top - strategic health management - principles and guidelines for the oil and gas industry

Report No. 6.88/307June 2000

Principles and guidelines for the oil & gas industry

Strategic health management

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Global experience

The International Association of Oil & Gas Producers (formerly the E&P Forum) has access to a wealth of technical knowledge and experience with its members operating around the world in many different terrains. We collate and distil this valuable knowl-edge for the industry to use as guidelines for good practice by individual members.

Consistent high quality database and guidelines

Our overall aim is to ensure a consistent approach to training, management and best practice throughout the world.

The oil and gas exploration and production industry recognises the need to develop con-sistent databases and records in certain fi elds. The OGP’s members are encouraged to use the guidelines as a starting point for their operations or to supplement their own policies and regulations which may apply locally.

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Many of our guidelines have been recognised and used by international authorities and safety and environmental bodies. Requests come from governments and non-government organisations around the world as well as from non-member companies.

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Whilst every effort has been made to ensure the accuracy of the information contained in this publication, neither the OGP nor any of its members will assume liability for any use made thereof.

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Strategic health management:Principles and guidelines for the oil

& gas industry

Report No: 6.88/307

June 2000

This document has been prepared for the OGP by a specially formed taskforce under the Safety Health and Personnel Competence Committee (SHAPCC) and the Health Subcommittee.

Taskforce membership

K Lindemann ExxonMobil ChairmanD Broun World Health OrganizationG de Jong ShellP Eitrheim StatoilC Johnson ExxonMobilA Martin BP AmocoB Price PhillipsJ Rowalt TexacoS Simpson Chevron

The taskforce was assisted in document development by:

M Makinen Abt Associates ConsultantsM van Elteren-Jansen OpdenKamp ConsultantsAG van Elteren OpdenKamp Consultants

Acknowledgments The taskforce would like to credit Stuart McGill (President, ExxonMobil Gas Marketing) and Lyn Arscott (Executive Director, OGP) for their leadership and vision in promoting and facilitating the progress of this initiative. Special recog-nition and appreciation goes to the World Health Organization (WHO) and Dr Gro Brundtland for the exceptional support and invaluable advice provided by her professional staff. This document would not have been possible without such a progressive working partnership.

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Strategic health management: principles and guidelines for the oil & gas industry

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IntroductionPurpose ............................................................................................................................................................... 1Scope .................................................................................................................................................................. 1Key message........................................................................................................................................................ 1

Benefits of effective strategic health managementOpportunities for co-operation outside the oil & gas industry ............................................................................ 2Industry investment in health care ...................................................................................................................... 2

Vision and principlesVision ................................................................................................................................................................. 4Key principles ..................................................................................................................................................... 4

BackgroundRationale for strategic health management.......................................................................................................... 5

The strategic health management approachIntegrating strategic health management............................................................................................................. 6Linkage to other systems..................................................................................................................................... 8Leadership and commitment............................................................................................................................... 9Policy and strategic objectives ............................................................................................................................. 9Organisation and resources ............................................................................................................................... 10Evaluation and risk management ...................................................................................................................... 10Planning ........................................................................................................................................................... 11Implementing and monitoring .......................................................................................................................... 11Auditing and reviewing..................................................................................................................................... 12

Incorporating strategic health management into projectsImplementing strategic health management ...................................................................................................... 13Lifecycle elements ............................................................................................................................................. 13

AppendicesAppendix 1: Glossary ........................................................................................................................................ 15Appendix 2: Stakeholder consultation............................................................................................................... 17Appendix 3: Health performance indicators ..................................................................................................... 20Appendix 4: Case studies .................................................................................................................................. 23Appendix 5: Reference material ........................................................................................................................ 28

Table of contents

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Introduction

PurposeThe purpose of this document is to provide a basis for incorporating workforce and community health considerations systematically into project planning and management.

Increasingly, opportunities for long-term development of oil and gas exploration and production are occurring in regions of the world with limited health infrastructure and less-than-optimum health status.

Strategic Health Management (SHM) involves systematic, co-oper-ative planning in each phase of the lifecycle of a project to ensure the health of the workforce and promote lasting improvements in the health of the host community.

The principles and guidelines contained in this report are intended to facilitate the co-operative interaction among industry groups, host governments, the local health care system, community representatives and other stakeholders.

The Guidelines describe the main elements necessary to develop, implement and maintain a Strategic Health Management system. The focus is on community health rather than on workplace and workforce health since the latter subjects are well documented in the industry.

These guidelines are intended to convey that:

• industry co-operation on health is benefi cial;

• industry can help host governments fulfi ll responsibilities for community health;

• primary health care focus can have the greatest impact;

• early stakeholder involvement and consultation can achieve last-ing improvements in community health;

• strategic planning for health should be risk-based and subject to ongoing performance evaluation.

Primary health care*Essential care available at a cost a country and community can afford, with methods that are practical, scientifi cally sound, and socially acceptable.

Such care encompasses:

• health education

• disease prevention & control

• immunisation

• proper nutrition

• safe water

• basic sanitation

• maternal & child care

• treatment of common diseases & injuries

• access to essential drugs

* Alma Ata Declaration, WHO, Geneva, 1978

Scope

Key message

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An effective SHM system yields benefi ts that extend from the health of the project workforce into the host community.

Benefi ts of SHM include, but are not limited to:

• improved health of the workforce and dependents, and reduced health costs through better host community health care systems and infrastructure;

• improved health status in the surrounding host community through promotion of primary health initiatives;

• increased opportunity for future economic development and sus-tainability of changes in host community health status through strategic planning;

• enhanced industry relationships with the host community, includ-ing government, the local health system, and civil society through co-operative consultation;

• improved corporate reputation through proactive focus on health.

Health and wealth“Poor health is more than just a con-sequence of low income; it is also one of its fundamental causes. Health and demography are not the only infl uences on economic growth, but they certainly appear to be among the most potent. Investments in pri-mary health help stimulate a coun-try’s development.”

World Health Opportunity Report, WHO,May 13, 1999

Benefi ts of effective strategic health management

In addition to the co-operation and/or collaboration among oil and gas related companies proposing to operate in a given area, other industries (mining, forestry, manufacturing, etc.) should be encour-aged to participate in strategic health initiatives. Most community health issues are largely independent of the particular industry sector or individual companies that may be impacted. Co-operative plan-ning and implementation will be more effective and effi cient if the other industry stakeholders are involved along with governments and other non-industry stakeholders.

Opportunites for co-operation outside the oil & gas industries

Industry investment in health care

The process of strategic health management is intended to establish early and ongoing dialogue with the host government and other stake-holders, and thereby avoid unrealistic expectations about roles and responsibilities for funding and investment in health.

In certain circumstances the industry operator may elect to comple-ment the host government’s role by providing health care for the project workforce and their dependents. As an example, this could take the form of investment in health planning and provision of health support for the project workforce and their dependents. Such costs should be considered in the budgeting process and the design of health benefi ts plans.

The aim of the strategic health planning process is to insure that attention is given to priority health programmes within the host com-munity. The process is not intended to proscribe funding levels or rec-ommend funding mechanisms. Rather, there is an expectation that

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through the process, health priorities would be addressed more effec-tively and effi ciently, using whatever funding may be available. Invest-ment in community health programmes is the primary responsibility of the local government. In all cases, the decision on where and how much to invest in community health programmes rests with the gov-ernment.

Since the aim of co-operation among stakeholders is to strengthen existing community programmes, industry operators, acting individ-ually or jointly, may choose to assist the local government in support of specifi c health programmes. Such assistance may take the form of direct or indirect investment, or could occur through more tradi-tional philanthropic corporate contributions. In all cases, the decision on whether to invest and how much to invest, rests with industry.

