Executive summary

• Objectives
• Activities
• Dashboard of priority health risks/impacts
• Key findings and recommendations

Lists

• List of tables
• List of figures
• Acronyms
• Glossary

Terms of reference

• Project background
• Objectives of:
  • HIA
  • Outputs of the CHSMP
• Scope of work

Site description and activities (expanded from internal context)

• Project location and community context
• Overview of project/site activities, key operational aspects and infrastructure (e.g. front-end engineering design)
• Labour force and accommodation
• Project/site temporal boundaries
• Project/site spatial boundaries (linear features (roads))
• Specific elements:
  • Size and origin of workforce (especially contractors)
  • Housing/accommodation
  • Water supply and sanitation
  • Waste management
  • Need for dams
  • Current/planned workplace health services
  • Transport (goods and workers)
  • Need for displacement/resettlement
  • Potential for site-induced migration (SIM)
  • Current, planned or past SED development initiatives

Relevant legislation and regulations

• National regulations and legislation
• International management standards and regulations

Health-impact assessment approach methodology

Activities performed in the health-impact assessment

• Form and level of HIA (desk/rapid/comprehensive)
• Completed activities:
  • Desk-based data collection
  • Field-based data collection
  • Stakeholder engagement and analysis

Community profile

• Demographics
• Systemically vulnerable groups
• Potentially affected stakeholders

Baseline health status (expanded from external context)

• Key indicators and burden of disease from national, regional and district
• Key indicators and burden of disease data at the local level as a summary
• Key indicators, health outcomes and related determinants at a local level, described per CHS areas

Impact/risk assessment and associated mitigation/ management measures

• Described per CHS areas
• Ideally separated into direct, indirect and, where relevant, cumulative impacts
• Ideally, link management controls to the relevant impacts

Consideration of alternatives

• (more for projects where design elements can be considered for change)

Limitations

CHSMP in a matrix

• Per thematic area
• Summarised from the impact/risk-assessment section
• See Tool 4C. 6

Summary

As relevant

References

Appendices/Annexes

1. Communicable diseases linked to the living environment and housing

• Links to inadequate housing design, overcrowding and housing inflation
• Indoor air pollution related to use of biomass fuels
• Poor socio-economic conditions
• Diet and nutrition
• Age (e.g. with children vulnerable to certain disease or indoor air pollution)
• Health prevention and care-seeking behaviour
• Access to, acceptability and affordability of health services
• Education

Transmission of communicable diseases through close contact and via the respiratory or droplet route:

• Bacterial: bacterial pneumonia (e.g. Streptococcus pneumonia, Haemophilus influenzae etc.) bacterial meningitis (Group B streptococcus), plague, diphtheria, and pertussis.
• Mycobacterial: tuberculosis, leprosy
• Viral: Covid-19, influenza, viral meningitis, measles, varicella, rhinovirus, RSV etc.

2. Vector-related diseases

• Housing
• Poor socio-economic conditions
• Environmental sanitation/hygiene
• Health prevention and care-seeking behaviour
• Access to, acceptability and affordability of health services.
• Age and pregnancy
• Education

• Mosquito: malaria, dengue, yellow fever, lymphatic filariasis, rift valley fever.
• Fly: human African trypanosomiasis, onchocerciasis, etc.)
• Tick and flea: rickettsial, lyme’s disease, plague
• Lice-related diseases

3. Soil, water- and waste-related diseases

• Poor socio-economic conditions
• Access to basic services
• Water access and quality
• Household water treatment and storage
• Sanitation/excrement management and soil contamination
• Food safety/contamination
• Health prevention and care-seeking behaviour
• Access to, acceptability and affordability of health services.
• Age
• Education

Diseases that are transmitted directly or indirectly through contaminated water, soil or non-hazardous waste:

• Diarrheal diseases- bacterial (E.coli, shigella, cholera, salmonella), protozoal (giardia) and viral (rota-virus)
• Schistosomiasis (bilharzia)
• Hepatitis A and E
• Poliomyelitis
• Soil-transmitted helminthiases (hookworm) or intestinal parasites (round worm)

4. Sexually transmitted infections

• Poverty
• Gender inequality
• Health prevention and care-seeking behaviour
• Access to, acceptability and affordability of health services
• Substance abuse
• Cultural
• Education

• Sexually transmitted infections such as syphilis, gonorrhoea, chlamydia, hepatitis B and, importantly, HIV/AIDS.
• Often co-morbid linkages to other conditions such as HIV and TB

5. Food and nutrition-related issues

• Age
• Poverty
• Gender
• Feeding behaviours and practices
• Changes in agricultural and subsistence (hunting, gathering) practices, including shift to cash-based economy.
• Food safety and security
• Access to land plays a major role in developing subsistence-farming contexts
• Food inflation
• Climate and propensity for disasters
• Education

• Under- and over-nutrition
• Anaemia or micronutrient deficiencies (folate, Vitamin A, iron, iodine)
• Food hygiene and related conditions
• Malnutrition plays a co-morbid factor in many diseases (e.g.):
  • Obesity with non-communicable diseases
  • Increase morbidity and mortality due to infectious disease in children
  • Low-birth-weight children

