Annex 4. Initial Environmental Examination Health Office.pdf

USAID/TANZANIA

HEALTH PORTFOLIO IEE

INITIAL ENVIRONMENTAL

EXAMINATION

PURPOSE

This IEE provides pre-implementation initial review of the environmental impacts for health projects planned under the Tanzania Health Portfolio.

PROJECT/ACTIVITY DATA

Project/Activity Name: Tanzania Health Portfolio Geographic Location(s) (Country/Region): Tanzania Amendment (Yes/No), if Yes indicate # (1, 2...): N Implementation Start/End Date (FY or M/D/Y): January 2022 - January 2027 If Amended, specify New End Date:

Solicitation/Contract/Award Number(s):

Implementing Partner(s): TBD Bureau Tracking ID:

Tracking ID of Related RCE/IEE (if any): Tanzania Health Portfolio https://ecd.usaid.gov/document.php?doc_id=54590 Tracking ID of Other, Related Analyses:

Tanzania PERSUAPs: NAFAKA and Mboga na Matunda:https://ecd.usaid.gov/document.php?doc _id=50646. (expires April 2022)

Tanzania Natural Resource Management and Biodiversity Project IEE https://ecd.usaid.gov/document.php?doc_id=53179.

ORGANIZATIONAL/ADMINISTRATIVE DATA

Implementing Operating Unit(s):

(e.g. Mission or Bureau or Office)

USAID/Tanzania

Other Affected Operating Unit(s):

Lead BEO Bureau: AFR Funding Account(s) (if available):

Original Funding Amount:

If Amended, specify funding amount:

If Amended, specify new funding total:

Prepared by: Thibaut Williams, and Dosteus Lopa, MEO

USAID/Tanzania; ECOS Date Prepared: November 2021

ENVIRONMENTAL COMPLIANCE REVIEW DATA

https://ecd.usaid.gov/document.php?doc_id=54590 https://ecd.usaid.gov/document.php?doc_id=50646 https://ecd.usaid.gov/document.php?doc_id=50646 https://ecd.usaid.gov/document.php?doc_id=53179.

HEALTH PORTFOLIO IEE

Analysis Type: ☒Environmental Examination ☐Deferral Environmental Determination(s): ☒Categorical Exclusion(s)

☒Negative ☒Positive ☐Deferred (per 22 CFR 216.3(a)(7)(iv)

IEE Expiration Date (if applicable): 31 January 2027 Additional Analyses/Reporting Required:

Climate Risks Identified (#): Low 17 Moderate 10 High ___ Climate Risks Addressed (#): Low 17 Moderate 10 High ___ about:blank about:blank

HEALTH PORTFOLIO IEE

THRESHOLD DETERMINATION AND SUMMARY OF FINDINGS

PROJECT SUMMARY

This IEE addresses activities expected to be implemented by USAID/Tanzania’s Health Office.

This document provides a preliminary review of the reasonably foreseeable effects on the environment of health-related activities expected to be implemented by USAID/Tanzania.

Activities implemented will support the USAID/Tanzania Country Development Cooperation Strategy (CDCS) goal of “Tanzanian youth advance the country’s long-term prosperity and journey to self-reliance .”

ENVIRONMENTAL DETERMINATIONS

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

(22 CFR 216).

TABLE 1: ENVIRONMENTAL DETERMINATIONS

Projects/Activities Categorical Exclusion Citation (if applicable)

Negative Determination

Positive Determination

Deferral

Intervention Category 1:

Technical assistance and capacity building to improve use of quality health services.

Intervention Category 2:

Direct healthcare service delivery (i.e., prevention, care and treatment) focusing on HIV/AIDS, malaria, TB services, and family planning outreach.

Intervention Category 3:

Identify and implement vector control approaches aimed at reducing the burden of malaria and moving towards the long-term goal of malaria elimination.

Intervention Category 4:

Community Engagement Strengthening Activities.

1 Positive Determinations require preparation of a Scoping Statement and Environmental Assessment.

2 Deferrals must be cleared through an Amendment to this IEE prior to implementation of any deferred activities.

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Intervention Category 5:

Governance, policy development, and finance.

Intervention Category 6:

Increase health-seeking behaviors and health social norms through communication and education.

Intervention Category 7:

Direct procurement of commodities and strengthening of commodities, logistics and diagnostic systems.

*LLINs and IRS w condition met by IVM MVC

PEA

Intervention Category 8:

Small-scale construction.

CLIMATE RISK MANAGEMENT

The Climate Risk Management (CRM) screening identifies climate-related risks to activities that should be addressed to enhance resilience and safeguard development objectives. This screening was conducted as part of implementing the Reference for ADS Chapter 201 “Climate Risks Management for USAID Projects and Activities.” The results of the screening are documented in Section 4.2. The Climate Risk Screening Matrix is provided in Annex 1.

BEO SPECIFIED CONDITIONS OF APPROVAL

The negative determinations recommended in this IEE are contingent on full implementation of specified conditions and a set of general monitoring and implementation measures specified in Section 5 of the IEE.

COVID-19 Conditions:

In order to reduce COVID-19 transmission during the implementation of these activities, USAID managers are encouraged to:

• Ensure all activities addressed by this IEE adhere to current, applicable COVID-19 guidelines. Refer to the AFR COVID-19 PIEE (attached and linked here --https://ecd.usaid.gov/document.php?doc_id=52754) for links to U.S. and international guidance on appropriate measures to reduce COVID-19 transmission. Such measures may include, but are not limited to social distancing, use of personal protective equipment, limiting the size of gatherings and travel, and effective disinfection.

