Attachment J.3-Request for Categorical Exclusion.pdf

REQUEST FOR CATEGORICAL EXCLUSION (RCE)

Project/Activity Data

Project/Activity Name: USAID Nepal Health Surveys

Geographic Location(s) (Country/Region): Nepal/Asia Region

Amendment (Yes/No), if Yes indicate # (1, 2...): N/A Implementation Start/End Date (FY or M/D/Y): 2024-2028

If Amended, specify New End Date: N/A

Solicitation/Contract/Award Number(s): Fixed price Contract, To be determined

Implementing Partner(s): Pre-award; to be determined

Bureau Tracking ID:

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

Tracking ID of Other, Related Analyses: N/A

Organizational/Administrative Data

Implementing Operating Unit(s):

(e.g. Mission or Bureau or Office)

USAID/Nepal Health Office (HO)

Other Affected Operating Unit(s):

Lead BEO Bureau: Asia Bureau

Funding Account(s) (if available): USAID/Nepal

Original Funding Amount: USD 4.5 million

If Amended, specify funding amount:

If Amended, specify new funding total:

Prepared by: Sabita Tuladhar, Health Office

Date Prepared: April 01, 2024

ENVIRONMENTAL COMPLIANCE REVIEW DATA

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

☐Negative Determination with Condition ☐Positive Determination ☐Deferred (per 22 CFR 216.3(a)(7)(iv)

IEE Expiration Date (if applicable):

Additional Analyses/Reporting Required: N/A Climate Risks Identified (#): Low ____x__ Moderate ______ High ______ Climate Risks Addressed (#): Low ______ Moderate ____ High _____

Attachment J.3 Request for Categorical Exclusion (RCE)

1. BACKGROUND AND PURPOSE OF ACTIVITY

1.1 Purpose and Scope of IEE

The purpose of this request for categorical exclusion (RCE) document is to establish that all proposed activities belong to classes of actions eligible for Categorical Exclusions as set out in Agency regulations (22 CFR 216.2(c)) and that there are no foreseeable significant direct or indirect impacts that would preclude them from receiving a Categorical Exclusion. Upon approval of this document, the Categorical Exclusions are affirmed for the project/activity. This analysis also documents the results of the project/activity level Climate Risk Management process in accordance with USAID policy (specifically,ADS 201 mandatory reference 201mal).

This RCE is a critical element of USAID’s mandatory environmental review and compliance process meant to achieve environmentally sound activity design and implementation.

1.2 BACKGROUND

USAID Nepal Health Surveys is an activity to design and implement the Demographic and Health Survey round 9 (DHS-9) activities in Nepal. This activity will work closely with the Government of Nepal's (GON) Ministry of Health and Population (MOHP) to design and implement two large-scale, nationally representative population-based and health facility-based surveys: the 2025 Nepal Health Facility Survey (NHFS) and the 2026 Nepal Demographic and Health Survey (NDHS).

2. DESCRIPTION OF THE ACTIVITY

The goal of “USAID Nepal Health Surveys'' is to support the Government of Nepal's (GON) Ministry of Health and Population (MOHP) in designing and implementing two large-scale, nationally representative surveys - the 2025 Nepal Health Facility Survey and the 2026 Nepal Demographic and Health Survey.

These surveys will support the GON's efforts to track the health sector’s progress towards the 2030 United Nations Sustainable Development Goals (SDGs) and the Nepal Health Sector-Strategic Plan (NHS-SP) 2023–2030 goals. These surveys will be key data sources for USAID/Nepal to measure the endline results of the health component of Development Objective (DO) 3 of the Country Development Cooperation Strategy (CDCS) 2020–2025, measure baselines, and set targets for its next CDCS. The survey data will also support policy development and programming for a wide range of stakeholders including national, provincial, and municipal governments and Nepal’s development partners.

USAID Nepal Health Surveys will carry out the following two nationally representative surveys:

1. 2025 Nepal Health Facility Survey (NHFS): The 2025 NHFS will assess the overall availability of specific client services in health facilities (HFs), both public and private, in Nepal. These include the general readiness of HFs to provide client services; the availability of essential drugs; the service-specific readiness of HFs; the quality of services; client perceptions, feedback, and accountability systems; and financial, inventory, and personnel management.

