Wayne Dunn presents to World Bank Development Marketplace on the South African Mining Industry’s response to HIV/AIDS

Beyond the Paycheck 16-June-03 1

Beyond the Paycheck Mining Industry Response to HIV/AIDS at

the Family and Community Level

Presentation to

World Bank Development Marketplace June 16, 2003

Phillip Von Wielligh Jim Cooney Wayne Dunn

Placer Dome


Agenda • Background

• Meeting the challenge

• DM Project – Development

– Implementation

– Impacts

– Challenges and Learnings

• Care Positive – Scaling up and

addressing economic impacts


Background

• HIV/AIDS is the worst epidemic in human history. At every level it is causing devastation, destruction and suffering throughout Southern Africa

• The mining industry and its stakeholders are experiencing severe social and economic impacts

• Mine employees have a higher HIV prevalence rate (~25%) than the general population


Background (cont)

• Impact is felt more severely in the rural areas – Mineworkers come from throughout

Southern Africa (South Africa, Lesotho, Mozambique, Swaziland, Botswana) to work in South African gold mines

– Each mineworker is supporting an extended family of 10-20 people

– When they become too ill to work they are faced with going home, literally to die

– Families and communities not only lose remittances but they must care for the terminally ill worker with little or no training and very little public health infrastructure


Background (cont)

• Over 250,000 mineworkers in South

African mining industry

• Medical repatriation rate of 1.25% per

year

• Increasing numbers mineworkers are

medically repatriated every month

– If one considers all other employers

(government, rail, ports, etc.) this number

increases exponentially)

• Numbers will increase as AIDS

epidemic progresses


Background (cont.) • Not only is this a human tragedy, it

also affects mining industry economics adversely

• Mineworkers, faced with a choice between staying on the mine as long as possible, where they receive medical care and are able to continue sending money home, or losing their paycheck and returning home where health services are minimal and over extended

• Most were staying onsite, often to the point of death

• In addition to leaving families unprepared, this had huge impacts on industry productivity and profitability


Meeting the Challenge

• The mining industry recognized that

it had to be a key stakeholder in

addressing this catastrophe

• Placer Dome, through the South

Deep Care Project had already

committed to developing HIV/AIDS

programming to follow-up on its

groundbreaking retrenchment

mitigation project (more on this

later)


Minesite and Local Community Programs

• Minesite Programs

• Local Community

Programs


Beyond the minesite

• Mineworkers’ families were

scattered over an 800 by 4000km

area, much of it in isolated and

inaccessible areas.

• Entire mining industry was facing

a common set of problems

• Collaboration created economies

of scale and potential for

additional scalability

• TEBA had an existing

infrastructure and presence

throughout the region


Developing a Home Based Care Program

• Placer Dome, as operator of the Placer Dome Western Areas Joint Venture South Deep Mine, took the lead in working with TEBA to develop an industry wide approach

• Decision was made to address the social impacts in the first stage and then to develop additional programs to mitigate the economic impact


Developing a Home Based Care Program

• Develop a home based care program that would enable mineworkers to return home to a functioning care system

• Pilot the program in several areas and then roll it out throughout the labour supply area

• Develop a fee for service model that would facilitate broad buy-in from the mining industry – and eventually from other industries and public sector stakeholders

• With support from World Bank Mining Group we submitted a proposal to the Development Marketplace (AIDS Campaign Team Mining)


Implementation Steps

• Consult with stakeholders (NUM,

Chamber of Mines, Service

Providers, Governments, etc.)

• Develop a draft process to go from

medical repatriation at the

minesite to reception in home

community and ongoing provision

of support

• Secure mining company support

Family

prepared

for his

arrival

Arrival

counseling

Appointment

of

Caregiver

Training

of

Caregiver

Mineworker

Medically

Discharged

Ongoing

support

and

monthly

medical kits

TE

BA

Ho

me

Ba

se

d C

are

Pro

ce

ss


Implementation Steps (cont)

• Develop a Steering Committee

– Design training curriculum (Care

Supporters and Providers)

– Oversee program operation

– Develop rural implementation

capacity (recruit and train

fieldworkers and Care

Supporters)

– Pilot area first then more general

rollout

Masana Clinic

XAI XAI, Mozambique


In the communities

• Develop partnerships

and relationships to

enable families to

access any existing

local services and

support (e.g., NGO,

government,

education, welfare,

etc.)