• Share with the partner:

o Applicable COVID-19 guidance from the USAID Mission or U.S. Embassy;

o Applicable COVID-19 guidance from local authorities;

o The following Agency-wide “COVID-19 GUIDANCE FOR IMPLEMENTING

PARTNERS” page on the USAID website: https://www.usaid.gov/work-usaid/resources-for-partners/covid-19-guidance-implementing-partners.

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• Ensure that partners have appropriate training, authorization, and resources to meet the expectations of the applicable guidance while implementing these activities.

Reporting Conditions:

The AFR BEO requests that the activity managers/AORs/CORs provide access to the

Regional Environmental Advisor (REA) and to the AFR BEO Team to review (not approve) the Environmental Mitigation and Monitoring Plans/Reports (EMMPs/EMMRs) that will be written to implement the findings of this IEE. These should be uploaded into the appropriate sub-folder(s) of this Google Drive folder: https://drive.google.com/drive/folders/1q7HGMzgopJ- MuKxkQEJ4GSPp9R7Qzv-5?usp=sharing This will facilitate access by all parties who need these documents, including the Mission Environmental Officer and the AOR/COR. This will allow the REA and the BEO Team to spot-check and review these documents to confirm that the mitigations seem appropriate and are cognizant of the specific design of the activities.

Procurement and distribution of Insecticide Treated Bednets (ITNs):

The improper use of Insecticide-Treated Bednets (ITNs) (either “long-lasting” or user-treated) as fishing nets may have significant adverse impacts on aquatic ecosystems. Refer to section 3 for more discussion of impacts.The 2017 IVM PEA mandates that for USAID-supported activities entailing the procurement and distribution of ITNs, the Country Office will work with its implementing partners to evaluate whether bednets are currently misused for the purpose of fishing in regional waterbodies, and “where there is evidence of misuse for fishing...collaborate across sectors to develop a sustainable, locally relevant solution”. Within 6 months from the issuance of this IEE, the Mission must conduct a preliminary assessment to evaluate whether bednets are currently misused for the purpose of fishing in regional waterbodies. Depending upon the results of the Initial Site Assessment and in consultation with the BEO, the Mission will either proceed with a Rapid Assessment, as outlined in the 2018 PMI Toolkit, or evaluate and implement appropriate mitigations. Refer to section 5.3 for details about completing the Initial Site Assessment, including timing and approvals.

IMPLEMENTATION

In accordance with 22 CFR 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.

https://drive.google.com/file/d/1St5nIkxVs9R-w3U0opgnYO_O94dFu9n7/view?usp=sharing https://drive.google.com/file/d/1tXue5o6PkU3B2DzewY7QctMKpSGG8ztk/view?usp=sharing

HEALTH PORTFOLIO IEE

USAID APPROVAL OF INITIAL ENVIRONMENTAL EXAMINATION

PROJECT/ACTIVITY NAME: Tanzania Health Portfolio

Bureau Tracking ID: https://ecd.usaid.gov/document.php?doc_id=54590

Approval: Cleared 02/17/2022 Veeraya (Kate) Somvongsiri, Mission Director Date

Clearance: Cleared 12/17/2021 Thibaut Williams, Activity Manager Date

Clearance: Cleared 12/17/2021 Ananthy Thambinayagam, Health Officer Director Date

Clearance: Cleared 12/16/2021 Dosteus Lopa, Mission Environmental Officer Date

Clearance: Cleared 12/30/2021 David Kinyua, Regional Environmental Advisor Date

Clearance: Cleared 12/22/2021

Clearance:

Michael McBroom, Acting Program Office Director

Cleared

Date

02/07/2022

Clearance:

Ian Robertson, Regional Legal Officer

Cleared

Date

02/13/2022 Anya Glenn, Acting Deputy Mission Director Date

Clearance: Cleared 01/26/2022 Colin Quinn, Climate Integration Lead Date

Concurrence: 02/17/2022 Brian Hirsch, AFR Bureau Environmental Officer Date

DISTRIBUTION:

https://ecd.usaid.gov/document.php?doc_id=54590

HEALTH PORTFOLIO IEE

INITIAL ENVIRONMENTAL

EXAMINATION

CONTENTS

Purpose 1 Project/Activity Data 1 Organizational/Administrative Data 1

ENVIRONMENTAL COMPLIANCE REVIEW DATA 1

THRESHOLD DETERMINATION AND SUMMARY OF FINDINGS 3

project SUMMARY 3

TABLE 1: ENVIRONMENTAL DETERMINATIONS 3

CLIMATE RISK MANAGEMENT 4

BEO SPECIFIED CONDITIONS OF APPROVAL 4

IMPLEMENTATION 5

USAID APPROVAL OF INITIAL ENVIRONMENTAL EXAMINATION 6

1.0 PROJECT/ACTIVITY DESCRIPTION 4

1.1 PURPOSE OF the IEE 4

1.2 PROJECT/ACTIVITY OVERVIEW 4

1.3 PROJECT/ACTIVITY DESCRIPTION 8

TABLE 2: ENVIRONMENTAL DETERMINATIONS by intervention category 8

2.0 BASELINE ENVIRONMENTAL INFORMATION 24

2.1 LOCATIONS AFFECTED AND ENVIRONMENTAL CONTEXT (ENVIRONMENT,

PHYSICAL, CLIMATE, SOCIAL, THREATENED AND ENDANGERED SPECIES) 24

2.2 APPLICABLE AND APPROPRIATE PARTNER COUNTRY AND OTHER

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

POLICIES, AND REGULATIONS 27

2.3 COUNTRY/MINISTRY/MUNICIPALITY ENVIRONMENTAL CAPACITY ANALYSIS 28

3.0 ANALYSIS OF POTENTIAL ENVIRONMENTAL AND SOCIAL RISK 29

3.1 Adverse Impacts of Health Care Service Delivery Due to Failure to Properly Manage Resulting Wastes 29 Intervention category 1: Technical assistance and capacity building to improve use of quality health services. 31 INTERVENTION CATEGORY 2: Direct healthcare service delivery (i.e., prevention, care and treatment) focusing on HIV/AIDS, malaria, TB services, and family planning outreach. 33

