Gold is perhaps best known for its prominence in the jewellery market, but one panel discussion at Mining Indaba in Cape Town pointed out just how significant the role of the yellow metal ? and the companies that mine it ? can be when it comes to healthcare.


Malaria, which has long been endemic in Africa, is not only the primary cause of adult morbidity and the continent?s single biggest killer of children under five, but is also a leading cause of workdays lost due to illness.
Speaking at the World Gold Council?s ?Gold for Health? panel discussion, Dr Devanand Moonasar, a director at South Africa?s National Department of Health, highlighted the gravity of the malaria situation in Africa.

?There are 207 million cases of malaria every year in the world and of that 174 million are from Africa,? he said. ?There are 627,000 deaths every year due to malaria and 91% of these occur on the African continent. What?s also very startling is about 86% of those are children who are under five-years of age.? ?At a time when we have such great technology for drilling, but still above the surface we have this problem that?s preventable, treatable and can be cured but every year we see the same statistics,? he lamented.

While malaria continues to pose a huge threat to health across Africa, gold is being used in rapid diagnostic kits (see box) and in 2006 one gold miner took a definitive step towards combatting the disease in Ghana when it launched an indoor residual spraying programme in houses, hospitals, orphanages and other buildings in a bid to reduce malaria by 50% in the municipal district of Obuasi.
The company in question was AngloGold Ashanti Ltd and Dr Brian Chicksen, vice-president for safety at AngloGold, told the audience in Cape Town exactly why the project was just what the doctor ordered. ?In many ways, what we have done in Ghana is not rocket science, but it?s innovative in the sense that it brings together a whole lot of different pieces into one and the programme has had a meaningful impact on the area of Obuasi, which is intimately linked with mining.?
After an initial investment of US$1.7 million in the first year and around US1.3 million each year thereafter, in just two years the company saw the incidence rate of malaria in the local population plummet 72%.

Lost days due to malaria were reduced from 6,983d/mth to just 282 days by 2009. There were 6,711 cases of malaria recorded at the Edwin Cade Hospital in Obuasi in 2005 (see chart). By mid-2013, that figure had shrunk to just 238 cases.

Dr Alexis Nang-Beifubah, regional director of health services in Ghana, spoke about the difference that the programme has made to the local community. ?I think AngloGold Ashanti has definitely demonstrated two things: that partnership and using multiple approaches are what we need to control malaria in Ghana,? he said. ?My presence here is a demonstration of the success that AngloGold Ashanti started something that was considered corporate social responsibility, but it has now been demonstrated to the health sector in Ghana that the way to go about combatting this disease that has afflicted our country over the years is partnership and the implementation of all the new strategies to control it.?

In 2009, AngloGold, together with the Ghanaian government, received a US$133 million grant for a five-year period from The Global Fund to roll out a programme based on the Obuasi model across 40 districts in the country.
Fellow panellist Dr Brian Brink, Anglo American plc?s chief medical officer and a board member of The Global Fund, highlighted the significance of AngloGold?s initiative. ?You?ve heard how they came to mine gold and in the process they?ve taken away probably the single most urgent health issue for the entire community, not just around the gold mine but extending right into the depths of Ghana,? he said.

?You can?t run a profitable mine in a community that?s sick,? he added. ?Business will not succeed in sick populations. If we want to secure opportunities for growth and for business in the future then we need to understand that burden of disease and understand how business can get involved to get rid of that burden of disease and make the difference that will create the economic growth that we?re all looking for.?

Chicksen added that the company has already rolled out similar programmes in Mali, Tanzania and Guinea. He said that the programme is expected to reach 4.6 million people and generate around 3,500 jobs in Ghana by December 2015, but admitted that there are still some considerable challenges ahead. ?We are faced with the challenge of how we make the structure we?ve created sustainable and the transition of that vehicle from the private sector into something that is more broadly owned by the people of Ghana in a sustainable way and also ensure it?s sustainable for the economic trade,? he said.

Partnership approach

Brink added that a collaborative multi-stakeholder approach was vital to maintaining and replicating the success of initiatives such as AngloGold?s indoor residual spraying programme. ?One thing that?s for sure is that business can?t do it on its own,? he said. ?And what we?ve also discovered is, in many of the places that we work the governments can?t do it on their own either and nor can civil society.?

?But if you can bring all three of these together there?s absolutely no doubt that partnerships can achieve much more than anyone could do on their own,? added Brink.

?What we?ve seen in recent years is these partnerships are growing and becoming more secure. Two of the biggest ones that have appeared in the last decade are The Global Fund ? to fight aids, TB and malaria ? and the GAVI alliance for vaccines and immunization. These are completely new funding models that are helping to get rid of the burden of disease. But even more importantly it?s the expression of partnership where everybody can come together and do something better.?

Dr Trevor Keel, session chair and head of technology at the World Gold Council agreed that partnership was one of the key lessons that could be learned from the programme. ?AngloGold has shown what can be done if you involve all parties, and the results of the spraying programme to date bring to clarity the kind of impact this programme can have on a community,? he said. ?It shows that collaboration between companies and governments is critical in making a programme like this sustainable.?

Speaking to Mining, People and the Environment after the session, Keel added: ?The Obuasi mine is 115-years old. AngloGold was really focused on engaging with the local community and partners. For the type of project to work you need the participation of everyone. AngloGold did this and that?s what the Global Fund recognized when it decided to award the grant.

In the general context of Africa, Moonasar stressed that there are still significant gaps and mining companies must work to boost partnerships and work collaboratively. ?It?s important to find a way to see how partners and the mining sector can align with national strategies for their own healthcare programme on the mines,? he said.

?Sometimes there?s a resource limitation within mining companies as well, how can they partner with each other to be able to deliver a supportive, collaborative effect. The third thing for us is the mining sector has a strong capacity to lend to government and share with government so that we don?t get these statistics that we get every year.?

Detecting malaria
The World Health Organization (WHO) has developed its own rapid diagnostic kit (RDT), using particles of gold, that can quickly identify whether or not a person is infected with malaria.
The gold, which is in the form of tiny purple-coloured nanoparticles, mixes with the blood sample and, if malaria is detected, drives a colour change on the test strip. This combination of simplicity and reliability means that RDTs can be used anywhere in the world, without the need for expensive equipment or complex supply chains.

Dr Trevor Keel, head of technology at the World Gold Council, told Mining, People and the Environment why the diagnostic kit has proven to be such a breakthrough for malaria diagnosis. ?The RDT itself only costs about 50 cents ? it?s very reliable and can tell you when somebody is infected with malaria in just 20 minutes with just a single drop of their blood.?

Although the technology itself is not new, Keel stressed that the WHO?s efforts to improve the reliability of the kits is now paying off. ?The WHO recognised the importance of this technology years ago, but they also recognised that they had a very significant problem ? nobody really believed them. There were so many problems with the quality control of these tests and they were often manufactured quite poorly. The test would be run and nobody would believe the outcome, so the person would be given anti-malarial drugs anyway, whether they had malaria or not.?

Asides from being an economic burden, the WHO began to recognise that this misdiagnosis was creating an arguably even greater problem: anti-malarial resistance. ?The WHO recognised this problem and worked with a number of NGOs around the world,? said Keel. ?They actually took the kits and started testing them and forced improvement of these particular pieces of technology.?

According to the WHO, 155 million malaria RDTs were sold worldwide in 2011. ?Today healthcare workers trust the tests and governments are also putting their trust in the quality of the tests,? added Keel.

Source:?Jack Adom


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