Consider malaria...A signifi cant threat to projects in endemic areas with impacts on the health and pro-ductivity of the workforce and the local host community

How does strategic health management apply?

Engage key stakeholders to plan for impacts that extend beyond the workforce, recog-nising that sustainable improvements in community health will benefi t the project

The workforce and dependants in the host community… receive education, appropriate preventative measures, and ready access to diag-nosis and treatment (e.g. repellants, bed nets and health benefi ts to pur-chase local preferred medical care).

The host community… strengthen existing programmes to control and treat malaria through co-operative initiatives with other industry and key stakeholders, including local government and international aid organisations (e.g. refocus allocated social programme support to primary health care and widespread vector control measures).

The extended community… indi-vidual or pooled corporate contri-butions to target credible global programmes addressing prevention and new drug & vaccine develop-ment (e.g. WHO).

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Vision

Vision and principles

Key principles

The vision for SHM is to achieve lasting improvements in local health support capability through proactive partnerships among key stake-holders in industry, government and civil society, to enhance quality of life for all.

The success of the business and opportunities for future economic development are linked to the health of the host community where employees work and live. Accordingly, the following key principles should guide company involvement in SHM:

• emphasis on primary health care initiatives;

• industry co-operation and partnership in strategic planning and implementation;

• focus on strengthening existing resources and fostering local pro-gramme development and ownership;

• early consultation with host government and key stakeholders on goals, roles and plans;

• activities based on assessments of local health status and needs, and guided by strategic health plans;

• use of objective measurements to monitor and evaluate results.

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Background

Individual operators are adept at deploying tactical measures to meet the immediate and near-term health needs of the workforce. However, there is growing recognition of the potential benefi ts of co-operation with other stakeholders to address workforce and host community health concerns. In addition, it is clear that achieving longer-term health objectives requires strategic planning that must begin in the earliest stages of the new venture.

The desire among industry operators to align and cooperate on achiev-ing common health objectives was the key driver for this document.

Rationale for strategic health management

There is growing recognition that the success of ventures in less-developed parts of the world extends beyond the health of the work-force and is linked to the health of the host community. Addressing health concerns may have both social and economic benefi ts and foster future economic development.

Timely and lasting improvements in community health are diffi cult to achieve and do not occur passively. Members of industry, sharing common principles and a common vision, must be prepared to engage host governments and other key stakeholders actively in co-operative consultation to plan actions that may achieve the desired outcomes. Planning and coordinating such critical interactions over the life of a project is strategic health management.

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The strategic health management approach

Integrating strategic health management

The fi gure opposite provides an overview of a systematic approach to SHM. The annotations in green on the right of the fi gure provide ref-erence to the elements of the International Association of Oil and Gas Producers’ Guidelines for the development of health, safety and environ-ment management systems, (OGP Report No. 6.36/210).

Throughout the project, the focus is on maintaining a healthy work-force and promoting lasting improvements in the health of the host community. The SHM approach should ensure that:

• the commitment to SHM is defi ned through management’s state-ment of policy and objectives, and their willingness to provide the resources needed to support the process;

• roles and responsibilities of multi-functional industry team mem-bers and the interface with key stakeholders and host govern-ments are clearly delineated;

• strategic health management is governed by an overall plan that is modifi ed and adapted over the life cycle of the project;

• plans are risk-based and relate to input from the World Health Organization and other groups with the knowledge and expertise to assist host governments and communities in setting health pri-orities;

• specifi c plans developed for each stage of the project lifecycle are subject to monitoring in accordance with agreed performance measures.

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Figure 1 – a systematic approach to strategic health management

Projectin a region of the world with limited health

infrastructure and less-than-optimal health status

HSE management system

Strategic health management plan

• top down management commitment and definition of vision

OGP guidelines on HSE management

systems

OGP guidelines on strategic health management

Leadership and commitment

Policy and strategic objectives

Organisation, resources and

documentation

Evaluation and risk management

Planning

Implementation and monitoring

Audit and reviewHealthy workforce

Improved community health

Pro

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atio

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Exp

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tion

&

app

rais

al

Dev

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Pro

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Dec

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• set direction and strategic objectives

• assemble multi-functional team• define roles and interfaces

• conduct health risk & impact assessment

HSE

Medical Humanresources

Communityliaison

Operations

WHO

Internationalaid organisations

Communities

Governments

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Linkage to other systems

SHM should be linked to, or embedded into, a higher-level HSE or management system governing overall project operations. Such a linkage is critical to ensure top-down commitment and to defi ne the principles and vision needed to guide development of the SHM plan. Where comparable management systems have been adopted, and other operators and key stakeholders share principles and a vision for health, there will be a greater willingness to work co-operatively toward common goals.

The relationship between the elements of the International Associa-tion of Oil and Gas Producers’ Guidelines for the development and application of health, safety and environmental management systems (OGP Report No. 6.36/210) are shown in the table below.

HSE system elements Implications for strategic health management

Leadership and commitment Top-down commitment and company appreciation for the link between business success and the health of the community where employees work and live.

Policy and strategic objectives Guiding principles of action aimed at maintaining a healthy work force and advocacy for lasting improvements in community health through co-operative consultation with host governments and other stakeholders.

Organisation, resources Formation of a multi-functional strategic health management team to and documentation develop a strategic health management plan.

Evaluation and risk management Establish networks for consultation with local health authorities and the World Health Organization to assess risks, needs and priorities.

Conduct initial health risk and impact assessment as basis for strategic health management plan with activities (industry best practices) linked to key phases of project life cycle.

Planning Develop a strategic health management plan aligned with the company’s overall policy and objectives. Local health authorities and WHO should have input to plan development and participate in defi ning performance indicators.

Implementation and monitoring Carry out activities including monitoring as described in the strategic management plan and adjust activities occurring in subsequent phases of the project lifecycle based on feedback and performance measures.

Auditing and reviewing Link assessment of the overall strategic health management system to audits carried out as part of normal business controls. Key performance measures should be reviewed periodically with responsible management to reinforce top down commitment or to trigger necessary changes in company policy, objectives or resource allocation.

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Leadership and commitment

Senior management of the company should demonstrate their com-mitment to SHM in all of their actions that impact the health of workers, dependents, contractors, and the host community.

Leadership and commitment is demonstrated when management at all levels:

• defi nes and reinforces the vision;

• allocates the necessary resources to ensure access to health care for the workforce and to facilitate improvement in the health of the host community;

• develops a clear defi nition of delegated responsibility to nomi-nated individual managers for SHM activities;

• demonstrates a proactive commitment to working in partnership with host authorities, the local health system, the host commu-nity and international assistance organisations;

• acts on suggestions from the workforce and stakeholders;

• requires that contractors align their policies and practices with SHM objectives.

The SHM approach should be aligned with the company’s overall policies and strategic objectives.

Policy

The senior management should make clear in a policy statement or reference to existing health policies their commitment to and expec-tations of SHM.

The policy statement could include some or all of the following fea-tures:

• demonstrate the organisation’s belief that employee health is important to the business and that improved community health is attainable;

• acknowledge the importance of a focus on primary health care;

• highlight the importance and relevance of an effective partner-ship with stakeholders;

• convey a sense of commitment to achieve sustainability of health improvements, after project decommissioning;

• be available publicly in appropriate host languages.

Policy and strategic objectives

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Strategic Objectives

The SHM policy statement provides the starting point for establish-ing strategic objectives.

