The document discusses the impacts of HIV/AIDS on mining communities in Southern Africa and efforts by Placer Dome mining company to address it. It describes how Placer Dome developed a home-based care program through TEBA to support medically discharged miners and their families, and how the program exceeded targets in its first year. It also discusses challenges faced and lessons learned, and a vision to integrate the home-based care program with Placer Dome's existing Care project to provide long-term social and economic support for affected rural families and communities through a sustainable fee-for-service model.

1. Beyond the Paycheck
Mining Industry Response to HIV/AIDS at
the Family and Community Level
Presentation to
World Bank Development Marketplace
June 16, 2003
Phillip Von Wielligh Jim Cooney Wayne Dunn
Placer Dome
Beyond the Paycheck 16-June-03 1

2. Agenda
• Background
• Meeting the challenge
• DM Project
– Development
– Implementation
– Impacts
– Challenges and
Learnings
• Care Positive
– Scaling up and
addressing economic
impacts
Beyond the Paycheck 16-June-03 2

3. Background
• HIV/AIDS is the worst
epidemic in human history. At
every level it is causing
devastation, destruction and
suffering throughout Southern
Africa
• The mining industry and its
stakeholders are experiencing
severe social and economic
impacts
• Mine employees have a higher
HIV prevalence rate (~25%)
than the general population
Beyond the Paycheck 16-June-03 3

4. Background (cont)
• Impact is felt more severely in the
rural areas
– Mineworkers come from throughout
Southern Africa (South Africa, Lesotho,
Mozambique, Swaziland, Botswana) to
work in South African gold mines
– Each mineworker is supporting an
extended family of 10-20 people
– When they become too ill to work they
are faced with going home, literally to die
– Families and communities not only lose
remittances but they must care for the
terminally ill worker with little or no
training and very little public health
infrastructure
Beyond the Paycheck 16-June-03 4

5. Background (cont)
• Over 250,000 mineworkers in South
African mining industry
• Medical repatriation rate of 1.25% per
year
• Increasing numbers mineworkers are
medically repatriated every month
– If one considers all other employers
(government, rail, ports, etc.) this number
increases exponentially)
• Numbers will increase as AIDS
epidemic progresses
Beyond the Paycheck 16-June-03 5

6. Background (cont.)
• Not only is this a human tragedy, it
also affects mining industry
economics adversely
• Mineworkers, faced with a choice
between staying on the mine as long
as possible, where they receive
medical care and are able to continue
sending money home, or losing their
paycheck and returning home where
health services are minimal and over
extended
• Most were staying onsite, often to the
point of death
• In addition to leaving families
unprepared, this had huge impacts on
industry productivity and profitability
Beyond the Paycheck 16-June-03 6

7. Meeting the Challenge
• The mining industry recognized that
it had to be a key stakeholder in
addressing this catastrophe
• Placer Dome, through the South
Deep Care Project had already
committed to developing HIV/AIDS
programming to follow-up on its
groundbreaking retrenchment
mitigation project (more on this
later)
Beyond the Paycheck 16-June-03 7

8. Minesite and Local Community Programs
• Minesite Programs
• Local Community
Programs
Beyond the Paycheck 16-June-03 8

9. Beyond the minesite
• Mineworkers’ families were
scattered over an 800 by 4000km
area, much of it in isolated and
inaccessible areas.
• Entire mining industry was facing
a common set of problems
• Collaboration created economies
of scale and potential for
additional scalability
• TEBA had an existing
infrastructure and presence
throughout the region
Beyond the Paycheck 16-June-03 9

10. Developing a Home Based Care Program
• Placer Dome, as operator of
the Placer Dome Western
Areas Joint Venture South
Deep Mine, took the lead in
working with TEBA to develop
an industry wide approach
• Decision was made to address
the social impacts in the first
stage and then to develop
additional programs to mitigate
the economic impact
Beyond the Paycheck 16-June-03 10

