OHS

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

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

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102 year old History
Miners Phthisis Act 19 of 1912
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In Summary

• Problem governance, claims management, service
  delivery, infrastructure, sustainability
• Paradox lots of data
• Pressure multiple fronts (1867 diamonds 1886
  - gold)
• Potential for change, Auditor Generals report
• Promise .

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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

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Strategic Plan (2013-2015)

• 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

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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)

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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 14 000 claimants)
• Actuarial valuation problems

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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)

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Goals

• Make policy and legislative changes
• Improve governance
• Optimise management
• Enhance service delivery
• Ensure sustainability of the Compensation Fund
• Conduct research

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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

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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

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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

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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

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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)

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Actuarial Valuation

• Depends on base (CCOD, MBOD, outside system not
  diagnosed, do not know their rights)
• Depends on disease process (latency, more than 1
  disease)

Mines ? 500k
??? Ex-workers
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Occupational Injuries

• Abrupt break in
• AGENT HOST ENVIRONMENT balance
• Cause established

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Occupational Diseases

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

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Surveillance

• data for action (Giesecke, 1999)
• ongoing, systematic collection, analysis
  interpretation of data for planning,
  implementation evaluation (CDC, 1988)

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Surveillance Data

• MHSC / DMR / CoM
• DoL, DoH
• Pathaut
• Special surveys
• TB incidence
• Dust surveys

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Wilson K. NIOH. 2011
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Fatalities Target 20 reduction in the incidence
of compensated work-related fatalities by 30 June
2012 with an interim target of 10 by
200607. Result The interim target was achieved
in 200607 and a 17 decrease has been recorded
up to 200708. 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 2009. 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
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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)

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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

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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

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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

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Conceptual Model Delivery of Services
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OH Service Model
PHC Nurse / CHW
SUPPORT
REFERRAL
Family Medicine / Nurses / Occ Hyg
Occ Med Spec / Nurses / Occ Hygiene /
Rehabilitation
Academic / Reference Units
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One Stop Facilities
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Budget

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

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Occupational Health (Budget)
R 000 12/13 13/14 14/15 15/16
Employees compensation 23 294 23 790 23 501 24 676
Goods services 14 584 23 559 26 807 27 459
Transfer payments 2 916 3 062 3 215 3 215
Capital 2 277 2 389 2 389 2 389
TOTAL 43 071 52 800 55 912 57 739
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Staff Establishment (July 2014)
No of Posts Management Filled Vacant Professional Support Staff Filled Vacant
Administration 44 4 3 1 40 33 7
Claims Processing 57 2 2 - 55 47 8
Clinical Services 20 2 - 2 18 9 9
Revenue Inspections 17 4 2 2 13 6 7
Governance 2 1 1 - 1 - 1
TOTAL 140 14 9 5 127 95 32
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The Compensation Fund
R 000 12/13 13/14 14/15 15/16
Revenue 402 369 436 830 502 004 552 167
Expenditure 153 414 221 103 255 116 260 111

Investments 2 221 338 2 469 866 2 593 359 2 723 027
Fund Value 2 444 319 2 549 477 2 680 359 2 823 027