Such objectives could include:

• establishing co-operative partnerships among industry, govern-ment, and key stakeholders;

• maintaining and improve the health status of the workforce, con-tractors and dependents living in the host community;

• leveraging external resources (e.g. from international assistance organisations) to contribute to the development of sustainable improvements in the local health system.

Organisation and resources

The management structure for SHM should identify and defi ne the responsibilities, authorities, and accountability of the personnel within the company assigned leadership for implementation. SHM is a line responsibility discharged through multi-functional teams consisting of operations, HSE, HR, community liaison and external affairs per-sonnel. The organisational structure should describe the relationships between company leadership on SHM and all relevant stakeholders.

Documentation

Documentation should be maintained to provide records of critical aspects of the SHM system. Responsibilities should be established for the availability, maintenance, and modifi cation of such documents.


Health risk and health impact assessments

Health Risk Assessments (HRA) and Health Impact Assessments (HIA) are critical to the development of a SHM plan. When feasible, assessments of health risks related to the workforce and work place should be conducted along with assessments of health impacts related to the surrounding community. Multi-functional teams of suitably qualifi ed personnel should carry out the assessments.

The HIA may be conducted as part of an Environmental Impact Assessment (EIA) or Social Impact Assessment (SIA). A baseline study is carried out as part of this activity. For the purpose of SHM, it is essential to consider the potential for the project to impact posi-tively on the surrounding community over time. In this way, longer-term goals can be set and plans developed to achieve those goals through co-operative stakeholder activities.


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Stakeholder consultation

A critical element of the HIA and of the SHM process is identifi ca-tion of, and consultation with, key stakeholders. This is an ongoing process that can be time-consuming. Therefore, the need for consul-tation should be considered early in strategic planning to avoid costly errors or remedial measures later in the project lifecycle. (See Appen-dix 2.)

Recording and managing risks

The results of the HRA and HIA should be recorded and prioritised in context with the EIA and SIA fi ndings. Procedures should be in place to modify the SHM plan to mitigate the risks identifi ed in the subsequent assessments. Emphasis should be placed on pursuing opportunities for proactive positive impacts, while addressing poten-tial problems in a preventive, rather than reactive fashion, wherever possible.

SHM is integrated with the overall business plan for the project. Con-sequently, the SHM plan should be developed in the context of other project plans, including those addressing the social, environmental and economic aspects in order to achieve the optimum net benefi t to the project and to the community.

The health situation and needs assessments performed at various times in the project life cycle provide the basis for the initial SHM plan and determine how it is modifi ed. Many changes in situation of the project and health need should be anticipated over the life cycle. One element of health needs that will change in a relatively predict-able fashion over the project life cycle is the size and composition of the workforce and their dependents. Changes in the health status of the host community may be less dramatic and may occur more slowly but still require ongoing assessment.

Planning

Implementing

Activities should be carried out in accordance with the SHM plan and transition smoothly across all phases of the project lifecycle based on data from feedback and performance measures. (See section Incor-porating strategic health management into projects, page 13.)

Monitoring

Performance and results monitoring should be part of the SHM plan. Routine monitoring of technical progress and fi nancial results will need to be enhanced beyond traditional occupational health consid-erations to include community health performance indicators. The following elements should be included in the monitoring plan:

Implementing and monitoring

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• performance indicators and their defi nitions;

• baseline data collection;

• performance targets;

• data sources;

• method of data collection;

• frequency and schedule of data collection;

• responsibilities for acquiring data.

The monitoring plan should also cover the development of consistent approaches to data analysis, reporting and use of information, includ-ing:

• data analysis methods;

• identifying needs for evaluation by other stakeholders;

• plans for internal and external communication using monitoring information.

Records

Documentation on adherence to the SHM policy and the extent to which planned objectives and performance criteria have been met should be kept in a manner consistent with that followed for other business systems. Such documentation could include:

• assessment reports;

• audits;

• reviews;

• reports on follow-up actions;

• incident reports from unforeseen health problems.

A system of planned and systematic audits of SHM operations, together with management reviews of performance should be estab-lished and maintained as a normal part of the project operations. The audit plan should identify specifi c areas to be audited, the frequency of those audits and the responsibilities for auditing specifi c activities or areas. Audit frequency should be determined by the degree of risk and the results of previous audits and inspections.

Company or external audits do not replace the need for frequent assessments of progress and achievements of the SHM plan, con-ducted jointly with local stakeholders, where appropriate.

Auditing and reviewing

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Incorporating strategic health managementinto projects

Ideally, SHM is introduced during early project management; how-ever, it is possible to introduce SHM at any stage of the project life cycle, as long as the requisite steps that lead up to the design of the SHM plan are completed. Senior management commitment to the initiative and the elaboration of a clear vision and principles will enable the entire process and will insure that all efforts are aligned with the overall business plan.

Implementing strategic health management

The following elements are part of the project life cycle:

Prospect evaluation

includes negotiations with host government/communities to obtain a licence; assessing existing infrastructure and the available workforce, and the potential economic viability of a project (duration 1 to 2 years);

Exploration and appraisal

includes geological and geophysical surveys, and exploratory and appraisal drilling; after which a commercial development decision is made (duration 1 to 3 years);

Development

includes design, engineering, procurement, construction, and installation(duration 3 to 5 years);

Production

including wells on stream, development drilling, maintenance, enhanced recovery programmes, etc.(duration 5 to 40+ years);

Decommissioning

includes plugging and abandoning wells, removing facilities, and con-ducting site remediation and reclamation.

The following table highlights examples of SHM activities, grouped by category, that could be associated with the various phases of a project life cycle. (See Appendix 4 for Case Studies of a new develop-ment project in Camisea, Peru, and an existing project in Nigeria, page 23.)

Lifecycle elements

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• Assemble initial cross-functional SHM team

• Adjust SHM team to include appropri-ate functional/stakeholder represen-tation

• Transition SHM responsibilities to appropriate stake-holders





Planning

Implementing and monitoring

Auditing and reviewing

• Conduct preliminary Health Risk Assessment (HRA) in the project work area

• Identify local health authorities and determine structure of local com-munity health delivery system

• Assess adequacy of local health resources

• Conduct initial Health Baseline and Health Impact Assessment (HIA) to gather data on community health needs and expectations using input from the host community, other aid companies in the area, and local inter-national organisations

• Re-assess adequacy of health resources

• Update HRA and HIA with input from key stakeholders

• Re-assess adequacy of existing local health resources

• Update HIA with input from key stake-holders

• Re-assess adequacy of existing local health resources

• Conduct fi nal Baseline Health Assess-ment and HIA with input from key stakeholders

• Develop medical care delivery plan to ensure proper heath support for trav-ellers, expatriates and the local work-force

• Develop medical emergency response plan

• Develop worker occupational health and safety plan

• Develop initial SHM plan based on potential for successful exploration phase

• Update medical care delivery plan and identify opportunities to utilise shared community resources

• Update worker occupational health and safety plan

• Update SHM plan through production phase with input from key stakehold-ers

• Update medical care delivery plan and identify opportunities to strengthen existing community resources


• Update SHM plan based on potential for commercial development

• Update medical care delivery plan using shared community resources


• Update SHM plan through decommis-sioning with input from key stake-holders

• Discuss SHM plan completion with stakeholders to address specifi c issues related to sustainability, including transfer of facilities and equipment to local ownership

• Establish preferred medical resources and implement risk-based medical, occupational health (OH) and safety programmes

• Assess quality of medical services (QA) and measure relevant health perform-ance indicators (HPI)

• Consult with other companies and international aid organisations about activities and experience in the area

• Update preferred medical resources and implement risk-based medical, OH and safety programmes

