The Compensation Commissioner noted that restructuring the Compensation Commission for Occupational Diseases (CCOD) was fundamental to providing better healthcare services for workers. He also acknowledged the support of the Department of Health’s Director-General and briefly outlined some of the key challenges which include governance, claims management, service delivery, infrastructure and sustainability.
The Commissioner explained that the issues would be addressed by developing a streamlined and integrated management structure for the Medical Bureau and the Compensation Commission. The Commissioner noted the tremendous support from the Director-General and the Department, and that the Committee and the Auditor General of South Africa had expressed concern in the past about the implementation of strategic plans.
Several strategic objectives, programmatic interventions with targets and timeframes were outlined. The Commissioner presented a summary of the critical areas which included problems in government, claims management, service delivery, infrastructure and sustainability in addition to some actuarial valuation problems. The Commissioner highlighted the problems resulting from outdated legislation and proposed legislative reform. He cited the Occupational Diseases in Mines & Works Act (No. 78 of 1973) as an example.
Members commended the efforts of the national Department Health to fill vacant posts but questioned if the plans were integrated into the National Development Plan and the National Health Insurance. They also questioned the efforts to control and manage silica dust exposure on the mines, the strategies for capacitating miners on their rights and the role of health and safety officers. Members expressed concern at the absence of clear timeframes and asked how the monitoring and evaluation would be managed.
Members noted the high tuberculosis (TB)/HIV co-infection rates on the mines and asked how patients were identified and followed up. They expressed concern at obvious fiscal constraints and questioned if sufficient funds would be available for the rollout of decentralisation of services to miners. They also questioned how the funds would be sufficient to extend the right to migrant miners.
Members asked how the R2 700 paid to beneficiaries of the Eastern Cape Project was derived.
The Chairperson stated that the Compensation Commission for Occupational Diseases (CCOD) was not doing well and that the Committee had not visited it. He also informed Members that the Mediation Committee would meet later in the day to discuss the National Health Amendment Bill [B24B-2011].
Compensation Commission for Occupational Diseases Strategic and Annual Performance Plan 2013:
Dr Barry Kistnasamy, Commissioner, Compensation Commission for Occupational Diseases (CCOD), presented the Strategic and Annual Performance Plan (see attached presentation) and outlined the current context, diagnostics of issues, and budget to inform Members in their deliberations. He conceded that some issues had been neglected and that re-structuring the CCOD would assist in providing better healthcare services for workers.
Dr Kistnasamy also stated that the Miners' Phthisis Act (No. 19 of 1912) was more than one hundred years old. He summarised some of the key challenges which included governance, claims management, service delivery, infrastructure and sustainability. He explained that the challenges would be addressed by developing a unified management structure (Medical Bureau, Compensation Commissioner). He noted the tremendous support from the Director-General and the Department. He also noted that the Committee and the Auditor-General of South Africa (AGSA) had expressed concern in the past about the implementation of strategic plans.
Dr Kistnasamy noted that substantive changes to the Occupational Diseases in Mines & Works Act (No. 78 of 1973) were required.
He then outlined the past performance of the CCOD for the financial year 2012/13, which reflected a poor performance record in submitting annual reports, weak management systems and non-compliance. Administrative costs were covered by Department of Health (R34.4m) – 1.4% of Fund. He said that the Compensation Fund totalled (R2.4b) and included subsidiary accounts, namely, the Mines account, Works account, State account & Research account. R336m was the total revenue and there was R149m in expenditure. It further included the compensation for occupational diseases (workers & ex-workers in controlled mines & works) (R140m). R2.9m in pensions covered 188 pensioners and the Eastern Cape project (R54 000 to 20 claimants). He noted however that there were some actuarial valuations problems.
Medical Bureau for Occupational Diseases briefing
Dr Kistnasamy outlined the mandate of the Medical Bureau for Occupational Diseases (MBOD) (see attached presentation), and highlighted some of the strategic objectives, goals and critical issues. He reported that due to loss of data between 2000 and 2004 no annual reports had been submitted since 2000. Some outreach programmes were conducted but was considered insufficient.
He further reported that the sustainability of the fund depended on ensuring a functioning Risk Committee. The Risk committee deliberated on the risk to the workers on occupational diseases. He said that while it was an important committee it was not functional.
Dr Kistnasamy informed the Committee that scientific evidence would suggest that the inhalation of diesel fumes were cancer-causing and was a source of concern. He proposed a series of special investigations since the initial investigations revealed major irregularities.
He said that workers should go to work to be healthy and injury free. The focus should therefore be on prevention. He also stated that the casualisation of labour presented serious systemic problems. The conditions under which miners worked exposed them to silica dust which increased their risk of cancer and TB and that HIV-positive miners were at particular risk. He warned of the consequences for humans when digging a hole in the ground. He suggested expanding data and data surveillance.
Dr Kistnasamy informed the Committee of R2.4 million in the research account and recommended allocating funds for operational research. The Occupational Health budget was located within the budget of the National Department of health. R52 million had been granted and a submission would be made to National Treasury to ascertain how to increase the fund value.
