Mafefe: AI-Assisted Screening on the Front Line of South Africa's Asbestos Legacy

On 17 August 2026, South Africa's Minister of Health, Dr Aaron Motsoaledi, launched an integrated health screening programme at Mafefe in Lepelle-Nkumpi, Limpopo. Healthcare Framework (HCF) and Nexus Intelligence support the programme together with the Medical Bureau for Occupational Diseases (MBOD), the National Department of Health, the Limpopo Department of Health and other partners. More than 2,700 residents have been screened.

Community members access a range of integrated services, including general wellness screening, HIV and lung health screening, occupational health assessment where relevant, laboratory testing and digital chest X-ray. Chest X-rays are inferenced on site by Nexus AI CXR, in under 45 seconds, without a radiologist present and without an internet connection.

Why Mafefe

Mafefe has a long and difficult history of asbestos exposure. Mining may have ended decades ago, but the health consequences remain relevant for former mineworkers, their families and the wider community. TB, silicosis, asbestosis and other occupational lung diseases share a screening pathway and disproportionately affect people who worked in or lived beside extractive industry.

The programme was therefore designed as more than a once-off screening activity. It is intended to create a practical pathway from community-based screening to referral, specialist review and continuity of care.

How the programme works

• → Each participant is registered in Healthcare Framework (HCF), which creates a clinical record for the screening encounter and manages the assessment and programme workflow, including general wellness, HIV and lung health screening.
• → Ultra-portable X-ray units are used at the site, allowing digital chest X-rays to be taken in remote settings where there is no fixed radiography facility and, in many cases, no electricity.
• → Chest X-rays are inferenced on site by Nexus AI CXR, offline and in under 45 seconds, indicating any findings that are not consistent with a normal lung field, including findings suggestive of tuberculosis, with the AI output staying linked to the patient record.
• → CloudX, through HCF's automated image allocation algorithm, allows radiologists to remotely report on the chest X-ray cases that require clinical confirmation, in partnership with MBOD and Wits University.
• → Clinical teams use HCF to manage patient care, track laboratory results and radiologist reports, and generate referral letters, ensuring patients are referred to the appropriate hospital, in this case Lebowakgomo Hospital, and that treatment is initiated where required.
• → Patient and screening data between HCF and the MBOD system were integrated for the Mafefe project, ensuring unified reporting and client medical records.
• → MBOD Benefit Medical Evaluations for former mineworkers run in parallel, with support from partners including RMA, supporting access to the occupational disease compensation process.

About Nexus AI CXR

Nexus AI CXR is a CE MDR Class IIb certified medical device. It indicates any findings that are not consistent with a normal lung field, including findings suggestive of tuberculosis, and shows the health worker heat maps and contour lines over the regions the models consider significant. The result supports prioritisation and clinical judgement stays with the clinician. Multi-pathology classification, including silicosis and other pneumoconioses, is a Beta feature outside the CE certification and is progressing through external evaluation with the Stop TB Partnership.

What the deployment demonstrated

With more than 2,700 residents screened, the programme demonstrated that integrated clinical services combining digital health systems, AI-assisted chest X-ray screening, remote radiology reporting, case management and referrals can be delivered effectively in rural and remote communities with limited resources.

Projects like these support quality clinical care, early disease detection, access to compensation for eligible former mine workers, and improved referral and treatment initiation. The programme provides a valuable model for comprehensive lung health screening in both the wider community and former mine-working communities.

We are grateful to the National Department of Health, the Limpopo Department of Health, MBOD, Wits University, RMA, local healthcare teams, community leadership and all of the partners contributing to the Mafefe programme.