Assessing and monitoring health impacts of infrastructure development projects in sub-Saharan Africa

In many sub-Saharan African countries, large infrastructure development projects in the natural resources, water management and agricultural sectors typically consider potential environmental and social impacts as part of the permitting process, while a specific focus on health impacts is often lacking. Health impact assessment (HIA) applies a combination of procedures, methods and tools that systematically judge the potential and sometimes unintended effects of a project on the health of a population and the distribution of those effects within the population. HIA seeks to predict health impacts and inform decision-makers on appropriate actions to manage those impacts with the ultimate goal to minimize negative health impacts and promote positive health impacts. As of 2016, there were few examples in the public domain on how health issues were addressed within an evidence-based HIA for large-scale projects in sub-Saharan Africa, despite monitoring and evaluation (M&E) being an integral part of the HIA process.
The main objective of this PhD thesis was to assess and monitor health impacts of infrastructure development and management projects in sub-Saharan Africa and to evaluate the effectiveness of HIA of large-scale infrastructure development projects to mitigate negative health impacts and promote health benefits. Several case studies from complex eco-epidemiological settings are presented focusing on implementation and outcomes of HIA of infrastructure development projects and on M&E of health outcomes and health-related indicators in communities potentially affected by these projects.