Preparing a Rapid HIA on Irrigation and Malaria

Preparing a Rapid HIA on Irrigation and Malaria

Spring 2017

Tutorial Assignment #3

A 4-5 page paper on a rapid HIA is the assignment. Let’s review the malaria problem of interest, the key facts for you to consider, and how to prepare the report. The report is due on March 8^th at 11:59 pm. The grading rubric for this assignment comes at the end of this guidance statement.

There are no new required readings for this assignment. Use the analytical tools, including the assessment tools, you have learned in the course to puzzle it out.

Contents:

• Problem Statement
• Key Facts
• The Assignment
• Grading Rubric

1. Problem Statement.

Irrigated rice is the fulcrum of food security throughout Southeast Asia. Unfortunately, the rice production cycle is often associated with the spread of malaria in both settled and deforested regions.

In one country known for its island grouping of the (largely Muslim) population, the government has decided to push year-round rice production in the mountainous region of its main island. Why? Because food security is weak in the mountains, compared to the central valley where the rice fields are more efficiently managed.

The Ministry of Agriculture is gung-ho about this plan, and wants to implement it all throughout the mountains, with a big push for increasing its domestic budget and acquiring large foreign aid support to make the nation rice self-sufficient and an exporter throughout Asia and parts of Africa where rice is the staple.

Your consulting firm has been hired to conduct an environmental impact assessment of the strategic rice expansion plan, with enough funding to test its feasibility in upland rice regions over two years. Even though the agriculture and health ministries have a poor record for communicating and collaborating, the Planning Commission has included in your firm’s TOR the requirement to investigate whether the rice expansion plan will also expand the geography and health impact of malaria in the mountains. And any other health problems that you encounter, that could be avoided with a better approach.

 

2. Key Facts.

• The central province of the island has most of the malaria cases, located in the uplands where terraced rice on slopes is cultivated without any clear beginning or ending to the growing season. There are abundant streams and springs available year-round for the female mosquito to oviposit its eggs in the wet rice fields that never dry out. Larvae grow and hatch out as the rice reaches harvest, on a continuous basis. There have been malaria epidemics throughout the central province amid suspicions that rice cultivation is involved in some way. Government feels it must address the malaria problem or their rice production goal (e. self-sufficiency plus exports) will have to be abandoned.
• Most of the malaria control program consists of insecticide-spraying in houses (DDT mostly), which is noxious to the people and spreads insecticide resistance). Children have asthma attacks from spraying inside that often keep them out of school. The spraying makes little sense, since the malaria vectors are exophilic (mostly travel and rest outside dwellings)
• Environmental Management of the malaria problem has been successful in two instances: (i) The agriculture ministry worked in one sub-district to synchronize rice planting and harvesting, then clear the irrigation trenches of breeding mosquitoes and then larvicide other known mosquito breeding sites. (ii) The health ministry introduced larvivorous fish as fingerlings in freshly flooded rice fields to interrupt the maturation of the mosquito vector which develops from a larva to an adult as the rice plant grows to maturity. Farmers cooperated and made additional income from the pisciculture. In both cases malaria cases in local villages were reduced and there were no outbreaks. However, spraying continued in those villages so no one method can definitively take the credit.
• Community behaviors that affect malaria transmission include: (i) few houses have indoor toilets, so women meet at dawn near community water pipes near forests where malaria vectors rest in the bushes. Women fill their jugs, go to the “bathroom”, chat a bit and agitate the female mosquito which bites them and goes back to sleep! (ii) The sunset prayer for Muslims takes place at the community mosque and afterwards men socialize and the drowsy mosquitoes takes a blood meal on the way to sleep. Crowding like this makes it easy to spread the infection. (iii) A local NGO acquired insecticide-impregnated bednets to protect sleeping children from being bitten. A pilot test in two villages was conducted with the health ministry’s agreement NOT to spray in houses during the pilot. Child malaria cases went down over one calendar year.
• Drug programs in health centers suffer from short supply and over-subscribing leading to drug resistance by the malaria parasite. Active case detection in villages was replaced with passive detection in health centers to improve accurate diagnosis by microscopes and speed treatment to infected patients thereby eliminating the parasite reservoir before new people could be infected. Progress has been slow, but with improvement.
• DDT and other insecticides grab 75% of the malaria control budget, leaving the remainder to case detection and treatment and very little for environmental management. In similar situations, outbreaks based on insecticide resistance have a rebound effect with high mortality of mothers and children. International companies supply the insecticides with generous pay-offs to “enlightened” officials. Better health of the population is your firm’s main concern, but this will rile up vested interests.

3. The Assignment

Ill-health caused by a development project can lead to reduced productivity, school absenteism, increased consumption of medicine and more visits to health centres.

 

Such hidden costs can be reduced or avoided by safeguarding human health.   Therefore, it is necessary to assess the potential health impacts of the proposed new strategy for controlling malaria.

