Health and wellbeing
- 3,288 employees on ART, with a default rate of 2%.
- TB cure rate of 82%, against a target of 85%.
- Launch of community TB outreach programme.
We recognise the interdependency between health and safety given that effective health-management systems can reduce illnesses, fatigue and medical expenses and significantly improve the safety performance of our work teams. While the provision of adequate healthcare is not a specific board initiative, we remain committed to our occupational health, HIV/Aids, tuberculosis (TB) and community healthcare projects, as well as the education initiatives we have in place to encourage individuals to take responsibility for their health.
While our CEO is legally accountable for the health of our employees and contractors, healthcare delivery is the responsibility of our Occupational Health and Hygiene Department. Health forms part of our Employee and Community Value Propositions and we are as committed to improving peoples’ health as we are to our safety performance.
Employees with disabilities
This year we have focused on integrating sound safety and health practices into our systems and technology synergies, and hope employees benefit from this co-ordinated effort. One of these synergies has resulted in the development of strategies to manage fatigue and those with disabilities. 0.9% of our employees are people with disabilities. Through our Disability Policy we make provision for accommodation, retraining or alternative placement of people with disabilities and we have over the years provided infrastructure changes to accommodate employees with disabilities.
Our healthcare strategy was reviewed this year in order to meet customer expectations and ensure future sustainability. We adopted the slogan “Your Health, Our Priority” with the involvement of our employees through an internal competition.
Our strategy is built on the following five objectives:
- Improve health outcomes for TB, HIV/Aids and chronic disease patients through comprehensive principal healthcare and health promotion.
- Provide customer-centred services by creating a “Caring and Safe” environment for employees.
- Provide preventive health programmes that promote healthy choices, including managing occupational exposure risk profile and occupational diseases.
- Ensure legal compliance in terms of risk-based medical and biological surveillance and fit-for-purpose business practices.
- Provide sustainable interventions to enhance quality of life including community health initiatives.
Employee health benefits
All of our employees and contractors have access to various on-site healthcare facilities. The Andrew Saffy Memorial Hospital is based in Wonderkop, and offers medical and surgical wards for minor surgeries, a casualty and out-patients department, and a registered retail pharmacy. We also have four clinics – two at Marikana, one at Limpopo and one at the PMR – which provide primary and occupational healthcare services, as well as a contractor hub that offers medical facilities.
This year we spent R151.3 million on employee health initiatives, of which R26.6 million was related to the prevention and management of HIV/Aids. Capital expenditure of R3.25 million was incurred on the acquisition of a new patient transport vehicle, physiotherapy, pharmacy and occupational hygiene equipment, protection of the X-ray equipment, installation of a ducting system to improve ventilation in the outpatients department, and the construction of a new helipad to comply with safety regulations.
Our internal healthcare system is a diverse one, which is focused on various areas, including:
- Human immunodeficiency virus (HIV) and anti-retroviral treatment (ART) management.
- Chronic diseases such as epilepsy, asthma, diabetes and hypertension.
- Trauma and emergency care.
- Everyday illnesses, such as colds and flu.
- Women’s health, including ante-natal care.
Focussing on women’s health, and to promote gender equality, we have established a three-bed female ward where women can be admitted for short-term treatment. Around 18,000 consultations take place each month. Our bed occupancy rate was 64% in 2013 and the average length of stay was five days.
Our treatment centres follow a customer-centred approach, which focuses on the interaction between health workers and patients, and we rely on patient feedback to ensure our programmes respond appropriately to employee needs and beliefs. Our customer satisfaction and health perception surveys throughout the year averaged 75% satisfaction, and we have actions in place to deal with comments received, along with a customer service project to enhance competencies in dealing with customers.
We monitor the outcomes of treatment of diseases, in order to understand how successful protocols are and to adapt as necessary. Of the 3,552 patients registered for chronic illness, 90% are on controlled treatment.
All Lonmin employees are able to join our Lonmin medical scheme, which fully covers the cost of their medical treatment. The cost of treatment of dependants is also subsidised. Through this scheme employees are granted unlimited numbers of visits to Lonmin medical professionals, four external general practitioner visits, prescribed minimum benefits and specialised treatment. If employees prefer to choose their own medical aid scheme, the monthly payments towards this are subsidised by their medical benefit. All employees have access to Careways, a wellness scheme that includes counselling. Access to Careways is also available to family members and, following the events of last August at Marikana, support was further extended to ensure that families of employees in labour-sending areas received counselling in conjunction with the Department of Social Development.
One of the most critical lessons that came out of the tragedy at Marikana was the value of emergency preparedness. The drills that we have been conducting for a number of years in this regard enabled us to manage some 56 injured casualties on 16 August 2012 at the Andrew Saffy Memorial Hospital, located on site. We had support agreements in place with nearby hospitals and emergency services to support with treating disaster and mass casualties, and these external facilities were fully utilised during the events.