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INTERVENTION CATEGORY 3: Identify and implement vector control approaches aimed at reducing the burden of malaria and moving towards the long-term goal of malaria elimination INTERVENTION CATEGORY 4: Community Engagement Strengthening Activities 36 INTERVENTION CATEGORY 5: Governance, policy development, and finance 38 INTERVENTION CATEGORY 6: Increase health-seeking behaviors and health social norms through communication and education 39 INTERVENTION CATEGORY 7: Direct procurement of commodities and strengthening of commodities, logistics and diagnostic systems 40 INTERVENTION CATEGORY 8: Small-scale construction 42

4.0 ENVIRONMENTAL DETERMINATIONS 45

4.1 RECOMMENDED ENVIRONMENTAL DETERMINATIONS 45

4.2 CLIMATE RISK MANAGEMENT 45

Methodology 46 Risk Ratings and Defined Actions 46

5.0 CONDITIONS AND MITIGATION MEASURES 48

5.1 CONDITIONS 48

5.2 AGENCY CONDITIONS 49

5.3 MITIGATION MEASURES 50

Intervention category 1: Technical assistance and capacity building to improve USE OF quality health services. 51

TABLE 5A. SUMMARY OF MITIGATION MEASURES FOR INTERVENTION CATEGORY 1

INTERVENTION CATEGORY 2: Direct healthcare service delivery (i.e., prevention, care and treatment) focusing on HIV/AIDS, malaria, TB services, and family planning outreach. 53

TABLE 5B. SUMMARY OF MITIGATION MEASURES FOR INTERVENTION CATEGORY 2

INTERVENTION CATEGORY 3: Identify and implement vector control approaches aimed at reducing the burden of malaria and moving towards the long-term goal of malaria elimination

TABLE 5C. SUMMARY OF MITIGATION MEASURES FOR INTERVENTION CATEGORY 3

INTERVENTION CATEGORY 4: Community Engagement Strengthening Activities 59

TABLE 5D. SUMMARY OF MITIGATION MEASURES FOR INTERVENTION CATEGORY 4

INTERVENTION CATEGORY 5: Governance, policy development, and finance 61

TABLE 5E. SUMMARY OF MITIGATION MEASURES FOR INTERVENTION CATEGORY 5

INTERVENTION CATEGORY 6: Increase health-seeking behaviors and health social norms through communication and education 62

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TABLE 5F. SUMMARY OF MITIGATION MEASURES FOR INTERVENTION CATEGORY 6

INTERVENTION CATEGORY 7: Direct procurement of commodities and strengthening of commodities, logistics and diagnostic systems 64

TABLE 5G. SUMMARY OF MITIGATION MEASURES FOR INTERVENTION CATEGORY 7

INTERVENTION CATEGORY 8: Small-scale construction 68

TABLE 5H. SUMMARY OF MITIGATION MEASURES FOR INTERVENTION CATEGORY 8

6.0 LIMITATIONS OF THIS INITIAL ENVIRONMENTAL EXAMINATION 72

7.0 REVISIONS 72

ATTACHMENTS: 72

Annex 1. Project Climate Risk Management Summary Table 73

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1.0 PROJECT/ACTIVITY DESCRIPTION

1.1 PURPOSE OF THE IEE

The purpose of this document, in accordance with Title 22, Code of Federal Regulations, Part 216 (22 CFR 216), is to provide a preliminary review of the reasonably foreseeable effects on the environment of the USAID intervention described herein and recommend determinations and, as appropriate, conditions, for these activities. Upon approval, these determinations become affirmed, and specified conditions become mandatory obligations of implementation.

This IEE also documents the results of the 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 design and implementation. Potential environmental impacts should be addressed through formal environmental mitigation and monitoring plans (EMMPs) and/or Environmental Assessments (EAs), if needed.

1.2 PROJECT/ACTIVITY OVERVIEW

Intervention Category 1: Technical assistance and capacity building to improve use of quality health services.

Illustrative Activities:

1. Provide capacity building to healthcare workers (e.g., pre-service training, on-the-job training, classroom training, mentoring, supportive supervision, quality improvement initiatives) in public and private health facilities.

2. Strengthen access to and use of quality maternal, newborn, child and adolescent health (MNH), and family planning (FP) services at the facility level and through outreach services.

3. Conduct a baseline assessment of tuberculosis (TB) facility-based services and ensure universal access to TB and Drug-Resistant (DR)-TB services, including TB diagnostics services(e.g., sample collection and transportation)..

4. Improve use of data and technology for decision-making and program improvement related to health services.

5. Provide high quality technical expertise and assistance to the National Malaria Control Program (NMCP) and the Zanzibar Malaria Elimination Program (ZAMEP) to strengthen surveillance systems and support data use for the development of evidence-based policies, strategies, and implementation plans related to malaria case management, malaria in pregnancy (MIP),seasonal malaria chemoprevention, malaria vaccines and other preventive approaches (see Intervention Category 3 for additional malaria prevention activities).

6. Strengthen case management and MIP prevention by supporting the implementation and/or planning and data use of Malaria Services and Data Quality Improvement (MSDQI) in public and private health facilities in selected districts of mainland and Zanzibar.

