Health sector involvement in federal environmental licensing and malaria control in the Brazilian Amazon, 2008–2024: an analysis of linked administrative records

Malaria remains a major public health concern in the Brazilian Amazon region. Large-scale infrastructure developments, such as hydroelectric dams, can increase malaria risk by modifying ecosystems and attracting human population. Since 2001, the Brazilian legislation has required the health sector to be integrated into environmental licensing in endemic areas. However, the effectiveness of this mandate has not yet been fully evaluated. We aimed to analyse the implementation of malaria-related health actions within federal environmental licensing processes in the Brazilian Amazon. A retrospective descriptive analysis of linked administrative records, complemented by an exploratory segmented trend analysis was conducted on all federal developments licensed by the Brazilian Institute of the Environment and Renewable Natural Resources (Ibama) between 2008 and 2024. Information from the environmental licensing systems was cross-referenced with Brazilian Ministry of Health’s (MoH) records on malariological evaluations. The proportion of developments with documented MoH participation was analysed, as were the differences by sector and location and the time lag between the start of licensing and the first formal response from the MoH. Of the 3335 developments reviewed, 897 (26.9%) were in the Amazon region. Among these, only 140 (15.6%) were monitored by the MoH. Coverage varied by sector, with mining (20.6%) and power generation (19.1%) showing slightly higher proportions, followed by power transmission (16.3%) and transportation (14.2%). Most monitored developments received MoH involvement within one year of licensing initiation (70.0%), although some experienced delays of up to 16 years. A declining trend in monitoring was observed after 2015, reaching a low of 7.8% in 2024. Our findings show that most infrastructure developments advance without MoH oversight. Sectors with high malaria risk such as mining and power generation remain largely unmonitored. Despite existing regulations, the health-environment integration in the federal licensing processes in the Amazon region remains limited and inconsistent. Low coverage and delayed health-sector engagement may limit timely assessment and mitigation of malaria-related risks. Strengthening timely MoH participation in eligible Amazonian developments is important to align economic development with public health protection.