11. Developing a Home Based Care Program
• Develop a home based care program that
would enable mineworkers to return
home to a functioning care system
• Pilot the program in several areas and
then roll it out throughout the labour
supply area
• Develop a fee for service model that
would facilitate broad buy-in from the
mining industry – and eventually from
other industries and public sector
stakeholders
• With support from World Bank Mining
Group we submitted a proposal to the
Development Marketplace (AIDS
Campaign Team Mining)
Beyond the Paycheck 16-June-03 11

12. Implementation Steps Mineworker
Medically
Discharged
• Consult with stakeholders (NUM,
TEBA Home Based Care Process
Family
Chamber of Mines, Service prepared
for his
arrival
Providers, Governments, etc.)
• Develop a draft process to go from Arrival
counseling
medical repatriation at the Appointment
of
Caregiver
minesite to reception in home
community and ongoing provision Training
of
Caregiver
of support
• Secure mining company support Ongoing
support
and
monthly
medical kits
Beyond the Paycheck 16-June-03 12

13. Implementation Steps (cont)
• Develop a Steering Committee
– Design training curriculum (Care Masana Clinic
Supporters and Providers) XAI XAI, Mozambique
– Oversee program operation
– Develop rural implementation
capacity (recruit and train
fieldworkers and Care
Supporters)
– Pilot area first then more general
rollout
Beyond the Paycheck 16-June-03 13

14. In the communities
• Develop partnerships
and relationships to
enable families to
access any existing
local services and
support (e.g., NGO,
government,
education, welfare,
etc.)
• Traditional healers
Beyond the Paycheck 16-June-03 14

15. Overview of Home Based Care
Patient
Home-Based Carer
Village Care Supporter
TEBA Rural Development-HBC
Mines
Beyond the Paycheck 16-June-03 15

16. Project Impacts
• Broad stakeholder participation in
HBC
• Monthly medical kits
• Improved nutrition and care for
affected families
• Full industry participation
– 8 mining companies
– Over $300,000 in direct cash payments
• DfID support enabled extension to all
affected employees in Lesotho
Beyond the Paycheck 16-June-03 16

17. Project Impacts
• Care for patients through HBC
enables families to better care
for others who are suffering from
AIDS but not eligible under this
program
• External evaluation of the project
is currently being done by the
University of Pretoria
Beyond the Paycheck 16-June-03 17

18. INDUSTRY HOME BASED CARE RESULTS
(Year One)
Milestone Target Actual
Community Care 87 127
Supporters engaged
87 123
Community Care Training
People under Home 696 801
Based Care
THE PROJECT EXCEEDED TARGETS
IN EVERY AREA
Beyond the Paycheck 16-June-03 18

19. Scaling Up and Expanding
• Currently planning year
two rollout (we didn’t want
to plan until we had the
results of the external
review
• Expectations are to
double the number of
homebased care families,
caregivers and regions
where the program will be
delivered
• A strategy for rolling out
into additional industries
will be developed in year
2
Beyond the Paycheck 16-June-03 19

20. Challenges and Learnings
• Difficulty getting proper
repatriation notification from
mining houses (need
improved communication and
coordination)
• Families needed more
counseling than originally
anticipated
• Patients needed medical
attention on arrival
– Dehydration, exhaustion, etc.
Beyond the Paycheck 16-June-03 20

21. Challenges and Learnings
• Traditional healers
are vitally important
stakeholders
– Xai Xai training
program
Beyond the Paycheck 16-June-03 21

22. Challenges and Learnings (cont.)
• Maximizing the role of local
stakeholders results in improved
efficiency and increased local capacity
• Involvement of local leadership and
traditional healers improves local
acceptance and enhances community
and family impact
• Expanding into other markets
(industries) and developing financial
partners requires sophisticated
communication and strategic marketing
skills (organizational development)
Beyond the Paycheck 16-June-03 22

23. Challenges and Learnings (cont.)
• Utilization of local
suppliers (e.g. trainers)
and professionals
increases local
acceptance of the
program and increases
overall community
capacity to address the
epidemic
•An industry-wide approach is much more effective
and efficient than a company by company
approach
Beyond the Paycheck 16-June-03 23

