Developing Effective Public Health Strategies to Reduce Mercury Exposure in ASGM Communities

The Minamata Convention on Mercury states that the National Action Plan (NAP) for artisanal and small-scale gold mining (ASGM) must specifically include a public health strategy regarding the exposure of mining communities to mercury. To support the Ministries of Health in developing evidence-based country-specific public health strategies, the World Health Organization (WHO) recently produced a Step-by-step guide for developing a public health strategy for artisanal and small-scale gold mining in the context of the Minamata Convention on Mercury. Beyond its application in ASGM NAPs, this guide is a useful resource for governments addressing ASGM at any level, including through the planetGOLD programme.

 

Available in Arabic, English, French, Portuguese, Russian, and Spanish, this step-by-step guide shows how to develop an evidence-based public health strategy for a NAP. The guide includes the research methodology and tools needed to conduct a rapid health assessment and institutional capacity assessment in ASGM communities. Users are guided through all steps from conducting the research to developing a public health strategy for the NAP.

Researchers or other assessors should use this guide to help Ministries of Health develop an evidence-based public health strategy as part of the ASGM NAP. The public health strategy should include gathering health data, training of health care workers, and awareness-raising through health facilities.

The approach for collecting and using the evidence was developed by WHO and the Swiss Tropical and Public Health Institute and pilot-tested in three countries – Ghana, Mozambique and Nigeria – between 2017 and 2019. Outcomes from the pilot test country workshops are described in Developing public health strategies for artisanal and small-scale gold mining within the Minamata Convention on Mercury: findings and lessons learned from country workshops (available in the same six languages as the step-by-step guide).

Purpose and structure of the guide

Objectives of the step-by-step guide are to:

1. Provide guidance on the overall approach, including templates and tools, for conducting the assessment activities that will provide evidence;
2. Offer guidance for translating evidence, other findings and insights gained from the assessments into a public health strategy; and
3. Share lessons learned from the three pilot studies in Ghana, Mozambique and Nigeria that applied the approach.

The step-by-step guide walks users through 6 steps to develop a public health strategy.

 

Step 1: Read the WHO Guidance Document Addressing health when developing national action plans on artisanal and small-scale gold mining under the Minamata Convention on Mercury (available in Arabic, Chinese, English, French, Portuguese, Russian, Spanish) to obtain broad guidance on addressing health during the wider process of developing the NAP.

Step 2: Stakeholder Engagement to identify and engage stakeholders from the start and define their roles and responsibilities.

Step 3: Plan the Assessments

• Institutional Capacity Assessment to evaluate the institutional capacities at national and subnational levels to address ASGM-related health issues.
• Rapid Health Assessment to evaluate the health situation in ASGM communities and the capacity of the health system to respond to their particular health needs.

Step 4: Conduct the Assessments

• Collect the data
• Analyze the data and write a report of the findings

Step 5: Synthesize Findings and Make Recommendations

Institutional capacity assessment

• Evaluation of the institutional capacities at national and subnational levels, and
• Formulation of recommendations at ‘policy & regulation’ and ‘structural’ and ‘process’ levels.

Rapid health assessment

• Evaluation of the health issues related to ASGM and health systems’ readiness, and
• Formulation of recommendations at ‘individual’, ‘community’ and ‘institutional’ levels.

Step 6: Conduct a National Multi-stakeholder Workshop to Develop the Public Health Strategy

Objectives of the national multi-stakeholder workshop are to:

• Inform stakeholders of the findings and recommendations of the two assessments, and
• Jointly develop the public health strategy based on the findings and recommendations of the assessments.

Tools and key findings

The step-by-step guide web page contains all of the tools – in the form of 13 Annexes – needed to conduct the two studies to lead to a robust public health strategy.

Overall experience of the Step-by-Step Guide Approach revealed the following four key points:

• A realistic timeline to implement is 6-12 months, depending on country-related factors such as the duration of the ethical approval process.
• Four to five days were needed for the institutional capacity assessment as well as per visited ASGM community for the rapid health assessment (approximately 2-3 weeks of data collection).
• At least two full days were needed for the workshop to allow sufficient time to present all of the assessment findings and recommendations and to undertake group work to develop the public health strategy.
• The two assessments achieved their objective to generate the evidence base for the ASGM-related health issues and the institutional capacities and thus provide the basis to develop the public health strategies.

For more WHO reference materials, please visit the ASGM section of Minamata Convention on Mercury: annotated bibliography of WHO information.