Tuberculosis (TB) is an infectious bacterial disease which is transmitted by air and can be fatal. Tanzania has one of the highest burdens of TB in the world with approximately 295 TB cases per 100,000 adults. The mining sector is hardest hit by TB due to vulnerabilities caused by factors such as workers’ exposure to silica and dust, poor working and living conditions and a lack of TB prevention and education services. Added to these factors are others associated with migration such as a lack of social support structures and the inability to access or afford health services. The prevalence of the disease, especially in small scale mining workers, erodes the positive contribution made by the sector to Tanzania’s economic development. Immediate intervention is required because the disease can be controlled and cured through early diagnosis and treatment. 

The International Organization for Migration (IOM) in Tanzania, in close collaboration with the Ministry of Health and Social Welfare (MoHSW) is supporting the implementation of the 2012 Southern African Development Community Declaration on TB in the Mining Sector (SADCD). The SADCD affirms the member States’ commitment to the elimination of TB and pledges to improve practices related to health and safety in the mining sector. Under the framework of the Partnership on Health and Mobility in East and Southern Africa (PHAMESA), IOM assists the Technical Working Group (TWG) on TB/HIV Control to plan and execute interventions related to TB control in mines across the country.

In October 2014, the TWG conducted a baseline assessment to assess current practices among small scale miners in Kahama, Geita and Merarani mining areas. The assessment indicated that TB is prevalent in the two large gold mining sites of Geita and Kahama in Tanzania and. Mine workers contract TB due to poor working conditions, especially in small scale mines, where they work in confined spaces with little or no protective gear. Once contracted, TB spreads within the community due to the close quarters in which miners work and live. A lack of TB education means that workers do not identify the disease and cannot take leave from work to access health services (which they also may be unable to afford). They are then forced to leave work once debilitated by the disease leaving them with no income and no compensation. The assessment highlights that the control of TB requires that workers are rapidly diagnosed and treated.

IOM and MoHSW facilitated three meetings related to the control of TB in Tanzania between 29 June and 3 July 2015. Representatives from the government, the mining industry, local authorities, civil society organizations and miners’ associations came together in Mwanza to discuss findings from the assessment and to formulate plans to control TB in Tanzania. Regarding the meetings, co-organizer Dr Allan Tarimo of the MoHSW says, “The burden of TB in mining is high. The findings from rapid assessments show that exposure and risks of TB and HIV among mineworkers are much higher than the general population. There is a huge need for a collective effort and allocation of resources to reduce these epidemics in mining areas”.

During the first meeting, TWG members reviewed the three year work plan based on the final draft of the National TB Strategic plan and the SADC Regional Concept Note for the new Global Fund programme. The programme foresees a series of interventions on TB care, prevention and strengthening community systems which focus on provision of health services.

Mining company representatives joined TWG members during the second meeting which took place on 1 and 2 July 2015. Participants welcomed the assessment as it provides an overview of the current situation of TB in mining and can be used for planning project interventions. Issues such as occupational health, employee rights and the inclusion of small scale miners in legislation were highlighted and discussed. Members agreed on rapid action to increase education of TB risk factors and transmission, to advocate for preventive measures to be taken and to explore avenues to improve the access to, and availability of, health services.

Representatives and stakeholders of mining companies, the media and civil society organizations came together during the third meeting on 2 and 3 July. Participants were given a detailed overview of TB and an opportunity to examine and build on the recommendations of the two previous meetings. Mining company representatives supported an initiative to increase the number of Gene X-pert machines (a machine which can diagnose TB) to enable the rapid identification and treatment of TB in mining settings. Media representatives also supported an initiative to promote a greater awareness of TB through mediums accessible to the mining community, such as local radio station broadcasts.

The gathering of a cross section of individuals involved with TB and mining in Tanzania afforded the unique opportunity to identify innovative solutions to the practical challenges posed by TB in the mining sector. Ms Enna Lutengano, IOM’s Migration Health Consultant, stresses that TB in mining is a multidisciplinary sector and that IOM is committed to encouraging a commitment from all stakeholders to work together towards the control and reduction of TB in the mining sector in Tanzania. Decision makers and more partners will be approached to strengthen efforts to control and reduce TB in the mining sector. The Global Fund Programme is expected to start implementation in October 2015 and is expected to be a strong first step in addressing many of the challenges identified.