Background: The global mining industry has an opportunity to mobilize resources to advance progress against the Sustainable Development Goals (SDGs). In 2018, the Anglo-American Group outlined aspirations for mining host communities to meet the SDG3 health targets. To progress from aspiration to action we designed and implemented a mixed-methods approach to attain a deeper understanding of the health and wellbeing priorities within the local context of host communities of fifteen mines in South Africa. Methods: To identify local needs and priorities relating to SDG3 targets in host communities, stakeholder workshops and key informant interviews were conducted between June and August 2019. A baseline assessment of health data, related to each of the SDG3 targets and indicators and to each host community location, was also conducted. Findings emerging from the qualitative and quantitative baseline assessments were compared to identify the extent to which health issues aligned and health and wellbeing priority areas for action. Results: A total of 407 people participated in the workshops, and 85 key informants were interviewed. Quantitative data were available at sub-national level for seven of the nine SDG3 targets and eleven of the 21 indicators. Key priority areas for action identified through alignment of the qualitative and quantitative data were maternal mortality (SDG3.1), HIV (SDG3.3.1), tuberculosis (SDG3.3.2), substance abuse (SDG3.5), and road traffic accidents (SDG3.6) We found consistency in the individual, interpersonal, community, societal, and structural factors underlying these priority areas. At a structural level, poor access to quality healthcare was raised at every workshop as a key factor underlying the achievement of all SDG3 targets. Of the five priority areas identified, HIV, TB and substance abuse were found to overlap in the study communities in terms of risk, burden, and underlying factors. Conclusions: We demonstrate a mixed method approach for identifying local health needs and prioritised SDG3 targets in mining host communities. Consistency in reporting suggests the need for effective, efficient and feasible interventions to address five priority areas. Given the prominent economic role of the mining sector in South Africa, it can play a critical role in implementing programmatic activities that further progress towards achieving the SDG3 targets.
An assessment of the health and wellbeing priorities in the host communities of fifteen Anglo American mining operations across four provinces in South Africa was conducted using a mixed-methods approach where existing health data were quantitatively appraised and qualitative research was conducted. Following discussions with mining stakeholders, a host community was defined as being within at least fifty kilometres of a mining operation. All host communities within this range were included regardless of their relationship with mining operations (for example, regardless as to whether the majority or all residents were non-workforce). As our focus is on the independent health needs of each community, we do not consider the type of mining operation in our analysis. The fifteen mining operations in South Africa are located in the provinces of Mpumalanga, Northern Cape, Limpopo, and North West, and all host communities identified were open towns (i.e. not company towns). Of the fifteen operations, seven mine platinum, two mine iron ore, and six mine coal. Figure Figure11 presents the province, municipality and district where each mine site is located. For reasons of confidentiality, we have masked the names of each mine site. Mine locations in South Africa Stakeholder workshops and key informant interviews were conducted between June and August 2019, where participants were encouraged to identify local needs and priorities, relating to SDG3 targets, in their host communities. Study participants were identified and invited to volunteer to participate by mine social-performance teams based on their community stakeholder fora, other stakeholders, and/or by the South African research team (consisting of consortium members at London School of Hygiene and Tropical Medicine, Soul City Institute for Social Justice, and Research and Training for Health and Development). The study was explained to participants using a Participant Information Sheet (specific to workshops or interviews) and all participants provided written informed consent. A workshop guide was developed using a participatory action research approach that included techniques such as listing, scoring, ranking, and group discussions [7]. The one-day workshops were conducted at community venues centrally located within a host community and comprised participant-led activities where participants identified which SDG3 targets were local priorities by indicating them on SDG-specific wall posters. After reaching consensus on the three or four priority SDG3 targets, break-out groups were formed to discuss each in turn; feedback was then provided to the whole group and suggestions for action put forward. Findings were recorded on record sheets, and these sheets were reviewed and subjected to quality control by the study team. At each site, at least one of the facilitators were fluent in the local languages. In Mpumalanga province, municipality-wide workshops, instead of single-site workshops, were conducted due to the mining operations interacting with the same body of stakeholders (i.e. one workshop was conducted for the three mine sites located in eMalahleni municipality, and one conducted for the two mine sites located in Steve Tshwete). In Limpopo, workshops were conducted in two municipalities serving one mine site (i.e. Blouberg and Musina). We developed key informant interview guides for stakeholders from local community-based organisations (such as women’s and youth groups, non-government organisations, schoolteachers, and health service providers) and official stakeholders (including local, regional, national level representatives of the Ministry of Health, mine staff, and public health service facility managers). The interview guides were semi-structured and covered organisation focus, participant’s experience and involvement in health and wellbeing improvement, key considerations for achieving SDG targets, priority areas of action, gaps in the response, and suggestions for action. Findings were recorded on a record sheet and reviewed by the study team. A framework to support a thematic analysis of the data was developed and reviewed. Qualitative data arising from each workshop and key informant interview were analysed separately and then combined for each mine or district. Using the analysis framework, the following topics were recorded: data overview and sources, SDG target prioritisation, underlying factors, and suggestions for action. Guided by the socio-ecological model, participant responses were categorised to identity structural, societal, community, and individual-level underlying factors relating to each target in order to explore the interdependence between multiple behavioural and social determinants [8]. In relation to the location of each mine, we undertook a baseline assessment of health data related to each of the SDG3 targets and indicators. To facilitate a comparison of the quantitative data (collected in 2019) with qualitative data, we focused on the most recent year data were available (i.e. we do not consider multiple time points). The assessment commenced with a review of the SDGs United Nations Indicators website, and province, district and municipal data available from governmental and non-governmental reports [9]. The major sources drawn upon for this activity were the District Health Plans and District Health Barometers, supplemented by data from Arrive Alive for road traffic accidents (RTAs) and the National Statistics Service, including the latest national mortality report for South Africa [10]. A non-systematic review of the relevant published literature was also conducted. Municipality was the default geography for results. Where information was not available at the municipality level we defer, depending on data availability, to district or province. In 2020, a second round of quantitative data collection was conducted in relation to HIV so that newly published numbers from the 2019 Thembisa model could be included [11, 12]. An SDG indicator was identified as a priority area when it had been put forward for selection by multiple stakeholders in workshops and/or interviews and/or when the quantitative baseline data indicated a clear burden of disease in the community above the national or the designated SDG targets. As described above, during the qualitative appraisal, participants (individually or in groups) identified three or four priority areas for action in their community. These expressed priorities were then collectively counted and ranked. In the quantitative assessment, health and wellbeing indicators were priority ranked based on the extent to which their burden exceeded their respective target. Following this process of ranking, the qualitative and quantitative priorities were compared and assessed for alignment. The study protocol was approved by the Human Sciences Research Council research ethics committee in South Africa (ref: 10/20/02/19) and the London School of Hygiene and Tropical Medicine research ethics committee in the United Kingdom (ref: 16349).
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