Fundação Renova

14 – Physical and mental health of impacted population

Objective of the program

To develop activities that support the physical and mental health of the impacted people and to develop a epidemiological and toxicological study for identifying the retrospective epidemiological and sanitary profile, nowadays and prospective, of the residents from Mariana to the mouth of the Doce River in order to assess the risks and correlations resulting from the collapse.

Progress of Program

Barra Longa

Since the collapse of the Fundao Dam, the municipality of Barra Longa has received support from the Public Unified Health System (SUS) to assist the affected population. Currently, through a public civil action (ACP), approved by the 12th Court, financial resources are made available for the hiring of 4 doctors on duty, 2 nurses on duty, 2 nursing technicians, 1 psychiatrist, 1 psychologist and, for the Health Surveillance Department, 2 medium level professionals, 2 technical level professionals and 2 higher level professionals. For logistical support, Renova Foundation provides 2 vehicles for the Municipal Health Department of Barra Longa including respective fuel cards.

Medical professionals and nurses work performing consultations and clinical procedures at the Health Assistance Center (CAS) 24 hours a day, with an average of 545 consultations and 218 procedures per month.

The professionals hired can also support the actions developed in Primary Health Care (PHC), through the Family Health Strategy (ESF), which offers services for the promotion, prevention and treatment of physical and mental health in communities both in urban areas and rural area of the Municipality.

As for mental health care, performed both at the CAS and at the ESF, an average of 150 monthly consultations performed by the psychiatrist and an average of 94 monthly consultations by the professional psychologist were reported. The Health Department also reported the important work developed by Health Surveillance professionals in feeding the Public Unified Health System (SUS) information systems (Federal Sinan, SIM, Covid-19 platforms, among others), monitoring data from the Water Quality for Human Consumption Monitoring System (SISAGUA), supervision and guidance of vendors and population regarding sanitary measures to be followed to combat COVID-19 and sanitary inspection in commercial establishments, among others.

The vehicles made available by the Renova Foundation are used to transport patients, attend to the Family Health Strategy, assist the Health Surveillance team to carry out prevention, promotion and health recovery actions, among others.

The Renova Foundation also supports the municipality with R$ 175,000.00 (two annual transfers in 2020 and 2021) to complement exams and specialized consultations, purchase of medical supplies, general supplies and medicines. In addition, it provided 4 laptops and 4 desktop computers to the Health Surveillance Department.

On August 19th, pants, vests, t-shirts and kits to combat Dengue, Chikungunya and Zika were delivered to the Health Surveillance Department, in compliance with the ACP.

Mariana

Since the collapse of the Fundao Dam, the municipality of Mariana has received support to serve the affected population. Currently, through an ACP approved by the 2nd Civil Court, the Renova Foundation maintains funding, through the company Contexto, for 10 health professionals working to support and strengthen the Public Unified Health System (SUS). In April and May 2021, the City of Mariana began hiring some of the professionals who will replace those currently hired by Contexto. The remainder must be replaced after hiring the professionals approved in the selection process approved in July and after carrying out a new simplified process to fill vacancies that could not yet be filled by the former. These professionals work in the following municipal health facilities:
• “Espaço Conviver”, which provides Mental Health services to the affected population, offering specialized psychological and psychiatric care and psychosocial support. The rent for this space is financed by the Renova Foundation, that also financed the purchase of furniture and equipment for it to function properly.
• CAPS and CAPSAD, in which care is provided by a multidisciplinary team that works in an interdisciplinary manner and primarily provides care to people in mental suffering, including those with needs arising from the abuse of alcohol and other drugs, in their territorial area, or in crisis situations or in psychosocial rehabilitation processes.
• UBS in Bento Rodrigues and Paracatu, where services are offered with a Nutritionist, Physiotherapist, Dentist, ESF Doctor, Psychiatrist, Nurse and Psychologist. The objective of this Health Unit is to address up to 80% of the health problems of the affected population, without the need for referral to other services, such as urgent care and hospitals. In this UBS, as in other UBS in the Municipality, affected families can have access to promotion, prevention and treatment actions related to women's and children's health, mental health, family planning, cancer prevention, prenatal care and care of chronic diseases such as diabetes and hypertension, bandaging, nebulization, taking vaccines, collecting samples for laboratory tests, having dental treatment, receiving basic medication and being referred to specialists.

Mariana – Health (10 professionals working through the company Contexto on August 15th/21):
ESF General Practitioner - 1 (40h/week) - Practice: ESF Bento Rodrigues and Paracatu;
Psychologist - 6 (30h/week) - Practice: 3 at CAPS, 1 at ESF Bento Rodrigues and Paracatu, 1 at CREAS (granted by Health) and 1 at Conviver;
Occupational Therapist - 1 (30h/week) - Practice: 1 at CAPSij;
Health Analyst - 2 (30h/week) - Practice: 2 at Conviver.

Completion of the 1st training workshop for Public Unified Health System (SUS) professionals - Health Information Management
Completion of the 2nd Training Workshop for Public Unified Health System (SUS) professionals - Health Risk Communication
2nd Transfer of financial resources in the amount of R$ 1,589,000 for hiring human resources in the health department in Mariana, in compliance with the ACP

Barra Longa

Since the Fundao Dam collapse, the municipality of Barra Longa has been receiving support from the Public Unified Health System (SUS) to assist the affected population. Currently, through a public civil action (ACP), approved by the 12th Court, financial resources are made available for the hiring of 4 doctors on duty, 2 nurses on duty, 2 nursing technicians, 1 psychiatrist, 1 psychologist and, for the Health Surveillance Department, 2 medium level professionals, 2 technical level professionals and 2 higher level professionals. For logistical support, Renova Foundation provides 2 vehicles for the Municipal Health Department of Barra Longa including respective fuel cards.