 

Assessment also has its costs. In order to contain the costs of assessment, a rapid HIA should precede a full HIA. The rapid HIA is cheap. The full HIA is expensive, time-consuming and may not be required.

 

The main output of the rapid assessment you will conduct is a decision about whether a full HIA assessment is needed or not. You must justify your decision.

 

The methods that your team uses will involve:

 

• Identifying health hazards.
• Assessing health risks associated with the project.
• Proposing measures for health risk management.
• Considering opportunities for the improvement of health.

 

 

You will prepare a Summary Rapid Health Impact Assessment Table for the government that is sponsoring your study, along with your recommendation for a full HIA, yes or no. It wiil look like this.

 

SUMMARY RAPID HIA TABLE

 

Project title

 

Location

 

Community group

 

Health hazards        Community Environmental        Institutional             Expected

risk factors   risk factors              risk factors              changes                                                                               (prior to                    

the project)                                                 

 

Definitions

• A health hazard is an agent that may cause harm.
• A health risk is a measure of likelihood that an identified hazard (malaria) causes harm to a particular group of people at a particular time and place.
• A health impact is a change of health risk associated with a project.

 

 

 

 

Item 1.           What Health Hazards Are Involved

 

Summarize the hazards that the malaria situation pose to a rice-producing community and list these hazards in your Table for each health hazard and enter this information in Column 1 of the Summary Rapid HIA Table.

 

Item 2. Community health risk factors

 

Health risk assessment

 

In order to assess the health risks you will need to decide on  the scope of the assessment. This includes geographical boundaries, time boundaries and affected communities. Draw this information from the ”Key Facts” section.

 

Community health  risk factors are characteristics of a community or  community group, which determine its vulnerability to a health       hazard. Enter the most important risk factors in Column 2 of the Summary Rapid  HIA Table

 

Environmental risk factors are characteristics of the physical or social environment, which determine the level of exposure of a community to a health hazard.

 

Item 3.           Environmental risk factors

 

For each of the health hazards that you have identified, the next step is to determine the nature of the environmental risk factors (both social and physical). For malaria, will the new malaria surveillance  project change the environment and increase/decrease vector breeding sites?  Will the transmission season be extended?  Or will the new approach substitute surveillance and environmental management for insecticide spraying (which is pretty much all they do now). Enter the environmental risk factors you consider most important in Column 3 of the Summary Rapid HIA Table.

 

Item 4.           Institutional risk factors

Institutional risk factors are the strengths and weaknesses of public and private institutions that play a role in protecting health prior to the project. We know that there are internal struggles with government agencies (agriculture and health), external donors with commercial interests, and conflicts within families and communities, where growing rice year-round by farmersmay expand the harm that malaria causes to the community and families.

 

Institutional factors. Ministries or agencies responsible for health-related issues can be judged in terms of:

1. Capacity,e. the resources available in terms of staff and equipment.

 

1. Capability,e. the knowledge, skills and experience of the staff and the procedural framework that allows them to operate as efficiently as possible.

 

1. Jurisdiction, i.e. their power to regulate or control a particular aspect of the project.

 

List the institution risk factors the project will face in Column 4 of the Summary Rapid HIA Table.

Item 5.           Expected changes in health risks attributable to the project.

Since your firm has ample funding for two years, you can work with Key Informants (KIs) in government, the communities, farmers’ groups, and the donor community to gather views and sniff out likely responses to what you’re your thinking of proposing. Or you can directly convene a Stakeholders’ Consultation where you present the Summary Rapid HIA Table and. inform the stakeholders that your recommendation must follow upon consideration of all their opinions. Your firm has already informed government that you are willing in principle to conduct the full HIA if it is approved and funded, but the firm’s final report must consider the range of opinions expressed during the Stakeholders’ Consultation. This will improve your firm’s credibility since you will not automatically recommend a big contract for yourselves.

List the “expected outcomes” that emerge from the Consultation in Column 5 to complete the Summary Rapid HIA Table,

Conclusion. Please submit your report with a recommendation that justifies a full HIA, or does not. You may wish to recommend certain information gathering as a prologue to the Stakeholders’ Meeting or the HIA decision to go forward. Please indicate how this activity fits into the overall plan. Please fill out whichever is convenient and send with your report.

4. GRADING RUBRIC

Material Used: Used at least one course material which improved the discussion (2/2)

Length: Double spaced 4-5 typed pages, concisely and well-written (3/3)

Influences listed: Three environmental, community health and institutional risk factors (respectively, > 9 in total) placed in the table. Must include a table properly formatted (4/4)

Key Points: Two dynamics of the expected changes in health risks were provided, e.g. spraying can decrease mosquito population but increase resistance (3/3)

Decision: Made a recommendation which IA tools to include, decide which (>2) tools are required, and state why (3/3). This will give weight to the HIA yes/no decision you will make.

Total: 15/15