Kenya SO3 Health IEE 060908

Sensitive But Unclassified

INITIAL ENVIRONMENTAL EXAMINATION

REQUEST FOR CATEGORICAL EXCLUSION

Country/Region: Uganda / East Africa

Program/Activity Number: Development Objective (DO) 3 / Intermediate Result (IR) 3.1

Program /Activity Title: Improved Health and Nutrition Status in Focus Areas and Population Groups / More Effective Use of Sustainable Health Services

Functional Objective:3 Investing in People

Program Area:3.1 Health

Program Elements:3.1.1 HIV/AIDS

3.1.2 Tuberculosis

3.1.3 Malaria

3.1.6 Maternal and Child Health

3.1.7 Family Planning and Reproductive Health

3.1.8 Water Supply and Sanitation

3.1.9 Nutrition

Funding Period: January 1, 2016 to September 30, 2021

LOP Amount: Estimated at $2,500,000,000 (flatline scenario over 5 years)

Sub- Activities/Amounts:

1. Indoor Residual Spraying (IRS-II): $88,831,827
2. TBD – Malaria Action Program for Districts (MAPD): $45,000,000
3. Deliver Project Task Order 7: 51,462,373
4. Centers for Disease Control Interagency Agreement (CDC IAA): 2,750,000
5. Strengthening TB and HIV/AIDS Response in the South Western Region of Uganda

(STAR):

1. East Central: $54,999,939
2. East: $63,701,157

1. Targeted HIV/AIDs and Lab Services (THALAS): $19,800,000
2. Strengthening Uganda’s Systems for Treating AIDS Nationally(SUSTAIN): $58,246,424
3. Monitoring and Evaluation Emergency Plan Program(MEEPP II): $12,250,816
4. Strengthening Human Resources for Health (SHRH): $23,000,000
5. Strengthening Decentralization for Sustainability (SDS): $54,990,271
6. TBD – Strengthening Decentralization for Sustainability (SDS)Follow-on: $50,000,000
7. Private Health Support (PHS): $23,500,000
8. Communication for Healthy Communities (CHC): $49,997,475
9. Advocacy for Better Health: $19,980,735
10. Uganda Health Supply Chain Project (UHSC): $29,900,000
11. Strengthening Uganda’s Systems for Treating AIDS Nationally (TRACK TB): $12,275,135
12. Applying Sciences to Strengthen and Improve Systems (ASSIST): $15,000,000
13. Regional Health Integration to Enhance Services (RHITES)
14. East Central: $57,067,000
15. East: $54,925,000
16. Southwest: $59,637,000
17. North-Achioli: $35,000,000
18. North-Lango: $35,000,000
19. Social Marketing Activity: $16,000,000
20. Strategic Information Technical Support Project (SITSP): $15,000,000
21. Long Term Methods Family Planning (LTM): $20,000,000
22. Long Term Methods Family Planning follow-on (LTM-II): $60,000,000
23. Reproductive Health Vouchers Program (RHVP): $24,500,000
24. Saving Mothers, Giving Life (SMGL) Construction, A&E: $4,400,000
25. Advancing Partners and Communities (APC): $5,000,000
26. Fistula Care Plus: $5,000,000
27. Maternal and Child Survival Program (MCSP): $10,000,000
28. Uganda Demographic and Health Survey (UDHS): $5,000,000
29. Comprehensive HIV/AIDS and Health Services at the Workplace Activity: $15,000,000
30. TBD – Site Improvement Monitoring Systems (SIMS): $15,000,000

IEE Prepared By: Chris Penders, GH/OCS, on behalf of the USAID/Uganda Health Office

Current Date: January 06, 2016

IEE Expiration Date: September 30, 2021

IEE Amendment (Y/N): No

Additional References:

This IEE builds on the following USAID environmental compliance documentation that is already in effect for ongoing activities in USAID/Uganda:

• Uganda IRS Supplemental Environmental Assessment, Amendment #1 2014-2019. Bethesda, MD. AIRS Project, Abt Associates Inc. (November 2014).
• Uganda IRS Supplemental Environmental Assessment(2010) http://gemini.info.usaid.gov/egat/envcomp/document.php?doc_id=37067
• Uganda_DO1_PERSUAP – this is for the Economic Growth D.O.: http://gemini.info.usaid.gov/egat/envcomp/repository/doc/43631.docx
• USAID Integrated Vector Management Programs for Malaria Vector Control: Programmatic Environmental Assessment 2012 update: http://gemini.info.usaid.gov/egat/envcomp/repository/pdf/39185.pdf
• Uganda DO1 FtF IEE 08132014: http://gemini.info.usaid.gov/egat/envcomp/repository/pdf/41076.pdf (original); http://gemini.info.usaid.gov/egat/envcomp/repository/pdf/43481.pdf (Amendment 1); http://gemini.info.usaid.gov/egat/envcomp/repository/pdf/44841.pdf (Amendment 2)
• Uganda Infrastructure Development IEE 051715: http://gemini.info.usaid.gov/egat/envcomp/repository/pdf/43816.pdf
• Uganda Education, Youth & Child Development (EYCD) IEE 092815

http://gemini.info.usaid.gov/egat/envcomp/repository/pdf/45391.pdf

ENVIRONMENTAL DETERMINATION RECOMMENDED

Categorical Exclusion: XNegative Determination: X

Positive Determination: NoneDeferral: None

ADDITIONAL ELEMENTS:

