Occupational safety and health

Good progress was made towards the group's long-term objective of eliminating accidents during the year with all the major safety indicators improving on the previous year and reaching their best ever levels. From a health perspective, some progress is reported along with some negative statistics, the latter particularly in respect of occupational lung disease (OLD) and tuberculosis (TB) on the South Africa operations. This is largely because of the increasing impact of the HIV/AIDS epidemic in southern Africa.

Safety performance

Safety performance at AngloGold Ashanti was the best ever for the company, with all major safety parameters indicating an improving trend. In fact, the group has achieved a 57% improvement in LTIFR and a 51% improvement in FIFR over the past six years.

Regrettably, however, 32 employees lost their lives in work-related accidents during the year, 31 of these at the South African operations. The single non-South African fatal accident was at the Morila mine in Mali.

As a result, the group's Fatal Injury Frequency Rate (FIFR) was 0.19 per million man hours worked, improved by 34% on the rate of 0.29 achieved last year. The Lost Time Injury Frequency Rate (LTIFR) also declined significantly, by 26%, to 6.56 per million man hours from 8.83 the previous year. The latter exceeds the company's objective of achieving a 20% improvement in the LTIFR. Both the LTIFR and FIFR statistics represent record lows for the company.

Causes of fatal accidents

The primary causes of fatal accidents were falls of ground (60%), with seismically-induced falls of ground accounting for 58% of these. Other primary causes were: machinery (13%), trucks and tramming (6%), and vertical transport (6%).

Fatal accident reviews

AngloGold Ashanti has a policy of investigating all fatal accidents independently of mine-based and statutory investigations using a team convened by the corporate office, and followed up by a formal executive review conducted at the corporate office. The group believes that this methodology not only indicates the seriousness with which the board and executive view fatal accidents, but reveals important risk issues and lessons learnt.

Health performance

AngloGold Ashanti continues to provide comprehensive health care services to employees either through AHS (in South Africa), overseen by AHS (elsewhere in Africa) or through mine-based and external health care service providers (elsewhere in the world).

Medical surveillance at the South African operations is conducted in line with the Mine Health and Safety Act: 51,084 occupational medical surveillance examinations (initial, periodical, transfer and exit) were performed in 2004. Medical surveillance is also undertaken at other operations, in line with specific needs and local legislation.

In South Africa, noise-induced hearing loss (NIHL), occupational lung diseases (OLD) and tuberculosis (TB) are categorised as occupational diseases and are therefore compensable by law. In 2004:

• 285 new cases of NIHL were compensated during 2004, which is a rate of 7 per 1,000 employees. This is a decrease of 61% on the previous year's rate of 18 per 1,000 employees.
• 319 cases of OLD were compensable in the South Africa region during 2004, which is a rate of 8 per 1,000 employees.
• 1,386 new cases of TB were detected and treated during the year, which is a rate of 35 per 1,000 employees. The rates are increasing despite intensive efforts to both detect and treat TB. This is because of an increasing incidence of HIV and AIDS amongst a silica-exposed workforce.

Governance and structure

The safety, health and sustainable development committee of the board has as its brief the evaluation of social, economic, environmental and health impacts of the company's operations on both local and global communities and to achieve a substainable balance between economic and social development with due regard to:

• the safety of its employees;
• the health of its employees; and
• the impact of its operations on the environment.

One of the stated primary objectives of this committee is to ensure the elimination of all work-related accidents and diseases, and the committee conducts on-site inspections on matters of serious concern.

The committee comprises two non-executive directors, Bill Nairn (chairman) and Dr James Motlatsi, and the chief executive officer Bobby Godsell. Members of management, including chief operating officer, Dave Hodgson, are invited to participate, as well as John McEndoo (Safety), Dr Dave Barnes and Dr Brian Chicksen (Health), Andrew Mackenzie (Environment) and Paul Hollesen (Community Development).

The management of safety and health issues at an operational level falls under the auspices of the chief operating officer, who is supported by line management. In the case of health services in South Africa and, to some extent, in the rest of Africa, these are guided and provided by AHS under the direction of Dr Brian Chicksen.

Responsibility for safety and health has been devolved to operational line management, down to the level of first line supervisor. The actual operational structure varies from operation to operation. At the Geita Mine in Tanzania, the environmental manager, safety manager and health services manager all report to the general manager. At the Obuasi mine in Ghana each underground section and the surface operations have a safety engineer dedicated to them. These safety engineers play a co-ordinating role and support the line managers, who are also supported by safety and health representatives appointed from amongst the workforce.

