Environmental and Social Management Framework for Tanzania ...

REGIONAL HEALTH SYSTEMS STRENGTHENING AND TB
SUPPORT PROJECT
Environmental and Social Management Framework for
Tanzania, Kenya and Uganda
Kent Kafatia
P.O. Box 31271
Capital City, LILONGWE 3
MALAWI
Tel +265 888831596; +265 999831595; +265 1 750094
e-mail kafatiakent@yahoo.co.uk
25 September 2009

REGIONAL HEALTH SYSTEMS STRENGTHENING AND TB
SUPPORT PROJECT
Draft Environmental and Social Management Framework
for
Tanzania, Kenya and Uganda
Kent Kafatia
P.O. Box 31271
Capital City, LILONGWE 3
MALAWI
Tel +265 888831596; +265 999831595; +265 1 750094
e-mail kafatiakent@yahoo.co.uk
25 September 2009

TABLE OF CONTENTS
TABLE OF CONTENTS ........................................................................................................ii
LIST OF ACRONYMS ...........................................................................................................v
EXECUTIVE SUMMARY ...................................................................................................vii
CHAPTER 1 INTRODUCTION........................................................................................1
1.1 PROJECT BACKGROUND ...................................................................................1
1.2 PROJECT SETUP IN THE THREE PARTICIPATING COUNTRIES .............1
1.3 PROJECT DEVELOPMENT OBJECTIVES .....................................................14
1.4 DESCRIPTION OF THE PROJECT’S AREAS OF INFLUENCE..................14
1.5 OBJECTIVES OF THE ESMF.............................................................................15
1.6 JUSTIFICATION FOR THE ESMF.....................................................................15
1.7 POTENTIAL USERS OF THE ESMF ................................................................16
1.8 APPROACH AND METHODOLOGY FOR ESMF PREPARATION .............16
1.9 ORGANIZATION OF THE ESMF .......................................................................17
CHAPTER 2 LEGAL, REGULATORY, AND ADMINISTRATIVE FRAMEWORK
19
2.1 BASIS FOR THE FRAMEWORK........................................................................19
2.2 POLICIES ...............................................................................................................19
• National Environment Policy;..................................................................................19
• National Policy on HIV and AIDS; .........................................................................19
• National Land Policy; ..............................................................................................19
• Construction Industry Policy; ..................................................................................19
• National Water Policy;.............................................................................................19
• National Gender Policy;...........................................................................................19
• Health Sector Strategic Plans;..................................................................................19
• National Health Laboratory Strategic Plans; ...........................................................19
• National Policy Guidelines for Healthcare Caste Management; and.......................19
• National Environmental Health, Hygiene and Sanitation Strategy .........................19
2.3 THE WORLD BANK SAFEGUARD POLICIES................................................19
2.3.1 Environmental Assessment (OP/BP 4.01) .......................................................20
2.3.2 Involuntary Resettlement OP/BP 4.12.............................................................20
2.3.3 The World Bank’s Categorization of Projects.................................................21
2.4 LEGAL FRAMEWORK .........................................................................................22
• Urban Planning Act; ................................................................................................22
• Health Laboratory Practitioners Act;.......................................................................22
• Water Resources Management Act;.........................................................................22
• The National Constitution of the participating country;..........................................22
• Environmental Management Act;............................................................................22
CHAPTER 3 IMPACT IDENTIFICATION AND ASSESSMENT.............................23
3.1 METHOD AND TECHNIQUES USED IN IDENTIFICATION AND
ASSESSMENT ..................................................................................................................23
3.1.1 Public Consultations and Field Investigations.................................................23
3.1.2 Literature Gathering and Review.....................................................................23
3.1.3 Categorization of Impacts................................................................................24
3.2 ASSESSMENT OF IMPACTS.............................................................................24
3.2.1 Generic Positive Impacts .................................................................................24
3.2.2 Generic Negative Impacts................................................................................25
CHAPTER 4 ENVIRONMENTAL AND SOCIAL MANAGEMENT PLAN............30
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4.1 ENVIRONMENTAL AND SOCIAL IMPACT MITIGATION .............................30
4.2 GENERIC ENVIRONMENTAL AND SOCIAL MANAGEMENT PLAN .........30
CHAPTER 5 ENVIRONMENTAL AND SOCIAL MONITORING...........................41
5.1 OBJECTIVES OF ENVIRONMENTAL AND SOCIAL MONITORING..........41
5.2 ENVIRONMENTAL AND SOCIAL MONITORING PLAN ...............................41
5.3 MONITORING INDICATORS..............................................................................43
5.4 MONITORING FOR IMPLEMENTATION .........................................................45
CHAPTER 6 ENVIRONMENTAL AND SOCIAL SCREENING ..............................46
6.1 ENVIRONMENTAL AND SOCIAL SCREENING PROCESS ........................46
6.2 COMPLETING THE ENVIRONMENTAL AND SOCIAL SCREENING FORM
46
6.3 ASSIGNING APPROPRIATE ENVIRONMENTAL CATEGORY...................46
6.4 CONDUCTING A LIMITED EIA OR FULL EIA.................................................47
6.5 REVIEW AND APPROVAL .................................................................................47
6.6 PUBLIC CONSULTATION AND DISCLOSURE..............................................48
CHAPTER 7: CAPACITY BUILDING MEASURES FOR THE REGIONAL
HEALTH SYSTEMS STRENGTHENING AND TB SUPPORT PROJECT .................50
7.1 ESTABLISHMENT OF A SECTOR ENVIRONMENTAL AND SOCIAL UNIT
50
7.2 CORE FUNCTIONS OF THE ESU ....................................................................50
7.3 TRAINING ..............................................................................................................51
7.4 CAPACITY BUILDING COSTS...........................................................................52
CHAPTER 8 CONCLUSION AND RECOMMENDATIONS.....................................55
REFERENCES.......................................................................................................................57
ANNEXES ..............................................................................................................................59
ANNEX 1: ENVIRONMENTAL AND SOCIAL SCREENING FORM....................59
ANNEX 2: SUBPROJECTS ENVIRONMENTAL AND SOCIAL CHECKLIST ...66
ANNEX 3: ENVIROMENTAL REVIEW (ER) FORM...............................................68
ANNEX 4: LIMITED ENVIROMENTAL ASSESSMENT (LEA) FORM ................69
ANNEX 5: ENVIRONMENTAL GUIDELINES FOR CONTRACTORS ................71
ANNEX 6: GENERIC EIA TERMS OF REFERENCE ............................................74
ANNEX 7: SUMMARY OF THE BANK’S SAFEGUARD POLICIES ....................76
ANNEX 8: LIST OF INDIVIDUALS/INSTITUTIONS CONTACTED .....................82
ANNEX 9: TANZANIA’S LEGAL, REGULATORY, AND ADMINISTRATIVE
FRAMEWORK ...................................................................................................................84
BASIS FOR THE FRAMEWORK....................................................................................84
POLICIES ...........................................................................................................................84
National Environment Policy (1997)...............................................................................84
National Policy on HIV and AIDS (2001).......................................................................84
National Land Policy (1995)............................................................................................85
Construction Industry Policy (2002)................................................................................85
The National Water Policy (2002)...................................................................................86
National Gender Policy (1999) ........................................................................................86
The Health Sector Strategic Plan III, 2008 ......................................................................86
The National Health Laboratory Strategic Plan (2009-2015)..........................................87
LEGAL FRAMEWORK .....................................................................................................87
Urban Planning Act, 2007................................................................................................87
The Health Laboratory Practitioners Act, 2007...............................................................88
The Water Resources Management Act, 2009 ................................................................88
The Constitution of the United Republic of Tanzania (1977-1995)................................89
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The Environmental Management Act (2004) ..................................................................89
The Environmental Impact Assessment and Audit Regulations (2005)..........................91
Mining (Environmental Management and Protection) Regulation (1999)......................92
The Land Act (1999) and the Land Regulations (2001)..................................................92
The Occupational Health and Safety Act (2003).............................................................95
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LIST OF ACRONYMS
AIDS Acquired Immuno Deficiency Syndrome
BSL -3 Bio-safety Level 3
CDC Centre for Disease Control
CPHLs Central Public Health Laboratories
DED Deutscher Entwicklungsdienst
DEMC District Environmental Management Committee
DEMO District Environmental Management Officer
DHMT District Health Management Team
DHO District Health Officer
DSS Diagnostic Services Section
DHSWO District Health and Social Welfare Officer
e.g. For Example
EAIDSNet East Africa Integrated Disease Surveillance Network
EA Environmental Audit
ECSA East, Central and Southern African Health Community
EIA (EA) Environmental Impact Assessment
EIS Environmental Impact Statement
EMA Environmental Management Act
EMC Environmental Management Committee
EMO Environmental Management Officer
EMP Environmental Management Plan
ER Environmental Review
ESIA Environmental and Social Impact Assessment
ESMF Environmental and Social Management Framework
EMP Environmental and Social Management Plan
EQA External Quality Assessment
HCFS Health Care Facilities
HCW Health Care Waste
HCWM Health Care Waste Management
HCWMO Health Care Waste Management Officer
HCWMP Health Care Waste Management Plan
HIV Human Immuno-deficient Virus
HSSP III Health Sector Strategic Plan III
IDA International Development Agency
KFW Kreditanstalt Fur Wiederaufbau
LEA Limited Environmental Assessment
LGA Local Government Authority
LTD Limited
MDG Millennium Development Goals
MOHSW Ministry of Health and Social Welfare
MDR-TB Multi Drug Resistant Tuberculosis
MUHAS Muhimbili University of Health and Allied Sciences
NEMC National Environmental Management Council
NEP National Environmental Policy
NGOS Non Governmental Organization
NHCWMP National Health Care Waste Management Plan
NHLQATC National Health Laboratory for Quality Assurance and
Training Centre
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NIMR National Institute for Medical Research
NSCHCWM National Steering Committee For Health Care Waste
Management.
NTRL National TB Reference Laboratories
OP Operational Policy
PAD Project Appraisal Document
PC Project Coordinator.
PEA Preliminary Environmental Assessment
PHC Primary Health Care
REME Regional Environmental Management Expert
SRL Supranational Reference Laboratory
TB Tuberculosis
TRC Technical Review Committee
TZ Tanzania
UNDP United Nation Development Programme
UNICEF United Nation International Children Emergence Funds
UNEP United Nation Environmental Programme
WHO World Health Organization
USA United State of American
WHO-GPA World Health Organization Global Programme on AIDS
vi

EXECUTIVE SUMMARY
Introduction
The World Bank is supporting the Regional Health Systems Strengthening and TB
Support Project (part of the Africa Regional Communicable Disease Control and
Preparedness Program), which aims at controlling and/or eliminating priority
communicable diseases on the continent. Kenya, Tanzania and Uganda, which are
part of the twenty-two high burden countries worldwide, will initially participate in this
project. Other countries will be eligible to participate in a second phase, provided
they meet the eligibility criteria.
Project Components
The project has two components as follows:
Component 1 (US$42.5 million) for Specialized Diagnostic Services for TB and Other
Communicable Diseases, will focus on improving access to quality diagnostic
techniques for TB and other communicable diseases, by strengthening national
public health laboratories as well as specialized satellite laboratories; and putting in
place systems for laboratory management and surveillance. This would involve
funding three mutually complementary activities of Networking National TB
Reference Laboratories, Networking Central Public Health Laboratories and
Networking Satellite Diagnostic and Treatment Centres.
Component 2 (US$16.5 million) for Regional Capacity Building for Management and
Monitoring of Communicable Diseases, aims at strengthen regional capacity to
manage and monitor communicable diseases. This would be accomplished by
Supporting the Re-establishment of the East Africa Integrated Disease Surveillance
Network; Providing Regional Training to Improve Availability of Qualified Laboratory
Staff; and Joint Operational Research, Knowledge Sharing and Coordination at the
Regional Level.
Project Development Objectives
The development objective of the project is to strengthen regional capacity for the
diagnosis, management, and surveillance of TB and other communicable diseases.
The project is aimed at improving access, quality, and efficiency of TB diagnostic
services, using an integrated approach to laboratory strengthening. The project will
ultimately contribute to improving health outcomes in the participating countries.
The specific objectives are to:
• establish additional Supranational Reference Laboratories in strategic
locations, for quality assurance, training, and capacity building;
• introduce modern diagnostic techniques (drug resistance surveillance and
compliance with bio-safety and infection control standards);
• and develop and test alternative service delivery models to promote private
sector involvement.
Project’s Areas of Influence
The project will involve upgrading, rehabilitation, and/or construction of laboratories.
The civil works as well as generation of medical waste form these laboratories will
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have negative environmental and social consequences. Therefore the project has
triggered OP/BP 4.01(Environmental Assessment) and has been assigned to the
World Bank environmental category B.
Potential safeguard issues and areas of influence will be on the environmental
components of soil, air and water, and vegetation. Issues on social components will
relate to traffic accidents, safety of workers and potential for spread of TB and HIV
and AIDS. The areas to be affected by the social components include public places
where people gather in large numbers; poorly ventilated public places and
laboratories; points or places of collection, transportation, storage and analysis of
specimens; as well as places for disposal of laboratory and hospital waste.
To ensure that these consequences or impacts are avoided, minimized or mitigated,
this Environmental and Social Management Framework, (ESMF) has been prepared
to conform to; and to be in line with the requirements of the participating countries as
well as the World Bank.
Objectives of the ESMF
This Environmental and Social Management Framework (ESMF) is prepared to
ensure proper assessment and mitigation of potential adverse environmental and
social impacts, for the construction and rehabilitation of the laboratories. It includes
issues related to operation of the laboratories and those which need to be addressed
for laboratory waste management.
Among other things, the ESMF outlines an environmental and social screening
process, focusing on the completion of the Environmental and Social Screening
Form. It includes an Environmental and Social Management Plan (EMP), guidelines
for monitoring and development of appropriate monitoring indicators, capacity
building measures for environmental management and cost estimates for the
environmental work. It also includes (as appendices) Environmental Guidelines for
Contractors, a summary of the Bank’s Safeguard Policies, an Environmental and
Social Checklist and Generic EIA Terms of Reference, to be used in the event that
the screening results indicate the need for preparation of an EIA report. The EIA
recommendations will be incorporated into the design and cost estimates of the
Regional Health Systems Strengthening and TB Support Project.
Justification for the ESMF
For the Regional Health Systems Strengthening and TB Support Project, the precise
type and location of proposed project activities are not known at this time. Therefore
the potential social and environmental impacts of the project activities cannot be
identified and mitigation measures determined in the context of a traditional EIA, for
the specific sub-projects. This ESMF provides generic impacts and mitigation
measures associated with the construction, rehabilitation and operation of health
care laboratory facilities. Specific sub-project activities, their impacts and mitigation
measures will be identified once the project sites have been located.
The ESMF therefore, complements the EIA procedures for meeting the
environmental and social management requirements, and the Healthcare Waste
Management Policy Guidelines developed for the participating countries. The ESMF
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is also in line with the World Bank Operational Policies for environmental
management of projects where specific details are not yet known.
Approach and Methodology for Preparation of the ESMF
In the development of this ESMF, a high degree of consultation with various key
stakeholders was employed. The rationale of these extensive consultations was to
solicit views of a cross section of key stakeholders including key officials of
Government Departments involved in the project and the EIA process.
Information for the preparation of the ESMF has been collected through a number of
research methods, which include review of related literature from published and
unpublished documents, field investigations and consultation with key stakeholder.
The field investigations and public consultations were conducted in Dar es Salaam
from August 4 to 22 and the key stakeholders consulted are presented in Annex 8.
Summary of Features of the ESMF
The impact of TB in Africa and Sub-Saharan Countries and the effects of TB
combined with the HIV/AIDS; and high incidences of maternal and infant mortality
rates associated with sepsis are the driving forces for this project. Three Sub-
Saharan countries (Kenya, Uganda and Tanzania) are participating in the first phase
of the project.
In general; the legal, regulatory and administrative framework to support
environmental management of the Regional Health Systems Strengthening and TB
Support Project in the participating countries is established. However, the legal
framework for environmental management is not explicit for projects whose activities
are not well defined and the project locations are not yet known. Hence the
participating countries’ legislation, together with the Word Banks Safeguard Policies
(focusing the Environmental Assessment Policy (OP 4.01)), are the basis of this
ESMF.
Although the ESM has been prepared with information obtained primarily from
Tanzanian, the other participating countries would use it to suit their specific needs
with little modification, if any. This is so because the types of works (comprising
construction of new and refurbishing of existing laboratories) are similar in all the
three countries.
In general, the civil works elements of the project would not normally require an
Environmental Impact Assessment (as the type of project activities would be
considered minor). However discharge of medical wastes would attract some strict
environmental control and therefore, in this respect, preparation of an EIA may be a
necessity.
This ESMF will assist in determination of whether or not particular sub-projects
require an EIA. The principle and process of carrying out this determination are very
well described in chapter 6 and would be applicable to any situation in the
participating countries, especially in view of the fact that the project activities would
basically be the same. Differences might occur where the project sites are not
biophysically similar and in these cases, the ESMF would assist in determining to
select an environmentally suitable area and to reject those sites which would not be
ix

suitable. The World Bank environmental policy insists that all projects whose exact
activities and locations are not known should be subjected to the screening process.
The Environmental and Social Screening Process will be used for assessing whether
a sub-project is likely to have significant environmental and social impacts and to
determine the level of environmental work required for the sub-projects. The
Environmental and Social Screening Form, to be used for determining whether it will
be necessary to carry out a full EIA, a limited EIA or simply an Environmental Review
is provided as Annex 1 to this ESMF.
Generic impacts of the proposed project including the methods and techniques used
to identify these impacts are elaborated in Chapter 4 of this ESMF. The impacts are
organised into the four project phases of planning and design, construction and
rehabilitation, operation and maintenance and decommissioning and closure. The
typical environmental and social components to be impacted upon include soil,
vegetation, landscape and landform, surface water, ecosystems, socio-economic,
and health and safety components. The potential impacts include soil erosion, water
pollution and siltation, dust and noise nuisances, traffic congestion and accidents,
occupational health and safety of workers as well as the general public, TB and HIV
and AIDS infections.
Management of these environmental and social impacts will be through
Environmental and Social Management Plans (EMP), which details mitigation
measures for the impacts and responsible institutions for carrying out these
measures. A generic environmental and social management plan is presented in
Chapter 4 and a generic environmental monitoring plan is outlined in Chapter 5.
Finally this ESMF proposes capacity building measures, including the establishment
of an Environmental and Social Unit (ESU) and areas of training including
sensitization, costs for the training and sensitization activities and the groups of
people to be trained and sensitized. These include top level staff of the Ministry of
Health and Social Welfare, project implementers, District staff and local community
groups.
Key Recommendations of the ESMF
This ESMF recommends that for successful implementation of the project, there is
need to ensure that the existing environmental regulations are adhered to in all the
participating countries. Specifically, the recommendations made in this ESMF should
be implemented and for its successful application, involvement and participation of
all stakeholders and local communities is very important. The ESMF further
recommended that:
• The screening process and the screening forms should be used for all the
sub-project activities of the Regional Health Systems Strengthening and TB
Support Project;
• The Ministry of Health and Social Welfare should be adequately supported to
set up the proposed Environmental and Social Unit, to oversee the
implementation of this ESMF as well as the National Healthcare Waste
management Programme(NHCWMP);
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• Environmental and social awareness and training, as presented in the
capacity building proposal, for the key stakeholders and affected communities
should be implemented;
• Regularly updating of this ESMF, to respond to changing designs and local
conditions in the participating countries is very important and should be done
as appropriate;
• Building capacities at the district level, for appropriate information
management systems, to facilitate the environmental and social management
process should be supported by the project;
• At the district level, the necessary resources and equipment for producing the
required documentation and completing the screening forms as well as
preparing reports for the implementation of the ESMF recommendations
should be provided; and
• that staff at all levels should be empowered to adequately administer the
ESMF throughout the project implementation.
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CHAPTER 1 INTRODUCTION
1.1 PROJECT BACKGROUND
In 1993, the World Health Organisation (WHO) declared tuberculosis (TB) a global
emergency. TB has been on the rise since the 1980s, with its spread concentrated in
South East Asia and Sub-Saharan Africa. The resurgence of TB, especially in Africa
where approximately two thirds of those living with HIV also carry it, is connected
with the HIV and AIDS pandemic. HIV and TB represent two of the most significant
health challenges in human history and the combination of the two infections is
particularly devastating because HIV dramatically increases the severity of TB
infection.
In general, the numbers of new TB cases (fuelled by the HIV/AIDS epidemic) and
mortality rates have been on the rise in Africa since 1990, while other regions have
shown a steady decline in the tuberculosis burden. Tuberculosis cases have also
increased significantly in recent years, in Sub-Saharan Africa where there is virtually
no diagnostic or surveillance capacity at the supranational level. Africa as a region
has made progress in laboratory-based surveillance of some diseases (polio,
measles, HIV/AIDS, meningitis). However, there has been little progress in early
detection of other epidemics such as drug resistant tuberculosis. To contribute to
the improvement of this situation, the proposed project will strengthen the operations
of regional and national laboratories in the three participating countries of Tanzania,
Uganda, and Kenya.
1.2 PROJECT SETUP IN THE THREE PARTICIPATING COUNTRIES
The World Bank is supporting the US$140 million Health Systems Strengthening and
TB Support Project which, aims at strengthening regional capacity for the diagnosis,
management, and surveillance of TB and other communicable diseases. A strategy,
currently under preparation, will flesh out the main objectives of the broader program
(e.g. strengthening regional institutions for cross-border and inter-country
collaboration; reinforcing regional diagnostic and laboratory capabilities; and
developing regional capacity for integrated multi-disease surveillance and response
preparedness).
The project is part of the Africa Regional Communicable Disease Control and
Preparedness Program, which aims at controlling and/or eliminating priority
communicable diseases on the continent. The initial countries which will participate
in this project are Kenya, Tanzania and Uganda, which are part of the twenty-two
high burden countries worldwide. Other countries will be eligible to participate in a
second phase, provided they have:
(i) a clear policy framework which outlines the country’s commitment to
strengthening laboratory systems and a clear plan for introducing new
diagnostic techniques for TB.
(ii) a high burden of TB, a high risk of MDR-TB, and high rates of TB/HIV coinfection.
1