• Continue to monitor QA and relevant HPI

• Consult with local stakeholders on community health needs and expec-tations

• Direct social assistance funds/contributions to primary health care programmes



• Engage local stake-holders, govern-ment, and WHO in discussion of roles and goals for addressing health pri-orities

• Facilitate involvement of international aid organisations

• Participate in joint assessments of community health plan performance and communicate results



• Engage local stake-holders, gov-ernment, and WHO in discussion of progress toward priority health improvement goals

• Facilitate involvement of international aid organisations that can be self-sustaining

• Participate in joint assessments of community health plan performance and communicate results

• Engage local stake-holders, govern-ment, and WHO in discussion of progress achieved on priority health improvement goals

• Assess overall performance relative to objectives established for each phase of the plan and share learnings with stakeholders for SHM work else-where

• Assess system elements to see whether they conform to planned arrangements and that there is an effective functioning of policy, objec-tives and performance criteria

• Assess capability of SHM team to develop longer-range plans if the project proceeds to exploration

• Identify areas for improvements


• Assess SHM plan and capability of cur-rent SHM team to develop longer-range plans if the project proceeds



• Assess SHM plan and capability of cur-rent SHM team to develop longer-range plans through production


• Assess system elements to see if they conform to planned arrangements and that there is an effective func-tioning of policy, objectives and per-formance criteria

• Assess SHM plan and capability of cur-rent SHM team to develop longer-range plans into decommissioning


• Assess overall SHM planning process and prepare recommendations for future projects


SHM Activities Prospect evaluation Exploration & appraisal Development Production Decommissioning

Phases of project life cycle

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Appendix 1 – Glossary

Audit

An independent, systematic and documented process of obtaining and evaluating objectively verifi able evi-dence to determine that results conform to audit criteria implementation is effective and the system is suitable to achieve the HSE policy and objectives.Source: Guidelines for the development and application of health, management and environmental management systems - OGP Report No. 6.36/210, 1994.

Best practices

Systems, processes, policies, methods or incentives that have been demonstrated to achieve superior results within an industry segment.

Company

An organisation engaged, as principal or contractor, directly or indirectly, in the exploration for and produc-tion of oil and/or gas. For bodies or establishments with more than one site, a single site may be defi ned as a company. Source: Guidelines for the development and application of health, management and environmental management systems - OGP Report No. 6.36/210, 1994.

Consultation

Soliciting people’s views on proposed actions and engag-ing them in a dialogue. Consultation should be under-taken as an integral part of SHM and health impact assessment. It aims to inform and educate stakeholders, to identify their views and concerns and to obtain feed-back about proposals.

Dependents

Typically a direct family member of company and/or contractor staff, wife, husband and children. The defi -nition is infl uenced or is made by local laws and prac-tices.

Environmental Impact Assessment (EIA)

Environmental impact assessment is a formal, consult-ative process to identify potential environmental and social impacts, to communicate with stakeholders, and to defi ne alternatives and mitigation strategies.

Essential drugs

Essential drugs are those that satisfy the health care needs of the majority of the population; they should

therefore be available at all times in adequate amounts and in the appropriate dosage form. The WHO Model List of essential drugs is intended to be fl exible and adaptable to many different situations; exactly which drugs are regarded as essential remains a national responsibility.Source: Globalization and access to drugs - perspectives on the WTO-TRIPS agreement. WHO, January 1999

Health

A state of complete physical, mental and social well being, and not merely the absence of disease or infi r-mity.Source: WHO constitution of 1948.

Health authorities

Legally constituted groups and entities with authority over health care in a certain area: responsible for organ-ised public and private health services, the policies and activities of health departments and ministries. Next to this offi cial health care system, other systems exist, such as traditional medicine that infl uences Primary Health Care.Adapted from: District Health Care - challenges for planning, organisation and evaluation in developing countries. R. Amo-noo-Lartson, et al, Macmillan Education Ltd London, 1988 and Health Promotion Glossary, WHO, Geneva, 1998.

Health Impact Assessment (HIA)

Evaluation of the possible impact of new projects on the health of host communities. Health Impact Assessment is normally carried out as part of or in conjunction with the Environmental Assessment and a Social Impact Assessment process. The results are used to develop appropriate mitigation measures and an improvement plan in consultation with the host community.

Health Performance Indicators (HPI)

Specifi c measures to describe management, operational process or performance (See Appendix 3).Source: Glossary of HSE terms, OGP Report No. 6.52/244, 1996

Health resources

Resources that are explicitly dedicated to the produc-tion of health and health gain. They may be invested by public and private agencies as well as by people as indi-viduals and groups. Investment in health strategies are based on knowledge about the determinants of health

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and seek to gain political commitment to healthy public policies.Source: Health Promotion Glossary, WHO, Geneva, 1998

Health Risk Assessment (HRA)

A process of identifying and assessing systematically work place health hazards and risk, to ensure that they are adequately controlled. Health risk assessment can be undertaken both for new projects and existing opera-tions. Conducting such an assessment at the appropri-ate stages of the design before operation commences, will not only minimise risks to health, but will also avoid the potential need for expensive modifi cations at later dates.

Host community

A specifi c group of people, often living and working in a defi ned geographical area impacted by the project, who share common culture values and norms, are arranged in a social structure according to relationships which the community has developed over a period of time. They exhibit some awareness of their identity as a group, and share common needs and commitment to meeting them.Source: Health Promotion Glossary, WHO, Geneva, 1998.

Host government

Legally constituted groups and entities with authority over the project. National, regional and local authori-ties must be considered. They play an important role in clarifying the extent of responsibilities for social provi-sions as part of the project approval process.Adapted from: Integrating social concerns into private sector decision making, World Bank discussion paper no.384, 1998.

Monitoring

Monitoring provides the means of measuring perform-ance against established requirements, including objec-tives, targets and performance criteria.Source: Guidelines for the development and application of health, management and environmental management systems - OGP Report No. 6.36/210, 1994.

Multi-functional team

People with different functional disciplines and skill sets working together to produce solutions to complex problems.

Primary Health Care

Primary health care is essential health care made acces-sible at a cost a country and community can afford, with methods that are practical, scientifi cally sound and socially acceptable Source: Alma Ata Declaration, WHO, Geneva, 1978.

Project lifecycle

Activities related to all phases of the project inclusive of prospect evaluation, exploration and appraisal, develop-ment, production and decommissioning.

Social Impact Assessment (SIA)

Social impact process is the process that predicts the signifi cant social consequences of an activity, evaluates alternative sites, techniques and technologies in terms of their social impact, and proposes changes and manage-ment solutions that will lead to a reduction of adverse effects and to the enhancement of positive effects.

Stakeholders

All those individuals, groups and other parties who might, for whatever reason, have a legitimate interest in, or might wish to infl uence the activities of, the com-pany. They may also be referred to as interested par-ties.

Strategic Health Management (SHM)

Systematic, co-operative planning throughout the project life cycle to maintain the health of the work-force and promote lasting improvements in the health of the host community. Source: Strategic health management: principles and guidelines for the oil & gas industry - OGP report 6.88/307, June 1999.

Sustainable development

Meeting the needs of present without compromising the ability of future generations to meet their own needs.Source: 1987 Report of the World Commission on Environ-mental Development (Brundtland Commission), as adopted at the 1992 UN Conference on Environment and Development (UNCED or Rio Conference).

Workforce

Company and contractor staff actually working on the project, inclusive of the local population. Source: Glossary of HSE terms. OGP Report No. 6.52/244, 1996.

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Appendix 2 – Stakeholder consultation

What is consultation?