CONDITIONS: XEMMP: XERF/ERR: X WQAP: X

SUMMARY OF FINDINGS:

The purpose of theHealth SectorInitial Environmental Examination (IEE) is to provide threshold determinations for USAID/Uganda activities under Intermediate Result (IR) 3.1, More Effective Use of Sustainable Health Services, as part of Development Objective (DO) 3, Improved Health and Nutrition Status in Focus Areas and Population Groups.

This IEE consolidates threshold determinations for activities managed by the Health Office, which will be implemented in the next five years. Section 1.3 gives a description of envisaged health activities; Section 2 provides an overview of Uganda’s environment and the health sector; Section 3 provides an evaluation of the potential environmental impacts of health activities; Section 4 provides the threshold environmental determination and mitigation actions, monitoring and compliance assurance, and general project implementation and monitoring requirements.

RECOMMENDED THRESHOLD DETERMINATIONS:

This IEE recommends the following environmental determinations.

1)A Categorical Exclusion is recommended for: meetings, workshops, capacity building, evaluations,research, skills development and training, and providing technical assistance, among others, pursuant to 22 CFR 216.2 (c)(i).

2)A Negative Determination with Conditions per 22 CFR 216.3 (a) (2) (iii) is recommended for activities that will have no significant adverse environmental impacts with adequate mitigation and monitoring, this include the following activities:

a)Activities that generate Health Care Waste (HCW)

b)Water, Sanitation and Hygiene (WASH)

c)Indoor Residual Spraying (IRS)

d)Long Lasting Insecticide-treated Bed Nets (LLINs)

e)Procurement, storage, management and disposal of public health commodities

f)Construction and Renovation (C&R)

g)Nutrition commodity management including packaging, warehousing and distribution

Activities with a Negative Determination with Conditions require the development of an Environment Monitoring and Mitigation Plan (EMMP) which identifies the IEE conditions and mitigation measures for each activity that will have an adverse effect on the environment.

Environmental Responsibilities:

As required by ADS 204.3.4, USAID/Uganda Health Office and activity implementing partners will actively monitor and evaluate whether the environmental features designed for theseHealth activities resulting from the 22 CFR 216 process are being implemented effectively and whether there are new or unforeseen consequences arising during implementation, that were not identified and reviewed in accordance with 22 CFR 216. If additional Healthactivities not described in this document are added, an amended environmental examination must be prepared and approved.

In the event that any new Health activity differs, substantially from the type or nature of activities describes here or require different or additional mitigation measures beyond these described, this IEE will be amended.

APPROVAL OF ENVIRONMENTAL ACTION RECOMMENDED:

USAID/Uganda Health IEE

CLEARANCE:

Deputy Mission Director

USAID/Uganda______Date:______

Mark Meassick

Mission Director

USAID/Uganda______Date:______

Leslie Reed

CONCURRENCE:

Bureau Environmental Officer:

AFR/SD______Date:______

Brian Hirsch

File Name: ______

ADDITONAL CLEARANCES:

Deputy Mission Environmental Officer

USAID/Uganda______Date:______

J. Ashley Netherton

Health Office Director

USAID/Uganda______Date:______

Margaret Sancho

Regional Environmental Advisor:

USAID/East Africa

______Date:______

David Kinyua

INITIAL ENVIRONMENTAL EXAMINATION

Region: Uganda/ East Africa.

Program/Activity Number: Development Objective (DO) 3 / Intermediate Result (IR) 3.1

Program /Activity Title: Improved Health and Nutrition Status in Focus Areas and Population Functional Objective: 3 Investing in People

1.0BACKGROUND AND ACTIVITY DESCRIPTION:

1.1Purpose and Scope of Initial Environmental Examination (IEE):

The purpose of this IEE is to provide threshold determinations for the existing and new Development Assistance (DA) programming activities in Health, in accordance with the requirements of Regulation 22 CFR 216, This document will assist in ensuring environmental compliance, and will permit the implementation of the proposed DA funded program activities in accordance with USAID Environmental Policy and Procedures (22 CFR Part 216).