Medical professionals and nurses provide medical assistance and procedures at the Health Assistance Center (CAS) 24 hours a day, with an average of 545 consultations and 218 procedures per month.

As for mental health care, an average of 150 monthly consultations were performed by the psychiatrist and an average of 94 monthly consultations by the professional psychologist. The Health Department also reported the important work developed by Health Surveillance professionals in feeding the Public Unified Health System (SUS) information systems (Federal Sinan, SIM, Covid-19 platforms, among others), monitoring data from the Water Quality for Human Consumption Monitoring System (SISAGUA), supervision and guidance of vendors and population regarding sanitary measures to be followed to combat COVID-19 and sanitary inspection in commercial establishments, among others.

The vehicles provided by Renova Foundation have been used to transport patients, assist in the transportation of the Family Health Strategy, transporting the Health Surveillance team to carry out prevention, promotion and health recovery actions, among others.

The Renova Foundation also supports the municipality with R$ 175,000.00 (two annual transfers in 2020 and 2021) to complement specialized examinations and consultations, purchase medical supplies, equipment and medicines. In addition, it provided 4 laptops and 4 desktop computers to the Health Surveillance Department.

Mariana

Since the Fundao Dam collapse, the municipality of Mariana has been receiving support to assist the affected population. Currently, through a public civil action (ACP) approved by the 2nd Civil Court, the Renova Foundation maintains the funding for 16 health professionals, deployed by the company Contexto, to strengthen the Public Unified Health System (SUS). In April and May 2021, the City of Mariana began hiring some of the professionals who will replace those currently hired by Contexto. The remaining professionals must be replaced after hiring the professionals approved in the selection process sanctioned in July and after carrying out a new simplified process to fill vacancies that could not yet be filled through the former. These professionals work in the following municipal health facilities:
• “Espaço Conviver”, which provides Mental Health services to the affected population, offering specialized psychological and psychiatric care and psychosocial support. The rent for this space is financed by the Renova Foundation, which also financed the purchase of furniture and equipment for it to function properly.
• At CAPS and CAPSAD, care is provided by a multidisciplinary team with an interdisciplinary approach, focusing on people suffering mental distress or with a mental disorder, including those needing care due to alcohol and other drug abuse, within their territorial area, either in crisis situations or in psychosocial rehabilitation processes.
• UBS in Bento Rodrigues and Paracatu is offering the following consultations: Nutritionist, Physiotherapist, Dentist, ESF General Practitioner (GP), Psychiatrist, Nurse and Psychologist. The objective of this Health Unit is to address up to 80% of the health problems of the affected population, without the need for referral to other services, such as urgent care and hospitals. In this UBS, as in other UBS in the Municipality, affected families can have access to the promotion, prevention and treatment related to women's and children's health, mental health, family planning, cancer prevention, prenatal care, care related to chronic diseases such as diabetes and hypertension, bandages, inhalers and oxygen, vaccination, specimen collection for laboratory tests, dental care, basic medication provision and referral to specialists.

Mariana – Health (16 professionals working through the company Contexto on June 15/2021):
Psychiatrist - 1 (20h/week) - Practice: ESF Bento Rodrigues and Paracatu;
ESF General Practitioner - 1 (40h/week) - Practice: ESF Bento Rodrigues and Paracatu;
Nurse - 2 (40h/week) - Practice: 1 ESF Bento Rodrigues and Paracatu and 1 at CAPSAD;
Psychologist - 9 (30h/week) - Practice: 5 at CAPS, 1 at CAPSAD, 1 at ESF Bento Rodrigues and Paracatu, 1 at CREAS (granted by the Health Department), and 1 at Conviver;
Occupational Therapist - 1 (30h/week) - Practice: 1 at CAPSij;
Health Analyst - 2 (30h/week) - Practice: 2 at Conviver.

Barra Longa

For the delivery of PPE in accordance with the provisions of the ACP, repellents, sunscreens, boots, hats and gaiters were delivered to the Health Surveillance Department

SUS staff started training.

Mariana

Since the Fundao Dam collapse, the municipality of Mariana has been receiving support to assist the affected population. Currently, through a public civil action (ACP) approved by the 2nd Civil Court, the Renova Foundation maintains the funding for 16 health professionals, deployed by the company Contexto, to strengthen the Public Unified Health System (SUS). In April and May 2021, the City of Mariana began hiring some of the professionals who will replace those currently hired by Contexto. The remainder must be replaced after approval of the selection process that is in progress, which is scheduled for the month of July. These professionals work in the following municipal health facilities:
• “Espaço Conviver”, which provides Mental Health services to the affected population, offering specialized psychological and psychiatric care and psychosocial support. The rent for this space is financed by the Renova Foundation, which also financed the purchase of furniture and equipment for its proper functioning.
• At CAPS and CAPSAD, care is provided by a multidisciplinary team with an interdisciplinary approach, focusing on people suffering mental distress or with a mental disorder, including those needing care due to alcohol and other drug abuse, within their territorial area, either in crisis situations or in psychosocial rehabilitation processes.
• UBS in Bento Rodrigues and Paracatu is offering the following care: Nutritionist, Physiotherapist, Dentist, ESF General Practitioner (GP), Psychiatrist, Nurse and Psychologist. The objective of this Health Unit is to attend up to 80% of the health problems of the affected population, without the need for referral to other services, such as urgent care and hospitals. In this UBS, as in other UBS in the Municipality, affected families can have access to the promotion, prevention and treatment related to women's and children's health, mental health, family planning, cancer prevention, prenatal care, care related to chronic diseases such as diabetes and hypertension, bandages, inhalers and oxygen, vaccination, specimen collection for laboratory tests, dental care, basic medication provision and referral to specialists.

