OBJECTIVE: Onshore oil and gas projects can have large footprints with potentially significant impacts on local communities over its producing life. In complex developing world country contexts, project execution challenges are often exacerbated by a high background burden of disease and a fragile local health system. The ExxonMobil-constructed and operated Papua New Guinea (PNG) LNG Project (Project), the largest private investment in the history of Papua New Guinea, is an example of a large development in a significantly challenged community health context. Having recognized the healthrelated risks early, the Project team developed an integrated community health impact mitigation and investment plan consisting of: (i) the development of a private-public partnership with the PNG Institute of Medical Research (PNGIMR) to execute a robust longitudinal surveillance system, (ii) capacity building efforts to strengthen both local and national health care and diagnostic capacity, including (a) a state of the art infectious disease research laboratory managed by PNGIMR and located at the PNG School of Medicine campus and (b) a teaching and clinical support by both PNGIMR and seconded faculty from Texas Children's Hospital and (iii) strategic impact prevention measures, e.g., water/sanitation, domestic violence, health lifestyles, executed by local NGOs across all project areas. METHODS:Based on the findings of a pre-project health impact assessment, the Project assessed that a comprehensive integrated impact mitigation and focused capacity building program for potentially impacted communities was essential. Because of the complexity and geographical distribution of the project, control/comparison sites were also developed so that any significant changes in community health outcomes could be placed in context. Health stakeholders included the Project workforce, affected communities and both provincial and national health authorities. Interventions followed best practice in building public-private partnerships and were fit to purpose, i.e., tailored to address local and provincial / national issues that would be directly impacted by the PNG LNG Project. RESULTS: Formal Memorandum of Understanding and Investment Agreements between ExxonMobilPNG Ltd and PNG health authorities were executed. Longitudinal surveillance included two project impact sites and two comparison sites covering over 50,000 persons. The entire surveillance system was accepted into the INDEPTH Network and is fully compliant with international health monitoring standards. The PNG LNG Project was the first oil and gas sponsored project in the 45-member, 20-country, 50ϩsite INDEPTH Network. A variety of population demographic and specialty studies have been executed that have accurately tracked changes in socio-economics and in/out migration while determining prevalence and incidence for major diseases such as tuberculosis and sexually transmitted infections, including the first ever study of HPV in PNG women. NOVEL/ADDITIONAL INFORMATION:Key findings are ...

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OBJECTIVE: Public-Private Partnerships (PPP) are a tool that the international development community, including international financial institutions (IFIs) are increasingly utilizing for developing and / or enhancing critical public infrastructure assets and services. The PNG LNG Project, ExxonMobil PNG Ltd used the PPP approach in multiple instances to support positive development outcomes. In the health sector, a PPP-known as the Partnership in Health Program (PiHP) -was developed to support Project, community and broader national health objectives. This PPP was not based on either physical infrastructure, (e.g., clinics, hospitals) or traditional clinical services, (e.g., out and inpatient care). Instead, ExxonMobil PNG Ltd developed the PiHP as an initiative focused on higher end scientific / medical services that would provide crucial data for overall countrywide public health policy development, planning and program implementation. The lessons learned from this five-year effort will be presented. METHODS:The long-term revenue stream of the PNG LNG Project is potential transformative for PNG's macro-economic position. PNG has an extremely high burden of disease largely dominated by infectious diseases. However, the pattern and distribution of disease is extremely uneven and some areas of the country are likely undergoing an epidemiological transition, i.e., a movement from infectious to non-communicable diseases. As part of the overall impact mitigation and extended benefits planning for the PNG LNG, a novel use of the PPP model was developed. Both impact mitigation and extended countrywide benefits for the health sector were incorporated into a PPP involving the statutory research arm of the PNG Ministry of Health [(PNG Institute of Medical Research (PNGIMR)] and ExxonMobil PNG Ltd. Formal ЉMemorandum of UnderstandingЉ and Sponsorship Agreements with key stakeholders were jointly developed. Scientific, financial and capacity development objectives were specified and included a set of key performance indicators. RESULTS:A five-year program was designed and implemented. Over 50,000 persons were covered and monitored by a comprehensive demographic surveillance system that was accepted into the 20 country international INDEPTH Network. This is the first PPP sponsored site accepted by INDEPTH in its 18-year history. A unique 2ϩ BSL infectious diseases research laboratory was developed under the PiHP and co-located within the PNG School of Medicine. Significant stewardship was provided and included financial accountability training and monitoring of PNGIMR. Important scientific discoveries involving tuberculosis, human papilloma virus, febrile surveillance and non-communicable diseases have been documented with significant public health policy implications. NOVEL / ADDITIONAL INFORMATION:The PPP model can be successfully adapted to meet both impact mitigation and extended benefit needs for a large oil and gas project. There are, significant Љlessons learnedЉ when undertaking a PPP of this size and magnitude. The ...

