Shireen Pardesi, Muzimkhulu Zungu and Sam Molautsi

27 August 2014

Annual Performance Plan of MBOD/CCOD

Presentation to Portfolio Committee on Health

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

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

102 year old History…

Miners’ Phthisis Act 19 of 1912

In Summary…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 General’s

report• Promise ….

• Problem – governance, claims management, service delivery, infrastructure, sustainability

• Paradox – lots of data…• Pressure – multiple fronts (1867 –

diamonds; 1886 - gold)• Potential for change, Auditor General’s

report• Promise ….

InterventionsInterventions

• 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

• 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

Strategic Plan (2013-2015)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

• 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

Policy InitiativesPolicy 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)

• 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)

Past PerformancePast 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

• 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

Past PerformancePast 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)

• 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)

GoalsGoals

• Make policy and legislative changes

• Improve governance

• Optimise management

• Enhance service delivery

• Ensure sustainability of the Compensation Fund

• Conduct research

• Make policy and legislative changes

• Improve governance

• Optimise management

• Enhance service delivery

• Ensure sustainability of the Compensation Fund

• Conduct research

Strategic ObjectivesStrategic 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

• 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

GovernanceGovernance• Advisory and Audit & Risk Committees (CCOD)• Certification, Review and Joint Committees

(MBOD)• Risk Committee (MBOD)• Internal

• Health & Safety• Equity & Skills• Internal Audit

• Service providers

• Advisory and Audit & Risk Committees (CCOD)• Certification, Review and Joint Committees

(MBOD)• Risk Committee (MBOD)• Internal

• Health & Safety• Equity & Skills• Internal Audit

• Service providers

Claims Administration & Service DeliveryClaims 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

• 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

Outreach & AwarenessOutreach & 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

• 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

Sustainability of the Compensation FundSustainability 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)

• 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)

Actuarial ValuationActuarial Valuation

Mines ? 500k

??? Ex-workers

• Depends on base (CCOD, MBOD, outside system – not diagnosed, do not know their rights)

• Depends on disease process (latency, more than 1 disease)

• Depends on base (CCOD, MBOD, outside system – not diagnosed, do not know their rights)

• Depends on disease process (latency, more than 1 disease)

Occupational Injuries• Abrupt break in …AGENT – HOST – ENVIRONMENT

balance• Cause established

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

Surveillance

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

Surveillance Data• MHSC / DMR / CoM• DoL, DoH• Pathaut• Special surveys

– TB incidence– Dust surveys

Wilson K. NIOH. 2011

FatalitiesTarget: 20% reduction in the incidence of compensated work-relatedfatalities by 30 June 2012 with an interim target of 10% by 2006–07.Result: The interim target was achieved in 2006–07 and a 17%decrease has been recorded up to 2007–08. Figure 2 shows that aslong as this improvement is maintained the 2012 target is achievable.

Aspirational targetTarget: Australia to have the lowest work-related traumatic injury fatalityrate in the world by 2009.Result: While Australia has one of the fastest falling fatality rates amongthe best performing countries world wide, it has remained in 7th place.

Safe Work, Australia.

2010

ResearchResearch

• 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)

• 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)

Human Resource, Technical & Infrastructural Needs

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

• 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

Annual Performance Plan (2014/15)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

• 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

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

Conceptual Model – Delivery of Services

PHC Nurse / CHW

Family Medicine / Nurses / Occ Hyg

Occ Med Spec / Nurses / Occ Hygiene / Rehabilitation

Academic / Reference Units

OH Service Model

REFERRAL

SUPPORT

One Stop Facilities

• Occupational Health Cluster (National Department of Health)

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

• Occupational Health Cluster (National Department of Health)

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

BudgetBudget

Occupational Health (Budget)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

Staff Establishment (July 2014)Staff Establishment (July 2014)

No of Posts

Management Filled VacantProfessional

& 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

The Compensation FundThe 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