Mariana – Health (16 professionals working through the company Contexto on June 15/21):
Psychiatrist - 1 (20h/week) - Practice: Family Practice ESF Bento Rodrigues and Paracatu;
ESF General Practitioner - 1 (40h/week) - Practice: Family Practice ESF Bento Rodrigues and Paracatu;
Nurse - 2 (40h/week) - Practice: 1 at Family Practice ESF Bento Rodrigues and Paracatu and 1 at CAPSAD;
Psychologist - 8 (30h/week) - Practice: 4 at CAPS, 1 at CAPSAD, 1 at ESF Bento Rodrigues and Paracatu, 1 at CREAS, and 1 at Conviver;
Occupational Therapist - 2 (30h/week) - Practice: 1 at CAPS and 1 at CAPSij;
Health Analyst - 2 (30h/week) - Practice: 2 at Conviver.

The Renova Foundation also supports the municipality of Mariana with 5 vehicles, with respective fuel cards, to serve the affected population, aiming to strengthen the work in the areas of primary care, specialized care, mental health, health surveillance, pharmaceutical assistance, actions related to the prevention, promotion and health recovery, etc.

Barra Longa

Since the Fundao Dam collapse, the municipality of Barra Longa has been receiving support to their Public Unified Health System (SUS) to assist the affected population. Currently, through a public civil action (ACP), approved by the 12th Court, financial resources are made available for the hiring of 4 doctors on duty, 2 nurses on duty, 2 nursing technicians, 1 psychiatrist, 1 psychologist and, for the Health Surveillance Department, 2 professionals medium level, 2 technical level professionals and 2 higher level professionals. For logistical support, the Renova Foundation provides 2 vehicles for the Municipal Health Department of Barra Longa including respective fuel cards.

Medical professionals and nurses provide medical assistance and procedures at the Health Assistance Center (CAS) 24/7, with an average of 545 consultations and 218 procedures per month.

For mental health care were reported an average of 150 monthly consultations by the psychiatrist and an average of 94 monthly consultations by the psychologist. The Health Department also reported the important work developed by Health Surveillance professionals in feeding the SUS information systems (Federal Sinan, SIM, Covid-19 platforms, among others), monitoring data from the Water Quality for Human Consumption Monitoring System (SISAGUA), supervision and guidance of vendors and population regarding sanitary measures to be followed to combat COVID-19, and sanitary inspection in commercial establishments, among others.

The vehicles provided by the Renova Foundation have been used to transport patients, assist in the transport of the Family Health Strategy, transport the Health Surveillance team to carry out prevention, promotion and health recovery actions, among others.

The Renova Foundation also supports the municipality with R$ 175,000.00 (two annual transfers in 2020 and 2021) to supplement specialized examinations and consultations, purchase medical supplies, equipment and medicines. In addition, it made available 4 notebooks and 4 desktops to the Health Surveillance Department.

Barra Longa

Since the Fundao Dam collapse, the municipality of Barra Longa has been receiving support to their Public Unified Health System (SUS) to assist the affected population. Currently, through a public civil action (ACP), approved by the 12th Court, financial resources are made available for the hiring of 4 doctors on duty, 2 nurses on duty, 2 nursing technicians, 1 psychiatrist, 1 psychologist and, for the Health Surveillance Department, 2 professionals medium level, 2 technical level professionals and 2 higher level professionals. For logistical support, the Renova Foundation provides 2 vehicles for the Municipal Health Department of Barra Longa including respective fuel cards.

Medical professionals and nurses provide medical assistance and procedures at the Health Assistance Center (CAS), 24/7, with an average of 545 consultations and 218 procedures per month.

For mental health care were reported an average of 150 monthly consultations were performed by the psychiatrist and an average of 94 monthly consultations by the professional psychologist. The Health Department also reported the important work developed by Health Surveillance professionals in feeding the SUS information systems (Federal Sinan, SIM, Covid-19 platforms, among others), monitoring data from the Water Quality for Human Consumption Monitoring System (SISAGUA), supervision and guidance of vendors and population regarding sanitary measures to be followed to combat COVID-19 and sanitary inspection in commercial establishments, among others.

The vehicles provided by the Renova Foundation have been used to transport patients, assist in the transport for Family Health Strategy, transport the Health Surveillance team to carry out prevention, promotion and health recovery actions, among others.

The Renova Foundation also supports the municipality with R$ 175,000.00 (two annual transfers in 2020 and 2021) to complement specialized examinations and consultations, purchase medical supplies, equipment and medicines. In addition, it made available 4 notebooks and 4 desktops to the Health Surveillance Department.

Mariana

Since the Fundao Dam collapse, the municipality of Mariana has been receiving support to assist the affected population. Currently, through a public civil action (ACP) approved by the 2nd Civil Court, the Renova Foundation maintains funding, through the company Contexto, for 17 health professionals working to strengthen the Public Unified Health System (SUS). These professionals work in the following municipal health facilities:
• “Espaço Conviver”, which provides Mental Health services to the affected population, offering specialized psychological and psychiatric care and psychosocial support. The rent for this space is financed by the Renova Foundation, which also financed the purchase of furniture and equipment for its proper functioning.
• At CAPS and CAPSAD, care is provided by a multidisciplinary team with an interdisciplinary approach, focusing on people suffering mental distress or with a mental disorder, including those needing care due to alcohol and other drug abuse, within their territorial area, either in crisis situations or in psychosocial rehabilitation processes.
• UBS in Bento Rodrigues and Paracatu is offering the following care: Nutritionist, Physiotherapist, Dentist, ESF General Practitioner (GP), Psychiatrist, Nurse and Psychologist. The objective of this Health Unit is to attend up to 80% of the health problems of the affected population, without the need for referral to other services, such as urgent care and hospitals. In this UBS, as in other UBS in the Municipality, affected families can have access to the promotion, prevention and treatment related to women's and children's health, mental health, family planning, cancer prevention, prenatal care, care related to chronic diseases such as diabetes and hypertension, bandages, inhalers and oxygen, vaccination, specimen collection for laboratory tests, dental care, basic medication provision and referral to specialists.

