Baobab Iron-Ore Project, Tete Province, Mozambique
Community Health Impact Assessment Report
Project Number: COA2014
Prepared for: Baobab Resources Plc
______Digby Wells and Associates (International) Limited (Subsidiary of Digby Wells & Associates (Pty) Ltd). Co. Reg. No. 07264148. Henwood House, Henwood, Ashford, Kent, TN24 8DH, United Kingdom Tel: +44 123 363 1062, Fax: +44 123 361 9270, [email protected], www.digbywells.com ______Directors: AR Wilke (South African), AJ Reynolds, GE Trusler (C.E.O) (South African) ______
This document has been prepared by Digby Wells Environmental.
Report Type: Community Health Impact Assessment Report
Project Name: Baobab Iron-Ore Project, Tete Province, Mozambique
Project Code: COA2014
Name Responsibility Signature Date
Vumile Dlamini Report Writer V. Dlamini May 2015
Natasha Taylor- 1st Review May 2015 Meyer
Jan Perold 2nd Review March 2015
This report is provided solely for the purposes set out in it and may not, in whole or in part, be used for any other purpose without Digby Wells Environmental prior written consent.
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EXECUTIVE SUMMARY
Capitol Resources Limitada (Capitol Resources), a wholly owned subsidiary of Baobab Resources Plc (Baobab) - a Mozambique-focused iron ore, base and precious metal explorer, is proposing to develop the Tete Iron Ore Project located north of the provincial capital of Tete, in the Chiúta and Moatize districts of Mozambique. The concession, covering exploration licence areas 1032L, 1034L and 1035L is being explored and managed by Capitol Resources Limitada (CRL); a 100% owned subsidiary company of Baobab. The Tete Pig Iron Ore and Ferro-Vanadium Project (Project) is focused on the Tenge Hill deposit located approximately 80 kilometers northeast of the town Tete, Tete Province, on the banks of the Revuboe River. HEALTH IMPACT ASSESSMENT METHODOLOGY A Health Impact Assessment (HIA) is a practical, multi-disciplinary process, combining a range of qualitative and quantitative evidence in a decision-making framework. An HIA seeks to identify and estimate the lasting or significant changes of different actions IFC Performance Standard 4 “Community Health, Safety and Security” on the health status of a defined population. The methodology of this “The client will evaluate the risks and impacts to the health and safety of the Affected Communities during project life-cycle and HIA was based on the Good Practice will establish preventive and control measures consistent with Note (GPN) for HIAs as supported by Good International Industry Practice (GIIP), such as in the World the International Finance Corporation Bank Group Environmental, Health and Safety Guidelines (EHS Guidelines) or other internationally recognised sources. The (IFC). The IFC has published a set of client will identify risks and impacts and propose mitigation Performance Standards (PS) for large measures that are commensurate with their nature and projects that will require international magnitude. These measures will favour the prevention or avoidance of risks and impacts over minimization.” funding. PS4 which deals specifically with Community Health, Safety and Security, recognises that project activities result in both positive and negative impacts to communities. The GPN has been developed specifically to provide guidance on community health for this Standard. The HIA was supported by a systematic and consistent approach to collecting and analysing baseline health data through the Environmental Health Areas (EHA) framework. Twelve different EHAs are described, which provide a linkage between project-related activities and potential positive or negative community-level impacts. This incorporates a variety of biomedical and key social determinants of health. Through this integrated analysis, cross- cutting environmental and social conditions that contain significant health components are identified instead of focusing primarily on disease-specific. Specific Potentially Project Affected Communities (PACs) and health impacts related to different activities of the Project have been described.
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COMMUNITY HEALTH IMPACT ASSESSMENT ACTIVITIES The specific activities of the community HIA (cHIA) included: ■ A desktop literature review outlining the host country and community health profile; ■ Collecting primary data by participatory means with the use of semi-structured questionnaires and key informant interviews with relevant stakeholders; ■ Collecting additional secondary information that was not available in the public domain that is available in published and grey data; ■ Understanding proposed Project designs, present and planned work activities, project schedule and location of PACs; ■ Considering the potential future health impact that the proposed Project will have on the health of the respective communities; ■ Determining the existing health needs of the community based on health strategies, infrastructure, programs, service priorities, delivery plans and challenges; and ■ Developing evidence-based recommendations to avoid/mitigate negative and enhance positive impacts resulting from the proposed Project at the relevant project stage. The field work was performed by cHIA specialists from Digby Wells. The desktop work was completed in May 2014. The field work took place from the 30th June to 5th of July 2014. A broad range of stakeholders was consulted. Key informant interviews were conducted with district health authorities and medical personnel at the local health facilities and hospitals. Focus Group Discussions (FGDs) were held in eight communities that are in close proximity to the proposed Project including; ■ Cacoma; ■ Chianga; ■ Massamba; ■ Matacale; ■ Mbuzi; ■ Muchena; ■ Nhambia; and ■ Tenge KEY FINDINGS AND RECOMMENDATIONS Access to the Healthcare facilities is a challenge for the communities in the proposed Project area as many reside approximately a six hour walking distance from a healthcare facility and
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have to rely on public or private transport to access care. Emergency services are non- existent. Services are not free, substantiated by 100% of respondents claiming to have to pay for medical services. The communities have a relatively high dependency ratio1 due to the high levels of poverty and unemployment. In terms of Healthcare services and infrastructure, the proposed Tenge Project (Project) induced impacts need to be considered in two tangents. One, being a positive impact whereby there is the potential for the proposed Project to support the development of improved health services through direct and indirect interventions; and the second, being a negative impact whereby the proposed Project may stretch the already burdened capacity of the Healthcare services in the Project Region and communities in the vicinity of the proposed Project area. Malaria is a major public health challenge in the Project area and is regarded as the biggest concern related to burden of disease. It accounts for a significant portion of medical consultations (both clinics and hospitals) at the local level. Community knowledge on transmission and prevention of malaria is good. Ownership of insecticide-treated nets is good, although it is difficult to assess proper utilisation. Ninety four percent (94%) of Chiúta household respondents declared that they sleep under a mosquito net, this decreases to 66% of Moatize households. Over one third of Moatize households (37%) do not sleep under a mosquito net. There are very few interventions in the area to reduce the burden of disease from malaria. Although water is available throughout the year (during both wet and dry seasons), there is generally poor access to drinking water sources. There are two boreholes serving the communities in the project area, and 5 to 6 boreholes serving the project concession area alone. Thus, untreated water sources such as rain, rivers/streams, open-air wells, and hand dug wells supply water to a considerable portion of the population in the project area. There are very few improved sanitation facilities such as ventilated improved pit latrines (VIP) within the communities. The vast majority of households throughout the villages do not have access to their own improved sanitation facility and resort mainly to traditional pit latrines (more common) or open-air defecation (less common). Diarrhoeal diseases are common. The spontaneous migration and settlement of job seekers and their families into the proposed Project area can be expected, and this may have specific health impact implications for the receiving communities, as well as the in-migrants. These include:
1 A measure showing the number of dependents (aged 0-14 and over the age of 65) to the total population (aged 15-64). This indicator gives insight into the amount of people of non-working age compared to the number of those of working age. A high ratio means those of working age - and the overall economy - face a greater burden in supporting the ageing/ elderly population.
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■ Increased use of and demand for already inadequate community housing, water, sanitation, food, and medical services can mean that health needs go unmet and new health challenges arise (with a likely increase in cost); and ■ The potential for an increase in accidents and injuries due to changes in road traffic, may significantly and adversely affect levels of accidents in the area. There is the possible impact due to increased demand on limited services and an increased potential for environmental contamination. Baobab could support local authorities with sanitation programs in PACs. The proposed Project may lead to increased traffic loads on primary and access roads and has thus the potential to increase the number of traffic accidents. This can be abated through improving road safety by collaborating with the district road-safety unit to establish and maintain pictorial road-safety signage near the site in local language (Portuguese) and English language (if needed); clearly demarcated pedestrian crossings in appropriate places etc. This could be achieved by establishing and implementing a Traffic Management Plan. With regards to the social determinant of health, the expected influx of people and increased income may result in illegal substances being available more freely. It is difficult to speculate whether the prevalence of tobacco smoking and or substance abuse may increase due to the presence of the proposed Project. However, it is possible that it may increase as there may be an increase in the number of young people with more than adequate incomes, who will be in a position to afford these commodities. Baobab may be in a position to conduct substance-abuse prevention education programs in the workplace and within the already affected (by alcohol) communities. When discussing the exposure of people to potentially hazardous materials, noise and malodours, one needs to be cognisant of the in-migration of people. An influx of people into the proposed Project area may increase domestic activities, including the use of domestic fuels. This may result in an increase in air pollution exposure, followed by associated increases in the prevalence of related respiratory illnesses. The clearing of the site (construction phase) and vehicular movement are the main activities and may have potential impacts on the ambient noise levels. Increased activity of vehicles and heavy machinery may also have some contribution to the increased local noise levels on surrounding farmers. There is sufficient evidence that noise causes adverse health effects such as cardiovascular effects.
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TABLE OF CONTENTS
1 Introduction ...... 1
1.1 Project Location...... 1 2 Project Description ...... 2
2.1 Key Operational Aspects of the Proposed Project ...... 2 2.1.1 Proposed Activities ...... 2 2.2 Site Access ...... 3 2.3 Associated Infrastructure ...... 3 3 Legal, Administrative, and Legislative Framework ...... 4
3.1 Mozambican Legislation ...... 4 3.1.1 Constitutional Requirements for Environmental Protection in Mozambique ...... 5 3.2 International Conventions ...... 6 3.3 International Management Standards ...... 7 3.4 Company Management Standards ...... 7 4 Methodology...... 7
4.1 Introduction and Definition ...... 8 4.2 Determining the scale of the HIA ...... 8 4.3 Definition of the Study Area ...... 11 4.4 Literature review ...... 12 4.5 Questionnaire Design ...... 12 4.6 Fieldwork ...... 12 4.6.1 Interviews ...... 13 4.6.2 Focus groups ...... 14 4.6.3 Detailed Household Surveys ...... 15
4.6.4 H2S Strip Test ...... 15 4.7 Impact Categorisation: Environmental Health Areas (EHAs) Framework ...... 16 4.8 Impact Assessment ...... 18 4.8.1 Key Issues and Related Health Impacts ...... 18
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4.8.2 Impact Assessment Methodology ...... 18 4.8.2.1 Prioritising ...... 19 4.8.3 Impact Analysis, Mitigation and Enhancement ...... 22 4.9 Data Gaps and Limitations of the cHIA Study ...... 22 5 Baseline Community Health Profile ...... 22
5.1 General Health Profile: Country and Province Specific ...... 22 5.1.1 Health Infrastructure ...... 22 5.1.2 Health Personnel ...... 23 5.1.3 The Presence of Non-Governmental Organisations in Tete ...... 24 5.1.4 Contraception and Family Planning ...... 27 5.1.5 Maternal Health and Child Mortality ...... 27 5.1.6 Domestic Violence ...... 28 5.1.7 Guinea Worm ...... 29 5.1.8 Sexually Transmitted Infections and HIV/AIDS ...... 30 5.1.9 Knowledge, Attitudes and Behaviour In Relation to HIV/AIDS ...... 30 5.1.10 Malnutrition in Children ...... 32 5.1.11 Malaria ...... 33 5.1.12 Pre-natal Care ...... 33 5.1.13 Tuberculosis ...... 33 5.2 Baseline Health Status (Local Level) ...... 34 5.2.1 EHA #1 Vector-Related Diseases ...... 35 5.2.1.1 Malaria ...... 35 5.2.2 EHA #2 Communicable Diseases Linked To Housing Design...... 35 5.2.3 EHA #5 Soil-, Water- and Waste-Related Diseases ...... 35 5.2.4 EHA #6 Food- and Nutrition-Related Issues ...... 39 5.2.5 EHA #7 Accidents/Injuries ...... 40 5.2.6 EHA #8 Exposure to Potentially Hazardous Materials, Noise and Malodours . 41 5.2.7 EHA #9 Social Determinants of Health ...... 41 5.2.7.1 Employment ...... 41
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5.2.7.2 Changes in Income and Expenditure ...... 41 5.2.7.3 Education ...... 42 5.2.7.4 Gender-based Violence, Alcohol and Drugs ...... 42 5.2.8 EHA #10 Cultural Health Practices ...... 42 5.2.9 EHA #11 Health Systems Issues ...... 43 5.2.9.1 Maternal and Child Health ...... 45 6 Impact Assessment ...... 45
6.1.1 EHA #1 Vector-Related Diseases ...... 45 6.1.2 EHA #5 Soil, Water and Waste Related Diseases ...... 47 6.1.3 EHA #6 Food- and Nutrition-Related Issues ...... 48 6.1.3.1 Malnutrition ...... Error! Bookmark not defined. 6.1.4 EHA #7 Accidents/Injuries ...... 50 6.1.5 EHA #8 Exposure to Potentially Hazardous Materials, Noise and Malodours . 51 6.1.5.1 Solid Waste (General and Hazardous) ...... 51 6.1.5.2 Disposal of Waste Rock and Tailings ...... 52 6.1.5.3 Pollution of Soil and Water Resources ...... 52 6.1.6 EHA #9 Social Determinants of Health ...... 54 6.1.6.1 Gender-based Violence and Substance Abuse ...... 54 6.1.6.2 Employment and Influx Management ...... 55 7 Conclusion ...... 45
8 References ...... 58
LIST OF FIGURES
Figure 4-1: Selecting an HIA type ...... 10 Figure 4-2: Women gathered for FGD at Tenge village ...... 15 Figure 5-1: A hand dug well in Chianga village...... 36 Figure 5-2: Water pump at Massamba village ...... 37 Figure 5-3: Water pump at Matacale village ...... 38
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Figure 5-4: Women carrying out domestic chores by the river at Tenge village ...... 39 Figure 5-5: Muchena Clinic ...... 44 Figure 5-6: Beds at Kazula clinic ...... 44 Figure 5-7: A broken down Chiuta District Hospital van ...... 45
LIST OF TABLES
Table 4-1: Levels of HIA (IFC, 2009) ...... 10 Table 4-2: Environmental Health Areas ...... 17 Table 4-3: Ranking of Evaluation Criteria ...... 19 Table 4-4: Matrix used to determine the overall significance of the impact based on the likelihood and effect of the impact...... 20 Table 4-5: Description of Environmental Significance Ratings and associated range of scores ...... 21 Table 5-1: NGO presence in Tete ...... 24 Table 5-2: Water test results ...... 38
LIST OF APPENDICES
Appendix A: Plans Appendix B: FGD Questionnaires Appendix C: Key Informant Interview Questionnaire Appendix D: Directorate Interview Questionnaire
LIST OF PLANS
Plan 1: Project Area Plan 2: Site Layout Plan 3: H2S Strip Test Sampling Locations
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ACRONYMS TABLE
ACT Artemisinin-based Combination Therapy AIDS Acquired Immunodeficiency Syndrome ART Anti-retroviral Treatment CES Coastal and Environmental Services cHIA Community Heath Impact Assessment CHMP Community Health Management Plan DALY Disability Adjusted Life Years DOTS Directly Observed Treatment Strategy EHA Environmental Health Area EIA Environmental Impact Assessment ESHIA Environmental, Social and Health Impact Assessment FGD Focus Group Discussion GWD Guinea Worm Disease HIA Health Impact Assessment HIV Human Immunodeficiency Vius HMP Health Monitoring Plan IFC International Finance Corporation INSIDA Inquérito Demográfico e de Saúde (Mozambique HIV/AIDS Indicator Survey) INH Isoniazid
IPTp Intermittent Preventive Treatment of Malaria in Pregnancy ITN Insecticide-treated BedNet IWMI International Water Management Institute KAP Knowledge, Attitude and Practices KII Key Informant Interview KPI Key Performance Indicator KS Kaposi’s sarcoma LLIN Long Lasting Impregnated BedNet M&E Monitoring and evaluation MDG Millennium Development Goal MDHS Mozambique Demographic and Health Survey
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MDR Multidrug Resistant MICS Mozambique Multiple Indicator Cluster Survey MMR Maternal Mortality Rate MoH Ministry of Health MSF Medecins Sans Frontieres MTILD mosquito insecticide treated long term NCD Non-Communicable Disease NGO Non-Governmental Organization NTD Neglected Tropical Disease PAC Project Affected Community PHC Primary Health Care PS Performance Standard SIA Social Impact Assessment STI Sexually Transmitted Infection TB Tuberculosis ToR Terms of Reference TSF Tailings Storage Facility UNAIDS Joint United Nations Programme on HIV/AIDS UNICEF United Nations Children’s Fund USAID United States Agency for International Development WHO World Health Organization
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1 Introduction EOH Coastal & Environmental Services (hereafter CES) has been commissioned by Capitol Resources Limitada (Capitol Resources), a wholly owned subsidiary of Baobab Resources Plc (Baobab) to conduct an Environmental Impact Assessment (EIA) for the proposed Tenge Iron Ore Project (Project) in the Tete Province of Mozambique. Digby Wells Environmental has been contracted to conduct a community Health Impact Assessment (cHIA) for the aforementioned Project; this assessment constitutes one of a suite of specialist studies undertaken in support of the EIA. The objective of the cHIA is to assess the potential impacts of the proposed Project on the health and physical well-being neighbouring communities. It also proposed measures to mitigate negative health impacts and enhance positive ones. This document presents the results of the community Health Impact Assessment (cHIA) for the proposed Project north of the provincial capital of Tete, in the Chiúta and Moatize districts in Mozambique. The objective of the cHIA is to assess the potential human health impacts associated with the proposed Project on neighbouring communities, through the evaluation of various determinants of health, including those identified in the various specialist studies undertaken for the project that are of relevance to the cHIA findings.
