A Mining Health Initiative case study: Rio Tinto QMM and its health programme in Madagascar: Lessons in Partnership and Process January 2013 1 FUNDING The Mining Health Initiative is grateful to the following organisations and foundations for the financial support that made this project and this case study possible. CONSORTIUM The Mining Health Initiative is implemented by a consortium comprising the following organisations and institutions. 2 Contents FUNDING ................................................................................................................................................. 2 CONSORTIUM .......................................................................................................................................... 2 ACRONYMS ............................................................................................................................................. 5 EXECUTIVE SUMMARY ............................................................................................................................ 7 Inside the fence ............................................................................................................................... 7 Outside the fence ............................................................................................................................ 8 Alignment with the national health system .................................................................................... 8 1. BACKGROUND AND PURPOSE OF THE CASE STUDY ....................................................................... 9 2. CASE STUDY METHODOLOGY ....................................................................................................... 11 Constraints .................................................................................................................................... 11 3. CONTEXT ANALYSIS ....................................................................................................................... 12 3.1. Company profile .................................................................................................................... 12 3.2. Country information ............................................................................................................. 15 Recent historical and political overview ....................................................................................... 15 Demographic profile ..................................................................................................................... 15 Development status ...................................................................................................................... 16 Madagascar and EITI ..................................................................................................................... 16 3.3. Health status ......................................................................................................................... 17 National level ................................................................................................................................ 17 3.4. Health system: structure, functionality and accessibility ..................................................... 19 3.5. MOH strategic priorities ........................................................................................................ 20 3.6. Stakeholder context .............................................................................................................. 21 4. PROGRAMME CHARACTERISTICS .................................................................................................. 22 4.1. Overview ............................................................................................................................... 22 4.2. Conception process ............................................................................................................... 22 4.3. Components of the health programme ................................................................................ 23 Inside the Fence ............................................................................................................................ 23 Outside the Fence ......................................................................................................................... 27 4.4. Programme management structure ..................................................................................... 29 3 5. PARTNERSHIPS .............................................................................................................................. 31 5.1. Overview of partners ............................................................................................................ 31 Inside the Fence ............................................................................................................................ 31 Outside the Fence ......................................................................................................................... 31 5.2. Financing modalities ............................................................................................................. 33 6. PROGRAMME COSTS ..................................................................................................................... 33 6.1. Inside the fence services ....................................................................................................... 33 6.2. Outside the fence services .................................................................................................... 35 7. PROGRAMME BENEFITS AND IMPACT .......................................................................................... 39 7.1. Employees and families ........................................................................................................ 39 7.2. Communities ......................................................................................................................... 40 Impact on Disease ......................................................................................................................... 40 Impact on Access .......................................................................................................................... 40 7.3. Mining company ................................................................................................................... 41 Impact on Workforce Productivity ................................................................................................ 42 Social License to Operate .............................................................................................................. 42 7.4. Local government and health system ................................................................................... 42 8. CONCLUSIONS AND LESSONS LEARNED ....................................................................................... 44 Inside the fence ............................................................................................................................. 44 Outside the fence .......................................................................................................................... 45 Alignment with the national health system .................................................................................. 46 9. REFERENCES .................................................................................................................................. 47 10. ANNEX ....................................................................................................................................... 49 10.1. Annex A: Persons interviewed .......................................................................................... 49 10.2. Annex B: Recommendations to RTQMM .......................................................................... 52 10.3. Annex C: Further information on functionality and accessibility of the health system ... 54 4 ACRONYMS AIDS Acquired Immune Deficiency Syndrome ANC Antenatal Care ARI Acute Respiratory Tract Infection AusAID Australian Agency for International Development CSB Centre de Santé de Base, basic health centre CSR Corporate Social Responsibility CHW Community Health Worker DFID Department for International Development (UK) DHS Demographic and Health Survey DRSP Direction Régionale de Santé Publique, regional health management team EITI Extractive Industries Transparency Initiative FTSE Financial Times and Stock Exchange GAVI Global Alliance for Vaccines and Immunisation GFATM Global Fund to fight HIV/AIDS, Tuberculosis and Malaria GIZ Gesellschaft für Internationale Zusammenarbeit (German Government Agency for Development Cooperation) GP General Physician (medical doctor) HANSHEP Harnessing Non-State Actors for Better Health of the Poor HDI Human Development Index DHS Demographic and Health Survey (EDS = Enquête Démographique et de Santé) HIV Human Immuno-deficiency Virus ICMM International Council on Mining & Metals IFC International Financial Corporation IRS Indoor Residual Spraying LLIN Long Lasting Insecticide treated Nets M&E Monitoring and Evaluation MDG Millennium Development Goal MHI Mining Health Initiative MOH Ministry of Health NGO Non Governmental Organisation 5 OPIC Organisation Publique de Coopération Inter-Communautaire, Public Organisation of Intercommunity Cooperation PDSSPS Plan de Développement du Secteur Santé et de la Protection Social, Development Plan for the Health and Social Protection Centre PEPFAR President’s