)Covers minimum 2 years working in mines for TBCovers dependentsEnsure publicity, coverage and response to track and trace claimantsBenefits and amounts to be finalisedLegal costs up to 25% of settlement amountClass Action LawsuitSlide 41

42. No parallel system of services and certificationProvide support for enhanced service delivery of the Medical Bureau and Compensation Commissioner of DOHUse database of 600 000 ex-mineworkers & 400 000 current mineworkersProvision of medical assessmentsProvision of health care (oxygen etc in deserving claimants)Tracking and tracingFast-track payments from Settlement Fund which supplement payments of Compensation FundDifferentiate categories of additional compensationReform of LegislationIn-principle discussions with parties in class actionSlide 42

43. Changes to Occupational Diseases in Mines & WorksGovernance structure for Compensation FundStreamlined administrationLevy to cover income protection, administration, medical assessments & health care‘Clean break’Covers current and ex-mineworkersNew workers joining mining sector under Compensation for Occupational Injuries & Diseases ActUndertake study visits for good practiceHost scientific workshopsRisk work, medical assessmentsGuidelines for servicesReform of Legislation / ServicesSlide 43

44. Convene joint meeting of Mineral Resources, Health & Labour CommitteesShort term (by 31 March 2018)Enhanced services to mineworkers including rehabilitationLink compensation, UIF, pension & provident funds (mineworkers)Ensure technical, human, infrastructural and financial resourcesBuild on experiences of Department of Health initiativesEmphasize prevention of occupational diseases & injuriesOccupational exposure levelsSurveillance systemMonitoring & enforcement / Independent auditsShared data base (Mineral Resources, Health & Labour and additionally Home Affairs, SASSA, IEC)Social determinants (housing, transportation)Ensure financial services for ex-mineworkers / beneficiariesEndorse the principles of DOH that will accompany the Settlement AgreementSuggested Role of Portfolio CommitteeSlide 44

45. Medium Term (2 years)Amended Occupational Diseases in Mines & Works Act (Health)Amended Compensation for Occupational Injuries & Diseases Act (Labour)Sustained partnership across Social Protection Funds (across all employment sectors) to deliver services & ensure payment of benefitsMeetings on comprehensive social security system for formal workersMeetings on interventions for informal workersDevelop monitoring and reporting systemDevelopment of human, technical and infrastructural resources for occupational health / compensationSuggested Role of Portfolio CommitteeSlide 45

46. Long Term (5 years)Amended Occupational Health Legislation to integrate health, safety and compensation - prevention, services (including rehabilitation), compensation & enforcement – as per Cabinet resolution of 1999Link to comprehensive social security reform for workers in South AfricaFunctional occupational health system including compensation linking to other reformsRegional policy framework on occupational health & compensation (SADC, AU)Suggested Role of Portfolio CommitteeSlide 46

47. Working TogetherPresidency, Mineral Resources, Labour, Social Development & HealthChamber of Mines / Gold Working GroupTrade UnionsEx-mineworker associationsProvinces / Local Govt / Trad LeadersNeighbouring countriesSocial partners (World Bank, UKAID, IOM, Aquity, ECF, Health Focus, AURUM, XDS, TEBA, TIMS, SAT)Slide 47

48. "Two hundred thousand subterranean heroes who, by day and by night, for a mere pittance, lay down their lives to the familiar 'fall of rock' and who, at deep levels, ranging from 1,000 to 3,000 feet in the bowels of the earth, sacrifice their lungs to the rock dust which develops miners' phthisis and pneumonia." Sol Plaatje, first Secretary General of the African National Congress, describing the lives of miners in 1914~One hundred years ago…

49. Sharing the Cake…

50. Thank YouSlide 50Dr Barry KistnasamyCompensation CommissionerDepartment of Health kistnb@health.gov.za011-356 56020722200247