1.1 Project Location Mozambique is located on the east coast of southern Africa. It covers an area of 799,380 km2, with a coastline approximately 2,515km long. Mozambique shares extensive borders, on the west with South Africa, Swaziland, Zimbabwe, Zambia and Malawi, and on the north with Tanzania. The Tete Province is located in the extreme northwest of the country, and is bordered by three (3) countries with a total length of 1480km, including the Republic of Malawi (610km), the Republic of Zambia (420km) and the Republic of Zimbabwe (450km). The Capital of the Tete Province is Tete City. Tete City has thirteen (13) districts - including the Tete City, which are: In the north of the Zambezi River: Angónia, Moatize, Mutarara Tsangano, Zumbu, Chifunde, Chiúta, Macanga, Marávia, and in the south of the Zambezi River: Cahora Bassa, Changara, Mágoè and Tete City. Tete City has thirty four (34) administrative posts and three municipalities (Tete City, Moatize and Villages Ulónguè). The proposed Project is located north of the provincial capital of Tete, in the Chiúta and Moatize districts. The Project extends over one licence area –1035L – all of which is 100% owned by Capitol Resources. The concession, covering exploration licence area 1035L is being explored and managed by Capitol Resources Limitada (CRL); a 100% owned subsidiary company of Baobab. The proposed Project is focused on the Tenge Hill deposit located approximately 80 kilometres (km) northeast of the town Tete, Tete Province, Mozambique. The project area is located on the banks of the Revuboe River (Appendix A, Plan 1).
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The mining operation will include an open cast mine at Tenge Hill, waste rock and slag dumps, a processing plant, a tailings storage facility (TSF) and office and accommodation facilities (Appendix A, Plan 2).
2 Project Description The Project area is located on the banks of the Revuboe River (Appendix A, Plan 1). The mining operation will include an open cast mine at Tenge Hill, waste rock and slag dumps, a processing plant, a tailings storage facility (TSF) and office and accommodation facilities (Appendix A, Plan 2).
2.1 Key Operational Aspects of the Proposed Project
2.1.1 Proposed Activities The proposed Project will be in operation for approximately 21 to 36 years (depending on the mining scenario to be followed). Project activities will include, in which mining will comprise the following stages: ■ Clearing existing vegetation; ■ Removing and stockpiling topsoil; ■ Drilling and blasting 10m – 15 m deep open pits; ■ Excavating rocks with front-end loaders; ■ Transferring the rocks to the crusher plant; ■ Screening the material from the crusher; ■ Crushing and screening the material three times; ■ Disposal of the waste rock from the screening process; ■ Separating the material into iron–ore product and tailings, using dry magnetic cobbing; ■ Disposal of the tailings; ■ Pre-reduction classification of the product (either dry or dry-wet process); ■ Production of pig iron and by-products (titanium as well as vanadium slag), using a melting furnace; and ■ Rehabilitation of the site From the mine, the product will be transported along a dedicated haul road to an as-yet- undetermined location adjacent to the railway line linking Moatize and Sena. At time of writing (May 2014), an access corridor has been identified and marked, although its position may change slightly as more information becomes available. Factors considered in identifying this access corridor to date have been the following:
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■ The position of villages and farms; ■ A suitable point for crossing the Ncondezi river; ■ The tenements of other miners and positioning of their infrastructure; ■ Engineering requirements such as slopes and soils. The haul road will be 20 meters wide (and may one day include a railway), and will run within the area defined as the “access corridor”. Also within the access corridor will be a 220 kV power line. During the construction phase, it has been recommended (Coffey Mining, 2013) that this road remain as gravel. In the operations phase it will be upgraded to asphalt. This is to prevent the asphalt road being damaged during the construction phase.
2.2 Site Access Approximately 6 km of gravel roads suitable for mining operations will be required to service the mine area. These roads would be constructed during the dry season above the existing levels to ensure road stability during the wet season. Access to, and transport of product from, the mine site will be via road and possibly rail in the future. The access road, rail line and powerline infrastructure will likely follow a single corridor, approximately 50 m wide. Three alignment options are under consideration. Route Options 1 and 2 run from the east of the mine site to national road EN103 and the Sena Railway, east of Moatize. Route Option 3 generally runs from the west of the mine site along sections of the EN459 track and the national roads EN222 and EN221. From Moatize (or a new rail siding to the east), product will be transported to the ports of Beira and Nacala for export to the international market. For the purpose of this Project, Route Option 3 has been assessed.
2.3 Associated Infrastructure Large projects such as this one will generally build a significant number of physical structures that can impact the overall human environment. The proposed Project infrastructure includes: ■ The Waste Rock Dump (WRD) and Open Pit; ■ The Tailings Storage Facility (TSF) and Slag dump; and ■ The stockpiles and Plant area. In addition to these, the proposed Project may also construct temporary and permanent housing, sewage-treatment plants, catering facilities, maintenance yards, and a variety of administrative and management office buildings. In addition, containment ponds known as environmental-control dams are often constructed due to the need to capture sediments and surface-water runoff. All of these structures can potentially impact, positively or negatively,
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on local communities. Careful analysis of distinct facilities is important so that primary design changes can be made to efficiently and cost-effectively abate negative impacts. A camp will provide accommodation and other facilities for employees including all plant operators, maintenance, logistics and management personnel. Fuel storage facilities, parking and repair facilities for the mining vehicles and machinery as well as laydown areas will also need to be constructed. Large volumes of steel and concrete will be required for the construction of the processing plant, smelter and other infrastructure at the mine. The exact volumes have not yet been determined. Coal to be used in the beneficiation and pig iron production plants is likely to be obtained from the coal mines neighbouring the 1035 L licence area. Water will either be extracted from the Ncondezi River, Revuboe River or from ground water and is likely to require treatment. Exact volumes have not yet been determined.
3 Legal, Administrative, and Legislative Framework
3.1 Mozambican Legislation The Mozambican government has obligations under its national constitution and international human rights law to protect a range of rights, including to food, water, work, housing, and health. These obligations require the government to avoid any deliberate retrogressive measures that interfere with the enjoyment of these rights and to take measures to promote their progressive realization. This means coordinating management of extractive industries with national poverty reduction strategies, strengthening protections for people negatively affected by mining projects, and providing fair, appropriate remedies for them. Private companies, such as Baobab, are required to respect these rights by conducting due diligence studies to prevent human rights abuses through their operations, and mitigating them if they occur. The Mozambican legal system is based on the Romano-Germanic tradition of the civil law. It is directly inherited from Portugal. At independence, all Portuguese laws not inconsistent with the new constitution were retained and remain in force. Much background law from that period including, for example, the civil code and the civil procedure code (much of it dating from the mid-20th century) remains little modified. In the rest of this Section, and unless otherwise noted, “laws” refers to acts of parliament, “decrees” and “resolutions” to acts of the Council of Ministers which, in constitutional terms, is the Government of Mozambique, and “rulings” or “ministerial rulings” to the acts of a single ministry or of ministries jointly. No specific references were found that legally require the assessment of community health or the use of Health Impact Assessment (HIA) as a requirement for mining project developments in Mozambique. However, the Constitution of the Republic of Mozambique (2004) addresses matters relating to the environment and quality of life in Articles 45, 81, 90,
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98, 102 and 117. Article 90 (Economic, social and cultural rights and duties) of Title III (Fundamental rights, duties and liberties), gives the people of Mozambique the right to live in a balanced environment. Moreover, Article 102 specifies that the state shall determine how natural resources may be exploited so that both human wellbeing and national interests are safeguarded. The Mozambican health and mining laws were assessed during the HIA process. The requirement and nature of health care support provided to the community was also determined. This also included the health provided to the workforce, as some households might have a member who is employed by Syrah Resources. The following Mozambican laws were relevant to the HIA process (The World Law Guide, 2013):
■ The Labour Law (Law 23/07 of August 1, 2007) discusses health and safety requirements and actions;
■ The Law on HIV/SIDA (Law 5 of 2002) discusses, among other things, pre-employment HIV testing and dismissal based on HIV status. It also requires that employers provide employees with HIV education and advice;
■ Technical Safety and Health Regulations for Mining and Geological Activities (Decree no 61/2006 of 26 December);
■ Regulation on Biomedical Residues Decree no 8 /2003 of 18 February;
■ Regulation on Environmental Quality Standards and Effluent Emission (Decree No. 18/2004 of 2 June); and
■ Standards and Regulations of Mozambique National Drinking Water issued by the Ministry of Health.
3.1.1 Constitutional Requirements for Environmental Protection in Mozambique The Constitution of the Republic of Mozambique (2004) addresses matters relating to the environment and quality of life in Articles 45, 81, 90, 98, 102 and 117. Article 90, which is part of Chapter V (Economic, social and cultural rights and duties) of Title III (Fundamental rights, duties and liberties), gives the people of Mozambique the right to live in a balanced environment. It commits ‘the State and local authorities, in collaboration with other appropriate partners, to adopt policies for the protection of the environment and care for the rational utilisation of all natural resources’. Article 98 deals with state property and the public domain, and establishes that ‘natural resources situated in the soil and in the subsoil, in internal waters, in the sea, on the
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continental shelf, and in the exclusive economic zone are the property of the State’. In paragraph 2 of the same Article, items constituting the public domain of the state are listed, some of them being (a) the maritime zone; (d) zones of nature protection; and (e) water and naturally occurring minerals. Article 102 specifies that the state shall determine how natural resources may be exploited so that both human wellbeing and national interests are safeguarded. Article 117 of the Constitution goes further by stipulating that the state is responsible for promoting initiatives that ensure ecological balance and the conservation of the environment for improving the quality of life of the citizens (paragraph 1). According to paragraph two of this article, the State shall adopt policies aiming at: a) Preventing and controlling pollution and erosion; b) Integrate the environment objectives in sector policies; c) Promoting the integration of environmental values in educational policies and programmes; d) Ensuring the rational utilisation of natural resources within their capacity to regenerate and bearing mind the rights of future generations. Articles 45(f) and 81(2b) place an obligation on communities to protect their environment and allow for class action relating to environmental issues.
3.2 International Conventions Mozambique is a signatory to various international conventions that will be applicable to the project and may be seen to provide additional direction in the absence or limitation of local legislation or policy. Those relevant for the health components include the following: ■ The United Nations Declaration on Rights of the Indigenous Peoples. ■ Stockholm Convention on Persistent Organic Pollutants. ■ International Health Regulations as promulgated by the World Health Organization. ■ Basel Convention on the control of trans-boundary movements of hazardous wastes and their disposal; and ■ United Nations Agencies including: . United Nations Environmental Program; . International Health Regulations as promulgated by the World Health Organization; and . United Nations Development Program. Global and Inclusive Agreement 2002.
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3.3 International Management Standards There are a number of international guidelines or best practice guidelines that refer to community health in development or industrial projects. The World Bank Group’s standards and norms, in particular those developed by its private sector arm, the International Finance Corporation (IFC), are generally considered as the benchmark. The IFC has published a set of Performance Standards for large projects that will require international funding. Performance Standard 4 (PS4): Community Health, Safety and Security, recognises that project activities result in both positive and negative impacts to communities (IFC, 2012). The objectives of this PS4 are: ■ To avoid or minimise risks to and impacts on the health and safety of the local community during the project life cycle from both routine and non-routine circumstances; and ■ To ensure that the safeguarding of personnel and property is carried out in a legitimate manner that avoids or minimises risks to the community’s safety and security. IFC Performance Standard 4 “Community Health, Safety and Security” states that: “The client will evaluate the risks and impacts to the health and safety of the Affected Communities during project life-cycle and will establish preventive and control measures consistent with Good International Industry Practice (GIIP), such as in the World Bank Group Environmental, Health and Safety Guidelines (EHS Guidelines) or other internationally recognised sources. The client will identify risks and impacts and propose mitigation measures that are commensurate with their nature and magnitude. These measures will favour the prevention or avoidance of risks and impacts over minimization.” In addition to being considered the benchmark standards for major projects, the IFC’s Performance Standards are applicable to projects seeking financing from either the IFC or other Equator Principles funding institutions.