Mariana – Health (17 professionals working through the company Contexto on May 15/21):
Psychiatrist - 1 (20h/week) - Practice: Family Practice ESF Bento Rodrigues and Paracatu;
ESF General Practitioner - 1 (40h/week) - Practice: Family Practice ESF Bento Rodrigues and Paracatu;
Nurse - 2 (40h/week) - Practice: 1 at Family Practice ESF Bento Rodrigues and Paracatu and 1 at CAPSAD;
Dentist - 1 (30h/week) - Practice: Family Practice ESF Bento Rodrigues and Paracatu;
Psychologist - 8 (30h/week) - Practice: 4 at CAPS, 1 at CAPSAD, 1 at ESF Bento Rodrigues and Paracatu, 1 at CREAS, and 1 at Conviver;
Occupational Therapist - 2 (30h/week) - Practice: 1 at CAPS and 1 at CAPSij;
Health Analyst - 2 (30h/week) - Practice: 2 at Conviver.

The Renova Foundation also supports the municipality of Mariana with 5 vehicles, with respective fuel cards, to serve the affected population, aiming to strengthen the work in the areas of primary care, specialized care, mental health, health surveillance, pharmaceutical assistance, actions related to the prevention, promotion and health recovery, etc.

There were no relevant facts this month.

The Municipality of Barra Longa, as of 03/09/21, assumed the hiring of all professional positions previously done through the company Contexto. This way, the contract between the Renova Foundation and Contexto will be terminated and the financing of professionals for Barra Longa will continue exclusively through financial transfers, as defined in the Agreement approved in Action nº 1024832-63.2020.4.01.3800.

Completed the amendment of the lease contract of the “Conviver” space in Mariana.

There were no relevant facts in february.

Finalization of the competitive hiring process for the company responsible for
implementation of the Training Program for professionals working in the public health system (SUS) of the impacted municipalities considered by TTAC.

1st Financial transfer in the amount of R$ 751,502.40 to carry out the
simplified selection and hiring process for Human Resources in the region of
Barra Longa, in compliance with the Public Civil Action (“ACP”).

Delivery of 2 vehicles with pre-paid fuel card. In compliance with Public Civil Action (ACP) - Barra Longa - MG.

Delivery of 4 computers and 4 notebooks. In compliance with Public Civil Action (ACP) - Barra Longa - MG.

Suspended the publication of the FAPES RFP at the request of TB-Health

Judicial decision approved alteration of the list of human resources in the Barra Longa Judicial Agreement at the request of the municipality

Deadline extension on the agreement with FAPES to launch the RFP for studies. The process was delayed, as FAPES requested a temporary suspension of activities due to the COVID-19 pandemic. Activities have already resumed. Forecast for the launch is November 30th, 2020.

12th federal court provided judicial approval for the health action plan to be developed in the municipality of Barra Longa/MG.

Risk to Human Health Assessment Studies (ARSH) carried out in the municipality of Linhares/ES were made available to CIF, Federal Prosecution Service and SESA/ES.

Receipt of a new proposal for the timeline of the public RFP process for epidemiological and toxicological studies in partnership with FAPES / FAPEMIG

• Working on another amendment to the Contexto contract, which provides supplementation for health professionals to the municipalities of Mariana/MG and Barra Longa/MG, until 09/30/2020.

• The contract with Contexto has been amended. It provides for additional health professionals for the municipalities of Mariana and Barra Longa, in Minas Gerais. The new contractual amendment is in place since 01/07/2020, without interrupting the service provided.

• Resuming renovation and expansion works on the Children's Psychosocial Care Center (CAPSIJ) in Mariana, Minas Gerais.
• Completing the 4th cycle of vector control (mosquitoes), in compliance with the Contingency and Drought Plan for the barrier of the Pequeno River, in Linhares, Espirito Santo, and Sooretama, Espirito Santo. This action is a result of complying with CIF resolutions No. 180, 220, and 266.

• Resumption of the works of the Children's Psychosocial Care Center (CAPSIJ) in Mariana/MG, respecting safety standards based on the COVID-19 workers' safety guidelines.
• Request for temporary suspension of the RFP for contracting epidemiological and toxicological studies by the Foundation for Supporting Research and Innovation of Espirito Santo (Fapes).

• Temporary suspension of construction works at the Children's Psychosocial Care Center (CAPSij) in Mariana/MG, following the isolation guidelines due to COVID-19.
• Beginning of the judicialization process of the health action plan in the municipality of Barra Longa/MG.

• Signature of the technical cooperation agreement with the Foundation for the Supporting Research and Innovation of Espirito Santo (FAPES) and Foundation for Supporting Research of the State of Minas Gerais (Fapemig), for contracting epidemiological and toxicological studies.

• Launch and suspension of the selection process conducted by the municipality of Mariana/MG to hire health and social protection professionals.

Finalization of the first amendment to the contract for supplementing labor in the municipalities of Mariana and Barra Longa by the supplier Contexto.
Public presentation of the final results of the Human Health Risk Assessment Study (ARSH) in rural areas of Mariana and Barra Longa, in accordance with the communication plan prepared together with the Government of the State of Minas Gerais.
Preparation of the 2nd phase of the Human Health Risk Assessment Study has not been completed. Cause: change of study conduct strategy. Countermeasure: Incorporation and expansion of the study through GAISMA (Integrated Environmental Management in Health and Environment), conducted by PG023 - Tailings Management. Therefore, the 2nd phase of the ARSH will be executed within this new study, based on the new strategy.
The epidemiological and toxicological studies (descriptive epidemiological study, toxicological study, study on worker’s health and the follow-up study of the exposed and potentially exposed population) did not take off. Cause: redefinition of the strategy for contracting epidemiological and toxicological studies by Technical Board of Health. Countermeasure: It was defined that the studies will be carried out through the signing of a Technical Cooperation Agreement with the FAPES/FAPEMIG institutions.