Consultation describes the process of seeking the views of interested or affected parties (or ‘stakeholders’) and engaging them in constructive dialogue. It’s more than just simply talking or providing information once deci-sions have been made. Consultation is about a two-way sharing of information. It’s about listening, learning and responding to views.

Since the whole basis of SHM is shared responsibility and a co-operative approach between industry, local government and communities, consultation is an essen-tial tool for managing two-way communication and should form an integral part of the SHM process.

Why consult?

Any consultation process has a number of objectives, which may vary throughout the different phases of the project. Key objectives will include to:

• inform and educate to improve understanding;

• establish areas of co-operation and involvement;

• identify problems, concerns and needs;

• learn through local knowledge;

• evaluate alternatives and seek solutions;

• resolve and avoid confl icts.

By actively involving individuals, groups and organisa-tions with a stake in the project, consultation can also provide a number of benefi ts:

enhanced learning through local knowledge and under-standing - consultation provides access to the knowl-edge and experience of organisations which may assist in addressing issues, identifying opportunities and set-ting priorities;

improved decision making and project performance - by discussing and addressing issues early in the process, delays, mistakes and remedial measures which may be more costly or less effective when implemented at a later stage, can be avoided;

identifi cation of opportunities for partnerships and co-operation - early consultation can help to identify stakeholders with whom the company can work in part-nership, bringing additional expertise, competence and credibility to the process;

increased long-term project viability and ownership - by jointly discussing objectives and approaches, there will be greater willingness to work together towards common goals;

building trust and co-operation through understand-ing each other’s needs, concerns and values.

Consultation should always be undertaken in cases where an SHM approach is being discussed or an HIA undertaken. Often it is likely to form part of a com-pany’s wider consultation programme.

Key to any consultation programme is the need to start early. Time is required to build trust and enable stake-holders to understand, absorb and respond to infor-mation. Equally, companies require suffi cient time to understand concerns raised and address them in project planning and design. For SHM, early consultation is particularly vital in order to agree respective roles and responsibilities and identify key issues and opportuni-ties for programme development.

When should consultation be undertaken?

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Who to consult?Many different individuals or groups may be involved in consultation at the local, national or international level. Primary stakeholders are those directly affected by a project. In most cases, this will be local communi-ties and the organisations and spokespersons through whom they are represented, e.g. tribal elders, religious leaders, indigenous organisations/federations, etc. Sec-ondary stakeholders are those not directly affected for a project, but who may have an infl uence, interest or expertise to offer. In the case of SHM, this may include:

• local and national government, e.g. health agencies/ providers;

• WHO;

• non-governmental organisations (NGOs);

• research and academic institutions, e.g. local uni-versities;

• donor agencies and fi nancial institutions, e.g. IFC, the World Bank;

• other companies (E&P or others) operating in the region;

• partners/potential partners;

• suppliers contractors.

Tools and techniques for consultation

Stakeholders will operate at different levels with differ-ent resources, understandings and concerns, requiring that a variety of techniques be used:

Meetings are one of most common methods for consul-tation. Small meetings may be held between one single stakeholder and the company to discuss a specifi c issue or wider, public meetings may be held, open to all stake-holders, to discuss a range of issues, hear each other’s views and be stimulated by each other’s ideas;

Workshops are similar to public meetings, but they usu-ally have a specifi c focus, such as a task or goal to achieve. In the case of SHM, for example, workshops may be useful to discuss and agree priorities for local health programmes with the involvement of all relevant stakeholders;

Interviews and surveys may be used to seek views or collect information for baseline studies. For SHM, for example, local communities may be surveyed about their views on health needs, whilst for an HIA, they may be interviewed to obtain information about their health status;

Written information, such as newsletters, briefi ng papers and HSE reports may be used in conjunction with other techniques to help better explain informa-tion.

Whichever tool is used, it is important to ensure that the process is open and transparent and appropriate for the stakeholder. The location and format of meetings, for example, should refl ect the local culture and create familiarity and trust. Written information should be timely, accurate, understandable to non-technical read-ers and available in appropriate languages.

Organisation for consultation

Many different departments may be involved in con-sultation. Clear roles and responsibilities need to be identifi ed and adequate resources allocated. Account-ability should lie with the project manager who will be responsible for developing the programme. Other staff typically involved will include HSE and public/external affairs staff. For larger projects, there may need to be roles dedicated to co-ordinate and run the exercise and Community Liaison Offi cers to work with stakehold-ers in the fi eld. Each will require appropriate skills, atti-tudes and decision-making authority. In some cases, it

may be useful to involve or draw upon the advice of external experts such as social scientists and independ-ent facilitators/moderators for meetings.

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Undertaking consultation can have perceived and real risks for the company. However, many of these may be addressed and avoided by effective early planning. Common issues include:

representativeness of stakeholders - companies must ensure that all stakeholders affected by a project are able to input, particularly those who may be unlikely or unable to articulate concerns due to cultural, gender, economic or other factors. Similarly, consultation with NGOs should not be used to second guess the views of those directly affected;

lack of integration of input to planning and design process - consultation is not an ‘add on’ to a project, nor a ‘one off ’ exercise conducted at the start. Views obtained should feed into, and infl uence, project plan-ning for consultation to be genuine and effective;

confl icting company messages - stakeholders should hear the same message from all company representatives. Promises should not be made which cannot be deliv-ered. A clear consultation plan produced early on with defi ned roles and responsibilities can help avoid this problem;

lack of feedback - consultation is a two way process. Constructive responses should be provided to input received in order to maintain credibility and trust and avoid unsubstantiated fears of adverse impacts, or false hopes of benefi ts. Feedback is also vital to ensure stake-holders remain interested and actively contribute to the process;

unrealistic expectations - business must recognise that stakeholders, particularly local communities, need time to understand, absorb and respond to information and this must be worked into schedules. Equally, stake-holders may have unrealistic assumptions about what is under discussion. Clear objectives and limitations should therefore be agreed at the start.

Consultation as an integral part of project managementThe form and extent of consultation will depend upon the project scale, location, issues and impacts, as well as the characteristics of the stakeholders. For most projects (e.g. establishing an SHM plan or conducting an HIA), there will be three key phases of consultation:

Before the project commences, a number of inter-related preparation activities should be undertaken: a consulta-tion plan, which may form part of the wider SHM plan, should be produced setting out objectives, identifying who will be consulted and detailing roles and respon-sibilities etc. It may also be useful to collect informa-tion about local customs and etiquette and undertake appropriate cultural awareness training. Furthermore, at this early stage, some initial stakeholder contact may be useful to identify issues, opportunities and potential partners.

During the actual preparation of the SHM plan or conduct of the HIA, consultation will be at its most intense. Input should be sought at each stage, with views

assessed, acted on and feedback provided. For SHM, the types of issues that may require consultation will include:

• identifi cation of potential health risks and options for mitigation;

• assessment of local health needs and options for development;

• agreement priorities for local programmes and roles and responsibilities.

Having invested the time and resources to establish and build relationships, consultation should continue even after a particular study or a phase of a project is complete. Updates should be regularly provided to participants and further input sought as necessary. An evaluation of the process should also be undertaken such that learnings may be incorporated into subse-quent consultations.