3.4 Company Management Standards Baobab does not have a specific management standard that addresses community health or supports the use of HIA as a tool. However, the company’s Occupational Health & Safety Corporate Policy addresses the health and wellbeing of its employees, contractors and visitors in all areas of the company’s activities.
4 Methodology Activities undertaken during this assessment are outlined below. ■ Impact assessment process which will: . Consider the potential future health impacts that the proposed Project will have on the health of these respective communities;
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. Determine the existing health needs of the community based on health strategies, infrastructure, programmes, service priorities, delivery plans and challenges; . Based on the existing evidence rank the likelihood and consequence of difference health impacts to outline their significance and prioritisation for mitigation. A confidence ranking will be applied based on the available evidence; and . Develop evidence-based recommendations to avoid/mitigate negative, and enhance positive, impacts resulting from the project at the relevant project stage.
4.1 Introduction and Definition A Health Impact Assessment (HIA) is a practical, multi-disciplinary process, combining a range of qualitative and quantitative evidence in a decision-making framework. An HIA seeks to identify and estimate the lasting or significant changes of different actions on the health status of a defined population (Winkler et al., 2010). HIA may be defined as “a combination of procedures, methods and tools by which a project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population”. The objective of an HIA is to deliver evidence-based recommendations to maximize potential positive health benefits and prevent or mitigate any detrimental health impacts that a project may have on the potentially affected communities (PAC) (WHO/ECHP, 1999, IAIA, 2006). The World Health Organisation (WHO) defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. This is influenced through complex interaction of social, economic, genetic, and environmental factors (WHO, 2010c). The ultimate deliverable of an HIA is a community Health Management Plan (cHMP) (Winkler et al., 2011). This plan would be based on evidence and stakeholder input, prioritised according to impacts and needs, and having clear indicators to monitor and evaluate project impacts and programs. The cHMP will also facilitate the development of social development programs linked to health. The holistic model of health used in the HIA process acknowledges that the health status of a population is affected by factors known as health determinants (e.g. education, income level, health services, etc.). All of these are closely interlinked and differentials in their distribution lead to health inequalities. These include both biophysical and social determinants of health as well, and not just purely health outcomes. The methodology allows HIA practitioners to consider how a project affects these determinants of health, as well as health outcomes.
4.2 Determining the scale of the HIA The level or scale of a cHIA depends on the complexity of the project, the magnitude of expected impacts, as well as the project phase during which the cHIA is undertaken. Various levels of cHIA are defined in Table 4-1 below (IFC, 2009).
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When gathering new field data for the HIA, the project will encounter different levels of effort and needs. The key descriptive terms for these cases— “comprehensive” and “rapid appraisal”—indicate the different depths of analysis and consultation required, and whether the performance of the HIA involves collecting new field data. In Figure 4-1, the ‘potential health impact’ axis considers health issues in the proposed project location, such as: ■ Hazardous materials exposure—how the facility will operate, and what the potential exposures are to physical, biological, and chemical agents; ■ Resettlement or relocation—moving communities or providing compensation for relocation; ■ Endemic disease profile—malaria, dengue, ■ HIV/AIDS, tuberculosis, schistosomiasis, etc.; ■ Health systems and infrastructure—poor or nonexistent health infrastructures; and ■ Stakeholder concerns—critical community issues, such as water quality or access, increased road traffic and accidents The ‘social sensitivity’ axis covers a broad range of issues, many of which are typically addressed within the social analysis of the potentially affected communities (for example, conflict, resettlement, political factors, vulnerable communities, human rights, and equity concerns). The vulnerable status includes factors such as gender, ethnicity, culture, sickness, physical or mental disability, poverty or economic disadvantage, and dependence on unique natural resources (ibid.).
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Figure 4-1: Selecting an HIA type Since the proposed Project is a large, complex project, and a significant influx of persons is expected, a comprehensive HIA was deemed necessary. An essential element of the comprehensive HIA is the need for some type of new data collection in potentially affected communities, and for helping to predict changes in health determinants, the associated risks, and health outcomes. A comprehensive HIA includes screening, scoping, stakeholder consultation, risk assessment, appraisal, implementation and monitoring, and verification. Stakeholder communication and consultation should take place at all stages—from screening through implementation and monitoring (IFC, 2009). The activities undertaken in the comprehensive HIA are highlighted in Table 4-1. Table 4-1: Levels of HIA (IFC, 2009)
Level of HIA Characteristics
Provides a broad overview of possible health impacts; Desktop HIA Analysis of existing and accessible data; No new project specific survey data collection.
Provides more detailed information of possible health impacts; Scoping/Rapid Appraisal HIA Analysis of existing data;
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Stakeholder and key informant analysis; and No new project-specific survey data collection.
Provides a comprehensive assessment of potential health impacts; Robust definition of impacts; Comprehensive HIA New project specific survey data collection; and Participatory approaches involving stakeholders and key informants.
4.3 Definition of the Study Area To identify and quantify potential community health impacts an accurate population profile is needed and it is important to distinguish between differences in exposure and susceptibility of these communities. Thus, besides a demographic profile of the at-risk population and the identification of the most vulnerable groups –identified through the stratification of Project Affected Communities (PACs) –it is crucial to understand how the development, construction and operation activities are likely to impact at both a household and community level (Mindell, 2001). Impacts caused by resettlement, shifts in the social structures, or influx triggered increases in population density are considered within the overall social and health assessments. The relevant overall population is divided into Project Affected Communities (PACs). A PAC is a defined community within a clear geographical boundary where project-related health impacts may reasonably be expected to occur. As mentioned, the Project area overlaps over two neighbouring districts, namely Chiúta and Moatize. Eight PACs were identified within the Project area. Two of these (Mboza and Tenge-Makodwe) are located in Moatize district, and six (Nhambia, Mbuzi, Muchena, Chianga, Matacale and Massamba) are located in Chiúta district. Description and assessment of impacts on the PACs was conducted against the backdrop of the following nested contexts: ■ Country Specific. For the purpose of this Report, the term “country specific” refers to Mozambique, as country –national information. ■ Project Region. For the purpose of this Report, the term “project region” refers to the two neighbouring districts which the proposed Project encompasses, namely Chiúta and Moatize. ■ Local Level. For the purpose of this Report, the term “local level” refers to the eight main villages or communities consulted, of which two are located in Moatize district (Mboza and Tenge-Makodwe) and the remaining six are located in Chiúta district (Nhambia, Mbuzi, Muchena, Chianga, Matacale and Massamba) (Appendix A, Plan 1).
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■ Project Area. The “Project area” is the geographic area where the mining operation will be developed. This will include an open cast mine at Tenge Hill, waste rock and slag dumps, a processing plant, a tailings storage facility (TSF) and office and accommodation facilities (Appendix A, Plan 2).
4.4 Literature review A desktop literature review was undertaken in order to: ■ Outline the country and community health profile from a desktop perspective including a literature review; and ■ Review the findings of other specialist studies undertaken as part of the overall EIA, in order to identify biophysical or socio-economic impacts of the proposed Project that may have indirect community health implications or effects. Some core documents were consulted in the literature review. These included (i) the preliminary report of the 2011 Mozambique Demographic and Health Survey (MDHS) (Instituto Nacional de Estatística (INE) et al., 2012); (ii) the 2009 Mozambique HIV/AIDS Indicator Survey (INSIDA) (Instituto Nacional de Saúde (INS) et al., 2010); (iii) the 2013 Moçambique Inquérito Demográfico e de Saúde 2011 Instituto Nacional de Estatística Ministério da Saúde Maputo, Moçambique (Instituto Nacional de Estatistica and UNICEF, 2009); (iv) the 2007 Mozambique National Malaria Indicator Survey (MIS) (National Malaria Control Programme et al., 2009) (v) the 2003 Mozambique Demographic and Health Survey (Instituto Nacional de Estatística (INE) et al., 2013); and reports from the World Health Organisation (WHO) and United Nations Children’s Fund (UNICEF). Other sources are listed within the references section.
4.5 Questionnaire Design Participatory tools were used in data collection. These tools included a semi structured interview with four key informants, and a questionnaire administered to community members through Focus Group Discussions (females only) and a detailed Household Survey (HS). It was decided to only include women groups during the FGDs as they are generally considered to be the gatekeepers to family health and usually have a good understanding of critical issues that influence health at the community and household level. The questionnaires were designed to assist in the identification of the major health concerns for the community (malaria etc.), institutional issues (satisfaction or lack thereof with health facilities), socio-economic aspects and environmental concerns.
4.6 Fieldwork A field visit was undertaken in order to: ■ Collect primary participatory data in the form of semi-structured focus group discussions with men and women in the different project affected communities;
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■ Gather additional information that was not available in the public domain during the desktop review. This includes collection of information from health facilities, from the national health information management system, as well as from unpublished reports and documents –qualitative and quantitative data; ■ Identify key informants and conduct interviews using a semi-structured questionnaire; ■ View the standards of the local health facilities and functionality of the health management information system; and ■ Visualise the project and location of communities in relation to planned project activities.
The field work took place from the 30th June to 5th of July 2014. This was conducted by Ms Karien Lotter, a member of the Social Sciences Department of Digby Wells. The field visit provided an opportunity to visualise and assess the prevailing situation in the communities and their relation to the proposed Project. This was important in order to understand the potential areas of influence of the project and also the general living conditions in the communities living in the proposed Project area.
4.6.1 Interviews During the field visit, interviews were conducted with key Healthcare personnel from two Healthcare facilities – Moatize Hospital and Kazula Clinic, as well as two district administrators (directorate interviews) – Chiuta District and Tete Province. The objective of these interviews was to gain a better understanding of the structure and capacity of the local health system and also to enquire what health statistics were available at the local level and where possible obtain authorised copies of statistics and reports. Key Informant Interviews were conducted with the health personnel at these facilities, using a semi-structured questionnaire. This included specific questions about health, social and environmental determinants. Interviews and discussions were open and conducted in Portuguese, Chewa and Nhúnguè. The key informants consulted during the field visit are: ■ Mr Jose Meque, Contact details: +258826413280 /+258845603401 / [email protected]; Position: Employee of the Provincial Health office for Tete province in the Dept of Public Health, School Health and tropical diseases department; Date: 30 June 2014 ■ Mr Juma Horacio, Contact details: [email protected] /+258825456790; Position: Tachnician at Chiuta Hospital (the director was not available so asked Juma to fill in for him); Date: 1 July 2014 ■ Mrs Laurinda Manuel, Contact details: +258865472318; Position: Clinic Director of Kazula Clinic; Date: 1 July 2014
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■ Mr Azelia Ernesto Novela, Contact details: [email protected]; Position: Doctor at Moatize hospital and director of Health and social services; Date 1 July 2014 Other Healthcare facilities were initially identified using a Geographic Information System (prior to the field visit). There are listed below: ■ Muchena and Massamba clinics no longer operational. ■ Massamba has always only been a medication distribution point, now a haphazard supply of medication – not reliable at all and only basic medication available. The gentleman there has stopped giving people treatment because the government told him to stop – he has no formal training. ■ Muchena Clinic closed about two years ago because the government realised that the staff at the small clinics don’t have any training. It was subsequently made a medication distribution point but they have not received any medication in three months. ■ Matacale clinic: No-one has a recollection that there was ever a clinic. The people from the village travel to Kazula, which is their nearest health care facility.
4.6.2 Focus groups In addition to visiting the local health facilities, FGDs were conducted in the immediate and wider Project area. The FGDs were held at the following villages: ■ Cacoma Village ■ Chianga Village ■ Massamba Village ■ Matacale Village ■ Mbuzi (old Pondandue) ■ Muchena Village ■ Nhambia Village ■ Tenge Village It was decided to only include women groups during the field visit as they are generally considered to be the gatekeepers to family health and usually have a good understanding of critical issues that influence health at the community and household level. This allows for a high level understanding of the health challenges, from both a biophysical and social health perspective. FGD’s were moderated in Portuguese, with simultaneous translation into the local languages spoken (Chewa or Nhúnguè) in the community, through a local translator. Figure 4-2 illustrates a FGD that took place at Tenge Village.
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Figure 4-2: Women gathered for FGD at Tenge village
4.6.3 Detailed Household Surveys In order to gather quantitative data for the baseline study of the project area, a socio- economic survey was conducted by COWI, the specialists who conducted the Heritage and Social Impact Assessments for the ESIA process. The survey was conducted using a paper- based questionnaire applied to all the households living in the PACs. Eleven health related questions were submitted to COWI for inclusion into their Socio-economic survey. COWI selected a ‘corridor of influence’ which is composed of the prospection area 1035L with a buffer zone of 5 km and the projected haul road with a buffer zone of 70 m on each side. As part of the survey, 324 households living in the ‘corridor of influence’ were interviewed. At the household level the questionnaire was administered to the Head of Household or his/her spouse. The interview was conducted directly in Chewa or Nhúnguè (which are the indigenous languages spoken in the Project area) by interviewers that were fluent in the languages.
4.6.4 H2S Strip Test
The H2S strip test allows you to identify if hydrogen sulphide producing bacteria are present in the tank. If this is the case then the rainwater tested contains faecal matter and is potentially dangerous to human health upon consumption.
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The H2S strip test is a bottle with a piece of paper impregnated with nutrients inside it. The paper will release the nutrients into the water once the sample has been added and the kit hand-shaken. This will allow the bacteria to grow. Karien Lotter collected water samples and conducted this test (refer to Plan 3, Appendix A for sampling locations). To use the H2S strip test she had to: ■ Allow the water to run for thirty seconds. ■ Then let the water run slowly, before opening the bottle ■ Without touching the inside of the bottle with hands. Half fill the bottle with water to the line indicated on the bottle. ■ Close the bottle and shake the bottle. ■ Place in a sunlight protected box in a warm place. ■ Check the bottle for a colour change. ■ Check the bottle every 12 hours for 72 hours (3 days). ■ Colour changes after 72 hours are not positive results. ■ If the water turns a black colour then the test shows that bacteria are present. (Positive result). ■ All the water in the bottle must be discarded into the sewage system.
4.7 Impact Categorisation: Environmental Health Areas (EHAs) Framework Potential community health impacts were identified on the basis of: (i) the available health data from the literature review; (ii) the information generated through stakeholder consultation; (iii) the knowledge of the project context and developments; (iv) input from other specialist studies that inform the elements of the Environmental, Social and Health Impact Assessment (ESHIA) and (v) experience of previous HIAs in similar settings (Winkler et al., 2010). The identified potential impacts were then categorised in terms of twelve Environmental Health Areas (EHAs) – a set of health-related factors and considerations defined by IFC methodology. These are summarised in Table 4-2. The set of EHAs provides a linkage between project-related activities and potential positive or negative community-level impacts, and incorporates a variety of biomedical and key social determinants of health. In this integrated analysis, cross-cutting environmental and social conditions that contain significant health components are identified instead of an HIA focusing primarily on disease-specific considerations – as is frequently done in many biomedical analyses of potential project- related public health impacts. The EHA framework is based on an analysis performed and published by the World Bank (IFC, 2009).
