Assessing health impacts of the Chad-Cameroon petroleum development and pipeline project: challenges and a way forward

Health impact assessment (HIA) of projects, programmes and policies is increasingly recognized as a powerful methodology for mitigating negative health impacts and enhancing equitable and sustainable development, yet applications in the developing world are sparse. Here, we focus on a large infrastructure development in sub-Saharan Africa, namely the Chad-Cameroon petroleum development and pipeline project. We adapted a five-step process for HIA, consisting of (1) screening of project documents, (2) profiling of affected communities, (3) identifying priority health areas, predicting potential impacts, and proposing mitigation measures, (4) implementing interventions, and (5) monitoring and evaluation of health impacts. We found that project scoping was broad, including extensive environmental and social assessments. Innovative features of the project include the high degree of public-private partnerships, and the management of oil revenues for purposes of poverty reduction. The project also addressed occupational and public health issues, and developed and implemented measures to prevent or mitigate potential health impacts. However, there was a disproportionate emphasis on workers' health, particularly on the prevention/mitigation of construction-related injuries, sexually transmitted infections (STIs; mainly HIV/AIDS), and malaria. Health impacts among surrounding communities, and cumulative health impacts in the larger region were not considered in a comprehensive way. Concluding, there is a need for a more systemic approach to HIA and its incorporation within 'Equator Principles', which are increasingly adopted by the international financial community. This process would include clarification of corporate social responsibility beyond the project fence line in the mitigation of health problems at regional levels. Finally, we propose the establishment and running of a longitudinal demographic surveillance system, which-coupled with regular household surveys-would facilitate monitoring and evaluation of impacts on health, social wellbeing and equity in the broadest possible manner.