6. Non-communicable diseases

• Age
• Gender
• Genetics
• Poverty
• Substance abuse
• Cultural
• Education
• Feeding behaviours and practices
• Health prevention and care-seeking behaviour
• Access to, acceptability and affordability of health services
• Exposure to hazardous substances

• Cardiovascular diseases (hypertension, heart disease, stroke)
• Diabetes
• Chronic lung disease
• Cancer

7. Accidents/injuries and safety-related issues

• Age
• Gender
• Poverty
• Substance abuse
• Emergency-response services
• Health facilities
• Exposure to hazardous substances
• Culture
• Education
• War and conflict (safety/security)
• Police and justice system
• Social and community cohesion

• Road traffic accidents
• Work-related accidents
• Community accidents related to site infrastructure and equipment, including blasting, tailings storage facilities, water control dams, mobile equipment, vehicles on public roads, etc.
• Non-accidental trauma linked to inter-personal or crime-related violence.
• Gender (domestic)-based violence

8. Veterinary medicine and zoonotic diseases

• Poverty
• Culture
• Diet and nutrition status
• Health and risk-taking behaviour
• Education
• Health prevention and care-seeking behaviour
• Access to, acceptability of, and affordability of health services
• Food inflation
• Climate and propensity for natural disasters
• Ecosystems services and biodiversity

• Diseases affecting animals (e.g. bovine tuberculosis, swinepox, avian influenza).
• Diseases that can be transmitted from animal to human (e.g. rabies, brucellosis, Rift Valley fever, Lassa fever, Ebola fever leptospirosis, etc.).

9. Environmental health determinants

As described in Box 4C.3, this considers the environmental health determinants linked to the project/site and related activities. Quantifiable risks to communities attributable to site activities can be modelled (e.g. generally following a human health risk assessment methodology) and impacts on well-being and quality of life associated with project-attributable changes in determinants of health can be assessed (generally using qualitative methods of assessment and including both actual measurable changes, as well as perceived changes, i.e. linked to communities’ perception of risk). Determinants include:

• Noise, water (surface/ground), soil pollution, and air pollution (indoor and outdoor).
• Exposure to heavy metals and hazardous chemical substances and other compounds from process activities. These can be related to emissions, or spills (including transport, disposal) or transfer from the workers to the public (e.g. on contaminated clothing).
• Ionizing radiation
• Visual impacts
• Malodours

There is a significant overlap in the environmental impact assessment in this section. Outcomes may include:

• The hazard and potential exposure.
• Emergency-response systems to deal with acute exposure episodes.
• Psychosocial stress and mental health issues.

10. Social determinants of health

As described in Box 4C.3 this considers the social health determinants and may include:

• Gender
• Poverty
• Social status
• Housing
• Land access and physical/economic displacement
• Inequalities
• Education
• Employment and working conditions
• Culture and ethnicity.
• Security and violence
• Substance abuse
• Access (transport, information, communication)
• Affordability
• Social and community cohesion
• Expectations of the project

There is a significant overlap in the social impact assessment in this section. Health outcomes may include:

• Psychosocial stress and mental health issues
• Gender issues and gender-based violence
• Suicide

11. Health-seeking behaviours and cultural health practices

• Poverty
• Culture
• Health and risk-taking behaviour
• Education
• Health prevention and care-seeking behaviour
• Access to, acceptability and affordability of health services
• Ecosystems services and use of traditional plant-based medicine

• Herbal intoxication
• Delayed care-seeking behaviour

12. Health systems issues

Health system determinants, including:

• Health system
• Health policies and plans
• Physical health infrastructure, including governance and quality management systems, accessibility, affordability, capacity training, building of infrastructure, services, equipment and supplies, referral systems future development plans, etc.
• Human resources for health
• Health financing
• Health programmes management delivery systems (e.g. malaria, TB, HIV/AIDS initiatives, maternal and child health, etc.)
• Health-management information system

• Various health outcomes linked to health services and systems

Objective

• Identifies and anticipates the future health risks and impacts that may be associated with a project/site
• Link to 4C toolkit.

• Identifies and evaluates the existing or current health needs in the community.
• Link to 4A toolkit.

• Identifies and evaluates workplace hazards and exposure risk assessment.
• Link to SHE way and occupational health and safety risk assessments.

Outputs

• Development of a CHSMP supported by an effective monitoring plan.
• Mitigation hierarchy seeks to avoid, minimise or mitigate risks and impacts rather than remediate and compensate/offset them.

• Development of a community health improvement plan that addresses public health challenges on the basis of the results of the community health needs assessment.
• Plan is used to set priorities and to co-ordinate and target resources for maximal and sustained benefits.

• Development of an occupational health and safety management plan with clear protective and preventive controls.
• Controls hierarchy with a preference for preventative controls (elimination, substitution and elimination), and where these are not possible, mitigation controls (separation, administration and, finally, personal protective equipment (PPE)).

Legislation

• Generally limited, with a narrow focus to consider health protection/health promotion as part of environmental management acts.
• With a few exceptions, public health legislation that incorporates the assessment of potential community health and safety risks and impacts is not available.
• Often poor linkages between health acts and environmental management acts, so health not integrated and no specialist health review capability of EIA.

