Investigating Health Impacts of Natural Resource Extraction Projects in Burkina Faso, Ghana, Mozambique, and Tanzania: Protocol for a Mixed Methods Study

Prospects and Perspectives of Health Impact Assessment: A Systematic Review of the Peer-Reviewed Literature From June 2007 to January 2023

Objectives

In 2008, an analysis investigating health impact assessment (HIA) practice found that only 6% of HIA-related peer-reviewed publications had a focus on low- and medium-developed countries, whereas 94% were conducted in countries with a high or very high development state. We aimed to update and deepen these observations.

Methods

We conducted a systematic review, searching PubMed and Web of Science for HIA-related papers published in the scientific literature from June 2007 to January 2023. Only applied HIA and papers with HIA as a subject were included.

Results

The search yielded 3,036 publications and the final selection consisted of 1,019 publications. The annual number of total publications increased considerably over the past 15 years. Whereas research-driven HIA (n = 460) showed a steep increase, step-by-step HIA (n = 71) did not show a clear trend.

Conclusion

The gap between the number of HIA-related peer-reviewed publications focusing on low/medium and high/very high developed countries has diminished from 6/94 to 11/89. There is a growing tendency to apply the terminology HIA for health impact modelling studies and quantitative health risk assessments.

Exploring the Impact of Mining on Community Health and Health Service Delivery: Perceptions of Key Informants Involved in Gold Mining Communities in Burkina Faso

Sub-Saharan Africa is rich in natural resources but also faces widespread poverty. The United Nations' Sustainable Development Goals brought increased attention to resource extraction projects, emphasizing their development potential in extraction regions. While mining companies are required to conduct environmental impact assessments, their effect on the project-affected communities' health mostly lacks systematic management, and their consideration of community perspectives is insufficient. Between March and May 2019, qualitative research was conducted at three industrial gold mines in Burkina Faso. Thirty-six participants, including community leaders, healthcare providers, and mining officials, were interviewed through key informant interviews about their perceptions on the impacts of mining operations on health, health determinants, and health service delivery. Disparities in perceptions were a key focus of the analysis. Mining officials reported mainly positive effects, while healthcare providers and community leaders described enhancing and adverse health impacts without clear trends observed regarding the extent of the impacts on health determinants. The perception of predominantly positive health impacts by mining officials represents a potential risk for insufficient acknowledgement of stakeholders' concerns and mining-related effects on community health in affected populations. Overall, this study enhances comprehension of the complex interplay between mining operations and health, emphasizing the need for comprehensive assessments, stakeholder involvement, and sustainable practices to mitigate negative impacts and promote the well-being of mining communities.

A roadmap for using DHIS2 data to track progress in key health indicators in the Global South: experience from sub-saharan Africa

High quality health data as collected by health management information systems (HMIS) is an important building block of national health systems. District Health Information System 2 (DHIS2) software is an innovation in data management and monitoring for strengthening HMIS that has been widely implemented in low and middle-income countries in the last decade. However, analysts and decision-makers still face significant challenges in fully utilizing the capabilities of DHIS2 data to pursue national and international health agendas. We aimed to (i) identify the most relevant health indicators captured by DHIS2 for tracking progress towards the Sustainable Development goals in sub-Saharan African countries and (ii) present a clear roadmap for improving DHIS2 data quality and consistency, with a special focus on immediately actionable solutions. We identified that key indicators in child and maternal health (e.g. vaccine coverage, maternal deaths) are currently being tracked in the DHIS2 of most countries, while other indicators (e.g. HIV/AIDS) would benefit from streamlining the number of indicators collected and standardizing case definitions. Common data issues included unreliable denominators for calculation of incidence, differences in reporting among health facilities, and programmatic differences in data quality. We proposed solutions for many common data pitfalls at the analysis level, including standardized data cleaning pipelines, k-means clustering to identify high performing health facilities in terms of data quality, and imputation methods. While we focus on immediately actionable solutions for DHIS2 analysts, improvements at the point of data collection are the most rigorous. By investing in improving data quality and monitoring, countries can leverage the current global attention on health data to strengthen HMIS and progress towards national and international health priorities.

Industrial mining and HIV risk: evidence from 39 mine openings across 16 countries in sub-Saharan Africa

OBJECTIVES

The aim of this study was to assess the impact of natural resource extraction projects on HIV transmission risks in local communities in sub-Saharan Africa.

DESIGN

Difference-in-differences design using repeated cross-sectional data from around newly opened mines.