Intervention Category 2: Direct healthcare service delivery (i.e., prevention, care and treatment) focusing on HIV/AIDS, malaria, TB services, and family planning outreach.

https://www.usaid.gov/our_work/environment/compliance/22cfr216 https://www.usaid.gov/ads/policy/200/201mal

HEALTH PORTFOLIO IEE

Illustrative Activities:

1. Increase awareness of citizens’ HIV status through targeted testing services (e.g., index testing, out-patient department screening/testing, social network testing, mobile testing, distribution of HIV self-test kits) Strengthen anti-retroviral therapy (ART) and management of TB, HIV, and sexually transmitted infections (STIs) through training, mentorship and provision of equipment. Encourage health providers to regularly screen for intimate partner and gender-based violence (IPV/GBV).

2. Screen at-risk groups for STIs and refer for testing & treatment.

3. Facilitate family planning and outreach services (e.g., distribution of condoms) in health facilities and the community.

4. Work to eliminate mother-to-child transmission of HIV through training and direct care.

5. Scale up continuous care interventions to improve HIV treatment outcomes (e.g., community ART, adherence counseling, tracking missed appointments).

6. Address gender dynamics to create environments that increase protection against HIV and TB.

7. Expand access to safe, high-quality Voluntary Male Medical Circumcision (VMMC) services for Tanzanian boys and men and achieve 95% coverage in all the five regions (i.e., Iringa, Morogoro, Njombe, Singida, Tabora).

8. Integrate provision of pre-exposure prophylaxis (PrEP) into HIV prevention and treatment services for high-risk individuals who test HIV negative in index testing and all other forms of testing.

9. Provide case management services to orphans and vulnerable children

10. Strengthen malaria case surveillance and reactive case detection, including the data collection and management systems that enable the identification of new cases of malaria and trigger investigation and response measures (e.g., reactive drug administration [RDA]).

Intervention Category 3: Identify and implement vector control approaches aimed at reducing the burden of malaria and moving towards the long-term goal of malaria elimination.

Illustrative Activities:

1. Determine targeted populations’ access to insecticide-treated nets (ITNs) and the quantity of ITNs needed in the coming years to maintain high population access.

2. Deliver ITNs to targeted populations and create an enabling environment to revive the commercial markets for ITNs.

3. Provide guidance on new evidence-based vector control approaches that show potential for successful outcomes and assist with implementation of proven approaches.

4. Implement entomological monitoring (e.g., insecticide resistance and bioassay) of indoor residual spraying (IRS), ITN, and foci investigation.

5. Strengthen the IRS logistics and warehousing system through enhanced forecasting of IRS needs, training, and supervision.

6. Ensure safe and correct insecticide application, thus minimizing human and environmental exposure to IRS insecticides, in compliance with the Pesticide Evaluation

HEALTH PORTFOLIO IEE

Report and Safer Use Action Plan (PERSUAP3) and Supplemental Environmental Assessment (SEA4).

7. Equip the country with knowledge and skills to plan and implement integrated vector control interventions, including safe and cost-effective IRS, entomological monitoring, and the deployment of insecticide-treated nets.

8. Strengthen and improve the use of larval source management activities in low malaria transmission areas.

Intervention Category 4: Community Engagement Strengthening Activities.

Illustrative Activities:

1. Engage and improve capacity of community health workers (CHW) to provide community-based TB, malaria and FP services with tools, training and incentives

2. Establish and strengthen linkages between communities and health facilities to support delivery of malaria, TB, HIV and FP services (e.g., engage community groups to identify and conduct TB screening of high-risk individuals and community hotspots)

3. Engage Accredited Drug Dispensing Outlets (ADDOs) and Traditional healers (THs) to conduct TB and malaria screening, case identification, and referral of presumptive cases

4. Establish and improve community-based services that address GBV and violence against children

5. Build capacity of gender specific groups to provide TB services and engage youth and women to participate in TB prevention and access to family planning services

6. Provide technical and implementation support for Integrated Community Case Management (iCCM), including development and rollout of training and supervision

7. Facilitate the start-up of saving and lending groups (e.g., Worth Yetu groups, COCOBAs)

8. Provide educational subsidies to vulnerable adolescent girls aged 10-14 and sponsor vulnerable adolescent girls aged 20-24 to attend vocational education and to start-up their own businesses.

Intervention Category 5: Governance, policy development, and finance.

1. Improve governance and management systems that respond to healthcare needs of different segments of the population, including continued service to the poor and marginalized

3 Tanzania PERSUAPs: NAFAKA and Mboga na Matunda https://ecd.usaid.gov/document.php?doc_id=50646.

4 SEA for Nationwide IRS in Tanzania: 2020-2025 https://d1u4sg1s9ptc4z.cloudfront.net/uploads/2021/03/tanzania-irs-supplemental-environmental-assessment-2015-2020.pdf

HEALTH PORTFOLIO IEE

2. Advocate for policies for more effective governance and accountability (e.g., support for public sector reform, local government transparency, and stronger environmental oversight)

3. Establish customer responsive and self-sustaining public-private partnerships that provide quality essential medicines and health commodities

4. Mobilize capital through innovative financing that mutually benefits Christian Social Services Commission (CSSC) health facilities, local health insurance providers and commercial investors

5. Promote citizen engagement to increase the quality of health services (e.g., community scorecards, community-led monitoring)

6. Mobilize resources for loan guarantee facilities

Intervention Category 6: Increase health-seeking behaviors and health social norms through communication and education.