• May be mandated in certain jurisdictions to support the development of health policies and health plans. However, this may be a public policy requirement and not one that a mining company needs to consider.
• May be a project commitment as part of a social development or a social labour plan.

• Generally mandated under national occupational health and safety or mine health and safety regulations.

Spatial

• The scope is focused on an area defined by the activities of the impact assessment, termed the area of influence (AOI).

• The scope is focused on a pre-defined area that is established as part of the programme design.

• Workplace.
• May extend to contractor work areas and aspects such as transport providers.

Temporal

• Considers the lifecycle of the project, from pre-feasibility to construction, operations, decommissioning and post-closure – so, the full life of asset plan.

• Considers programmatic targets set by the proposed intervention; e.g. 5 to 10-year goals or plans.

• Requires continual review and update.

Consideration of area of influence (AOI)

• The project/mine is central to impacts (direct/ indirect/cumulative), and prevention/ mitigation are focused on anticipated impacts.
• The populations in the AOI are often termed potentially affected stakeholders, including those that [may] be directly and indirectly affected by the project.
• Sensitive receptors may be present in the AOI.
• PACs may be homogeneous and heterogeneous, depending on the type of impact.
• Management interventions are both ‘inside and outside the fence’.

• Does not generally consider the influence of a project or mine on existing community health needs and priorities of interventions.
• potentially affected stakeholders and their homo/heterogenicity are generally not considered.
• Management interventions are always ‘outside the fence’.

• Management interventions are always ‘inside the fence’.

Use of baseline data

• Baseline data collection focused on proposed level of the assessment. Not all projects/sites require extensive data-collection activities.
• Baseline data serves to broadly inform the evidence (key burden of disease and related determinants) to inform the identification and evaluation between site-related activities and community-level impacts.
• Collected baseline data may provide a useful point of departure, the effective monitoring of impacts and interventions is generally supported by specific data-collection processes that feed into a surveillance system.

• Baseline data collection is focused on establishing the priority health challenges and opportunities for improvement.
• Generally, does not consider the potential CHS impacts or risks from a site/project.
• May or may not be able to monitor interventions through the baseline data collected (depends on range and depth).
• Baseline data, ideally, should be collected as part of the intervention to monitor success factors.

• Generally, includes a rapid appraisal of baseline data to determine CHS risks to the workforce:
  • Biological risks factors from communicable diseases
  • Safety concerns
  • Emergency preparedness and response to accidents and injuries
  • Health system strength to recognise and respond to a disease outbreak.
  • Health services to support the needs or the workforce
  • Environmental health factors such as food and water hygiene.

Health topics methodology

• Generally, follows the environmental and social determinants of health and health-outcomes model as described in the community health and safety area framework approach.

• No set methodology, but can be focused on indicators linked to a planned intervention; for example, a pre-defined water and sanitation programme will consider related indicators.
• Can use methods such as the Sustainable Development Goals (SDGs) – especially SDG No. 3 which relates to health and well-being.
• Can follow a CHSA methodology.

• Follows specific health risk assessment methodology as defined in the SHE Way and ORM.

Health system alignments

• The health system is viewed in terms of its institutional capacity and ability to ‘absorb’ or support anticipated impacts- which may include specific strengthening

• The health system is viewed with regards to what ways it needs to be supported or strengthened.

• The health system in viewed in terms of its institutional capacity and ability to support potential workplace health requirements
• Emergency preparedness and response capacity.

Focus of interventions or controls

• Interventions are either required or recommended to mitigate negative impacts and should not be viewed as voluntary.
• Focus on risk and impact mitigation either at:
  • The level of the community.
  • Within the workplace to prevent or manage community health impacts from an environmental, safety, health or social perspective.

• Interventions (from a private-sector perspective) are generally considered as ‘voluntary contributions’ or ‘negotiated commitments’.
• Interventions have the potential to enhance management measures proposed in respect of impact assessment.

• Primarily workplace
• Some controls that can limit community-based exposure, with these often considered as part of the HIA.

Priority-setting

• Based on the risk and impact assessment that considers SHIRA requirements.

• Based on an SED element priority matrix.

• WRAC

External stakeholder engagement

• Requires extensive engagement.

• Requires extensive engagement.

• Requires limited to no consultation.

Community stakeholder

• Requires proactive and diverse community engagement
• Needs to consider systemically vulnerable groups.

• Requires proactive, broad and diverse community engagement
• Requires multi-sectoral collaboration and transparency
• Should involve the community as co-decision-makers to improve engagement, participation and accountability
• Community and government priorities can often present divergent views

• Generally, not required unless communication on workplace exposure risks and controls is required to manage stakeholder perceptions.

Sustainability considerations

• Not central, as primary focus is on risk and impact management.
• Sustainability may be considered for interventions that include health systems strengthening or similar.

• Sustainability of interventions is a key determinant, with clearly defined exit strategies.

• Not applicable as workplace controls.

Monitoring and evaluation

• Essential
• Baseline data collected as part of impact assessment may be adequate to inform impacts, but not always suitable to monitor impacts or interventions.

• Essential
• Baseline data may be collected as part of interventions to track outcomes.

• Essential.

