ANNEX 4 - Rwanda_THRIVE_Project_IEE_FINAL_06102020.pdf

RWANDA/THRIVE PROJECT

USAID 216 IEE TEMPLATE VERSION 2, APRIL 2018

INITIAL ENVIRONMENTAL EXAMINATION

Project/Activity Data Project/Activity Name: USAID/Rwanda Thrive Project

Geographic Location(s) (Country/Region): Rwanda/East Africa Amendment (Yes/No), if Yes indicate # (1, 2...):

No

Implementation Start/End Date (FY or M/D/Y):

2020 – 2025

If Amended, specify New End Date: N/A Solicitation/Contract/Award Number: N/A Implementing Partner(s): N/A Bureau Tracking ID:

Tracking ID of Related RCE/IEE (if any):

Tracking ID of Other, Related Analyses:

Organizational/Administrative Data Implementing Operating Unit(s):

(e.g. Mission or Bureau or Office)

USAID/Rwanda Health Office

Other Affected Operating Unit(s): USAID/Rwanda Economic Growth Office Lead BEO Bureau: Africa Bureau Funding Account(s) (if available):

Original Funding Amount: $490,528,958

If Amended, specify funding amount:

If Amended, specify new funding total:

Prepared by: Khatidja Naithani Date Prepared: March 2020

ENVIRONMENTAL COMPLIANCE REVIEW DATA

Analysis Type: • Environmental

Examination

• Deferral

Environmental Determination(s): • Categorical Exclusion(s)

• Negative

• Positive

• Deferred (per

22CFR216.3(a)(7)(iv) IEE Expiration Date (if different from implementation end date):

Additional Analyses/Reporting Required:

Climate Risks Identified (#): Low ___X__ Moderate __X____ High ______ Climate Risks Addressed (#): Low ___X___ Moderate ___X__ High ______

THRESHOLD DETERMINATION AND SUMMARY OF FINDINGS

PROJECT/ACTIVITY SUMMARY

The Health Office believes that—through strengthening the health system for increased sustainability; improving utilization of health, nutrition and WASH services; and strengthening the capacity to address the health needs of high-risk individuals—we can improve the health outcomes for targeted populations. Activities within the Thrive Project will engage the mission, the Government of Rwanda, implementing partners, local civil society organizations, and the private sector. Moreover, the results of these activities are seen as mutually supportive and intersecting with other sectors programmed by USAID/Rwanda. In the nutrition and WASH sectors, the Health and Economic Growth (EG) teams plan to continue their long-standing collaboration and coordination with specific attention to nutrition-sensitive agriculture and animal-source foods. To support early childhood development and youth engagement, the health team envisions growing its collaboration with the Education team and Youth Advisor.

Finally, the focus on district-level capacity building for health programming and health services has highlighted the need for the Health Office to collaborate closely with its Democracy and Governance counterparts in its upcoming health program.

The Thrive Project will focus on the following three intermediate results:

IR 1: Health System Strengthened for Increased Sustainability: Moving beyond a focus on the health system in isolation, multiple systems and policies that cut across sectors must be strengthened in order to sustainably increase capacity of the GOR to self-govern and finance the health, nutrition, and WASH sectors.

IR 2: Improved Utilization of Health, Nutrition and WASH Services: Health care providers at community and facility levels will be supported to provide high quality services to the Rwandan population, along with creating increased demand for services and adoption of healthy behaviors.

IR 3: Strengthened Capacity to Address the Health Needs of High-Risk Populations: There will be focused interventions around early childhood development, GBV services, physical rehabilitation services for the disabled, and prevention of adolescent pregnancy (as well as support for teen mothers).

The proposed Thrive Project will consolidate and replace two existing projects:

1. The Community Health and Improved Nutrition (CHAIN) Project is a six-year (FY 2014-FY 2020), $182 million project to increase the utilization of quality health, nutrition, and WASH services and products by target populations and communities; and

2. The Strengthening the Capacity of Health Sector to Deliver Quality Health Services Project (SCHS) is a five-year (October 2014 – September 2019), $290.6 million project to strengthen Rwanda’s health system.

Funding by activity is included in Annex 1.

ENVIRONMENTAL DETERMINATIONS

Upon approval of this document, the determinations become affirmed, per Agency regulations

(22CFR216).

ACTIVITY TYPES

This analysis addresses the following activity types that can be expected under this IEE:

Activity Type 1: Training, mentoring, capacity building and technical assistance

Activity Type 2: Policy, strategy and tool development

Activity Type 3: Strengthening supply chain (procurement, warehousing, distribution and waste management)

Activity Type 4: Malaria Prevention

Activity Type 5: Infection Prevention Control (Training, technical assistance, and capacity building of workers, waste workers, staff, and volunteers in areas of PPE use, waste management, procurement, storage, and disposal of commodities, and disinfection)

Activity Type 6: Nutrition activities

Activity Type 7: WASH

Activity Type 8: Social Behavior Change

Activity Type 9: Refurbishment/rehabilitation

CLIMATE RISK MANAGEMENT

Rwanda is already impacted by climate change and will likely continue to be affected in numerous sectors including health, water, energy, and agriculture. With little adaptive capacity and extensive proliferation of non-climate stressors (e.g. degraded environments, conflict, land tenure issues), climate change impacts will continue to be felt by vulnerable populations in Rwanda and East Africa at large. Climate threats to project infrastructure may affect health in communities by contamination of water suppliers or increase of disease due to increased vector outbreaks. These risks are low to moderate in the time frame of this project, and will be addressed via strengthened surveillance systems, communication activities, and modification of project activity grants/contracts to incorporate specific language on climate risk assessment and subsequent management actions. Engineering analysis preceding design activities must include consideration of climate change and its potential impacts on the location (siting), functionality and sustainability of resulting infrastructure and infrastructure services. Such analysis must include identification of relevant data sets and gaps, review of local building standards and codes for adequacy; and determination of safety factors or other measures of uncertainty that will be carried through design. The results of this analysis, including risks identified and how they are addressed, shall be documented.