24. Challenges and Learnings (cont.)
• Continual communications
and reaching out to
external stakeholders can
identify additional partners
and synergies
• External evaluation can
provide valuable insights
and also help to attract
new partners
• Metrics and indicators are critical to success and
should be planned from the onset
Beyond the Paycheck 16-June-03 24

25. Challenges and Learnings (cont.)
• Service Termination – service to
the families currently terminates
with the death of the mineworker.
This leaves a huge gap at a
critical point for the families, who
have come to depend on and
trust the caregivers. Support
should continue for a period
beyond death to assist the family
to cope
• The prestige and profile of the
Development Marketplace award
helped tremendously to open
doors with other partners and
stakeholders
Beyond the Paycheck 16-June-03 25

26. What happens to children and
families when the breadwinner
can’t work
Beyond the Paycheck 16-June-03 26

27. Building on the Care Project
• Placer Dome has successful
experience in assisting
mineworker families to become
economically active
• In 1999 the company retrenched
over 2,500 workers who returned
to their families in rural areas
throughout Southern Africa
• The Care project was designed to
mitigate the economic impact on
families
Beyond the Paycheck 16-June-03 27

28. Building on the Care Project
• A unique 13-step process was Planning Phase
1. Labour Force Rationalization Plan
2. Retraining/Redeployment Assessment
3. Detailed Retrenchment Plan
designed that provided counseling,
training and support to retrenchees
Awareness/Orientation Phase
,
1. Counselling Economic Lifeskills &
Opportunity Orientation
2. Opportunity Awareness Workshops
and their families, right in the areas
(Economic Opportunity/Career Fairs)
3. T raining Needs Assessment
Personal
where they lived Economic Plan
Prepared &
Assessed
• Proxy model enabled direct Decision on Economic Option
participation by women and other Enterprise S tream
Employment S tream
family members Business Planning & Preparation
1. Business Orientation
a) Idea Generation Workshops
b) Business T raining Activities
Employment Planning & Preparation
1. Skills T raining (Vocational/Agricultural)
2. Employment Counseling / Placement
• The project has enabled nearly
2. Develop Draft Business Plan (Job search/Resume, etc.)
(to be reviewed with Counselor)
(plan will contain financial, operational
and skills upgrading plan) Personal
3. Preparation of Micro-Finance Application Employment Plan
60% of the affected families to 4. Submission to Micro-Finance Agency
Business &
Prepared
develop alternative economic Financing Plan
Prepared Ongoing Processes
Follow-up sessions/
opportunities Evaluation of Micro Finance Application
Business Operation
activities to monitor
effectiveness of
• An extensive network of
1. Ongoing availability of T echnical Assistance
and Business Counselling interventions
2. Ongoing faclitiation of skills training needs
(i.e., business, agriculture, vocational, etc.) Communication and
consultation with
fieldworkers and project partners stakeholders
Continuous improvement
were developed and are still in Retrenchee is Re-Integrated
and Economically Active
process (review feedback;
enhance programs,
place procedures, processes)
Beyond the Paycheck 16-June-03 28

29. Moving forward
• The Care project piloted an
innovative means of assisting rural
families to become economically
active and it has an effective
infrastructure and management
system in place
• ACT Mining Home Based Care
project piloted a cost effective, fee
for service program to support
medically repatriated workers and
their families
Beyond the Paycheck 16-June-03 29

30. Our Vision for the Future
Care Process
Care Positive
• Integrate the Home Based Care +
project with the Care process and
launch as a fee for service based Home Based Care
program to address the social and =
economic impacts that AIDS is
having on rural families and Care Positive
communities
• Start with the mining industry but
design the infrastructure and
management systems to enable
participation by other industries,
governments and donor
community stakeholders
Beyond the Paycheck 16-June-03 30

31. Summary
Beyond the Paycheck 16-June-03 31

32. Conclusion
• The pieces are available to put in
place a cost-effective, scalable
program to help mitigate the family
and community level impact of AIDS
in rural areas
• Placer Dome is willing to lead and co-
finance but the project is beyond the
scope of a single mining company
• We request your guidance and
assistance to develop the appropriate
financial and technical cooperation
that can make this dream a reality
Beyond the Paycheck 16-June-03 32