(iii) a clear analysis of total financial needs, what other partners are doing, and
what the expected gap would be.
(iv) agreed to use one-third of the IDA country allocation to benefit from the twothirds
top up from regional funds.
1.2.1 Tanzania
The Ministry of Health and Social Welfare for mainland Tanzania oversees
laboratory services at referral and national levels and will have the overall
responsibility for the project. The 2009-2015 National Health Laboratory Strategic
Plan, prepared by the Diagnostic Services Section (DDS), aims at establishing
quality laboratory services at all levels in an effort to ensure equitable, gender
sensitive services, with an efficient and effective governance system and
establishing partnership with public and private laboratories. The plan was
developed in consultation with the national disease programs (e.g., TB, malaria), and
serves as a good framework for the project. The Laboratory Services group within
the DDS is responsible for managing the National Health Laboratory Quality
Assurance and Training Center, a new facility constructed by USG/PEPFAR, which
the government would like to develop into a regional training institute.
The Central Tuberculosis Reference Laboratory (CTRL), which will play a key role in
the regional project, heads the national TB laboratory network and will participate in
the proposed regional lab network. The reference laboratory is managed by the
National Tuberculosis and Leprosy Program and the National Institute for Medical
Research and physically located in the Central Pathology Laboratory at Muhimbili
Hospital. The current space is inadequate and instead of functioning as a public
health laboratory it responds more to the clinical needs of the hospital. The
reference laboratory is responsible for:
(i) performing acid-fast bacilli (AFB) smears,
(ii) Löwenstein-Jensen cultures, and drug susceptibility testing (DST);
(iii) maintaining AFB smear microscopy quality assurance;
(iv) conducting drug resistance surveillance (as the only public laboratory in
the country conducting drug sensitivity testing); and
(v) providing support for coordination, training, and operational research.
The National Institute for Medical Research, which will serve as a key center for
conducting operational research, collaborates closely with various stakeholders,
including the flagship Field Epidemiology Training Program, and the Medical
Research Centre within Muhimbili University of Health and Allied Sciences, which
will facilitate close links between training and research.
In Tanzania, the activities under the regional project will be carried out through the
institutions noted above. No new structures would be established for the proposed
project. The Health Sector Reform Secretariat, which manages the portion of the
Bank’s Health Sector Development Project (HSDP) that does not go through basket
financing, will have overall responsibility for coordinating the fiduciary aspects for the
proposed activities. A full time public health specialist will be recruited to coordinate
the activities under the regional project.
2

1.2.2 Uganda:
In line with the 2008 Maputo Declaration on Strengthening of Laboratory Systems in
Africa, Uganda has outlined an appropriate policy framework, which calls on all
stakeholders including government, donors and partners to join efforts in promoting
integrated support for laboratory systems. The National Health Policy and the Health
Sector Strategic Plan II recognize laboratory services as one of the major support
services needed for effective and efficient delivery of the minimum health care
package. The policy aims, inter alia, at: (i) enhancing coordination of laboratory
services, strengthen staffing, and establish M&E systems at all levels of the health
system; and (ii) establishing partnerships between public and private laboratories to
improve equity and access to quality laboratory services.
TB laboratory services are well integrated with other laboratory services throughout
the health care system, and with the exception of the NTRL, no stand-alone
laboratories exist for TB. The National TB Reference Laboratory has overall
responsibility for ensuring that the TB Control Program can rely on quality-assured
reliable diagnostic TB services to support case detection and management and to
protect the community against the public health threat of TB, including MDR-TB.
The NTRL is the only laboratory that performs culture and DST for the national TB
control program. The NTRL functions can be grouped into the three main areas of:
(i) providing quality technical services for detection and identification of
mycobacteria;
(ii) providing leadership, supportive supervision, and training to the TB lab
network; and
(iii) conducting surveillance, collating and monitoring drug susceptibility
information.
The Central Public Health Laboratory (CPHL), which will be expected to play a key
role in carrying out the surveillance and outbreak related activities, is based in the
Department of National Disease Control. In addition to disease surveillance and
outbreak investigations, the CPHL provides reference services to confirm
bacteriological and parasitic disease etiologies for the entire national laboratory
network. The CPHL:
(i) acts as the center for coordination and stewardship of laboratories
services;
(ii) has led the development of the National Health Laboratories Policy and
other national documents, including guidelines, training manuals, and
Standard Operating Procedures;
(iii) runs an external quality assessment scheme and a support supervision
program; and
(iv) coordinates in-service training for health laboratories. The CPHL works
closely with the Epidemiological Surveillance Division in implementation of
integrated disease surveillance.
In Uganda, the activities carried out under the regional project would rely primarily on
country systems. Additional technical and managerial assistance to the NTRL,
CPHL, and other supportive departments within the Ministry of Health will be
3

equired to ensure timely and appropriate implementation and monitoring of project
activities.
1.2.3 Kenya:
Kenya has developed several policy and strategic documents including the National
Health Sector Strategic Plan II (NHSSP II), National Public Health Laboratory
(NPHL) Plan, Division of Leprosy, Tuberculosis and Lung Disease (DLTLD) Strategic
Plan, and the Draft Central Tuberculosis Reference Laboratory (CTRL) Strategic
Plan, which identify laboratory services as an essential support service for the
efficient delivery of quality health services.
The Department of Disease Control within the Ministry of Medical Services has been
designated as the unit which will lead Kenya’s activities under the regional project.
The Head of Disease Prevention and Control will be the focal point for the project
and a small project support team consisting of one national project officer and two
consultants (an accountant and an operations officer) will handle day to day
operations and reporting requirements.
To ensure effective coordination with the Ministry of Medical Services (MoMS) and
surveillance program, a coordination committee will be established which will include
an officer in-charge of Disease Surveillance and Response Unit, Chief Medical Lab
Technologist from MOMS and Head of Technical Services from the National Public
health Labs Division. The department is well placed to handle this role as it is
responsible for managing three key units:
(i) Division of TB, Leprosy and other lung disease programs;
(ii) Central TB Reference Laboratory which reports administratively to the
NPHL; and
(iii) Division of Disease Surveillance and Response which handles disease
outbreak monitoring and response preparedness.
The second ministry of health (Ministry of Public Health and Sanitation) has
responsibility for: (i) facilities at levels 2 and 3 (dispensary and health centers); (ii)
disease control programs; and (ii) Kenya Medical Research Institute (KEMRI), a
parastatal body with substantial capacity. While the recent establishment of two
ministries of health creates potential complexities, to date the coordination and
collaboration on the preparation of this regional project has been good.
The Kenya health service delivers medical laboratory tests through a network of
about 960 clinical laboratories, of which 70 percent belong to the government, 20
percent to the NGOs, and 10 percent to the private for profit sector. Over 80 percent
of all laboratories participate in the national tuberculosis program. These clinical
laboratories receive support from central reference laboratories whose primary
function is to support quality assurance and provide specialized services. The
central reference labs are grouped under the umbrella of the National Public Health
Laboratory (NPHL) and maintain close links with their respective programs. The
NPHL has the overriding responsibility for data collection and dissemination and
coordinates laboratory specimen collection, transporting, testing or shipping the
4

specimen to designated laboratories during outbreaks and emergencies for
specialized diagnostic testing.
The Central TB Reference Laboratory, which will network with the other participating
countries, provides reference and specialized testing, including testing of new
technologies (rapid molecular testing for MDR-TB), based upon agreed
specializations. With support of the regional project, the CTRL would, in cooperation
with NPHL, incorporate multi-drug resistance tuberculosis surveillance and response
preparedness into the integrated multi-disease surveillance system for the East Africa
region.
There is high-level support for the proposed activities both at the Ministries of Health
and the Ministry of Finance and there is also recognition that the spread of MDR-TB
needs to be addressed forcefully and in a coordinated fashion with its neighbors.
Kenya’s involvement in the regional project provides an opportunity to demonstrate
leadership in addressing difficult cross border public health issues stemming from the
inflow of refugees.
1.2.4 Regional Coordination:
The regional project will foster cross-country and cross-institutional collaboration,
exchange and disseminate timely information, promote regional harmonization, and
foster exchange of expertise and best practices among the Ministries of Health of
Kenya, Tanzania, and Uganda. The East, Central and Southern African Health
Community (ECSA), based in Arusha, will have the overall responsibility for
coordinating activities at the regional level. ECSA will collaborate as necessary with
the East African Community (EAC), which has a small health desk located in Arusha
as well.
ECSA is a regional inter governmental organization comprising Kenya, Lesotho,
Malawi, Mauritius, Seychelles, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe.
Established in 1974 by the Commonwealth Secretariat in London, its objectives are to
foster regional cooperation in health and to strengthen capacity to address the health
needs of its member states. The institution’s core mandate is "To promote and
encourage efficiency and relevance in the provision of health services in the region."
ECSA is recognized as an important indigenous organization that has earned the
support of governments and other regional and international organizations. It enjoys
political, administrative and professional support of the Member States who guide and
monitor its activities through regular Ministerial Conferences, Expert Committee
Meetings and other forums.
ECSA has solid governance structures which will support the proposed regional
project by:
(i) offering a regional platform for governments, professional organizations
and the scientific community to promote cooperation, networking,
collaboration and joint/cross border actions in health;
(ii) establishing a regional focus for learning and information brokerage by
documenting and promoting the exchange of ideas, experiences, best
practices, knowledge and information in health;
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(iii) promoting a regional voice for member states in all matters of health at
regional and international decision making forums; and
(iv) advocating for greater attention and resources to strengthening laboratory
capacity in the region.
Participating countries will contribute a portion of the proceeds of their IDA credits for
coordination of these activities. Member states are the main source of ECSA's
funding, contributing roughly 80 percent of ECSA’s total budget, with the balance
provided by other donors and partners.
Project Components
The project includes two components as follows:
Component 1: Specialized Diagnostic Services for TB and Other
Communicable Diseases (US$42.5 million)
This component will improve access to quality diagnostic techniques for TB and
other communicable diseases, by strengthening national public health laboratories
as well as specialized satellite laboratories and putting in place systems for
laboratory management and surveillance. This would involve funding the following
three mutually complementary set of activities:
1. Networking National TB Reference Laboratories
The Bank-funded regional project would assist to establish an East Africa
network of national TB reference laboratories, to strengthen TB quality
assurance and conduct epidemiological surveillance, including addressing the
emergent threat of multi-drug resistant TB.
The national TB reference laboratories would serve as models for prevention,
control, and treatment efforts; acting as centres of excellence for knowledge
generation and sharing. The laboratories would provide reference and
specialized services, including testing of new technologies. Standardized
quality assurance programs will be harmonized among the three East African
national TB laboratories and inter-laboratory external quality assessments
(EQA) would be supported. This would be an effective mechanism in the
current absence of a Supranational Reference Laboratory.
The regional project would establish the foundations for the East Africa
laboratory network by first bolstering the capacities of the three national TB
reference laboratories and subsequently assisting to put in place a
Supranational Reference Laboratory (SRL). This would substantially boost
Africa’s capacity as there is currently only one such laboratory in South Africa.
As national capacities are enhanced and the network becomes fully
functional, one of the three national TB reference laboratories (NTRL) will
develop into a full Supranational Reference Laboratory. There is already an
international commitment to establish such a supranational structure in East
Africa and both the World Health Organization (WHO) and the TB Union have
established processes for accrediting one of the laboratories to meet
international standards.
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The regional project would fund a full range of activities to strengthen and
upgrade the NTRLs in the three participating countries and to establish them
into a functional network. The ultimate goal is to ensure that TB diagnostic
procedures are performed by appropriately trained and adequately protected
technicians, operating in well equipped and safe laboratories and
accordance with national and international proficiency and quality standards.
To this end, the project would fund:
(i) physical upgrading or construction of new laboratories to meet biosafety
level III standards;
(ii) introduction of modern diagnostic technologies, to complement
financing from UNITAID, as may be necessary;
(iii) technical assistance to facilitate development and introduction of
standardized operating procedures, and quality assurance systems;
(iv) equipment and logistical resources to establish integrated laboratory
data management systems, communication systems, laboratory
logistics, and commodity management systems;
(v) materials and protective gear (e.g. masks, gloves) and related waste
management equipment to ensure the safety of lab personnel; and
(vi) provision of operating funds to render the laboratories functional,
including strengthening human resources as the backbone of quality
diagnostics.
2. Networking Central Public Health Laboratories
The Central Public Health Laboratories (CPHLs) in the three countries would
also be strengthened and upgraded to play a key role in controlling and
preventing the spread of communicable diseases. Bank funding would assist
the three countries to strengthen laboratory-based disease surveillance to:
(i) provide early warning signals for health risks of regional and
international concern,
(ii) collaborate in investigations of disease outbreaks and;
(iii) establish and maintain an integrated data management system to
facilitate sharing of relevant data across the sub-region.
The regional project would assist Kenya, Tanzania and Uganda to comply
with the International Health Regulations (enacted in 2007) to which they have
committed themselves by signing. The project would help the countries to
establish capacity to conduct early identification of public health emergencies
of international concern.
The project would assist the countries to begin consolidating laboratory and
diagnostic capacity and to reap greater economies of scale. This would foster
a more efficient and cost-effective operation of the laboratory network. The
process would be gradual and progressive, starting with the National TB
Reference Laboratories and the Central Public Health Laboratories, which in
all cases are in need of more adequate laboratory space.
Relocating the national TB reference laboratories and the central public health
laboratories to one location will enable them to share support systems and
ultimately to consolidate their capacity and work effectively in the East Africa
lab network. The activities to be funded would be broadly similar to those
in
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noted above and would comprise (i) physical infrastructure; (ii) equipment,
supplies, and logistical resources; (iii) technical assistance; and (iv) operating
funds.
3. Networking Satellite Diagnostic and Treatment Centres
To expand diagnostic capacities beyond the national level and support cross
border patients, the regional project would fund a number of satellite
diagnostic and treatment centres in the participating countries. These satellite
centres would provide diagnostic services and care in areas where a large
number of TB cases are in migrants or refugees from neighbouring countries,
as well as contain cross-boarder spread of TB and other communicable
diseases. The goal is to use an integrated model whereby diagnostic capacity
(e.g. bacteriology, parasitology, chemistry, and haematology) is expanded
across diseases. The satellite centres could serve as a source of expertise to
conduct external quality assurance, perform supervision, provide consultation,
train local technicians, and offer advanced testing for lower level laboratories.
These facilities would also serve as disease surveillance sites. Bank
financing would promote a systems approach to optimize laboratory testing
and ensure access to appropriate services.
The Regional Health Systems Strengthening and TB Support Project would
finance the following types of activities:
(i) infrastructure upgrading and refurbishing, as needed;
(ii) equipment and supplies for both general laboratory strengthening and
to enable them conduct liquid culture and drug sensitivity testing, using
molecular testing to complement UNITAID financing;
(iii) second line drugs for treatment of multi-drug resistant TB to mitigate
the risk of other funds not being available;
(iv) equipment and technical support for upgrading laboratory information
systems and connecting all partners in order to improve the quality and
organization of laboratory data and speed the flow of information for all
laboratory testing for all diseases;
(v) telemedicine capacity to allow laboratory technicians and clinicians
across participating sites to share expertise and consult in case of
complex TB and other cases;
(vi) technical support for conducting operational research to develop
evidence-based recommendations for use of new laboratory
technologies and for management of co-infected and MDR-TB patients;
and
(vii) operating costs to enable the laboratories to conduct internal and
external quality assurance and supervision.
Component 2: Regional Capacity Building for Management and Monitoring of
Communicable Diseases (US$16.5 million)
The second component aims to strengthen regional capacity to manage and monitor
communicable diseases. This would be accomplished by:
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1. Supporting the Re-establishment of the East Africa Integrated
Disease Surveillance Network
One of the key activities of the Bank-funded regional project will be to
revitalize the East Africa Integrated Disease Surveillance Network
(EAIDSNet). The network is a joint effort of the National Institutes for Medical
Research and the Ministries of Health of Kenya, Tanzania, and Uganda.
The regional project will provide financing to restart the network, render it
functional, produce a joint annual surveillance report on communicable
diseases, and establish a network-based data management system to be
used by all countries. To this end, the project would fund:
(i) technical support to reconfigure and re-establish EAIDSNet, starting
with an assessment of current capacities, constraints, and institutional
responsibilities for epidemiological and laboratory surveillance efforts,
drawing lessons from the earlier experience;
(ii) equipment, logistical, and communication resources to establish
networks and channels for data sharing across countries; and
(iii) support for ECSA, which would play a coordinating role in the
production of the annual surveillance reports.
2. Providing Regional Training to Improve Availability of Qualified
Laboratory Staff
To address human resources constraints, which are prevalent across the
three countries, the Bank-funded regional project would support sub-projects
to train trainers and laboratory technologists in the latest diagnostic
techniques and to train laboratory managers. This training will be critical for
rolling out the new technologies described under the first component.
Priority areas for training sub-projects identified by the participating countries
include:
(i) laboratory quality management systems;
(ii) internal and external quality assessments;
(iii) new technologies supported under the project and refresher courses
for basic laboratory procedures;
(iv) laboratory services for emergency and outbreak preparedness and
response;
(v) public health laboratory training, including in waste management and
infection control;
(vi) accreditation preparedness and assessment training; and
(vii) epidemiology and statistics for laboratory management.
All topics are considered important for effective operation of public health
laboratories in the participating countries.
Training will have a regional focus, working with a range of institutions within
the three countries and across the region. The recently constructed National
Health Laboratory Quality Assurance and Training Centre in Tanzania will be
established as a regional training centre for the East Africa Community,
providing up to date in-service training and post-graduate mentorship,
including exchange programmes with other countries in the region. Other
9

egional training centres like the African Centre for Integrated Laboratory
Training in Johannesburg will also be considered for providing training,
particularly for trainers. The Bank-funded regional project would support
training activities which have been agreed upon at national and regional levels
and are included in an annual training plan. These plans will be developed
and agreed upon in regional consultations convened by ECSA.
To support development of human resources capacity in the three countries, a
joint, comprehensive review of laboratory training and skills development
would be undertaken. This would involve:
a) needs assessment to revise the pre-service training curriculum to address
rapidly changing technological and laboratory quality management needs
and promote standardization where feasible;
b) establishment of standards of competence and education requirements for
different levels of laboratory practices, which are regionally standardized
where possible; and
c) development of a human resources plan for laboratory personnel.
The Bank would finance:
d) attendance in training courses at national and regional institutes;
e) laboratory attachments and regional exchanges at recognized centres of
laboratory excellence;
f) graduate training, as may be required to support the project objectives,
and based on established criteria to be spelled out in an operational
manual;
g) technical assistance to support review and revision of curricula and human
resources planning; and
h) operating costs for workshops and training events.
3. Joint Operational Research, Knowledge Sharing, and Coordination at
the Regional Level.
The Bank-funded regional project would support a joint operational research
and knowledge sharing agenda to be developed and conducted among the
participating countries. The need to support expansion of operational research
to encourage evidence based approaches to rolling out new diagnostic
technologies and new treatments in Africa is well recognized in the Better
Health in Africa report (World Bank, 1994)
The roll out of new diagnostic techniques and the expansion of treatment for
patients with multi-drug resistant forms of TB will be closely monitored and
evaluated. Particular attention will be given to cost effectiveness, equity, and
sustainability issues. Likewise, operational research will help inform practice
with regard to which specialized tests should be performed, on which patients
and how often. The evidence generated from the satellite diagnostic and
treatment sites will help inform the scale up of these interventions in the
participating countries and more broadly in the region. The knowledge
generated in carrying out this regional project will be systematically
10

