Healthsystem for TB HIV and silicosis in south African mines

Introduction
The mining sector is important in the economy and society within South Africa and the SADC region. It contributes 7.7% of the GDP of South Africa directly, and is worth US$ 2.5 trillion (net asset value). Its interventions with respect to TB, HIV and Silicosis have been far from satisfactory with many commissions of enquiry and legal challenges. Silica exposure has had a multiplier effect on the TB incidence and alongside HIV has led to a triple burden of disease amongst mine workers. A rapid appraisal to examine the policies and health services for TB, HIV and Silicosis in the mines was commissioned in 2010.

Methods
Sixty eight mines were randomly selected from a list of registered mines; interviews were conducted using a structured questionnaire, a desktop review of the legislative framework and two expert review panels were held.

Results
Study response rate was 93%. Overall 40% of mines provided TB services, 38% provided HIV services on site. Mines without services were dependant on public healthcare facilities. Of the visited mines 79% had an HIV policy and 59% had a TB policy. The surveillance system for TB, HIV and Silicosis was fragmented and weak; and there was poor enforcement of legislation.

Discussion
To control TB, HIV and Silicosis in South African mines, the development of a policy and legislative framework that goes beyond self-reporting; development of a strong surveillance system and consideration of a global financing model will be key.