BEO SPECIFIED CONDITIONS OF APPROVAL

The activities in this IEE are likely to produce significant medical waste; refer to section 5.3 for mitigation measures on how medical waste should be handled.

IMPLEMENTATION

In accordance with 22CFR 216 and Agency policy, the conditions and requirements of this document become mandatory upon approval. This includes the relevant limitations, conditions and requirements in this document as stated in Sections 3, 4, and 5 of the IEE and any BEO Specified Conditions of Approval. If additional activities are added to the project outside of this document, an amendment will be submitted.

INITIAL ENVIRONMENTAL EXAMINATION

PROJECT/ACTIVITY NAME: Thrive Project

Bureau Tracking ID: ______________________

CONTENTS

PROJECT/ACTIVITY SUMMARY 2

ENVIRONMENTAL DETERMINATIONS 3

ACTIVITY TYPES 3

CLIMATE RISK MANAGEMENT 3

BEO SPECIFIED CONDITIONS OF APPROVAL 4

IMPLEMENTATION 4

USAID APPROVAL OF INITIAL ENVIRONMENTAL EXAMINATION Error! Bookmark not defined.

1.0 PROJECT/ACTIVITY DESCRIPTION 6

1.1. PURPOSE AND SCOPE OF IEE 6

1.2 PROJECT/ACTIVITY OVERVIEW 6

1.3 PROJECT/ACTIVITY DESCRIPTION 7

BEO CONDITIONS OF APPROVAL 10

2.0 BASELINE ENVIRONMENTAL INFORMATION 11

2.1 LOCATIONS AFFECTED AND ENVIRONMENTAL CONTEXT (ENVIRONMENT,

PHYSICAL, CLIMATE, SOCIAL). 11

2.2 APPLICABLE AND APPROPRIATE PARTNER COUNTRY AND OTHER

INTERNATIONAL STANDARDS (E.G. WHO), ENVIRONMENTAL AND SOCIAL LAWS,

POLICIES, AND REGULATIONS 14

2.3 COUNTRY/MINISTRY/MUNICIPALITY ENVIRONMENTAL CAPACITY ANALYSIS (AS

APPROPRIATE) 16

4.0 ENVIRONMENTAL DETERMINATIONS 23

4.1 RECOMMENDED ENVIRONMENTAL DETERMINATIONS AND CONDITIONS 23

4.2 CLIMATE RISK MANAGEMENT 26

5.0 CONDITIONS AND MITIGATION MEASURES 34

5.1 CONDITIONS 34

5.2 AGENCY CONDITIONS 35

5.3 MITIGATION MEASURES 36

6.0 LIMITATIONS OF THIS INITIAL ENVIRONMENTAL EXAMINATION 40

7.0 REVISIONS 41

1.0 PROJECT/ACTIVITY DESCRIPTION

1.1. PURPOSE AND SCOPE OF IEE

The purpose of this document, in accordance with Title 22, Code of Federal Regulations, Part 216 (22CFR216), is to provide a preliminary review of the reasonably foreseeable effects on the environment of the USAID/Rwanda Thrive Project described herein and recommend determinations and, as appropriate, conditions, for these activities. Upon approval, these determinations become affirmed, per 22CFR216 and specified conditions become mandatory obligations of implementation. This IEE also documents the results of the project/activity level Climate Risk Management process in accordance with USAID policy (specifically, ADS 201mal).

This IEE is a critical element of USAID’s mandatory environmental review and compliance process meant to achieve environmentally sound activity design and implementation. Potential environmental impacts should be addressed through formal environmental mitigation and monitoring plans (EMMPs) and/or Environmental Assessments (EAs), if needed.

In addition, this IEE sets out activity-level implementation procedures intended to ensure that conditions in this IEE are translated into project-specific mitigation measures, and to ensure systematic compliance with this IEE during project and activity implementation. These procedures are themselves a general condition of approval for the IEE, and their implementation is therefore mandatory. This IEE is a critical element of a mandatory environmental review and compliance process meant to achieve environmentally sound activity design and implementation

AOR/CORs are responsible for ensuring that the Mission Agreement Officer (AO) and/or Contracting Officer (CO) incorporate these conditions into all solicitation documents and, thereafter, into contracts, grants, cooperative agreements, or other implementing mechanisms.

This is especially important during the Post Award Briefings and during work plan preparation and work plan reviews. Incorporation of environmental requirements in procurement documents ensures that Implementing Partners (IPs) apply environmental compliance issues during the design, planning, implementation, monitoring and evaluation of activities.

This IEE replaces and supersedes the Mission’s previous health IEEs; except that ongoing activities operating under an approved environmental mitigation and monitoring plan (EMMP) may continue operating under that EMMP.

