Health sector involvement in federal environmental licensing and malaria control in the Brazilian Amazon: a retrospective observational study

Malaria, a disease with a long history in the Brazilian Amazon region, continues to be a significant public health challenge, particularly for those populations considered most vulnerable. Large-scale infrastructure developments in the region have the potential to heighten the risk of transmission by modifying environmental conditions and drawing migratory labour flows. Since 2001, Brazilian legislation has mandated the involvement of the health sector in environmental licensing processes in areas endemic or at risk of malaria, yet this integration remains limited. An analysis was conducted of federal licensing processes registered with Ibama between 2008 and 2024, with the objective of identifying those that occurred in Amazonian states and verifying which of these were monitored by the Ministry of Health (MoH). Of the 3,335 processes analysed, 897 (26.9%) involved the Amazon region. Of these, a total of 140 cases (representing 15.6% of the total number of cases) had a process initiated at the MoH. The mining (20.3%) and power generation (19.1%) sectors had the highest proportions of cases that resulted in a process being opened. The follow-up period exhibited variability over time, reaching a peak of 28.9% in 2014 and subsequently declining, with a figure of 6.7% recorded in 2018. While 70.0% of the projects under scrutiny resulted in a case being initiated at the MoH within a year, 8.6% required a period of up to three years, and a case was documented that exhibited a 16-year interval between the initiation of proceedings at Ibama and at the MoH. The findings suggest that most projects on Amazon region are progressing without the necessary involvement of the health sector, thereby increasing the risk of adverse impacts on malaria control measures. It is imperative to enhance the systematic and timely involvement of the MoH in environmental licensing processes to ensure that development is aligned with the overarching objective of eliminating malaria in Brazil.

Keywords

Malaria; Brazil