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Table 4-2: Environmental Health Areas
Environmental Health Areas (EHAs)
Vector-related diseases – Mosquito, fly, tick and lice-related diseases (e.g. malaria, dengue, 1. yellow fever, lymphatic filariasis, rift valley fever, human African trypanosomiasis, onchocerciasis, etc.)
Acute respiratory infections and respiratory effects from housing – Transmission of communicable diseases (e.g. acute respiratory infections, pneumonia, tuberculosis, meningitis, 2. plague, leprosy, etc.) and respiratory infections that can be linked to overcrowding and housing inflation. It also considers indoor air pollution related to use of biomass fuels.
Veterinary medicine and zoonotic issues – Diseases affecting animals (e.g. bovine 3. tuberculosis, swinepox, avian influenza) or that can be transmitted from animal to human (e.g. rabies, brucellosis, Rift Valley fever, Lassa fever, leptospirosis, etc.)
Sexually-transmitted infections, including Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome (HIV/AIDS) – Sexually-transmitted infections such as syphilis, 4. gonorrhoea, chlamydia, hepatitis B and, most importantly, HIV/AIDS. Linkages of TB will be discussed where relevant under HIV, but often linked to EHA1.
Soil-, water- and waste-related diseases – Diseases that are transmitted directly or indirectly 5. through contaminated water, soil or non-hazardous waste (e.g. diarrheal diseases, schistosomiasis, hepatitis A and E, poliomyelitis, soil-transmitted helminthiases, etc.)
Food- and nutrition-related issues – Adverse health effects such as malnutrition, anaemia or micronutrient deficiencies due to e.g. changes in agricultural and subsistence practices, or food 6. inflation; gastroenteritis, food-borne trematodiases, etc. This will also consider feeding behaviours and practices. Access to land plays a major role in developing subsistence farming contexts.
Accidents/injuries – Road traffic or work-related accidents and injuries (home and project 7. related); drowning
Exposure to potentially hazardous materials, noise and malodours – This considers the environmental health determinants linked to the project and related activities. Noise, water and air pollution (indoor and outdoor) as well as visual impacts will be considered in this biophysical 8. category. It can also include exposure to heavy metals and hazardous chemical substances and other compounds, solvents or spills and releases from road traffic and exposure to mal- odours. There is a significant overlap in the environmental impact assessment in this section. Ionizing radiation also falls into this category.
Social determinants of health – Including psychosocial stress (due to e.g. resettlement, overcrowding, political or economic crisis), mental health, depression, gender issues, domestic 9. violence, suicide, ethnic conflicts, security concerns, substance misuse (drug, alcohol, smoking), family planning, health seeking behaviours, etc. There is a significant overlap in the Social Impact Assessment (SIA) in this section.
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Environmental Health Areas (EHAs)
Cultural health practices – Role of traditional medical providers, indigenous medicines, and 10. unique cultural health practices
Health systems issues – Physical health infrastructure (e.g. capacity, equipment, staffing 11. levels and competencies, future development plans); program management delivery systems (e.g., malaria-, TB-, HIV/AIDS-initiatives, maternal and child health, etc.)
12. Non-communicable diseases – Cardiovascular diseases, cancer, diabetes, obesity, etc.
4.8 Impact Assessment
4.8.1 Key Issues and Related Health Impacts This section provides an analysis of the potential impacts associated with the proposed Project and has included the analysis of potential negative impacts and their mitigation measures, but also includes potential positive impacts and measures to enhance these. This is based on the evidence presented in the baseline health description, the planned project activities and information obtained from the other available specialist studies. The key health impacts and needs have been described in the EHA framework. While it is recognised that some of these existing health needs will be inherited by the proposed Project, and may be regarded as the responsibility of the government, they may influence the impacts and need to be considered for mitigation/management. Project interventions are required to mitigate and enhance the impacts that the proposed Project may have on the PACs.
4.8.2 Impact Assessment Methodology Five factors need to be considered when assessing the significance of impacts, namely: 1. Relationship of the impact to temporal scales - the temporal scale defines the significance of the impact at various time scales, as an indication of the duration of the impact. 2. Relationship of the impact to spatial scales - the spatial scale defines the physical extent of the impact. 3. The severity of the impact - the severity/beneficial scale is used in order to scientifically evaluate how severe negative impacts would be, or how beneficial positive impacts would be on a particular affected system (for ecological impacts) or a particular affected party.
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4. The severity of impacts can be evaluated with and without mitigation in order to demonstrate how serious the impact is when nothing is done about it. The word ‘mitigation’ means not just ‘compensation’, but includes concepts of containment and remedy. For beneficial impacts, optimization means anything that can enhance the benefits. However, mitigation or optimization must be practical, technically feasible and economically viable. 5. The likelihood of the impact occurring - the likelihood of impacts taking place as a result of project actions differs between potential impacts. There is no doubt that some impacts would occur (e.g. loss of vegetation), but other impacts are not as likely to occur (e.g. vehicle accident), and may or may not result from the proposed development. Although some impacts may have a severe effect, the likelihood of them occurring may affect their overall significance. Each criterion is ranked with scores assigned as presented in Table 4-3 to determine the overall significance of an activity. The criterion is then considered in two categories, viz. effect of the activity and the likelihood of the impact. The total scores recorded for the effect and likelihood are then read off the matrix presented in Table 4-4, to determine the overall significance of the impact. The overall significance is either negative or positive. The environmental significance scale is an attempt to evaluate the importance of a particular impact. This evaluation needs to be undertaken in the relevant context, as an impact can either be ecological or social, or both. The evaluation of the significance of an impact relies heavily on the values of the person making the judgment. For this reason, impacts of especially a social nature need to reflect the values of the affected society.
4.8.2.1 Prioritising The evaluation of the impacts, as described above is used to prioritise which impacts require mitigation measures. Negative impacts that are ranked as being of “VERY HIGH” and “HIGH” significance will be investigated further to determine how the impact can be minimised or what alternative activities or mitigation measures can be implemented. These impacts may also assist decision makers i.e. numerous HIGH negative impacts may bring about a negative decision. For impacts identified as having a negative impact of “MODERATE” significance, it is standard practice to investigate alternate activities and/or mitigation measures. The most effective and practical mitigations measures will then be proposed. For impacts ranked as “LOW” significance, no investigations or alternatives will be considered. Possible management measures will be investigated to ensure that the impacts remain of low significance.
Table 4-3: Ranking of Evaluation Criteria
F F T
E E C Temporal Scale Score
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Short term Less than 5 years 1
Medium term Between 5-20 years 2
Between 20 and 40 years (a generation) and from a human Long term perspective also permanent 3
Over 40 years and resulting in a permanent and lasting change that Permanent will always be there 4
Spatial Scale
Localised At localised scale and a few hectares in extent 1
Study Area The proposed site and its immediate environs 2
Regional District and Provincial level 3
National Country 3
International Internationally 4
Severity Severity Benefit
Slight impacts on the affected Slightly beneficial to the affected Slight system(s) or party(ies) system(s) and party(ies) 1
Moderate impacts on the affected Moderately beneficial to the Moderate system(s) or party(ies) affected system(s) and party(ies) 2
Severe/ Severe impacts on the affected A substantial benefit to the Beneficial system(s) or party(ies) affected system(s) and party(ies) 4
Very Severe/ Very severe change to the A very substantial benefit to the Beneficial affected system(s) or party(ies) affected system(s) and party(ies) 8
Likelihood
Unlikely The likelihood of these impacts occurring is slight 1
May Occur The likelihood of these impacts occurring is possible 2
Probable The likelihood of these impacts occurring is probable 3 LIKELIHOOD Definite The likelihood is that this impact will definitely occur 4 * In certain cases it may not be possible to determine the severity of an impact thus it may be determined: Don’t know/Can’t know Table 4-4: Matrix used to determine the overall significance of the impact based on
the likelihood and effect of the impact.
Effect
eli
ho od Lik
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3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 4 5 6 7 8 9 10 11 12 13 14 15 16 17
2 5 6 7 8 9 10 11 12 13 14 15 16 17 18
3 6 7 8 9 10 11 12 13 14 15 16 17 18 19
4 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Table 4-5: Description of Environmental Significance Ratings and associated range of scores
Significance Description Positive Negative Rate
Low An acceptable impact for which mitigation is desirable but not 4-7 4-7 essential. The impact by itself is insufficient even in combination with other low impacts to prevent the development being approved. These impacts will result in either positive or negative medium to short term effects on the social and/or natural environment.
Moderate An important impact which requires mitigation. The impact is 8-11 8-11 insufficient by itself to prevent the implementation of the project but which in conjunction with other impacts may prevent its implementation. These impacts will usually result in either a positive or negative medium to long-term effect on the social and/or natural environment.
High A serious impact, if not mitigated, may prevent the 12-15 12-15 implementation of the project (if it is a negative impact). These impacts would be considered by society as constituting a major and usually a long-term change to the (natural &/or social) environment and result in severe effects or beneficial effects.
Very High A very serious impact which, if negative, may be sufficient by 16-20 16-20 itself to prevent implementation of the project. The impact may result in permanent change. Very often these impacts cannot be mitigated and usually result in very severe effects, or very
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beneficial effects.
4.8.3 Impact Analysis, Mitigation and Enhancement Analysing health impacts is often based on a broad range of factors. The impact analysis considers the baseline health, as described above in Section 5.
4.9 Data Gaps and Limitations of the cHIA Study This cHIA has focused on understanding the high level health issues in the proposed Project area. The cHIA also assessed health data gaps that may exist and determined what additional information would be required to inform a more comprehensive health evidence base. A gap analysis is necessary in order to establish whether sufficient data is available to inform a risk/impact analysis and mitigation phase or whether additional baseline data is required. It should, however, be noted that interviews and FGDs are normally based on respondents’ self-declaration which may be prone to recall or response bias. Moreover, when it comes to questions on one’s private life, study participants tend to be affected by a social desirability bias, where they may choose to give answers that are socially acceptable.
5 Baseline Community Health Profile
5.1 General Health Profile: Country and Province Specific The health indicators for Mozambique describe a challenging situation and some health data for the country are lower than the average for other sub-Saharan African countries. Life expectancy at birth is 44 for men and 46 for women compared with the 47 and 49 respectively for the World Health Organization (WHO) African Region. The national infant and under-five mortality rates are 102 and 152 per 1,000 live births respectively compared with regional figures of 100 and 167 respectively. Similarly, in Mozambique the density of doctors and nurses and midwives per 1,000 population is 0.027 and 0.322 compared to regional figures of 0.217 and 1.172 respectively. In contrast, immunization coverage among 1 year olds (e.g. measles 77%, DTP3 72%) in Mozambique is similar to the mean of the other sub-Saharan African countries (66% for both) (WHO, 2006).
5.1.1 Health Infrastructure The health system in Mozambique is comprised of the public sector, the private sector, and the private not-for-profit sector. However, the public sector is the main provider of health services nationwide. It plays a main role in defining policies, developing strategic plans, resource mobilization and allocation as well as developing cooperation relations. There are 10 provincial health directorates, 128 district health, women and social welfare directorates that supervise and follow up the implementation health care provision in 1277 health units countrywide (number of health units in 2007).
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The national health system is organized into four levels of care: ■ Levels I and II, which are the most peripheral ones and which are meant for implementing the Primary Health Care (PHC) strategy and serve as a referral for the clinical conditions that do not have response at Level I; and ■ Levels III and IV which are fundamentally meant for more specialised curative care and serve as a referral for the immediately inferior levels.
5.1.2 Health Personnel Mozambique has a publicly funded health system providing healthcare for the majority of the population. The system is based on the values and principles of primary healthcare. However, equity and universal access to health services is not yet a reality despite strong commitments from the Ministry of Health (MoH). The major impediment to delivering essential interventions is the shortage of skilled health workers. With 64.5 medical doctors (MoH, 2011) nurses and maternal and child health nurses per 100,000 population in 2011 (ibid.). Mozambique is below the minimum acceptable health worker density threshold of 230/100,000. The shortage is further compounded by an imbalanced distribution of healthcare personnel across regions and between urban and rural areas. The number of health workers is increasing; however, has not yet reached the growing needs of the population. The total health workforce of the MoH increased from 25,683 health workers in 2006 to 35,503 in 2011 (+38%). Health professionals (regime especial da saúde) made up just over half (54%) of the workforce in 2011, compared to 52% in 2008. General staff constitute the remaining percentage. In 2011, the total number of doctors in National Health System of Mozambique was 1,268 of whom 23% (289) were non-Mozambican nationals (ibid.) for a population of approximately 22.3 million people. Since 2005, the number of national doctors increased by 72% (from 569 in 2005 to 979 in 2011), and the number of maternal and child health nurses almost tripled over a period of 11 years (from 1,414 in 2000 to 3,926 in 2011). The challenges in human resources for health are a result of limited production capacity, difficulties in attracting and retaining skilled and higher qualified personnel to remote areas, inadequate human resources for health planning and management capacity at all levels, staff dissatisfaction about remuneration and working environment, low annual allocation of new posts for the health sector, and an increasing competition with the private sector (NGOs and private for profit sector) for experienced staff with managerial skills, medical doctors, laboratory and pharmaceutical staff. To address these challenges, the Ministry of Health is currently implementing a 7-year Human Resources Development Plan 2008-2015 that outlines four key areas: ■ Organization of services and normative framework;
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■ Strengthening management, planning and administration capacities; ■ Improving human resources distribution, motivation, and retention; and ■ Increasing capacity of pre-service training, post- graduate training, and in-service training networks. Furthermore, to increase basic health services at community level, the MoH with support from partners is training more Community Health Workers (Agentes Polivalentes Elementares - APE). One initiative is the WHO supported Rapid Expansion 2015 Programme (RAcE), which is currently being implemented in Mozambique. The RAcE aims at training community health workers in diagnosing, treating and referring cases of some of the main public health diseases, namely malaria, pneumonia and diarrhoea. In 2012, the district of Chiúta was served by 5 health centres with a total of 49 beds, of which 19 were maternity ward beds (INE, 2013). In 2005, there were 25 health technicians and assistants in the district, of which 90% had only basic/elementary health training (MAE, 2005). There were 3,200 residents per health technician (MAE, 2005). Despite the expansion of the health system during 2009-2012, the health unit/resident ratio and the health unit bed/resident ratio remain high: in 2012 there were 17,919 residents per health unit and 1,792 residents per health unit bed. In 2012, the district of Moatize was served by 12 healthcare centres with a total of 132 beds, of which 60 were maternity ward beds (INE, 2013b). In 2005, there were 86 health technicians and assistants in the district, of which 91% had only basic/elementary health training (MAE, 2005b). There were 2,100 residents per health technician (MAE, 2005b). Similar to Chiúta, despite the expansion of the health system in Moatize during 2009-2012, the health unit/resident ratio and the health unit bed/resident ratio remain high: in 2012 there were 24,361 residents per health unit and 2,215 residents per health unit bed.
