Private Sector

Responsibilities and Opportunities

in Combatting HIV/AIDS and TB in Africa

Dr Brian Brink – Chief Medical Officer

How Africa turned AIDS around

2

Special Report to the

African Union Summit

May 2013

Source:

How Africa turned AIDS around

3 Special Report to the African Union Summit May 2013 Source:

PRIVATE SECTOR RESPONSIBILITIES IN DEVELOPING COUNTRIES

5

APPROACH TO HEALTH

Benchmarking Standards Guidelines Support Assurance

Occupational Hygiene Leading indicators

Occupational Medicine Leading and Lagging indicators

Occupational Health Anglo American Occupational Health Way

Employee Health and Wellness Including HIV/AIDS and TB

Families Health Insurance

Communities

Global Health

Health Management Information Systems

6

EMPLOYEE HEALTH AND WELLNESS

• Focus on all employees receiving an annual health screening and basic medical examination:

– Medical history screening for common diseases and lifestyle risks

– Height, Weight, Body Mass Index (BMI)

– Visual acuity

– Blood pressure

– Haemoglobin

– Blood sugar

– Cholesterol

– Substance abuse screening

– Voluntary counselling and testing (VCT) for HIV and TB

• Early diagnosis, early access to counselling, care, support and treatment. Ensuring that chronic diseases are properly managed.

• Reducing absenteeism, improving productivity

• Analysis of health trends over time and focusing management attention on emerging health issues

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PROGRESSION OF HIV INFECTION OVER TIME

AIDS TREATMENT

HIV TREATMENT

Deteriorating health Absenteeism Tuberculosis Disability Risk of death

YEARS

IMM

UN

ITY

(C

D4

CO

UN

T)

HIV/AIDS Key indicators

2008 2009 2010 2011 2012

Number of employees 81,450 66,661 73,129 77,075 70,690

Best estimate of HIV prevalence 18% 18% 16.5% 16.7% 16.8%

Estimated number of HIV positive employees 14,444 12,057 12,066 12,864 11,884

Number of employees participating in VCT 63,817 54,662 68,741 70,909 57,810

Number of contractors participating in VCT 37,397

Percentage employee VCT uptake 78% 82% 94% 92% 82%

New HIV infections 902 527

Crude HIV incidence 1.17% 0.74%

Number of HIV positive employees enrolled in

HIV wellness programmes 7,361 6,116 7,105 7,846 8,361

% HIV Wellness programme enrolment 51% 51% 60% 61% 70%

Number of employees taking ART 3,072 3,211 3,971 4,730 5,332

% of HIV positive employees taking ART 21% 27% 33% 37% 45%

HIV Incidence trend amongst employees at Thermal Coal

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

2005 2006 2007 2008 2009 2010 2011 2012

HIV Incidence

HIV Incidence

9

94% of

employees

retested for

HIV every year

since 2006

MOAE0203

Company-level ART provision to

employees is cost saving

A modelled cost-benefit analysis of the impact of

HIV and ART in a mining workforce in South Africa

Gesine Meyer-Rath1,2,3,4, Jan Pienaar10,11, Brian Brink11, Andrew van Zyl6, Debbie

Muirhead5,6, Emma Beruter6, Alison Grant6,7, Rory Leisegang6,8,9, Lilani

Kumaranayake5, Gavin Churchyard6, Charlotte Watts5 , Peter Vickerman5

1 Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, UK 2 Center for Global Health and Development, Boston University, US

3 Health Economics and Epidemiology Research Office (HE2RO), Wits Health Consortium, South Africa 4 Faculty of Health Sciences, University of the Witwatersrand, South Africa

5 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK 6 The Aurum Institute, South Africa

10 Anglo Coal Highveld Hospital, South Africa 11Anglo American, South Africa 7 Department of Clinical Research, London School of Hygiene and Tropical Medicine, UK

8 Division of Clinical Pharmacology, University of Cape Town 9 Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town

11 *Benefits include: disability, ill-health early retirement, death benefits, dependant pensions

CONCLUSIONS OF LSHTM STUDY

The cost of AIDS in the workforce is due to:

• Increased benefit* payments 44%

• Absenteeism 39%

• Training and recruitment 7%

• Medical costs 10%

The cost of ART makes up only 5% of the cost of AIDS

The savings under ART are mainly due to reductions in benefit payments and

absenteeism costs by 14% - 18%

Anglo American Thermal Coal mines have been saving 9% on the annual cost

of HIV/AIDS by making ART available to their workforce since 2003 ($31.2

million reduced to $27.6 million)

These results are based on real programme experience over 10 years

The results demonstrate strongly that investment in treatment is worthwhile

TUBERCULOSIS

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ANGLO AMERICAN TUBERCULOSIS INDICATORS

2009 2010 2011 2012

Employees 66,661 73,129 77,075 70,690

Pulmonary TB 786 582 758 517

Extra-Pulmonary TB 133 145 148 160

Total new TB cases 919 727 906 677

TB Incidence per 100,000 population

1,379 994 1,175 958

MDR TB Cases 12 19 28

TB Deaths 86 65 59

14

ANGLO AMERICAN THERMAL COAL

TUBERCULOSIS STATISTICS

2006 2007 2008 2009 2010 2011 2012

Annual TB Incidence Rate/100 000 937 704 856 712 525 468 696

0

100

200

300

400

500

600

700

800

900

1000

Annual TB Incidence Rate/100 000

Annual TB Incidence Rate/100 000 Expon. (Annual TB Incidence Rate/100 000)

YTD Forecast for 2012

CONTRACTOR CEO

HEALTH AND WELFARE SUMMIT Johannesburg - 29 November 2012

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• All contractors are required to comply with and participate in Anglo

American’s occupational health programmes and comply with

standards

• Long-term contractors will be required to participate in Anglo

American’s Health and Wellness programmes in the same way as

Anglo American employees. A monthly capitation fee ($20) will be

levied if the contractors do not have health insurance. Anglo American

will subsidise half the capitation fee.

• Basic package of care will include a comprehensive response to HIV

and TB including treatment.

HEALTH OUTCOMES OF THE CONTRACTOR SUMMIT

COMMUNITY HEALTH

Facilitating tangible health

improvements in local communities

and

Being a positive influence on health in

developing countries

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• The pillars of health system strengthening are:

– Improving health facilities and equipment

– Human resources for health – the “health workforce”

– Procurement and supply chain management

– Financial management and funding (health insurance)

– Health information systems

– Governance and accountability

– Monitoring and evaluation

• There are many opportunities for companies to get involved by

sharing core competencies.

• Anglo American believes that sharing its health information

system “theHealthSource” can be of great value for health

systems strengthening in rural communities.

HEALTH SYSTEMS STRENGTHENING

IN RURAL COMMUNITIES

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theHealthSource

THANK YOU