Task 1: Scoping

• To establish a detailed understanding of the project
• Anticipating potential health impact areas of concern/benefit
• Review available data, define data gaps and data closure opportunities
• Define level of HIA and required tools, resources

• Internal
  • Ideally, internal process
  • Allocate CHS lead
  • Establish CHS steering committee that reports to the SPMC
  • Establish CHS working group
  • Group CHS specialist support
• External consultant
  • Role may be limited to data review and collection at this stage
  • Scoping may require CHS specialist support if resources not available at site/BU/ Group

• Map key external stakeholders and likely issues/concerns
• Initial engagement with public health authorities at local or regional level.
• Engage public health programme managers
• Engage health agencies or non-governmental organisations (NGOs)
• Engage community or faith-based organisations
• Limited field visits and local stakeholder engagement

• Formal scoping exercise report:
  • Summary internal context
  • Summary of external context as initial baseline health description and legislation review
  • Description of potential health impact areas of concern
  • Outline potential data gaps and data closure opportunities
  • Define level of HIA
  • Terms of reference/ summary of next steps

• Depends on the complexity of the project and ability to engage with external stakeholders
• Generally, 4-8 weeks.

Task 2: Review context (baseline data collection)

• Collect additional baseline health data based on the data gaps determined in the scoping exercise.
• Data collection may also serve to support SED programmes in 4A

• Internal
  • CHS lead responsible
  • Support from CHS steering and working group
  • Group CHS specialist support
• External consultant
  • Generally required to support baseline data collection (depends on scope)

• Extensive engagement with actors mentioned in scoping
• Extensive engagement with community, including potentially participatory data collection
• Potential need for ethical approval.

• A fully referenced baseline health report aligned to the defined scope
• Note that the scope of the HIA may differ from the scope of a baseline that may be required to support SED health and wellness programmes

• Depends on the complexity of the scope.
• Primary quantitative cross-sectional studies may take 6-9 months.

Task 3 and 4:

• Risk/impact Assessment
• Update SHIRA

• Identify and analyse the existing health data, systemic vulnerabilities and evaluate how site/project-related activities might potentially cause risk or impacts by applying SHIRA processes and requirements

• Internal
  • Ideally, internal process
  • Requires input and review by the CHS steering committee.
  • May require cross-functional workshop with CHS working group.
  • Group CHS specialist support
  • Cross-functional integration across environmental and other social studies
• External consultant
  • Role may be to facilitate the SHIRA process and direct evidence-based controls related to the identified impacts.
  • Support on specialised or complex technical areas (e.g. toxicology).

• Generally limited unless community input is required/warranted
• Part of disclosure and communication (as required)

• A health impact assessment report that includes:
  • Impact definition: cause and comment on potential health impacts and project influence.
  • Impact evaluation/assessment to describe the prevailing baseline health conditions, inherent and residual impacts.
  • Recommend mitigation/management measures to effectively avoid, mitigate or control different impacts.
• Recommend opportunities for socio-economic development for positive contributions, with linkages into 4A toolkit.

• Depends on complexity.
• 3-4 weeks after baseline completed.
• Requires a detailed project description/ internal context review.
• Dependencies on specialist environmental or socio-economic studies, as relevant.

Task 5:

Develop CHS management plan

• To support the prioritised approach to managing (and monitoring) impacts and risks

• Internal
  • Ideally, managed internally and directed by the CHS steering group.
  • Group CHS specialist support.
• External consultant
  • Can be considered to develop the health monitoring programme, including developing key performance indicators linked to impacts and interventions

• Engagement with public health authorities on management measures in communities. Evaluate opportunities for partnerships and alignment with existing strategies/programmes.
• Engagement and communication with communities and other interested/affected parties

• A CHS management plan that can ideally be integrated into the SMP.
• Ideally, the management plan should link the monitoring requirements/ elements.

• Requires the completion and acceptance of the impact assessment and related management measures.
• Depending on complexity but 2‒4 weeks to develop thematic framework plan.
• Detailed plans on interventions dependent on proposed actions

Task 7:

Develop CHS monitoring plan

• To support the monitoring and evaluation of impacts and management measures.

• Internal
  • Support from CHS steering and working group
  • Group CHS specialist support
• External consultant
  • Technical support as required.
  • Use of platforms like Isometrix

• As required as part of plan

• A CHS monitoring plan that, ideally, links to the management plan.
• Evaluates the implementation and success/ improvement factors

• Ongoing
• Different metrics/ indicators may have different timeframes

Tasks 6 and 7:

Implementation of CHS management and monitoring plan (monitor and evaluate)

• Implementation of CHS management and monitoring plan

• Internal
  • Support from CHS steering and working group
  • Group CHS specialist support
• External consultant
  • Implementing partners
  • Isometrix for monitoring

• As required on communication or engagement commitments.
• Linked to grievances as required

• Implementation of interventions.
• Monitoring and evaluation as per plan.
• Reporting as per plan

• Ongoing and depends on programme interventions.