This IEE provides the first review of the reasonably foreseeable effects on the environment of the proposed development interventions and activities in the Health portfolio. Activities that are integratedwith other sectors, including agriculture and health, are cross-referenced to existing relevant USAID/Uganda IEEs and other environmental documentation.

This IEE consolidates the threshold determinations for all activities currently envisioned under the Health portfolioand partially replaces the DO3: Investing in People (Health), Blanket IEE developed in 2009 which expireson December 31, 2015. This IEE replaces the expiring IEE and will cover the period from January 1, 2016 through September 30, 2020.

In the event that any new proposed activity in Health differs substantially from the type or nature of activities described here or requires different or additional mitigation measures beyond these described, this IEE will be amended.

Ongoing activities operating with an approved environmental mitigation and monitoring plan (EMMP) conforming to the requirements of the IEE “Uganda_FY08_SO9_IEE_092408” may continue operating under that approved EMMP. Ongoing activities without an approved environmental mitigation and monitoring plan (EMMP) are required to prepare and have approved an EMMP based on this IEE in a timely manner.

1.2Background:

In spite of decades of substantial international support, Uganda’s health, population, education and income conditions remain worrisome. Meanwhile, Government of Uganda (GOU) budgetallocations to Uganda’s social sectors have declined, from 40 percent of total budget allocations in1998 to about 28 percent in the current budget. While many basic indicators of health continue tostagnate, the World Health Organization (WHO) cites that health sector funding from the GOUremains inadequate at 10.2 percent of general government expenditures. Continued widespread official corruption and mismanagement, combined with a growing trend toward diminished respect for civil and human rights, are impeding progress in the health sector.

In response to these challenging conditions, the USAID/Uganda Health Office has developed a comprehensive approach to address Development Objective (DO) 3 on health and education, Intermediate Result (IR) 3.1:More Effective Use of Sustainable Health Services.

1.3Description of Activities:

As described fully in the USAID/Uganda Project Appraisal Document (PAD) More Effective Use of Sustainable Health Services (2013), USAID is focusing efforts in the following three areas (sub-IRs):

1. Strengthening health systems;
2. Improving accessibility to quality health services; and
3. Increasing health seeking behaviors and demand for quality services.

Expected outcomes under the above sub-IRs include:

• Functional enabling environment and partnerships to implement sector policies, regulations and strategies;
• Increased availability of resources for public and private sector health services;
• Improved organization and management of service delivery;
• Increased availability and accessibility to health services;
• Improved quality of health services; and
• Increased adoption of healthy behaviors by communities in focus areas and target populations.

The USAID/Uganda Health Office has developed a set of activities that seek to address the myriad of challenges confronting the health sector. Activities vary in size and scope, and may address multiple sub-IRs or be designed to target specific obstacles within a sub-IR. Each of these activities is described below.

1. Indoor Residual Spraying (IRS-II)

The goal of IRS-II is to contribute to effective use of social sector services through three main objectives: (1) implementation of a high quality, safe and effective IRS program; (2) developing the national capacity to conduct IRS and; (3) conducting comprehensive monitoring and evaluation of the IRS program. The project objectives will be achieved through the following IRs:

1.1IRS programs planned in collaboration with the NMCP/MOH, districts and other stakeholders;

1.2Develop sufficient program infrastructure, skills and information, to effectively manage the IRS program;

1.3Ensure quality management of operational, technical and financial elements of the program;

2.1Provide National and District level trainings and technical assistance on IRS related activities;

2.2In collaboration with the NMCP/MOH, participation from stakeholders for IRS established;

2.3Cost-effective innovations for the IRS program efficiently implemented;

3.1Develop and implement IRS program management and performance monitoring plans.

1. Malaria Action Plan for Districts (MAPD) [Not listed in the FY15 OP]

This activity seeks to build on already experienced, existing service delivery platforms to integrate the delivery of health care services, and organize project implementation through a combination of regionally based health service delivery programs. Supportive supervision is provided by integrated, regional teams and high-level, centrally supported, cross-cutting programs to strengthen health systems.

1. Deliver Project Task Order 7 for Malaria[From OP]

The availability of essential malaria commodities such as long-lasting insecticide-treated bed nets (LLINs), Artemesinin-based Combination Therapies (ACTs), Artesunate injectable for severe malaria and rapid diagnostics test kits is critical to implementation of President’s Malaria Initiative programs. Through this mechanism, USAID will procure essential malaria commodities both for the private-not-for-profit and public sector. The purpose of this funding is to increase availability and access to these essential commodities to reduce malaria-related morbidity and mortality in the country.