documented and disseminated. Regional workshops will be convened by
ECSA on an annual basis, or more often as needed, to share lessons and
good practices.
The Bank-funded project will fund:
(i) technical assistance for operational research to be conducted by
national research institutes, in collaboration with international
researchers; and
(ii) operating costs to organize regional meetings and workshops.
The project construction activities in the three participating countries are very similar
(except for a few differences) and are generally minor activities. Tanzania and
Uganda for instance, are planning to construct bio-safety level 3 (BSL -3)
laboratories, while Kenya is not. On the other hand, Kenya and Tanzania are
proposing to construct new central public health laboratories while Uganda is not.
Construction and renovation of satellite diagnostic and treatment centres is proposed
for Kenya. Goods to be procured under this project will include drugs and reagents,
medical equipment (e.g. fluorescent or LED microscopes and other laboratory equipment)
incinerators, computers, computer software and protective material.
Although full details of the planned units to be constructed in each participating
country are not fully established at this time, the types of civil works in all the three
participating countries are similar and an indication of the planned project activities
by country and project component is given in Table 1.1
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Table 1.1 Project Activities by Country and Component
KENYA TANZANIA UGANDA
COMPONENT 1: SPECIALIZED DIAGNOSTIC SERVICES
TB Laboratory Network/Central Public Health Laboratory Network
Construction of a Bio-safety level (BSL-3) National TB Reference Laboratory CDC X X
Construction of new Central Public Health Laboratory integrated with TB Reference
Laboratory (Tanzania) or rehabilitation (Kenya)
X X CDC
Acquisition of equipment, supplies and reagents to complement grant financing from
UNITAID
X X X
Introduction of standardized operating procedures and quality assurance systems across X X X
participating labs
HR strengthening in technical and managerial areas X X X
Establishment of intranet with web-and video interface across participating countries X X X
Establishment of standardized, integrated electronic data management system X X X
Provision of TA to facilitate investigations of disease outbreaks in collaboration with public X X X
health labs in neighbouring countries
Support for operating costs
Networking Satellite Diagnostic and Treatment Centres
X X X
Construction/renovation of satellite diagnostic and treatment centres X
Equipment and supplies for both general lab strengthening and to enable these labs to
conduct liquid culture and drug sensitivity testing using molecular testing
X X
Development and introduction of standardized quality assurance systems, including
supervision
X X X
Capacity building and supporting regional staff exchange programs X
Development of communication systems and telemedicine capacity across participating
sites to share expertise and consult in case of complex cases
X X X
Provision of second line TB drugs in support of MDR-TB, in case other funds are not
X X
available
COMPONENT 2: REGIONAL CAPACITY BUILDING FOR MANAGEMENT AND MONITORING OF COMMUNICABLE
DISEASES
Provision of infrastructure, technical, and administrative support for multi-disease X X X
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surveillance and outbreak preparedness
Establishment of integrated electronic data management system X X X
Establishment of communication channels, development of HR capacity, and production
of annual reports
X X X
Technical support to carry out operational research and generate evidence-based
recommendations
X X X
Establish a regional training centre for the East Africa Community X
Finance annual training plans agreed on at national and regional levels X X X
Formulation of a joint, comprehensive plan for laboratory training and skills
development
X X X
Support for regional-level costs associated with coordination, information exchange, and
annual reporting by ECSA
X X X
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1.3 PROJECT DEVELOPMENT OBJECTIVES
The development objective of the Project is to strengthen regional capacity for the
diagnosis, management, and surveillance of TB and other communicable diseases.
The project will facilitate knowledge sharing and assist participating countries to
translate their common interests and goals into a community of practice, promoting
common approaches to prevention and control of communicable diseases, learning
from each other, and working towards greater regional integration. The project is
aimed at improving access, quality, and efficiency of TB diagnostic services using an
integrated approach to laboratory strengthening. The specific objectives are to:
(iii) establish additional Supranational Reference Laboratories in strategic
locations to provide quality assurance, training, and capacity building;
(iv) introduce modern diagnostic techniques, increasing capacity for drug
resistance surveillance, and ensuring compliance with bio-safety and infection
control standards in a group of national reference and public health
laboratories; and
(v) develop and test alternative service delivery models to promote private sector
involvement.
The project would also facilitate learning and knowledge sharing across the network
of participating laboratories and countries. In the short-term, the development of
laboratory waste management plans for the above participating countries are
intended to strengthen environmentally safe waste disposal.
The project will ultimately contribute to improving health outcomes in participating
countries. It will contribute to the achievement of MDG 6 (Combat HIV/AIDS, malaria
and other diseases), and more specifically to the global targets to “reduce the
prevalence and death rates associated with TB” and to increase the “proportion of
TB cases detected and cured”. It may also contribute to MDG 5 (Improve maternal
health) and MDG 4 (Reduce child mortality) by reducing maternal and under-five
mortality due to TB.
1.4 DESCRIPTION OF THE PROJECT’S AREAS OF INFLUENCE
Upgrading, rehabilitation, and/or construction of laboratories as well as generation of
medical waste will have negative environmental and social consequences. Therefore
the project has triggered OP/BP 4.01(Environmental Assessment) due to the
planned construction/rehabilitation of laboratories as well as the generation of
medical waste at these laboratories; and has been assigned to the World Bank
environmental category B.
Potential safeguard issues and areas of influence will be on the environmental
components of soil, air and water, and vegetation. Issues on social components will
relate to traffic accidents, safety of workers and potential for spread of HIV and
AIDS. The areas to be affected include public places where people gather in large
numbers; poorly ventilated public places and laboratories; points or places of
collection, transportation, storage and analysis of specimens; as well as places of
disposal of laboratory and hospital waste.
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To ensure that these consequences or impacts are avoided, minimized or mitigated,
this Environmental and Social Management Framework, (ESMF) has been prepared
to conform to; and is in line with the requirements of the participating countries and
the World Bank.
1.5 OBJECTIVES OF THE ESMF
This Environmental, Health and Social Management Framework (ESMF) for the
Regional Health Systems Strengthening and TB Support Project is prepared to
ensure proper assessment and mitigation of potential adverse environmental, Health
and social impacts, for the construction and rehabilitation of the laboratories. The
ESMF also includes issues related to operation of the laboratories and those which
need to be addressed for waste management. The Tanzania’s Health Care Waste
Management Plan (2003/2004) has also been developed and updated, taking into
account the laboratory issues and the other participating countries will also have
their Health Care and Waste Management Plans updated and reviewed.
The ESMF outlines an environmental and social screening process, focusing on the
following steps:
(i.) completion of the Environmental and Social Screening Form;
(ii.) assignment of the appropriate environmental category as per OP 4.01;
(iii.) carrying out the appropriate level of environmental work;
(iv.) review and clearance of the screening results;
(v.) preparation of EIA reports, where this may be necessary and;
(vi.) Preparation of Environmental management Plan
The ESMF includes an Environmental and Social Management Plan (EMP),
guidelines for monitoring and development of appropriate monitoring indicators,
capacity building measures for environmental management and cost estimates for
the environmental work. It also includes (as appendices) Environmental Guidelines
for Contractors, a summary of the Bank’s Safeguard Policies, an Environmental and
Social Checklist and Generic EIA Terms of Reference, to be used in the event that
the screening results indicate the need for preparation of an EIA report. The EIA
recommendations will be incorporated into the design and cost estimates of the
Regional Health Systems Strengthening and TB Support Project.
The ESMF will facilitate environmentally and socially sustainable construction and
rehabilitation of the laboratories in all the participating countries. In the long-term, as
other countries join efforts to combat TB, the ESMF and the laboratory waste
management plans could be adapted to suit their environment, as appropriate.
1.6 JUSTIFICATION FOR THE ESMF
For the Regional Health Systems Strengthening and TB Support Project, the precise
type and location of proposed project activities are not known at this time. Therefore
the potential social and environmental impacts of the project activities cannot be
identified and mitigation measures determined in the context of a traditional EIA, for
the specific sub-projects.
For development project activities whose design details and locations are known, the
respective participating counties’ Environmental Management Act and the
15

Environmental Impact Assessment and Audit Regulations would prescribe the
conduct for Environmental Impact Assessment. However, these instruments may not
sufficiently provide and support the screening process for identification, assessment
and mitigation of potential localized impacts, where the project details and specific
project sites are not yet known, as required by the Bank. This ESMF provides
mechanisms for ensuring that potential environmental and social impacts of the
Regional Health Systems Strengthening and TB Support Project activities are
identified, assessed and mitigated as appropriate, through an environmental and
social screening process. This ESMF would therefore, complement the participating
countries’ EIA procedures for meeting the environmental and social management
requirements. The ESMF complements and is in line with the World Bank
Operational Policies for environmental management of projects where specific
details are not yet known.
1.7 POTENTIAL USERS OF THE ESMF
The ESMF has been prepared as a reference manual for use by key stakeholders to
be involved in the planning, implementation, management and operation of the
proposed Regional Health Systems Strengthening and TB Support Project. As a
reference material, the ESMF would be useful to the following project key
stakeholders, ministries and departments in the participating countries:
• Ministries responsible for Health and Social Welfare
• Participating Countries of the Regional Health Systems Strengthening and TB
Support Project who may update the ESMF as necessary;
• Funding and Donors Agencies;
• Town & Country Planning Committees and District Executive Committees in
the selected cities and districts of the participating countries;
• Politicians and Local Traditional Leaders;
• Senior Government officials responsible for policy making and development
planning; and
• National Healthcare waste management Programmes for the participating
countries
1.8 APPROACH AND METHODOLOGY FOR ESMF PREPARATION
One of the key objectives of the ESMF is to provide a screening process for potential
environmental and social impacts for planned future project activities of the Regional
Health Systems Strengthening and TB Support Project and to recommend generic
management and monitoring plans for addressing the potential negative impacts. In
the development of this ESMF a high degree of consultation with various key
stakeholders was employed. The rationale of these extensive consultations was to
solicit views of a cross section of key stakeholders including key officials of
Government Departments involved in the project and the EIA process.
The strategies for executing this assignment followed the six steps listed below:
• review of documents for project concept and implementation processes for
the proposed project activities;
• review of other relevant literature and government regulations for
environmental management and preparation of EIAs;
16

• identification and analysis of potential generic environmental and social
impacts the project activities are likely to trigger and generate within and
around the project sites;
• identification of appropriate generic mitigation measures for the negative
environmental and social impacts
• development of the appropriate screening process for project sites and project
activities, and;
• Compilation of a generic management and monitoring plan for addressing the
impacts during implementation, operation and maintenance of the project
activities.
Information for the preparation of the ESMF has been collected through a number of
research methods, which include review of related literature from published and
unpublished documents, field investigations and consultation with key stakeholder.
The field investigations and public consultations were conducted in Dar es Salaam
from August 4 to 22 and in Nairobi from August 23 to 25. Some of the key
stakeholders consulted are presented in Annex 8
1.9 ORGANIZATION OF THE ESMF
This ESMF report is organised as follows:
Chapter 1 provides the introduction to the project; summarising the project
background, the impact of TB in Africa and Sub-Saharan Countries and the effects of
TB combined with the HIV and Aids scourge. The project description involving the
countries participating in the first phase of the project (Kenya, Uganda and Tanzania)
is given in this chapter where the three project components are summarised. Also
presented in this chapter are the project development objectives, which focus on
contributing to improving health outcomes in the participating countries. A description
of the project activities in the three participating countries and the areas of influence
in the environmental and social setting is given in this chapter; linking these activities
to the aims, objectives and justification of the ESMF. Finally, the approach and
methodology used in preparation of the ESMF as well as the potential users are
outlined.
In Chapter 2, the legal, regulatory and administrative framework for environmental
management of the project is given. The chapter outlines the relevant policies, laws
and administrative instruments, including the National environmental Policy, the
Environmental Management Act and the Health Sector Strategic Plan, to mention a
few. The Word Banks Safeguard Policies are given in this chapter, emphasizing the
Environmental Assessment Policy (OP 4.01), which is triggered by the project; and
the World Bank’s environmental classification of projects is outlines.
Chapter 3 gives short descriptions of the generic impacts of the Regional Health
Systems Strengthening and TB Support Project, highlighting the methods and
techniques used to identify these impacts. The impacts are organised into the four
project phases of planning and design, construction and rehabilitation, operation and
maintenance and decommissioning and closure. The typical environmental
components to be impacted include soil, landscape and landform, water, air,
vegetation, society and health.
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Chapter 4 dwells on environmental and social impact management, presenting the
Environmental and Social Management Plan (EMP). The EMP details mitigation
measures for the impacts, indicating the responsible institutions for carrying out
these measures.
Chapter 5 presents the generic Environmental and Social Monitoring plan including
typical monitoring indicators, to be used for checking implementation of the EMP.
Chapter 6 presents the Environmental and Social Screening Process to be used for
assessing whether a sub-project is likely to have significant environmental, health
and social impacts and to determine the level of environmental work required for the
sub-project. The chapter introduces the Screening Form to be used for determining
whether it will be necessary to carry out a full EIA or whether a limited EIA will suffice
for the sub-projects.
Chapter 7 proposes capacity building measures, including the establishment of an
Environmental and Social Unit (ESU) in the three participating countries and areas of
training, costs for the training and the groups of people to be trained.
Finally, Chapter 8 gives the conclusions and recommendations of the ESMF among
which are to ensure that the ESMF implementation is adequately supported and the
capacity building measures are implemented at all levels.
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CHAPTER 2 LEGAL, REGULATORY, AND
ADMINISTRATIVE FRAMEWORK
2.1 BASIS FOR THE FRAMEWORK
The legal, regulatory and administrative framework has to be based on information
gathered from relevant participating country through literature review and public
consultation. Typical relevant policy and regulatory framework for the Regional
Health Systems Strengthening and TB Support Project would include the information
provided in this section. Where differences appear, adjustments to the framework
must be made to suit the particular situation in the participating country, at the time
of project implementation.
2.2 POLICIES
National policies relevant to the Regional Health Systems Strengthening and TB
Support Project would include;
• National Environment Policy;
• National Policy on HIV and AIDS;
• National Land Policy;
• Construction Industry Policy;
• National Water Policy;
• National Gender Policy;
• Health Sector Strategic Plans;
• National Health Laboratory Strategic Plans;
• National Policy Guidelines for Healthcare Caste Management; and
• National Environmental Health, Hygiene and Sanitation Strategy
2.3 THE WORLD BANK SAFEGUARD POLICIES
The World Bank has keen interest in protection of the environment, for investment
projects they support, in line with its ten safeguards policies. These policies provide
guidelines, aimed at preventing and mitigating undue harm to people and the
environment, when implementing development projects. The safeguard policies,
which provide a platform for the participation of stakeholders in project design and
implementation and are:
a) Environmental Assessment (OP/BP 4.01) (TRIGERRED)
b) Forests (OP/BP 4.36)
c) Involuntary Resettlement (OP/BP 4.12)
d) Indigenous Peoples (OP/BP 4.10)
e) Safety of Dams (OP/BP 4.37)
f) Pest Management (OP 4.09)
g) Physical Cultural Resources (OP/BP 4.11)
h) Natural Habitats (OP/BP 4.04)
i) Projects in Disputed Areas (OP/BP 7.60)
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j) Projects on International Waterways (OP 7.50)
Details of the ten World Bank's safeguard policies is provided in Annex 6.
The Regional Health and TB Support Project triggers OP 4.01 on Environmental
Assessment. Resettlement of people (provided for by OP 4.12 - Involuntary
Resettlement) will not occur under the project, although temporary use of people’s
land to facilitate access, construction and movement of vehicles is possible. This can
easily be managed through proper planning and timing of activities as well as
involvement of the affected people to avoid any loss of crops or property at the
particular time of construction and in this regard, this ESMF provides for screening of
project activities and sites to avoid triggering of this policy. The two policies are
described in detail as follows:
2.3.1 Environmental Assessment (OP/BP 4.01)
The objective of Environmental Assessment is to ensure that projects are
environmentally sound and sustainable, and that decision-making is improved
through appropriate analysis of actions and mitigation of their likely environmental
impacts. This policy is triggered if a project is likely to have potential adverse
environmental risks and impacts in its area of influence. Construction and
rehabilitation of laboratory buildings may have negative environmental impacts,
which require mitigation. Therefore, in line with this Operational Policy, this
environment and social management framework, for screening of the Regional
Health and TB Support Project activities and sites has been prepared.
2.3.2 Involuntary Resettlement OP/BP 4.12
The policy acknowledges that development projects that displace people generally
give rise to economic, social and environmental problems. Its objective therefore, is
to avoid or minimize involuntary resettlement where feasible, by exploring all viable
alternative project designs. OP 4.12 is intended to assist displaced persons in
maintaining or improving their living standards. It encourages community
participation in planning and implementing resettlement; and in providing assistance
to affected people, regardless of the legality of title to the land they posses, which
has to be acquired for project activities. The Bank guidelines therefore, prescribe
measures to minimize the negative impacts to ensure that the displaced community
benefits from the project and to ensure that the affected persons are:
• compensated for their losses at full replacement costs prior to the actual
move;
• assisted with the move and supported during the transition period in the
resettlement site;
• assisted in their effort to improve (or at least restore) their former living
standards, income earning capacity and production levels;
• integrated socially and economically in the host communities, so that
adverse impacts in the host communities are minimized. This is best
achieved through appropriate planning and consultation, involving affected
people.
20

In addition; land, housing, infrastructure and other compensation should be provided
to the adversely affected population, indigenous groups, ethnic minorities, and
pastoral people who may have usufruct or customary rights to the land and other
resources taken for the project. The absence of legal title to land by such groups
should not be a bar to compensation.
The policy is triggered not only if physical relocation occurs, but also by any loss of
land resulting in relocation or loss of shelter; loss of assets or access to assets; loss
of income sources or means of livelihood, whether or not the affected people must
move to another location.
The existing policies, land laws and regulations regarding land acquisition and
compensation in the participating countries are generally consistent with the World
Bank Operational Guidelines. Therefore, if necessary at all, compensation could still
be handled within the existing regulations, without contradicting the World Bank
Policy requirements. However, since the laboratory rehabilitation and construction
works for this project will be confined to within the existing hospital building premises
and to unoccupied land owned by the government within existing government
hospital infrastructure, no significant damage to properties will be expected from the
project activities.
2.3.3 The World Bank’s Categorization of Projects
Environmental consequences should be recognized early in the project cycle and
taken into account in project selection, siting, planning and design. In so doing,
adverse environmental and social impacts may be prevented, minimized, mitigated
and/or compensated for; and positive impacts may be enhanced. The World Bank’s
Environmental Assessment includes the process for mitigating and managing
environmental and social impacts throughout project implementation and the
Environmental Assessment Sourcebook (1993) and its updates (1996, 1997) provide
technical guidance. The World Bank's categorization of projects, with respect to
significance of environmental impacts is as follows:
1) Category "A": A proposed project is classified as Category “A” if it is likely to
have significant adverse environmental impacts that are sensitive, diverse, or
unprecedented. These impacts may affect an area broader than the sites or
facilities subjected to the physical works. Environmental Assessment for a
Category “A” project examines the project's potential negative and positive
environmental and social impacts, compares them with those of feasible
alternatives (including the "without project" situation), and recommends any
measures needed to prevent, minimize, mitigate or compensate for adverse
impacts and improve environmental performance. For a Category “A” project,
the borrower is responsible for preparing a report, normally an EIA (or a
suitably comprehensive or sectoral EIA) that includes as necessary, elements
such as environmental audits or hazard or risk assessments.
2) Category “B”: A proposed project is classified as Category “B” if its potential
adverse environmental and social impacts (on human populations or
environmentally important areas including wetlands, forests, grasslands, and
other natural habitats) are less adverse than those of Category “A” projects.
These impacts are site-specific; few if any of them are irreversible; and in
21

most cases mitigatory measures can be designed more readily than for
Category “A” projects. The scope of EIA for a Category “B” project may vary
from project to project, but it is narrower than that of Category “A” EIA. Like
Category “A” EIA, it examines the project's potential negative and positive
environmental and social impacts and recommends any measures needed to
prevent, minimize, mitigate, or compensate for adverse impacts and improve
environmental performance.
3) Category “C”: A proposed project is classified as Category “C” if it is likely to
have minimal or no adverse environmental impacts. Beyond screening, no
further EA action is required for a Category “C” project.
4) Category “Fl”: A proposed project is classified as Category “Fl” if it involves
investment of Bank funds through a financial intermediary, in subprojects that
might result in adverse environmental impacts.
The construction and rehabilitation of infrastructure under the Regional Health
Systems Strengthening and TB Support Project, is likely to have no significantly
adverse environmental and social impacts, which require mitigation. However, in line
with the Operational Policy, this ESMF is prepared for screening of the project
activities. Given that the Regional Health Systems Strengthening and TB Support
Project has been classified as a Category B, the project will not fund any
investments classified as Category A, based on the screening results.
2.4 LEGAL FRAMEWORK
Typical national legal framework relevant to the Regional Health Systems
Strengthening and TB Support Project would include;
• Urban Planning Act;
• Health Laboratory Practitioners Act;
• Water Resources Management Act;
• The National Constitution of the participating country;
• Environmental Management Act;
Local Government Authorities (City, Municipal, District and Town Councils)
Environmental Impact Assessment and Audit Regulations;
Mining (Environmental Management and Protection) Regulation;
The Land Act (1999) and the Land Regulations;
Land acquisition for development of public infrastructure;
Valuation of land and properties for compensation;
The Occupational Health and Safety Act;
An example of how the above policies, legal and regulatory framework would be
relevant to the Regional Health Systems Strengthening and TB Support Project and
the relevant areas of application is given in Annex 9, which presents the framework
reviewed for Tanzania.
22

CHAPTER 3 IMPACT IDENTIFICATION AND
ASSESSMENT
3.1 METHOD AND TECHNIQUES USED IN IDENTIFICATION AND
ASSESSMENT
The consultant used a number of methods and techniques to determine the
environmental and social impacts of the Regional Health Systems Strengthening and
TB Support Project. These include the following
3.1.1 Public Consultations and Field Investigations
In Dar es Salaam, discussions were held with a number of key stakeholders
including staff of the World Bank Office who provided details of the project. These
details included the Project Appraisal Document (PAD), the Project Implementation
Plan and other project details obtained through verbal discussions.
Discussions were also held with a number of officers in the Ministry of Health and
Social Welfare; regarding health care waste management, health sector reforms and
health services infrastructure including existing laboratories and designs for the new
facilities to be constructed or renovated. Also discussed were the existing set up,
processes and regulations for health care waste management. Elaborate
discussions were held on the environmental laws, regulations and procedures with
the National Environmental Management Council (NEMC). A list of persons met and
discussed with is included in Annex 8.
Field investigations comprised visits to government institutions, departments and
laboratories including the National Health Sector Reform Secretariat, the National
Tuberculosis and Leprosy Programme (NTLP), the Centre for Disease Control
(CDC), the National Institute for Medical Research (NIMR), the Central TB
Reference Laboratory (CTRL), the National Health Laboratory for Quality Assurance
and Training Centre (NHLQATC) and the Medical Research Centre (at MUHAS).
These visits and other guided tours were made to gain familiarization with the project
and on the existing establishments, laboratory facilities and their operations.
In Nairobi, discussions were held with a number of officers from the World Bank
offices and from the Ministry of Public Health and Sanitation on 24.08.09.
3.1.2 Literature Gathering and Review
A number of documents relating to the project were gathered during the Public
consultation and Field Investigations. These include the various Acts and Legislation
covered in Annex 9, which were sourced mainly from the institutions visited in
Tanzania and Kenya. Some documents related to ESMF preparation and some
ESMFs prepared in the past were also used in the preparation of this document. The
literature gathered was reviewed to assess issues that needed clarification before
use in the preparation of this ESMF. A list of some of the literature and documents
reviewed is provided in the References.
23