1.2 PROJECT/ACTIVITY OVERVIEW

For many years, USAID has been supporting a number of facility and community health service delivery and health systems strengthening activities. This support, along with that of other donors and stakeholders and the leadership of the Government of Rwanda, has led to significant development progress and improvements in the health sector and health outcomes. As a result, the focus of USAID activities and development assistance may need to shift in its new Thrive Project. The approach for Thrive will be to coordinate various sectors and programs in support of improved health. The activities of the project will encompass nutrition, WASH, agriculture and economic growth, early childhood development, youth engagement, and capacity building at the district level.

1.3 PROJECT/ACTIVITY DESCRIPTION

TABLE 1: DEFINED OR ILLUSTRATIVE PROJECTS/ACTIVITIES AND SUB-ACTIVITIES

Activity Type Implementing Mechanism IRs/Sub IRs

Activity Type 1: Training, mentoring, capacity building and technical assistance

-Ubaka Ejo -Turengere Abana -Gimbuka

-ACHIEVE

-Rwanda Integrated Health Systems Activity -Ingobyi Activity -Nutrition Activity -WASH Activity -Rwanda Demographic and Health Survey -One Health Workforce NextGen

-MDIVE

-Digital Square -Ingobyi Activity Follow-On -OVC/DREAMS Follow-on -HSS (RIHSA Follow-on) -GHSA/EPT Preparedness

IR1/Sub-IRs 1.1, 1.2, 1.4 IR2/Sub-IRs 2.1, 2.2, 2.3, 2.4 IR3/Sub-IRs 3.1, 3.2, 3.3, 3.4

Activity Type 2: Policy, strategy and tool development

-Rwanda Integrated Health Systems Activity -WHO Consolidated Grant -Ingobyi Activity -Nutrition Activity -WASH Activity -One Health Workforce NextGen -Ingobyi Activity Follow-On

-ACHIEVE

-OVC/DREAMS Follow-on -HSS (RIHSA Follow-on) -GHSA/EPT Preparedness

IR1/Sub-IRs 1.1, 1.2, 1.4 IR2/Sub-IRs 2.1, 2.2, 2.3, 2.4 IR3/Sub-IRs 3.1, 3.2, 3.3, 3.4

Activity Type 3: Strengthening supply chain (procurement, warehousing, distribution and waste management)

-Medicines, Technologies and Pharmaceutical Services -Global Health Supply Chain - Procurement Supply Management -Rwanda Medical Supply, Ltd.

-Promoting the Quality of Medicines +

IR1/Sub-IRs 1.1, 1.2, 1.3

Activity Type 4: Malaria Prevention

-CDC Interagency Agreement -VectorLink -Environmental Compliance Support -Ingobyi Activity -Impact Malaria -Ingobyi Activity Follow-on

IR2/Sub-IRs 2.1, 2.4

Activity Type 5: Infection Prevention Control (Training, technical assistance, and capacity building of workers, waste

-Ingobyi Activity -Ingobyi Activity Follow-On -GHSA/EPT Preparedness

IR2/Sub-IR 2.2 workers, staff, and volunteers in areas of PPE use, waste management, procurement, storage, and disposal of commodities, and disinfection)

Activity Type 6: Nutrition activities

-Nutrition Activity IR2/Sub-IR 2.1, 2.4 IR3/Sub-IR 3.1

Activity Type 7: WASH

-Isuku Iwacu -WASH Activity - Private Sector and Water Supply

IR2/Sub-IRs 2.1, 2.3, 2.4, 3.1, Activity Type 8: Social Behavior Change

-Ubaka Ejo -Turengere Abana -Gimbuka

-ACHIEVE

-RSMP

-Ingobyi Activity -Ingobyi Activity Follow-On -Nutrition Activity -WASH Activity - Private Sector and Water Supply -OVC/DREAMS Follow-on -GHSA/EPT Preparedness -Social Marketing for Health Products

IR2/Sub-IRs 2.1, 2.3, 2.4 IR3/ Sub-IRs 3.1, 3.2, 3.4

Activity Type 9:

Refurbishment/rehabilitation

-Ivuriro Iwacu -Ingobyi Activity

IR2/ Sub-IR 2.2

Project/Activity / Result 1: Health System Strengthened for Increased Sustainability

1.1 Strengthened Financing and Governance of the Health System

- Reduce financial barriers to health care through a mix of public and private interventions and provide tools for improved domestic resource mobilization and improve health care financing for the GOR

- Provide TA to MOH, RSSB and others for a sustainable CBHI system

- Strengthen the accreditation process at hospitals and health centers

- Create/strengthen fora for community engagement for accountability

1.2. Improved use of data for evidence-based decision making

- Training and mentoring in data use

- Track and respond to trends in data

- Build capacity of government staff to conduct/use quality of care surveys, audits of maternal, newborn and child deaths/near misses

1.3. Improved efficiency of the supply chain

- Strengthen and support a parastatal supply chain organization to improve efficiency and ensure sustainability of the national supply chain

1.4. Strengthened ability to prevent, detect and respond to Global Health Security threats

- Strengthen university networks to develop and deliver sustainable training that equip current and future professionals with competencies to address complex health issues

- Procurement of PPE and renovation of EVT isolation units; Training of CHWs on awareness, recognition, and reporting of EVD Project/Activity /Result 2: Improved Utilization of Health, Nutrition and WASH Services

2.1 Improved quality of community-based services

- Establish and support savings groups complying with evidenced based modalities

- Implement an evidence-based financial literacy curriculum

- Deliver evidence-based curricula on HIV, SRHR, nutrition and hygiene that is age-appropriate

- Train community workers to facilitate access to adolescent-friendly HIV and SRHR services

