Global Fund greenlights regional TB program for miners in Southern Africa

18 Aug 2015

The Wits Health Consortium has been approved as the principal recipient on a new, $30 million regional grant to address the growing problem of tuberculosis among Southern Africa’s miners.

Ten countries with substantial mining sectors will be included in the grant-supported programming: Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Zambia and Zimbabwe. The regional coordinating mechanism had applied for a $60-million grant over three years but was instead granted $30 million for a two-year period.

Miners in Southern Africa’s gold mines have the highest rates of tuberculosis (TB) infection in the world. Every year, half a million men travel from across the Southern African region to work in South Africa’s mines and, in doing so, contract TB as well as HIV and silicosis: a degenerative lung disease linked to exposure to silica dust in gold mines. This pattern of migration -- men arriving at the mines to work, becoming infected with TB and returning home again -- has created an enormous public health crisis throughout the region.

The rate of TB infection among miners is between 3,000 and 7,000 per 100,000 people: between four and seven times higher than the general population of South Africa, the country with the second highest TB rates in the world.

As grant making begins, affected communities are also mobilizing to engage in the regional program.

On 3-4 August, the Southern Africa Mining Association (SAMA) in partnership with Stop TB and Southern Africa Trust, brought together its affiliates from Botswana, Lesotho, Malawi, Mozambique, South Africa and Swaziland for a workshop in Johannesburg.

Members of the regional and national associations, including ex-mineworkers, widows, migrant labor organizations and other key stakeholders, learned about the recently-approved program and developed a road map for their own inclusion. Of the interventions recommended for funding by the Technical Review Panel (TRP), the associations identified three core priorities: the strengthening of one-stop-shop centers through linkages to compensation funds; improved understanding of the epidemiology of TB in the mining sector through a baseline study; and community systems strengthening through small grants to civil society for human rights and gender activities.

“The fact that there is community buy-in at this early stage is very promising for the regional program,” said Gemma Oberth, who facilitated the workshop for the Stop-TB Partnership. “As sub-recipients have yet to be identified, Wits Health Consortium would be well–advised to consider the SAMA road map during their selection process.”

The green light comes 28 months after the Fund committed to spending $102 million in new funding to TB programs in Southern African Development Community Member States (SADC).

According to RCM’s ‘TB in Mine’ concept, between 25 and 30% of Southern African miners are living with HIV which, due to their weakened immune system, makes them up to five times more likely to develop TB.

It is estimated that one in three miners will become infected with HIV within 18 months of working at a mine. Miners suffering from silicosis  face an almost three-fold risk of developing active TB compared to miners free from the disease.

HIV and silicosis together have dramatic consequences for the health of miners: HIV positive miners suffering from silicosis are 15 times more likely to develop TB than HIV negative miners free from silicosis.

A recent tracking survey in Swaziland conducted by the Ministry of Health and URC Swaziland also found that of 251 ex-mineworkers, 38 showed symptoms of TB and 12 were found to have active TB. The study also showed ex-mineworkers to have high rates of MDR- and XDR-TB.

A mapping of three countries (South Africa, Lesotho and Swaziland) estimates that a total 498,384 mineworkers are currently employed in the mines in South Africa, of which 30% are contract workers and 40% are migrant workers from Lesotho, Swaziland and Mozambique, while there are about two million ex-mineworkers. The percentage of migrant mineworkers from these countries in the past could have been higher than 40%.

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