3.1.3 Categorization of Impacts
To facilitate identification and assessment of impacts, typical project activities, to be
implemented under the laboratory construction and upgrading of the Regional Health
Systems Strengthening and TB Support Project were broadly categorized into the
following project phases:
planning and design;
construction and rehabilitation;
operation and maintenance and.
decommissioning and closure.
Activities in each of the project phases listed above will have environmental and
social consequences on the different environmental components such as landscape,
soils, vegetation, water resources, air quality, ecosystems, and the socio-economy.
Table 3.1 relates the four project phases to the environmental components.
3.2 ASSESSMENT OF IMPACTS
3.2.1 Generic Positive Impacts
Most of the impacts of the Regional Health Systems Strengthening and TB Support
Project will be positive and will generally impact on the socioeconomic component at
the global, regional and national level. The participating regional countries will benefit
from direct positive impacts in the areas of improved health and the associated
socio-economic development. Key positive impacts of the project will be major and
long term and will include the following:
1. Improvement of Health in Participating Countries
The project will contribute to improvement of health in participating countries
through increase in provision of and access to improved health care and
laboratory services to patients.
2. Contribution to Global and Regional Health Objectives
The project will contribute to the achievement of the Millennium Development
Goal Number 6 (Combating HIV and AIDS, malaria and other diseases), and
more specifically to the global targets to “reduce the prevalence and death rates
associated with TB” and to increase the “proportion of TB cases detected and
cured”.
3. Increase in TB Case Detection and Treatment Success Rates
Improving the accuracy and turnaround time of TB diagnostic techniques will
contribute to increase in case detection and treatment success rates, as TB
infectious individuals will be placed on correct treatment in the early stages.
4. Complementing other TB Programmes
By focusing on diagnostic capacities, the project will complement initiatives of
other donors financing scale-up of TB treatment, including improved access to
MDR-TB treatment. Combination of these efforts will contribute to the overall
reduction in TB burden and transmission rates.
24

5. Conformity with and Support to the Africa Action Plan Flagship Goal VIII.
The flagship goal VIII calls for strengthening health systems of countries in Sub-
Saharan Africa. The Regional Health Systems Strengthening and TB Support
Project will contribute to improving and modernizing regional disease surveillance
and laboratory capacity in participating countries and in the region.
6. Harmonization of Strategic Priorities of Regional Institutions
The project provides a conduit for implementing key disease control strategic
priorities of regional institutions. The Southern African Development Community
(SADC), including Tanzania which is hardest hit by the dual HIV/TB epidemic,
has prepared a Strategic Plan for Tuberculosis control for 2007 to 2015. Planned
activities include the creation of an additional regional reference laboratory by
2010, to better address issues of monitoring and diagnosis, particularly for cases
of multi-drug resistant TB.
7. Support to Cross-boarder Activities
The project will support activities to combat cross-border diseases, and to
standardize and harmonize quality assurance of laboratories. This is prominent
among the priorities of several regional institutions including the East African
Community (EAC), East Central and Southern African Community (ECSAC) and
SADC.
8. Employment Opportunities
The project will contribute to the employment of both skilled and unskilled
workers in all the stages of implementation.
9. Skills Development and Training
The project will include establishment of a regional training centre, formulation of
joint training plans, and conducting joint human resource training assessments
for regional training and capacity building. Short and long term training
programmes for staff development in laboratory and diagnostic skills will be
implemented and staff will also have access to higher level professional training.
3.2.2 Generic Negative Impacts
The Regional Health Systems Strengthening and TB Support Project will have
negative environmental and social impacts, primarily associated with construction of
new laboratories and rehabilitation of existing ones. In addition, the project will
generate negative impacts associated with laboratory operation activities and waste.
Many of the negative impacts from construction and rehabilitation will be minor, short
term and localised; while impacts from laboratory operation activities and waste
could be adverse and long term, with spatial extent ranging between local, regional
and global.
Negative impacts from laboratory operation activities and waste will be covered in
detail separately in the Laboratory Waste Management Plans. This ESMF focuses,
to a large extent, on impacts from laboratory construction and rehabilitation activities.
These impacts are presented in Table 3.1 and summarised as follows:
25

IMPACTS DURING PLANNING AND DESIGN
Most of the impacts during planning and design will relate to the laboratory design
layout to ensure spacious, easy and safe working environment for staff. The design
should allow for free, easy and safe movement of staff to work with infected material.
The layout should consider minimal movement of people (other than the laboratory
staff) in the working areas and should include adequate space for storage of
disposable and re-usable materials as well as waste. Most important, the laboratory
should be well ventilated.
Other impacts during planning and design will relate to activities for filed
investigations and surveying, during which minor destruction of trees and vegetation,
loosening of soil as well as disturbance of wildlife and micro-organisms might occur.
IMPACTS DURING CONSTRUCTION AND REHABILITATION
The impacts during construction will be typical of any building construction works and
will include the following:
1. Impacts on Soil
During construction, soil erosion will occur on construction sites as well as sites
where construction materials will be mined. Soil exposure, breaking up,
loosening, erosion and compaction will result from movement of heavy plant,
equipment and vehicles on earth roads, around materials mining sites and
around the construction sites. Loss of productive top soil will occur in areas
where construction materials will be mined and where new temporary access
roads and working areas will be opened. These impacts will be localised,
moderate and short term
Soil contamination from construction wastes (e.g. cement, paints, fuels and
lubricants) may occur during construction. Soil contamination may also arise from
accidental or deliberate disposal of construction waste and chemicals. Soil
contamination from construction wastes will be localised, minor and short term.
2. Vegetation
Trees and vegetation are likely to be removed and destroyed during clearing of
construction sites, access routes and during mining for construction materials.
Use of burnt bricks for the project is likely to contribute indirectly to deforestation.
3. Landscape and Landform
Where new laboratory structures are to be constructed, land preparation activities
will result in changes in natural ground slopes and landform. Solid wastes from
construction activities and packaging materials may contaminate the soil and
deface the landscape. These changes may affect the existing scenery, and
restrict peoples’ movement. However due to the limited nature of the construction
and rehabilitation activities, the impacts will be localised, minor and short term.
4. Impacts on Surface Water
As a result of the loosening of soils due to movement of vehicles and mining of
construction materials, sediments will be generated and will subsequently be
26

washed away into drains and nearby streams, causing water pollution and
siltation. Water pollution from construction wastes as well as on-site makeshift
toilets may also occur. The impacts will be localised, moderate and short term.
The construction activities may lead to changes in natural drainage flow pattern
of surface water and runoff, particularly where new laboratory facilities are to be
constructed near streams and natural water bodies. Changes in natural drainage
flow pattern are likely to occur due to construction of temporary drainage
channels for protecting mining areas for materials, construction sites and
temporary access roads. Clearing of vegetation in some areas may lead to
increased runoff. Construction waste and rubble, if not disposed in designated
places, is likely to lead to clogging of drainage systems and, in some places,
creating stagnant pools of water where mosquitoes, flies and other insects might
breed.
The nature of these impacts will be localised, short term and moderate due to the
small nature of the construction and rehabilitation works.
5. Air Pollution
Air pollution will arise from vehicle emissions, earthmoving equipment and dust.
Air pollution from vehicle emissions will be short term, moderate and localised
6. Impacts on Ecosystems
Impacts on ecosystems may be in form of damage, fragmentation or loss of
habitat and biodiversity; contamination of biota and destruction or disruption of
wildlife. These impacts will be minor, localised and short term due to the small
nature of the civil works.
7. Socio-economic
People living in the neighbourhood of the project activities may temporarily lose
access to water, electricity or telephone services, should these be accidentally
damaged by the contractor during excavation. People may also be subjected to
noise and vibration disturbances as well as temporary obstruction on roads and
walkways. Slow movement of material haulage trucks as well as pedestrians
around the construction sites may also lead to traffic congestion and accidents.
Excavated soil and piled construction materials could obstruct movement of
people and vehicles as well as affect the general aesthetics of the surroundings.
These socio-economic impacts will be temporal in nature, short term and
localised.
8. Health Impacts
During construction, people will gather together and associate to accomplish the
construction tasks. Some of the people may come from places outside the
neighbourhood. These gatherings and associations between migrants and local
residents may lead to casual sexual relationships, thereby increasing chance of
contracting and spreading STI and HIV and AIDS.
27

IMPACTS DURING OPERATION AND MAINTENCE
1. Impacts on Soil
Chemicals and detergents used in the laboratories during operation may be
disposed on soil, thereby contaminating the soil. This is likely to take place in
areas where there are no appropriate waste disposal systems and facilities.
2. Impacts on Surface Water
Water contamination may occur from laboratory waste, detergents and chemicals
used in the laboratories during operation. Water contamination from waste,
detergents and chemicals may cover large areas and may be long term.
3. Air Contamination
Air contamination may also take place from TB infected material along the
patients’ or TB specimen areas of movement. Chances of air contamination from
TB infectious waste material or persons may be high, long term and may cover
large areas where infected people or materials will be found.
4. Health and Safety
TB, infections are likely to occur where people are exposed to infectious material
or persons. These infections may occur:
• in places where infected persons live together with others in crowded
situations;
• in hospitals and laboratories where TB patients seek medical attention and
give out specimens for examination;
• during transportation of specimens form the sample collection to delivery
points;
• during sample culturing and examination in labs; and
• during handling and disposal of laboratory waste.
Impacts on safety on workers may arise from accidents in the laboratory and
risks of fire. Health impacts could be major, long term and fatal, and may cover
wide areas due to peoples’ mobility.
IMPACTS DURING DECOMMISSIONING
Decommissioning entails closure of the facilities and services. Consideration of
impacts of decommissioning is important so that on closure of these facilities, due
consideration is given to mitigate impacts from abandoned structures and
equipment. Appropriate consideration should also be given to staff that may be made
redundant. Decommissioning impacts are likely to be minor, localised and short
term.
1. Surface water
Quarry mining voids, if left open, would lead to pools of stagnant water. Ground
levelling and backfilling of quarry mining sites is likely to affect natural drainage flow
pattern and general flow of surface water and runoff. These activities are also likely
to cause water siltation.
28

2. Vegetation
Destruction of trees and vegetation is likely to occur at the quarry mining sites during
the filling up of mining voids and ground levelling.
3. Ecosystem
Wildlife and micro-biota acclimatized to the quarry mining sites environment is likely
to be disturbed or destroyed.
4. Socio-economic
Loss of income and employment due to closure of facilities is likely to occur due to
closure of the laboratories and other facilities providing related services.
29

CHAPTER 4 ENVIRONMENTAL AND SOCIAL
MANAGEMENT PLAN
4.1 ENVIRONMENTAL AND SOCIAL IMPACT MITIGATION
Environmental and social impact mitigation for the Regional Health Systems
Strengthening and TB Support Project considers generic measures to reduce the
negative environmental effects associated with implementation (construction,
expansion, rehabilitation, operation and decommissioning) of the project. These
generic measures are provided in the Environmental Management Plan (EMP),
Table 4.1
The purpose of the (EMP) is to ensure that the identified environmental and social
impacts are mitigated, controlled or eliminated through planned activities to be
implemented throughout the life of the Regional Health Systems Strengthening and
TB Support Project.
Basically the EMP:
1) is a lists the potential environmental impacts;
2) provides the mitigation/enhancement measures against each impact;
3) assigns the responsible institutions to carry out the mitigation measures;
4) proposes dates by or during which the mitigation measures must be carried
out and;
5) gives an estimate of the cost for implementing the mitigation measures
For the Regional Health Systems Strengthening and TB Support sub-projects, the
specific EMPs and their implementation will be based on modifications to Table 4.1
to suit the specific sub-project activities on the specific sites. Once the specific EMPs
have been designed for the Regional Health Systems Strengthening and TB Support
Sub-project activities, a certain amount of flexibility should be allowed to optimize its
implementation and to take into account any future changes or modifications made
on the design and implementation of the project activities.
4.2 GENERIC ENVIRONMENTAL AND SOCIAL MANAGEMENT PLAN
Table 4.1 should be considered as the main frame to guide the determination of
specific potential impacts of the Regional Health Systems Strengthening and TB
Support Sub-project activities. The generic or typical environmental impacts in Table
4.1 were developed based on the general project description, public consultations
and professional judgment, with respect to the likely project activities. The list of
impacts is by no means exhaustive.
30

Table 4.1: Generic Environmental and Social Management Plan
Project Stage / Environmental Components
During Planning Surveying and Design
Soil
Vegetation
Ecosystems
Health (ergonomics)
During Construction
Soil
Impacts
Exposing and loosening of
soil
Destruction of trees and
vegetation
Disturbance of wildlife and
micro-organisms
Infection of staff due to
inappropriate working
conditions
Accidents
Soil exposure, loosening,
breaking up and erosion
Mitigation Measures Responsible
persons/Institution
Limit extent of site
and vegetation
clearing for the
preliminary activities
Limit extent of site
and vegetation
clearing for the
preliminary activities
Limit extent of site
and vegetation
clearing for the
preliminary activities
Design laboratory to
include adequate
space and ventilation
Design laboratory to
include adequate
space for free and
safe movement
Limit extent of
vegetation clearing
on construction sites,
materials mining
sites, working areas
and service roads
Consultant N/A
Consultant N/A
Consultant N/A
Consultant and
Client
Consultant and
Client
Estimated
Cost per
Site
N/A
N/A
Contractor N/A
31

Project Stage / Environmental Components
Vegetation
Impacts
Soil contamination from
cement, paints, lubricants,
and fuels.
Mitigation Measures Responsible
persons/Institution
Control movement of
vehicles, heavy plant
and equipment on
earth roads and
working sites
Regular use of water
sprays and
compacting soil on
earth roads and
around working areas
Store and contain
construction materials
on lined surfaces, in
covered areas.
Provide drains and
oil interceptor where
necessary
Loss of productive topsoil Limit extent of topsoil
removal.
Removal and destruction
of trees and vegetation
Replace topsoil after
construction
Limit extent of trees
and vegetation
removal
Contractor N/A
Contractor N/A
Contractor N/A
Estimated
Cost per
Site
N/A
15,000.00
10,000.00
1,000.00
2,000.00
32

Project Stage / Environmental Components
Landscape and landform
Surface water
Impacts
Solid waste from
construction and
packaging materials such
as rubble, cement bags,
paint tins and other
materials will pollute and
deface land.
Change in natural slopes
and landform, affecting
scenery and peoples’
movement
Change in natural
drainage flow pattern and
surface water runoff
Changes in flow of surface
water runoff due to
clearing of vegetation
Drainage clogging
resulting in impeded water
flow and creation of
stagnant water pools
Mitigation Measures Responsible
persons/Institution
Re-plant trees and
vegetation after
construction
Collect and dispose
wastes in designated
disposal sites as
required by the Local
Authority
Terrace, level
grounds and backfill
all voids after
construction
Provide adequate
and effective drains
leading to natural
drainage systems
Provide effective
drains to direct
surface water to
natural drainage
systems
Keep all drains clear
of silt and debris and
backfill voids
regularly and after
construction
Contractor N/A
Estimated
Cost per
Site
Contractor 2,000.00
Contractor N/A
Contractor N/A
Contractor N/A
Water contamination from Collect and dispose Contractor N/A
33

Project Stage / Environmental Components
Air
Ecosystems
Impacts
rubble, cement, paints,
lubricants and fuels as well
as makeshift toilets
Surface water siltation due
to loosening of soils by
movement of vehicles and
due to mining of materials
Water pollution from
construction wastes as
well as on-site makeshift
toilets
Air pollution from
emissions from
construction machinery
and from dust
Destruction/disruption of
wildlife
Mitigation Measures Responsible
persons/Institution
wastes in designated
disposal sites as
required by the Local
Authority
Use water sprays on
roads and
construction sites and
compact loose soils.
Collect and dispose
wastes in designated
disposal sites as
required by the Local
Authority
Provide appropriate
and approved
temporary toilets
Maintain construction
machinery regularly
as recommended by
dealers
Use water sprays on
roads and
construction sites and
compact loose soils.
Limit extent of site
and vegetation
clearing.
Estimated
Cost per
Site
Contractor Provided
for under
“soil”
above
Contractor N/A
N/A
Contractor N/A
Contractor
Provided
for under
“soil”
above
N/A
34

Project Stage / Environmental Components
Social / economic
Impacts
Contamination of biota Collect and dispose
wastes in designated
disposal sites as
required by the Local
Temporary loss of access
to
Services such as water
telephones and electricity
due to possible damage by
contractor
Noise & vibration
disturbances due to
movement of heavy plant
and equipment
Disturbance of traffic and
movement of people
Temporary obstruction of
walkways due to road and
sidewalk barriers.
Mitigation Measures Responsible
persons/Institution
Authority
Identify location of
water pipes,
telephone and
electric cables before
construction
Construction to be
during official
government working
hours.
Vehicles, plant and
machinery to be
regularly maintained
as recommended by
dealers
Provide alternative
routes and passages
with appropriate
directional signs,
where appropriate
Provide alternative
routes and passages
with adequate and
Contractor N/A
Contractor
Estimated
Cost per
Site
N/A
Contractor N/A
Contractor N/A
Contractor N/A
35

Project Stage / Environmental Components
Health and Safety
Impacts
Mitigation Measures Responsible
persons/Institution
Potential for accidents due
appropriate
directional signs
Provide alternative
to slow movement of routes and passages
heavy vehicles, general with adequate and
traffic and pedestrians appropriate
near the construction sites directional signs
Aesthetics Remove and dispose
wastes regularly in
appropriately
designated disposal
site.
Accidents to staff and
public on construction sites
and project activity areas
Use shields to isolate
and enclose
construction sites.
Provide appropriate
protective clothing for
staff and ensure they
use them
Provide appropriate
signs for staff and
public.
Provide first aid
boxes.
Acquire appropriate
Contractor N/A
Contractor N/A
Contractor N/A
Estimated
Cost per
Site
36

Project Stage / Environmental Components
During Operation and Maintenance
Soil
Surface water
Air
Impacts
Spread of TB, STIs, HIV
and Aids
Soil contamination from
detergents and chemicals
Surface water pollution
from detergents and
chemicals
Air contamination from TB
infectious persons and
waste
Mitigation Measures Responsible
persons/Institution
workman’s
compensation and
insurance for staff
Conduct awareness
meetings and provide
condoms to staff
Use appropriate
waste drainage
system leading to
septic tank or public
sewerage facilities;
as provided by
contractor
Use appropriate
waste drainage
system leading to
septic tank or public
sewerage facilities;
as provided by
contractor
Ensure adequate
ventilation in
laboratories and
treatment areas
Ensure proper
handling of specimen
MOH in
collaboration with
National Aids
Commission
Client N/A
Client N/A
MOH
Estimated
Cost per
Site
2,000.00
37

Project Stage / Environmental Components
Ecosystem
Health and Safety
Impacts
Contamination of biota
from laboratory wastes
Transmission of diseases
and spread of STIs and
HIV and Aids
Spread of TB in
communities, hospitals, on
specimen handling and
transportation routes, in
laboratories and in
handling and disposal of
laboratory waste
Mitigation Measures Responsible
persons/Institution
and laboratory waste
by staff and
contracted personnel
Ensure that staff
know and use the
recommendations in
the HCWMP
Conduct staff
awareness
campaigns quarterly
Dispose laboratory
waste in designated
places
Conduct civic health
education
Conduct civic health
education and
implement the health
Care Waste
Management Plan
Accidents and risks of fire Provide protective
clothing and fire
MOH N/A
MOH
Estimated
Cost per
Site
15,000.00
Provided
for in “Air”
above
MOH 50,000.00
38

Project Stage / Environmental Components
Impacts
During Decommissioning (backfilling and covering materials mining sites)
Landscape and landform
Surface water
Ecosystem
Change in natural slopes
and landform
Change in natural
drainage flow pattern
Changes in flow of surface
water and runoff
Mitigation Measures Responsible
persons/Institution
fighting equipment
Raise awareness on
staff about accidents
and fire risks biannually
Terrace and level
grounds and backfill
all voids after
rehabilitation
Provide adequate
and effective drains
to natural drainage
systems
Provide effective
drains to direct
surface water to
natural drainage
systems
Backfill all voids and
Creation of stagnant water
pools
mined areas
Surface water siltation Use water sprays on
roads and working
sites and compact
loose soils.
Destruction of trees and Limit extent of site
vegetation
and vegetation
clearing.
Estimated
Cost per
Site
6,000.00
Contractor N/A
Contractor N/A
Contractor N/A
Contractor N/A
Contractor N/A
Contractor
6,000.00
39

Project Stage / Environmental Components
Socio-economic
Health and safety
Impacts
Disturbance of wildlife Limit extent of site
and vegetation
Loss of income and
employment due to closure
of facilities
Accidents
Mitigation Measures Responsible
persons/Institution
clearing.
Prepare staff exit
strategies and pay
compensations
Provide appropriate
protective clothing for
staff and ensure they
use them
Provide appropriate
signs for staff and
public.
Provide first aid
boxes.
Acquire appropriate
workman’s
compensation and
insurance for staff
Contractor N/A
MOH N/A
Contractor N/A
Estimated
Cost per
Site
40

CHAPTER 5 ENVIRONMENTAL AND SOCIAL
MONITORING
5.1 OBJECTIVES OF ENVIRONMENTAL AND SOCIAL MONITORING
The objectives for environmental and social monitoring are to:
• alert the project developer and controlling authorities and to provide timely
information about the success or otherwise of the EIA process as outlined in
the ESMF. This will facilitate changes to be made in the implementation of the
sub-projects where appropriate;
• make a final evaluation, to determine whether the mitigation measures
designed for the sub-projects have been successful. This evaluation
compares the pre-sub-project environmental and social condition with that
after completion of the sub-project, to determine whether the original
environmental and social conditions have been restored, improved or made
worse;
• ensure that the operation and maintenance activities are being carried out in a
manner that protects the environmental and social conditions as well as the
health and social wellbeing of the workers including the general public; and
• ensure that changes if any, to the ESMF and additional training capacity
building required to improve the performance of the framework are
implemented.
5.2 ENVIRONMENTAL AND SOCIAL MONITORING PLAN
The environmental and social monitoring plan assists to measure the level of
success in the implementation of the mitigation measures, as provided in the EMP.
The environmental and social monitoring plan (example given in Table 5.1) provides
a link to the mitigation measures in the EMP and specifies the activities to be
undertaken to ensure that the mitigation measure are efficiently, effectively and
timely implemented.
To assess whether the goals of the environmental and social management plan are
being met, the environmental monitoring plan will indicate parameters to be
monitored, institute monitoring milestones and provide resources necessary to carry
out the monitoring activities.
Specifically, the environmental and social monitoring plan provides:
1) actions or mitigation measures to be undertaken;
2) a description or list of parameters to be measured and monitoring locations
where appropriate;
3) indicators to measure and verify level or extent of implementation of the
mitigation measures;
4) frequency of measuring and verifying the indicators; and
5) institutions of persons responsible for carrying out the monitoring
41