He explained that human resources were in the process of being re-organised. The Director-General deployed 30 interns and had provided them with letters of appointment. He highlighted the need to clear backlogs to improve turn- around times.
He noted that the MBOD would follow a public health approach. A study was looking into the socio-economic impact on the surrounding mining communities.
The Chairperson suggested soliciting the advice of legal advisers to scrutinise the Act that was one hundred years old.
Dr Kistnasamy concluded that while the mining industry was a significant national resource it must be acknowledged that the effects of mining on communities placed a huge burden on state resources particularly in terms of public health.
The Chairperson expressed his view that the economy of the country depended on the well being of the mining industry and reiterated the seriousness of the challenges under discussion. He expressed concern that many of the mineworkers affected had already died. This was particularly the case in the Eastern Cape.
Ms B Ngcobo (ANC) noted the Director-General’s effort in working towards filling vacancies utilising interns in the national Department of Health but raised concern that these efforts were not enough in the context of large-scale unemployment.
Ms M Segale-Diswai (ANC) explained that she was a nurse by profession and in her experience it was the nurses who were burdened with caring for sick miners. She suggested empowering nurses with occupational health training and that they are located at the point-of-care to further the decentralisation of access to services for the miners.
Ms Segale-Diswai asked if the Eastern Cape Project would be expanded to other provinces.
Dr Kistnasamy replied that such a decision was beyond the mandate of the Commissioner.
Dr Malebona Matsoso, Department of Health Director-General, agreed that primary healthcare nurses must be trained and skilled in occupational care.
Mr D Kganare (COPE) asked if decentralising services would include miners from other countries and how this would impact on the total budget. He also asked for clarity on the role of health and safety officers on mines.
Ms H Msweli (IFP) expressed concern that no annual report was submitted between 2000 and 2004. She wanted to know how the Commissioner had arrived at R2 700 per claimant.
Dr Kistnasamy answered that R54 million was divided by the number of people. R54 million was the original amount in the Transkei government funds made available by the Chamber of Mines. The funds were then transferred to the CCOD to act as a coordinating mechanism. There were currently only twenty claimants.
Ms D Robison (DA) stated that she was not aware of the carcinogenic nature of exposure to diesel. She questioned how the CCOD would be integrated into the National Health Insurance (NHI) and if this was provided for in the NHI budget.
Ms T Kenye (ANC) noted that the plan did not include timeframes and asked how monitoring and evaluation would be managed.
Dr Kitnasamy replied that there was no quick fix solution and internal organisational retooling was requisite. Performance agreements were in place and the process carried a three to five year timeframe.
Ms Kenye wanted to know what could be done to mitigate the impact of and manage the exposure to silica dust on mines.
Dr Matsoso explained that the miners did not know they had a lung disease when they presented at clinic indicating a missed opportunity to intensify TB case finding.
Dr Muzimkhulu Zungu, Acting Director, Medical Bureau for Occupational Diseases (MBOD), commented that a Southern African Development Community (SADC) declaration was signed by heads of state in 2012. He said that Lesotho, Swaziland and South Africa had high rates of TB/HIV co-infection. In South Africa the TB rates on the mines were 7 000 per 100 000 which was seven times higher than in the general population. Between 10 and 20% of mine workers had HIV and no existing data on multi-drug resistant/ extensively drug-resistant tuberculosis (MDR/XDR TB). Studies were underway which would assist in providing additional data. He suggested approaching the Medical Research Council to assist with research capacity.
Ms Kenye asked for clarity around the strategy to raise awareness among miners about their right to access adequate basic healthcare notwithstanding their right to claim compensation for illnesses acquired as a result of exposure to dust from mines.
Dr Kistnasamy replied that Unions would fulfil an important role in outreach activities and raising awareness among miners. The National Union of Mineworkers was planning six workshops. The Department would also work with ward-based committees.
Ms Kenye reiterated concern at the lack of available resources for an expanded programme that would include miners from the SADC region.
Mr G Legetho (ANC) noted the number of vacant vacancies within the national Department and asked when these positions would be filled.
Dr Kitnasamy acknowledged that more needed to be done. He also acknowledged the complex nature of the issues and the historical and existing challenges but believed that good progress was being made.
Dr Kitnasamy commented on the vacant vacancies, noting that the Department conducted a clean-up of the Persal database last year. A three-year framework was in place to remedy some of the issues. He said posts had been advertised and eight accounting posts would be filled by June 2014. In addition approximately four hundred unemployed graduates were provided with two-year contracts.
Dr Matsoso commented that the SADC protocol that prescribed on TB in mines had attracted interest from the United Nations agencies including the Global Fund and presented an opportunity to access additional funding resources.
Dr Kitnasamy suggested that companies which had caused the problem commit to contributing resources to the solutions. He cited policy initiatives in the pipeline that would result in amendments to the Occupational Diseases in Mines and Works Act 1973.
The Chairperson suggested that the Committee set aside more time to investigate matters further since it was clear that legislative reform would be necessary.
The meeting was adjourned.
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