Shireen Pardesi, Muzimkhulu Zungu and Sam Molautsi 27 August 2014 Annual Performance Plan of MBOD/CCOD Presentation to Portfolio Committee on Health

Overview History Diagnostics of problems Strategic Plan Annual Performance Plan Way forward Conclusion History Diagnostics of problems Strategic Plan Annual Performance Plan Way forward Conclusion

102 year old History… Miners’ Phthisis Act 19 of 1912

In Summary… Problem – governance, claims management, service delivery, infrastructure, sustainability Paradox – lots of data… Pressure – multiple fronts (1867 – diamonds; gold) Potential for change, Auditor General’s report Promise …. Problem – governance, claims management, service delivery, infrastructure, sustainability Paradox – lots of data… Pressure – multiple fronts (1867 – diamonds; gold) Potential for change, Auditor General’s report Promise ….

Interventions Unified management structure (Medical Bureau, Compensation Commissioner) All activities now in one building Support from National Department of Health Development of the strategic plan and annual performance plan Unified management structure (Medical Bureau, Compensation Commissioner) All activities now in one building Support from National Department of Health Development of the strategic plan and annual performance plan

Strategic Plan ( ) Combines the Compensation Commissioner and Medical Bureau (Occupational Diseases in Mines & Works Act (1973) Vision: An accessible and effective occupational health system and services that ensure …..compensation for workers and their beneficiaries Mission: Enhancement of the health system to prevent occupational diseases and provide services Combines the Compensation Commissioner and Medical Bureau (Occupational Diseases in Mines & Works Act (1973) Vision: An accessible and effective occupational health system and services that ensure …..compensation for workers and their beneficiaries Mission: Enhancement of the health system to prevent occupational diseases and provide services

Policy Initiatives Amendments to the Occupational Diseases in Mines & Works Act (1973) Expanding the coverage of controlled mines & works Provision of decentralised services for workers & ex-workers Explore models for service delivery (within & outside South Africa) Alignment of compensation (Department of Labour & Treasury) Amendments to the Occupational Diseases in Mines & Works Act (1973) Expanding the coverage of controlled mines & works Provision of decentralised services for workers & ex-workers Explore models for service delivery (within & outside South Africa) Alignment of compensation (Department of Labour & Treasury)

Past Performance Poor performance (annual reports; compliance; management) Administration covered by Department of Health (R34.4m) – 1.4% of Fund Compensation Fund (R2.6b) Mines account, Works account, State account & Research account R336m revenue & R149m expenditure Compensation for occupational diseases (workers & ex- workers in controlled mines & works) (R140m) Pensions (R2.9m) (188 pensioners) Eastern Cape project (R34m to ~ claimants) Actuarial valuation problems Poor performance (annual reports; compliance; management) Administration covered by Department of Health (R34.4m) – 1.4% of Fund Compensation Fund (R2.6b) Mines account, Works account, State account & Research account R336m revenue & R149m expenditure Compensation for occupational diseases (workers & ex- workers in controlled mines & works) (R140m) Pensions (R2.9m) (188 pensioners) Eastern Cape project (R34m to ~ claimants) Actuarial valuation problems

Past Performance Medical Bureau for Occupational Diseases No annual reports since 2000 Medical examinations of workers and ex-workers 186 service providers Review and certification Training and outreach (provincial hospitals) Risk Committee non-functional since 1998 (controlled mines & works) Medical Bureau for Occupational Diseases No annual reports since 2000 Medical examinations of workers and ex-workers 186 service providers Review and certification Training and outreach (provincial hospitals) Risk Committee non-functional since 1998 (controlled mines & works)

Goals Make policy and legislative changes Improve governance Optimise management Enhance service delivery Ensure sustainability of the C ompensation Fund Conduct research Make policy and legislative changes Improve governance Optimise management Enhance service delivery Ensure sustainability of the C ompensation Fund Conduct research

Strategic Objectives Policy & legislative changes Implement the strategic plan Improve corporate governance (various committees) Reorganise claims administration Consolidate outreach activities Ensure financial sustainability Develop a surveillance system Conduct appropriate research Assess the human resource, technical and infrastructural needs Policy & legislative changes Implement the strategic plan Improve corporate governance (various committees) Reorganise claims administration Consolidate outreach activities Ensure financial sustainability Develop a surveillance system Conduct appropriate research Assess the human resource, technical and infrastructural needs

Governance Advisory and Audit & Risk Committees (CCOD) Certification, Review and Joint Committees (MBOD) Risk Committee (MBOD) Internal Health & Safety Equity & Skills Internal Audit Service providers Advisory and Audit & Risk Committees (CCOD) Certification, Review and Joint Committees (MBOD) Risk Committee (MBOD) Internal Health & Safety Equity & Skills Internal Audit Service providers

Claims Administration & Service Delivery Registry Quantify files Merge CCOD and MBOD files Verify data Sort files (year, claim type etc) Inspections of mines and works ( database of 249 controlled mines & works) Link IT systems (Registry, Mineworkers System & Accounting System) Reconciliations Registry Quantify files Merge CCOD and MBOD files Verify data Sort files (year, claim type etc) Inspections of mines and works ( database of 249 controlled mines & works) Link IT systems (Registry, Mineworkers System & Accounting System) Reconciliations