METHODS

We combined data on mine openings with HIV data from the Demographic and Health Surveys (DHS). Using logistic regression models, we compared HIV-related indicators between mining (i.e. up to 10 km distance from the mine) and comparison (i.e. 10-50 km) areas before and after mine opening to identify their impact on HIV prevalence, sexual behavior and HIV knowledge.

RESULTS

A total of 33 086 individuals across 39 mine openings were analyzed. Adjusting for baseline differences and temporal trends in the study regions, mine opening increased the odds of HIV infection almost two-fold [odds ratio (OR): 1.93, 95% confidence interval (CI): 1.19-3.14]. Strongest effects were seen in high-prevalence countries and in the 20-29 years age group. In mining communities around operational mines, there was a tendency towards lower HIV knowledge (OR: 0.81, 95% CI: 0.63-1.04). New mine openings increased the odds of risky sexual behaviors, such as having multiple sex partners (OR: 1.61, 95% CI: 1.02-2.55), high-risk sexual partners (OR: 1.45, 95% CI: 1.03-2.05) and unprotected sex with high-risk partners (OR: 1.77, 95% CI: 1.18-2.67).

CONCLUSION

The findings suggest that in our sample of households surrounding industrial mines, HIV infection risks substantially increase upon mine opening. Existing strategies for addressing mining-related risks for HIV transmission seem to be insufficient. Further efforts for mitigating and monitoring impacts of mines are needed.

"It Is Like We Are Living in a Different World": Health Inequity in Communities Surrounding Industrial Mining Sites in Burkina Faso, Mozambique, and Tanzania

Background: Health equity features prominently in the 2030 Agenda for Sustainable Development, yet there are wide disparities in health between and within countries. In settings of natural resource extraction (e.g., industrial mines), the health of surrounding communities is affected through myriad changes in the physical, social, and economic environment. How changes triggered by such projects translate into health inequities is poorly understood. Methods: This qualitative study explores potential layers of inequities by systematically coding perceived inequities of affected communities. Drawing on the framework method, we thematically analyzed data from 83 focus group discussions, which enrolled 791 participants from 10 study sites in Burkina Faso, Mozambique, and Tanzania. Results: Participants perceived inequities related to their individual characteristics, intermediate factors acting on the community level, and structural conditions. Due to environmental pollution and land loss, participants were concerned about unsecured livelihoods. Positive impacts, such as job opportunities at the mine, remained scarce for local communities and were claimed not to be equally distributed among community members. Conclusion: Extractive industries bear considerable risks to widen existing health gaps. In order to create equal opportunities among affected populations, the wider determinants of health must be considered more explicitly in the licensing process of resource extraction projects.

Health impacts of industrial mining on surrounding communities: Local perspectives from three sub-Saharan African countries

Industrial mining projects can play an important role in global sustainable development if associated health risks are minimised and opportunities maximised. While a broad body of evidence from quantitative studies exists that establishes the interlinkages between mining operations and effects on public health, little research has been conducted investigating health impacts from the perspective of affected communities. This is particularly true in sub-Saharan Africa, where about a third of the remaining global mineral resources are endowed and health-related indicators for sustainable development are lagging behind. In this multi-country qualitative study, we explore community perceptions regarding impacts of industrial mining on their health and well-being. In nine study sites in Burkina Faso, Mozambique and Tanzania, we conducted 83 participatory focus group discussions with a total of 791 participants (385 men, 406 women). Our findings reveal a broad range of perceived impacts on environmental, economic and social determinants of health, with secondary health implications related to morbidity, mortality and well-being. Overall, perceived negative impacts prevailed, mainly related to environmental pollution, change in livelihoods or social disruption. Perceived positive impacts on health and well-being were related to interventions implemented by the mines such as new or improved water sources, health care facilities, roads and schools. The consistency of these findings across countries and study sites suggests a structural problem and indicates a pressing need to address health by acting on the wider determinants of health in mining regions. Participatory health impact assessment should be strengthened in host countries to foster strategic interventions, include marginalised population groups, and protect and promote the health of local communities. By including community perspectives on health before and during project implementation, policymakers can take advantage of economic opportunities while avoiding the pitfalls, bringing their communities closer to achieving good health and well-being goals by 2030 and beyond.

Water and health in mining settings in sub-Saharan Africa: A mixed methods geospatial visualization

Industrial mining transforms local landscapes, including important health determinants like clean water and sanitation. In this paper, we combined macro-level quantitative and micro-level qualitative data to show how mining projects affect water infrastructures and ultimately the health of affected communities. Although we observed a positive trend of water infrastructure in mining settings, surrounding communities are also characterized by water scarcity and degradation of water quality. The video at the core of this publication showcases inter-linkages of the findings obtained at both the macro- and the micro-levels, embedding our results in a geospatial context. While mining projects can have positive impacts on the development of local water infrastructure, improved management of negative impacts of mining projects is needed for promoting 'Good health and well-being' and 'Clean water and sanitation' as promulgated by the Sustainable Development Goals of the 2030 Agenda.