PG014
• The delivery of the construction of the Primary Health Care Unit of Ponte do Gama, in the municipality of Mariana, was made official through the Receipt Agreement.
• Sending an official letter to TB-Health on the Barra Longa plan, detailing the HR hiring proposal, with the support of a social entity.
• Meeting with the WG Planning for adjustments to the Program Definition document. The document will be updated according to the discussions and will be sent back to the WG.
• Analysis and submission of the opinion on the Belo Oriente Health Action Plan, sent by the municipality through TB-Health.
• Presentation of the final results of the Human Health Risk Assessment Studies (ARSH) in the Mariana and Barra Longa areas, conducted by the companies Technohidro and Ambios (the latter refused to participate), through a consolidated report to the Secretary of State of Health-MG, Ministry of Health, TB-Health and experts from the Federal Prosecution Service (FGV, AECOM and Ramboll).
• Sending letters with the proposal of the HR hiring model, with the support of a social entity, to the municipalities that are affected by the Fiscal Responsibility Law, to TB-Health and other competent bodies.
• In October, the engineering and licensing projects for the renovation/construction of the Children's Psychosocial Care Center (CAPSij) were approved, with the consequent initiation of works.
• The amendment process of the contract with supplier Contexto (addendum 2) for labor supplementation in the municipalities of Mariana and Barra Longa was not completed. Cause: Delay in the procedures of the Renova Foundation. Countermeasure: Accompany the following phases to meet the new agreed deadlines and finalize the procurement process.

• Termination of emergency contract for vehicle rental to serve Mariana and delivery of vehicles to the municipality through the new contract. Served through the new contract for the municipality of Mariana.
• Completion of the mobilization of dedicated teams to support the implementation of mitigation measures, in accordance with the repair plan of the municipalities in the Doce River Channel region. Introductory training sessions marked the beginning of activities.
• Delay in signing the cooperation agreement with the municipality of Barra Longa and consequent delay in hiring extra labor. The municipality claims to be within the prudential limit of the Fiscal Responsibility Law and cannot receive funds for direct or indirect hiring of professionals. The Renova Foundation advises to contract a Social Entity for the new model to be adopted. The new deadline for signing the cooperation agreement with the municipality will be December/2019.
• Delay in approval engineering and licensing projects for renovation/construction of the Children's Psychosocial Care Center - CAPSJ, in Mariana. On 08/30/19, the revised projects in compliance with the considerations proposed by the responsible agencies were filed with the Mariana Municipal Office. The public office then made the request for adjustments to the document, and it has already been modified and filed. The works are now expected to start in November/2019.

• Completion implementation of the system for receiving water quality monitoring reports.
• Revision of the “Definition of the Health Program” document by the Renova Foundation and submission to the CIF.
• Completion of the sourcing process for car rental (new contract).
• Meeting with the municipalities of Linhares and Sooretama (ES) to evaluate the 2nd cycle of actions of the Vector Control Plan, related to the Contingency Plan, in compliance with Resolution 220, item 1: to approve the opinion on the Contingency Plan - removal actions in Linhares and Patrimonio da Lagoa (Sooretama), according to Technical Note No. 10/2018/CTSaude.
• Alignment meeting of the Physical and Mental Health Program impacted with the municipalities of Linhares, Regencia and Sao Mateus (ES) and presentation of toxicological studies conducted by the University of Sao Paulo (USP - Ribeirao Preto).
• Delay in closing the emergency vehicle provision contract to serve the municipality of Mariana, since the vehicles will only be available under the new contract in October/19.
• Delay in approving engineering and licensing projects for renovation/construction of the Children's Psychosocial Care Center (CAPSJ) in Mariana (MG). On 08/30/19, the revised projects in compliance with the considerations proposed by the responsible agencies were filed with the Mariana Municipal Office.
• Delay in signing the partnership agreement with the municipality of Barra Longa (MG) and consequent delay in the beginning of the transfer of funds to supplement labor in Barra Longa. The municipality claims to be within the prudential limit of the Fiscal Responsibility Law and cannot receive funds for direct or indirect hiring of professionals. The model to be used to hire extra labor is being reevaluated in order to begin the process.

• Schedule for commencement of construction of the Children's Psychosocial Care Center (CAPSJ) in Mariana was revised, according to CIF Resolution 189.
• Completion of the hiring of the territory teams that are to support the implementation of mitigation measures (providing support to the Social Protection and Health programs) in the affected municipalities.
• Visit to the municipalities of Colatina, Baixo Guandu and Linhares (ES).
• Installation of an additional fence at the Primary Health Care Unit in the district Ponte do Gama, in Mariana, (item not covered by the Renova Foundation's renovation), as requested by the Mariana Municipal Secretary of Health.
• Delay in approving engineering and licensing projects for renovation/construction of the Children's Psychosocial Care Center (CAPSJ) in Mariana. On 08/30/19, the projects complying with the revisions proposed by the responsible agencies were filed with the Mariana Municipal Office.
• The first transfer of funds for additional labor in Barra Longa was delayed. The municipality claims to be within the prudential limit of the Fiscal Responsibility Law and cannot receive funds for direct or indirect hiring of professionals. The model to be used for extra labor is being reevaluated by TB-Health and the municipality so that the process can be started.
• The deadlines for the implementation of the system for receiving reports with results of water quality monitoring for human consumption is being validated by the Doce River Basin Monitoring Program.