Safety and health policies

The group's values and business principles on safety and health and accompanying safety and health policy are minimum guidelines for the group in respect of safety and health. Regions and operations are encouraged to develop their own specific principles, guidelines and policies in line with local conditions and legislation. (See Tau Lekoa occupational health and safety policy (PDF - 25KB) and Geita Gold Mine values (PDF - 24KB) on the Report to Society 2004 website.)

The Australia region has a signed health and safety policy in line with the AngloGold Ashanti health and safety policy and objectives. This policy was reviewed by employees and a group of external stakeholders in 2003 with a positive response received and will be reviewed again by external stakeholders in 2005. (See Australia region safety and health policy (PDF - 67KB) on the Report to Society 2004 website)

The Sadiola and Yatela mines in Mali have developed a code of conduct with three parts, dealing with safety and health, and the environment. Because these are applicable to local employees and communities they are available in English and French. (See Sadiola/Yatela safety and health policy (PDF - 30KB) on the Report to Society 2004 website)

Safety and health agreements

The South Africa region has safety and health agreements and policies in place at all mines and business units that have been negotiated with representative unions as prescribed by the Mine Health and Safety Act.

At Navachab in Namibia a health and safety agreement was concluded with the representative union in 1997 and, as a consequence of this, union and other employee representatives attend safety meetings on a regular basis.

Where no formal agreements are in place at the other operations, participation by employees is encouraged as it is a fundamental philosophy of the group that safety and health is the responsibility of each individual, as well as that of management.

Complying with laws, regulations, standards

AngloGold Ashanti is committed to complying with all relevant laws, regulations and standards applicable to the countries in which its operations are located. In the absence of appropriate laws, regulations or standards, or where these are perceived to be inadequate, the company will adopt standards reflecting good practice.

Enforced stoppages by regulatory authorities, non-compliance with legislation or fines imposed by regulatory authorities

A total of 13 withdrawals/partial withdrawals and/or stoppages were instigated by the South African Department of Minerals and Energy (DME) in line with section 54 of the Mine Health and Safety Act during the year. (See table bottom right.) Two stoppages resulted in a significant interruption to business (of more than three days):

• on 18 August 2004 a working place at Great Noligwa mine was stopped for three weeks while the mine instituted remedial safety measures, following a multiple fall of ground seismic-related fatal accident; and
• work on the reef horizon was suspended for five consecutive Sundays following a fatal accident at Tau Lekoa mine.

A fine of R200,000 was imposed by the DME relating to a gas explosion that took place at Mponeng mine on 29 June 1999 and in which 19 employees lost their lives. The investigation conducted by the DME after the accident highlighted a number of procedural shortcomings at the mine, although these were found not to relate directly to the accident.

At the Obuasi mine in Ghana, two breaches of the mining regulations resulted in reprimands from the Department of Mines:

• on 5 April 2004, a fire in the No 2 compartment of the Sansu Shaft occurred after shaft repairs using an oxy-acetylene cutting device. No injuries occurred. Remedial action has been put in place; and
• on 3 May 2004, an eight-year old girl drowned while swimming in a defunct slurry trench. This and all similar trenches in the area have been filled and the area is being rehabilitated for eventual hand-over to the community.

No other breaches to, or violations of, the various legislation or regulations were reported during 2004, and no further non-compliance fines were paid in respect of safety and health.

Risk assessments

Risk assessments are conducted at both group and operational level, right down to working places. This is to understand the potential safety and health risks that exist so that they may be removed or reduced to tolerable levels. A detailed discussion on risk analysis within the group can be found in the Annual Report 2004.

Risk assessment may be conducted by or with the assistance of external consultants, by the group's corporate office, by underwriters (for insurance purposes) or by the operations themselves. An important development that has taken place in recent years has been the extension of basic hazard identification into the front line supervisory ranks and to employees themselves.

At Geita in Tanzania, for example, many supervisors, safety officers and representatives have been trained to conduct risk assessments.