- Implement a mentoring program for OVC and AGYW enrolled in the program

- Implement an evidence-based violence prevention program

- Enable policy environment for water and sanitation at district level

- Engage Private sector to increase water, sanitation and hygiene services

- Indoor residual spraying for malaria prevention

- Improved malaria diagnosis and response

2.2 Improved quality of facility-based services

- Apply WHO maternal and newborn, pediatric, and small and sick newborn quality of care standards

2.3 Increased demand for services

- Increase basic sanitation services in households

- Promote behavior change related to WASH

- Increase early ANC visits

- Increase uptake of family planning services

2.4. Increased adoption of healthy behaviors

- Promote positive health behaviors in the antenatal period, immediate and essential newborn care, for prevention of common childhood illnesses

- Promote nutrition, and dietary practices for women of reproductive age

- Promote optimal infant and young child feeding practices

- Strengthen referral pathways from community to facility

- Promote behavior change related to WASH Practices

- Promote malaria prevention activities

Project/Activity 3: Strengthened Capacity to Address the Health Needs of High-Risk Individuals

3.1 Increased effectiveness of ECD programs

- Support establishment of ECD services at community growth promotion sites

- Improve positive parenting and early stimulation from 0-6 years

- Increase access for children with disabilities to ECD services

- Strengthen community-based growth monitoring and promotion including tracking of child stunting at community level

- Build the capacity of community providers to deliver integrated nutrition, ECD, WASH, and related health services

- Strengthen referral pathways from community to health facilities on acute malnutrition and development challenges for children

3.2 Increased access to comprehensive services for GBV victims

- Support community service providers, families, and girls and young women in efforts to prevent and to respond appropriately to violence

- Strengthen community linkages to facilities that offer post-violence care including PEP and emergency contraceptives, and education about PEP

- Develop tools and procedures to strengthen the successful facilitation of violence response services by community cadres

3.3 Increased access to quality sustainable physical rehabilitation services

- Map and strengthen referral pathways

- Community outreach/orientation to raise awareness about availability/importance of rehabilitation services and increase demand

- Targeted support to persons with disabilities and their families, or Disabled Persons

Organizations (DPOs)/community-based organizations to facilitate access to services and opportunities

- Develop and implement relevant trainings for existing and emerging relevant professionals

3.4 Adolescent pregnancy reduced and teen mothers supported

- Support at risk adolescent girls and teen mothers

- Support youth-friendly health services to enable adolescents to access contraceptives

BEO CONDITIONS OF APPROVAL

The activities in this IEE are likely to produce significant medical waste; refer to section 5.3 for mitigation measures on how medical waste should be handled.

2.0 BASELINE ENVIRONMENTAL INFORMATION

2.1 LOCATIONS AFFECTED AND ENVIRONMENTAL CONTEXT (ENVIRONMENT, PHYSICAL,

CLIMATE, SOCIAL).

Activities implemented by the Health Office take place throughout the country and a variety of environmental situations may be encountered. Over the life of the PAD, USAID anticipates further refinements and adjustments to the targeted districts to ensure support is reaching those most in need, as well as being harmonized with other Mission priorities and investments by the GOR and other development partners. The country’s environmental baseline is summarized in section 2.2 below.

Rwanda, known as the “land of a thousand hills”, is a small fertile country in the heart of Africa.

The Rwandan relief is hilly and mountainous with an altitude averaging 1700 meters. The highest point on Mt Karisimbi is 4,507 meters above sea level. Rwanda has volcanic mountains at the northern fringe and undulating hills in most of the central plateau. However, the eastern part of the country is relatively flat with altitudes well below 1500 meters. This relief pattern gives Rwanda a mild and cool climate that is predominantly influenced by altitude. The average temperature is 20 degrees Celsius with monthly variations of about 1.5 degrees. Total average annual rainfall is around 1,028 mm and it follows the typical bimodal pattern found in other parts of Africa (REMA Rwanda: State of Environment and Outlook Report, 2017). The lowlands of the southwest in Bugarama plain with an altitude of 900m are part of the tectonic depression of the African Rift Valley. It shares boundaries with the Democratic Republic of Congo (DRC) in the west, Uganda to the north, Tanzania to the east, and Burundi to the south.

Rwanda’s hilly topography and the rainy climate together create conditions that lead to floods and landslides, exacerbated by the influx of migrants to unplanned urban settlements on fragile slopes combined with increased rainfall due to climate change. In particular, climate change is predicted to cause excessive rainfall in the western part of the country and at the same time long dry spells in some areas of the East, both leading to regular food insecurity with associated nutrition and health consequences It is projected that between 1970 and 2050, average annual rainfall will increase by up to 20 percent. As well, climate change is likely to increase average temperatures, which could alter the growing range of key crops, lead to food insecurity and water stress and potentially force even more subsistence farmers to migrate to informal urban settlement (REMA Rwanda: State of Environment and Outlook Report, 2017). The changes will lead to various environmental and health challenges for the country.

Rwanda’s economy and the livelihoods of its people are inextricably linked to the environment and the country’s natural resources such as water, land, air, plants, and animals.

Population

Rwanda’s population growth over the last 4 decades has been unprecedented from approximately

2.6 million in 1960 to 8.2 million in 2002 (National Census Service, 2005) to a population in mid- 2014 was estimated at around 11.1 million people, with a population growth rate of 2.3 percent (Population Reference Bureau, 2014). That population growth rate implies a population doubling time of 30 years. Rwanda is the most densely populated country in Africa, with an average of 421 people per km².