• Updated version of the Health Program Definition document sent to the Technical Board (TB of Health), which has not yet commented on it. On 07/25/2019, the Renova Foundation sent a letter to the Interfederative Committee (CIF) announcing that it was awaiting a response from the Technical Board.
• Reports (partial and final) of the first phase of the Human Health Risk Assessment Study (ARSH) were received and the necessary assessments (Peer Review) were submitted.
• The Primary Health Care unit of the Ponte do Gama district in Mariana was restored and made available to the municipality (works completed on 05/31/19). Since the municipality did not accept the property, a letter was sent to the Municipal Health Department of Mariana informing the availability of the property. The secretary visited the site and requested the installation of an additional grid, an item not included in the scope of the restoration performed by the Renova Foundation.
• Furniture/Equipment delivered to the CONVIVER space in Mariana.
• Visit to the municipalities of Bom Jesus do Galho, Corrego Novo, Sao Pedro dos Ferros and Raul Soares.
• The Partnership Agreement to be signed between FAPES/FAPEMIG and the Renova Foundation was prepared and the work plan is being developed by the Renova Foundation and FAPES/FAPEMIG. Although the drafting of the partnership agreement was completed on time, it has not been signed yet. The Technical Board requested that the States of MG and ES be included as intervening parties in the agreement with FAPES/FAPEMIG, however, since May/19, they have not presented the state legal opinions with duties inherent to the states, a fact that is compromising Renova Foundation's duties.
• The hiring and mobilization of the territory teams that are to support the implementation of mitigation measures (providing support to the Health and Social Protection programs) with the affected municipalities was not completed. The Renova Foundation will request new technical proposals for participating suppliers to complete the procurement process.

• Initiation of the second stage of vector control in Linhares and Sooretama (application of “Ultra Low Volume” - ULV - of biological larvicide and insecticide for vector and larval control).
• Study by Ambios was filed at the State Health Secretariat of Minas Gerais.
• Technical visits to the municipalities of Alpercata, Aracruz, Baixo Guandu, Belo Oriente, Colatina, Fundao, Galileia, Governador Valadares, Marilandia, Naque, Resplendor, Sooretama and Tumiritinga, to present the program and open dialogue on health impacts due to the dam collapse.
• The structural project of the Child and Youth Psychosocial Care Center (CAPSij) of Mariana was filed with the Secretariat of Works in May/19. To date, the Renova Foundation has not received a reply from the Secretariat on the approval of this project.
• The restoration works at the Primary Health Care Unit, in the district of Ponte do Gama, were completed in May/19. However, the municipality has not yet formalized the acceptance of delivery of the recovered property.
• A partnership agreement was drafted jointly between FAPES/FAPEMIG, Renova Foundation and Technical Board of Health and the work plan is being prepared by the Renova Foundation and FAPES/FAPEMIG. Although the partnership agreement was drafted on time, it has not yet been signed. The Technical Board requested that the states of Minas Gerais and Espirito Santo be included in the agreement with FAPES/FAPEMIG as intervening parties, however, since May/19, they have not presented the state legal opinions with duties inherent to the states, a fact that is compromising Renova Foundation's duties.
• Delay in the validation of the Health Program Definition document by the Technical Board of Health, as the TB demands that the document should include Public SUS funding within its scope regardless of any correlation with the collapse, a fact that is compromising the execution of duties of the Renova Foundation.
• Delay in the first transfer of funds for additional workforce in Barra Longa. The municipality claims to be within the prudential limit of the Fiscal Responsibility Law and cannot receive funds for direct or indirect hiring of professionals. The model to be used for extra workforce is being reevaluated with the municipality so that the process can be started.

• First phase of the Risk to Human Health (ARSH) study filed at the State Health Secretariat of Minas Gerais.
• Project for construction / renovation of the CAPSij of Mariana, registered at the Secretariat of Works of the municipality of Mariana.
• Delivery of leased vehicles to the Health Department of Mariana to attend the municipality, in compliance with the Mariana ACP Judicial Agreement.
• Transfer of funds to carry out the hiring process of manpower by the municipality of Mariana, for reinforcing the Health Care team, according to the Mariana ACP Judicial Agreement.
• Visit to affected municipalities (Sao Jose do Goiabal, Sem Peixe, Rio Casca, Caratinga, Fernandes Tourinho, Dionisio, Marliéria and Bugre) to present the Health Care program and identify damages caused by the dam collapse.

• Judicial Agreement of ACP Mariana was signed.
• Leased the property for operation of Conviver - specialized mental health care for those affected from Mariana (municipality will only open the center once the furniture/equipment arrives).

Initiation of process for leasing a space for Conviver, specialized mental health care for those impacted in Mariana.
Delivery of renovated Community Center / Health Post of the district of Ponte do Gama, in Mariana. Delivery of the temporary Basic Health Unit (UBS), of Bento Rodrigues and Paracatu, renovated for the municipality of Mariana.

Roof renovation works at the Basic Health Unit continued.
A specialized company was hired for pest control related to the barrier of the Juparana Lagoon and Pequeno River, and environmental monitoring in Linhares.
CAPSij: basic project approved by the health care team of the municipality. Renova is awaiting the rectification of the property registry by the municipality, which is incorrect in its measures.

Renovation works started on the roof of the Basic Health Unit (UBS) that serves the community of Bento Rodrigues and Paracatu de Baixo, in Mariana.
Discussion and elaboration of the pest control plan related to the opening of the Juparana Lagoon and Pequeno River barriers, together with Linhares environmental monitoring.
The basic project prepared for the renovation of the CAPSIJ was presented to the teams of Sanitary Surveillance and Secretariat of Works of Mariana.