Illustrative Activities:

1. Support social marketing and communication for behavior change and increased use of health services

2. Strengthen community services focused on promoting health behavior and use of healthcare services

3. Support the implementation of social behavior change (SBC) activities for malaria, family planning, child health and other areas through mixed-media SBC campaigns (e.g., radio, community theatre, interpersonal communication, small groups)

4. Provide technical assistance to the Government of Tanzania (GOT) and civil society organizations on SBC-related issues

5. Promote menstrual hygiene management among girls aged 10-14 and distribute reusable Huru kits

6. Promote positive gender norms at the community level through evidence-based approaches such as SASA

7. Promote the uptake of Intermittent Preventive Treatment (IPTp3 and 4) for malaria in pregnancy

8. Promote behaviors around ITN access and use

9. Create awareness on acceptance of IRS, mass drug administration (MDA) and RDA, and other preventive activities

10. Train parents and caregivers of at-risk youth through evidence-based approaches (i.e., Sinovuyo, Furaha)

11. Educate children 9-14 years on sexual violence prevention using evidence-based approaches (e.g., Coaching Boys to Men, ImPower)

12. Improve ability of individuals to practice healthy behaviors through FURAHA YANGU, SITETEREKI, and NAWEZA campaigns

13. Strengthen community support for health-seeking behaviors

14. Improve systems for coordination and implementation of SBC interventions

Intervention Category 7: Direct procurement of commodities and strengthening of commodities, logistics and diagnostic systems.

HEALTH PORTFOLIO IEE

1. Support pharmaceutical procurement, supply chain management, and distribution of pharmaceuticals or medical commodities for the prevention and treatment of HIV/AIDS and associated complications (e.g., ARVs); TB; opportunistic infections; malaria, including intermittent preventive treatment of pregnant women (IPTp) (e.g., prophylaxis, and artemisinin-based combination therapies [ACTs]) and rapid diagnostic tests (RDTs);

contraceptives; and clinical equipment and supplies

2. Support logistics management of pharmaceuticals, diagnostic equipment, and commodities

3. Procure and distribute VMMC kits

4. Support procurement and distribution of ITNs.

5. Support procurement of insecticide that is used for IRS and larval source management and other preventive activities

6. Support procurement of reagents that are used for entomological monitoring, molecular analysis and drug efficacy monitoring

7. Support procurement of family planning commodities for public and for social marketing use

Intervention Category 8: Small-scale construction.

● Construction and/or rehabilitation of new or existing structures (e.g., housing for healthcare workers, health clinics, warehouses to store medical products)

1.3 PROJECT/ACTIVITY DESCRIPTION

TABLE 2: ENVIRONMENTAL DETERMINATIONS BY INTERVENTION CATEGORY

Interventions Categorical Exclusion Citation (if applicable)

Negative Determination

Positive Determin ation5

Deferral6 Mechanism

Intervention Category 1: Technical assistance and capacity building to improve use of quality health services.

1.1 Provide capacity

building to healthcare workers (e.g., pre-service training, on-the-job training, classroom training, mentoring, supportive

5 Positive Determinations require preparation of a Scoping Statement and Environmental Assessment.

6 Deferrals must be cleared through an Amendment to this IEE prior to implementation of any deferred activities.

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supervision, quality improvement initiatives) in public and private health facilities.

1.2 Strengthen access

to and use of quality maternal, newborn, child and adolescent health (MNH), and family planning (FP) services at the facility level and through outreach services.

§216.2(c)(2)(i) Education, technical assistance, or training programs except to the extent such programs include activities directly affecting the environment

1.3 Conduct a

baseline assessment of tuberculosis (TB) facility-based services and ensure universal access to TB and DR- TB services, including TB diagnostics services (e.g., sample collection and transportation, temporary storage, treatment and disposal).

§216.2(c)(2) (iii)Analyses, studies, academic or research workshops and meetings

1.4 Improve use of

data and technology for decision-making and program improvement related to health services.

§216.2(c)(2)(xiv) Studies, projects or programs intended to develop the capability of recipient countries to engage in development planning, except to the extent designed to result in activities directly affecting the environment (such as construction of facilities, water supply systems, waste water treatment, etc.)

HEALTH PORTFOLIO IEE

1.5 Provide high

quality technical expertise and assistance to the National Malaria Control Program (NMCP) and Zanzibar Malaria Elimination Program (ZAMEP) to strengthen surveillance systems and support data use for the development of evidence-based policies, strategies, and implementation plans related to malaria case management, malaria in pregnancy (MIP) seasonal malaria chemoprevention, malaria vaccines and other preventive approaches (see Intervention Category 3 for additional malaria prevention activities).

§216.2(c)(2)(i) Education, technical assistance, or training programs except to the extent such programs include activities directly affecting the environment

1.6 Strengthen case

management and MIP prevention by supporting the implementation and/or planning and data use of Malaria Services and Data Quality Improvement (MSDQI) in public and private health facilities in selected districts of mainland and Zanzibar.

§216.2(c)(2)(xiv) Studies, projects or programs intended to develop the capability of recipient countries to engage in development planning, except to the extent designed to result in activities directly affecting the environment

(such as construction of facilities, water supply systems, waste water treatment, etc.)

HEALTH PORTFOLIO IEE

Intervention Category 2: Direct healthcare service delivery (i.e., prevention, care and treatment) focusing on HIV/AIDS, malaria, TB services, and family planning outreach.

