What does a national public health strategy for ASGM look like?

Latin America takes a serious look.

October in Montevideo can be on the chilly side, but this was countered by the warm welcome from the Uruguayan Ministry of Health and the energy of representatives from ministries of health from across Latin America as they gathered earlier this month to discuss the health aspects of implementing the Minamata Convention.

Latin America played an important role in building support for the Convention, and is again leading the way in ratifying it so that it will enter into force. The workshop built on this regional momentum to ensure that health is addressed in National Action Plans for artisanal and small-scale gold mining (ASGM). And this is no mean feat.

Participants from Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay and Venezuela, as well as the World Health Organisation, civil society organisations and academics discussed the current state of knowledge of the sector. In a declaration at the end of the workshop, participants noted the need for guidance on how to address the health challenges in artisanal and small-scale mining communities. To date, the health sector does not have a lot of experience working with ASGM communities. However, the Minamata Convention obligates responsibility for implementing a public health strategy to address the exposure of artisanal and small-scale gold miners and their communities to mercury. In order to do so, the health sector needs to address issues of gathering data, training health workers, communicating risks and protecting vulnerable populations.

The health information system in most countries does not capture information about mercury exposure or illnesses and injuries related to artisanal and small-scale gold mining more broadly. There is a recognition that this is missing and that the solution is far from simple. Gathering appropriate data requires elements that often go beyond an adequate surveillance system. ASGM is often in remote regions that lack basic services. It can be hard to find sufficiently qualified health workers, let alone practitioners that are adequately prepared to diagnose and report ASGM related illnesses. Health professionals that serve ASGM communities need to be supported so that they can address the additional health concerns of these populations, which go beyond the standard burden of disease that they are trained for. Rural health clinics will need to be linked to appropriate laboratory capacities for diagnosis. In addition, a significant social marketing campaign will need to be developed in order to clearly communicate risks to vulnerable populations, miners and mining communities, in order to realistically create substantive changes in practices in the sector.

Above all, it is clear that multiple ministries will need to work together for coherent and effective implementation of National Action Plans for ASGM. The nitty gritty of inter-ministerial collaboration is difficult. Incentives and working modalities in most countries are not built to support this type of collaboration. It will need to be hammered out differently in each country.

As countries go about developing a health strategy in the context of the Minamata Convention there is a veritable lacuna of guidance material for them to draw on. The World Health Organisation is piloting a rapid health assessment tool in the ASGM context, which includes elements of health system readiness as well as miners perception of risks and health conditions commonly reported by miners and health workers. In addition, a training guide for health professionals is also being prepared by the WHO. Once finalised, this will be useful for Ministries of Health. To contribute to this process, the Artisanal Gold Council has developed some materials and products about health and ASGM for public health professors and health practitioners to use both for themselves, and also with ASGM communities (soon available in Spanish). The AGC will be delving into the Peruvian context, but are ready to share our expertise and partner with others as we go. We are excited to contribute to more training and guidance material for people operating at all levels of the health system.

Health systems need to dive deeply into the ASGM sector in order to curb the effects of decades of mercury use on human health. In addition to developing human resources, the health sector will requires significant financial support over a long period of time to implement appropriate health strategies. There are resources available to countries through the Global Environmental Facility to support the implementation of their National Action Plans, and a portion of this must be allocated to health.

The World Health Organisation and the Pan American Health Organisation have done a great job at keeping health and Minamata on the agenda, and kick-starting discussions, such as the one they co-hosted in Uruguay. The sharing of experiences and knowledge needs to continue. Establishing a community of learning and practice for health and Minamata, and more specifically for ASGM will be important to keep progress going. And the AGC will do its best to contribute.