5.1.3 The Presence of Non-Governmental Organisations in Tete There are currently eleven (11) NGOs operating in various areas of the Tete Province. These NGOs are responsible for promoting healthy lifestyles, and improving overall health in the targeted populations. There is good coordination between these NGOs, and some NGOs are supporting the Cholera outbreak plaguing the capital of the Province of Tete. The table below illustrates each NGO with their respective activities and areas of activity within the Tete Province. Table 5-1: NGO presence in Tete
NGO Location of Activity Function of NGO
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Supports the Integrated Network to combat HIV/AIDS Finance training for medical MSF Luxemburg Angonia, Tete City and Moatize staff, make supervision for Healthcare facilities in terms of upgrading building infrastructure and buying furniture
World Vision Mozambique serves children in communities Mutarara, Cahora, Moatize, across the country through child Visão Mundial/ World Vision C.Bassa, Changara, Chiuta and sponsorship, with programmes Magoe providing including healthcare, education, and water and sanitation.
Partnering local organisations and the Government to advance elder people's rights to healthcare, financial security, and protection from injustice and abuse Work to reduce the impact of HIV and AIDS Ensuring elder's needs are met HelpAge International Changara in emergency relief efforts Have community-based committees, which provide cash donations and cash for food programme to many households. Assisting households benefit from services like Healthcare and education
Cahora Bassa, Moatize, Finances the training and Danish International Changara and Directorate of supervision of medical staff, Development Agency (DANIDA) Provincial Health home-based carers
United Nations International Focus on child and maternal Children's (Emergency) Fund Provincial health; education and (UNICEF) adolescent development; child protection and social policy and
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advocacy
Brazilian multinational diversified metals and mining RIO DOCE Provincial corporation that supports health through corporate social investment/ responsibility
Conducts and supports medical Ghent University Moatize and Tete City research
Supports institutes for training, research and assistance in tropical medicine and healthcare in developing countries such as Mozambique. Works with scientific institutions Instituto De Medicina Tropical/ Tete City, and the Tete in Mozambique, and the Institute of Tropical Medicine Provincial Hospital government for a long-lasting improvement of healthcare and disease control Finances the training of health workers in the diagnosis and control of HIV Infections
Their efforts are to strengthen the government's primary healthcare system, with clinical, public health support, and helping build management and leadership capacities Health Alliance International Directorate of Provincial Health: (HAI) Tete The HAI, Mozambique currently has seven different projects addressing challenges such as health systems strengthening, malaria, tuberculosis, ARV treatment strategies, immunizations and vaccinations
They are an international Le Fonds des Nations Unies source of funding for population pour la population (FNUAP)/ Directorate of Provincial Health and reproductive health United Nations Population Fund programmes (UNFPA) It supports programmes that
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help women, men and young people to plan their families and avoid unwanted pregnancies, undergo pregnancy and childbirth safely, avoid STIs – including HIV/AIDS, and to combat violence against women
Focuses on gender issues, HIV/AIDS, the environment, food safety and nutrition, Japan International Cooperation Directorate of Provincial Health science & technology, rural Agency (JICA) development, disaster risk reduction, and landmine removal
Source: Tete, aos 09 de Maio de 2008
5.1.4 Contraception and Family Planning Eleven percent (11%) of married women and 30% of single women, who are sexually active report to using some modern method of contraception. The use of modern contraception is strongly correlated with the education: 31% of women with secondary education or more use a modern method, compared with only 5% of those who are unschooled. The public sector is the main supplier of contraceptive methods, providing contraceptives to 77% of users. It is estimated that one third of married women practice family planning (INE, 2013).
5.1.5 Maternal Health and Child Mortality The importance of ensuring that mothers and their babies are well-nourished is widely recognised. A pregnant woman’s nutritional status influences the growth and development of her foetus and forms the foundations for the child’s later health. Maternal health refers to the health of women during pregnancy, childbirth, and the post-partum period. While motherhood is often seen as a positive and fulfilling experience, for many it is associated with suffering, ill-health and even death (WHO, 2013). A key element of maternal and child health services is the provision of safe delivery care. The proportion of deliveries in a health care setting, as well as the supervision of the delivery by a trained health provider, are both important determinants to good maternal and foetal outcomes. Accessibility issues may hamper women from accessing a safe delivery site, particularly in remote areas. High delivery fees and lack of trained midwives and health personnel may also discourage women from going to a health centre and force them to deliver at home. The maternal mortality ratio (per 100,000 live births) in Mozambique has decreased from 1,000 deaths in 1990, 780 deaths in 2000 to 550 deaths in 2008. Therefore Maternal
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Mortality Rate (MMR) is still alarmingly high (WHO, 2012). The 2011 MDHS found that the percentage of births attended by skilled health professionals was 54%. However, there’s a large disparity between rural (44%) and urban areas (80%) (Instituto Nacional de Estatística (INE) et al., 2012). Although the situation of child mortality has improved noticeably in recent years, statistics report that one in every ten Mozambican children dies before their fifth birthday. From the period 1996-2001 to the period 2006-2011 infant mortality decreased from 106% to 64%. During this same period, the decline in child mortality was 158% to 97%. The highest infant mortality occurs in children born in intervals of less than 24 months. It is estimated that the Mozambican woman bares the risk of her child dying from obstetric causes (throughout her procreative life) is an average of 0.024.
5.1.6 Domestic Violence Domestic violence is a form of gender-based violence that primarily affects women. Always considered as a problem of an intimate nature, domestic violence is now recognized as a phenomenon that is observed in all spheres of society, regardless of the level of development of countries and the socio-economic and cultural characteristics of the people. Long regarded as a problem domestic violence, in particular violence against women today is a serious human rights violation and is punishable by law. The UN Declaration on the Elimination of Violence against Women, adopted in 1993 is an international recognition of this form of discrimination against women (United Nations General Assembly, 1993). Violence against women has profound implications for health but is often ignored. WHO’s World Report on Violence and Health notes that “one of the most common forms of violence against women is that performed by a husband or male partner.” Although the adoption of the law on domestic violence in 2009 represents significant progress, its impact on the Mozambican society has been limited. A “domestic violence” unit has been created within the Ministry of the Interior but its means are too meagre to allow for effective action. Domestic violence enjoys considerable social legitimacy stemming from a widespread view that the man, as the head of family, has the prerogative to use force to solve marital disputes conflicts. According to research by Africa for Women’s Rights, rape accounts for half the reported cases of violence against women in Mozambique. Sexual abuse at school, including harassment of girl students by their teachers or by fellow students, has increased alarmingly. According to the Mozambican law, incest is rape with aggravating circumstances, but there is no specific government policy to control this type of violence. There is no sanction for marital rape. A third of the women were victims of physical violence since the age of 15 years and 25% were victims in 2010 (INE et al., 2012). A quarter of the men were the victim of physical violence since the age of 15 years and 11% were victims in the same year. Twelve percent
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(12%) of women reported to having been forced to have sexual relations at some point in their lives, whilst 7% reported to having been forced to have sexual relations in 2010. Among men, these proportions are 7% and 5% (ibid.). A third of the women claimed to have suffered emotional violence by the husband and 46% report having been victims of physical, sexual or emotional violence. Forty six percent (46%) of men report having experienced violence the emotional part of the wife and 48% report having been victims of physical, sexual or emotional violence (ibid.).
5.1.7 Guinea Worm Dracunculiasis, also known as Guinea worm disease (GWD), is an infection caused by the parasite Dracunculus medinensis and is has been reported as pandemic Mozambique. A parasite is an organism that feeds off of another to survive. GWD is spread by drinking water containing Guinea worm larvae. Larvae are immature forms of the worm. GWD affects poor communities in remote parts of Africa that do not have safe water to drink. GWD is considered by global health officials to be a neglected tropical disease (NTD) – the first parasitic disease slated to be eradicated. People become infected with Guinea worm by drinking water from ponds and other stagnant water containing tiny "water fleas" that carry the Guinea worm larvae. The larvae are eaten by the water fleas that live in these water sources. Once drunk, the larvae are released from copepods in the stomach and penetrate the digestive track, passing into the body cavity. During the next 10-14 months, the female larvae grow into full-size adults. These adults are 60-100 centimetres (2-3 feet) long and as wide as a cooked spaghetti noodle. When the adult female worm is ready to come out, it creates a blister on the skin anywhere on the body, but usually on the legs and feet. This blister causes a very painful burning feeling and it bursts within 24-72 hours. Immersing the affected body part into water helps relieve the pain. It also causes the Guinea worm to come out of the wound and release a milky white liquid into the water that contains millions of immature larvae. This contaminates the water supply and starts the cycle over again. For several days, the female worm can release more larvae whenever it comes in contact with water. People do not usually have symptoms until about one year after they become infected. A few days to hours before the worm comes out of the skin, the person may develop a fever, swelling, and pain in the area. More than 90% of the worms come out of the legs and feet, but worms can appear on other body parts too. People in remote rural communities who have Guinea worm disease often do not have access to healthcare. When the adult female worm comes out of the skin, it can be very painful, slow, and disabling. Often, the wound caused by the worm develops a secondary bacterial infection. This makes the pain worse and can increase the time an infected person
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is unable to function for weeks or even months. Sometimes, permanent damage occurs if a person’s joints are infected and become locked. There is no drug to treat Guinea worm disease and no vaccine to prevent infection. Once part of the worm begins to come out of the wound, the rest of the worm can only be pulled out a few centimetres each day by winding it around a piece of gauze or a small stick. Sometimes the whole worm can be pulled out within a few days, but this process usually takes weeks. Medicine, such as aspirin or ibuprofen, can help reduce pain and swelling. Antibiotic ointment can help prevent secondary bacterial infections. The worm can also be surgically removed by a trained doctor in a medical facility before a blister forms.
5.1.8 Sexually Transmitted Infections and HIV/AIDS Sexually transmitted infections (STIs) such as gonorrhoea, syphilis or chlamydia are an important global health priority because of their devastating impact on women and infants and their inter-relationships with HIV/AIDS. STIs and HIV are linked by biological interactions and because both infections occur in the same population cohorts. Infection with certain STIs can increase the risk of HIV acquisition and transmission as well as alter the course of HIV disease progression. In addition, STIs can cause long term health problems, particularly in women and infants. Some of the health complications that arise from STIs include pelvic inflammatory disease, infertility, tubal or ectopic pregnancy, cervical cancer, and peri-natal or congenital infections in infants born to infected mothers. STIs are linked to high risk sexual behaviour which is usually defined as having sexual intercourse with any persons other than a spouse or a regular partner. In Tete Province, the prevalence of STIs decreased from 31,017 cases in 2004 to 27,594 cases in 2007 with a negative growth of 11.2 % without death. This is a clear indication that more efforts need to be made in disseminating messages of HIV/AIDS awareness and more attention should be paid to changing risk behaviours, as those STIs are a gateway to HIV/AIDS.
5.1.9 Knowledge, Attitudes and Behaviour In Relation to HIV/AIDS The basic knowledge about HIV and AIDS and acceptance that its transmission can be avoided are needed to combat the epidemic. The experience of many countries shows that general knowledge tends to be very high, but knowledge of how to prevent HIV tends to be lower. The proportion of women and men aged 15 to 49 years who have heard about HIV and AIDS is quite high, with 98% in women and 100% in men. Four Provinces (Zambezia, Inhambane, Maputo Province and Maputo City) all women have heard about HIV and AIDS. The lowest proportion of women who have heard of HIV and AIDS was recorded in Niassa (90%) and Nampula (93%). Although the difference is small, the percentage of women who have heard of HIV and AIDS increases with the level of education and wealth quintile. Ref? Practically all the Mozambicans (98% of women and 100% of men) have heard of HIV/AIDS, but only 31% of women and 51% of men have a comprehensive knowledge about the
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disease. Forty-three percent (43%) of women and 51% of men believe that it is justifiable for a woman to refuse to have a relationship with her husband, knowing that he has sexual relationships with other women. One in four men aged 15 to 49 reported to having paid for sex, but only a third of men who had paid for sex in last 12 months used a condom at last paid sex. Forty-five percent (45%) of women 15-49 years and 23% of men at these ages had been tested for HIV/AIDS. Almost half (47%) of Mozambican men have been circumcised. The prevalence of male circumcision is much higher in the Northern Provinces and Inhambane. Ref? The proportion of adults who knows two methods of preventing HIV, i.e., to reduce the number of sexual partners and condom use does not vary with age, but varies with the other Socio demographic characteristics. Women who have never had sex have low level of knowledge compared to unmarried women who have ever had sex (39% versus 59%, respectively). Divorced or widowed men have a low level of knowledge (67%) compared to men who never married but who already had relationships sex (77%). Ref? Women living in rural areas have a low level of knowledge (46%), compared to women living in urban areas (62%). The same trend, although less dimension was observed for men (71% versus 80%, respectively). The level of knowledge about the two prevention methods increases with the level of education on women and men and wealth quintile only in women. In men not observed a clear association between wealth quintile and knowledge of prevention. Ref? The knowledge of the particular aspects that make up the comprehensive knowledge about AIDS is relatively high among women and men aged 15-49, with the level of knowledge about individual indicators slightly higher among men compared to women. By example, 67% of women and 87% of men know that a healthy-looking person can be HIV-positive. Regarding the level of knowledge that HIV cannot be transmitted through the bite of mosquito, 77% of women and 76% of men know that HIV cannot be transmitted through mosquito bite. The trend of differences based on gender of the respondents to maintain the belief that HIV can be transmitted through supernatural means (81% for women and 90% for men) and the knowledge that no one can be infected with HIV by sharing food with someone who is infected with the virus that causes AIDS (82% for women and 87% for men). However, the proportion of women and men who claim that a healthy person can be HIV positive and that reject the two most common misconceptions about HIV transmission is low for both women as for women (48% and 63% respectively). Ref? As noted, the comprehensive knowledge about HIV and AIDS among women and men aged 15-49 is low. Less than a third (31%) in women and slightly more than half (51%) in men have comprehensive knowledge about AIDS. Women 40-49 have the lowest level (28%) of comprehensive knowledge while women aged 25-29 have the highest level (35%). In men, those aged 20-24 years have the highest levels (57%). In women the knowledge is higher in those who never married and who have had sexual intercourse (41%) and lowest in never married and never had sex (22%). Ref?