Avoiding common problems and pitfalls

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Appendix 3 – Health performance indicators

Performance Indicators are needed with the aim of measuring the success or otherwise of SHM plans and projects. The ultimate aim of monitoring of perform-ance is to demonstrate that sustainable improvements in the health of target groups are being achieved and maintained. Thus, there are two types of indicators: indicators that measure progress against plans and tar-gets, so-called process indicators; and indicators that actually describe the status of, or trends in, health status of the target population. Indicators of the latter type, so-called outcome indicators, traditionally refer to measures of life expectancy, or cause-specifi c mortality rates. As eventual health outcome is mainly determined

by aspects of Primary Health Care (PHC), the focus should be on defi ning performance indicators refl ecting improvements in Primary Health Care. Other indica-tors should be added, in particular indicators that can be used as a management tool for tracking progress of ongoing SHM projects. What should be kept in mind is that the most important indicators are the ones that are developed within the project itself. Criteria for selecting monitoring indicators include relevance to SHM objec-tives; accessibility of data; simplicity; standard scientifi c and ethical criteria. Examples of indicators encompass-ing Primary Health Care objectives are provided in the following sections.

1. Health education

Promoting education concerning prevailing health problems and methods of preventing and controlling them.

Indicator Unit of measurement

Information materials provided about: Number

local prevailing health problems/methods

of preventing and controlling these problems

family planning

STD / HIV-AIDS

(use of posters and other simple health education materials)

Trainers trained in PHC (training courses for professionals) Number

Community health education provided Number or % of eligible people

2. Proper nutrition

A signifi cant risk factor for disease is malnutrition, which is primarily concentrated in the world’s poorest and most disadvantaged populations.


Growth (upper arm circumference measurement) cm

Child stunting (growth faltering rates) % of children under 5

Daily per capita calorie supply calories

Daily per capita protein supply grams

3. Safe water and basic sanitation

Safe water supply and basic sanitation involves: ensuring the continuous availability of suffi cient quantities of water of suffi cient quality, within adequate institutional frameworks, applying sound management practices, appropriate technologies and full-cost accounting, and effectively maintaining facilities and equipment.


Quantity of water number of litres per person per day

Quality of water - access the number of users per water point

Quality of water - compliance with standards % of samples compliant

The presence of latrines and disposal pits % of households

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4. Maternal and child care, family planning

In some of the “least developed countries”, more than 20% of children die before they reach the age of 5. In a typical “developed country”, however, less than 1% of children will do so (WHO, 1997).

Perinatal conditions contribute between 2.4 and 3.2 million deaths to the global burden of disease each year, of which about 1 million are due to low birth weight.

Other reproductive health conditions that have major impacts on health status include maternal deaths during childbirths.


Maternal mortality rate Number of deaths/total number of confi nements

Low birth weight % of births below 2,500 grams

Infant mortality rate (=MIR) Number of deaths under 1 year in a year/number of life births in the year

Under-5 clinic and growth monitoring % of children

Antenatal clinic % pregnancies

Assisted delivery % of deliveries

Fertility rate Number of children per woman 15-49 years

Use of contraception Number of women using contraceptives/total amount of fertile women

Infectious diseases are the major cause of death in developing countries.. The six major diseases in children are: measles, tetanus, pertussis, tuberculosis, poliomyelitis and diphtheria. These are all serious diseases that can be effectively prevented by immunisation.


Immunisation coverage % of children fully immunised

Prevalence of named diseases – number of cases; or – rate per 100,000

Deaths for named diseases – number of cases; or – rate per 100,000

5. Immunisation

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This includes giving fi rst aid and preventing accidents.


Acute respiratory infections in children under fi ve – number of cases; or – rate per 100,000

Diarrhoeal diseases in children under fi ve – number of cases; or – rate per 100,000

Malaria – number of cases; or – rate per 100,000

Incidence of infectious diseases – number of cases; or – rate per 100,000

Mortality from accidents, violence – number of cases; or – rate per 100,000

Outpatient department consultation number of consultations

Outpatient department treatment number of treatments

Utilisation of the health care system number of patients(district hospitals, health centres and health posts)

6. Treatment of common diseases and injuries

At least one-third or the world’s population lacks regular access to essential drugs.


Availability of drugs

% of a selection of essential drugs available at % availableremote health centres/basic dispensaries

% of a selection of essential drugs available as % availablegenerics in private pharmacies

Affordability of drugs

Cost of treatment of case as % of family food cost for 1 day % of cost

% of drugs prescribed by generic name %

7. Access to essential drugs

A number of basic health indicators cannot be directly placed under one of the general issues given above.


Annual population growth rate %

Crude birth rate per 1,000 population

Crude death rate per 1,000 population

Life expectance at birth years

General parameters

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Appendix 4 – Case studies

The following case studies of a new development in Camisea, Peru and an existing develop-ment in the Ugborodo community of Nigeria illustrate the benefi ts of SHM principles.Note: In 1999, it was decided not to pursue the Camisea Project. However, existing commitments, includ-ing those for community health are being fulfi lled, as planned.

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Introduction

This article defi nes how Shell Prospect-ing and Development Peru (SPDP) worked actively to meet its own objec-tives while at the same time forging links that would result in the presence and responsibility of the government. Success grew from collaboration in two areas - health and regional plan-ning. Even with the decision not to proceed much had been done to sup-port sustainable improvements in local services and infrastructure.

To achieve our objectives required active consultation, identifi cation of areas that would bring early success and the determination of champions within government itself. Recognising that the region was remote and defi -cient in government services meant expectations would be high that the company becomes the vehicle by which regional improvements would be made. Thus the company had to dem-onstrate leadership while at the same time engaging government in a par-ticipatory mode.

The challenge of collaboration

On initiation of the Camisea project, SPDP encountered a challenge common to industrial operations throughout the developing world. We had entered an area that lacked suffi -cient presence of both government and local stakeholders. The region’s social and ecological environments suffered from a lack of planning and insuffi -cient resources to undertake such plan-ning. Those crucial resources that were available were assigned without co-ordination among government agen-cies, NGO providers and local recipients (most offi cials had never even visited the local population). This prevented much progress beyond inad-equate provision of health and educa-

tion infrastructure. The few resources often faced last-minute reallocation to sporadic and very ineffi cient “fi re-fi ghting” of emergencies such as acute respiratory disease, diarrhoea, or malaria epidemics.

Facing this reality, stakeholders had high expectations that the company would either directly supply services or provide the fi nancial support neces-sary for local providers to maintain or expand their existing operations. His-torically, in similar situations compa-nies have become directly involved in providing services to treat the most visible symptoms of local problems, either providing local services, or a piecemeal provision of local infrastruc-ture.

Unfortunately, this often results in company support that increases the existing competition and frictions among stakeholders, and leads the company to assuming a greater de facto role of governance spanning from regional healthcare to resolving con-fl icts among landowners.

Recognising this risk, SPDP spent sig-nifi cant effort in designing the proc-esses required to avoid these eventual pitfalls. The process began with par-ticipatory assessments or “diagnostics” that resulted in stakeholder designed and owned plans in the areas of health and regional planning.

Health and regional diagnostics

An accurate understanding of the local reality is fundamental to building consensus and buy-in among the communities, government and other stakeholders for regional planning and action. In order to commence this understanding, in 1996 SPDP sup-ported a diagnostic of the regional public health situation before the start of operations and within a year sup-

Partnering with government on health care and social issues.“A community win/win”by Dr Mary Malca, SPDP, Alan Dabbs, Pro Natura andMurray Jones, SIEP EPS-HE

Dr Mary Malca has a MSc in Health Eco-nomics. She joined SPDP in 1997 as Corpo-rate Medical Adviser. Previously she worked for nine years in the Peruvian Social Security Institute as project manager dealing mainly with cost effectiveness of health care inter-vention, quality assurance of medical serv-ices and epidemiological surveillance as a management tool. After March 1999, she will continue in a part time role as health adviser to Shell Peru.