Forest Cover

Rwanda has a wide variety of forested landscapes that fall into four categories namely:

- Afro-montane rainforests: the natural forests of the Congo Nile Ridge comprised of Nyungwe National Park (NNP), Gishwati, and Mukura; the natural forests of Volcanoes National Park (VNP);

- Natural forests in savannah and gallery-forest in the Akagera National Park (ANP) and remnants of gallery forests and savannahs of Bugesera, Gisaka and Umutara;

- Tree plantations dominated by exotic species (Eucalyptus spp, Pinus spp, Grevillea robusta, etc.); and

- Trees scattered on farmlands (agroforestry species) and along anti-erosion ditches.

Since about 2007, Rwanda has stemmed forest loss and significantly increased the area under forest cover by banning timber felling in indigenous forests and state plantations and through an aggressive tree-planting program. By 2015, 29.2% of the country was covered in forest. Natural forests, which cover 10.8% of the country, are comprised of an association of forested belts in national parks, forest reserves, natural and gallery forests, and other remnant forests. Human-made forests consisting of forest plantations of exotic tree species (mostly eucalyptus and pine,) woodlots, and agroforestry plantations cover 18.4% of the country and make up 63% of all forest cover.

Biodiversity and Protected Areas (national parks and reserves).

Rwanda is one of Africa’s most biologically rich regions, with some 2,150 known plant species, 151 mammal species (representing 40% of Africa’s mammalian species,) 87 species of amphibians and reptiles, and 670 bird species. It is home to about 30% of the global population of mountain gorillas and provides habitat for a large troupe of 500 chimpanzees as well as many other primate species. According to the Rwanda Development Board Annual Report, the tourism sector brought in $438 million in revenues in 2017, a significant proportion of which was generated by gorilla tourism. Gorilla-related tourism not only protects the species and its habitat but also generates jobs and combats poverty through revenue sharing schemes.

Rwanda has four types of protected areas which include national parks (Akagera National Park, Nyungwe National Park, Volcanoes National Park, and the Gishwati-Mukura National Park); forest reserves (Iwawa Island forest); forests of cultural importance (Buhanga forest); and wetlands of global importance (Rugezi-Bulera-Ruhondo wetland complex). Besides those forests with a legal status of protected areas, there are other forests of cultural importance (Busaga forest in Muhanga district) and other remnants natural forests which are more or less protected by law. In fact, the current law on forests prohibits human activities in natural forest.

Rwanda’s hydrological network

Rwanda is endowed with abundant water resources, but they are unevenly distributed over the country’s area and throughout the year. The main watersheds are the Congo and Nile River Basins. Rwanda’s hydrological network includes numerous lakes and rivers and their associated wetlands.

The major lakes include Kivu, Burera, Ruhondo, Muhazi, Cyohoha, Sake, Kilimbi, Mirayi, Rumira, Kidogo, Mugesera, Nasho, Mpanga, Ihema, Mihindi, Rwampanga and Bisoke Crater Lake. The major rivers include the Akagera, Akanyaru, Base, Kagitumba, Mukungwa, Muvumba, Nyabarongo, and Ruvubu in the Nile Basin and Koko, Rubyiro, Ruhwa, Rusizi, Sebeya in the Congo Basin.

An inventory of wetlands was conducted by the Rwanda Environment Management Authority (REMA) showed that Rwanda has 860 marshlands and 101 lakes covering a total surface of 278,536 ha (10.6 % of the country surface area), and 149,487 ha (5.7% of the country surface area), respectively. This inventory also found 861 rivers totaling 6,462 km in length. 41 percent of the inventoried marshlands a recovered by natural vegetation, 53 percent are under cropping (which represents about 148 344 ha), and about 6 percent are fallow fields. The biggest marshlands are associated with and clustered around the rivers. Rugezi and Kamiranzovu are high altitude wetlands while most of the others are low altitude.

Energy Rwanda has ample non-renewable and renewable energy resources, including peat and methane deposits, and hydro, geothermal, solar and sustainable biomass. Current electricity generation is as follows: Hydro is 48 percent of the installed capacity, Diesel & Heavy Fuel Oil 25 percent, Methane gas 14 percent, Peat seven percent and Solar six percent. Rwanda imports all of its oil-based products.. Biomass production, transport, and combustion have important environmental impacts, including the release of methane and carbon dioxide. Only 23 percent of Rwanda’s households (500,000 customers) are connected to the grid, and its per capita electricity use, at 42 kWh per year, is one of the world’s lowest (REMA State of the Environment, 2015).

Agriculture Landholdings in Rwanda are very small (50% cultivating less than 0.5 ha, and more than 25% cultivating less than 0.2 ha). Crops are grown on steep slopes of up to and above 55% grade.

Agriculture, especially rain-fed subsistence farming, continues to be the most important economic sector in Rwanda. According to the GDP National Accounts, at the end of 2018, the agriculture sector accounted for 30% of GDP and, according to the EICV5, employs 69% of the working population. Agriculture also makes up the largest share of land use nationally according to the NISR’s report on Rwanda Natural Capital Accounts - Land in 2018. Based on 2014 data from the land administration information system, agriculture accounts for 60.6% of land use, followed by forestry (9.3%) residential (8.5%), livestock (5.7%), and industrial (0.2%). Respectively, 13.5% and 2.2% of land use is categorized as “unclassified” and “other”.