• Traditional healers


Patient

Home-Based Carer

Village Care Supporter

TEBA Rural Development-HBC

Mines

Overview of Home Based Care


Project Impacts

• Broad stakeholder participation in

HBC

• Monthly medical kits

• Improved nutrition and care for

affected families

• Full industry participation

– 8 mining companies

– Over $300,000 in direct cash payments

• DfID support enabled extension to all

affected employees in Lesotho


Project Impacts

• Care for patients through HBC

enables families to better care

for others who are suffering from

AIDS but not eligible under this

program

• External evaluation of the project

is currently being done by the

University of Pretoria


INDUSTRY HOME BASED CARE RESULTS (Year One)

Milestone Target Actual

Community Care

Supporters engaged

87

127

Community Care Training

87

123

People under Home

Based Care

696

801

THE PROJECT EXCEEDED TARGETS

IN EVERY AREA


Scaling Up and Expanding • Currently planning year

two rollout (we didn’t want to plan until we had the results of the external review

• Expectations are to double the number of homebased care families, caregivers and regions where the program will be delivered

• A strategy for rolling out into additional industries will be developed in year 2


Challenges and Learnings • Difficulty getting proper

repatriation notification from

mining houses (need

improved communication and

coordination)

• Families needed more

counseling than originally

anticipated

• Patients needed medical

attention on arrival

– Dehydration, exhaustion, etc.


Challenges and Learnings

• Traditional healers

are vitally important

stakeholders

– Xai Xai training

program


Challenges and Learnings (cont.) • Maximizing the role of local

stakeholders results in improved

efficiency and increased local capacity

• Involvement of local leadership and

traditional healers improves local

acceptance and enhances community

and family impact

• Expanding into other markets

(industries) and developing financial

partners requires sophisticated

communication and strategic marketing

skills (organizational development)


Challenges and Learnings (cont.) • Utilization of local

suppliers (e.g. trainers)

and professionals

increases local

acceptance of the

program and increases

overall community

capacity to address the

epidemic

•An industry-wide approach is much more effective and efficient than a company by company approach


Challenges and Learnings (cont.) • Continual communications

and reaching out to

external stakeholders can

identify additional partners

and synergies

• External evaluation can

provide valuable insights

and also help to attract

new partners

• Metrics and indicators are critical to success and should be planned from the onset


Challenges and Learnings (cont.) • Service Termination – service to

the families currently terminates with the death of the mineworker. This leaves a huge gap at a critical point for the families, who have come to depend on and trust the caregivers. Support should continue for a period beyond death to assist the family to cope

• The prestige and profile of the Development Marketplace award helped tremendously to open doors with other partners and stakeholders


What happens to children and

families when the breadwinner

can’t work


Building on the Care Project

• Placer Dome has successful experience in assisting mineworker families to become economically active

• In 1999 the company retrenched over 2,500 workers who returned to their families in rural areas throughout Southern Africa

• The Care project was designed to mitigate the economic impact on families


Building on the Care Project • A unique 13-step process was

designed that provided counseling, training and support to retrenchees and their families, right in the areas where they lived

• Proxy model enabled direct participation by women and other family members

• The project has enabled nearly 60% of the affected families to develop alternative economic opportunities

• An extensive network of fieldworkers and project partners were developed and are still in place

Business Operation

1. Ongoing availability of Technical Assistance

and Business Counselling

2. Ongoing faclitiation of skills training needs

(i.e., business, agriculture, vocational, etc.)

Awareness/Orientation Phase

1. Counselling, Economic Lifeskills &

Opportunity Orientation

2. Opportunity Awareness Workshops

(Economic Opportunity/Career Fairs)

3. Training Needs Assessment

Decision on Economic Option

Employment StreamEnterprise Stream

Business Planning & Preparation

1. Business Orientation

a) Idea Generation Workshops

b) Business Training Activities

2. Develop Draft Business Plan

(to be reviewed with Counselor)

(plan will contain financial, operational

and skills upgrading plan)

3. Preparation of Micro-Finance Application

4. Submission to Micro-Finance Agency

Evaluation of Micro Finance Application

Employment Planning & Preparation

1. Skills Training (Vocational/Agricultural)

2. Employment Counseling / Placement

(Job search/Resume, etc.)

Retrenchee is Re-Integrated

and Economically Active

Personal

Economic Plan

Prepared &

Assessed

Personal

Employment Plan

Prepared

Business &

Financing Plan

Prepared

Planning Phase

1. Labour Force Rationalization Plan

2. Retraining/Redeployment Assessment

3. Detailed Retrenchment Plan

Ongoing Processes

Follow-up sessions/

activities to monitor

effectiveness of

interventions

Communication and

consultation with

stakeholders

Continuous improvement

process (review feedback;

enhance programs,

procedures, processes)


Moving forward

• The Care project piloted an innovative means of assisting rural families to become economically active and it has an effective infrastructure and management system in place

• ACT Mining Home Based Care project piloted a cost effective, fee for service program to support medically repatriated workers and their families


Our Vision for the Future

Care Positive • Integrate the Home Based Care

project with the Care process and launch as a fee for service based program to address the social and economic impacts that AIDS is having on rural families and communities

• Start with the mining industry but design the infrastructure and management systems to enable participation by other industries, governments and donor community stakeholders

Care Process

+

Home Based Care

=

Care Positive


Summary


Conclusion

• The pieces are available to put in place a cost-effective, scalable program to help mitigate the family and community level impact of AIDS in rural areas

• Placer Dome is willing to lead and co-finance but the project is beyond the scope of a single mining company

• We request your guidance and assistance to develop the appropriate financial and technical cooperation that can make this dream a reality