An example of a risk assessment that draws on the broad base of experience and expertise within the group was recently conducted at the South America region's Cerro Vanguardia operation in Argentina to ensure that these open-pit operations are managed in line with world best practice. (See case study: Towards best practice in open-pit mining.) Yet another example are the Hazop studies that were undertaken during 2004 as part of the process of constructing the Hanna Cyanide recovery plant at Sadiola and Yatela in Mali.

The Australia region uses the SafeGold risk management system as the basis for risk management.
All employees are trained in hazard identification and risk assessments. Risks are managed through the hierarchy of control and there is demonstrated use of the high levels of control including elimination of hazards and engineering out the hazards rather than relying on personal protective equipment.

At Sunrise Dam a formal process of identifying potential hazards and defining control processes for the underground operation was recently undertaken. This process identified some 1,600 hazards which were subsequently assessed and addressed. At present the mining contractor is reviewing this list of hazards and controls that are in place. During the Mineral Council of Australia's Minex evaluation, the application of the rigorous risk management process was identified as a principal strength in the safety management programme. (See case study: Sunrise Dam awarded prestigious Minex trophy.)

This process has been extended to exploration activities, such as the Tropicana project, where risk was assessed by the team working on the project prior to the project commencing. An external party was used to educate the team in the principles of risk assessment and assist in the process. Major risks identified were reviewed and action plans developed to reduce their impact. Having undertaken this process before the project commenced, all personnel were made aware of the hazards, resulting in no incidents and injuries occurring to date.

The Australia region has also made good progress in its transition to using leading rather than lagging indicators. For example, three positive indicators used to measure safety performance include corrective actions completed, scheduled inspections conducted and a number of green (or incident-free) days achieved.

In South America (Argentina and Brazil), annual Hazard Identification and Risk Assessments (HIRAs) are undertaken by company teams, and these are subject to internal and external audits. The HIRA is conducted for each activity, identifying risk factors, consequences, existing and proposed risk measures. The final result is a matrix indicating a Residual Risk Profile and respective controls, which has brought about a significant reduction in the number of lost-time accidents.

Audits

Both internal and external audits are conducted on a regional and operational basis. Many operations outside of South Africa have adopted the National Occupational Safety Association (Nosa) systems and were audited during the year.

It has been AngloGold Ashanti practice to engage the services of recognised safety experts to undertake a high-level safety audit, with recommendations made to the board committee. Retired state mining engineer (Western Australia) Jim Torlach, undertook a second audit of the operations in late 2004, including the South African, Malian and Australian operations. His brief was to review the progress made on, and compliance with, certain of the recommendations made in his previous report from 2002/2003. (See case study: Australian expert evaluates AngloGold Ashanti's safety risks.)

The assessment of the group's adherence to the international Cyanide Protocol (See case study: Developing and implementing best practice for cyanide implementation.) uses a novel approach of creating expert teams drawn from different regions to work with a local team in undertaking what is essentially a detailed risk assessment and audit.

Both the South Africa region Occupational Health Centres were audited during the year by an external auditor using Anglo American plc guidelines. Both centres achieved more than 95% in all audit elements.

Employee involvement and communication

AngloGold Ashanti encourages both employee involvement in matters relating to safety and health, and communication with employees in this regard. This is necessary to understand and arrive at the best outcomes, and to gain commitment in the implementation of safety and health programmes. Effective communication is an important adjunct to safety management, not only to disseminate knowledge, but also to ensure that employees are aware of their own responsibilities.

The group uses the intranet, mine-based newsletters, safety newsletters and a monthly safety letter from its chief operating officer to communicate about safety and health issues and ensure that they remain a priority. Operations are required to report on monthly, quarterly and annual safety performance in respect of both leading and lagging indicators. Coaching to interpret these indicators through these media is ongoing.

In South Africa, employee involvement is specified by law. In line with the Mine Health and Safety Act, 2,500 workplace and 60 full time safety and health representatives have been trained, designated and appointed. These cover all South African production employees and all working places.

In Ghana, article 16 of the collective bargaining agreement between the company and union allows for safety and health representatives to be appointed from within the workforce. The union is represented on a panel of investigators during enquiries into incidents and is actively involved in safety and health campaigns coordinated by the safety, health and environment department. One of the challenges that remains in Ghana, and elsewhere, is to obtain employee support for, and participation in, the various programmes.

At Sadiola and Yatela in Mali, safety representatives are elected (most recently in February 2004) and form part of the team that drives both safety communication and management.