A contact centre was also established at the hospital to manage all family member enquiries, and to counselling and support. The Company activated an emergency call centre for all employees that wanted to report intimidation, violence or who wanted to receive a security update.
The Lonmin HIV/Aids policy focuses on HIV/Aids education, addressing the stigma that persists around the disease and ensuring that any employees with HIV or Aids have the necessary medical and emotional support they need.
The policy supports five strategic objectives:
- Educate and inform about HIV/Aids.
- Provide access to voluntary counselling and testing (VCT).
- Provide employees who are HIV-positive with medical and emotional support.
- Administer ART to patients who are HIV-positive.
- Ensure equitable treatment for those infected, in line with the law, company policies and agreements.
HIV/Aids-related conditions remain the primary cause of mortality among in-service employees, with 99 of our employees falling victim to HIV/Aids-related illnesses during the year (2012: 104).
We have committed to a number of HIV/Aids related targets to drive business to focus specifically on HIV/Aids:
- Maintain our ratio of workplace peer educators to employees at above one active peer educator for every 75 employees through to 30 September 2014.
- Maintain the rate of anti-retroviral treatment (ART) defaulters at below 5% of overall ART participants through to 30 September 2014 from a 2013 baseline year.
Through the ICMM we share information with industry peers about our programmes to learn from each other. We also collaborated with a number of non-governmental organisations to create awareness around HIV/Aids and we include a number of requirements in our vendor application forms to encourage suppliers to focus on HIV/Aids.
During this year, 17,682 HIV tests were conducted during campaigns and at occupational health centres. Of those tested, 11.4% were HIV-positive. This was a lower percentage than the projected prevalence rate of 19.1% indicated by our actuarial models, although this percentage does not reflect those HIV-positive employees who were already aware of their HIV-positive status and did not test again during the year. 74% of the HIV positive employees are enrolled on either the wellness or the ART programme. We aim to increase this coverage further to 80% in 2014.
Voluntary counselling and testing
Following an extensive analysis, there has been a strong correlation between our ongoing awareness programmes and the steady increase in participation by our employees in voluntary counselling and testing (VCT).
We have regular VCT campaigns at different operational sites. Suppliers, contractors and community members are received free of charge and encouraged to participate in these campaigns. We held ten VCT campaigns during the year and 5,700 employees and contractors participated. We also hosted a golf day through our Supply Chain Department to raise funds for various charities, which we took as an opportunity to spread awareness about HIV/Aids and our VCT programme.
We also offer a wellness programme that is designed to cater for the physical and emotional effects of HIV and peer educators also play an important role in facilitating this support. 690 employees participated in the wellness programme in 2013, an increase of 5% from the 657 participants registered in 2012. See Case study: Participation and communication the basis of successful peer education.
Free anti-retroviral treatment (ART) is provided once an employee’s CD4 T-lymphocyte count drops below 350. In 2013, 3,288 people participated in our ART programme (2012: 2,510), an increase of 31% from the previous year.
Encouraging adherence to an individual’s prescribed ART regimen is critical to the success of our ART programme. Pleasingly, our ART default rate has declined to around 2%, from 10% in 2012. Education and training campaigns, on-going counselling of patients, close collaboration with unions and administrative controls have all played a role in this important achievement.
A rehab and fitness programme at our physiotherapy centre completed a study on 79 employees with HIV/Aids and/or TB, which found that 62 of the participants were strong enough to resume their work after six weeks in the programme.
We supply ART for life to employees and ensure their access to our ART programme even after retirement. The intervention of ART has reduced the predicted impact of HIV/Aids, as per the actuarial model on projected mortality rates. This programme costs around R7,800 per person annually.
In support of our ART, HIV-positive employees and contractors are taught about healthy eating, offered group counselling and are trained about their condition and treatment.
Our occupational health and hygiene initiatives are aimed at reducing the risk of exposure to potentially hazardous working conditions, as well as constantly improving working conditions and meeting regulatory compliance in terms of risks such as noise-induced hearing loss (NIHL), occupational asthma, dermatitis and tuberculosis (TB). See Case study: Diesel particulate matter.
We introduced physical and functional work capacity testing in 2008 as a means of ensuring that all recruits are capable of performing their jobs without health or injury risks. The tests include cardio-respiratory function assessments, along with job-specific capability tests.
We had no cases of occupational dermatitis or asthma during the year. Two employees at the PMR have demonstrated positive skin prick test results for platinum salt sensitivity, but have not displayed any symptoms. They are being closely monitored.
Noise-induced hearing loss
Noise-induced hearing loss (NIHL) remains our primary occupational health risk. The DMR, in conjunction with the Chamber of Mines and other industry role players have set the following milestones to eliminate NIHL:
- No deterioration in hearing greater than 10% amongst occupationally exposed individuals after December 2008.
- Noise emitted by installed equipment must not exceed 110 decibels dB (A) at any location in the workplace across industry, by December 2013.
We conducted several initiatives during the year aimed at reducing the incidence of NIHL, categorised into four key areas:
- Engineering control.