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5.1.10 Malnutrition in Children Malnutrition is one of the greatest concerns in public health and the largest contributing factor to child mortality in less developed countries, where the majority of children who are malnourished are found. Socio-economic, climate, geography, agricultural and many other factors all contribute. Malnutrition develops due to a combination of anorexia, poor intake, malabsorption and increased requirements. There is often interplay between malnutrition and ill health. Deficiencies (such as Vitamin A) suppress host immunity, impair growth and development, and have a negative influence on pregnancy outcome. These conditions favour diseases such as persistent diarrhoea, intestinal parasites, measles, pneumonia, TB and HIV/AIDS, which in turn are important cause’s malnutrition. Consequently, malnutrition is one of the important indicators for monitoring a given population’s health status and gives a reliable snapshot on the burden of disease within a community (Chhabra and Rokx, 2004). Malnutrition is extremely common in Mozambique and a big problem in the project area. In the past decade Mozambique had suffered from natural disasters, including droughts and floods in 2001 and 2007, which has led to the displacement of many thousands of people. Flooded land became unsuitable for cultivation and grazing and many landmines from the civil war in the 1970s are still posing a threat to the farmers. The food situation is still critical. The latest food security outlook for Mozambique, released by the Famine Early Warning Systems Network in 2011, noted that 456,000 people were in need of food assistance between April 2010 and March 2011. The Ministry of Agriculture estimated that in the centre and south of the country 605,000 hectares of planted land were lost to drought - equivalent to 30% of the total land planted in the affected areas - representing a national loss of 13% maize and 11% of cereal production for 2011. Many Mozambicans had lost their crops twice, moving from drought areas to fields which were afterwards submerged by flooding (IRIN, 2010). Food security in Mozambique is currently a national challenge. Feeding practices and general diet is not that well understood, although reports suggest that women are poorly educated on proper feeding practices. Feeding practices are extremely important to address as these are problematic and simply having adequate supply of food will not ensure adequate nutrition. Influx of people into the area will put a strain on existing land and yields may reduce. Inflation could reduce food security in a situation of already high food prices that communities cannot afford. Changes in practices also need to be considered over the medium term. The community may start buying more food in the form of refined products as a result of economic upliftment. A reduction in physical exertion may also result as a result of changing livelihoods. Ironically, the final result could be an increased incidence of obesity.
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5.1.11 Malaria Malaria is endemic throughout the country, in areas where the climate favours its transmission over throughout the year, reaching its highest point during the rainy season. Plasmodium falciparum is the most common parasite, accounting for about 90 % of all infections malarial while P. malariae and P. ovale are accounted for 9% and 1% of all infections, respectively. The MoH states that in Mozambique, malaria is the leading cause of problems health, accounting for 40 % of all outpatient visits. Up to 60 % of hospitalized patients in paediatric wards are admitted due to severe malaria. Malaria is also a major cause of death in hospitals. Almost 30 % of all hospital deaths are because of this disease. The estimated prevalence in the age group 2-9 years of various age from 40% to 80 % , and 90 % in children under 5 years of age are infected by malaria parasites , according to some estimates reveal made in some areas of the country . Malaria is also a major problem that affects pregnant women in rural areas. Approximately 20 % of pregnant women are infected with the parasite (MoH, 2007). Half of the households have at least one network Mosquito Insecticide Treated Long Term (MTILD) and 19% reside in dwellings sprayed in the last twelve months (2011). Thirty five percent (35%) of children under five slept under a MTILD the night before. Thirty four percent (34%) of pregnant women slept under a MTILD the night before. Forty percent (40%) of women who had a live birth during the past two years took antimalarial drugs during pregnancy and 19% received Intermittent Preventive Treatment (IPT). Fifteen percent (15%) of children with fever received combined Artemisinin2 based therapy on the same day or the day after onset of fever. Slightly more than one third of children (35%) were tested positive for malaria.
5.1.12 Pre-natal Care Ninety one percent (91%) of women in Mozambique who had live births in 2011 received antenatal care from qualified health personnel. Slightly more than half (51%) of these women had four or more visits for prenatal care. Two thirds of mothers who had live births in the last five years were protected against tetanus in the last birth. Slightly more than half of births (55%) occurred in the five previous years were held in state health facilities and 43% took place at home.Ref?
5.1.13 Tuberculosis Tuberculosis (TB) is one of the leading causes for morbidity and mortality in Mozambique, particularly affecting young adults, children and people living with HIV/AIDS. Mozambique ranked number 17 on the list 22 high-burden TB countries in the world in 2008 (WHO, 2012). According to the WHO, Mozambique had an estimated incidence rate of 544 cases per
2 Artemisinin, also known as Qinghaosu, and its derivatives are a group of drugs that possess the most rapid action of all current drugs against Plasmodium falciparum malaria
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100,000 populations (WHO, 2012). Due to the high HIV/AIDS burden in Mozambique, the number of TB cases is likely to increase further over the next few years (USAID, 2009). The TB-HIV co-infection rate is high, with 61% of TB patients testing HIV positive (WHO, 2012). Due to the lack of infrastructure and a shortage of human resources, health services for TB control and prevention in Mozambique are inadequate. All districts are implementing Directly Observed Treatment Short Course (DOTS)3, while only 40% of the population has access to DOTS (USAID, 2009). This results in low case detection rates and high death rates among patients with treatment. Furthermore Mozambique has only one laboratory which performs specific testing for TB drug resistant cases, therefore, suspected MDR-TB cases have limited access to the diagnosis.
5.2 Baseline Health Status (Local Level) The following section describes the baseline health status in the proposed Project area and at local level with reference to the EHAs. This is based on the national and regional baseline health data that was identified during the desktop review and primary data collected during the field visit from the 30th June to 5th of July 2014. Data at the local level is based on the aforementioned FGDs and KII that were carried out during the field visit. It is important to note that only the EHAs relevant to the proposed Project have been discussed in the section below. EHA#2 (communicable diseases linked to housing design), EHA #3 (veterinary medicine and zoonotic diseases) and EHA#12 (Non-communicable diseases) have not been discussed as, during the field visit and analysis, these were found to be immaterial in the proposed Project area. Communicable diseases (e.g. acute respiratory infections, pneumonia, tuberculosis, meningitis, plague, leprosy, etc.) rely on fluid exchange, contaminated substances, or close contact to travel from an infected carrier to a healthy individual. Therefore, they are directly linked to housing design, overcrowding and housing inflation. Nhambia was the only village out of eight, where FGD participants reported to overcrowding as a problem. EHA#2 has therefore been ruled out as a point of discussion in the section below. The high burden of communicable diseases in many of the sub-Saharan African countries focused the attention of policy makers and health care services to this health threat. The recognition of the magnitude of the problem has become evident in the region where most of the focus has been on the high burden from communicable diseases. With regards to EHA#12, lack of data and perhaps understanding may have been mistaken for the non- existence of the problem and has resulted in little attention being paid to the diseases. Not a single NCD was mentioned during FGDs, and thus this EHA has have not been included in the discussion below.
3 DOTS or Directly Observed Treatment Short course is the internationally recommended strategy for TB control that has been recognized as a highly efficient and cost-effective strategy.
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EHA#4 Sexually-Transmitted Infections, Including HIV/AIDS has been excluded from the discussions below as HIV/AIDS was not brought up as a disease of concern in any of the eight FGDs that were held.
5.2.1 EHA #1 Vector-Related Diseases
5.2.1.1 Malaria Malaria is the most significant public health threat and cause of mortality in the proposed Project area and indeed in the proposed Project region(s). Malaria was mentioned as the most important disease in the focus group discussions at the local community level. Health seeking behaviour was a concern of the Matacale village as respondents reported that to mixing and boiling indigenous roots for consumption with the first symptoms of malaria. If they do not get better then they will only then go to the nearest Healthcare facility (Kazula Clinic). This is in spite of free malaria treatment. Convulsions are generally managed by traditional healers and witch craft is often suspected. Knowledge of the cause of transmission was good across all villages, with the exception of Tenge village where respondents were not sure on the cause of malaria –“we have heard that mosquitoes cause it, but we do not know what else…we only know what causes STDs – men bring it into the village, or women who have gone to other villages”. The FGDs revealed outbreaks of cholera, dysentery and malaria in communities of the project area, the most recent dating back to 2000 – 2012. These vector-related diseases are linked to river floods and the rainy season. It is important to note that the communities of the project area are all located close to a waterbed, use basic sanitation facilities (latrines and burning or disposing of waste in a whole in the yard) and are served by basic health services.
5.2.2 EHA #2 Communicable Diseases Linked To Housing Design The state of housing in the district is basic rural thatched roofed reed structures, almost all without sanitation amenities or electricity. The majority of houses are made of reed walling, very few are made of blocks.
5.2.3 EHA #5 Soil-, Water- and Waste-Related Diseases The surface hydrology of the proposed Project area is defined by three major catchments, namely the Revuboe, Mussumbudze and Nhambia River catchments. The Project’s planned infrastructure will be located in the Revuboe catchment. The Revuboe River is fed by several ephemeral tributaries and perennial streams including some which flow through the proposed mine infrastructure area. The communities in the project area have limited access to clean/improved water supplies. According to information provided in the FGDs, the water supply and sanitation coverage in the district and the project area is low. According to the Instituto Nacional de Estatística
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(2013) two thirds of the district’s population (66%) uses an unprotected water source such as rivers/lakes (35%) or an open air well without a pump (31%), and only one-third (31%) uses protected wells. None of the surveyed households have a reticulated water supply at home. Households rely on external sources of water, the most common of which is river water. There is a heavy reliance on non-protected wells as a primary source of drinking water. No houses have running water within their property this is a similar case with access to electricity. Water is derived in most homes from standpipes, wells (some hand dug, illustrated in Figure 5-1) and nearby rivers. As illustrated in Figure 5-2 and Figure 5-3 , boreholes (and water pumps) also provide source of water.
Figure 5-1: A hand dug well in Chianga village Most households (95%) practice open air defecation and 50% of the households dispose of their waste in a public dump site, 33% burn it in their yard and slightly over 10% bury it in their yard (COWI SIA, 2015). Digby Wells carried out a hydrocensus (March 2014) within a 5 km radius of the proposed Tenge Pit, that included the identification of groundwater use and groundwater recharge. Most of the analysed parameters (groundwater samples) are within the stipulated World Health Organisation drinking water guidelines (2008), with the exception of total dissolved solids due to elevated alkalinity values. The groundwater showed high alkalinity values might pose health risk to water users (Digby Wells Groundwater Report, 2014). Water with high alkalinity has a soda-like taste and can dry out ones skin.
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The FGD’s revealed outbreaks of cholera, dysentery and malaria in communities of the project area. These vector-related diseases are linked to river floods and the rainy season. It is important to note that the communities of the Project area are all located close to a waterbody use basic sanitation facilities (latrines and burning or disposing of waste in a whole in the yard) and are served by basic health services.
Figure 5-2: Water pump at Massamba village
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Figure 5-3: Water pump at Matacale village Only three locations have clean/safe water which could be consumed without boiling. When asked whether they purified or treated water prior to consumption, seven out of the eight FGD respondent groups said no. The Massamba village was the only village which boiled their water prior to consumption. The test results are illustrated in the table below: Table 5-2: Water test results
Location Sample date Sample time Positive result date and time Cacoma 30-Jun 17h00 2 July 08h00 Chiuta clinic 01-Jul 14h00 Negative Kazula clinic 01-Jul 17h00 2 July 17h00 Moatize hospital 01-Jul 9h00 2 July 15h00 Massamba river 02-Jul 14h30 3 July 12h00 Massamba standpipe 02-Jul 14h30 Negative Muchena 02-Jul 10h30 Negative Capitol Resources Massamba Camp 03-Jul 12h00 5 July 07h00 Matacale river 03-Jul 11h30 4 July 16h00 Mbuzi 03-Jul 15h00 4 July 17h30 Chianga 04-Jul 15h30 5 July 18h00 Tenge river 04-Jul 9h30 5 July 18h00
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Tenge standpipe 04-Jul 11h45 5 July 20h00 Sanitation services in the area are limited and the prevalence of indicators for sanitation such as soil-transmitted diseases and schistosomiasis may suggest a high-level burden of disease. Schistosomiasis, also known as Bilharzia, is a disease caused by parasitic trematode schistosome worms. The district health authority reported that urinary schistosomiasis (S. haematobium) is very common in the area. Unhygienic practices such as washing clothes in the river (see, Figure 5-4) etc. may also contribute to the spread and increase the prevalence of schistosomiasis in the area.
Figure 5-4: Women carrying out domestic chores by the river at Tenge village
5.2.4 EHA #6 Food- and Nutrition-Related Issues Food security has a profound impact on health. Food security incorporates several aspects: food availability, individual access to food, utilisation of food and stability of food availability. Under-nourishment is a key impact indicator of food security and is defined as having an energy consumption that is continuously below a minimum dietary energy requirement for maintaining a healthy life and carrying out light physical activity (SAHR, 2008). Nutritional status is determined by the degree of nourishment. Under-nourishment, an indicator of food security, means consumption is continuously below. Food security is an important consideration in understanding potential health impact of development projects. This EHA is affected by influx of people resulting in increased demand for food.
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In six out of eight FGDs, participants mentioned that food security was not an issue while the women in Matacale and Muchena villages reported that it was a major concern especially in the months of February and March when their fields are flooded. Respondents from four out of eight villages complained of elephants destroying their crops. Crops are grown mainly for subsistence but excess food is sold for cash. Others stated that although their harvest is not enough to survive on for an entire year, when they run out of food, they do some work in some other people’s houses and garden, then use their wages to buy food.
5.2.5 EHA #7 Accidents/Injuries Although the biggest source of operations phase traffic is expected to be due to heavy truck traffic related to the transport of product, there will also be increased light and medium-heavy passenger vehicle traffic due to the transport of mine employees and contractors. At this stage it is not known how large the operations phase workforce will be, or how the workforce will be divided between locals (those living within the surrounding villages, or Tete or Moatize) and outsiders (including people from other parts of Mozambique and foreigners). With regards to labour, it should be possible to source most of the unskilled labour from the numerous villages surrounding the mine area. Access in the area is difficult in the rainy season, therefore the mine would probably need to upgrade existing access routes to a standard that allows them to be used by a 2-wheel drive passenger vehicle all year round, such as the busses which will probably be used to ferry workers from collection points to the mine, and return them at the end of their shift. There will also be a number of skilled workers coming to site from further afield than Tete for their shifts. These individuals will typically stay on site for 3 to 6 weeks, with 1 to 2 week rest periods thereafter. To arrive on site, this section of the workforce will need to fly in and out via Tete Airport, and be transported to site via road, more than likely along the haul road. The magnitude of traffic related to this is expected to be insignificant in comparison to product transport in the operations phase and construction phase traffic. A range of vehicle types are likely to be used during the construction of the mine. Heavy vehicles which will be required to transport goods, materials and equipment to site will include three, five and seven axle trucks; flatbed semi-trailers and, possibly, road trains pulling a number of trailers. Tracked vehicles such as excavators and bulldozers will be transported to site on lowloaders. It is probable there will be some abnormal loads for large items such as transformers that cannot be assembled on site. Tete is already experiencing an economic boom due to mineral resources discovered in the area, and various medium to large scale construction projects are already on the go (including the construction of the new bridge spanning the Zambezi River, approximately 6 kilometres downstream of the existing Samora Machel catenary bridge).
