Chief Medical Officer, Dr Brian Brink, outlines the key private sector responsibilities and opportunities in ending epidemics in Africa today.

1. Private Sector
Responsibilities and Opportunities
in Combatting HIV/AIDS and TB in Africa
Dr Brian Brink – Chief Medical Officer

2. How Africa turned AIDS around
Source:
Special Report to the
African Union Summit
May 2013
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3. How Africa turned AIDS around
Source:
Special Report to the African Union Summit May 20133

4. PRIVATE SECTOR
RESPONSIBILITIES IN DEVELOPING COUNTRIES

5. APPROACH TO HEALTH
Global
Health
Communities
Health Management
Information Systems
Families
Health Insurance
Employee Health and Wellness
Including HIV/AIDS and TB
Occupational Health
Anglo American Occupational Health Way
Occupational Hygiene
Occupational Medicine
Leading indicators
Leading and Lagging indicators
Benchmarking
Standards
Guidelines
Support
Assurance
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6. EMPLOYEE HEALTH AND WELLNESS
• Focus on all employees receiving an annual health screening and basic medical
examination:
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–
–
–
–
–
–
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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7. IMMUNITY (CD4 COUNT)
PROGRESSION OF HIV INFECTION OVER TIME
HIV TREATMENT
Deteriorating health
Absenteeism
Tuberculosis
Disability
Risk of death
AIDS TREATMENT
YEARS
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8. HIV/AIDS Key indicators
2008
2009
2010
2011
2012
81,450
66,661
73,129
77,075
70,690
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 employees
Best estimate of HIV prevalence
Number of contractors participating in VCT
Percentage employee VCT uptake
37,397
78%
82%
94%
527
1.17%
Crude HIV incidence
82%
902
New HIV infections
92%
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%

9. HIV Incidence trend amongst employees at Thermal Coal
HIV Incidence
2.5%
2.0%
94% of
employees
retested for
HIV every year
since 2006
1.5%
HIV Incidence
1.0%
0.5%
0.0%
2005 2006 2007 2008 2009 2010 2011 2012
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10. 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 (HE 2RO), 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. CONCLUSIONS OF LSHTM STUDY
The cost of AIDS in the workforce is due to:
•
•
•
•
Increased benefit* payments
Absenteeism
Training and recruitment
Medical costs
44%
39%
7%
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
*Benefits
include: disability, ill-health early retirement, death benefits, dependant pensions
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12. TUBERCULOSIS

13. ANGLO AMERICAN TUBERCULOSIS INDICATORS
2009
2010
2011
2012
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
Employees
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14. ANGLO AMERICAN THERMAL COAL
TUBERCULOSIS STATISTICS
Annual TB Incidence Rate/100 000
1000
YTD Forecast for
2012
900
800
700
600
500
400
300
200
100
0
Annual TB Incidence Rate/100 000
2006
2007
2008
2009
2010
2011
2012
937
704
856
712
525
468
696
Annual TB Incidence Rate/100 000
Expon. (Annual TB Incidence Rate/100 000)
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15. CONTRACTOR CEO
HEALTH AND WELFARE SUMMIT
Johannesburg - 29 November 2012

16. HEALTH OUTCOMES OF THE CONTRACTOR SUMMIT
• 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.
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17. COMMUNITY HEALTH
Facilitating tangible health
improvements in local communities
and
Being a positive influence on health in
developing countries

18. HEALTH SYSTEMS STRENGTHENING
IN RURAL COMMUNITIES
• 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.
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19. theHealthSource
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20. THANK YOU