Discussion of the vector control plan to be elaborated due to the opening of the barrier in the Juparana Lagoon and the Pequeno River, along with the environmental monitoring team of the municipality of Linhares.
Restructuring of the scope of the Health program, based on a new perspective of joint actions with the other programs of the Renova Foundation.
In response to the public civil action, there was discussion of the actions of the Health program in the municipality of Mariana during a meeting with the Prosecution Service of the state of MG.
Elaboration of the Health Contingency Plan for those affected by the opening of the barrier of the Juparana Lagoon and Pequeno River in the municipalities of Linhares and Sooretama.
Evaluation of the 2nd partial report of the Risk to Human Health Analysis Study.

Review of program definition, interfacing with other programs, exit criteria and development of more effective strategies.
Adjustments to clauses and responsibilities with research foundations (FAPES and FAPEMIG) for technical cooperation in the development of health studies.
Presentation and approval of the conceptual project for the renovation and construction of the CAPSIJ in Mariana, together with the municipality.

Analysis of the ticket opened through the communication channel of the Renova Foundation, regarding the occurrence of spotted fever in the municipality of Santa Cruz do Escalvado.
Presentation of the conceptual project elaborated for the renovation of the property where the CAPSIJ of the municipality of Mariana will be installed.

Review of the scope of the program and planning the actions for the problem tree workshop and the development of a logical framework for the additions to the Program Definition document.
Communication with the municipality of Barra Longa about the availability of the ambulance financed by the Health and Safety program (ambulance for works in the municipality, shared with the Health sector).
Issuance of the first partial report of the company Ambios on the ARSH study.
Presentation by INFO to the Board of Governors on the Health Repair Plan for the Municipality of Mariana.
Budgetary Review of the Program, including the new demands of the municipal and state Health Reparation Plans.

Discussion with the Prosecution Service on the health care provided to the people involved in the study, prepared by the Institute of Health and Sustainability - ISS; Supervising the actions for the renovation of the CAPSIJ of the municipality of Mariana, in compliance with CIF resolution 189; Integrate the Risk to Human Health Analysis Study with the programs that interface with the FR Health Program; Elaboration of work strategies for the Health program with researchers, related to the diagnostic workshop on Health in the municipalities, Mental Health Study and causal nexus analysis of the risks to Human Health due to the collapse.

The Human Health Risk Assessment Study (ARSH) was presented to the Renova Foundation programs that interface with the Health program.

The Human Health Risk Analysis Study (ARSH) was started.

The Plan for Health Care Services for the municipality of Mariana was restructured, according to orientation of the Board of Governors.

The first meetings where held with the municipal health care administrators of the state of Espirito Santo, aiming to identify possible changes in the epidemiological profile of the affected communities.

The program presented to the Technical Board of Health the Tender to contract the epidemiological study.

In addition, a Business Intelligence (BI) panel is being developed, which brings together information from the Health program and other Foundation initiatives that will carry out studies aimed at data that is applicable to the health of the impacted population.

Also contracted was the company that will carry out the Human Health Risk Analysis Study.

Another initiative worth mentioning is that during a meeting with the Barra Longa Department of Health the results of the water analysis in the municipality were shared.

Observation of the health care strategies provided to the population of Barra Longa related to the results of the exams performed by the Institute of Health and Sustainability (ISS). This work will be executed by the Public Health System. Observation began at the Hospital das Clinicas in Belo Horizonte (MG).

During this period, a forum was held with Espirito Santo municipal and state Health Departments to define a strategy for drafting a joint work plan with the affected state’s municipalities.

In addition, 10 tap water samples were collected from residents of the municipality, in order to check the quality of the city’s water supply. This was done after the Institute of Health and Sustainability found some level of nickel in the blood of 11 residents in exams.

The actions that define this program were analyzed and adjusted based on advice issued by the Technical Board of Health.

Together with the Health Care Secretariat of Barra Longa and the state of Minas Gerais, a support flow was set up to assist the population in case of intoxication, as pointed out by the Institute of Health and Sustainability. A meeting was also held with the Municipal Council in which answers were provided to questions regarding intoxication of people in the region.

Furthermore, the State Forum of Dialogue was implemented in the state of Espirito Santo to monitor the actions of this program.

The Health and Sustainability Institute of the Federal University of Minas Gerais (UFMG), presented the results of the analysis on the mental health situation of the population of Barra Longa (MG).
The Renova Foundation submitted the literature study on vector-borne diseases. Adjustments were requested, such as the addition of some regional diseases, which will be submitted according a new deadline.

There were also visits to the Primary Health Care Units of the municipality of Barra Longa and defined, together with the municipality, the health care and referral flow strategy, and the ambulance service. In addition, the hiring of a doctor by the municipality was discussed.

In February, the studies for the evaluation of the potential human health risks related to the air quality of Barra Longa (MG) were initiated.

The program prepared the monthly report and submitted with the Technical Board of Health the report that features the collected morbidity and mortality data (from 2005 to 2016).

Also submitted was the data collection on the profile of health services available in the 40 impacted locations. For health care cases the referral flow between the Renova Foundation and the municipality of Mariana was defined.

For the preparation of the first phase of the mental health study, the research institution that will be responsible for the work was hired.

A literature review was started on vector diseases. The hiring process for Descriptive and Human Health Risk Assessment studies was also opened.

In November, the Term of Reference of the epidemiological and toxicological study was reformulated following the minimum bases elaborated by the Technical Board of Health.
The report that is sent to the TB Health was adapted to meet the standard model established by Resolution 73.
The program gathered historical data on morbidity and mortality and the profile of available health services in the municipalities listed in the TTAC, through data available on DataSus.

The scopes of the ongoing studies and the term of reference of the human health risk assessment study were sent to the Technical Board of Health for approval.

Identification of researchers for the elaboration of preliminary studies (reference reports) of Mental Health, Vector Diseases, Human Toxicology, Air Pollution in Barra Longa and its impact on the health of the population and Morbidity and Mortality as data base. The hiring processes have begun.

