Time for a public-private partnership to defeat TB in southern Africa

by Aaron Motsoaledi and Mark Dybul | The Global Fund to Fight AIDS, Tuberculosis and Malaria
Monday, 24 March 2014 12:03 GMT

A patient waits for anti-tuberculosis drugs whilst carrying her child at the Blue House clinic, run by medical charity Medecins Sans Frontieres (MSF) in the Mathare valley slums of Kenya's capital Nairobi in this file photo. REUTERS/Thomas Mukoya

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* Any views expressed in this article are those of the author and not of Thomson Reuters Foundation.

It has become a cliché that diseases respect no borders. But the case of mine workers in southern Africa, with the highest TB infection rates in the world, is a stark example of clichés being anchored in reality.

This blog is co-authored by Aaron Motsoaledi, minister of health for South Africa and chair of the Stop TB Partnership and Mark Dybul, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria

It has become a cliché that diseases respect no borders. However, the case of mine workers in southern Africa is a stark example of clichés being anchored in reality.

The half-million miners in southern Africa have the highest TB infection rates in the world. South Africa’s immediate neighbours of Lesotho, Mozambique and Swaziland bear the brunt – nearly one-third of all new infections in the region can be traced to them, through no fault of their own.

The risk of TB in miners is high due to a conflation of risks: occupational exposure to silica dust that promotes TB; crowded hostel accommodation in and around mine sites; risky behaviours linked to high alcohol consumption and lack of leisure activities; and high HIV prevalence linked to multiple partners, use of sex workers, and long periods away from home.

Many mining companies have recognized the problem and have been pioneers in diagnosis and treatment of HIV in the workplace.  However, smaller mines in the informal sector have been less engaged.

Those working in the mines that have strong TB and HIV programs will receive treatment. When they leave the problems begin. Many miners often go home or go to another mine, in another country.

When they leave, they don’t have easy access to treatment. And even if they get treatment at a mine in another country in the region, they will likely begin a different regimen because standards and regulations vary from country-to-country in the region. 

Stopping and starting treatment causes drug-resistance, which is difficult and expensive to identify and treat, and is rapidly growing in southern Africa.  When miners are not able to access drugs either at home or in smaller mines that do not provide diagnosis and treatment, TB, and drug-resistant TB, spreads in their families and communities.

Interestingly, mineworkers’ TB in South Africa was declared “an urgent crisis” more than 100 years ago, by then-British High Commissioner Lord Milner. The fact that an entire century has passed and the situation is still with us is of great concern for governments in the region.


More worrying still is the prospect that the mistakes that happened  100 years ago still stand to be repeated in 52 African nations whose mineral wealth is confirmed but so far unexploited. We know from experience that poorly regulated resource extraction means local communities – and eventually entire populations – pay a heavy price with their health. We must not let this happen again.

But there is a solution – a public-private partnership beginning with those who have primary responsibility for the health of miners and their families – governments in the Region and the mining companies.

Two years ago, the heads of state of the Southern African Development Community recognised the special vulnerability of mineworkers in their lauded Declaration on TB in the Mining Sector, signed in August 2012. Since then, ministries of health in Lesotho, Mozambique, South Africa and Swaziland have aligned their standards and regulations to overcome part of the problem.

Mining companies, in particular those that have strong programs for workers while they are at their facilities, have expressed interest in extending their reach beyond their mines to follow miners as they move from mine to mine and country to country, and to into the communities where they live, as some already do for HIV. Labour unions can play a key role by helping ensure that their members are part of a system to help ensure they maintain access as they move around.


On March 25, the region’s leaders are convening a multi-departmental ministerial meeting on TB in the mining sector that calls on countries to act in parallel, in a supra-national response. Countries will pledge to adopt a uniform management approach for TB among mineworkers, regardless of when or where.

Ministers of health, minerals, labour and finance will endorse the first comprehensive economic analysis on the costs and benefits of mining-related TB control, making the case for coordinated action both within and between countries. And mining companies will, for the first time, join the discussion on finding solutions.   

The World Bank, the Stop TB Partnership, and the Global Fund to Fight AIDS, Tuberculosis and Malaria are joined together to support the southern African region as it embarks on a new phase of its fight against TB. If a strong public-private partnership can be created with matching resources, the World Bank and the Global Fund will commit up to $100 million each to the effort.

This is a unique moment to come together to defeat TB in southern Africa.  To achieve that ambitious but attainable goal, we must defeat TB and the suffering it causes mineworkers, their families and communities. After 100 years, it’s about time we did.