IDOM (Infectious Disease Outbreak Management) is a prevention and control approach used by ExxonMobil Corporation for infectious disease outbreak control in remote and offshore settings, The company examined the effectiveness of IDOM in containing varicella outbreaks in a large scale project in Papua New Guinea with a globally mobile labour force. Application: Infectious disease outbreaks can have serious health consequences, disrupt operations and affect company productivity. They are of particular concern in remote sites where large-scale outbreaks can exceed project medical team response capabilities as well as those of the local health system. Outbreaks can spread from the worksites to surrounding communities, impact the health of the populations and affect the company’s image and license to operate. IDOM is a public health tool combining sets of easily applicable procedures for outbreak prevention, preparedness and response. Observations: From December 2011 to May 2012, four separate outbreaks of varicella virus (chicken pox) were reported in various locations of the Liquified Natural Gas Project. The outbreaks occurred at three large-scale construction camps and one off-shore vessel resulting in 41 cases of chicken pox (approximate total worker population of affected sites 10,000). Earlier adoption of IDOM across project sites allowed quick case detection with timely implementation of mitigation measures that effectively interrupted transmission of the highly infective varicella virus. Several sites reported a single case but no further transmission was observed and no varicella case was reported in any of the surrounding communities. Significance: Adoption of IDOM was shown to be very effective for infectious disease outbreak prevention, preparedness and response in large-scale oil and gas construction projects and in preventing transmission to local communities.

OBJECTIVE Tuberculosis (TB) is one of the oldest diseases known to mankind. However, in many locations around the world, tuberculosis has now become a "re-emerging infectious disease" that can significantly impact workforce operations. As part of the PNG LNG Project, a comprehensive TB management strategy was developed that included both the workforce and key proximal communities. Pre-placement evaluations, ongoing surveillance and community incidence and prevalence studies were conducted in an integrated fashion. Innovative technology, including use of the GeneXpert platform, was systematically utilized at both key worksite locations and target communities to support pro-active TB mitigation efforts. METHODS Based on the findings of pre-project health risk and impact assessments (i.e. inside and outside the fence evaluations) and building on the corporate approach for TB control in Company workplaces, the Project determined that a comprehensive TB management program was essential. PNG has a significant underlying burden of TB with an increasing burden of multi-drug resistant TB (MDRTB), while local health capacity to accurately diagnose and treat TB is variable. Importantly, there are no current indications that the PNG TB burden is related to HIV co-infection. Given the large workforce used during the Project's construction phase and focus on maximizing local hires, a comprehensive program to rapidly assess potential workforce TB status was needed. Existing assessment methods including questionnaires, TB skin tests, and chest x-rays. As all of these methods had significant limitations a more rapid, sensitive and specific diagnostic system - the GeneXpert platform – was required. Comprehensive pre-employment evaluation was performed utilizing a combination of questionnaires, physical examinations and state of the art interferon-gamma release assays (IGRA) with the GeneXpert platform applied to suspect cases to enable rapid assessment and referral. In the proximal worksite communities, the PNG Institute of Medical Research performed systematic TB incidence and prevalence studies. In addition, TB knowledge, attitudes, practices and belief surveys were conducted along with an assessment of local public health capacity for TB diagnosis and treatment. Enhanced laboratory diagnostics, including GeneXpert and improved microscopy training, were added. RESULTS In line with the Project team's expectation, the underlying burden of TB was extremely high in local proximal worksite communities. TB incidence and prevalence levels were 2–4 times higher than reported government data. In one area, the TB burden recorded is one of the highest ever documented in the world. HIV co-infection was not significant as HIV rates were <2%. Not surprisingly, workforce pre-employment burden of both latent and active TB were significant and reflected the local population burden of disease. Detailed data will be presented regarding workforce IGRA experience, active surveillance results and the benefits of the GeneXpert platform. NOVEL / ADDITIONAL INFORMATION The development of an integrated, (workforce and community) comprehensive TB management and monitoring program represents a new benchmark both for PNG and the oil and gas industry. As noted through multiple engagements with the PNG government and donor community such an approach can be replicated by others in the extractives as well as non-extractives industries using field proven methods pioneered on the PNG LNG Project. In so doing the improvement in coverage and data quality can assist in improving public health policy development and implementation.

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