Table 5.1: Example of an Environmental and Social Monitoring Plan
Project Stage / Impacts Mitigation Monitoring Indicator Institution to
Environmental
Measures / Frequency of Monitor / Cost
Components
monitoring
During Planning Surveying and Design
Soil
During
Construction
Water Pollution
Trees and
vegetation
Exposing
and
loosening of
soil
Water
pollution
from
construction
wastes as
well as onsite
makeshift
toilets
Destruction
of trees and
vegetation
Limit extent
of site and
vegetation
clearing for
the
preliminary
activities
Collect and
dispose
wastes in
designated
disposal
sites as
required by
the Local
Authority
Provide
appropriate
and
approved
temporary
toilets
Limit extent
of site and
vegetation
clearing
1 To include travel expenses and subsistence allowances
Area cleared of
vegetation as a
percentage of total
working area
ONCE DURING
PLANNING AND
DESIGN
Number of times
waste is collected
and disposed of on
designated sites
MONTHLY
DURING
CONSTRUCTION
Total area cleared
of vegetation as a
percentage of
actual built up area
MONTHLY
District
Environmental
Management
Officer
$3,00.00 1
District
Environmental
Management
Officer
$3,00.00
District
Environmental
Management
Officer
$1,000.00
42

5.3 MONITORING INDICATORS
Monitoring indicators are a very important part of the monitoring plan. The indicators
have to be:
1) specific to avoid ambiguity of items being measured;
2) measurable to facilitate quantification; and
3) quantifiable to be easily translated into units of measurement and to facilitate
verification
Indicators can be measures in units of, for example, time (duration), frequency (how
often), area or volume (size of land cleared)
Three main socioeconomic indicators, by which to evaluate the successful
implementation of the environmental management plans are:
• affected individuals, households, and communities are able to maintain their
pre-project standard of living, and even improve on it;
• the pre-subproject environmental state of natural resources, bio-diversity and
flora and fauna has been maintained or improved; and
• the local communities remain supportive of the project.
The following are some of the general parameters and verifiable indicators that could
be used to measure the overall project’s success in terms of implementing the
intended mitigation plans and achieving the desired environmental and social
performance.
• number of sub-projects adopted after screening as required by the ESMF;
• percent improvement or degradation in the environmental health of the
communities using or affected by the sub-projects;
• percent improvement or degradation of bio-physical state of the environment;
• number and types of the key benefits to the community, from the project as a
result of using the ESMF and the screening process;
• percent decrease in patients’ fatal cases, as a result of adoption of safeguard
guidelines, compared with conversational practices;
• efficiency of sub-projects’ maintenance and operation performance;
• number of environmental resource persons on Technical Planning Teams and
District Management Teams who have successfully received EIA training in
screening methods etc.; and
• numbers of women trained
Specific environmental and social indicators target the mitigation measures in the
environmental management plan. Examples of specific indicators that could be used
for the Regional Health Systems Strengthening and TB Support Project are provided
in Table 5.2
43

Table 5.2: Some of the Indicators to be used for the Regional Health
Systems Strengthening and TB Support Project
Mitigation Measures † Monitoring Indicator
Limit extent of site and vegetation Total area cleared as a percentage of
clearing
actual built up area
Limit extent of topsoil removal.
Total surface area scraped of top soil as a
percentage of actual built up surface area
Replace topsoil after construction Volume of surface area replaced as a
percent of volume removed during site
clearing
Provide drains to bypass construction Number or length of effective drains
sites
constructed
Use water sprays and compact loose Total area sprayed with water and
soils on construction area and roads compacted
Store and contain construction materials Surfaced materials storage area as a
on lined surfaces.
percent of storage area not surfaced
Provide drains and oil interceptor Concentration of oil in surface water from
construction site
Collect and discharge wastes in Number of trips or frequency of carting
designated disposal sites
wastes to the designated disposal sites
Terrace and level grounds and backfill all Terraced steep slope area as a percentage
voids after construction
of total steep slope area
Keep all drains clear of silt and debris and Number of blocked drains and open pits
backfill voids regularly and after
construction
Provide effective drains to oil interceptor Quality of water with respect to
and remove and dispose contaminated
water in designate places
contamination from the project activities
Construct standard pit latrines with well Number of functional pit latrine in relation
designed soak away pits
to number of workers
Maintain construction machinery regularly Records of vehicle maintenance or number
as recommended by dealers
of complaints against noise or pollution
Identify location of water pipes, telephone Number of service facilities identified and
and electric cables before Construction verified by the utility providers in the
project area
Construction to be during official Number of complaints against noise from
government working hours.
the construction activities
Provide alternative routes and passages Number of complaints on slow traffic
with appropriate directional signs caused by the project activities.
Use shields to isolate and shield
construction sites.
† Mitigation measures taken from the EMP
Number of signs in appropriate locations
as recommended by the traffic or city
authorities
Length of sides exposed to public as a
percentage of shielded sides of the
44

Mitigation Measures † Monitoring Indicator
construction area
Conduct awareness meetings on TB and Number of awareness meetings
HIV and Aids infections; and provide conducted.
condoms
Percentage of staff having attended
awareness meetings to the total staff
employed
Provide adequate ventilation in
Number of complaints on poor ventilation
laboratories and treatment areas by staff and people using the laboratories
and treatment areas
Prepare staff exit strategies and pay Number of staff discharged without
compensations
counselling and compensation.
5.4 MONITORING FOR IMPLEMENTATION
Number of grievances by persons unfairly
discharged
Environmental and social monitoring and reporting procedures will ensure early
detection of conditions that necessitate particular attention or modification, to
achieve the desired levels of impact mitigation at any particular time during project
implementation. Monitoring and reporting will provide information on the progress
and results of mitigation.
Monitoring for implementation of the sub-project activities will facilitate a systematic
measurement of how the sub-projects are being implemented. This will form part of
the overall supervision of a sub project implementation. It will also ensure that
contractual agreements are being adhered to, in accordance with the approved
designs; and that no unforeseen negative impacts are occurring as the result of sub
project implementation. Environmental monitoring needs to be carried out during the
construction as well as operation and maintenance of the sub-projects.
The LGA’s Environmental Officer, with the support of the project staff will be
responsible for the day to day monitoring and reporting of feedback to the LGA’s
committee responsible for environment, throughout the life of the sub-project.
Specific attention is to be placed on monitoring of environmental management and
the civil works contractor during construction as well as monitoring of the
implementation of environmental and waste management plans during operation and
maintenance. Monitoring reports will be submitted to the District Council and the
ministry or institution responsible for environmental matters.
The environmental officer at the district will undertake compliance monitoring to
check whether prescribed actions have been carried out. In close collaboration with
the sub-project implementers, he will ensure that the monitoring plan for the
individual sub-projects is implemented as planned. The environmental officer at the
district, in collaboration with the District Management Team, will consolidate the subprojects
monitoring reports and submit them to the District Council and the institution
responsible for environmental matters.
45

CHAPTER 6 ENVIRONMENTAL AND SOCIAL SCREENING
6.1 ENVIRONMENTAL AND SOCIAL SCREENING PROCESS
The environmental and social screening process helps to:
• assess whether sub-projects are likely to have potential negative
environmental and social impacts;
• determine appropriate mitigation measures for activities with significant
adverse impacts, for incorporating them into the sub project design;
• review and approve sub-project proposals; and
• monitor environmental parameters during project implementation.
The extent of environmental and socials work required, to mitigate adverse impacts
for the sub-projects, will depend on the outcome of the screening process. For the
Regional Health Systems Strengthening and TB Support Project, environmental
screening will be done by completing the Environmental and Social Screening Form
(ESSF) attached as Annex 1.
6.2 COMPLETING THE ENVIRONMENTAL AND SOCIAL SCREENING FORM
The officer responsible for environmental matters at the district (representing the
District Environmental Management Committee) will guide and facilitate completion
of the Environmental and Social Screening Form; by the officer responsible for
health at the district.
Members of the district environmental management committee, depending on their
areas of expertise, will participate in filling the form. The checklist in Annex 2 will
guide the officer responsible for health at the district to identify appropriate mitigation
measure for the sub projects identified.
Cases of land acquisition, triggering OP 4.12 (Involuntary Resettlement) would not
apply in this project and any sub-projects requiring land acquisition for the Regional
Health Systems Strengthening and TB Support Project will not be eligible for funding.
6.3 ASSIGNING APPROPRIATE ENVIRONMENTAL CATEGORY
The screening process will lead to four safeguard options:
• no further action, if the sub project has no significant impacts on the
environment;
• simple Environmental Review to be carried out for sub-projects likely result in
a few minor environmental problems that can easily be mitigated.
• Limited Environmental Review for sub-projects that may create minor
environmental problems requiring frequent site visit or construction
modifications to minimize or eliminate impact.
• full Environmental Impact Assessment for sub projects resulting in potentially
significant direct or indirect adverse impact.
46

6.4 CONDUCTING A LIMITED EIA OR FULL EIA
After reviewing the completed Environmental and Social Screening Form, and the
sub project environmental checklist, the district environmental management
committee will determine the extent of environmental and social work required (i.e.
whether application of mitigation measures outlined in the environmental checklist
will suffice or not). Some design modifications can be incorporated in the project
costs at this stage, in order to minimize or avoid environmental impacts.
Depending on the magnitude of the environmental impacts identified, the designated
officer responsible for health at the district will carry out an Environmental Review
(ER) or Limited Environmental Assessment (LEA). Forms for carrying out ER and
LEA are attached as Annex 3 and 4 respectively.
Where results of the environmental and social screening process indicate the need
to carry out a full EIA, the systematic procedure for preparation of the EIA, up to
issuing of an EIA certificate (as provided for in the EIA procedures and guidelines
and the environment management regulations) shall be followed.
The Regional Health Systems Strengthening and TB Support Project will pay for the
EIA study, to be done by approved consultants and also pay for the review and
approval costs charged by the institution responsible for environmental matters. The
full EIA requires inputs from teams of specialists who will consult the relevant key
stakeholders. The officer responsible for health at the district, with assistance from
the Project Management Team will oversee the recruitment of an appropriate EIA
Consultant.
6.5 REVIEW AND APPROVAL
The LGAs’ (City, Municipal, District, or Town Council; as the case may be)
Environmental Review Committees will review the Environmental and Social
Screening Form, as well as the Environmental Checklists, completed during
preparation of the subprojects, to ensure that all environmental and social impacts
have been identified and a mitigation management plan proposed. The LGAs’
Environmental Review Committee will also ensure that an appropriate monitoring
plan, for implementation of the impact mitigation plan has been prepared.
If the application has satisfied all the environmental requirements on the screening
form and the check list, the LGAs’ Environmental Review Committee will clear the
sub-project and recommend to the ministry responsible for health for approval and
subsequent funding.
If the LGA’s Environmental Review Committee finds that the submitted design is not
consistent with the requirements of the environmental screening form and the
environmental checklist, the Region Health Systems and TB Support Project would
be requested to make appropriate design modifications and/or choose another site.
Thereafter, the sub-project will, once again, be subjected to another screening
process until it is conforms to the environmental requirements; and it will then be resubmitted
for review and approval.
47

Any proposed sub-projects that do not comply with the requirements of this ESMF,
the completed screening form and the World Bank safeguards policies will not be
cleared for approval.
6.6 PUBLIC CONSULTATION AND DISCLOSURE
Public consultations are critical in preparing an effective and acceptable sub-project.
All sub-project applications, planning reports and appraisal reports have to be
available for public examination at suitable and accessible locations including the
district council offices and the offices of the ministry of health.
Consultation with the local communities and all other interested and affected parties
is important during the screening process. Relevant standing committees of the
Local Government Authorities and of the Township, Wards and Villages as provided
for in the environmental management regulation or act shall be appropriately
involved or consulted.
Consultation and participation of Indigenous Peoples, particularly in Kenya, should
be effectively done to ensure that it adequately deals with their needs, priorities, and
preferences. Indigenous Peoples should be provided with relevant project
information in language(s) and in a manner suitable to them. Focus group
discussions should be carried out to assess the subprogram impacts and benefits of
these groups and to sensitize them accordingly. Reference should be made to
previous social assessments and the Indigenous/ Marginalized Peoples Framework,
prepared in 2009, under the Regional Health Systems and TB Support Project. As
appropriate, NGOs can be used and appropriate documents should be made
available to the affected Indigenous Peoples.
The consultations should identify key issues and determine how the concerns of all
parties will be addressed. To facilitate meaningful consultations, the Regional Health
Systems Strengthening and TB Support Project team and the consultant will provide
all relevant material and information concerning the sub-projects in a timely manner,
prior to the consultation. As far as practicable, this material and information will be in
a form and language to be easily accessible and understood by the people being
consulted. Depending the extent of public interest in the potential impacts of the sub
projects, a public hearing may be requested, to better convey public concerns and to
facilitate elaboration of the sub-project activities and their impacts.
The executive director at the district or his appointed staff will be responsible for
taking the minutes of the public hearing or disclosure meeting. The office of the
executive director at the district will produce and distribute copies of the minutes to
offices at the district/municipal councils, ward and village, political parties, NGOs,
and other civil societies in the community, as appropriate. A summary of the
outcome of this public consultation or disclosure meeting will be posted at
appropriate places.
Any affected or interested individual or group has the right of appeal, if dissatisfied
with the decision reached at any stage in the EIA process. The appeal process will
be according to the environmental management regulation or act.
Once the sub-project has been reviewed and cleared by the respective LGA’s
relevant environmental committee for the district, the affected persons, key
stakeholders and the general public will be informed about the results of the review.
48

The Environmental Screening results, together with any impact mitigation plans will
therefore be disclosed in appropriate public places, including at the offices of
Regional and District Commissioners as well as the Info-shop of the World Bank.
49

CHAPTER 7: CAPACITY BUILDING MEASURES FOR THE
REGIONAL HEALTH SYSTEMS STRENGTHENING AND TB
SUPPORT PROJECT
7.1 ESTABLISHMENT OF A SECTOR ENVIRONMENTAL AND SOCIAL UNIT
The ministry responsible for health and social welfare services should (in line with
provisions of the environmental management regulation or act) establish an
Environmental and Social Unit (ESU) - where this unit is not yet in place - to be,
among other things, responsible for:
(a) ensuring environmental compliance of the sector ministry, as required by
the Act;
(b) ensuring all environmental matters falling under the ministry (including
those of the Regional Health Systems Strengthening and TB Support
Project as reflected in the ESIA) are implemented and submitted to the
Directorate responsible for Environment; and
(c) coordinating with the Directorate responsible for Environment and the
institution responsible for national environmental management, on
environmental matters, with respect to shared responsibility
7.2 CORE FUNCTIONS OF THE ESU
Among other issues, the Environmental and Social Unit shall develop and promote a
clear understanding of environmental management requirements, for the
construction, operation and maintenance activities of the Regional Health Systems
Strengthening and TB Support Project. The Unit will assist the Project Management
to ensure that appropriate actions concerning all aspects of environmental
management (especially screening, and mitigation management) are included in
future contracts for the sub-projects. The unit will also monitor implementation of the
NHCWMP. In this respect, the Project Management Team will be able to design and
implement monitoring programs to ensure compliance with environmental
obligations.
The Environmental and Social Unit will be closely guided by the recommendations of
this ESMF, provisions of the national environmental regulation or act and the
guidelines for EIA to develop their operating guidelines or policy. These operating
guidelines will include:
• measures for sensitization of top level management on the importance of
environmental management, as required by the ESMF and the national
environmental regulation to foster management’s technical, human resource
and financial support;
• identification of appropriate representation to be responsible for environmental
matters at the regional, city, district and town levels. As far as practicable, the
existing staff at these administrative levels (e.g. the District Environmental
Management Officer and/or the District Health Officer) should be used; and
• development of environmental and social capacity within the ministry through
capacity building and training of the staff.
50

The proposed guidelines will detail the regulations and procedures for:
• screening of environmental sub-projects;
• determination of the level of environmental and socio-economic work for subprojects;
• development of Terms of Reference for detailed EIA including identification
and recruitment of suitably qualified consultants for the studies
• appraisal and approval of Screening Forms and EIAs and ensuring that the
EMPs are included in the tender and contract documents for sub-projects;
• monitoring implementation of the HCWMP;
• monitoring contractors’ compliance with the requirements of the ESMF, the
Screening Form and the EMP during construction, operation and
maintenance;
• designing and implementing training programmes for environmental and
social management.
The regulations and procedures developed as outlined above would comprise the
initial stages for establishment of corporate environmental management systems,
which should lead to sustained compliance with the national environmental
requirements. Therefore is very important for top level management to fully support
these initiatives financially, materially and in terms of human resource development.
7.3 TRAINING
Personnel responsible in one way or another, for implementing the environmental
activities should be trained and enabled to manage environmental screening,
Environmental Review, Limited Environmental Work or Full Environmental Impact
Assessment by either internal staff or consultants. They should also be trained in the
implementation and monitoring of the HCWMP.
Regular in-service training on environmental management and HCWM has to be
provided at various levels in the Ministry. These trainings can start with training of
trainers within the Ministry. The trainers would then deliver trainings on a regular
basis to existing and new staff of the ministry responsible for health. The national
environmental management authority may be used to provide or assist in providing
the initial training of trainers; and staff of the ministry responsible for health or a
consultant may facilitate training in Health Care Waste Management.
The general objective of the training and awareness programmes for implementation
of the ESMF and the HCWMP would be to:
• sensitize top level management of the ministry and other stakeholders, on the
importance of environmental management and Health Care Waste
Management, so that they may appreciate and approve the needs and
activities of front line staff, when implementing future environmental
management activities and training programmes;
• training district level staff to be able to:
o discuss the role of the various players in implementation and monitoring of
the EMP and the HCWMP;
51

o conduct or supervise the screening process;
o carry out or supervise the Environmental Review process;
o carry out or supervise Limited Environmental Assessments;
o select, recommend and supervise appropriate contractors to conduct full
EIAs and/or EA;
o monitor implementation of the EMP by the civil works contractor;
o monitor implementation of laboratory environmental work and Health Care
Waste Management activities; and
o Prepare sub-project interim and final environmental and HCWM evaluation
reports.
• Sensitize representatives and leaders of community groups (who will in turn
relay messages to their communities) on the implementation and
management of the mitigation measures; and on their roles in achieving
environmental sustainability; and to sensitize the committees on linkages
between environmental and social impacts and health; as well as on the
HCWMP.
In addition to the above training, it is recommended that exchange visits to other
participating countries be undertaken by staff representatives of the ministry
responsible for health, local government and the national environmental authority to
learn and share how environmental and health care waste management of their
project is handled and to draw lessons that can be applied in their own situation.
7.4 CAPACITY BUILDING COSTS
The proposed areas of training would therefore be based on the topics outlined in
Table 7.1 and the training material would be prepared to suit the three different
levels at the estimated costs indicated in Table 7.1.
Table 7.1: ESIA and HCWM Training Areas for Stakeholders of the Project
Type of training, target
group and training
duration
Sensitization of top level
management staff of the
ministry responsible for
health
1 Day
Training Elements Cost per
session
Introduction to the Regional Health Systems
Strengthening and TB Support Project
Introduction to ESIA and EMP for the
Regional Health Systems Strengthening
and TB Support Project
Relevant environmental legislation and
World Bank Safeguards; and compliance
requirements
Importance of environmental management
and health care waste management,
Importance of approving and supporting the
needs and activities of front line staff to
implement environmental management
activities and training programmes
($)
60000
52

Training operatives and
project staff of the
ministry responsible for
health
2 days
Training district level staff
Introduction to the Regional Health Systems
Strengthening and TB Support Project
Relevant environmental legislation and
World Bank Safeguards and compliance
requirements
Importance of environmental management
and health care waste management
Environmental, social and economic
impacts of the Regional Health Systems
Strengthening and TB Support Project and
on health
Introduction to ESIA and EMP for the
Regional Health Systems Strengthening
and TB Support Project and the HCWMP
o role of various players in
implementation and monitoring of the
EMP and HCWMP;
o conducting or supervising the
screening process;
o carrying out or supervising the
Environmental Review process;
o carry out or supervising Limited
Environmental Assessments;
o Elements of a full EIA and EA
o selecting and supervising an
appropriate contractor to do a full
EIA
o monitor implementation of the EMP
by the civil works contractor
o monitoring implementation of the
HCWMP
o preparing sub-project interim and
final evaluation reports; and
General coordination of laboratory
environmental work and Health Care Waste
Management activities
Introduction to the Regional Health Systems
Strengthening and TB Support Project
Relevant environmental legislation and
World Bank Safeguards and compliance
requirements
Importance of environmental management
and Health Care Waste Management,
Environmental, social and economic
impacts of the Regional Health Systems
Strengthening and TB Support Project and
on health
150,000
150,000
53