Task 8:

Review and adjust impact risk assessment and CHS management and monitoring plan

• To review actions and adjust/modify controls as required

• Internal
  • Support from CHS steering and working group
  • Group CHS specialist support
• External consultant
  • Implementing partners
  • Audit and assurance
  • Monitoring platforms

• As required based on changes and proposed adjustments

• Review and assurance report
• Modify and adjust interventions

• On-going
• Annual and 5- year reviews

Awareness

• Attended a short introductory session on HIA (1-2 days)

• Identifies what needs to be managed
• Can manage the CHS assessment (objectives and outcomes)
• Can support stakeholder engagement
• Can be a member of CHS steering group

Knowledge

• Attended a detailed training session on HIA (c.5 days) from an internal resource or reputable institution
• Good understanding of the mining process and company impact/risk assessment processes
• Good understanding of the IFC PS or Equator Principles processes and guidelines
• Adequate skills and qualifications

• Can fulfil role of CHS lead
• Member of the CHS setting group
• Can explain and advocate the HIA to internal and external stakeholders
• Can potentially lead the scoping assessment
• Can perform cross-functional liaison (occupational health, environment, social performance departments, etc.)

Skilled

• Attended detailed training session on HIA (c.5 days) from an internal resource or reputable institution
• Has suitable public health experience and qualifications
• At least 2 years’ experience conducting HIAs for mining projects, or experience on 5 or more projects (ideally, with support of an expert practitioner)
• Specific skills in impact/risk assessment.
• Good understanding of the IFC PS or Equator Principles processes and guidelines

• As above
• Can lead a ‘non-complex’ HIA and manage the HIA process/tasks
• Can lead a ‘complex’ HIA, with support from an experienced HIA practitioner
• Can appraise and audit a non- complex HIA

Expert

• As above
• Substantial experience in HIA
• National or international reputation
• At least 5 years’ experience in doing HIA
• Has led HIAs for complex mining projects

• As above
• Can lead complex HIAs
• Can support on complex methods and tools
• Can support training as required

Communicable-disease management plan

Sexually transmitted infections(STIs)/ CHSANo. 3

Develop a clear HIV policy and programme in the workplace and community

Develop a code of conduct on fraternisation of the workforce with the local community

Pre-development through operations

High

Workforce and immediate communities/relevantpotentially affected stakeholders

Site

Workers.

Contractors.

Unions.

Traditional authority.

Community-based organisations

Humanresources.

Provider

Process

Completed and implemented procedure

Single output

Single output and incidence reports

Develop and implement comprehensive HIV and STI prevention and treatmentprogrammesfor transport workers, especially long-distance truck drivers.

Pre-development through operations

High

Transport workers.

Contracted transport companies.

Communities along transport corridors and near truck stops

Site

Workers.

Contractors.

Unions.

Traditional authority.

Community-based organisations.

Public health authorities

Provider.

Humanresources.

Contractor

Process

Development and sign-off on policy and procedure

Procedure with defined objectives and interventions

Process and outcome

IEC and behaviour-change communication programmes

Number and percentage of people reached bybehaviour change communicationoutreach activities.

Monthly reporting

Reports onbehaviour change communicationmetrics as per plan

Process and outcome

Access to reproductive health services, voluntary testing and STI management

No of people reached by health services. 95:95:95 plan. No of STI cases treated

Monthly, quarterly and annual reporting

Vector-related diseases

Develop an integrated malaria and vector controlprogrammein the workplace

Vector control targeting larval source and adult control.

Education and awareness.

Bite prevention

Diagnosis/treat

Pre-development through operations

High

Workplace

Site

Workers

Contractors

Unions

Environment

Public health authorities

Vector control provider

Workplace health service

Environment

Process and outcome

As per elements defined per programme

Various as per programme design

Various

• A CHS lead assigned to lead the scoping exercise.
• A CHS steering committee should be established to guide the HIA process, beginning with the scoping exercise. To remain nimble, this should be a small group and should include the CHS lead, a member from Group Social Performance (SP), SED and Government Relations, as well as the Group CHS specialist. This working group may include external stakeholders (appropriateness to be determined on a case-by-case basis). The  CHS steering committee should report into the site Social Performance management committee if they are not the one and same thing.
• A separate CHS working group should or can be established in addition to the CHS steering committee. However, sites may consider only constituting the steering committee and fulfilling the functions of the working group by calling on relevant internal and external stakeholders who may be able to share pertinent information or be required to support the HIA process.
• The CHS working group should be established to support different elements of the scoping studies and the ongoing HIA process, including supporting engagement with various internal and external stakeholders, including:
  • Internal site resources or specialists that may have data or information that can be relevant to the HIA process or cross-functional roles based on their area of expertise/site level responsibility; e.g.
    • Environmental or biophysical data or information, including air quality, water quality, noise modelling etc.
    • Human resources on workplace demographics etc. especially of local residents.
    • Occupational health and safety
    • SED resources
    • Contracts management
    • Engineering and mining
    • Etc.
  • External stakeholders (as appropriate on a case-by-case basis) including:
    • Public health authorities at a national, regional (provincial) or district/local level. This engagement, and associated permissions that may be required, is very important to obtain so that it facilitates the engagement and participatory data-collection activities with public health services at the level of the site. Permission may be required at a higher level to engage with district or local healthcare workers/officials.
    • NGOs, community-based organisations or faith-based organisations involved in health or social development at the regional or local level.
    • Potential service providers or implementing partners.

• External skilled resources: as far as possible, the scoping exercise should be conducted internally, with support from the Group CHS specialist. However, depending on capacity various elements the scoping exercise can be outsourced to an external consultant if they have the correct skills and experience. Typically, this would be limited to supporting data gathering as part of the external data review (both desk and field-based work) and potentially elements of stakeholder engagement.

