As South Africa's Minister for Health, it may be surprising that many of the meetings I will have during my visit to Canada this week are not with health officials or medical personnel, but with representatives from mining companies.
Our mining industry has recently been the subject of intense international and national media scrutiny due to industrial unrest. As government, we have placed a high premium on returning stability to the industry and our deputy president has been tasked with managing this process. It is important that we succeed because mining is one of the driving forces of the South African economy, contributing around 20 per cent of the country's gross domestic product and being a major employer.
What is less well known, and so far has not been subject to the same degree of media attention, is the devastation caused to miners and their families by tuberculosis (TB). The disease, which was the number one killer of Canadians in the early 20th century, remains the leading cause of death in South Africa today. It is an airborne disease, spreading through the air when people who have it cough or sneeze, and is often fatal if left untreated.
In our mines, as many as one in every 15 miners gets sick with TB, the highest rate among any working population in the world. High HIV-infection rates, cramped living conditions and exposure to silica dust that damages the lungs of miners create a perfect breeding ground for the disease.
The effects are devastating not only for the many miners who die from TB and their families, but also for communities, companies and governments. The disease dents productivity, puts a drain on health budgets and spreads far into the rural areas that miners migrate from.
Migration means that the problem is not exclusive to South Africa. As I have often remarked, TB is like a snake, with its fangs buried in the mines of South Africa and its tail sweeping across the southern part of the African continent. One of the results is that Sub-Saharan Africa is not on track to meet the target of reducing deaths from TB by half by the time that the Millennium Development Goals expire in 2015.
This is part of a troubling global picture. TB is curable with drugs that cost as little as $25 a person. But global underinvestment and indifference mean that the disease killed an estimated 1.4 million people globally in 2011. The failure to deal decisively with TB has allowed drug-resistant strains of this airborne disease to develop. These are much more difficult and significantly more expensive to treat.
How do we respond? Some are keen to point the finger at the mining companies –including Canadian ones – with operations around the world, and particularly in Africa. But my message is that these companies are an essential part of the solution.
Certainly, companies have an important role to play. They must work alongside the government to provide health care to all miners – both direct employees and contractors – and reach out to affected communities, especially those neighbouring the mines.
But a sustainable solution, one that benefits both the region's people and economy, will require collaboration among a wider range of partners. There is progress on this front. Later in the year, ministers of health, labour, finance and mines, as well as development partners and mining companies, will come together at a TB and mining summit. Their task will be to agree on a common approach on some of the most challenging issues – standardizing approaches to treatment, setting up a common database to monitor miners' health, effective referral systems and working out how to roll out these services across the region in a new generation of public-private partnerships.
I hope that Canada will support us in these endeavors. Canada has long been a leader in supporting the global fight against TB, both through the Global Fund to Fight HIV/AIDS, TB and Malaria and through the Stop TB Partnership's TB REACH and Global Drug Facility Initiatives.
Canada's contributions to the Global Fund, along with those of other donor countries, have led to more than 10 million people with TB receiving treatment since 2002. Over a similar period, the Global Drug Facility has provided countries with more than 20 million courses of TB drugs, either in the form of grants or at the lowest possible price.
TB REACH, launched with Canadian funding in 2010, has proved to be a pathfinder in the fight against TB. Using mobile phone applications, public-private partnerships and other innovative approaches, some TB REACH projects have more than doubled the number of people who were found and provided with TB treatment. In many cases, the projects have attracted further funding and have been taken to scale though domestic programs and international financing streams such as the Global Fund and PEPFAR.
As a first-hand witness to the impact of Canadian investments in TB, I have a simple message this week – thank you, Canada. The people of Southern Africa have benefited from your investments and I hope that we can continue to fight TB in partnership. In the same vein we hope that those that invest in mines in Southern Africa will also continue to benefit from helping us to deal decisively with the scourge of TB.
Aaron Motsoaledi is the South African Minister of Health and the incoming chairperson of the Stop TB Partnership Coordinating Board, which is meeting in Ottawa from July 11-12.