Health and hygiene

	2009			2010-2011		Status			2012-2015
1	Status report on noise and dust-control programmes		1	Review priorities		Strategy revised		1	Review priorities
2	50% VCT		2	Track cases with >5% loss of hearing (shift from baseline)		Implemented		2	No cases >10% NIHL
3	A total of 200 peer educators trained		3	Reduce percentage of employees exposed to OEL dust and fumes		In progress		3	>80% VCT; >70% retention on treatment programme
4	Implement TB standard at three business units		4	70% VCT and 50% retention on treatment programme		38% retention on treatment programme		4	>85% TB cases complete treatment
			5	TB treatment provided at 50% of business units		2011 audit to assess implementation		5	Reduce new HIV infections by 5%
			6	Occupational risk and exposure profiling standard		Under development		6	Reduce indirect costs due to HIV/Aids by 5% from baseline
			7	Baseline study of indirect costs of HIV/Aids		In progress
			8	Awareness campaign on noise, dust and thermal stress at all business units		In progress

Highlights

• Interdisciplinary approach to health management implemented
• Pilot site Matla reduced dust levels by 40% in a MOSH project that will be rolled out to other sites and by other
  companies in the mining industry (refer to case studies below)
• Introduced early reporting of noise-induced hearing loss to proactively identify and minimise noise exposure
  to employees and enable Exxaro to track the effectiveness of its control programmes
• Revised corporate standard for medical surveillance
• Developed standard for reporting and statistics
• Reached our target of a 70% testing rate for HIV.

Acknowledging that collaboration across departments is essential for health and hygiene initiatives to succeed, during the year Exxaro formalised its interdisciplinary approach to health management in a forum represented by technology, information management, human resources and supply chain management.
Projects undertaken by this team include:

• Training occupational hygienists on the use of the hearing protection device tool developed by MOSH
  (refer to case studies below) to assist in selecting appropriate devices for various employee categories
• Refresher training on reading X-rays to identify early markers of lung diseases
• Developing procurement guidelines for selecting equipment based on noise levels.

Reporting standards

Exxaro has finalised a new management standard on health and hygiene reporting criteria across the group. In terms of this standard, business units will report to the executive committee monthly, quarterly and annually on key health and hygiene issues including noise, airborne pollutants, hazardous chemicals, thermal stress, fatigue, biological hazards and radiation. Detailed monthly reports will provide a holistic view of health and hygiene standards and trends across the group.

This will enable management to more effectively monitor the risk identification and assessment process, comply with legislation and reporting requirements for listed companies, and track the implementation of programmes against set targets.

Medical surveillance

A new standard was developed in 2010 covering medical surveillance of employees and contractors in terms of the Mine Health and Safety Act (29 of 1996), Occupational Diseases in Mines and Works Act (78 of 1993 as amended), Occupational Health and Safety Act (85 of 1993), National Nuclear Regulator Act (47 of 1999) and Compensation for Injuries and Diseases Act (130 of 1993).

The objectives of Exxaro’s new risk-based medical surveillance standard include:

• Early detection of adverse health effects and occupational diseases from workplace exposure
• Assessing the health status of employees by regularly collecting relevant health information to detect adverse health effects at the earliest opportunity and ensure continued fitness to work
• Enabling management to take appropriate and timely corrective action to safeguard the health and wellbeing of employees
• Improving risk management by identifying adverse health effects among employee groups exposed to similar occupational hazards (homogeneous exposure groups)
• Enabling employees to be fully informed of the risks associated with their work and procedures to minimise those risks and prevent occupational diseases
• Identifying occupational disease from previous and current occupational exposure, and referring affected employees for confirmation of diagnosis, treatment where appropriate, rehabilitation and proper placement
• Submitting claims for compensation where necessary.

As per legislative requirements, all employees and contractors are required to undergo medical surveillance
in terms of the risk assessment. This spans:

• Pre-employment/pre-placement medical examination
• Periodic medical examination
• Transfer medical examination
• Out-of-cycle medical examination
• Exit medical examination.

Meeting mining sector targets

Dust and noise-reduction targets set by the mining industry aim to reduce the number of NIHL and silicosis cases. This depends on:

• Minimising noise and dust exposure to below occupational exposure levels (OEL)
• Reducing the time spent by employees in noisy and dusty areas
• Proper use of personal protective equipment.