2.1 Increase

awareness of citizens’ HIV status through targeted testing services (e.g., index testing, out-patient department screening/testing, social network testing, mobile testing, distribution of HIV self-test kits). Strengthen anti-retroviral therapy (ART) and management of TB, HIV, and STIs through training, mentorship and provision of equipment. Encourage health providers to regularly screen for intimate partner and gender-based violence (IPV/GBV)

2.2 Screen at-risk

groups for sexually transmitted infections and refer for testing & treatment

§216.2(c)(2)(viii) Programs involving nutrition, health care or population and family planning services except to the extent designed to include activities directly affecting the environment

2.3 Facilitate family

planning and outreach services (e.g., distribution of condoms) in health facilities and the community

2.4 Work to eliminate

mother-to-child transmission of HIV

§216.2(c)(2)(viii) Programs involving nutrition, health

HEALTH PORTFOLIO IEE

care or population and family planning services except to the extent designed to include activities

2.5 Scale up

continuous care interventions to improve treatment outcomes (e.g., adherence counseling, tracking missed appointments)

§216.2(c)(2)(i) Education, technical assistance, or training programs except to the extent such programs include activities directly affecting the environment

2.6 Address gender

dynamics to create environments that increase protection against HIV and TB

§216.2(c)(2)(viii) Programs involving nutrition, health care or population and family planning services except to the extent designed to include activities

2.7 Expand access to

safe, high-quality Voluntary Male Medical Circumcision (VMMC) services for Tanzanian boys and men and achieve 95% coverage in all the five districts (Iringa, Morogoro, Njombe, Singida, Tabora)

2.8 Integrate provision

of pre-exposure prophylaxis (PrEP) into the prevention and treatment services. Provide PrEP for those high-

HEALTH PORTFOLIO IEE

risk individuals who test HIV negative in index testing and all other forms of testing.

2.9 Provide case

management services to orphans and vulnerable children

§216.2(c)(2)(viii) Programs involving nutrition, health care or population and family planning services except to the extent designed to include activities

2.10 Strengthen

malaria case surveillance and reactive case detection, including the data collection and management systems that enable the identification of new cases of malaria and trigger investigation and response measures (e.g., RDA)

§216.2(c)(2)(iii) Analyses, studies, academic or research workshops and meetings

Intervention Category 3: Identify and implement vector control approaches aimed at reducing the burden of malaria and moving towards the long-term goal of malaria elimination

3.1 Determine

targeted populations’ access to insecticide-treated nets (ITNs) and the quantity of ITNs needed in the coming years to maintain high population access

§216.2(c)(2)(iii) Analyses, studies, academic or research workshops and meetings

3.2 Deliver ITNs to

targeted populations and create an enabling environment to revive the commercial markets for ITNs

HEALTH PORTFOLIO IEE

3.3 Provide guidance

on new evidence-based vector control approaches that show potential for successful outcomes and assist with implementation of proven approaches

§216.2(c)(2)(i) Education, technical assistance, or training programs except to the extent such programs include activities directly

3.4 Implement

entomological monitoring (e.g., insecticide resistance and bioassay) of indoor residual spraying, ITN, and foci investigation

3.5 Strengthen the

IRS logistics and warehousing system through enhanced forecasting of IRS needs, training, and supervision.

3.6 Ensure safe and

correct insecticide application, thus minimizing human and environmental exposure to IRS insecticides, in compliance with the PERSUAP and SEA.

3.7 Equip the country

with knowledge and skills to plan and implement integrated vector control interventions, including safe and cost-effective IRS, entomological monitoring, and the deployment of insecticide-treated nets.

3.8 Strengthen and

improve the use of ☒ ☐ ☐ ☐

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larval source management activities in low malaria transmission areas

Intervention Category 4: Community Engagement Strengthening Activities

4.1 Engage and

improve capacity of community health workers to provide community-based TB, malaria, and FP services with tools, training and incentives

4.2 Establish and

strengthen linkages between communities and health facilities to support delivery of malaria, TB, HIV and FP services (e.g., engage community groups to identify and conduct TB screening of high-risk individuals and community hotspots)

4.3 Engage

Accredited Drug Dispensing Outlets (ADDOs) and Traditional healers (THs) to conduct TB and malaria screening, case identification, and referral of presumptive cases.

§216.2(c)(2)(viii) Programs involving nutrition, health care or population and family planning services except to the extent designed to include activities

4.4 Establish and

improve community-based services that address GBV and violence against children.

§216.2(c)(2)(viii) Programs involving nutrition, health care or population and family planning services except to the extent

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designed to include activities

4.5 Build capacity of

gender specific groups to provide TB services and engage youth and women to participate in TB prevention and access to family planning services.

4.6 Provide technical

and implementation support for Integrated Community Case Management (iCCM), including development and rollout of training and supervision.

§216.2(c)(2)(i) Education, technical assistance, or training programs except to the extent such programs include activities directly

4.7 Facilitate the start-

up of saving and lending groups (e.g., Worth Yetu groups, COCOBAs).

§216.2(c)(2)(i) Education, technical assistance, or training programs except to the extent such programs include activities directly

4.8 Provide

educational subsidies to vulnerable adolescent girls aged 10-14 and sponsor vulnerable adolescent girls aged 20-24 to attend vocational education and to start-up their own businesses.

§216.2(c)(2)(viii) Programs involving nutrition, health care or population and family planning services except to the extent designed to include activities

Intervention Category 5: Governance, policy development, and finance

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5.1 Improve

governance and management systems that respond to healthcare needs of different segments of the population, including continued service to the poor and marginalized.

5.2 Advocate for

policies for more effective governance and accountability (e.g., support for public sector reform, local government transparency, total marketing approach, and stronger environmental oversight).

5.3 Establish

customer responsive and self-sustaining public-private partnerships that provide quality essential medicines and health commodities.

§216.2(c)(2)(viii) Programs involving nutrition, health care or population and family planning services except to the extent designed to include activities

5.4 Mobilize capital

through innovative financing that mutually benefits Christian Social Services Commission (CSSC) health facilities, drug dispensing outlets, local health insurance providers and commercial investors.