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5.2.6 EHA #8 Exposure to Potentially Hazardous Materials, Noise and Malodours These may also be listed as environmental health determinants and include items such as pollution of air, soil and water as well as possible exposure to pesticides or other organic or inorganic pollutants, noise and malodours. The pathway of human exposure to pollutants can be complex and may be the result of a variety of sources. Exposures and environmental health determinants as a result of the project will be covered in a number of specialist reports. These include air quality, water, noise and soil studies. Pollution will most likely be from motor vehicles, dust and through poor local environmental practices.
5.2.7 EHA #9 Social Determinants of Health
5.2.7.1 Employment Employment is a major need in the project area. The SIA has highlighted the potential benefits that the project may bring for employment opportunities. There are distinct direct and indirect health benefits related to this, which is addressed in detail under the job creation and socioeconomic growth impact analysis in the SIA.
5.2.7.2 Changes in Income and Expenditure New projects have significant potential to positively alter underlying levels of community- and household-income poverty (IFC, 2009). These potential positive effects may have a profound impact on a variety of health performance indicators for all populations in a community (for example, children under age 5, women of reproductive age, elderly, and so on). Conversely, projects can trigger significant inflation, impacting both food and housing in surrounding communities. Significant food or housing inflation can adversely impact existing vulnerable groups, with negative consequences on individual- and community-level health performance indicators. Significant food or housing inflation can make recruitment and retention of healthcare workers and teachers extremely difficult for local communities. Significant and sudden changes in income can have a marked effect on alcohol usage and subsequent gender violence. To comprehensively predict the changes in income and expenditure consumption, one would not only have to analyse the demographic characteristics, household incomes and consumption expenditures, but also the distribution of income at household level, agricultural production and other characteristics as well as the informal sector. The household survey conducted by COWI (2015) revealed that: ■ Income sources are agriculture; unskilled paid labour; sale of cash crops, food and alcoholic drinks; and retirement pension. Except for the latter, these are all land- based or land-related income earning strategies;
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■ On average, Chiúta households earn more per month (USD 181) than Moatize households (USD 153). However, Chiúta households also have higher expenditures (USD 60); ■ The most common expenditures are food items (manufactured items such as oil and sugar, as well as fresh items such as fish, meat and cereals), followed by hygiene products, clothing and health care; ■ The vast majority of households do not use financial services; and ■ The rural character of the surveyed households is shown in the assets they own (axe and hoe).
5.2.7.3 Education Education is also a major existing need in the community. The level of education in the project area is described as low in the SIA. It was cited as a priority developmental need in the community. Women’s literacy is extremely important to enhance health needs in the family unit as they are the gatekeepers to health. The education level of the surveyed Household Head is low: nearly 50% of the surveyed Household Heads are illiterate (46% for Chiúta and 53% for Moatize) and 40% have primary schooling (45% for Chiúta and 36% for Moatize), while only 4% have secondary schooling (COWI SIA, 2015).
5.2.7.4 Gender-based Violence, Alcohol and Drugs Alcohol abuse is currently a major problem in the local study area, and this have the potential to increase during the lifespan of the proposed Project. Alcohol misuse is associated with assault and domestic violence. Five out of eight FGDs reported that most members of their communities drink a lot of alcohol, especially during the weekends and at the end of the month when men (those who are employed) have received their wages and salaries. Drug use was only reported by FGD respondents from Chianga village. The FGDs also revealed social conflicts such as marital conflicts due to alcohol abuse and disrespectful behaviour between community members, which are resolved by the traditional and local leaders.
5.2.8 EHA #10 Cultural Health Practices Culture and traditional values play a very important role in the village communities. Chiúta households seem more prone to seek treatment from a health unit, while Moatize households resort more to home-made remedies and herbal medicines. Most of the people who go to traditional healers are those who live far away from a health facility. Measures undertaken to seek treatment vary. While surveyed households in the Chiúta portion of the project area seem more prone to seek treatment from a health unit, specifically 65% for malaria cases, 59% for diarrhoea cases and 45% for flu cases. The Moatize households, in
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contrast, resort more to homemade remedies. The households sought treatment in health unit in 47% of cases of malaria and diarrhoea and 28% for flu, compared to using homemade remedies for 31% of cases of malaria and flu and 37% for diarrhoea (COWI, SIA). Three of the visited villages (Cacoma, Chianga and Mbuzi) claimed no knowledge of traditional healers within their communities or use of them. The remaining five villages place a large emphasis on traditional values and practices and this relates to health care and health seeking behaviour. Surprisingly, traditional medicine did not play a major or an integral role in health seeking behaviour and also where choices are made as to preference for health care. The vast majority sought help from Healthcare facilities as their first option. Numerous respondents stated that traditional medicine is often accessed after seeking care for a more western medical source. Respondents from Tenge village stated that they visit traditional a healer with illnesses such as vomiting and diarrhoea. They added on that most people visit him (the traditional healer) first because he is within a closer proximity (more accessible) than the clinic, although their preference is the clinic.
5.2.9 EHA #11 Health Systems Issues In terms of health, in 2012 both districts had health services composed of rural hospitals, health centres and health posts. Despite the expansion of the health system, the health unit/ resident ratio and the health unit bed/ resident ratio remained high. According to the FGD’s in the project area there is one health post, in Muchena, which provides basic healthcare services. The nearest health unit to the proposed Project area providing more advanced health care is the Kazula Health Centre, 70km away from the surveyed communities (COWI SIA, 2015). Within close proximity to the proposed Project area, there are three First Aid Care Units run by Red Cross Mozambique (Cruz Vermelha de Mocambique). One is located in Muchena (Figure 5-5), the second in Massamba and the third in Matacale (all at Chiuta District). The only State funded healthcare facility is located at the Administrative Post of Kazula and all the emergencies form the three First Aid Care Units are sent to Kazula and from Kazula to the Provincial Hospital in Tete. There are no Healthcare facilities (in close proximity to the proposed Project area) within the Moatize District. People from Tenge cross the Revuboe River to be assisted in Chiúta.
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Figure 5-5: Muchena Clinic
Figure 5-6: Beds at Kazula clinic Healthcare facilities do not have adequate stock of drugs with efficient replenishment whenever necessary. The Healthcare facilities suffer some challenges with increasing their capacity and efficiency. For example, they do not have an ambulance, see Figure 5-7.
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Figure 5-7: A broken down Chiuta District Hospital van
5.2.9.1 Maternal and Child Health Most women in the villages deliver their children at home/in the villages, as they are relatively far from the Healthcare facilities. These women are assisted by traditional birth attendants, elders (women) and other women.
6 Impact Assessment This section provides an analysis of the potential impacts associated with the proposed Project and has included the analysis of potential negative impacts and their mitigation measures, but also includes potential positive impacts and measures to enhance these. The key health impacts and needs have been described in the EHA framework. While it is recognised that some of these existing health needs will be inherited by the proposed Project, and may be regarded as the responsibility of the government, they may influence the impacts and need to be considered for mitigation/management.
6.1.1 EHA #1 Vector-Related Diseases During active construction periods, the proposed Project may create new breeding sites for key mosquito vectors which would significantly increase the vector-borne disease risk. New water bodies, such as surface-water environmental-control dams or new reservoirs, may become magnets for local community members and increase the risks of injury, including accidental drowning. In addition, water storage facilities require careful environmental engineering (for example, shoreline slopes and vegetation control) to prevent development
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of vector breeding sites. During construction and operations phases, tires, drums, and other containers may become significant breeding sites for mosquitoes, with subsequent increased risk of dengue fever outbreaks. While the malaria burden is high in the communities, and there is obviously a suitable environment for mosquito breeding and disease transmission to occur, the project does have the potential to impact malaria transmission. This will require mitigation; interventions may differ based on seasonal and land use practices. Modification of the environment frequently changes the habitat for mosquitoes to breed in. The presence of dams and stagnant water within the proposed Project area strongly increases the malaria risk during the rainy season. Impact evaluation:
EHA #1: Vector Related Diseases Effect Risk or Overall Temporal Severity of Spatial Scale Likelihood Significance Scale Impact Current Situation Current Permanent (4) Regional (3) Severe (4) Definite (4) HIGH – (15) Construction Phase Without Short Term Regional (3) Severe (4) Definite (4) HIGH – (12) Mitigation (1) Short Term Study Level MODERATE - With Mitigation Moderate (2) Probable (3) (1) (2) (8) Operational Phase Without Long Term (3) Regional (3) Severe (4) Definite (4) HIGH – (14) Mitigation Study Level MODERATE – With Mitigation Long Term (3) Moderate (2) Probable (3) (2) (10)
Project impact mitigation
■ Support malaria awareness campaigns in the communities. This can be done in collaboration with the local health authorities;
■ Ensure project designs reduce the potential for sources of vector breeding;
■ Develop community based programs in partnership with the local authorities and based on the strategy of the national malaria control program e.g. ITN distribution; and
■ Any workplace malaria and vector control program should include measures for reducing the potential for increasing vector densities and thus decrease disease transmission in the communities.
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6.1.2 EHA #5 Soil, Water and Waste Related Diseases The communities in the proposed Project area have limited access to clean/improved water supplies. There is a heavy reliance on non-protected wells as a primary source of drinking water. Influx may also play a role in availability of water due to increased demand, which may ultimately negatively affect water quality. Water-borne diseases such as diarrhoea are common and are linked to contaminated water and poor sanitary conditions. Water-washed diseases4 such as eye and skin infections are common. These are linked to poor hygiene. Sanitation services in the area are limited and the prevalence of indicators for sanitation such as soil-transmitted diseases and schistosomiasis may suggest a high-level burden of disease. During active construction periods, the Project may create new breeding sites for key mosquito vectors which would significantly increase the vector-borne disease risk. Water storage facilities require careful environmental engineering to prevent development of vector breeding sites. During construction and operation phases, tyres, drums, and other containers may become significant breeding sites for mosquitoes, with subsequent increased risk of malaria outbreaks. Groundwater quality may be impacted during construction as a result of localised hydrocarbon spills that may occur at workshops and yellow metal laydown areas, or hydrocarbon storage zones. Another potential risk to groundwater quality at the site is domestic waste generated by construction contractors and client staff. An increase in income earned during construction and operational phases of the Project may improve the ability to afford basic environmental health services through increased access to such services and ability to pay for better services. This may result in a decline in cases of soil, water and sanitation-related diseases. Impact evaluation:
EHA #5: Soil, Water and Waste Related Diseases Effect Risk or Overall Temporal Severity of Spatial Scale Likelihood Significance Scale Impact Current Situation Current Permanent (4) Regional (3) Severe (4) Definite (4) HIGH – (15)
4 Water-washed diseases are infections that are caused by poor personal hygiene resulting from inadequate water availability. These ailments may be prevented if people have adequate supplies of clean water available for personal hygiene. Typical water-washed diseases include shigella, which causes dysentery, scabies, trachoma, yaws, leprosy, conjunctivitis, skin infections and ulcers.
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Construction Phase Without Short Term Regional (3) Severe (4) Definite (4) HIGH –(12) Mitigation (1) Short Term Study Level May Occur With Mitigation Moderate (2) LOW – (7) (1) (2) (2) Operational Phase Without Long Term (3) Regional (3) Severe (4) Definite (4) HIGH – (13) Mitigation Study Level May Occur MODERATE – With Mitigation Long Term (3) Moderate (2) (2) (2) (9)
Project impact mitigation
■ The quality of groundwater and surface water must be monitored to ensure that the proposed Project does not have any detrimental effects on community water sources;
■ In alignment with the District authorities' need for social infrastructure, and as part of the Community Livelihood Plan or the project owner’s Social Responsibility Plan, build infrastructure that can improve the local health standards such as hand pumps, latrines and sanitary landfills;
■ Influx management;
■ Restrict access to Project created water bodies;
■ Perform end user analysis of water quality. This serves as an indicator for monitoring water quality where it is consumed and determines the level of general sanitation and hygiene even if water is collected from clean sources;
■ Ensure proper disposal of human waste that is generated from the Project;
■ Conduct health education programs for project workers regarding hygiene, housing, nutrition, soil, water and sanitation issues related diseases; and
■ Ensure proper waste management from Project generated waste according to waste management principles.
6.1.3 EHA #6 Food- and Nutrition-Related Issues Food is secured through subsistence farming and the purchase of food items. FGDs revealed that from December, to March are the hungry months with less food available from agricultural production and increased likelihood of hunger. The staple diet of the households consists of maize, beans and green leaves. Inflation could reduce food security in a situation of already high food prices that communities cannot afford. Changes in eating and feeding practices also need to be considered over the medium term. The community may start buying more food in the form of
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refined products as a result of economic upliftment. A reduction in physical exertion may also result as a result of changing livelihoods. Impact evaluation:
EHA #6: Food and Nutrition related issues Effect Risk or Overall Temporal Severity of Spatial Scale Likelihood Significance Scale Impact Current Situation Study Area May Occur MODERATE – Current Permanent (4) Slight (1) (2) (2) (9) Construction Phase Without Short Term Study Area MODERATE – Severe (4) Probable (3) Mitigation (1) (2) (10) Short Term Study Area May Occur With Mitigation Moderate (2) MODERATE - (1) (2) (2) Operational Phase Without Study Area Long Term (3) Severe (4) Probable (3) HIGH - (12) Mitigation (2) Study Area May Occur With Mitigation Long Term (3) Moderate (2) MODERATE - (2) (2)
Project impact mitigation:
■ Support sustainable livelihood programs through increased use of agriculture. It is essential to support the financial benefit of farming over other–such as community projects (garden projects at schools and villages); ■ Support mitigation measures for communicable diseases such as malaria, diarrhoea and respiratory infection to reduce the co-morbidity created by malnutrition; ■ Improve food security by: . Collaborating with the MoH to conduct anthropometric monitoring (height, weight, age) within the potentially affected communities; . Assisting with school feeding programmes, including education on food gardens, nutrition, and good nutritional habits; . Running competitions between schools on nutritional issues to create awareness;
■ Favour local procurement of food items in combination with incentives to increase local production.