Initiatives to reduce noise include:

• Enclosing machines with open cabins
• Boxing work benches
• Installing silencers on auxiliary fans
• Training.

Initiatives to reduce dust include:

• Removal of coal crusher at one of our sites
• Extraction fans at primary and secondary crushers
• Use of water in stockpile areas
• Dust suppression on opencast surface roads
• Increased ventilation in underground sections
• Wet plants
• Training.

Occupational diseases

Two pieces of legislation govern compensation: Compensation for Occupational Injuries and Diseases Act (COIDA) and the Occupational Diseases in Mines and Works Act which provides for medical benefits for former employees. Therefore, Exxaro educates employees on benefits they can access in their own health management but, more importantly, focuses on improving their health to avoid unnecessary or premature loss of life.

Exxaro is also participating in a tri-partite initiative (employers-employees-government represented by the Chamber of Mines, unions and Department of Health respectively) for former mineworkers to improve access to medical benefits as envisaged by the act. Internally we will also focus on education and awareness of the benefits of preventive measures in the workplace for employee health and wellbeing, as well as employees benefits provided for by legislation.

Reported cases are those newly diagnosed and submitted to the compensation authorities to confirm they are work related and eligible for compensation. In 2010 Exxaro reported 89 occupational diseases (compared to 85 in 2009): this is an early indicator of the possible occupational disease burden. These were occupational TB (52); NIHL (12); pneumoconiosis (23); dermatitis (1) and work-related upper-limb disease (WRULD) (1). Tracking this data indicates potential cases that could be compensated and provides an opportunity to reinforce preventive programmes.

In 2010, Exxaro had 35 occupational disease cases accepted for compensation: nine of NIHL, two of pneumoconiosis, 21 of occupational TB, two of dermatitis, and one WRULD. The five-year trend is shown below.

Cumulative occupational diseases

In 2010, there was a decrease in NIHL, but no decrease in pneumoconiosis and occupational TB. Efforts to reduce employees’ high noise exposure continue. There is also increased susceptibility to TB, possibly fuelled by the increase in the number of individuals with compromised immune systems. There have been no cases of silicosis.

In 2011, Exxaro will concentrate on a hearing conservation programme, ensuring each business unit has a dedicated and functioning committee to report and investigate incidents of hearing loss above 5% and to review that unit’s noise-related procurement policy and criteria. This will be supplemented by awareness campaigns across the group and system improvements for more accurate reporting.

Tuberculosis

New cases of non-occupational TB increased from 2008 (63) to 2009 (83 out of 11 180 employees). In 2010,
there were 30 new cases. The new TB standard issued for the group in 2009 to ensure uniform and comprehensive management of employees with TB has been implemented. This disease remains a focus for Exxaro’s health and hygiene team, given the scope of related risks, including:

• Spread of TB in the communities where employees and contractors live
• Significant risk of co-worker infection (10 to 18 people are infected by one active TB patient)
• The high prevalence rate of HIV (which compromises individual immune systems) is a known risk factor for developing TB, therefore TB and HIV/Aids programmes need to be reinforced
• Workplace exposure to mining dust is a contributing factor to TB.

Given the dramatic increase in TB rates in South Africa and in the mining industry in recent years, it is important to manage TB and HIV holistically through better surveillance, diagnosis, treatment and monitoring. At each business unit, TB education initiatives reach employees at least once a year. These include information on symptoms and the importance of early diagnosis for effective treatment. Adhering to this new standard is expected to reduce the risk of developing, contracting and spreading multiple- and extensively drug-resistant TB in Exxaro. This programme will be reviewed in 2011.

Number of TB cases

Areas for improvement that will influence the number of TB cases will be identified from the TB programme audit conducted in 2011. Ensuring early enrolment of HIV-positive employees onto the HIV management programme will also ensure early identification and treatment of patients co-infected with HIV and TB.

H1N1 (swine flu)

There was one recorded case of H1N1 in Exxaro in 2010 compared to three cases reported across the group in 2009. The individual was treated and recovered fully. Exxaro will continue to monitor and manage potential risks as the flu season approaches.

Wellness

Most business units arranged wellness days in 2010. Service providers conduct different healthscreening tests and advise participants on lifestyle issues. These days are open to employees, family members and the broader community. Although participation is voluntary, attendance is very good and contributes to the effectiveness of our wellness programme.