§216.2(c)(2)(viii) Programs involving nutrition, health care or population and family planning services except to the extent designed to include activities

5.5 Promote citizen

engagement to

Programs ☐ ☐ ☐ ☐

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increase the quality of health services (e.g., community scorecards, community-led monitoring) involving nutrition, health care or population and family planning services except to the extent designed to include activities

5.6 Mobilize resources

for loan guarantees and blended finance solutions

§216.2(c)(2)(viii) Programs involving nutrition, health care or population and family planning services except to the extent designed to include activities

Intervention Category 6: Increase health-seeking behaviors and health social norms through communication and education

6.1: Support social marketing and communication for behavior change and increased use of health services.

involving nutrition, health care or population and family planning services except to the extent designed to include activities

6.2: Strengthen community services focused on promoting health behavior and use of healthcare services.

§216.2(c)(2)(viii) Programs involving nutrition, health care or population and family planning services except to the extent designed to include activities directly affecting

6.3: Support the implementation of social behavior change (SBC) activities for malaria, family planning, child health and other areas through mixed-media SBC campaigns (e.g., radio, community theatre, interpersonal communication, small groups).

involving nutrition, health care or population and family planning services except to the extent designed to include activities

6.4: Provide technical assistance to the Government of Tanzania (GOT), civil society organizations, and private sector entities on SBC-related issues.

§216.2(c)(2)(i) Education, technical assistance, or training programs except to the extent such programs include activities directly affecting the environment

6.5: Promote menstrual hygiene management among girls aged 10-14 and distribute reusable Huru kits.

involving nutrition, health care or population and family planning services except to the extent designed to include activities

6.6: Promote positive gender norms at the community level through evidence-based approaches such as SASA.

involving nutrition, health care or population and family planning services except to the extent designed to include activities

6.7: Promote the uptake of Intermittent Preventive Treatment (IPTp3 and 4) for malaria in pregnancy involving nutrition, health care or population and family planning services except to the extent designed to include activities

6.8 Promote behaviors

around ITN access and use

§216.2(c)(2)(viii) Programs involving nutrition, health care or population and family planning services except to the extent designed to include activities

6.9 Create awareness

on acceptance of IRS, MDA, RDA, and other preventative activities

§216.2(c)(2)(viii) Programs involving nutrition, health care or population and family planning services except to the extent designed to include activities

6.10: Train parents and caregivers of at-risk youth through evidence-based approaches (i.e., Sinovuyo, Furaha) technical assistance, or training programs except to the extent such programs include activities directly affecting the

6.11: Educate children 9-14 years on sexual violence prevention using evidence-based approaches (e.g., Coaching Boys to Men, ImPower) technical assistance, or training programs except to the extent such programs include activities directly

6.12: Improve ability of individuals to practice healthy behaviors through FURAHA

YANGU,

SITETEREKI, and NAWEZA campaigns.

involving nutrition, health care or population and family planning services except to the extent designed to include activities

6.13: Strengthen community support for health-seeking behaviors.

involving nutrition, health care or population and family planning services except to the extent designed to include activities

6.14: Improve systems for coordination and implementation of SBC interventions.

technical assistance, or training programs except to the extent such programs include activities directly

Intervention Category 7: Direct procurement of commodities and strengthening of commodities, logistics and diagnostic systems

7.1: Support pharmaceutical procurement, supply chain management, and distribution of pharmaceuticals or medical commodities for the prevention and treatment of HIV/AIDS and associated complications (e.g., ARVs); TB;

opportunistic infections; malaria, including intermittent preventive treatment of pregnant women (IPTp) (e.g., prophylaxis, and artemisinin-based combination therapies [ACTs]) and rapid diagnostic tests (RDTs);

contraceptives; and clinical equipment and supplies.

7.2: Support logistics management of pharmaceuticals, diagnostic equipment, and commodities.

7.3: Procure and distribute VMMC kits.

7.4: Support procurement and distribution of ITNs.

*condition met by

IVM MVC

PEA

7.5: Support procurement of insecticide that is used for IRS, larval source management and other preventive activities.

*condition met by

IVM MVC

PEA

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7.6: Support procurement of reagents that are used for entomological monitoring, molecular analysis and drug efficacy monitoring.

7.7: Support procurement of family planning commodities for social marketing organizations and public and private sector entities.

§216.2(c)(2)(viii) Programs involving nutrition, health care or population and family planning services except to the extent designed to include activities

Intervention Category 8: Small-scale construction 8.1: Construction and/or rehabilitation of new or existing structures (e.g., housing for healthcare workers, health facilities, drug dispensing outlets, warehouses to store medical products).

Will this project/activity involve construction7 as defined by ADS 201 and 303? Yes ☒ No ☐

7 Construction, as defined by ADS 201 and 303, includes: construction, alteration, or repair (including dredging and excavation) of buildings, structures, or other real property and includes, without limitation, improvements, renovation, alteration and refurbishment. The term includes, without limitation, roads, power plants, buildings, bridges, water treatment facilities, and vertical structures. In the box below, describe any construction planned for this project/activity. Refer to ADS 201maw for required Construction Risk Management procedures.

https://www.usaid.gov/sites/default/files/documents/1865/201maw.pdf

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2.0 BASELINE ENVIRONMENTAL INFORMATION

This section describes the environmental context of the development challenge relevant to the country/location and nature of activities to be implemented. It also highlights applicable laws and related international agreements relevant to the activity.

2.1 LOCATIONS AFFECTED AND ENVIRONMENTAL CONTEXT (ENVIRONMENT,

PHYSICAL, CLIMATE, SOCIAL, THREATENED AND ENDANGERED SPECIES)

Geography, Climate and Topography Tanzania covers a land area of approximately 945,087 km2 comprised of land area of 883,749 km2, (881,289 km2 mainland and 2,460 km2 Zanzibar), plus 59,050 km2 of inland water bodies, and a marine territory of 241,541 km2, or 20% of the national territory, within its 200-mile Exclusive Economic Zone.

