Stakeholder perceptions of a workplace-based screening programme for artisanal and small-scale miners in Zimbabwe

Abstract

BACKGROUND : Artisanal and small-scale miners (ASMs) experience high prevalence of disease, notably tuberculosis (TB), human immunodeficieny virus (HIV), silicosis, sexually transmitted infections, substance misuse, and mercury and cyanide toxicity. Despite this, targeted healthcare interventions are limited. AIMS : To explore the perceptions of ASMs and their leaders/representatives in relation to a 5-year targeted health screening intervention for ASMs in Zimbabwe. Screening included TB, HIV and silicosis. Insights were also gathered from healthcare staff, academics and national stakeholders involved in the project. METHODS : Focus-group discussions (FGDs) were conducted with 31 participants (13 ASMs and ASMs’ representatives, 6 healthcare staff and academics, and 12 representatives from national organizations). Participants were asked to reflect on their experience and understanding of health screening activities for ASMs, as well as what further healthcare activity is required. RESULTS : Artisanal and small-scale miners felt that screening activity was beneficial. Fear and stigma were the main barriers to healthcare access during initial implementation; however, this was alleviated through collaboration with ASMs leadership and peer-officers. Health priorities identified for future healthcare activity included development of a health-screening checklist for ASMs, strengthening access to information, decentralization of occupational health services and addressing a greater package of health. Cross-collaboration between the mining sector, Ministry of Health and Childcare and other national stakeholders was identified as a priority. CONCLUSIONS : Targeted health screening and care is needed for this neglected and vulnerable group. The workplace screening offered a model to address this; however, more work is needed to ensure that ASMs in other locations and with additional health priorities are reached.