1. Centers for Disease Control Inter-Agency Agreement(IAA) [From OP]

The IAA with CDC was established to provide technical assistance to the President’s Malaria Initiative (PMI) and the GOU. The objectives for CDC are to:

1. Support the Uganda Malaria Surveillance Project (UMSP) to strengthen and expand malaria reference centers to improvesurveillance and malaria diagnostic capacity, conduct drug efficacy studies, and supportmonitoring activities. CDC will train clinicians and laboratory technicians on improved diagnostics, treatment, and data reporting.
2. Fund the senior PMI technical adviser at CDC Uganda, whose role is to provide TA to the GOU’s malaria program.
3. Provide short-term TA from CDC Atlanta to train GOU environmental complianceofficers, support the indoor residual spraying program in conducting effective entomological monitoring, and provide guidance to the PMI team.
4. Support the field epidemiology and laboratory training program, which places two epidemiologists at the MOH.

1. STAR – East Central (EC), East (E), andRHITES SW

The goal of the STAR activities – STAR-EC, STAR-E and STAR-SW – are to increase access to, coverage of, and utilization of quality comprehensive HIV/AIDS and TB prevention, care and treatment services in district health facilities and communities in the East Central, East and Southwest regions. Key objectives include: (1) strengthening decentralized HIV/AIDS and TB service delivery systems with emphasis on level III and IV health centers (HCs) and community outreach; (2) improving quality and efficiency of HIV/AIDS and TB service delivery; (3) 3trengthening networks and referral systems; and (4) intensifying demand for HIV/AIDS and TB services. Key populations targeted include sex workers and their partners, men who have sex with men (MSM), and other vulnerable populations (fisher-folk, migrant workers, motorcyclists, couples and truck drivers). Activities include: promotion of high impact prevention interventions, voluntary medical male circumcision (VMMC), prevention of mother-to-child transmission (PMTCT), condom use, HIV testing and counseling (HTC), care and support, pediatric and adult antiretroviral therapy, TB/HIV co-management and lab support. STAR-EC/E will utilize lessons learned to scale up high impact interventions and improve access for key populations and those in hard-to-reach areas. In partnership with districts and civil society organizations, STAR-EC/E will focus on quality improvement and capacity building in lab services and pharmaceutical management, and on strengthening coordination structures & partnerships to enhance sustainability. Monitoring and evaluation (M&E) will be accomplished using available national data, data from lot quality assurance sampling (LQAS) surveys, and data from routine reports.

1. Targeted HIV/AIDS Lab Services (THALAS)

The main goal of the THALAS program is to increase access to, coverage of, and utilization of quality comprehensive HIV/AIDS and tuberculosis care and treatment services; provide advanced HIV/AIDS care and treatment services for complicated cases referred from other HIV/AIDS care and treatment providers; and provide HIV diagnosis and monitoring services including viral load (VL) testing and DNA PCR for early infant diagnosis (EID). The EID service has been fully transitioned to Central Public Health Laboratories (CPHL). THALAS provides clinical care and adult and pediatric ART services. The project also provides HIV/AIDS routine laboratory monitoring and VL testing for patients. THALAS trains lab staff in manual and automated testing techniques and resident mentors at regional referral and general hospitals enhance delivery of quality services. THALAS supports resident mentors through THALAS preceptors and laboratory quality improvement (QI) teams. THALAS supports capacity building and provides technical assistance for Ministry of Health (MoH) laboratories that enhance quality of lab services. THALAS will continue to scale up HIV/AIDS care and treatment services, implement the revised MoH treatment guidelines, support national laboratory QI practices, and support MoH/CPHL in scaling up lab quality management practices.

1. SUSTAIN

SUSTAIN aims to provide quality HIV prevention, care and treatment services and TB/HIV services at selected regional referral and district hospitals in Uganda while simultaneously building their capacity to provide these services. This goal is pursued through training of health workers; improvement of laboratory infrastructure and equipment to enhance HIV/AIDS diagnosis and disease monitoring; developing systems for financial, human resources and logistics management; as well as quality assurance and improvement. The program is implemented in 19 hospitals (12 regional referral hospitals, 5 general hospitals and 2 level IV health centers). SUSTAIN has successfully integrated the previously vertical HIV clinical and laboratory services into the public healthcare system with up to 42,151 clients active on ART and 52,605 in care. SUSTAIN has also refurbished and equipped 17 regional referral and general hospital laboratories and elevated them to regional hubs for the Ministry of Health (MoH) laboratory sample transportation network. SUSTAIN activities include technical support in HIV/AIDS prevention, care and treatment, upgrading laboratories, establishing drug-resistant TB treatment centers and continued support to MoH laboratory hubs that support lower level laboratories around the country. Seven MoH regional medical equipment workshops will be upgraded, equipped and given routine support to effectively provide maintenance, repair and servicing of biomedical equipment in healthcare facilities across the country.