2 Days session
Sensitize representatives
and leaders of
community groups (who
will in turn relay the
message to their
communities)
2 Day session
Introduction to ESIA and EMP for the
Regional Health Systems Strengthening
and TB Support Project
o role of various players in
implementation and monitoring of the
EMP;
o conducting or supervise the
screening process;
o carrying out or supervising the
Environmental Review process;
o carrying out or supervising Limited
Environmental Assessments;
o Elements of a full EIA
o selecting and supervising an
appropriate contractor to do a full
EIA
o monitoring implementation of the
EMP by the civil works contractor
o preparing sub-project interim and
final evaluation reports; and
o monitoring laboratory environmental
work and Health Care Waste
Management activities
Introduction to the Regional Health Systems
Strengthening and TB Support Project and
the HCWMP
community group roles in achieving
environmental sustainability;
linkages between environmental and social
impacts and health;
Gender, Nutrition, TB, HIV and AIDS and
the Regional Health Systems Strengthening
and Support Project
Mitigation measures for the negative
impacts of the Regional Health Systems
Strengthening and TB Support Project
Implementation and monitoring of the EMP
and the Health Care Waste Management
Plan
5 days session Train health workers on Standards and
procedures for managing healthcare waste
in all regional and district hospitals
Medical waste
Equipment
Support regional and districts hospitals with
standards waste disposal facilities
100,000
4,000,000
1,600,000
54

CHAPTER 8 CONCLUSION AND RECOMMENDATIONS
This Environmental and Social Management Framework has been prepared to guide
project implementers and other stakeholders to identify and mitigate environmental,
health and social impacts of the Regional Health Systems Strengthening and TB
Support Project. It is recommended therefore that this framework should be used by
all the participating countries (with any minor modifications to suit their particular
situation) prior to any project activity of the Regional Health Systems Strengthening
and TB Support Project.
In implementing this ESMF it should be noted that the project sites, proposed for the
Regional Health Systems Strengthening and TB Support Project, are dynamic and
prone to environmental and social impacts that may be generated from activities of
other current or future development projects. Disposal of medical wastes, for
instance, will be done by other hospitals and laboratories, including private ones.
These impacts may affect the overall results in implementing this ESMF and would
retard health improvement efforts.
It is expected therefore that the other existing and new project activities will have
their own environmental and social management plans. In this regard, it is expected
that the departments responsible for environmental affairs and other stakeholder line
ministries will ensure that human activities that lead to HCW and other environmental
problems are properly managed and monitored. Hence the Ministry of Health, which
is the key and direct custodian of health for everyone should play a proactive role in
coordinating and cooperating with departments responsible for environmental
matters to ensure better health for all.
Successful implementation of this ESMF will also depend to a large extent, on the
involvement and participation of local communities. It is therefore recommended that
experts to be involved in the implementation of the project and the ESMF will, widely
consult with the local communities and provide the necessary community awareness
on health maters related to implementation of the ESMF. In this way, the project
would reap maximum benefits towards improvement of health for the local
communities which need these initiatives the most.
Implementers of this ESMF, in consultation with all the stakeholders and local
communities, should adopt and adapt (where appropriate) the screening process,
checklists and the EMP to suit local conditions.
Specifically it is recommended that:
• The screening process and the screening forms should be used for all the
sub-project activities of the Regional Health Systems Strengthening and TB
Support Project;
• The Ministry of Health and Social Welfare should be adequately supported to
strengthen or set up the proposed Environmental and Social Unit, to oversee
the implementation of this ESMF as well as the HCWMP;
• Environmental and social awareness and training as presented in the capacity
building proposal, for the key stakeholders and affected communities should
be implemented;
55

• Regularly updating of this ESMF, to respond to changing designs and local
conditions in all the participating countries is very important and should be
done as appropriate;
• Building capacities at the district level, for appropriate information
management, to facilitate the environmental and social management process
should be supported by the project;
• At the district level, the necessary resources and equipment for producing the
required documentation and completing the screening forms as well as
preparing reports for the implementation of the ESMF should be provide; and
• staff at all levels should be empowered to adequately administer the ESMF
throughout the project implementation.
This ESMF will provide the Regional Health Systems Strengthening and TB Support
Project implementers with the screening process that will enable them to identify,
assess and mitigate potential negative environmental and social impacts and to
ensure proper mitigation and possibly the preparation of a comprehensive EIA where
appropriate. Hence the following sections of the ESMF should be included in the
Project Implementation Manual:
• Sections 4.1 and 4.2 of Chapter 4, Environmental and Social Management
Plan
• Sections 5.1 to 5.4 of Chapter 5, Environmental Monitoring;
• Sections 6.1 to 6.6 of Chapter 6, Environmental and Social Screening; and
• Sections 7.1 to 7.4 of Chapter 7, Capacity Building and Training
Requirements
56

REFERENCES
1. Government of the United Republic of Tanzania, National Environment Policy
(1997
2. Government of the United Republic of Tanzania, National Policy on HIV and
AIDS (2001)
3. Government of the United Republic of Tanzania, National Land Policy (1995)
4. Government of the United Republic of Tanzania, Construction Industry Policy
(2002)
5. Government of the United Republic of Tanzania, National Water Policy (2002)
6. Government of the United Republic of Tanzania, National Gender Policy
(1999)
7. Government of the United Republic of Tanzania, Health Sector Strategic Plan
III, 2008
8. Government of the United Republic of Tanzania, National Health Laboratory
Strategic Plan (2009-2015)
9. Government of the United Republic of Tanzania, Urban Planning Act, 2007
10. Government of the United Republic of Tanzania, Health Laboratory
Practitioners Act, 2007
11. Government of the United Republic of Tanzania, Water Resources
Management Act, 2009
12. Government of the United Republic of Tanzania, Constitution of the United
Republic of Tanzania (1977-1995)
13. Government of the United Republic of Tanzania, Environmental Management
Act (2004)
14. Government of the United Republic of Tanzania, Environmental Impact
Assessment and Audit Regulations (2005)
15. Government of the United Republic of Tanzania, Mining (Environmental
Management and Protection) Regulation (1999)
16. Government of the United Republic of Tanzania, Land Act (1999) and the
Land Regulations (2001)
17. Government of the United Republic of Tanzania, Occupational Health and
Safety Act (2003)
18. Government of the United Republic of Tanzania, Health Laboratory Safety
and Waste Management Manual, November, 2006
19. Government of the United Republic of Tanzania, National Standards and
Procedures for Health Care Waste Management in Tanzania September,
2006
20. Government of the United Republic of Tanzania, Health Care Waste
Management National Policy Guidelines, September, 2006
21. Government of the United Republic of Tanzania, Health Care Waste
Management and Monitoring Plan
57

22. National Institute for Medical Research, Annual Report for the Period from 1st
July – 30th June 2008
23. Government of the United Republic of Tanzania, Health Sector Strategic Pan
July 2009 – June 2015
24. Ministry of Public Health and Sanitation Division of Leprosy, Tuberculosis and
Lung Disease DLTLD Guidelines on Management of Leprosy and
Tuberculosis March 2009 Version – Kenya.
25. National Health and Medical Research Council, National Guidelines for Waste
Management in the Health Industry, March 1999
26. National Institute for Medical Research, Annual Report for the Period from 1st
July – 30th June 2008
58

ANNEXES
ANNEX 1: ENVIRONMENTAL AND SOCIAL SCREENING FORM
The Environmental and Social Screening Form (ESSF) has been designed to assists
in the evaluation of sub projects for the Regional Health Systems Strengthening and
TB Support Project in Tanzania. The form is designed for assessment of
environmental and social impacts and their mitigation measures, if any, so that
requirements for further environmental analysis can be determined.
This form must be completed by the District Environmental Management Officer or
district staff appropriately trained to do so and in consultation with the affected
communities as well as key stakeholders of the sub-project. The form will form part
of the approval requirements for implementation of the sub-project activities.
PART A: GENERAL INFORMATION
1. Name of sub-project:
………………………………………………………………………...
2. Sector:
…………………………………………………………………………………..........
3. Name of the project location:
………………………………………………………………..
4. Name of Ward
………………………………………………………………………….........
5. Name of District
……………………………………………………………………………..
6. Name of Executing Agent
…………………………………………………………………...
7. Name of the Approving Authority
…………………………………………………………..
Details of the Person Responsible for Completing this ESSF:
8. Name:
………………………………………………………………………………………..
9. Job title:
……………………………………………………………………………………...
10. Telephone Number:
………………………………………………………………………...
59

11. Fax Number:
…………………………………………………………………………..........
12. E-mail Address:
…………………………………………………………………………….
13. Date:
………………………………………………………………………………………..
14. Signature:
…………………………………………………………………………………..
PART B: BRIEF DESCRIPTION OF THE SUB-PROJECT
Please provide information on the type and scale of the sub-project (area, required
land and approximate size of total building floor area).
Provide information about the nature of activities during the construction of the
facilities including support/ancillary structures and activities required to build it, e.g.
need to quarry or excavate borrow materials, laying pipes/lines to connect to energy
or water source, access road etc.
PART B: BRIEF SESCRIPTION OF THE ENVIRONMEENTAL SITUATION AND
IDENTIFICTION OF ENVIRONMENTAL AND SOCIAL IMPACTS
Describe the sub-project location, siting, surroundings (include a map or even a
sketch map)
Describe the land formation, topography, vegetation in and adjacent to the project
area.
Estimate and indicate where vegetation may have to be cleared.
60

No Description Yes No Not
known
PART C. ENVIRONMENTALLY SENSITIVE AREAS OR THREATENED SPECIES
THAT COULD BE ADVERSELY AFFECTED BY THE PROJECT
1 Intact natural forests
2 Riverine forest and river banks
3 Surface water courses, natural springs
4 Wetlands (lakes, rivers, swamp, seasonally inundated
areas)
5 Distance to the nearest wetland (lakes, river, seasonally
inundated areas) less than 30 km:
6 Area is of high biodiversity
7 Habitats of endangered/threatened species for which
protection is required under participating countries’ Laws.
PART D. GEOLOGY, TOPOGRAPHY AND SOIL
1 Direct cause or worsening of soil loss or erosion by the
project
2 Project will lead directly or indirectly to practices that could
cause soil loss or erosion
3 Need to consult a soil scientist on the project
4 Modification of slopes is required by the project
5 Project will affect stability of slopes directly or indirectly
6 Project is located where existing unstable slopes could be
a hazard
7 Soil instability in the project area black cotton soil,
earthquake, landslide, subsidence
8 Project will cause substantial increase in soil salinity
9 Increase in chances of floods, poorly drained, low-lying,
depression or block run-off – water
10 Soil contamination and pollution hazards will result from
the project
11 Risks of contamination and pollution from latrines, dump
sites, industrial discharge etc.
12 Need to consult a geo-technical engineer
PART E. LAND, VEGETATION AND PROPERTY
1 There are farm lands in the project area
2 Project will reduce or damage farm land
3 Project will cause loss of vegetation, crops and fruit trees
animals and livestock
4 Project will cause loss of houses, infrastructures (shed,
toilets, granaries)
5 Project will cause loss or interference with access, routes
for people, livestock etc
6 Land in the project area is intensively developed
7 The project will increase pressure on land resources
8 The project will result in decreased holdings by small land
owners
9 The project result in involuntary land take
10 A land use planner should be consulted
61

No Description Yes No Not
known
PART F. SURFACE WATER QUANTITY AND QUALITY
1 Project will increase demand or cause loss of available
surface water
2 Need to consult a hydrologist
3 Project will lead to additional discharges into surface water
4 Project could cause deterioration of surface water quality
5 Need to consult a hydrologist and/or water quality expert
PART G. GROUNDWATER QUALITY AND QUANTITY
1 Project will increase demand or cause loss of available
ground water resources
2 Project will cause natural or man-made discharge into
ground aquifer
3 Project could cause deterioration of ground water quality
4 Need to consult a hydrologist and/or water quality expert
PART H. AIR QUALITY
1 Project will pollute air directly
2 Project will lead to practices that worsen air quality
3 Project will lead to a change in engine or fuel use that
could cause serous air problems
4 Project will result in polluted and hazardous working
environments for staff
PART I. NOISE
1 Noise is a problem in the project area
2 Project will result in increase in noise generation
3 Project could make people to move to high noise level
locations
4 Project could result in noisy working environments for staff
PART J. AQUATIC ECOSYSTEMS
1 Significant aquatic ecosystems (wetlands, rivers, streams,
lakes or ponds) are in the project area
2 Project will affect the condition and use of ecosystems for
human consumptions
3 Significant wetland ecosystems (marsh, swamp, flood
plains, or estuary) are in the project area
4 Project will affect the use or condition of such wetlands
PART K. TERRESTRIAL ECOSYSTEMS
1 There are significant terrestrial ecosystem (forest,
savannah, grassland or desert) in the project area
2 Project will affect the use or condition of such ecosystems
PART L. ENDANGERED/ THREATENED/RARE/ENDEMIC/SPECIES
1 Endangered species exist in the project area
2 Project will affect the habitant and number of such species
PART M. MIGRATORY SPICES
1 Migratory fish, birds, or manuals use the project area
2 Project will affect the habitat and numbers of such species
PART N. BENEFICIAL PLANTS, ANIMALS, INSECTS, PESTS AND VECTORS
1 There are non-domesticated plants and/or animals, used
62

No Description Yes No Not
known
or sold by local people in the project area
2 Project will affect these species by reducing their numbers
or habitant
3 There are currently problems with pest (plants or animals)
in the project area
4 Plants or animals might become pests due to ecological
changes brought by the project in the area
5 There are known disease problems in the project area
transmitted through vectors
6 Project will increase vector habitat or population
7 Need to consult a public health officer
PART O. ENERGY SOURCE
1 The project will increase demand for conventional energy
sources
2 The project will create demand for demand for other
energy sources (wood and charcoal)
3 The project will promote supply of conventional energy
sources
PART P. RESOURCE DISTRIBUTION AND DEGRADATION
1 The project will increase demand for certain commodities
within or outside the project area
2 The project will result in decrease of production for certain
vital commodities
3 Project will use large amounts of natural resources
(construction materials, water, land and energy
4 Adverse impacts of the project will be unequally distributed
in the target population
PART Q. EMPLOYMENT AND INCOME
1 The project will remove job opportunities from the area
2 The project decrease income sources or means of
livelihood
PART R. LAND ACQUISITION AND LIVELIHOODS
1 Land will be acquired
2 People’s assets or livelihoods will be affected
3 People will loose access to natural resources
PART S. EXISTING AND MIGRANT POPULATION
1 There are people currently living in or near the project
area
2 The project will affect people in or near the project area
3 There are currently mobile groups in the target population
4 The project will result in the movement of people in or out
of the area
5 It is necessary to consult a sociologist
PART T CULTURAL AND RELIGIOUS VALUES AND HISTORICAL SITES
1 Cultural characteristics unique to the project area are
understood
2 The project will adversely affect religious and/or cultural
63

No Description Yes No Not
known
attitudes of area residents
3 The project will affect religious and or cultural sites or
monuments
4 There special superstitions or taboos that will affect
acceptance of the project
5 There are graveyards in the project area
6 There are historical buildings in the area
PART U TOURISM AND RECREATION
1 There is, at present, a significant degree of tourism in the
area
2 There is unexploited tourism or recreation potential in the
area
3 The project will adversely affect existing or potential tourist
or recreation attractions
PART V HAZARDOUS WASTES
1 The project will produce hazardous wastes requiring
special handling, storage, treatment and disposal methods
2. The project will cause spread of infection within and
outside the facility requiring adherence to standard
precautions
CONCLUSION:
Summary of possible safeguard options:
If all the above answers are “No”, there is no need for further action.
If there is at least one “Yes”, then Simple Environmental Review (ER), Limited
Environmental Review (LER), or application or Full Environmental Impact
Assessment (EIA) is required.
Guide on possible action to be taken
No further action if sub-project has no impacts on environment
Simple Environmental Review (ER) if sub-projects may create a few minor
environmental impacts which can be easily mitigated.
Limited Environmental Review (ER) if sub-projects may create minor environmental
problems that require site visit or construction modifications to minimize or eliminate
impacts.
Full Environmental Impact Assessment (EIA) if sub-projects will result into potentially
significant direct or indirect adverse impacts as per NEMC guidelines
Any other recommendation (Explain)
This form has been completed by:
Name: ……………………………………Title: …………………………………………
64

Date: ……………………………………..Signature: ……………………………………
Approved by District Executive Director
Name: ……………………………………Title: …………………………………………
Date: ……………………………………..Signature: ……………………………………
65

ANNEX 2: SUBPROJECTS ENVIRONMENTAL AND SOCIAL CHECKLIST
This Environmental and Social Checklist can be used or adapted to the particular
sub-project type for the Regional. The checklist will be completed by a member of
the project facilitation team from either the ward or district level. The member would
have received training in environmental assessment.
Members of Community Management Organizations (CMO) as well as members of
the village council (VC) in the project area will participate in filling the form and all
parties participating will have to sign the form.
Table 2.1 Environmental Checklist for Laboratory Construction and
Rehabilitation Sub -projects
Stage of construction and
potential negative
environmental and social
impact
Mitigation Measure Tick as
Relevant
Planning and Design
Displacement Prepare Resettlement
Action (OP 4.12)
Loss of farm land
During Construction
Soil erosion and landslide or
erosion
Soil erosion and pit formation
from sand mining
Soil erosion and pit formation
from brick moulding.
Loss of trees for fire wood for
brick curing, adding to
deforestation
Construction and cement dust
Construction noise
Avoid sloping or hilly land
Terracing
Excavation to level
Control water flows
Provide effective drainage
Use sand from approved
areas and suppliers
Backfill pits
Use concrete blocks
Use bricks from approved
areas and suppliers
Backfill pits
Use concrete blocks
Buy fuel wood from
approved dealers
Replanting trees or
support tree planting
programmes
Use breathing masks
Limit/ control plant and
vehicle movement
Use water sprays
Use of ear plugs
Limit/ control plant and
vehicle movement
Service vehicles regularly
Responsible
Person
66

Use of construction timber for
supports, door/widows and
furniture contributing to
deforestation.
Increase in human waste from
construction workers
Construction rubble (concrete,
bricks, blocks etc.)
Use of steel and iron for
construction, furniture
where possible
Buy poles, timber and
furniture from approved
suppliers.
Plant replacement trees or
support tree planting
initiatives.
Construct temporary
latrines for construction
workers.
Use broken bricks as hard
core for pavements or sell
to other contractors
Dispose rubble in
designated disposal sites
During operation
Spread of infections Adhere to HCWMP
Provide protective wear
and equipment
Used tools and equipments Disinfect and dispose tools
and equipment as
recommended in the
Medical waste from laboratory
and hospitals, dispensaries or
health post
This form has been signed by:
HCWMP.
Dispose of waste as
recommended in the
HCWMP
Chairperson of the Village (Full Name)……………….Signature.
…………Date………..
Village Executive Officer (Full Name)…………………Signature. …………Date……….
Chairperson for CMO (Full Name) …………………… Signature.
………….Date………
Member of CMO (Full Name) …………………………Signature. ………………………
67

ANNEX 3: ENVIROMENTAL REVIEW (ER) FORM
TYPE OF EXPECTED IMPACT
PHYSICAL ENVIRONMENT:
Soil erosion
Water Siltation
Surface water pollution
Ground water pollution
Excessive dust or noise during construction
BIOLOGICAL ENVIRONMENT
Removal or disturbance of natural vegetation
Sub project location in buffer zone or protected area
Disturbance of animals or important animal habitat
SOCIAL ENVIRONMENT
Degradation of a landscape aesthetics
Degradation or disturbance of historical or cultural sites
Toxic substance that pose a risk to human health
Socioeconomic loss to individuals or families
DESCRIPTION OF IMPACT PROPOSED MITIGATION
MEASURE
Completed by:
Name: ……………………………………………………Position: ……………………………………………………………………….
Signature: ………………………………………………...Date: ………………………………………………………………………….
Approved by:
Name: ……………………………………………………Position: ……………………………………………………………………….
Signature: ………………………………………………..Date: …………………………………………………………………………..
68

ANNEX 4: LIMITED ENVIROMENTAL ASSESSMENT (LEA) FORM
Note: This form must be completed for a sub-project that may pose minor
environmental problems. The form must be filled by a designated District
Environmental Management Officer (DEMO) or his designated trained
representative. The form is part of sub-project application requirements.
Sub project Name: ………………………………………………………………………….
Location (Village, Ward, District)………………………………………………………….
Type of sub-project: ……………………………………………………………..................
Number of people benefiting the sub-project:
…………………………………………......
General Description of the sub project:
• Sub project objectives: …………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
• Sub project components: ……………………………………………………………….
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
Baseline Description of the Affected Environment
• Physical-chemical environment (soil, air, water, etc.)
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
• Biological-Ecological Environment (habitats and Communities, Flora etc):
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
• Socio-economic Environment (historical sites, aesthetic aspects, public health,
infrastructure, loss of property, loss of income etc)
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
Identification of Negative Environmental and Social Impacts
• Impacts in the physical-chemical environment (soil, water, water, air)
69

………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
• Impact on the Biological Environment (Flora, fauna, habitat etc.)
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
• Impacts on the Socio-economic Environment (Historical sites, aesthetic, public
health, infrastructure etc)
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
Mitigation Measures
Description of Impact Mitigation Measures
…………………………………… ………………………………
…………………………………… ………………………………
…………………………………… ………………………………
…………………………………… ………………………………
Report prepared by:
Name: ………………………………………………………………………………………
Position: ……………………………………………………………………………………
Signature: ………………………………………………………………………………….
Date: ……………………………………………………………………………………….
Approved by:
Name: ………………………………………………………………………………………
Position: ……………………………………………………………………………………
Signature: …………………………………………………………………………………..
Date: ……………………………………………………………………………………….
70