Climate change Rwanda is highly vulnerable to the impacts of climate change, especially temperature and rainfall fluctuation, since it relies heavily on rain-fed agriculture for subsistence livelihoods and tea and coffee cash crops.

According to the Rwanda Health Project Climate Change Considerations prepared by USAID, by the 2050s, the average annual temperature in Rwanda is expected to increase by 1.4-2.3°C and the duration of heat waves will increase by 7-22 days. Rwanda will likely experience an increase in average rainfall (range of -3 to +9 percent) and an increase in the frequency (7-40 percent) and intensity (2-11 percent) of heavy rainfall (7-40 percent). Rwanda will also likely experience an increase in the duration of dry spells with a range of 0 to +7 days.

Increases in rainfall, drought, and temperature fluctuation all have effects on population health, which are described with mitigation and adaptation recommendations in Section 4.2 Climate Risk Management.

2.2 APPLICABLE AND APPROPRIATE PARTNER COUNTRY AND OTHER INTERNATIONAL

STANDARDS (E.G. WHO), ENVIRONMENTAL AND SOCIAL LAWS, POLICIES, AND

REGULATIONS

In Rwanda, and also at the global level, there is growing concern that development activities may cause damage to the environment and the natural resources upon which economies are based.

A major national challenge in Rwanda today is how to maintain sustainable development without damaging the environment. As a result, environmental management in Rwanda has been given great prominence. Rwanda has strong environmental regulations—inspired by donors and regional and international conventions ratified by Rwanda—and a major focus of environmental management has been to ensure adherence with the established regulations.

The political and economic context affecting the environment is also described in national and sectorial development strategies, policies, plans, and laws, most of which have been reviewed and updated in the last 10 years. In 2005, Rwanda Environment Management Authority (REMA) was established to act as the implementation organ of environment-related policies and laws.

REMA is also tasked with the coordination of different environmental protection activities undertaken by environmental promotion agencies. The other mandates of REMA include the following:

- To promote the integration of environmental issues in development policies, projects, plans and programs;

- To coordinate implementation of Government policies and decisions taken by the Board of Directors and ensure the integration of environmental issues in national planning among concerned departments and institutions within the Government;

- To advise the Government with regard to the legislation and other measures relating to environmental management or implementation of conventions, treaties and international agreements relevant to the field of environment as and when necessary;

- To make proposals to the Government in the field of environmental policies and strategies.

REMA and other related agencies have developed laws and ministerial orders which govern environmental management in Rwanda. REMA regulations also require that any projects, programs, or policies that may affect the environment be subjected to environmental impact assessment before obtaining authorization for implementation.

The last environmental threats and opportunities assessment (ETOA) produced for review by USAID in 2014 characterized Rwanda’s national and sectoral development strategies, policies, plans, and laws as the most updated and comprehensive legal framework for environmental management in the region. There are various socio-economic development and strategic policy documents that ensure, regulate and promote environmental conservation. These documents call for a well-regulated environment management system that takes into account principles of sustainable development while at the same time contributing to poverty reduction.

These policies, particularly those that govern environmental management in the health sector, include but are not limited to the following:

● Vision 2050 (2018)

● National Strategy for Transformation (2018)

● National Environmental Policy (2005)

● Health Sector Policy for Rwanda (2015)

● Fourth Health Sector Strategic Plan (July 2018 – June 2024)

● National Community Health Policy (2008)

● National Sanitation Policy (2016)

● Environmental Health Policy (2008)

● Land Policy (2004)

● Environmental Policy (2003)

● National Forestry Policy (2010)

● National Policy for Water Resources Management (2011)

● National Climate Change and Low Carbon Development Strategy (2011)

● Rwanda Biodiversity Policy (2011)

● Protected Areas Concessions Management Policy (2013)

● Second National Communication, UNFCCC (2012)

● Intended Nationally Determined Contributions (2015)

● Green Growth and Climate Resilience Strategy (2011)

● Green Growth and Climate Resilience Strategy Sectoral Working Papers (2011)

● National Adaptation Program of Action (2006)

● Organic Law on the Environment (2005)

The following are the some of the key policy, legal and legislative documents that have a bearing on and must to be adhered to by this project:

The Constitution of the Republic of Rwanda, adopted in June 2003, ensures the protection and sustainable management of environment and encourages rational use of natural resources. The Rwandan constitution addresses certain environmental dimensions, including environmental impact Article 48 states: ‘Any citizen has a right to a safe environment, satisfying and sustainable. Any person has the duty of protecting, maintaining and promoting the environment. Any act aiming at damaging the environment is punished by the law. The state must protect the environment.’

Later, article 192 forbids any accords authorizing the storing on Rwandan territory of toxic waste and other substances, which may dangerously damage the environment. It states: ‘Accords on installation of military barracks on the national territory and those authorizing the storage of toxic waste and other substance which are dangerous for the environment are prohibited.

Organic Law (No. 04/2005 of 08/04/2005): The Act dictates that the national environment protection, conservation and management policy is the responsibility of the Government of Rwanda. This law serves to: conserve the environment, people, and their habitats; set up fundamental principles related to protection of environment; discourage any activities that may degrade the environment; promote the social welfare of the population while considering equal distribution of the existing wealth; consider the durability of resources with a special emphasis on equal rights to present and future generations; guarantee to all Rwandans sustainable development which does not harm the environment and the social welfare of the population; and establish strategies of protecting and reducing negative effects on the environment and improving/restoring the degraded environment.