- Equipment noise.
- Rock drill silencing programme.
- Administrative control.
- Risk assessment, measurement of noise and noise exposure, zoning and demarcation.
- Training and awareness.
- Personal protective equipment.
- New hearing protection for specific levels of exposure, supported by training
- Medical surveillance.
Our Hearing Conservation Steering Committee was reconvened this year and it assists with adjusting our hearing protection measures according to the feedback we receive from employees.
We diagnosed 48RA new cases of NIHL in 2013 (2012: 42), which amounts to an increase of 14%. The reasons for this include a rise in the number of diagnoses during the year of older employees who had experienced prolonged exposure to noise during their working lives, and the inclusion of cases where hearing loss had potentially occurred as a side effect related to HIV/Aids and TB infection and treatment. Rock drills in some areas are also still emitting high noise levels, but rollout of our drill silencing programme continued during the year and remains on track for completion.
We have an annual target to reduce the number of new NIHL cases by 10% from a 2012 baseline year.
Tuberculosis (TB) is a significant threat to health in South Africa, and is particularly so in labour-intensive industries and when it is associated with HIV/Aids. The year 2013 saw great strides being made in reducing the incidence of TB at Lonmin.
As in previous years we screened all employees and contractors for TB during occupational health examinations, and provided treatment to all of those who were diagnosed. In addition, we have continued with TB contact tracing to monitor TB treatment defaulters in a manner similar to that in which we manage ART defaulters. This year we extended the contact tracing to the community.
In conjunction with the Department of Health and donor-funded service providers we have been testing households in the community for HIV and TB and have been monitoring their treatment to ensure that those people on medication remain on their treatment plan and are able to feel its full benefits. While this project has been challenging at times due to the difficulties of monitoring patients and receiving feedback, we are committed to continue with it in the hope of achieving our goal of reducing the incidence of TB amongst our employees and in local communities.
In 2013 446LA new cases of TB were diagnosed and treated (2012: 527 cases), and we achieved a cure rate of 82% for cases where the treatment outcome is known, against an ongoing target of 85%. We recorded 24 cases of multi-drug resistant tuberculosis (MDR TB) and zero cases of extremely drug resistant tuberculosis (XDR TB) (2012: 11 and 0). The increase in multi-drug resistant tuberculosis impacted negatively on our TB cure rate.
- Rates of injury, occupational diseases, lost days and absenteeism and total number of work-related fatalities by region and by gender.
- Education, training, counselling, prevention and risk control programmes in place to assist workforce members, their families and community members regarding serious diseases.
We understand that our employees’ health is not only affected by their time at work, but also by external influences at home, that are outside the reach of our standard occupational health programmes.
By working closely with local communities and the Department of Health we are able to identify and address health needs in these areas, and monitor their effectiveness in the short-, medium- and long-term. With so many of our employees residing in local communities, we can be confident that our community health collaborations reach them at home as well.
Addressing the root causes of community health concerns
A GLC health survey undertaken in 2006 and reviewed during 2012 revealed that community ill health was often related to a lack of piped water, the use of pit latrines, burning wood for cooking and heating, burning waste, single room dwellings and risky sexual behaviour. In June 2013, we conducted a door-to-door campaign to educate local communities about the connection between responsible environmental behaviour and personal health. This campaign reached 4,077 households. Key issues such as air pollution and waste management were addressed, and the initiative will be monitored as part of on-going health promotion projects in the GLC.
As with many of our community initiatives, we cannot work in isolation, and our partnership with the Department of Health on various long-term projects in the GLC is imperative. Regular meetings with the Department strengthen our relationship with a common purpose, and help us to track health trends in the area to ensure that our interventions are successful and are addressing the correct issues.
During 2013, we completed numerous infrastructure projects in support of regional healthcare that we were able to hand over to the Department. These included three houses to be used for accommodation for medical staff in Wonderkop, a clinic in Limpopo that was handed over during December 2012 and a facility for mothers and children in the East Rand that was officially handed over to Gauteng Department of Health in July 2013.
We have also partnered with the University of Pretoria on projects around the extremely important topic of nutrition.
Five community food centres are supported by Lonmin, through the provision of food supplies and the payment of stipends to community volunteers for the preparation of food. More than 400 orphaned and vulnerable children are fed over weekends and school holidays.
TB in our communities
Our community TB outreach programme consists of awareness campaigns, case finding, contact tracing and DOTS (Direct Observed Treatment Support). In collaboration with Madibeng Research Centre, community health projects were implemented where TB education was given priority in the communities. Nkathalo is a non-profit organisation working with us, tracing TB patients (mine index patients) in the communities. TB and HIV-testing is conducted and community members are referred to health institutions for TB treatment and follow-up where needed.
R5.7 million was spent on community health initiatives, including expenditure at our Limpopo operations. Of this, R2.9 million was spent on health infrastructure.
- Development and infrastructure investments and services provided primarily for public benefit through commercial, in kind, or pro bono engagement