Alan Dabb works with Pro-Natura, an international NGO founded in Brazil dedi-cated to sustainable development by building partnerships between communities, NGOs, governments and the private sector. As Pro-Natura’s representative within the project he advised Shell on the social aspects of the Camisea project, including the development of a corporate role in promoting regional development as well as advice on minimis-ing the social impact of the operation.

Murray Jones joined SIEP EPS-HE in 1992 from Shell Canada where he was senior envi-ronmental adviser in Resources Operations. In 1996 Murray became Manager HSE for SPDP, returning to The Hague in 1998 fol-lowing the decision not to proceed with the project. Murray is actively working on doc-umenting lessons learned in the Camisea project and using these to assist new and ongoing business.

In the Camisea project, a decision was made to actively promote government involvement in Health & Social issues from the earliest stages. The up-front investment in Health Care has paid off. Local satisfaction has increased as communities see work towards addressing their identifi ed priorities. By building consensus there is less risk of com-petition for resources among the different stakeholders. The local stakeholders have now established contact with the appropri-ate government departments and thus can seek and receive their support rather than only from the corporation.

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ported a second diagnostic of broader social and environmental issues.

Key government, NGO and commu-nity stakeholders were involved in lead-ing and conducting the diagnostics in order to ensure buy-in on the eventual fi ndings and recommendations result-ing from the processes. In the case of the socio-economic diagnostic SPDP asked the regional government to pay a share of the study itself. Once Terms of Reference were established SPDP’s role was largely confi ned to logistics and facilitation. The diagnostics helped build commitment among stakehold-ers not only because they improved understanding, but also because they included direct participation of key leaders during the planning. Further-more, as the process gained momen-tum, stakeholders realized that they were working on something that potentially enabled long-term planned solutions to problems that had previ-ously required constant fi re fi ghting.

Diagnostics to reality

While signifi cant work was done regarding health and regional plan-ning, the process with public health began earlier and therefore provides the more complete case for discussion. The Health diagnostic set the model for engaging with the people and the government. The study was presented in a formal, local workshop to which representatives of all communities and government were invited. With over 50 community persons in attendance (representing a regional population of some 10,000) consensus was reached on the major priorities. These included health education, training and co-ordination among stakeholders in the health profession. It was notable that they did not call for expensive infra-structure or construction of facilities. The results, along with the community priorities, were presented at a Lima based workshop, again with commu-nity participation, and at which the Minister of Health publicly stated his support of the process and commit-ted to participation in the implemen-tation of the priorities. On the basis of this strong commitment, the real work began on a health plan with parties that included regional health direc-tors, and Ministry of Health offi cials, PISAP (a Catholic heathcare NGO) and the community representatives themselves. It took over nine months to arrive at terms of reference for implementing the health plan and a

further nine months to establish and maintain full stakeholder participa-tion. But the result was a proposal for action approved in writing by all the involved parties. An important com-mitment was made by government for personnel to accompany and monitor the implementation team.

Two areas were chosen for implemen-tation - education of communities and local services capacity building. The fi rst phase, addressing education, com-menced in June 1998 and will run to completion in July 1999. It provides for education seminars to increase local abilities to train and implement basic health care and has, as a visible delivery, a community radio broad-casting system. The ownership of the process has been quickly and meas-urably taken-up by the communities and their native association of native health care workers and teachers.

Other benefi ts include:

• sustainable sources of income for some participants;

• the integration of native health workers across the region in a co-operative manner;

• the integration of traditional mid-wives;

• the production of health educa-tion materials, e.g. radio spots, posters, compilation of traditional children stories.

As of March 1999, although only a relatively short amount of time has passed, signifi cant progress has been made towards addressing the regional health priorities. According to Min-istry of Health authorities, from less than 50% of implementation of national programmes, they have now reached 80% implementation. From less than 30% coverage of population under epidemiological surveillance, more than 64% coverage will be achieved by the end of the year. An additional expected benefi t will be the diminishing of epidemics as cases are recognised and treated early.

Conclusions• the process of joint engagement is not

easy

• it is diffi cult to gain generic understand-ings of sustainability

• the process is time consuming at start

• local planning skills require capacity building

• the process requires company ‘push’ demanding of company resources

• expectations of the various parties is not consistent at the start

• commitments to participation of the right people are hard to come by

• diagnostics provide well researched benchmarks on the local reality that should be used by the company for planning of programmes and monitor-ing of impacts of operations

• the results are clearly based on under-standing and teamwork

• community needs and expectations need to be matched with national pri-orities and policies

• the side benefi t is community empow-erment, allowing access to more oppor-tunities through their own skills

• sustainable results are possible through collaboration.

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Introduction

Chevron Nigeria is one of the major oil and gas exploration and produc-ing companies in Nigeria and oper-ates a joint venture partnership with Nigerian National Petroleum Corpo-ration (NNPC). Its operational area is in the Niger delta and currently spans over 5000 km offshore and 2600 km onshore. The operation is made up of 23 oil fi elds: 12offshore, 9 in the swamp and 2 on land. The opera-tional headquarters is at the Escravos Terminal which has all the facilities of a small but comfortable commu-nity. One of such facilities is a well-equipped and staffed industrial clinic which provides round-the-clock med-ical services for the workers.

The Escravos operation is hosted by about 7 villages which make up the Ugborodo and Ugboegungun Com-munities with a population of about 50,000 people, the majority of whom are fi shermen maintaining a largely rural lifestyle. The terrain is swampy and harsh, and social amenities and infrastructure are almost non-existent. The nearest health facility to these areas is located about 75 kilometres away, in Warri, and takes about 2 hours boat ride to reach .

The Ugborodo Cottage Hospital

The idea of building a health facility was conceived with the objective of providing comprehensive and qualita-tive health service to the com pany’s neighbouring communities – the Ugborodo area – as part of the total development of the people.

Thus an 18-bedded facility was built by the Chevron/NNPC joint venture, and commissioned in 1992. It con-sisted of a complex with a male, a female and a children’s ward, con-sulting rooms, a maternity dispensary, drug store and living accommodation for a doctor and 2 nurses. Beds, hos-

pital equipment, and drugs and dress-ings were provided for its smooth take off and then it was handed over to the local health authority, the Delta State Health Board, to be run in line with the national health policy.

Soon after this take-off, things began to deteriorate. The hospital ran out of drugs and dressings, maintenance of infrastructure and equipment was not forthcoming and the staff complained of poor living conditions. The hospi-tal eventually degenerated into a mere consulting clinic and was abandoned by the people. Average attendance was 4 - 5 daily. The hospital no longer had the desired impact on the lives of the people. It became imperative that something had to be done to salvage the hospital.

On June 7th 1996, NNPC/Chevron Joint Venture signed a Memorandum of Understanding with the Delta State Ministry of health that assigned the company more direct involvement in the running of the affairs of the hos-pital. It also encouraged community and government participation in deci-sion making and implementation, a factor considered vital to the success of such community based projects.

Among others, the Memorandum of Understanding provided for the fol-lowing:

Administration

• establishment of a Hospital Man-agement Committee consisting of 5 members, two representing each of Chevron/NNPC and Ugborodo Community and one representing the government run-ning the hospital as an annex of Warri Central Hospital;

• adequate record keeping drug store control by the Chevron pharmacist;

Maintaining a mutually benefi cial relationship with host communities: our unique wayby PA Ajayi, SPE; EO Kpiasi and D Wilkie, Chevron Nigeria Ltd.