The National Land Law Organic Law N°24/2012 of 15/06/2012: This Law determines modalities of the allocation, acquisition, transfer, use and management of land in Rwanda. It also establishes the principles applicable to rights recognized over all lands situated on Rwanda’s national territory and all rights united or incorporated with land, whether naturally or artificially. For the purpose of land use consolidation, it is prohibited to subdivide plots of land reserved for agriculture and animal resources if the result of such subdivision leads to parcels of land of less than a hectare in size. Owners of lands are prohibited to subdivide and shall co-own and use the land in accordance with the laws.

2.3 COUNTRY/MINISTRY/MUNICIPALITY ENVIRONMENTAL CAPACITY ANALYSIS (AS

APPROPRIATE)

Institution Roles and Responsibilities

USAID USAID is the financier and oversees the technical implementation and monitoring of this IEE as well as project activities for the Integrated Health Project.

Ministry of Infrastructure

(MININFRA)

The mission of the Ministry of Infrastructure is to ensure sustainable development of infrastructure—transport, energy, water supply and sanitation, housing and human settlement—and drive economic growth with a view toward enhancing the quality of life of the population.

MININFRA supervises activities meant to elaborate, monitor and assess the implementation of national policies and programs on matters relating to habitat and urbanism, transport, energy, water and sanitation, including leading programs to improve access to affordable energy, water and sanitation, and related services for the population. MININFRA oversees the implementation of national policies and quality standards and norms to promote cost effectiveness, environmental sustainability, and safety.

Ministry of Environment (MoE)

The Ministry of Environment was established to ensure the conservation, protection and development of the environment. The Ministry is responsible for the development of environmental policies and procedures (including impact assessments), protection of natural resources (water, land, flora, and fauna), environmental legislation, biodiversity, and other environmental aspects informed by the Environment Law among others. It is also tasked with safeguarding green and climate resilience for growth of the economy.

Chapter IV of the Organic Law Article 65 specifies that every project shall be subjected to environmental impact assessment prior to its commencement.

Rwanda Environment Management Authority

(REMA )

With regards to the management of the bio-physical environment throughout Rwanda, the overall responsibility lies with the Rwanda Environment Management Authority. In November 2003, the Government of Rwanda approved the law establishing the Rwanda Environment Management Authority (REMA). The functions of REMA include:

● To advise the Government on legislative and other measures for the management of the environment or the implementation of relevant international conventions, treaties and agreements in the field of environment, as the case may deem necessary.

● To take stock and conduct comprehensive environmental audits and investigations, to prepare and publish biannual reports on the state of natural resources in Rwanda.

● To ensure monitoring and evaluation of development programs in order to control observance of proper safeguards.

● To render advice and technical support, where possible, to entities engaged in natural resource management and environmental protection.

Rwanda Development Board (RDB)

This is a one-stop institution bringing together several government bodies in Rwanda focused on promoting investment in Rwanda. RDB has a department responsible for EIA processes including reviewing all projects EIA reports before approval of the implementation of the projects, a duty that was previously undertaken by REMA

Ministry of Health (MoH

The MOH is currently implementing its Fourth Health Sector Strategic Plan (HSSP IV ) July 2018 – June 2024. The MOH supports, coordinates, and regulates all interventions whose primary objective is to improve the health of the population.

Services are provided at different levels of the health care system (community health workers, health posts, health centers, district hospitals, and referral hospitals) and by different types of providers (public, confessional, private-for-profit, and NGO). At all levels, administrative structures (e.g. boards and committees) and implementing agencies oversee the provision of health-related services and the health system.

At the village level, community health workers (CHWs) are supervised administratively by local officials in charge of social services and technically by the health centers. CHWs receive compensation for their work through formally established local cooperatives. At the sector level, health center committees provide oversight of the work of the various units in the health center, its outreach and supervision activities, and general financial control

Ministry of Agriculture and Animal Resources

(MINAGRI)

The GOR’s Vision 2050, National Strategy for Transformation, and the Strategic Plan for Transformation of Rwandan Agriculture IIII all have the overall goal of changing the Rwandan agriculture sector from subsistence-based agriculture to a productive high-value, market-oriented farming that is environmentally friendly and has a positive impact on other sectors of the economy. The policy of the MINAGRI is to increase animal production, modernize farming, reduce poverty, ensure food security, and produce a surplus for the market.

The Directorate General of Rwanda Agriculture and Livestock Inspection and Certification Services is responsible of the overall coordination of all the functions of the National Plant Protection Services (NPPS) including enforcement of the Rwanda plant health law and regulations for phytosanitary measures necessary for trade; plant pest/disease monitoring, surveillance and diagnosis; conducting Pest Risk Analysis; and conducting inspection and certification. It delivers animal products certification services including the enforcement of sanitary laws, monitoring and surveillance of animal diseases, and animal inspection and certification.

The Directorate General of Strategic Planning and Programs Coordination coordinates the formulation of policies and sector strategies and monitors and evaluates the implementation of agricultural sector programs. It ensures timely preparation of budget and operational action plans; coordinates the preparation of short, medium, and long term investment plans for the agriculture sector; monitors macroeconomic coherence in the agriculture sector; establishes and develops working relationships with partners;

supervises and coordinates agriculture statistics activities; coordinates, monitors, and evaluates the implementation of agricultural programs in collaboration with the Directorates General of Crop and Animal Production;

produces regular reports for the agricultural sector; coordinates new projects formulation; and coordinates multilateral and bilateral cooperation and reporting.