Support to the team of the Tailings Management Program - PG 23 to elaborate the scope of analysis and monitoring of air quality in Barra Longa (MG), with a focus on the control of the population’s health.

A verification was made of the types of health care services available in the 40 affected municipalities. In addition, the program team has collaborated and aligned with other programs of the Renova Foundation for the analysis of risks to human health.

Renova supported two initiatives in Barra Longa (MG) to promote physical and mental health in the municipality: The Project for Generation of Work and Income in Mental Health, focused on women, and the habilitation and accreditation of the 24-hour Emergency Care Unit.

With the objective of maintaining the quality of health care service for the affected population, an alignment was made with the Health Care Secretariat of Barra Longa and the hiring of health professionals for the municipality.

In addition, meetings with the Federal University of Ouro Preto (UFOP), Federal University of Minas Gerais (UFMG) and Campinas (Unicamp) discussed the possibility of partnerships and studies aimed at promoting the understanding and the subsequent development of the socioeconomic context of the region.

Implementation of the project of Mental Health, Alcohol and Other Drugs, which promotes the socialization and well-being of women from 25 to 60 years. The initiative is a partnership between the Renova Foundation, public authorities and civil society. The workshops will be held weekly, with themes to be defined together with the public.

On May 4, a workshop was held in Belo Horizonte (MG), aiming to align strategies and expectations for the epidemiological study in the territories impacted by the collapse of the Fundão dam. During the occasion, the study's reference term was presented, which is under analysis of the Technical Board of Health Care. Experts and stakeholders from the area participated, who also discussed topics such as dust monitoring in Barra Longa (MG) and toxicology.

Two meetings were held with the municipal departments of health of Barra Longa and Mariana (MG) on the implementation of the assistance plan for physical and mental health care, specifically on the hiring of professionals to assist the population through the Unified Health System (SUS).

In April 2017, the public management workshops in the Social Protection area took place in the municipalities of Naque, Belo Oriente, Fernandes Tourinho, Periquito, Iapu, Sobrália, Alpercata, Governador Valadares, Tumiritinga, Galiléia, Conselheiro Pena, Resplendor, Itueta, Aimorés, Baixo Guandu, Colatina, Marilândia, Linhares and Aracruz. The action aims to gather data from the health area to subsidize the implementation of a coordinated and intersectoral action between the public authorities and the Renova Foundation.

Meetings were also held with the health secretaries of Barra Longa and Mariana (MG), for discussions on the implementation of the physical and mental health support plan, as well as providing care to the population through SUS services.

Delivery of the Basic Health Unit in Mariana (MG), to assist the communities of Bento Rodrigues and Paracatu. Moreover, a meeting was held in the municipality with the staff of social assistance services for the presentation of the Rainfall Contingency Plan of the municipality (Civil Defense), associated with the Rainfall Contingency Plan of the Municipal Department of Social Development and Citizenship.

A workshop was held for public health care managers to raise subsidies for the implementation of a coordinated and intersectoral action between public authorities and the Renova Foundation for the impacted population, based on the formulation of the municipalities of Mariana and Barra Longa (MG).

A meeting was held with the health secretary of Barra Longa for the analysis of research studies conducted by the Health and Sustainability Institute, and the researchers responsible, Evangelina da Motta Pacheco Alves de Araujo Vormittag and Maria Aparecida de Oliveira.

The technical term of reference of the health studies was submitted to the Technical Board of Health to start the discussions.

Ongoing in Barra Longa (MG) is the technical support for the management of municipal health through doctor’s offices specialized in collective and mental health. The following were completed: The Diagnostic Health Report of the municipality, the Protocol focused on Mental Health, Alcohol and Other Drugs and a Panel of Indicators and Goals for Mental Health, Alcohol and Other Drugs. In addition, training workshops were held for healthcare teams on actions to combat yellow fever. The provisional renovated Basic Health Unit in Mariana (MG) was inaugurated for the communities of Bento Rodrigues and Paracatu (MG).

On January 20, the provisional Basic Health Unit in Mariana (MG) was inaugurated, which will assist the communities of Bento Rodrigues and Paracatu (MG). Ongoing in Barra Longa (MG) is the technical support for the management of municipal health through doctor’s offices specialized in collective and mental health. Regarding the epidemiological and toxicological study, academic institutions, internationally renowned professionals in the area and the Brazilian Academy of Sciences (ABC) are being considered for involvement and leading the activities.

In Mariana (MG), the renovation of the property that will be the provisional Basic Health Unit for the communities of Bento Rodrigues and Paracatu is in progress and estimated to be ready by January 13, 2017. In Barra Longa (MG) the technical support for the management of municipal health continues through doctor’s offices specialized in collective and mental health. In the period from November 28 to December 9, 2016, five courses/training workshops were held for health workers focusing on issues related to mental health, alcohol and other drugs. Regarding the epidemiological and toxicological study, academic institutions, internationally renowned professionals in the area and the Brazilian Academy of Sciences (ABC) are being considered for involvement and leading the activities.

The renovation of the property that will be the provisional Basic Health Unit for the communities of Bento Rodrigues and Paracatu is in progress. Also in progress in Barra Longa (MG) is the organization of municipal health through doctor’s offices specialized in collective and mental health. The Renova Foundation awaits assessment of the Memorandum of Understanding (MoU) by the Oswaldo Cruz Foundation (Fiocruz) to formalize the partnership in conducting epidemiological and toxicological studies.

The renovation of the property that will be the provisional Basic Health Unit for the communities of Bento Rodrigues and Paracatu has begun. The delivery is estimated for December 2016. In Mariana and Barra Longa the management plan was elaborated in accordance with the Department of Health, the Department of Development and the Public Prosecutor.

In Mariana and Barra Longa the plan management was elaborated in accordance with the Department of Health, the Department of Development and the Public Prosecutor.


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