The following text is the abstract from SPE paper 46873: Maintaining a mutually benefi cial relationship with host communities: our unique way by PA Ajayi, EO Kpiasi and D Wilkie, Chevron Nigeria Ltd

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Responsibility of Government

• provision of hospital staff includ-ing doctors and nurses;

• payment of staff salaries and a rea-sonable monthly imprest to cover cost of stationery, postage and other administrative expenses;

Responsibility of Chevron/NNPC

• provision and maintenance of nec-essary infrastructure and equip-ment;

• provision of drugs and dressings through the Chevron clinic on the Escravos Terminal

• provision and maintenance of 2 diesel powered electricity genera-tors, water well, refrigerators, air-conditioners, etc;

• provision of waterborne transport to and from Escravos for the doctor and nurses attached to the hospital.

The government would indemnify and hold Chevron harmless against all claims, court actions, damages, etc. arising regarding Chevron’s role in developing the hospital.

The company took immediate steps to rejuvenate the hospital.

1 An essential drug list was com-piled, drugs were procured and supplied to the hospital. To ensure standardization, drugs supplied were from the same source as for those used in Chevron’s own clin-ics. This singular action sent a strong signal to the community, and attendance gradually picked up again. Prescribed drugs were supplied free to patients.

2 Two Chevron nurses were posted to the hospital, each doing a week shift, to serve both as liaison offi cers (between the hospital and Chevron Nigeria), and as admin-istrators. The company’s doctor on the Escravos Terminal also pays regular visits to the hospital to monitor activities and protect Chevron’s interests and expenses.

3 Chevron carried out repair works on existing infrastructure and expanded facilities by adding a new living accommodation block to house more nurses, and a utili-ties block comprising a kitchen, dining hall and laundry. A new

set of hospital furniture was pro-vided.

4 Chevron provided two clinic attendants/medical records clerks, two additional security men and gardeners.

5 Communication link was estab-lished between the hospital and the Escravos Terminal by means of telephone and portable radio. Three television sets and a video cassette player were provided for health education and recreation.

The government continued to provide and pay the salaries of one doctor and three nurses per weekly shift. Chev-ron paid these government employees an additional monthly cash incentive to boost their morale.

The present standard of the hospital is comparable to that in any of Chev-ron’s clinics in Nigeria.

Services provided

Great emphasis is placed on preven-tive health services, considering the fact that most of the medical problems encountered are preventable diseases, mostly infectious, parasitic and life-style related. Preventive health services offered include monthly health talks/video show on topical issues, mass de-worming exercises, and antenatal clin-ics. The hospital staff also conduct monthly safety meetings and quality improvement meetings to keep up the standard of care.

Routine and emergency patient care is also provided free, and no form of identifi cation or payment is required for treatment. Severely ill and injured patients are stabilized and referred to the nearest government hospital in Warri.

Health protection programmes include pest control activities which are car-ried out by the pest control operator from the Escravos Terminal.

Community perception

A community survey recently con-ducted by the company’s public affairs group showed that the people are happy with the running of the health facility and are indeed very proud of it. They consider themselves part of the programme and they trust the staff, most of whom are indigenes of the area.

ConclusionsAs a way of maintaining a mutually ben-efi cial relationship with host communities, Chevron/NNPC joint venture embarks on several community projects, one of which is the provision of comprehensive health care for the community. Joint participation by Chevron/NNPC, the local health authority and the community has made the project a huge and enviable success. The community is very appreciative of the company’s effort and they are really proud of the facility. The relationship between the host community and the company has greatly improved.

References1. Kpiasi O: Community participation in

partnership with Chevron Nigeria Ltd to maximize the effectiveness of rural PHC hospitals in Delta State Nigeria. Dissertation for MSc. in health man-agement, University of Birmingham. (October 1995). 12.

2. Okorie E: Impact. A Community Affairs Publication of Chevron Nigeria Ltd. (1997).Vol.2 (8): 4

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Asian Development Bank

1992 Guidelines for the health impact assessment of devel-opment projects. Manila.

Ajayi, P. A.

1998 Maintaining a mutually benefi cial relationship with host communities: our unique way. SPE International Conference on Health, Safety and Environment in Oil and Gas Exploration and Production, Caracas, Vene-zuela.

Birley, M.H.

1995 The health impact assessment of development projects. Liverpool school of tropical medicine. HMSO, London.

OGP

1996 Glossary of HSE terms. Report no. 6.52/244, London.

OGP

1997 Principles for impact assessment: the environmental and social dimension. Report no. 2.74/265, London

OGP

1997 International standards for the oil and gas indus-tries. Report no. 1.15/267, London.

OGP

1994 Guidelines for the development and application of health, safety and environmental management systems. Report no. 6.36/210, London.

May, P.H., Dabbs, A., Fernandez-Davilla, P., Goncalves da Vinha, V. and Zaidenweber, N.

1999 Corporate roles and rewards in promoting sustain-able development: lessons learned from Camisea. Energy and resources group, University of California-Berkeley.

Pan American Health Organization

1999 Monitoring of Project Implementation - A Manual. Pan American Sanitary Bureau, Regional Offi ce of the WHO, February 1999.

Turnbull, R.G.H.

1992 Environmental and health impact assessment of development projects. A handbook for practitioners. World Health Organisation/Centre for Environmental Man-agement and Planning. Elsevier Applied Science, London.

World Bank

1997 Health Aspects of Environmental Assessment. Envi-ronmental Assessment Sourcebook Update, Number 18.

World Health Organisation

1996 Integration of Health Care Delivery. Technical Report Series, 861. Geneva.


1998 Health Promotion Glossary, Geneva.


1996 Final report of meeting on policy-oriented monitor-ing of equity in health and health care. Geneva.

World Commission on Environmental Development

1987 Report of the World Commission on Environmental Development (Brundtland Commission), as adopted at the 1992 UN Conference on Environment and Devel-opment (UNCED or Rio Conference).


1998 The world health report 1998. Life in the 21st cen-tury a vision for all. Geneva.


1997 Health and environment in sustainable develop-ment. Five years after the Earth Summit. Geneva.

Appendix 5 – Reference material


© OGP

What is OGP?

e International Association of Oil & Gas Producers encompasses the world’s leading private and state-owned oil & gas companies, their national and regional associations, and major upstream contractors and suppliers.

Vision

• To work on behalf of all the world’s upstream companies to promote responsible and profitable operations.

Mission

• To represent the interests of the upstream industry to international regulatory and legislative bodies.

• To achieve continuous improvement in safety, health and environmental performance and in the engineering and operation of upstream ventures.

• To promote awareness of Corporate Social Responsibility issues within the industry and among stakeholders.

Objectives

• To improve understanding of the upstream oil and gas industry, its achievements and challenges and its views on pertinent issues.

• To encourage international regulators and other parties to take account of the industry’s views in developing proposals that are effective and workable.

• To become a more visible, accessible and effective source of information about the global industry, both externally and within member organisations.

• To develop and disseminate best practices in safety, health and environmental performance and the engineering and operation of upstream ventures.

• To improve the collection, analysis and dissemination of safety, health and environmental performance data.

• To provide a forum for sharing experience and debating emerging issues.• To enhance the industry’s ability to influence by increasing the size and diversity of

the membership.• To liaise with other industry associations to ensure consistent and effective approaches

to common issues.

209-215 Blackfriars RoadLondon SE1 8NLUnited KingdomTelephone: +44 (0)20 7633 0272Fax: +44 (0)20 7633 2350

165 Bd du Souverain4th FloorB-1160 Brussels, BelgiumTelephone: +32 (0)2 566 9150Fax: +32 (0)2 566 9159

Internet site: www.ogp.org.uke-mail: [email protected]

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