Sibanye Gold Health Health Service Experience on HIV and TB Parallel Session at the 2015 SA AIDS Conference Dr Jameson Malemela
Discussion Points 1. Wellness and Prevention 2. Stakeholder Collaboration 3. Onsite Infrastructure 4. Clinical Results Picture 5. Mortality and Morbidity 6. Conclusion
Our values Deliver on our promises to all our stakeholders Accept responsibility and consequences for our actions Show regard and consideration for others Make it easy to work productively and safely People are our most important asset 3
WELLNESS AND PREVENTION
Our Wellness Ambassador
High Density(Old Hostels) Where Do Our Employees Stay Low Density(Company provided family units) Private accommodation Living out allowance (employees receive an amount which is intended for accommodation) Where one stays, determines the likelihood of diseases one can suffer from
Residential Profile of Employees 40% 39% 35% 30% 25% 34% 35% 32% 25% 36% 34% 33% 34% 34% 31% 31% 31% 31% 30% 27% 26% 24% 24% 26% 33% 29% 20% 20% 21% 15% 10% 8% 8% 9% 10% 11% 11% 13% 12% 5% 0% 2007 2008 2009 2010 2011 2012 2013 2014 High Density Accommodation Private Accommodation Low Density Accommodation Living Out Allowance (Count)
Analysis of Employee residential Profile(2007 to 2014) High Density Residential occupation declined from 39% to 26% of the workforce(current room occupancy is average of1.1person per room) Low density Residential Occupation increased from 8% to 12% of the workforce Private residence remained steady at about 33% of the workforce Living out allowance has increased from 20% to 29% of the workforce The Old Hostel Type Overcrowding occupancy has been eliminated
STAKEHOLDER COLLABORATION
Operation MoLeSwaSa(Mozambique, Lesotho, Swaziland and South Africa) Cross boarder TB and HIV adherence during holidays Aligned treatment regimens across the affected countries Cell phone adherence monitoring through sms exchange between patients and nurses World bank, URSA, ministries of health in destination countries Kick TB Collaboration HIV, TB and Communicable diseases screening GeXpert rollout in RSA NDOH, Mine employees, Global Fund, Aurum Health and peri-mining communities ETR(Electronic TB register implemented in all operations) Stakeholder Programmes
ONSITE INFRASTRUCTURE
Sibanye Gold New Health Strategy Wider Hospital Networks RMA Day 1 Trauma Accredited Specialised Care PHC Centres PHC qualified Dr support 24/7 Case Management Occupational Health Rehabilitation Fitness to Work Risk Assessments (TB etc.) Silicosis focus Healthy Employees Individualised Care Management Longer productive life Reduced Ill Health Retirement Shaft Clinic PHC Nurse Closer to work TB Dots + Medication Risk Assessments Emergency Medical Services Advanced Paramedic Teams Rescue 24/7 Satellite PHC Clinic Nurse Based Care Office Hours
Repositioned Case Management Model PHC Case Management, Chronic Disease Management, Medical Incapacity, Occupational Injuries and Disease, Epidemiology Case Management Providence, Proclin, Palladium, Qlickview Virtual Hospital Case Management, Utilisation Review, QA/QC, Medico-legal, Administration of claims, Medical Incapacity OHC Case Management, QA/QC on Mandatory COP, Occupational Injuries and Diseases, Medical Incapacity, Rehabilitation, Post Employment
Pillars of Health Promotion Awareness &Education HIV and TB Hypertension and Diabetes Mellitus Other Lifestyle Diseases Occupational Diseases Disease Prevention Priority Health Programmes Primary Prevention (Reduce exposure & Mitigate Risk)Vaccinations, Contact tracing, STI, Condom distribution. Secondary Prevention (Prevent progression to illness)-individual Health Risk Assessment /Executive Medicals Tertiary Prevention (Prevent progression to incapacity/disability) Rehabilitation, Redeployment, accommodation Lifestyle Interventions (Exercise,Nutrition, Supplements, Mid-shift feed, work life balance) Fatigue Management Chronic Disease Management Programme Incentive /Rewards Programme Special Needs People with Disabilities Pregnancy and Breast Feeding Travellers Health Community Health Partnerships with Regional DOH, Local Communities Targeted Community Interventions (HIV&TB)
Awareness and Education at shaft level Early detection and prevention of disease Early intervention on diseases process Individualised care Improved Accessibility Shorter turnaround times e.g. Emergency care Improve patient flow at main PHC No need to use sick shift when on chronic medication or having minor ailments because the shaft clinics covers all production shift rosters Impact Of PHC Shaft Clinics
CLINICAL RESULTS PICTURE
Tuberculosis TBT
Year to date Progress on Clinical Services Driefontein TB Cases TB Diagnose Areas and Percentage Year Total cases PHC PHC % T/F In T/F In % Hospital Hospital % 2013 267 0% 18 7% 249 93% 2014 241 223 93% 15 6% 3 1% 2015* 112 95 85% 8 7% 9 8% Cooke Ops TB Cases TB Diagnose Areas and Percentage Year Total cases PHC PHC % T/F In T/F In % Hospital Hospital % 2013 78 78 100% 0 0% 0 0% 2014 121 90 88% 19 16% 12 10% 2015* 36 32 91% 1 3% 3 8% Kloof TB Cases TB Diagnose Areas and Percentage Year Total cases PHC PHC % T/F In T/F In % Hospital Hospital % 2013 232 0 0% 8 3.4% 120 52% 2014 220 205 93% 6 2.7% 9 4.3% 2015* 96 90 94% 3 3.1% 3 3% Beatrix TB Cases TB Diagnose Areas and Percentage Year Impact Total of cases New Strategy PHC at Driefontein PHC % Operations T/F In T/F 2015 In % Hospital Hospital % 2013 231 210 0% 2 7% 19 8% 2014 233 211 91% 2 8% 20 9% 2015* 65 60 94% 1 8% 4 6%
Impact of New Model on TB Case finding Where the model is fully implemented there is up to 12% increase in New TB cases year to date Where the model is sub optimally implemented, there is up to 30% drop in TB detection rate year to date
CONCLUSION
In Conclusion Excellence attained in the continuum of care based on this model Continue with Multi-stakeholder partnering approach while awaiting for effective and efficient Primary Prevention (HIV vaccine) Use every opportunity at clinical and non-clinical level to build trust in the health systems Shared responsibility is extremely important in determining health outcome. This has serious bearing on desired positive behaviour in health care systems. There has been long time passing that patients believed some stakeholder will look after them regardless, without realising avoidable morbidity and mortality. Our constitution talks about rights and responsibilities. We need all citizens to understand that rights are not infinite. Human development is a very critical catalyst to successful disease intervention because it enables rapid change in previously held beliefs and assists in creation of new beliefs. This was long established from the disease theories of curse, punishment, germ and supernatural
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