The Directorate General of Crop Production monitors and evaluates the implementation of programs related to crop production and participates in the formulation of policies and strategies related to that sub sector in collaboration with the Directorate General of Strategic Planning and Program coordination.

It produces regularly reports on the implementation of programs related to crop production including input supply, input use, soil and water management programs, mechanization programs, post-harvest handling and storage programs, crop protection programs, and agricultural extension programs.

The Directorate of Animal Resources establishes and monitors policies, strategies, guidelines, and instructions aimed at improving animal resources in Rwanda. The Directorate monitors the implementation of the numerous nutrition-focused programs including the one cow per poor family (girinka) program; milk drinking campaign to fight malnutrition; one cup of milk per child in schools; programs for improving animal production including genetic improvement programs aimed at increasing animal products, the dairy strategy and meat strategy, the promotion of small stock in the country (sheep, goats, pigs and rabbits), promotion of poultry, promotion of beekeeping, and fish master plan

Rwanda Agriculture Board

The Rwanda Agriculture Board (RAB) is an autonomous body with a mission of promoting development of the agriculture sector into a knowledge-based, technology-driven, and market-oriented industry. RAB advocates using modern methods in crop, animal, fisheries, forestry and soil and water management in food, fiber and fuel wood production and processing. RAB is responsible for implementing MINAGRI policies for agricultural and animal husbandry, including: controlling and monitoring the use of selected seeds and agricultural inputs; coordinating activities of NGOs and private operators implementing agricultural and animal husbandry programs; providing extension services, and supporting technology dissemination for improved management of land, water and use of agricultural and animal husbandry mechanization.

Ministry of Finance and Economic Planning

(MINECOFIN)

The Ministry of Finance and Economic Planning (MINECOFIN) was formed in March 1997 from the joining of the Ministry of Finance and the Ministry of Planning. This was done in order to improve the co-ordination between the functions of finance and planning. In the ministerial re-structuring of February 1999, the Ministry took on the function of development cooperation from the Ministry of Foreign Affairs.

MINECOFIN is responsible for mobilizing both domestic and external financial resources as well as their efficient allocation and ensuring public financial management. The mission of the MINECOFIN is to raise sustainable growth, economic opportunities and living standard of Rwandans and achieve the highest standard of accountability and transparency in public financial management.

Rwanda Biomedical Centre (RBC)

The RBC was formed in 2011, merging fourteen institutions and several programs previously under the Ministry of Health. RBC’s mandate is to improve health outcomes of Rwandans by improving quality of services, access and equity, providing integrated services, promoting research activities, and ensuring financial stability and sustainability. RBC merges the procurement plans of the formerly independent institutions into one comprehensive health procurement plan and provides essential medicines and medical supplies for all health facilities.

Ministry of Local Government

(MINALOC)

MINALOC is responsible for good governance, decentralization, community development, local finance and social affairs as well as the implementation of the National Strategy for Community Development and Local Economic Development, the National Social Protection Strategy, and the National Decentralization Policy.

Ministry of Gender and Family Promotion

(MIGEPROF)

MIGEPROF facilitates the implementation of the National Gender Policy and Plan of Action to ensure effective gender mainstreaming and the full participation of women in all activities related to Rwanda’s socio-economic development and the National Policy for Family Promotion; the National Policy for Orphans and Other Vulnerable Children; and the National Policy for Family Promotion. The National Early Childhood Development Program, which coordinates nutrition interventions in Rwanda, is also located within

MIGEPROF.

District Local Governments

Responsible for the provision of basic services, including health, water, sanitation, and solid waste management. Local governments have financial autonomy (fiscal decentralization). They are responsible for the local implementation of health and nutrition-related programs and policies since they prepare and implement the consolidated district development plans.

The District Health Management Team (DHMT) comprises the district director of health, the hospital director, the director of CBHI, the director of pharmacy, and a representative of the health center managers. It is chaired by the vice-mayor for social affairs. The role of the DHMT revolves around planning and management, supervision, coordination, financial and resource oversight, regulation, and increasing participation on the part of the local community in the delivery and management of services.

For administrative matters, they are under the supervision of the District Health Unit (DHU). This is an administrative unit in charge of the provision of health services in the district and responsible for planning, monitoring, and supervision of implementing agencies. It participates in inter-sectoral collaboration and coordination through the Joint Action Development Forum

(JADF).

Water and Sanitation Corporation Ltd

(WASAC)

The Water and Sanitation Corporation (WASAC) manages water and sanitation services in Rwanda. The mission of WASAC is to provide quality, reliable and affordable water and sewerage services through continuous innovations and detailed care to our customers’ needs.

Anyway water or sanitation-related projects will be done in collaboration with WASAC guidelines.

Rwandan civil society organizations (CSOs)

Rwandan civil society organizations (CSOs) operate in all parts of the country and in a wide range of fields relevant to the implementation of the Thrive Project including health, nutrition, services for vulnerable populations, and agriculture. These organizations participate and contribute to health and nutrition programs at both the local and national levels and play a major role in community health matters. Many CSOs participate in the JADF at the district level to promote cooperation between civil society, the private sector, and the public sector. However, cooperation and formal CSO networking could be improved.

Communities Often the beneficiaries of health programs, they are also involved in project identification, planning, and implementation.

3.0 ANALYSIS OF POTENTIAL ENVIRONMENTAL RISK1

This section describes the results of an analysis of activities/project elements for potential adverse environmental, social, and climate impacts. The risks that climate change poses to the activities is described in Section 4.2.