ANNEX 5: ENVIRONMENTAL GUIDELINES FOR CONTRACTORS
1. General Provisions and Precautions
The contractor shall take all necessary measure and precautions to ensure that all
the works and associated operations on or off the work sites are carried out in
accordance with statutory and regulatory environmental requirement of the
participating countries.
The contractor shall avoid and prevent any nuisance or disturbance associated with
execution of work under this project. In the event of any soil, debris or silt from the
work sites being deposited on any adjacent land, the contractor shall immediately
remove all such spoil debris or silt and restore the affected area to its original state,
to the satisfaction of the responsible authorities.
2. Protection of Water and other Public Services
The Contractor shall ensure that no public services are disrupted as a result of
execution of the construction works. In particular, the Contractor shall:
• not interfere with supply or abstraction of water for public or private use;
and shall not pollution any water resources (including groundwater) as a
result of execution of the works;
• not disrupt power supply or telephone connections or any other public or
private services including footpaths and walkways;
• not discharge or deposit any waste or any material into any waters or any
grounds except with the permission of the appropriate regulatory
authorities.
• at all times ensure that all streams and drains within and adjacent to the
work sites are kept safe and free from any debris and any material arising
from the works;
• protect all water courses (including ditches, canals, drains and lakes) from
pollution, siltation, flooding or erosion as a result of the execution of the
works.
• assume all responsibility to locate or to confirm the details and location of
all utility services on or in the vicinity of the site
• assume responsibility for any damage and \or interference caused by him
or his agents, directly or indirectly, arising from actions taken or a failure to
take action to protect pubic or private utilities. The Contractor shall be
responsible for full restoration of any damage caused and for restoration of
services.
• Water and waste products shall be collected, removed and disposed of at
an approved location and in a manner that will not cause pollution or
nuisance.
• The contractor shall not dispose of any surplus material on private land
unless authorized in writing by the owner(s), authenticated before a notary
public, and with previous authorization of the CSC.
3. Control of Air Pollution
• Open fires and burning of construction waste shall not be permitted;
71

• Blasting and quarrying shall be carried out using material and methods
approved by the appropriate controlling authority and in a manner to avoid
dust emission.
• Dust- generating operations shall not be permitted to affect any residential
areas, pedestrians or any public or private property. Where dust
generation is inevitable, appropriate measures such as use of water
sprays and fencing shields or appropriate covering material shall be
employed. All workers shall be protected from dust emissions by providing
them with appropriate protective wear.
• All construction machinery, plant and equipment including all vehicles shall
be regularly maintained to ensure that no smoke or obnoxious gas is
discharged to pollute the air and affect the public or property.
4. Mining and Acquisition of Construction Material
• All mining and quarrying activities shall be carried out outside in approved
places, using approved mining and quarrying practices. Topsoil from
borrow pit and mining areas will be saved and reused in re-vegetating the
pits to the satisfaction of the consultant and client
• All mined areas shall be restored to original or better state in full
compliance of environmental regulations, standards and according to
contract specifications. Restoration of the borrow areas and their
surroundings, shall be done according to environmental regulations and to
the satisfaction of the consultant and client before approval of payment
under the terms of contracts.
• Borrow pits shall be levelled and covered to facilitate natural drainage and
scenic beauty, or to create functional water storage structures as
appropriate.
• Only licensed quarrying operations and sites shall be used as sources of
construction materials.
5. Prevention of Soil Erosion.
• The Contractor shall fence off construction sites, provide appropriate
drainage and ram or compact soils where necessary to stabilize the soils
and reduce erosion.
• All construction sites and sites used for mining materials shall be
backfilled, levelled and re-planted with trees, vegetation and grass to
restore them to the original state and to prevent soil erosion.
• As far as possible the contractor shall avoid or reduce construction
activities and mining of construction material during the peak of rainy
seasons.
6. Control of Social Impacts
• The Contractor shall coordinate with all the neighbouring land users and
respect their rights to a clean and safe environment. Written agreements
with local landowners for temporary use of their sites or property shall be
made and sites must be restored to original condition or conditions
acceptable to the owner within an agreed time. Camp sites shall be
maintained and cleaned up at all times and on completion of the works.
72

• Health and safety of workers shall be protected by providing basic
emergency health and first aid facilities and awareness meetings aimed at
the prevention of sexually transmitted diseases. Awareness meetings shall
be conducted as a part of all construction employee orientation programs.
Employees shall be provided with condoms for protection from STIs.
• The Contractor shall obtain all necessary written traffic control permissions
including for use of flagmen, traffic cones or other devices such as
barricades and/or lights which he must use to control traffic for safety of
pedestrians, cyclists and all road users, particularly school children.
• The Contractor shall not stockpile or store any construction materials; nor
park construction plant or vehicles in walk ways, pedestal routes or
driveways. Stockpiles of material shall be covered with tarpaulins or
sprayed with water where these materials pose risks of dust to the public
or people’s property.
7. Noise Control and Regulation
• The Contractor shall take all necessary measures to ensure that the
operation of all mechanical equipment and construction processes on and
off the site shall not cause any unnecessary or excessive noise to the
public. In addition, the Contractor shall operate noisy equipment within
government working times unless with prior arrangement and permission
from the employer
• Vehicle, plant and equipment exhaust systems shall be maintained in good
working order, as recommended by the manufacturers, to ensure that no
noise is unnecessarily generated to inconvenience the public.
• Construction works and operations shall be scheduled to coincide with
periods when people would least be affected by noise, having due regard
for avoiding any noise disturbances to local residents, hospitals, schools or
any other public and private places in the work site neighbourhood.
• The contractor shall notify public (likely to be affected by the works) of
impending construction operations and specify methods to receive and
handle all public complaints.
8. Environmental Monitoring
• The Contractor shall be responsible for monitoring all his activities and
ensuring that all environmental requirements and the above conditions are
met at all times
73

ANNEX 6: GENERIC EIA TERMS OF REFERENCE
1. Provide a full description of the nature of the project with respect to the name
of the proponent, the postal and physical address, the spatial location of the
potential site for the project, the estimated cost of the project, and size of land
for the project site, including water reticulation, waste disposal and access
roads.
2. Provide a site-specific map of the area (Scale 1:50,000) showing the
proposed project site and existing establishments in the area and surrounding
areas. A site plan for the project should also be provided.
3. Examine the existing conditions of the proposed site identifying and analysing:
Geological and soil conditions of the area;
The scope of vegetative resources of the area;
Existing land uses within the area and within adjacent villages;
Ecologically important or sensitive habitats and resources e.g. water
resources, biodiversity elements; and
Suitability of the site for the proposed development.
4. Describe the major activities to be undertaken for the construction and
operation of infrastructure services. This should include the size and type of
infrastructure, the type of equipment to be used, the method and duration of
construction, nature and quantity of wastes to be generated, the facilities for
appropriate disposal and management of waste, number of people to be
employed and.
5. State the reasons for selecting the proposed site, the consequences of not
undertaking the project at the proposed site and any alternative sites
considered.
6. Predict the major short and long-term environmental impacts of the project.
Examine both the positive and negative impacts as well as impacts on the
biophysical, social, economic and cultural components of the environment.
The potential impacts must include those related to:
• project location (e.g. resettlement of people, loss of forest land, loss of
agricultural land, impact on flora and fauna);
• construction works (e.g. soil erosion, disposal of construction spoils,
drainage and access roads)
• project operation (e.g. solid waste disposal, sewage disposal)
7. Prescribe measures to eliminate, reduce or mitigate the negative effects
identified and the measures to enhance the positive effects in 6.
8. Propose an Environmental Management Plan (EMP) in tabular form by which
all of the mitigation/enhancement measures prescribed will be carried out,
specifying who will be responsible for implementing these measures and the
schedule for implementation, cost of implementing the measures and the
source of funding. An environmental monitoring plan should also be prepared
74

including the indicators to be used for monitoring the impacts and responsible
persons and institutions that will conduct the monitoring.
9. Undertake public consultations to ensure that all interested and affected
parties are involved in the EIA process and incorporate their views into the
EIA. Evidence of consultation should be provided in the report.
10. Provide an account of all statutory and regulatory licenses and approvals
obtained for the project to ensure that they are in line with sound
environmental management practices and are in compliance with all relevant
existing legislation. Reference should be made, but not limited to the
Environment Management Act and other relevant and other relevant
legislation.
75

ANNEX 7: SUMMARY OF THE BANK’S SAFEGUARD POLICIES
OP/BP 4.01
Environmental
Assessment
OP/BP 4.04 Natural
Habitats
The objective of this policy is to ensure that Bank-financed
projects are environmentally sound and sustainable, and that
decision-making is improved through appropriate analysis of
actions and of their likely environmental impacts. This policy is
triggered if a project is likely to have potential (adverse)
environmental risks and impacts on its area of influence. OP
4.01 covers impacts on the natural environment (air, water and
land); human health and safety; physical cultural resources;
and trans-boundary and global environment concerns.
This policy recognizes that the conservation of natural habitats
is essential to safeguard their unique biodiversity and to
maintain environmental services and products for human
society and for long-term sustainable development. The Bank
therefore supports the protection, management, and restoration
of natural habitats in its project financing, as well as policy
dialogue and economic and sector work. The Bank supports,
and expects borrowers to apply, a precautionary approach to
natural resource management to ensure opportunities for
environmentally sustainable development. Natural habitats are
land and water areas where most of the original native plant
and animal species are still present. Natural habitats comprise
many types of terrestrial, freshwater, coastal, and marine
ecosystems. They include areas lightly modified by human
activities, but retaining their ecological functions and most
native species.
Depending on the project, and nature of
impacts a range of instruments can be
used: EIA, environmental audit, hazard or
risk assessment and environmental
management plan (EMP).When a project
is likely to have sectoral or regional
impacts, sectoral or regional EIA is
required. The Borrower is responsible for
carrying out the EIA.
Under Project, the Government has
undertaken an Environmental and Social
Impact Assessment to assess the social
and environmental impacts of the program.
This policy is triggered by any project
(including any sub-project under a sector
investment or financial intermediary) with
the potential to cause significant
conversion (loss) or degradation of natural
habitats, whether directly (through
construction) or indirectly (through human
activities induced by the project).
The policy is not triggered as it is not
expected that there will be significant
conversion of natural habitats since the
project is targeting smallholder farmers
within their existing agricultural lands.
Project activities that could negatively
impact on protected areas will not be
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OP/BP 4.36
Forests
OP 4.09 Pest
Management
The objective of this policy is to assist borrowers to harness the
potential of forests to reduce poverty in a sustainable manner,
integrate forests effectively into sustainable economic
development and protect the vital local and global
environmental services and values of forests. Where forest
restoration and plantation development are necessary to meet
these objectives, the Bank assists borrowers with forest
restoration activities that maintain or enhance biodiversity and
ecosystem functionality. The Bank assists borrowers with the
establishment of environmentally appropriate, socially
beneficial and economically viable forest plantations to help
meet growing demands for forest goods and services.
The objective of this policy is to (i) promote the use of biological
or environmental control and reduce reliance on synthetic
chemical pesticides; and (ii) strengthen the capacity of the
country’s regulatory framework and institutions to promote and
support safe, effective and environmentally sound pest
management. More specifically, the policy aims to (a) Ascertain
that pest management activities in Bank-financed operations
are based on integrated approaches and seek to reduce
reliance on synthetic chemical pesticides (Integrated Pest
Management (IPM) in agricultural projects and Integrated
Vector Management (IVM) in public health projects. (b) Ensure
that health and environmental hazards associated with pest
management, especially the use of pesticides are minimized
funded
This policy is triggered whenever any
Bank-financed investment project (i) has
the potential to have impacts on the health
and quality of forests or the rights and
welfare of people and their level of
dependence upon or interaction with
forests; or (ii) aims to bring about changes
in the management, protection or
utilization of natural forests or plantations.
The policy is not triggered as it is not
expected that there will be project activities
impacting on forests.
Project activities that could negatively
impact on forests will not be funded
The policy is triggered if : (i) procurement
of pesticides or pesticide application
equipment is envisaged (either directly
through the project, or indirectly through
on-lending, co-financing, or government
counterpart funding); (ii) the project may
affect pest management in a way that
harm could be done, even though the
project is not envisaged to procure
pesticides. This includes projects that may
(i) lead to substantially increased pesticide
use and subsequent increase in health and
environmental risk; (ii) maintain or expand
77

OP/BP 4.11
Physical Cultural
Resources
and can be properly managed by the user. (c) As necessary,
support policy reform and institutional capacity development to
(i) enhance implementation of IPM-based pest management
and (ii) regulate and monitor the distribution and use of
pesticides.
The objective of this policy is to assist countries to avoid or
mitigate adverse impacts of development projects on physical
cultural resources. For purposes of this policy, “physical cultural
resources” are defined as movable or immovable objects, sites,
structures, groups of structures, natural features and
landscapes that have archaeological, paleontological,
historical, architectural, religious, aesthetic, or other cultural
significance. Physical cultural resources may be located in
urban or rural settings, and may be above ground,
underground, or underwater. The cultural interest may be at the
local, provincial or national level, or within the international
community.
present pest management practices that
are unsustainable, not based on an IPM
approach, and/or pose significant health or
environmental risks.
Under the Project, the policy will be
triggered as the Project will support postharvest
integrated pest management and
therefore pesticides may be used.
A pesticides management and monitoring
plan has been prepared for the Project
This policy applies to all projects requiring
a Category A or B Environmental
Assessment under OP 4.01, project
located in, or in the vicinity of, recognized
cultural heritage sites, and projects
designed to support the management or
conservation
resources.
of physical cultural
The policy is not triggered as it is not
expected that physical cultural resources
will be affected.
Project activities that could negatively
impact on physical cultural resources will
not be funded
78

OP/BP 4.10
Indigenous
Peoples
OP/BP 4.12
Involuntary
Resettlement
The objective of this policy is to (i) ensure that the development
process fosters full respect for the dignity, human rights, and
cultural uniqueness of indigenous peoples; (ii) ensure that
adverse effects during the development process are avoided,
or if not feasible, ensure that these are minimized, mitigated or
compensated; and (iii) ensure that indigenous peoples receive
culturally appropriate and gender and inter-gene rationally
inclusive social and economic benefits.
The objective of this policy is to (i) avoid or minimize
involuntary resettlement where feasible, exploring all viable
alternative project designs; (ii) assist displaced persons in
improving their former living standards, income earning
capacity, and production levels, or at least in restoring them;
(iii) encourage community participation in planning and
implementing resettlement; and (iv) provide assistance to
affected people regardless of the legality of land tenure.
The policy is triggered when the project
affects the indigenous peoples (with
characteristics described in OP 4.10 para
4) in the project area.
The policy is not triggered as it is not
expected that indigenous peoples will be
affected.
Project activities that could negatively
impact on indigenous peoples will not be
funded
This policy covers not only physical
relocation, but any loss of land or other
assets resulting in: (i) relocation or loss of
shelter; (ii) loss of assets or access to
assets; (iii) loss of income sources or
means of livelihood, whether or not the
affected people must move to another
location.
This policy also applies to the involuntary
restriction of access to legally designated
parks and protected areas resulting in
adverse impacts on the livelihoods of the
displaced persons.
The policy is not triggered as no
involuntary resettlement will take place
under Project.
Any investments involving involuntary
79

OP/BP 4.37 Safety
of Dams
OP 7.50 Projects in
International
Waters
The objectives of this policy are as follows: For new dams, to
ensure that experienced and competent professionals design
and supervise construction; the borrower adopts and
implements dam safety measures for the dam and associated
works. For existing dams, to ensure that any dam that can
influence the performance of the project is identified, a dam
safety assessment is carried out, and necessary additional
dam safety measures and remedial work are implemented.
The objective of this policy is to ensure that Bank-financed
projects affecting international waterways would not affect: (i)
relations between the Bank and its borrowers and between
states (whether members of the Bank or not); and (ii) the
efficient utilization and protection of international waterways.
The policy applies to the following types of projects: (a)
Hydroelectric, irrigation, flood control, navigation, drainage,
water and sewerage, industrial and similar projects that involve
the use or potential pollution of international waterways; and (b)
Detailed design and engineering studies of projects under (a)
above, include those carried out by the Bank as executing
agency or in any other capacity.
resettlement will not be funded.
This policy is triggered when the Bank
finances: (i) a project involving
construction of a large dam (15 m or
higher) or a high hazard dam; and (ii) a
project which is dependent on an existing
dam. For small dams, generic dam safety
measures designed by qualified engineers
are usually adequate.
The policy is not triggered as no dams are
involved under Project.
Any investments involving dams will not be
funded
This policy is triggered if (a) any river,
canal, lake or similar body of water that
forms a boundary between, or any river or
body of surface water that flows through
two or more states, whether Bank
members or not; (b) any tributary or other
body of surface water that is a component
of any waterway described under (a); and
(c) any bay, gulf strait, or channel bounded
by two or more states, or if within one state
recognized as a necessary channel of
communication between the open sea and
other states, and any river flowing into
such waters.
The policy is not triggered as the Project
80

OP 7.60 Projects in
Disputed Areas
The objective of this policy is to ensure that projects in disputed
areas are dealt with at the earliest possible stage: (a) so as not
to affect relations between the Bank and its member countries;
(b) so as not to affect relations between the borrower and
neighbouring countries; and (c) so as not to prejudice the
position of either the Bank or the countries concerned.
will not have activities in international
waters.
Any investments involving international
waters will not be funded
This policy is triggered if the proposed
project will be in a “disputed area”.
Questions to be answered include: Is the
borrower involved in any disputes over an
area with any of its neighbours. Is the
project situated in a disputed area? Could
any component financed or likely to be
financed as part of the project be situated
in a disputed area?
The policy is not triggered as no project
activities will take place in disputed areas
under Project.
Any investments involving disputed areas
will not be funded
81

ANNEX 8: LIST OF INDIVIDUALS/INSTITUTIONS CONTACTED
Name / Position Institution Contact Areas of Discussion Date
Anicetus Honest / Ministry of Health and +255(0)754311115
Health Care Waste Management 05.08.09
National Coordinator
for HCWMP
Social Welfare ahonest2000@yahoo.com Project
Daniel
Ministry of Health and 0784269480 General project design process and 05.08.09
Mwakasungula /
Engineer
Social Welfare
specifications
Dr. S. M. Egwaga National Tuberculosis +255 (22) 2120261-7 Existing laboratory infrastructure 10.08,09
Programme Manager & Leprosy
+255 (22) 2118619
services and shortfalls. Possible
Programme (NTLP).
MOHSW
tantic@inafrica.com locations of proposed sites
Dr. Faustin N. Njau MOHSW, Department +255 (22) 2120261-7 Health Sector Reforms 07.08.09
Public Health of Health, Policy & 0784787118
Specialist (Head of Planning
faustinnjau@africaonline.co.tz
Health Sector
Reform Programme
faustinnjau@hotmail.com
Dr Sayoki Mfinanga NIMR, Muhimbili +255 (0) 22 2152232 Environmental component of the
Medical Research +255 (0)784 755632 current and planned research 12.08.09
Centre
programmes and challenges faced.
T. M. Chonde Central TB Reference tmchondes@yahoo.com Laboratory chemicals/drugs and 12.08.09
Laboratory
wastes including supply chain,
storage, administration and
distribution. Laboratory waste
management plans.
Prof. Eligius
Luyamuya
Medical Research
Centre, Muhimbili
University of Health
and Allied Sciences
Current and planned research
programmes and how these will
relate to the proposed project
activities. Current waste
13.08.09
82

M. Mwasekaga,
Senior Laboratory
Programme Officer
(MUHAS) management programmes and the
impact of the new activities
CDC mwasekagam@tz.cdc.gov Laboratory activities, equipment and
current challenges.
F. Rugiga NEMC 0713 622 421
frugiga@yahoo.com
Dr. Francis Mhimbira
Kibong’oto Hospital,
designated as the
national hospital for
MDR-TB
Helen Lugina East, Central and
Southern Africa
Health Community
(ECSA)
Dr. Francis A. Mhimbira MD
Kibong'oto Hospital
P. O. Box 12
Sanya Juu, Siha
Kilimanjaro,
Tanzania
Mobile No: - +255 754
291657
or +255 713 728285
Environmental Law and ESMF/ESIA
requirements and procedures.
Relevant legislation for smooth
implementation of the project in an
environmentally friendly and socially
acceptable manner
Current hospital waste management
practices and how these will be
affected by the project. Additional
remedial or mitigation factors to be
considered
Regional context of the project and
how Tanzania fits in. Plans for
coordinated approach to
management of environmental and
social concerns and harmonization of
waste management plans
11.08.09
17.08.09
11.08.09
(talked on
the phone)
83

ANNEX 9: TANZANIA’S LEGAL, REGULATORY, AND ADMINISTRATIVE
FRAMEWORK
BASIS FOR THE FRAMEWORK
This legal, regulatory and administrative framework is based on information
gathered from Tanzania during the period of public consultation. No information
was obtained from Kenya and Uganda as these two participation countries were
not visited for this purpose. It is therefore assumed that the framework is
generally similar in the three participating countries. Where differences appear,
adjustments to the framework must be made to suit the particular situation in the
participating country, at the time of project implementation.
POLICIES
National Environment Policy (1997)
The Tanzania National Environment Policy (NEP, 1997) provides the general
direction on environmental management in the country. It focuses on natural,
environmental and social concerns, and advocates the key principle of
sustainable development. The policy is the basis for guiding specific
environmental legislation for Government agencies and those deemed
responsible for regulating and accounting for environmental management. It
provides strategic direction on environmental management at all levels and in all
sectors of development. The policy also outlines the approach for defining and
mainstreaming environmental issues for decision-making on sectoral policy
action plans. The policy identifies six key environmental problem areas as: land
degradation, lack of access to good quality water, environmental pollution, loss of
wildlife habitat and biodiversity, deterioration of aquatic ecosystems and
deforestation.
The policy requires EIA to be mandatory for all development projects likely to
have significant impacts on the environment. The intention is to ensure that the
development projects are implemented in an economically sustainable manner,
while safeguarding environmental and social issues for the benefit of the present
and future generations. Civil works construction to build or rehabilitate the
laboratories under the Regional Health Systems Strengthening and TB Support
Project are meant to conform to this policy objective by avoiding or minimizing
environmental degradation through implementation of this ESMF.
National Policy on HIV and AIDS (2001)
This policy, formulated by the Government under technical support from the
World Health Organization Global Programme on AIDS (WHO-GPA), led to the
establishment of National HIV and AIDS Control Programme (NACP) in the
Ministry of Health and Social Welfare. The Commission provides leadership and
coordination of national multi-sectoral response to the HIV and AIDS epidemic.
84