Outreach & Awareness Involvement in various forums (Health, Labour, Mineral Resources; Development Partners; conferences & workshops) Meetings with trade unions and employer groups Through inspections Continuing professional development of health professionals Links to provincial health departments and district health Links to parliament & its outreach activities Involvement in various forums (Health, Labour, Mineral Resources; Development Partners; conferences & workshops) Meetings with trade unions and employer groups Through inspections Continuing professional development of health professionals Links to provincial health departments and district health Links to parliament & its outreach activities

Sustainability of the Compensation Fund Ensure a functioning Risk Committee Dusts Vapours, gases, any other factor affecting risk Revenue Assessment and collection of levies Investments Inspections Verification of data (risk shifts, contractors) Prevention interventions Correct the base for actuarial valuation Expansion of the base (controlled mines & works) Ensure a functioning Risk Committee Dusts Vapours, gases, any other factor affecting risk Revenue Assessment and collection of levies Investments Inspections Verification of data (risk shifts, contractors) Prevention interventions Correct the base for actuarial valuation Expansion of the base (controlled mines & works)

Actuarial Valuation MBOD 1.1m CCOD 200k Mines ? 500k ??? Ex- workers Depends on base (CCOD, MBOD, outside system – not diagnosed, do not know their rights) Depends on disease process (latency, more than 1 disease) Depends on base (CCOD, MBOD, outside system – not diagnosed, do not know their rights) Depends on disease process (latency, more than 1 disease)

Occupational Injuries Abrupt break in … AGENT – HOST – ENVIRONMENT balance Cause established

Occupational Diseases Not diagnosed / mis diagnosed Lack of knowledge Masked by other diseases Long lag time Need special investigations Difficult to find cause

Surveillance “data for action” (Giesecke, 1999) “ongoing, systematic collection, analysis & interpretation of data for planning, implementation & evaluation” (CDC, 1988)

Surveillance Data MHSC / DMR / CoM DoL, DoH Pathaut Special surveys – TB incidence – Dust surveys

Wilson K. NIOH. 2011

Fatalities Target: 20% reduction in the incidence of compensated work-related fatalities by 30 June 2012 with an interim target of 10% by 2006–07. Result: The interim target was achieved in 2006–07 and a 17% decrease has been recorded up to 2007–08. Figure 2 shows that as long as this improvement is maintained the 2012 target is achievable. Aspirational target Target: Australia to have the lowest work-related traumatic injury fatality rate in the world by Result: While Australia has one of the fastest falling fatality rates among the best performing countries world wide, it has remained in 7th place. Safe Work, Australia. 2010

Research Risks in mines and works Scientific approach to valuation Quantification of numbers of workers / ex-workers at risk + modelling studies Operational research (models for delivery) Risks in mines and works Scientific approach to valuation Quantification of numbers of workers / ex-workers at risk + modelling studies Operational research (models for delivery)

Human Resource, Technical & Infrastructural Needs Based on Strategic Plan Need for legal, accounting, economic, actuarial, health & social sciences, logistics Technical – Information Systems & Technology; digital X-rays, GeneXpert, lung function; financial models Infrastructural – buildings, vehicles & equipment, decentralised services Training & capacity building Based on Strategic Plan Need for legal, accounting, economic, actuarial, health & social sciences, logistics Technical – Information Systems & Technology; digital X-rays, GeneXpert, lung function; financial models Infrastructural – buildings, vehicles & equipment, decentralised services Training & capacity building

Annual Performance Plan (2014/15) Policy & legislative changes Implementation of strategic plan –Governance & management Service delivery –Re-organisation of claims administration –Outreach activities –Human resource, technical & infrastructural needs Sustainability of the Compensation Fund –Levies –Inspections Surveillance system Appropriate research Policy & legislative changes Implementation of strategic plan –Governance & management Service delivery –Re-organisation of claims administration –Outreach activities –Human resource, technical & infrastructural needs Sustainability of the Compensation Fund –Levies –Inspections Surveillance system Appropriate research

Occupational Health Services: Core Functions Preventive – Risk identification, assessment & management – Recognise high risk groups & priorities Health Promotion – Optimal physical & mental health – Healthy lifestyles Curative services – General practice level – Referral to specialists – First aid Rehabilitation & Compensation

Conceptual Model – Delivery of Services PHC / District Health System General Specialist hospitals Central hospitals

Community / PHC District Hospital Gen Spec Hosp Central PHC Nurse / CHW Family Medicine / Nurses / Occ Hyg Occ Med Spec / Nurses / Occ Hygiene / Rehabilitation Academic / Reference Units OH Service Model REFERRALREFERRAL SUPPORTSUPPORT

One Stop Facilities

Occupational Health Cluster (National Department of Health) The Compensation Fund (Trading Entity in Department of Health) Occupational Health Cluster (National Department of Health) The Compensation Fund (Trading Entity in Department of Health) Budget

Occupational Health (Budget) R ‘00012/1313/1414/1515/16 Employees compensation Goods & services Transfer payments Capital TOTAL

Staff Establishment (July 2014) No of Posts ManagementFilledVacant Professional & Support Staff FilledVacant Administration Claims Processing Clinical Services Revenue & Inspections Governance TOTAL

The Compensation Fund R ‘00012/1313/1414/1515/16 Revenue Expenditure Investments Fund Value