Health

G4:

G4-LA7
Workers with high incidence or high risk of diseases related to their occupation

Key features

  • All employees have access to comprehensive healthcare
  • All cases of noise-induced hearing loss reported for compensation
  • R320 million spent on employee healthcare in 2013
  • Comprehensive strategy to reduce the burden of disease and HIV
  • Freely available HAART and TB drugs

Targets and objectives for 2013/2014

Sibanye aims to provide an effective and efficient healthcare service at its operations with the objective of ensuring a healthier workforce and of improving productivity by focusing on prevention, early detection and treatment of disease.

Sibanye aims to create a working environment that is conducive to the long-term, holistic wellbeing of employees and contractors. Its approach is risk-based and focuses on the prevention and treatment of occupational illnesses through effective occupational health management and on a reduction in exposure to occupational hazards by – as reasonably practicable – engineering out health risks.

The Group’s health and wellbeing programme also addresses general health management, individual safety behaviour, lifestyle management (including influencers such as living conditions, nutrition, sport and recreation) as well as education and development.

All employees have a choice of medical-insurance products, which include access to the in-house restricted medical scheme, an open medical scheme and the comprehensive free medical services provided by the Group. Currently, around 25% of employees participate in the in-house medical scheme, and 21.5% in the open medical scheme. In 2013, health expenditure amounted to R320 million for the in-house service. The in-house medical scheme expense amounted to R230 million, which was derived from contributions by employees and the Group.

In 2013 Sibanye owned and managed two private hospitals, the Leslie Williams Hospital, located near Merafong, and the St Helena Hospital, located in Welkom. These hospitals provide medical services to employees and community members who are covered by medical-aid schemes.

The hospitals provide a wide range of services, including trauma, theatre, intensive care and general medical, TB and day wards. On average, the monthly admissions to Leslie Williams Hospital include 117 private cases and 183 employees (including contractors). At the St Helena Hospital, 287 private patients and 67 employees (including contractors) were admitted on average per month.

Employees have access to healthcare services at nine primary healthcare clinics located at and around Sibanye’s operations, and three on-shaft clinics. The primary healthcare services are doctor-based and include family physician services, digital radiology, laboratory, pharmacy, rehabilitation and social worker services. At shaft level, primary healthcare nurses provide health screening, consultation services and management of chronic conditions. In addition, monthly medication is also delivered to the shaft clinics.

OCCUPATIONAL HEALTH AND HEALTH MANAGEMENT

Areas of focus

NIHL, chronic obstructive airways disease (COAD), cardio-respiratory tuberculosis (CRTB) and silicosis are the most significant occupational diseases, while HIV/AIDS, hypertension and diabetes mellitus are the most challenging overall health concerns.

All employees undergo initial and annual medical surveillance, the scope and practice of which are aligned to legal requirements and regional health and safety risks. These assessments are aimed at prevention, early detection and treatment of occupational diseases. In South Africa, employees contracting NIHL, CRTB and silicosis at a level above a certain threshold are eligible for compensation through Rand Mutual Assurance Limited for NIHL and occupational injuries, and the Medical Bureau for Occupational Diseases for silicosis and TB.

Some 52,623 medical surveillance examinations were undertaken at Sibanye’s operations during the year (2012: 54,307), on entry to and exit from the Group, as well as annual examinations.

Employees are also offered quantitative, confidential health-risk assessments, which relate to occupational diseases as well as general health and lifestyle issues such as hypertension, diabetes, HIV testing, cholesterol, diet and mental health. Where necessary, participating employees are referred to appropriate preferred-provider practitioners.

ENGINEERING OUT HEALTH RISKS

As with safety risks, Sibanye reduces occupational health risks by proactive engineering aimed at reducing noise and dust levels. Key environmental management measures implemented to reduce noise and dust include:

  • installation of tip filters to prevent dust being liberated into ambient air;
  • chemical spraying to suppress dust from footwalls in pre-determined main-intake airways;
  • installation of mist sprays to suppress dust in ambient air at high dust sources where dust-extraction systems cannot be installed due to site-specific conditions or requirements;
  • installation of dust covers over the double-winch drums to reduce dust exposure for winch operators; and
  • issuing of real-time dust measurement equipment to allow for rapid trouble-shooting and the accumulation of more comprehensive risk mapping by environmental engineering staff.

Sibanye set and achieved an internal target of no more that 20% of dust exposure readings above 0.05mg/m³ by December 2013. The internal target was adopted to ensure compliance with the Mine Health and Safety Council (MHSC) milestone of no more than 5% of readings above 0.1mg/m³ by December 2008. The internal target will be reduced annually. The MHSC target has been achieved over the years with brief excursions over this target from time to time, which were controlled immediately when detected.

Work continues to ensure that the personal protective equipment (PPE) provided to employees is suitable and effective given underground conditions and employee activities. Projects currently underway include the examination of open-faced helmets that make use of an active ‘air curtain’ to minimise exposure to dust and diesel particulates.

OCCUPATIONAL HEALTH INCIDENCE

Noise-induced hearing loss

NIHL may be caused by repeated or extended exposure to sound at or above 85 decibels (dBA) over a prolonged period of time that causes irreparable damage to the sensitive structure within the inner ear. NIHL is a preventable disorder, even in noisy industrial environments, provided that hearing protection devices and other avoidance mechanisms are used and followed.