In Tanzania, both Geita and the contractors' employees are represented by a health, safety and environment (HSE) representative committee. These representatives are appointed by the various departmental heads. In this capacity they attend regular training sessions on their roles and responsibilities and are part of a group that is accountable for accident and incident investigations. They also play an important role in developing and implementing new safety and health systems and programmes, or raising employee concerns.

Although there is no formal union representation at the Australia operations, site management encourages teamwork and ownership in safety and health initiatives. Employees are encouraged to take responsibility for safety and to report risks and hazards before an incident can occur. This is reinforced through pre-shift instruction meetings and the ACTSAFE programme. The general manager is active in the promotion of safety and health on the site through the weekly safety and health meetings involving all employees and contractors. At the CC&V mine in the United States, the general manager conducts quarterly all-hands meetings that present an open forum to discuss safety, health and production status, and issues concerning the workforce.

Examples of forums for joint safety and health committees comprising management, employees and/or employee representatives.

Training

The provision of appropriate training is essential to ensure that employees are competent to carry out both their duties and responsibilities in a safe manner.

In South Africa, occupational environment, health and safety training is a particular priority for the company and is incorporated, in the first instance, into all technical training programmes and learning material with reference to the workplace and work-related hazards for each and every occupation and associated tasks. In 2004, 3,424 employees attended formal occupational environment, safety and health training, which took 7,833 shifts.

An important development in recent years has been the changes to legislation that have facilitated the empowerment of first line supervisors, both in examining and making safe their work areas, and in withdrawing from working areas should these be thought to be unsafe.

In the Australia region, safety and health training begins with induction which is competency based and then progresses to an area-specific induction. A 'buddy' system has been set up where an experienced person works with a new employee. Basic safety and health training is undertaken in areas such as hazard identification, risk assessment, job hazard analysis, working at heights, emergency response and fatigue management. Each area of the plant has its own safety and health training package. Safety and health and lifestyle topics are discussed regularly at safety meetings. Most of this training is formal and competency-based.

At CC&V in the USA, eight to 24 hours of safety and health training is conducted immediately following hiring. Eight hours of refresher training is conducted annually for all employees. Task training in the safety and health aspects of a task is conducted whenever an employee is assigned to a new task. Equipment operator skills training is conducted on an ongoing basis for mine operators.

Navachab mine in Namibia undertook a range of training programmes during the year: safety induction (annually for all employees), Nosa-related courses, incident investigation training, risk assessment training, cyanide basic awareness and intermediate training, safety representative training and defensive driving training.

In Ghana, safety related training has largely been informal and on-the-job for the majority of employees, while selected employees - who have a significant role to play in respect of safety and health - have enjoyed full time, formal training courses.

Some of the training that has taken place in Mali includes employee health and safety training courses (Levels 1 and 2), basic and intermediate cyanide training, fire fighting training, hazard recognition and hazard hunt training, as well as first aid training.

At Geita in Tanzania, all employees attend a health, safety and environment induction on their first day on site. Area-specific induction is then carried out by area supervisors before the employee may commence work. Other training is conducted on a needs basis and includes specific operator training, fire-fighting training, hazard identification, first aid training, cyanide awareness and response training. The on-site emergency response team (which includes two artisanal miners) trains twice a week after hours and one full day per month. They also receive training in all aspects of emergency response from external service providers.

At AngloGold Ashanti Mineração in Brazil, each employee spends between six and 10 hours each year on refresher safety training. This follows induction training (of 16 hours in total) on safety at work, firefighting, first aid, risk management and the handling of cyanide.

Safety programmes

A Safety Summit was held in March 2004 where five strategic thrusts for the South African safety programme were identified. This was followed by a re-launch of the South African safety programme involving a symbolic ceremony where the various business unit managers committed themselves and their business units to the implementation of the five strategic thrusts. (See box below).

Discussions on some of the initiatives undertaken on the South African operations may be found on the following links:

• From lagging to leading indicators - Tau Lekoa rises to the challenge
• Mponeng's safety strategy focuses on behavioural change
• Safety interventions at depth at TauTona

The Australia region recorded a number of achievements during the year. Among these was the successful implementation of the ACTSAFE programme at Sunrise Dam that has resulted in improved employee acceptance of responsibility for personal health and safety within the workplace.