Tanzania’s land ecosystems reflect variation in elevation, precipitation, and soils. Annual average rainfall ranges from 200 to 2000 mm, with most of the country receiving less than 1000 mm on average.

Rainfall is unimodal in the southern and western parts of the country and bimodal in the northern, eastern, and northern coastal areas. Arid grasslands and savanna ecosystems that receive less than about 400 to 600 mm of rainfall on average extend south from Tanzania’s border with Kenya. Semi-arid areas with 500 to 800 mm of precipitation occupy large central and southeastern zones. Plateau zones (800 to 1500 m in elevation) in western and southern Tanzania support miombo woodlands. Highland areas that are generally above 1000melevation form a broad ridge that bisects the country along the Eastern Arc Mountains;

others follow Tanzania’s western borders between Lakes Nyasa, Tanganyika and Victoria and its boundary with Kenya.2

Socio-economics3 Tanzania has one of Africa’s fastest growing economies. Yet, widespread poverty persists. In 12,28 percent of Tanzanians could not meet their basic consumption needs and 9.7 percent of the population is extremely poor, meaning they cannot afford to buy basic foodstuffs to meet their minimum nutritional requirements. Tanzania’s nearly 7 percent annual national GDP growth since 2000 has been hardly perceptible among Tanzania’s predominantly rural (73 percent) population.

Over the past decade, Tanzania achieved impressive GDP growth rates, averaging nearly 7 percent annually, and attracted substantial foreign direct investment. Recent natural gas discoveries off the coast hold the potential to significantly increase growth rates once reserves come online in the next seven to ten years. The business climate, however, remains challenging. To achieve its middle-income goal by 2025, Tanzania must fast track the implementation of policy and regulatory reforms that promote private investment in key productive sectors; curb corruption; produce a healthy and skilled labor force; and improve infrastructure. Moreover, the COVID-19 pandemic will interfere and bring more difficulties in all development processes.

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In Tanzania, women are disproportionately concentrated in vulnerable forms of work and face occupational segregation and low wages relative to men. This often reflects women’s disadvantages: their lower rates of education completion; gender norms and stereotypes that track men and women into different fields; and lack of an organized voice and bargaining power.

Economic constraints include lack of full-time employment; lack of access to care for children and dependents; lack of transportation; the pressures of global competition that keep female wages down; and direct discrimination. Growing numbers of youth who are entering Tanzania’s labor force are also at risk. With the rapid population growth in Africa and its implication for the age pyramid, youth unemployment has become a major issue of concern to African governments.

Health Sector As noted in the USAID/Tanzania health project documents, despite significant progress over the past 15 or so years, critical public health challenges in Tanzania remain. For instance, maternal and child deaths, resulting primarily from infectious diseases and lack of access to quality health services, remain high. Maternal health is one of the greatest health challenges in Tanzania, as the maternal mortality rate is 454 per 100,000 live births. Malaria is a major cause of maternal mortality, and also the leading cause of death amongst children.. In mainland Tanzania, more than 14 percent of out-patient visits are due to malaria, resulting in 6 million malaria cases annually, of which 2,500 result in-death (DHIS2). In 2005, Tanzania was selected as one of the first focus countries for the President’s Malaria Initiative (PMI), through which major progress has been made in malaria control; improvements have been seen in nearly all malaria indicators between 2005 and 2017.4

Tanzania also faces a generalized HIV epidemic on the Mainland, and a concentrated HIV epidemic in the Zanzibar archipelago. An estimated 1.7 million Tanzanians are infected with HIV and each year 68,000 new infections occur and 32,000 people die from the infection (UNAIDS Spectrum 2020). There are also significant gender differences in HIV prevalence; prevalence is higher for women (6.0%) than men (3.3%).5

AIDS-related mortality has resulted in widespread disruption of family structures; nearly 10%of children in Tanzania have lost one or both parents, many of these deaths caused by AIDS.

Social and gender norms, such as early marriage and gender-based violence, also pose significant barriers to health and development, particularly for girls. Tanzania has made some positive steps in the effort to reduce HIV/AIDS, yet challenges persist. For example, the Tanzania HIV Impact Survey (THIS) from 2016-2017 indicated that only 61% of persons living with HIV are aware of their status. While over 90% of those tested positive are linked to treatment and 87 of those on treatment are virally suppressed, viral suppressions remains low among children.

TB remains the leading cause of death amongst people living with HIV which is estimated at 9,800 deaths. Tanzania is in the top 30 countries with the highest TB burden. In 2020, the country was estimated to have 133,200 TB patients and 17,000 TB-related deaths. There has been progress in increasing annual TB detection but still only 56% of patients are clinically diagnosed.

USAID voluntary family planning programs are being integrated with other health services to contribute to the goal of reducing maternal mortality. Although the total fertility rate in Tanzania

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has fallen from 5.7 to 5.2 births per woman in recent years, there have been no significant changes in the country's unmet need for family planning. The use of modern contraception in Tanzania among married women has increased from 20 percent to 32 percent between 2005 and 2015-16, with use of any family planning method increasing from 26 percent to 38 percent.

After sustained efforts to improve contraceptive security and logistics, national contraceptive distribution has improved, but resource allocation and stock-outs remain problematic. Social marketing and communication are having an impact with rising sales of oral contraceptives and condoms.

Shortfalls in health systems and care delivery exacerbate these health crises. With this situation, fighting against COVID-19 is more challenging. It is known that decentralization, beginning in 1996, moved service delivery and organization responsibilities from the central level to the district level, but localized…