Sibanye seeks to reduce the extent to which employees are exposed to noise by reducing the noise at source, and ensuring that employees are made aware of the importance of wearing PPE. Education is undertaken during entry and annual induction processes, as well as through ongoing education campaigns.

In 2013, 88 cases of NIHL were diagnosed (2012: 51).

The MHSC requires that the total noise emitted by machinery may not exceed a sound pressure level of 110dBA in any location or workplace. An internal target was set, which requires that noise emitted by machinery may not exceed 105dBA. The MHSC target was achieved by withdrawing machinery exceeding the target and adopting a Buy Quiet Policy.

The testing of current hearing protection devices using in-ear dosimeters to measure net exposure, in addition to ambient noise, was initiated during 2013. Results are expected to identify the most suitable devices for Sibanye’s employees and assist with their standardisation across the Group.

Chronic obstructive airways disease

COAD is characterised by chronically poor airflow, resulting in shortness of breath, coughing and sputum production. Long-term exposure to smoking, genetic predisposition and particulates associated with air pollution, particularly in poorly ventilated areas, cause an inflammatory response in the lungs, resulting in a narrowing of the small airways and breakdown of lung tissue known as emphysema or chronic bronchitis. Various measures have been implemented to reduce the extent to which employees are exposed to dust and diesel particulates.

In 2013, 74 cases of COAD were recorded (2012: 54 cases). COAD is compensable, given its association with chronic dust exposure, TB and silicosis.

Silicosis

Silicosis is caused by dust particles, which are small enough (or respirable) to reach the small airways of the lung. Free silica (SiO2), also known as crystalline quartz, is found across a broad range of industries, including mining, cement manufacturing and quarrying. Most often pulmonary fibroses, in the form of tiny nodules, occur due to silica exposure in a dose-dependent fashion. In 2013, 129 cases of silicosis were reported (2012:77).

Tuberculosis

TB is recognised as an important health hazard in the industry with silica exposure and silicosis as causes. CRTB is a common and, in certain cases, lethal infectious disease, which typically attacks the lungs, pleura and heart. The disease is spread when airborne droplets from the cough or sneeze of an infected person are inhaled by others. It is a significant health risk in southern Africa, especially as the symbiotic relationship between TB, HIV and silica-dust exposure exacerbates the incidence of both diseases. People who live and/or work in close proximity are particularly susceptible to contracting the disease.

Given the significant magnitude of the TB and HIV epidemics in South Africa, Sibanye has designed a comprehensive strategy to reduce the burden of disease, which includes annual TB screening for all employees, voluntary HIV testing, molecular DNA testing for TB, freely available Highly Active Anti- Retroviral Treatment (HAART) and TB drugs, contact tracing of index patients’ contacts on mine and in peri-mine communities, as well as post-employment TB management in South Africa and in neighbouring Southern African Development Community (SADC) countries where TB is prevalent.

There were 480 (2012: 442) new cases of CRTB reported and treated in 2013. Of these cases, 34 (2012: 36) were multi-drug resistant TB (MDR-TB).

HIV/AIDS

HIV/AIDS remains a significant driver behind employee morbidity rates, mortality rates and medically induced retirement. In 2013, the medically related death rate across the Group was 4.87 per 1,000 employees (2012: 7.44).

Sibanye’s strategy to address HIV/AIDS, sexually transmitted infections (STIs) and TB has been developed in cooperation with the Southern African HIV Clinicians Society, and recognises the close relationship between HIV/AIDS, other STIs and TB, and exposure to airborne dust.

The strategy is focused on the following priorities:

  • Educating and raising awareness among employees by way of regular awareness campaigns and condom distribution in the workplace.
  • Providing free and confidential Voluntary Counselling and Testing (VCT) to all employees. In 2013, 4,359 employees and contractors (11.5% of total complement) participated in VCT (2012:6,074;12.51%)
  • Providing free HAART to infected employees at on-site clinics. In total 7,185 employees have benefited from the HAART programme since 2004 and, in 2013, 3,844 employees were managed on the HAART programme monthly. This reflects a retention rate of 54% (default rate of <5%). Most employees leave the programme for employment-related reasons (medical incapacity and retirement) and are referred to formal, state-run programmes to continue further management.
  • Providing support by way of services, such as doctor-based primary healthcare, psychological counselling and social services.

Sibanye provides home-based care for ex-employees, including labour sending areas, who are terminally ill or permanently incapacitated. In addition, Sibanye also provides TB care via TEBA for employees who can no longer work but who require continuation of TB care. This is monitored until completion of therapy and cure. Family members are counselled and screened for TB as part of this service offering.

Ex-employees with occupational injuries and/or disease are entitled to a benefit examination every two years.

A project is currently being driven by the national DoH and the Deputy President to open centres all over the country to meet this need. Currently, there is one centre in Mthatha and another planned for Carletonville.

Highly Active Anti-Retroviral Treatment (number of employees)
  2011 2012 2013
Started HAART 5,828 6,820 7,185
Retained on HAART 3,567 4,181 3,844
Left HAART 2,261 2,639 3,341
Tuberculosis
  2011 2012 2013
Total TB (number of employees) 1,087 1,070 777
Total TB rate (% of employees) 25.23 24.50 19.19