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6.1.4 EHA #7 Accidents/Injuries Two options exist for access to the project site: from the north via the EN221 and EN222, or from the south along the haul road which will be used during the operations phase. It is likely that the haul road will be constructed first, but left as a gravel road until the operational phase to prevent damage during the construction phase. The haul road is thus likely to carry heavy traffic and generate a lot of dust, affecting houses and crops in close proximity to the road. Construction works and operational activities will involve intense traffic of heavy vehicles and equipment, significantly increasing the traffic in the project area. As a result, there may be an increase safety risk to pedestrians (especially children), private road users and livestock. The incidence of vehicle accidents may also increase, partly because the road network in the project area is poor and the local population is used to low traffic volumes. This is of particular concern to the community of Mboza, located along the projected haul road. Impact evaluation:
EHA #7: Accidents/Injuries
Effect Risk or Overall Temporal Severity of Likelihood Significance Spatial Scale Scale Impact
Current Situation
May Occur MODERATE – Current Permanent (4) Regional (3) Moderate (2) (2) (11)
Construction Phase
Without Short Term Regional (3) Severe (4) Definite (4) HIGH - (12) Mitigation (1)
Short Term Study Area With Mitigation Moderate Probable (3) MODERATE - (1) (2)
Operational Phase
Without Long Term (3) Regional (3) Severe (4) Definite (4) HIGH – (14) Mitigation
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Study Area May Occur With Mitigation Long Term (3) Moderate (2) MODERATE -) (2) (2)
Project impact mitigation: ■ Improve road safety through the following means: . Collaborating with the district road-safety unit to establish and maintain pictorial road-safety signage near the site in the local language and English language (if needed); . Clearly demarcated pedestrian crossings in appropriate places; . Provide descriptions along project roadways directly surrounding project facilities, including conveyor-belt routes, roadway rerouting areas, and heavy-equipment crossing areas; ■ Develop and implement an Emergency Preparedness and Response Plan for construction and operation, including provisions to deal with traffic accidents, particularly accidents involving personal injuries. All drivers must be made aware of the procedures to be followed; ■ Develop community security and safety management plans for the project related to the different activities. This should include emergency response plans for both community related accidents and for the workplace and include a fire, rescue and chemical spill response capability, as well as medical emergency response strategies; and ■ Develop a clear policy for the management of emergencies or accidents in the community as a direct result of the projects activities.
6.1.5 EHA #8 Exposure to Potentially Hazardous Materials, Noise and Malodours The proposed Project has the potential to create significant environmental health concerns if such areas are not well managed. Concerns relate mainly to waste, water and air quality.
6.1.5.1 Solid Waste (General and Hazardous) Waste streams likely to be produced during the construction phase will include both general (non-hazardous) and hazardous wastes, and are expected to be similar in composition to the non-process wastes or co-products produced during the operational phase. The domestic waste stream will be comprised predominantly of non-hazardous waste types including paper, plastic, cloth and some food waste. In addition, relatively insignificant quantities of hazardous wastes may be included in this waste stream, including batteries, empty containers for cleaning chemicals, fluorescent light tubes, pesticide aerosol cans etc.
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Waste storage drums that have industrial residues may adversely impact household water and food supplies, because these containers are often prized as inexpensive storage devices. The construction and rehabilitation activities will also result in the generation of hazardous wastes including chemicals associated with machine and vehicle maintenance, oily rags and filters, empty containers for hazardous chemicals (paints, solvents, lubricants, herbicides, pesticides / herbicides) and electrical and electronic equipment. The uncontrolled storage of solid waste, in particular food waste, can attract vermin and pests including rodents, birds and flies. These vermin / pests may pose a nuisance to adjacent communities of Tenge-Makodwe and Nhamidima and may act as vectors for disease. The uncontrolled storage of solid waste can result in the release of unpleasant odours which may be regarded as a nuisance to adjacent land-users, particularly that down- wind of the material. Odorous compounds are also released from relatively well-managed solid waste disposal facilities. The presence of large quantities of litter around the facility or at the proposed landfill may constitute a visual impact to employees and local communities.
6.1.5.2 Disposal of Waste Rock and Tailings Although the project area is only sparsely populated, the communities of Tenge-Makodwe and Nhambia are within the footprint of the project site. In the highly unlikely event of a TSF failure, unstable tailings material could pose a risk to members of nearby communities. In addition, there is also a chance of small scale instability events on the slopes of the rock dumps which may result in injury to employees working at the dumps but these risks would normally be managed along with other routine occupational health and safety risks. A long term impact may occur within the study area and due to the potential for harm to individuals, including possible fatalities the severity of the impact is regarded as high.
6.1.5.3 Pollution of Soil and Water Resources While little information was available regarding potential environmental health exposures the following were considered and highlighted in the key informant interviews. The majority of households use wood for cooking and heating that may cause a health risk from indoor air pollution and associated respiratory health concerns. The housing arrangements and electrification of the area reduce the risks of this. Bush fires may also play a role as the emergency services are very limited. As waste removal from households is a serious challenge, many households burn waste that can emit harmful by products, especially plastics, having an adverse effect on human health. Although no dumping sites were observed during the field visit, rural areas such as these often have illegal dump sites and those which are available can contaminate water supplies and present unhygienic conditions, further exacerbating the negative impacts of human health. Run-off water is likely to be generated on site as a result of the high rainfall, washing of machinery (including vehicles) and, possibly, dust suppression activities. As this water
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migrates across the site it has the potential to pick up various pollutants such as hydrocarbons and small solid particles. Furthermore, the run-off from machine washing activities is also likely to contain hydrocarbons. If this water is discharged without treatment, chemicals (hydrocarbons, pesticides etc.) and sediment could be transported into surface and sub-surface water bodies, resulting in ecological disruption. Impact evaluation:
EHA #8: Exposure to Potentially Hazardous Materials, Noise and Malodours Effect Risk or Overall Temporal Severity of Spatial Scale Likelihood Significance Scale Impact Current Situation Study Area MODERATE – Current Permanent (4) Slight (1) Unlikely (1) (2) (8) Construction Phase Without Short Term Regional (3) MODERATE – Severe (4) Probable (3) Mitigation (1) (11) Short Term Study Area With Mitigation Moderate (2) Unlikely (1) LOW – (6) (1) (2) Operational Phase Without Very Severe VERY HIGH – Long Term (3) Regional (3) Definite (4) Mitigation (8) (18) Study Area With Mitigation Long Term (3) Moderate (2) Unlikely (1) MODERATE - (2)
Project impact mitigation:
■ All wastes must be managed according to the requirements of Mozambican legislation and, preferably, the requirements of the IFC General EHS Guidelines (2007);
■ A Storm Water Management Plan must be developed for the mine and it should incorporate measures to divert clean storm water away from stockpiles, waste storage and disposal areas and other operation areas;
■ The quality of groundwater and surface water must be monitored to ensure that the proposed Project does not have any detrimental effects on community water sources;
■ Evaluate and manage air, water and noise issues as part of the environmental impact assessment and environmental management plan requirements. Human health considerations should be considered based on results of the surveillance activity;
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■ The management of waste rock and tailings will conform to the requirements of the IFC’s EHS Guidelines for Mining (IFC, 2007);
■ Limiting the size of the tailings and waste rock stockpiles by trucking to the waste rock dump as soon as possible and also careful selection of sites for stockpiling so as to minimise negative impacts to vegetation and water resource. In addition, seepage water should be channelled to a central collection point to avoid water resource contamination.
■ As far as practical, the waste rock dump must be sited in a location such that in the event of failure, pollution of soil and water as well as physical risk to communities is minimised;
■ The integrity of the waste rock dump and tailings facility must be inspected regularly by suitably qualified personnel throughout the life of the mine;
■ Access to the TSF and waste rock dump should be restricted as far as practical and all local communities should be informed of the potential risks associated with these facilities through site notices and community meetings.
6.1.6 EHA #9 Social Determinants of Health
6.1.6.1 Gender-based Violence and Substance Abuse Alcohol abuse is currently a major problem in the local study area, and these have the potential to increase during the lifespan of the proposed Project. The SIA confirms this through the discussion of alcohol abuse (not much of a problem with drugs), and how this reinforces and accounts for a range of social pathologies, such as intra-household violence and women abuse. This would be due to the increase in income and mobility, affording individuals who previously could not afford these substances, to now indulge. While drug abuse is currently not a major problem, these have the potential to increase during the lifespan of the proposed Project. Impact evaluation and management measures:
EHA #9: Social determinants of health: Gender-based violence, alcohol and drugs Effect Risk or Overall Temporal Severity of Spatial Scale Likelihood Significance Scale Impact Current Situation Study Area Current Permanent (4) Severe (4) Definite (4) HIGH – (14) (2) Construction Phase Without Short Term MODERATE – Regional (3) Severe (4) Probable (3) Mitigation (1) (11) With Mitigation Short Term Study Area Moderate (2) May Occur LOW – (7)
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(1) (2) (2) Operational Phase Without Long Term (3) Regional (3) Severe (4) Definite (4) HIGH – (14) Mitigation Study Area May Occur With Mitigation Long Term (3) Moderate (2) MODERATE -) (2) (2)
Project impact mitigation: ■ Support information programs in the community on domestic violence, role of men and support of women, alcoholism and drug abuse; ■ Reduce substance-abuse and improve social cohesion by: . Conducting substance-abuse prevention education programs in the local schools and churches; . Providing recreational facilities for workers without families; . Contributing to the establishment of appropriate community recreation facilities- considering needs and assets of community; . Collaborating with the relevant authorities to establish a system to monitor violence and community cohesion related to project activities; . Participating in violence-prevention education programs, focusing on gender violence. ■ Support local authorities with improved policing and criminal justice system for gender-based violence; ■ Social management plans and recommendations as part of the SIA.
6.1.6.2 Employment and Influx Management During the construction and operational phases, it is possible that very few jobs will materialise or that workers will be drawn in from a wider area, with no appreciable benefit to local people. This may be due to local people not having the requisite skills for some of the skilled work. If the proposed developments do create jobs, it should be possible to negotiate planning agreements to provide training to prepare local people for employment. It is not possible to make job creation forecasts, as they are necessarily speculative, but experience at other locations suggests that the number of jobs for local people is usually over-estimated. As explained in the SIA, the construction and operation of the project will result in an influx of manpower and individuals outside the area of the project, in search of jobs and business opportunities in the project area. This may attract to the project area fringe elements that
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travel to undertake illegal activities, including labour and sexual exploitation, particularly of children, as observed elsewhere in large construction projects in Mozambique. The proposed Project faces the risk of unforced or voluntary migration, where it is assumed that migrants would be acting out of a rational self-interest as the motivating factor for moving. Often, if people are leaving behind adverse home conditions, they are migrating because of perceived opportunity rather than any specific guarantee of a job, particularly if a member of their extended family is already resident in the area (IFC, 2009). Migration is expected to yield positive benefits for the individual migrant (and his/her household), whether through remittance of incomes or settlement in the new location. In some circumstances, a significant migrant population may exist prior to project arrival, including artisanal and small- scale miners (ibid.). The long development cycles of large-scale projects such as the proposed Project can mean high levels of initial public awareness and speculation about Project development, often well before the project has a substantial physical presence. Such speculation raises local, regional, and national expectations of, and interest in, the potential for capturing benefits from the project. Thus begins a process by which numerous stakeholders position themselves to take advantage of any real or perceived Project-generated opportunities. The pattern of labour-based and economic in-migration typically follows project demand for labour (ibid.). In the case of the proposed Project, the construction phase has the highest workforce requirements. As the proposed Project moves from construction to operational phase, and requires a smaller and more stable workforce, recently arrived migrants may move on as employment opportunities decrease and the disposable income of the local population declines. Due to the low levels of socioeconomic development and unemployment in the Project area there might be high expectations about project benefits (compensation for lost assets, improved social infrastructure and services, employment). Differential project benefits may create conflicts between households and between communities in the proposed Project area and this can negatively affect project acceptance and social stability. This has been discussed in depth in the SIA. Education is also a major existing need in the community. The level of education in the proposed Project area is low. It was observed to be a priority developmental need in the community. Women’s literacy is extremely important to enhance health needs in the family unit as they are the gatekeepers to health. Once the mine becomes operational, several permanent jobs will be created, constituting of skilled, semi-skilled and unskilled labourers. Many of the highly-skilled workers may come from outside of the proposed Project area which may result in community tension and a reduced sense of well-being. Impact Evaluation and management measures:
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EHA #9: Social determinants of health: Employment and Influx Management Effect Risk or Overall Temporal Severity of Spatial Scale Likelihood Significance Scale Impact Current Situation Current N/A N/A N/A N/A N/A Construction Phase Without Short Term Regional (3) Moderately Definite (4) MODERATE - Mitigation (1) Beneficial (2) Short Term Regional (3) Substantial MODERATE + With Mitigation Probable (3) (1) Benefit (4) (11) Operational Phase Without Regional (3) Moderately Long Term (3) Probable (3) MODERATE - Mitigation Beneficial (2) Regional (3) Substantial With Mitigation Long Term (3) Definite (4) HIGH + (14) Benefit (4)
Project impact mitigation
■ Make recruitment and procurement rules and opportunities transparent and accessible to the public. Information about job opportunities should be made available outside the mining camp, possibly with the involvement of local leaders. The Human Resource manager, together with the community liaison officer, will be in charge of this based on the project’s Procurement Plan. In order to avoid the gathering of job seekers at the project’s gates, it might be necessary to hire labour brokers;
■ Prioritise local labour from the communities in the project area and surrounding communities, with gender balance. Due to lack of previous mining projects in the area, there might be a lack of skilled labour. Unskilled labour may be available for simple tasks such as trenching and security. With the provision of technical training, skilled labour may be available for simpler technical tasks and operation of machinery;
■ Refer to social management plans and recommendations as part of the social impact assessment; and
■ Plan for closure. Throughout project-cycle publish materials for community; include information about the closure and decommissioning phase and its effects on both workers and communities. Programmes focusing on counselling, to assist with social issues such as depression associated with retrenchment and reskilling of employees in advance.
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7 Conclusion This Report has indicated the need for monitoring and continued management to verify that mitigation measures are being implemented. A plan for continuous monitoring, adaptation of mitigation measures, and verification of performance, known as a cHMP, will assist in ensuring that measures are carried out and achieving their objectives. This plan would determine the authority for and assign responsibility for implementing each recommendation, establish a monitoring plan, and create or suggest mechanisms to verify that assigned responsibilities are being adhered to/met. Baobab will therefore need to develop a clear framework cHMP to address some of the potential impacts outlined in the section above. To support this, it is recommended that a surveillance programme be developed to monitor the identified health impacts and management measures implemented to manage them. Monitoring should focus on measures that are likely to be sensitive and early indicators of change. Monitoring and evaluation (M&E) plans should be based on appropriate, applicable, and relevant key performance indicators (KPIs) and this it is important to have a robust baseline with areas that can be measured based on impact management and interventions.
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Appendix A: Plans
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Appendix B: FGD Questionnaires
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Appendix C: Key Informant Interview Questionnaire
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Appendix D: Directorate Interview Questionnaire