• The CHS Lead (responsible/accountable person at site level) can be the same or a different person, but they should be accountable to a single person at the site level so that integration and overlap across studies is supported, as needed.
• Terms of reference for the CHS steering committee can be defined, e.g.:
  • Key objectives of the HIA process.
  • Key roles and responsibilities of team members.
  • Links to other Social Way and SHE way elements and requirements (including 4F: Land Access, Displacement and Resettlement and 4G: Site-induced Migration (SIM), etc.).
  • Cross-functional support and make-up of the CHS working group.
  • External stakeholder engagement strategy.
  • Timelines for various elements of the HIA, including specific milestones.
  • Spatial and temporal boundaries.
  • Review the outputs of the scoping exercise (as per purpose) and support the determination of the terms of reference for the next steps in the HIA process that can include:
    • Level of HIA.
    • Reviewing the CHS areas of concern based on:
      • systemic community vulnerabilities (existing health challenges/needs).
      • institutional capacity at the level of the community and the health authorities to manage or tolerate the potential health impacts.
      • Potential project-related health impacts linked to direct and indirect influences (site-level vulnerabilities).
    • Reviewing the area of influence (AOI) and potentially affected stakeholders
    • Reviewing the available data, data gaps and data-closure opportunities to support further baseline health studies.
    • Stakeholder engagement.
  • The inclusion of external stakeholders on the HIA steering Committee and/or the CHS working group should be decided on a case-by-case basis. Considerations may include site relations with government health authorities, and the authorities’ capacity, competency and interest in the HIA process. Benefits of including health authorities may include facilitated access to existing secondary CHS data and information, partnership building and facilitated planning in support of HIA tasks throughout the HIA process.
  • The CHS working group should continue throughout the entire HIA process. However, its membership may change over time, depending on the specific focus of each action

• Internal-context review (desk work and internal engagement across various functions)
  • Review the current internal context from the section 2 ‘Review and Planning’; if already undertaken, to screen for CHS concerns.
  • Focus on both existing site activities and planned future expansions.
  • Information on existing and planned site-level activities that may potentially cause CHS impacts can be collected from various elements (see Box 2.2 of Social Way Section 2 ‘Review and Planning’⁷); for example:
    • Social management plans
    • Life of asset plans
    • data already available from other departments, including Human Resources (HR); e.g. social profile of employees and their families and occupational health statistics
    • (if in projects phase or new elements) preliminary project description and planned front-end engineering design to understand the proposed activities
    • Reviews of reports and specialist studies that have been completed to date for the project or historically for the site
    • Current contractor social management specifications.
    • Review current mine complex (including associated facilities) activities from a process and spatial perspective.
    • Review current definition(s) of AOI to inform definition of potentially affected stakeholders
    • Review workplace risk and controls register (WRAC) to determine what CHS risk and impacts have been identified and associated controls
    • Review of grievance and commitments register
    • Review any past specialist studies of reports and specialist studies that have been completed to date, including
      • Any health impact assessments or any health-related consultancy documents of any nature – whether for Sustainable Mining Plan, workplace health or community health, etc. .
      • Current contractor social management specifications and reports.
      • Land access, displacement and resettlement reports and management plans.
      • SIM reports and management plans.
• Define and geo-reference potentially affected stakeholders within the AOI
• External context review (desk work, field work and external engagement, as shown in Figure 1)
  • Desk work
    • Review the current external context (available from Review and Planning, i.e. Section 2 Task 4) to screen for CHS concerns
    • Based on what is available, conduct a literature review of health-related information available in the public domain from standard source literature. This will be conducted in a CHSA framework to ensure that a systemic approach is followed. The review will consider priority health issues that are identified at the national, regional and district level and, where available, at the local level and will form the basis of the preliminary baseline health data description.
    • Any ESIA, social studies or similar.
    • Specialist biophysical studies: air quality, surface/ground water quality and quantity, soil and geochemistry, noise and vibration, etc.
    • Any socio-economic baselines or similar reports.
    • SED and Collaborative Regional Development reports
    • CHS-relevant grievances
    • LFI reports
    • Work with external contractors that may already be engaged with the site to support CHS-relevant elements of work and, in turn, to support the baseline health description from data that is available or easily collectable.
    • Any studies or reports from peer mining companies that highlight CHS impacts and interventions to consider similar risks or potential for cumulative impacts.
    • Review the local context to determine if there are any potential partners that can assist with the local collection of data (to perform some of the field tasks below).
    • Map key stakeholders and plan for external engagement
  • Field work (including external engagement)
    • Pre-field work planning that includes:
      • Timing and logistics
      • Stakeholder engagement plans and permissions.
      • -collection objectives and potential sources.
      • Review of CHS-relevant stakeholder feedback (from past 2 years or another relevant period)
    • Kick off meeting with the CHS steering group.
    • Understand the current project/site, associated facilities and future plans from a spatial perspective by reviewing maps on site and then undertaking an orientation drive-through of the site and prospective site.
    • Stakeholder engagement in the study area, including:
      • Initial engagement with the district-level health authorities (e.g. district health manager and district health officer), with a memorandum/letter introducing the HIA, its objective and intended outcomes, and to outline the envisaged role of the health authorities. This letter should be followed up with either an in-person or virtual meeting to further discuss the HIA, outline the phases, planned activities and to request formal support. Permission to engage with public sector health managers (at the district level) and health care staff (at facility level) should be requested, as well as a request to share reports and other documentation that may inform the health baseline, including any local municipality development plans and health strategies.
      • If it is possible at this stage, request a roundtable discussion with selected health programme managers from the district (or other appropriate) level to discuss existing health challenges and needs in the district and specifically in the AOI.
      • If permission is granted, conduct key informant interviews with selected groups in the district, municipal areas or AOI. These should be supported by a semi-structured instrument to support a systematic process and include:
        • Health agencies or NGOs
        • Community and faith-based organisations.
        • Healthcare workers at public health centres (mobile clinics, clinics or hospitals) and team leaders of community health workers, key health challenges in the community, health-seeking behaviour practices, and challenges such workers have in rendering medical services to the community.
      • Visit public health centres to understand their basic functionality through conducting a Service Availability and Readiness Assessment (SARA) based on an adapted WHO methodology.
      • If possible, conduct short focus group discussions using a semi-structured tool. In scoping, and depending on the setting, this may be limited to a key population sub-group. For example, in low-resource settings, women can be consulted considering their traditional role as gatekeepers to community and family health. Male focus group discussions may be conducted as part of the next phase.
      • Field visits to the potentially affected stakeholders or communities to directly observe the existing environmental, hygiene and social health conditions, with the use of a support observation tool.
• Gap analysis
  • Identify key data and data gaps, data gap closure opportunities (i.e. additional baseline data collection) and stakeholder engagement opportunities.
• Identify CHS areas of concern and preliminary assessment of CHS impacts and risks
  • Analysing key findings, including a dashboard of CHS areas of concern
  • As relevant, significant potential health impacts will be highlighted so they can be addressed without waiting for the entire HIA process to be completed (the significant potential health impacts can be captured under SHIRA) and recommended controls can be proposed for early implementation.
  • A preliminary assessment of CHS impacts, based on the available information, can already be undertaken during the CHS scoping exercise. These CHS impacts identified may already be included in the site SHIRA and WRAC during its next revision as part of the site’s transition-planning process before the entire HIA process is concluded

