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This plenary presentation at the Alternative Mining Indaba presented work taking place in EQUINET to raise health rights and duties in the extractive sector. Mining was noted to be a key vehicle linking African countries to neoliberal globalisation, with by 2008, developing countries reported to be transferring about a trillion dollars more a year to wealthy countries than they received in FDI. There is evidence of poor return for local wellbeing, with examples of districts with large EI projects having higher poverty and food insecurity and poorest improvements in these areas than those without, despite the wealth generated. The presentation raised the potential to better use the power of public health rights and laws in mining. Various international standards commit to protecting health in mining for workers and communities and the SADC UNECA harmonisation of policies and standards indicated that Member States should develop, adopt and enforce appropriate and uniform health, safety and environmental guidelines for the sector as an immediate milestone area. However, while there has been progress on doing this for TB and HIV and some attention is now being paid to chronic occupational diseases for ex mineworkers, there is as yet no comprehensive focus on public health in the mines. From an analysis of laws in the region no single country provides adequate legal protection, but different countries have good practice clauses that could be used for regional guidance on minimum standards. At regional level she observed that there is both a need and potential to harmonise rights and duties for health in SADC, to ensure health impacts are assessed and prevented before licenses are granted, mines provide living standards, incomes, health infrastructures and health services before people are resettled, the public health and health care of communities living in and around mines is invested in, including to address longer term impacts from mining that may persist even after mines close.

Health Centre Committees are potentially critical vehicles for community voice in health systems. They play not only a service and mobilisation role, but can be effective tools to improve the responsiveness and accountability of services – and thus have an important governance role to play. UCT’s Health and Human Rights programme in the School of Public Health and Family Medicine has been working with Zimbabwean and Zambian partners in EQUINET, on a project under the leadership of the Community Working Group on Health (CWGH) to strengthen Health Centre Committees (HCC’s) as vehicles for social participation in health systems in East and Southern Africa (ESA). UCT has led work to review and assemble capacity building materials for Health Committee training. . They found HCC training materials and processes in a number of countries, including Ethiopia, Kenya, South Africa, Tanzania, Uganda, Zimbabwe and Zambia. The training commonly covered introductions to the health system, its governance, planning and budget processes and HCC roles. It included information on HCCs functions such as problem solving, monitoring and accountability and social mobilization. There were gaps in some areas, such as on conflict management, fundraising, inter-sectoral work and deeper analysis of the causes of social inequalities in ill health and how to address them.

Stakeholders working with Health Centre Committees (HCCs) in East and Southern Africa (ESA) raised proposals in EQUINET policy brief 37 to improve the functioning and impact of HCCs as potential contributors to equitable, people centred health services. These proposals advocated for legal, institutional and social measures to support and clarify HCC roles, composition, powers and duties, to ensure the capacities and resources for them to function. They also proposed that HCCs strengthen their communication with the communities they represent backed up by wider measures for health literate and informed communities. Since then, institutions in EQUINET have followed up to act on the recommendations, building on existing work. This brief shares information on these developments. It reports some progress in legal recognition and setting of clearer constitutions for HCCs, clearer guidelines for the functioning, use of community based processes like photovoice to connect them with communities and their conditions in their dialogue with health services and efforts to share resources for capacity building of HCCs. It highlights that HCCs continue to play a role in improved frontline health systems. However the potential of HCCs still needs to be realised and the work continues.

The extractive (or mining) sector is a major economic actor in east and southern Africa. The mineral resources extracted are sought after globally, and how the sector operates affects the lives of millions of people. This brief aimed mainly civil society discusses the health impacts of the sector, how far these risks are recognised in policy and controlled in practice, and what civil society can do to ensure that health is protected in EI activity. It presents the proposals made at the 13th Southern Africa Civil society Forum in 2017 to advocate for regional health standards for EIs and a bottom up local to regional campaign for civil society to advocate for these harmonised standards for health in the mining (extractive) sector in SADC.