Another achievement was the effective implementation of exploration drilling equipment improvements which has seen the implementation of automatic break-out tools on all drill rigs. Breakout-tools are used for breaking the joints between drill rods. The rod string comprises a series of rods of three or six metres each, that are screwed together and added as the drill hole gets deeper. These joints become very tight as a result of the tremendous torques involved. Manually breaking the joints has long been recognised as a very hazardous task and the source of frequent hand and back injuries.

Two areas of concern remain, and will receive increased focus during the year ahead:

• the need for improved contractor management and, in particular, the need to review and increase contractor commitment to safety; and
• the high turnover of personnel in the mining industry and the implications this has for safety training.

In addition, the region will be undertaking a safety culture survey during the year ahead.

A primary challenge at the Ghanaian operations, and indeed elsewhere, is to reinforce the commitment of supervisors towards safety and health, in the same way that they have assumed responsibility for production. This accountability is now being incorporated into the formal responsibilities for senior employees at the time of their appointment. To ensure that all employees recognise their own responsibilities in respect of safety and health, a behaviour-based safety programme is planned for 2005. Another area of concern has been the negative impact that budgetary constraints have placed on the provision of personal protective equipment and safety facilities and this is being addressed.

At the Sadiola and Yatela operations in Mali, major challenges ahead include the further development of full time safety and health representatives, the inculcation of safety as a fundamental value within the company, improved vehicle controls, and the fostering of a risk control mindset. At Morila, a near-miss reporting system has been implemented, along with increased communication in local languages, in an effort to improve safety performance. Some success has been achieved, but this was negated by the relatively poorer performance by contractors during the Plant Expansion Project, which was completed in October 2004. Plans for the year ahead include:

• better supervision of contractors undertaking atypical work; and
• the implementation of a Behaviour-based safety programme for all employees. (See case study: Employee attitudes to safety in Mali.)

In the USA, at the CC&V mine, the DuPont STOP for Supervisors and Employee programmes continue to yield significant improvements in reported injuries and equipment damage incidents. A significant portion of the 2004 annual refresher training was devoted to programme skills and requirements. Overall, programme feedback has been positive both in reduction of accident occurrence and in changing attitudes to reflect positive methods of remedial measures. Continuing to improve the STOP programme and ensuring utilisation of STOP principles and observations will be a major focus during the year.

Current safety priorities for Geita mine in Tanzania include:

• the development and training of safety representatives;
• ensuring compliance with site driving rules (especially wearing of seat belts);
• increased drug and alcohol awareness programmes and substance abuse testing;
• risk assessment training;
• implementation of behaviour based safety system;
• reducing worker fatigue; and
• succession planning and localisation of safety skills.

Health programmes

The provision of health care in South Africa continues to be made under the auspices of AHS, which has undergone a change in strategic direction this year. A key strategic objective during 2004 was to align health care provision at other African operations with that of AHS facilities and this has largely been achieved. Three such facilities are discussed in this report. (See the case studies: Model mine medical facility at Iduapriem on page SH26, Upgrade planned for the Edwin Cade Memorial Hospital at Obuasi, and State-of-the-art x-ray facilities at Geita.) The first two operations are in Ghana and the latter is in Tanzania.

Occupational health threats

NIHL and OLD, as well as TB in South Africa, are the most significant occupational health threats faced by employees in the gold mining industry and the various operations have programmes in place to address these. Other threats are excessive fatigue and poor lifestyle and nutrition. The major health threat at the Mali, Ghana and Guinea operations remains malaria and this is dealt with separately in the HIV/AIDS and Malaria section. Indeed, one of the issues related to being a global group is both extensive travel and secondment. (A case study: Setting up tropical travel protocols as global travelling increases.)

Noise induced hearing loss (NIHL)

In South Africa baseline audiograms in terms of new compensation regulations were completed for all employees during 2003. The decreased NIHL levels recorded in 2004 do not represent a significant downward trend but are consequent upon this legislative charge. In light of this first-ever accurate baseline survey covering all employees at one time, and the increased levels of compensation that may be awarded in the future for NIHL, reducing noise levels at source and preventing hearing loss is an occupational health priority.

In this regard the muffling of all rock drills and noisy fans has been completed with the result that ambient noise levels have been significantly reduced. In addition to these engineering efforts, specifically selected hearing protection devices (HPDs) are available to employees. Increased education and training efforts on the need to wear HPDs, and the nature and consequences of NIHL, will be undertaken during the year ahead.