The Policy identifies HIV and AIDS as a global concern and as an impediment to
social and economic development, with serious negative and direct
consequences on human capital, social services and welfare in all sectors. It
recognizes the linkage between HIV and AIDS and poverty, as well as the
vulnerable groups of the society.
The main policy objective is reflected well in the establishment of TACAIDS and
its strategic objectives to deal with the specific problems of transmission, testing,
care for Persons Living with HIV and AIDS (PLHAS), enhancement of sectoral
roles, research and dissemination of information as well as development of HIV
vaccine. The policy provides direction for development and enactment of legal
instruments on HIV and AIDS ethics and legal status of HIV and AIDS affected
persons.
Other objectives of the policy include monitoring and safeguarding rights of
infected or affected people; preventing human rights abuse, discrimination and
social injustice; providing effective treatment for opportunistic infections; fighting
against drug substance abuse; prohibiting misleading advertisements on drugs
and other products for HIV and AIDS prevention; and treatment and care.
TB is closely connected to the HIV and AIDS pandemic. Therefore any strides in
the eradication of TB have to consider the policies on HIV and AIDS. In addition,
the project may lead to close interaction between construction workers and local
community members in the project areas. This may lead into increased
transmission of HIV and AIDS to both the workforce and the local communities.
National Land Policy (1995)
The National Land Policy of 1995 (Revised in 1997) recognizes the need for
protecting environmentally sensitive areas. It emphasizes protection of the
environment and natural ecosystems from pollution, degradation and physical
destruction. In addition, the policy recognizes the importance of protecting natural
resources such as water resources. It also recognises the importance of waste
management for environmental protection and highlights the need for
conservation and preservation of historic sites and buildings. Protection of natural
resources and appropriate management of wastes to avoid pollution during
construction and operation stages of the project is the essence of this ESMF for
the project.
Construction Industry Policy (2002)
Important issues of major concern in this policy include planning, design,
construction, production, procurement, repair, maintenance and demolition of
physical infrastructure in a sustainable manner to protect the environment. The
policy recognizes the importance of ensuring good quality and valuable service in
the development and maintenance of physical infrastructure, including buildings;
85

wastewater treatment facilities as well as solid waste collection and treatment
structures which are part of this project.
The policy recognizes the importance of involving various organizations and
persons including companies, firms and individuals working as consultants,
materials and equipment providers, plant and equipment suppliers as well as
builders and merchants. Activities of all these key players in the construction and
maintenance of the laboratory buildings will impact on the environment in some
way or another and provisions for mitigating the impacts are reticulated in this
ESMF.
The National Water Policy (2002)
The policy objective is to guide development of comprehensive legal instruments
for sustainable management of the national water resources. The policy
recognizes the need to protect water sources against pollution and environmental
degradation. The proposed project could result in degradation of water source if
not implemented properly. Hence there is need to ensure that pollution of water
source is avoided or minimized during construction, rehabilitation and operation
of the laboratory facilities and this is one of the general objectives of this ESMF.
National Gender Policy (1999)
The policy provides guidelines for development of gender sensitive plans,
programmes and strategies in all sectors and institutions. The policy emphasizes
gender equity and establishment of strategies for poverty eradication through fair
participation of both women and men in development. It advocates equal access,
by both men and women, to resources for their development and values the role
played by women in bringing about socioeconomic development. In line with the
requirements of this policy, the design, construction and operation of the
laboratory facilities will have to consider equitable participation and opportunities
to both men and women.
The Health Sector Strategic Plan III, 2008
The Health Sector Strategic Plan III (HSSP III) outlines the intentions of the
health sector for the period 2009 – 2015. It provides an overview of the priority
strategic directions across the sector, which is guided by the National Health
Policy, Vision 2025, the National Programme for Economic Growth and Poverty
Reduction as well as the Millennium Development Goals. HSSP III has eleven
strategies focusing on specific topics in the health services delivery, related to
diseases and management. Of relevance to the Regional Health and TB Support
Project is Strategy 8, which is for Prevention and Control of Communicable and
Non-communicable Diseases. The strategy aims at improvement of the
diagnostic capacity in laboratories as well as improvement in provision of
equipment and supplies. It advocates continuation of implementation of the “Stop
TB Strategy”. Environmental health strategies for the policy are being
considered in the project by including the policy provisions in this ESMF.
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The National Health Laboratory Strategic Plan (2009-2015)
The 2009-2015 National Health Laboratory Strategic Plan, prepared by the
Diagnostic Services Section (DSS) of the Ministry of Health and Social Welfare
aims at establishing quality laboratory services at all levels. This is to ensure
equitable and gender sensitive services, with an efficient and effective
governance system and establishing partnership with public and private
laboratories. The plan was developed in consultation with the national disease
programs (TB and malaria) and serves as a good framework for the project. The
Laboratory Services group within the DSS is responsible for managing the
National Health Laboratory Quality Assurance and Training Centre, a new facility
constructed by USG/PEPFAR, which the government would like to develop into a
regional training institute. This Strategic Plan is of direct relevance to the project.
Of interest (among other issues) is the observation made during public
consultation that private laboratories and hospital sometimes employ private
contractors to manage their hospital wastes and in so doing discharge the
wastes indiscriminately.
LEGAL FRAMEWORK
Urban Planning Act, 2007
The Act provides for the orderly and sustainable development of land in Urban
Areas, to preserve and improve amenities; to provide for the grant of consent to
develop land; and powers of control over the use of land and to provide for other
related matters.
Part II, Section 3(f) requires developers to protect the environment of human
settlements and ecosystems from pollution, degradation and destruction in order
to attain sustainable development.
The objectives of urban planning, as detailed in Part II, Section 4 include to:
• Facilitate efficient and orderly management of land use;
• Promote sustainable land use practices;
• Ensure public participation in the preparation and implementation of land use
policies and plans; and
• Facilitate the establishment of a framework for prevention of land use conflicts
The Act, in Part III, Section 6, gives powers to the Director of Urban Planning to
set standards for planning authorities on the most appropriate use of land
management such as change of use, extension, sub-division of land and
amalgamation of land.
Section 7 of Part 3 delegates the planning authority to every city council,
municipal council, town council and township authority to become a planning
87

authority in respect of their areas of jurisdiction. Sub-section (5) gives the
planning authority to, among other things:
• Ensure that planning incorporates gender perspectives and vulnerable
groups;
• Secure the orderly and environmentally sustainable development in its
area of jurisdiction;
• Control density of building on land;
• Control means of access to land or buildings;
• Regulate height, design, appearance and sitting of buildings;
• Grant planning consent;
• Recommend approval of applications made by developers for sub-division
of land or plots
Part IV, Section 29 (1) requires that no person shall develop any land within a
planning area without planning consent granted by the planning authority or
otherwise than in accordance with planning consent and any conditions specified
therein. Subsection (3) of the same part requires the submission of an
environmental impact assessment report for any development for which the
planning authority is of the opinion that the project development activities shall
have injurious impact on the environment.
The Health Laboratory Practitioners Act, 2007
The Health Laboratory Practitioners Act provides for the registration of health
laboratory practitioners and for related matters. Among other things, the Act, in
Part II, Section 6-(2) (b) mandates the Health Laboratory Practitioners’ Council
to:
• regulate the standards and practice of the professional health laboratory;
• advise the government on matters relating to delivery of health
laboratories services and performance of functions by health laboratory
practitioners;
• advise and regulate implementation of the curricula for the training of
health laboratory assistants, health laboratory technologists and health
laboratory scientists; and
• prescribe standards and conditions for establishing a training institution.
The Water Resources Management Act, 2009
Among other things, the Act provides for sustainable management and
development of water resources and for prevention and control of water pollution
and degradation.
One of the objectives of the Act is to ensure that the nation’s water resources are
protected by preventing and controlling pollution. The Act requires every person
residing in the Mainland Tanzania to have a stake and a duty to safeguard and
protect water resources and to inform the relevant authority, of any activity and
88

phenomenon that may affect the quantity and quality of the water resources
significantly.
The Act, without prejudice to the provisions of Section 57 of the Environmental
Management Act, provides for the Minister to prohibit human activities to be
conducted within sixty metres of any water dam or reservoir or water source.
The Constitution of the United Republic of Tanzania (1977-1995)
The Constitution of the United Republic of Tanzania has no express provision for
environmental protection. However, it has clauses for protection of natural
resources including land and other state property. Article 27 (1) of the
Constitution stipulates that: "Every person has the duty to protect the natural
resources of the United Republic of Tanzania, the property of the state authority,
all the property collectively owned by the people, and also to respect another
person's property." These provisions, for protection of natural resources have a
bearing on protection of the environment.
The Constitution also provides for the protection of the rights and interest of
citizens in matters concerning their property and acquisition. Article 24 (I) states
that every person is entitled to own property, and has a right to the protection of
his property held in accordance with the law. Sub-article (2) prescribes that it is
unlawful for any person to be deprived of property for any purposes, without the
authority of law, which makes provision for compensation.
The national constitution must be observed, especially in matters concerning
protection of natural resources. Under such circumstances the project is required
to ensure that contaminated water and hospital wastes are not discharged into
the environment and that natural resources are protected by adhering to the
recommendations of this ESMF.
The Environmental Management Act (2004)
The Environmental Management Act (EMA) provides the legal and institutional
framework for management of the environment and implementation of the
nation's Environment Policy. Part VI Sub-section 81(1) of the Act requires a
project proponent or developer to undertake Environmental Impact Assessment
at his/her own cost, prior to commencement or financing of a project or
undertaking. The types of projects requiring EIA are listed in the THIRD
SCHEDULE of the Act. In that regard the Act prohibits any development requiring
an EIA, to start without out an EIA certificate.
For effective implementation of the national environmental policy objectives, the
Act has identified and outlined specific roles, responsibilities and functions of
various key players and provided a comprehensive administrative and
institutional arrangement, comprised of:
National Advisory Committee
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Minister Responsible for Environment
Director of Environment
National Environmental Management Council (NEMC)
Sector Ministries
Regional Secretariat
Local Government Authorities (City, Municipal, District and Town
Councils)
The National Environment Management Council (NEMC) was established under
the provisions of the National Environmental Management Act of 1983. NEMC is
responsible for managing the EIA review process before advising the Minister
responsible for Environment, to consider issuing Environmental Permits. NEMC
is charged with the enforcement of compliance, review and monitoring of
environmental impact assessment as well as facilitation of public participation in
environmental decision making. Among its functions, NEMC reviews EIAs and
recommends them (or not) for approval and identifies projects or programmes for
which environmental audit or monitoring must be conducted. Among its other
duties, NEMC gives notification of public meetings for reviews of Environmental
Impact Statements (EIS) and ensures availability of related reports and
documents to those affected or involved.
Sub-section 86(1) stipulates that the Council shall, upon examination of a project
brief, require the proponent of a project or undertaking to carry out an
Environmental Impact Assessment study and prepare an EIS. According to Subsection
1-4 of the Act, the EIS should be submitted to the Council, which carries
out a review through its Technical Review Committee (TRC). During the review
process, the Council is required to make a site visit, for inspection and
verification of the project details and costs.
The Minister responsible for Environment has powers to delegate responsibility
for approval of EISs to the Director of Environment, LGAs and Sector Ministries.
The Sector Ministries are supposed to establish environmental management
sections, to liaise with the Ministry responsible for environmental matters. In
particular, it is the responsibility of the Environmental Section of each Ministry to
ensure that environmental concerns are integrated into the Ministries’
developmental planning and project implementation, to protect the environment.
The Environmental Management Sections of the Ministries are charged with
overseeing the preparation of EIAs required for investment in their sectors (EMA
paragraph 31 (k)). Each Ministry is required to appoint a Sector Environmental
Coordinator for all activities and performance of functions related to the
environment for the Ministry.
In addition there is (at the regional level) a Regional Environmental Management
Expert (REME) who advises Local Authorities on matters relating to the Act.
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In each city, municipality, district or town council, there is an appointed
Environmental Management Officer (EMO) and an Environmental Management
Committee (EMC). The EMOs’ responsibilities include monitoring of the
preparation, review and approval of EIAs for local investments. The EMOs report
to the Director of the Environment on implementation of the Act within their area
of jurisdiction.
The Act is relevant to the project in that it will have some impacts on the
environment. Thus, environmental management and monitoring of the impacts
arising from the project would require adherence to the environmental provisions
of the Act.
The Environmental Impact Assessment and Audit Regulations (2005)
The Environmental Impact Assessment and Audit regulations (2005) derive from
the Environmental Management Act. The regulations provide guidelines for
undertaking EIA and Environmental Audit (EA) for development projects with
significant environmental impacts.
The FIRST SCHEDULE of the regulations gives a list of projects requiring an EIA
and those that do not. According to the Schedule, Type “A” projects require an
EIA while Type B projects require preliminary environmental assessment (PEA).
Type B Projects are those likely to have some significant adverse impacts the
magnitude of which is not well known. Hence, a PEA would determine whether or
not the project should proceed without a full EIA. This practice is in line with the
screening process presented in this ESMF.
Part III, Section 5 of the EIA and EA Regulations requires the potential developer
to submit a project brief for the proposed project to the NEMC. Section 6(1)
specifies issues to be covered in the project brief and Section 6(3) requires the
project brief to be prepared by a registered environmental impact assessment
expert. According to Section 11(1), the developer is required to undertake an
environmental impact assessment if the project brief has no sufficient mitigation
measures; or undertake a preliminary assessment if more information is required
to determine a screening decision.
Section 11(2) outlines the steps and general contents of a PEA to include
description of the project characteristics and the affected environment,
identification of impacts on the local environment and assessment or evaluation
of the significance of the impacts.
Part IV, Section 13(1) requires the developer to conduct EIA in accordance with
the general environmental impact assessment guidelines and in accordance with
the steps outlined in the FOURTH SCHEDULE of the regulations. Section 16
requires the EIA study to cover environmental, social, cultural, economic and
legal issues.
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Part X, Section 44 (1 and 2) outlines the objectives of Environmental Audits and
its principal functions. Section 45 outlines the basic principles under which the
environmental audit is conducted and Section 46(1) specifies the type of projects
requiring environmental audits as specified in the THIRD SCHEDULE to the EMA
and the FIRST SCHEDULE of the EIA and EA regulations
The outline given above presents the conditions under which an EIA would have
to be prepared and the steps to be followed for preparation the EIA, should this
be required for the Regional Health Systems Strengthening and TB Support
Project.
Mining (Environmental Management and Protection) Regulation
(1999)
The Mining (Environmental Management and Protection) Regulation of 1999 was
established under the Mining Act of 1998. The Act requires mining applicants to
undertake EIA for mining projects. It also requires an Environmental Impact
Statement and Environmental Management Plan (EMP) to accompany
application for mineral rights.
Opening and operation of new borrow pits and quarry sites for the Regional
Health Systems Strengthening and TB Support Project will require application for
mining license. In addition, the owners and operators of the borrow pits and
quarry sites will be required to:
undertake EIA and submit an EIS and EMP;
restore borrow pits and quarry sites before abandonment and;
follow environmental regulations.
For the Regional Health Systems Strengthening and TB Support Project, there
may be no need for development and operation of new borrow pits and quarry
sites. However, should need arise, the consultant and contractor have to take
note of the above requirements and in addition, to observe the requirements of
the Mining (Safe Working and Occupational Health) Regulations (1999) which
prescribe the safety precautions and procedures to be followed in mining areas.
The Land Act (1999) and the Land Regulations (2001)
Land tenure and ownership in Tanzania is governed by the National Land Act
(No. 4 of 1999), Village Land Act (No.5 of 1999), Land Regulations 2001
Subsidiary Legislation, Land Acquisition Act (1967), Land Ordinance (1923 Cap.
113) and Town and Country Planning Ordinance (1956 Cap. 378); as well as the
1977 Constitution of the United Republic of Tanzania.
Land in Tanzania is owned by the State. Public land is either general land, village
land or reserved land. Development activities are permitted on general village
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land and not on restricted land reserved for national parks, protected areas and
wildlife forest reserves.
Public land has a dual system of tenure (customary and statutory rights of
occupancy). Tenure rights to land can be held by individuals and by
communities. Holdings of individuals can be (i) by leasehold right of occupancy
for varying periods e.g. 33, 66, or 99 years which must be confirmed by a
certificate of occupancy; (ii) by customary rights of occupancy, which must be
confirmed by a certificate of Customary Right of Occupancy and have no
specified term limit. Communities or Villages are allowed to hold land and to
manage it, although they do not formally own the land. Land tenure mechanisms
of relevance to the Regional Health Systems Strengthening and TB Support
Project are that:
• approved land use plans or layout and cadastral survey plan form the
basis for plot allocations
• Individuals land owners are given letters of offer (title) which state the size
of plot, use/development conditions, payable land rent, duration of
ownership and other covenants.
Plot owners are required by law, to prepare building plans according to
use/development conditions in the letter of offer and building permit from the
Local Authority. A change of land use requires an application to the Local
Authority. This has subsequently to be approved by the Minister responsible for
Lands.
Land acquisition for development of public infrastructure
Government departments intending to construct public buildings must also meet
the requirements for approved land use plan, cadastral survey plan, application
of change of use, building plans and building permit. Government institutions are
however, given a Letter of Allocation instead of a letter of offer (title) and
presently the government is exempted from paying land rent.
In cases where the government fails to obtain land through the usual allocation
procedures, the Land Acquisition Act No 47 of 1967 gives power to the President
to acquire "Land" from private occupants, where such land is required for any
public purpose. This Act, under section 4 (1) states that land shall be deemed
required for a public purposes, for exclusive Government use, for general public
use, for any Government scheme, for the development of agricultural land or for
the provision of sites for industrial, agricultural or commercial development, social
services or housing. The Land Acquisition Act further empowers authorized
Government officials to investigate land, in any locality for its possible acquisition,
for any public purpose.
The Act prescribes how compensation should be assessed for those whose
interest on land has been violated and directs the Government to pay for all
damage done. In case of dispute over the amount to be paid, either the Minister
or the person claiming compensation may refer such dispute to the Regional
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Commissioner in which the land is situated and the decision of the Regional
Commissioner shall be final.
The Minister should give notice of intention to acquire the land, to the persons
interested or claiming to be interested in such land, or to the persons entitled to
sell or convey the same. The Minister may by notice, direct the persons to yield
up possession of such land after the expiration of a period of not be less than six
weeks from the date of the publication of the notice in the Gazette.
Valuation of land and properties for compensation
Valuation and compensation are also provided for in the above Acts. In
assessing the value of improvements for compensation, the value should be that
which the said improvements can fetch if sold in the open market. According to
the regulations, assessment of the value of land and un-exhausted
improvements should be done by a Qualified Valuer and verified by the Chief
Valuer of the Government or his/her representative, following procedures
outlined in the Land (Compensation Claims) Regulations (2001) and the Land
(Assessment of Value for Compensation) Regulations (2001). The compensation
values should include the following: -
(i) the market value of the real property;
(ii) disturbance allowance;
(iii) transport allowance;
(iv) loss of profits or accommodation;
(v) cost of acquiring or getting the subject land and;
(vi) any other immediate costs or capital expenditure incurred on the
development
of the subject land.
Where the Regional Health Systems Strengthening and TB Support Project may
involve destruction of crops, properties or land acquisition, valuation is to be
effected according to existing legislation. However, this may easily be avoided by
early planning of construction works and appropriate notices being given to any
current casual users of the land.
Compensation
It is constitutional right in Tanzania that if one's property is either acquired or
nationalized, the individual so affected must be compensated for. Any person
whose right of occupancy, or recognized long-standing occupation, or customary
use of land is revoked; or otherwise interfered with to their detriment by the State
under the Land Act, or acquired under the Land Acquisition Act, is entitled to a
full, fair and prompt compensation. Compensation means paying for the loss
suffered or to be suffered by an individual, for his property (land) being acquired,
in such a manner that the affected is not negatively affected for loss of his
property.
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Compensation under Section 156 of the Land Act No. 4 of 1999 applies for nongovernmental
corporate body, institutions or group of persons. The Section
requires compensation to be paid to any person, for the use of land of which
he/she is in lawful or actual occupation as a communal right of way and with
respect to a way leave. These include:
Any damage suffered in respect of trees, crops, and buildings as result of
creation of way leave;
Damage due to surveying or determining the route of that way leave.
It is the responsibility of the government department of Ministry, Local
Government Authority or corporate body that applied for right of way to pay
compensation.
According to The Land (Compensation Claims) Regulation 2001, made under the
Land Act No.4 of 1999, the following are eligible for compensation / resettlement:
Holder of right of occupancy (Section 22 of the Land Act of 1999);
Holder of customary right of occupancy whose land has been declared a
hazard land (Section 49 of the Land Act, 1999)
Holder of customary land, whose land becomes granted to other person
and is moved or relocated under Section 34 of the Land Act, 1999;
Land obtained as a consequence of disposition by a holder of right of
granted or customary right of occupancy but is refused a right of
occupancy under section 54 of the Land Act, 1999;
Urban or peri-urban land acquired by the President under Section 60 of
the Land Act, 1999.
Sub-section 2 of Section 9 applies to all applications or claims for compensation
against government or Local Government authority, public body or institution.
According to Section 10(1) compensation shall take the form of:
Monetary compensation;
Plot of land of comparable quality, extent and productive potential to the
land lost;
A building or buildings of comparable quality, extent and use comparable
to the building or buildings lost;
Plants and seedlings;
Regular supplies of grain and other basic foodstuffs for a specified time.
The Occupational Health and Safety Act (2003)
The Occupational Health and Safety Act No. 5 of 2003, deals with regulation of
health, safety and welfare of workers in factories/ workplaces. Some of the
provisions that could be relevant to the project require the employer and
contractor to:
appoint a safety and health representative and a committee;
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egister their workplace before operation.
provide safety precautions;
ensure health and welfare of workers
ensure proper handling of hazardous materials / chemicals and process.
The Occupational Health and Safety Act is very important for the Regional Health
Systems Strengthening and TB Support Project during the civil works
construction as well as during the operation of the laboratory services.
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