• Seek advisory support from Group Social Performance (SP) CHS Specialist on adapting the general methods to each site and identifying support tools of use in assisting various actions.
• Actions are iterative and are not necessarily to be undertaken in chronological order.
• On internal-context review:
  • Ideally, the internal context review undertaken as part of Review and Planning (Section 2 task 2) is sufficiently detailed to enable an identification of the CHS areas of concern and an assessment of CHS impacts and risks. Otherwise, it may need to be expanded with a CHS focus or lens.
  • The internal context review aims to anticipate the spatial area of influence (AoI) and the potentially affected stakeholders within it, capture how site and site-related activities (including those from ancillary facilities) are influencing (or have the potential to influence) determinants of health and cause CHS impacts.
• On defining potentially affected stakeholders within the AOI:
  • Review how the project/site AOI is currently defined. There may be various AOIs defined based on environmental or social criteria – these may not necessarily cover all potentially affected stakeholders s form a CHS perspective.
  • Defining potentially affected stakeholders is an iterative exercise (can be revisited throughout the HIA process). Some potentially affected stakeholders may be easy to identify – e.g. communities in the immediate vicinity of a site’s fence line. Other potentially affected stakeholders may only be identified after engagement with external stakeholders.
  • potentially affected stakeholders can be defined or grouped based on similar exposure profiles (for example, resettlement, linear aspects, etc.) and population groups that may be systemically vulnerable
  • The definition of potentially affected stakeholders supports the spatial identification of CHS impacts (and, later on in the HIA process, the planning of CHS management measures) for each CHSA/CHS impact. It also informs the establishment of the CHS baseline and how Baseline Health Studies are planned for later on in the HIA process.
• On external-context review for CHS
  • The external-context review for CHS starts as part the CHS scoping exercise, with the objective of developing a preliminary CHS baseline. The external-context review for CHS will continue, after the CHS Scoping exercise is concluded, with additional health data and information collected as part of baseline health studies (Task 2 of the HIA process) – this will enable completing the CHS baseline.
  • Only CHS data and information that is publicly available and easily accessible to the CHS working group, supplemented by targeted/limited primary data collection (e.g. via key informant interviews and focus group discussions with key CHS stakeholders), should be collected during the CHS scoping exercise.
  • For work with external contractors that may already be engaged with site to support CHS-relevant elements of work, an addendum to the existing scope of work and contract will be required. This will require engagement and initial discussion to determine what data is available and of easy access and what level of granularity can be pulled out of the health information system to reflect local health profiles in the relevant AOI.
  • CHS field work should be planned alongside other relevant fieldwork activities (for example, on SED health initiatives or environmental studies) to maximise synergies and avoid stakeholder fatigue.
  • At the end of the CHS scoping exercise, the CHS data and information collected, reviewed and analysed should be consolidated (within the CHS scoping report) around each CHS area of concern and/or each potential CHS impact. The output of this consolidation will be the preliminary CHS baseline.
  • The preliminary CHS baseline should not be captured solely in a long, text-based report. There is significant value in maintaining an electronic database or data-management system so that data trends, different combinations of relevant data, and other statistics can be easily accessed. GIS mapping should be used to represent data spatially wherever possible. These options should be considered during the CHS scoping exercise.
  • External context data and information on CHS collected during the CHS scoping exercise can be used to inform the systemic vulnerability assessment (for example, on the human capital’s level of health and nutritional status and the physical capital’s healthcare services). (Further external-context data and information on CHS collected through additional baseline health studies will further refine the systemic vulnerability assessment).
  • During the CHS Scoping exercise, CHS-relevant stakeholders must be mapped. This task should be aligned with Section 3A Task 3 (Map stakeholders) as possible.
  • Targeted engagement and consultation with CHS stakeholders within the CHS AOI and the potentially affected stakeholders s should take place during the CHS scoping exercise. This engagement should be strategic; i.e. it should be outcomes-based:
    • to understand what sources of CHS data are available in the CHS AOI and on potentially affected stakeholders and the extent to which such data is adequate (e.g. of sufficient quality and disaggregation) for the purposes of establishing a CHS baseline and monitoring CHS impacts (appraise what routine health information or statistics are available in the local/ district/regional health information system)