Occupational lung disease (OLD)

Also in South Africa, exposure to silica dust remains one of the major contributing factors to the development of OLD. Silica exposure plays a role with HIV in the development of TB. Initiatives to eradicate dust and improve methods of control have continued. (See case study: Controlling dust levels underground remains a focus area.)

Silicosis

A legacy issue of both the South African and Brazilian mining industries is that of silicosis. Silicosis is an occupational lung disease caused by the inhalation of free silica dust which is present in mining areas where quartz concentrations are high, as is frequently the case in deep level mines. In South Africa the follow-up treatment and compensation systems set up in the past under the Occupational Diseases in Mines and Works Act, especially for ex-employees, do not seem to be functioning as well as intended. AngloGold Ashanti is working with the state, unions and other mining companies in developing solutions. (See Report to Society 2003.)

Tuberculosis (TB)

TB in silica-exposed employees remains a compensable disease in South Africa. The higher rates recorded in 2004 are a result of HIV/AIDS, silica exposure and an ageing workforce. More attention is being paid to the early detection of TB by using Digital Diagnostic Radiography (DDR), and this has also had an impact on TB rates. During 2004, a R5 million ($0.8 million) budget was approved for the purchase and equipping of two mobile DDR units. These will move from shaft to shaft and facilitate more frequent x-raying of employees in an effort to detect and treat TB infection earlier, thereby preventing its spread and the severity of impact.

Another milestone in 2004 was the granting to Aurum Health Research, a subsidiary of AHS, of $14 million over a five-year period by the Consortium to Respond Effectively to the AIDS/TB Epidemic (CREATE). The money will be used to research strategies around TB control in the South African gold mining industry. The grant, which is part of a larger award of $45 million to CREATE by the Bill and Melinda Gates Foundation, was announced in July 2004 at the XV International AIDS Conference in Bangkok. In addition to Aurum, members of CREATE include, among others, the Johns Hopkins University Centre for Tuberculosis Research, the London School of Hygiene and Tropical Medicine, the University of Stellenbosch and the World Health Organization. (See case study: Aurum's battle against TB gains momentum.)

The research being conducted by Aurum, is being done after extensive consultation, and collaboration, with several South African gold mining companies, including AngloGold Ashanti, Gold Fields and Harmony, the departments of Health, Labour, and Minerals and Energy; and various labour unions and associations. The aim of the research is to determine the effects of community-wide preventive therapy on TB rates in the South African gold mining industry. As mentioned above - the rates of TB among employees in the South African gold mining industry have risen sharply, coinciding with the onset of the HIV epidemic.

Heat and physical fitness

Deep level mining is often accompanied by exposure to heat; the deeper the mine, the hotter the rock temperatures. AngloGold Ashanti employs a heat stress management programme to promote the health and well-being of its employees and to meet the requirements of legislation. (See case study: New heat tolerance centre at West Wits.)

A related issue is the operation of the Functional Work Capacity (FWC) test battery developed by AngloGold Health Service and featured in last year's report. The use of this test battery has been extended to assess the fitness of women for work underground, which is particularly important in light of the South African mining industry Charter requirements.

Other issues

In Australia, lifestyle choice is a health challenge, and programmes are in place to assist employees in improving their personal health, for example, quitting smoking, eating balanced nutritious meals and encouraging personal fitness. A further area of activity during the year ahead is fatigue education and management.

CC&V in the USA has a limited number of health issues to manage. Despite elevated airborne concentrations of silver in the refinery, blood sampling of refinery personnel has not detected any problems. Nonetheless, reducing silver exposure to refinery personnel to less than a threshold limit value is the major health challenge for 2005 and significant engineering controls have therefore been implemented. Compliance with MSHA regulations relating to silver exposure is pending health sampling conducted by MSHA inspectors. A baseline risk assessment was performed in December 2004. The assessment will be verified with operating groups in early 2005, and a safety plan developed to address significant risks.

At Sadiola and Yatela in Mali, a major epidemiological baseline study has been initiated, along with the yellow fever inoculation programme. A programme to reduce and manage worker fatigue, along with a vitamin A distribution, is underway.

Malaria remains a major health threat in the African operations. This is dealt with in a separate section on HIV/AIDS and Malaria. Similarly, a review of activities relating to HIV/AIDS - also in the African operations - can be found in this section.