How to bring research evidence into policy? Synthesizing strategies of five research projects in low-and middle-income countries

Background

Addressing the uptake of research findings into policy-making is increasingly important for researchers who ultimately seek to contribute to improved health outcomes. The aims of the Swiss Programme for Research on Global Issues for Development (r4d Programme) initiated by the Swiss National Science Foundation and the Swiss Agency for Development and Cooperation are to create and disseminate knowledge that supports policy changes in the context of the 2030 Agenda for Sustainable Development. This paper reports on five r4d research projects and shows how researchers engage with various stakeholders, including policy-makers, in order to assure uptake of the research results.

Methods

Eleven in-depth interviews were conducted with principal investigators and their research partners from five r4d projects, using a semi-structured interview guide. The interviews explored the process of how stakeholders and policy-makers were engaged in the research project.

Results

Three key strategies were identified as fostering research uptake into policies and practices: (S1) stakeholders directly engaged with and sought evidence from researchers; (S2) stakeholders were involved in the design and throughout the implementation of the research project; and (S3) stakeholders engaged in participatory and transdisciplinary research approaches to coproduce knowledge and inform policy. In the first strategy, research evidence was directly taken up by international stakeholders as they were actively seeking new evidence on a very specific topic to up-date international guidelines. In the second strategy, examples from two r4d projects show that collaboration with stakeholders from early on in the projects increased the likelihood of translating research into policy, but that the latter was more effective in a supportive and stable policy environment. The third strategy adopted by two other r4d projects demonstrates the benefits of promoting colearning as a way to address potential power dynamics and working effectively across the local policy landscape through robust research partnerships.

Conclusions

This paper provides insights into the different strategies that facilitate collaboration and communication between stakeholders, including policy-makers, and researchers. However, it remains necessary to increase our understanding of the interests and motivations of the different actors involved in the process of influencing policy, identify clear policy-influencing objectives and provide more institutional support to engage in this complex and time-intensive process.

Health Studies in the Context of Artisanal and Small-Scale Mining: A Scoping Review

Artisanal and small-scale mining (ASM) is an important livelihood activity in many low- and middle-income countries. It is widely acknowledged that there are a myriad of health risk and opportunities associated with ASM. However, little is known with regard to which aspects of health have been studied in ASM settings. We conducted a scoping review of peer-reviewed publications, using readily available electronic databases (i.e., PubMed, Scopus, and Web of Science) from inception to 14 July 2020. Relevant information was synthesized with an emphasis on human and environmental exposures and health effects in a context of ASM. Our search yielded 2764 records. After systematic screening, 176 health studies from 38 countries were retained for final analysis. Most of the studies (n = 155) focused on health in ASM extracting gold. While many of the studies included the collection of environmental and human samples (n = 154), only few (n = 30) investigated infectious diseases. Little attention was given to vulnerable groups, such as women of reproductive age and children. Our scoping review provides a detailed characterisation of health studies in ASM contexts. Future research in ASM settings should address health more comprehensively, including the potential spread of infectious diseases, and effects on mental health and well-being.

Inclusion of Health in Impact Assessment: A Review of Current Practice in Sub-Saharan Africa

Natural resource extraction projects, including those in the mining sector, have various effects on human health and wellbeing, with communities in resource-rich areas in sub-Saharan Africa (SSA) being particularly vulnerable. While impact assessments (IA) can predict and mitigate negative effects, it is unclear whether and to what extent health aspects are included in current IA practice in SSA. For collecting IA reports, we contacted 569 mining projects and 35 ministries regulating the mining sector. The reports obtained were complemented by reports identified in prior research. The examination of the final sample of 44 IA reports revealed a heavy focus on environmental health determinants and included health outcomes were often limited to a few aspects, such as HIV, malaria and injuries. The miniscule yield of reports (1.6% of contacted projects) and the low response rate by the contacted mining companies (18%) might indicate a lack of transparency in the IA process of the mining sector in SSA. To address the shortcomings identified, policies regulating IA practice should strengthen the requirements for public disclosure of IA reports and promote a more comprehensive inclusion of health in IA, be it through stand-alone health impact assessment or more rigorous integration of health in other forms of IA.