    • to collect CHS data and information that may not be publicly available or of immediate access (e.g. grey literature; summary health statistics)
    • Map what health facilities are available in the CHS AOI and characterise access and quality to health services in the AOI (or plan this assessment of capacity for a later stage)
    • to consult on and understand potential CHS areas of concern and what the potential CHS impacts are likely to be (stakeholder engagement is fundamental to this objective)
    • to establish working relationships between the CHS working group and local (or district/regional) health authorities in support of baseline health surveys undertaken (as needed) on the next stage of the HIA process.
• On gap analysis
  • The preliminary CHS baseline should clearly identify the critical CHS baseline data gaps. Gaps may exist because data/information is not available or because the available data/information is not adequate or sufficient (e.g. there may be data-quality issues, or the available data is not sufficiently disaggregated to be representative of potentially affected stakeholders within the site CHS AOI).
  • This gap analysis is performed in order to establish whether sufficient data is available to proceed with the assessment of CHS impacts and the definition of a CHS Management Plan, or, in case of inadequate or insufficient data, whether the collection of additional baseline health data is warranted. In practice, the gap analysis has a focus on the health outcomes and determinants of major concern (the likely CHS impacts).
  • The gap analysis includes critical appraisal of data quality of identified data sources. Importantly, data on major health outcomes and determinants of concern requires a high level of accuracy on a regional and/or local level, allowing for an evidence-based assessment of CHS impacts and enabling subsequent monitoring of CHS impacts.
  • It is likely that many gaps will be identified in a preliminary CHS baseline. Filling all gaps would be a time-consuming, resource-intensive and complex process. Therefore, data gaps should be prioritised when planning for specific baseline health studies to fill them. The resources employed on filling the gaps should be proportionate to the scope and scale of the possible/likely CHS impacts associated with a site. Baseline health studies usually involve outsourcing to consultants or national/academic institutions.
  • If important data gaps are identified and primary data collection activities (baseline health studies) are required, it is important for data-collection strategies and activities to be highly focused and linked to specific key performance indicators (KPIs). This means that most CHS monitoring indicators and CHS KPIs are outlined or actually defined during the CHS scoping exercise, and not only later on in the HIA process when a CHS monitoring framework is established (i.e. during Task 7 ‘CHS monitor and evaluate’).
  • Data-collection option should be considered in the context of wider Anglo American work with external stakeholders. Identify interlinkages, synergies and overlaps across functions and studies, and plan accordingly, to avoid overlaps, duplication of work and maximise synergies in data collection.
• On identifying CHS areas of concern and preliminary assessment of CHS impacts and risks
  • The CHS areas of concern will be identified and described through application of a decision matrix that considers the methodological review of three variables as described in Figure 2 that includes:
    • The prevailing health conditions in the potentially affected stakeholders and the potential systemic vulnerability to changes in health determinants that may impact their health status or perceived quality of life/well-being. This includes the institutional capacity of the potentially affected stakeholders and the health authorities to manage or tolerate potential health impacts.
    • Proposed project activities (in general terms) and how these may impact CHS and well-being, either in a direct or indirect fashion (site-level vulnerabilities).
    • Stakeholder comment and concern, as well as precedence from similar projects
• If the required evidence is available in sufficient quality for the CHS working group to decide what CHS areas are of relevance and what the main CHS impacts are likely to be, then the HIA scoping exercise can proceed to its final task – planning next steps/activities in the HIA process and developing terms of reference for such activities – and then be concluded. However, if significant data gaps are identified within the CHS scoping exercise, then further information should be collected.
• In practice, there will always be data gaps and uncertainties during the CHS scoping exercise. The CHS working group should make a professional judgement about whether further data and information should be collected for the CHS scoping exercise versus continuing on with the HIA process. It is possible to proceed with the HIA process with some uncertainty on whether some CHS areas and impacts are likely to be of interest and to undertake additional baseline data collection later to resolve this uncertainty.