2. 2026 Nepal Demographic and Health Survey (NDHS): The 2026 NDHS will provide data for monitoring the population, health, and nutrition situation in Nepal. Specifically, it provides reliable estimates of fertility, marriage, family planning, breastfeeding practices, nutrition, food insecurity, maternal and child health, childhood mortality, awareness and behavior regarding HIV/AIDS and other sexually transmitted infections (STIs), women’s empowerment, domestic violence, fistula, mental health, accident and injury, disability, and other health-related issues such as smoking, knowledge of tuberculosis, and prevalence of hypertension.

Geographic Focus and Target Populations:

This is a non-programmatic, survey-based activity. The surveys implemented under this activity are nationally representative, drawing samples from all 77 districts across Nepal. The NDHS will survey women and men aged 15–49 years and collect the anthropometry of under five children from the households surveyed. The NHFS will survey all types of HFs available in the county, including conducting interviews with health workers and clients after they receive service and leave the HF.

3. NATIONAL ENVIRONMENTAL LEGISLATION

The Government of Nepal (GON) has enforced the Environmental Impact Assessment (EIA) Guidelines 19931; Environmental Protection Act 20192; Nepal Labor Act 20743, Environmental Protection Rules 20204, and Public Health Service Act, 20185 to legalize the environmental mitigation of development projects.

The GON has formulated five major environmental policies:

● To manage natural and physical resources effectively and sustainably.

● To balance development efforts and environmental conservation to fulfill the basic needs of the people in a sustainable manner.

● To safeguard national heritage.

● To mitigate the adverse environmental impact of development projects and human actions.

● To integrate the environment and development through appropriate institutions, adequate legislation and economic incentives, and sufficient public resources.

The Guidelines, Act, Rules and regulations provide a basic legal framework and require that a preliminary environmental study {which the GON also calls an initial environmental examination (IEE)}, or a more comprehensive EIA for projects likely to have greater environmental impact, is mandatory and to be done by the proponent prior to the implementation of any development activity. Environment Protection Rules and EIA guidelines have grouped projects into three categories from an environmental consideration point of view:

● Projects that need only a preliminary environmental study

● Projects that need a full-scale EIA

● Projects that are being proposed in sensitive areas

Screening is the first step in the environmental assessment process and is used to determine which study is required for the proposed program, project, or activity. It is the preliminary review of a project to determine potential environmental effects. Screening is the responsibility of the project proponent [or implementing agency]. For most smaller and less sensitive development projects, a preliminary environmental assessment, similar in many ways to a technical and economical pre-feasibility study, utilizing readily available information, undertaking less detailed investigations and using rapid methods for information collection and analysis, will be sufficient.

The following subsections provide a brief overview of the aforementioned Guidelines, Act, Rules, and other regulations.

3.1 NATIONAL ENVIRONMENTAL IMPACT ASSESSMENT GUIDELINES 1993

These guidelines were developed “to assess the environmental impacts likely to be caused by a project, and to promote its positive impacts and mitigate or eliminate adverse impacts by undertaking preventive or other effective measures after integrating the environmental impacts in the planning circle of all the projects to be initiated in the Kingdom of Nepal.” The guidelines require screening of all the activities of a project/program and determining whether an IEE or EIA is required. According to the guidelines, an IEE is required for those projects that are likely to cause known environmental impacts and that can be

5 hhttps://lawcommission.gov.np/en/?lsvr_document=the-public-health-service-act-2075-2018

4 https://doind.gov.np/detail/58

3 https://www.lawcommission.gov.np/en/wp-content/uploads/2021/03/The-Labor-Act-2017-2074.pdf

2 https://lawcommission.gov.np/en/wp-content/uploads/2021/03/The-Environment-Protection-Act-2019-2076.pdf

1 http://moste.gov.np/legal_documents/Regulation mitigated. All these projects are included in Schedule 1 of the guidelines. An EIA is required for those projects, as specified in Schedule 2, which have either known significant environmental impact or for which the environmental impacts are not clear.

3.2 ENVIRONMENT PROTECTION ACT 1997

The Parliament of Nepal passed an Act in 1997 for the protection of the environment. The provisions are similar to the guidelines of 1993, that an IEE or EIA is mandatory for the implementation of any development project, but it provides a legal cover to enforce the already existing regulations. In addition, the Act made approvals mandatory before doing any project, and provided recommendations to establish the Environment Protection Council, and Environment Protection Fund and laboratory; to appoint environmental inspectors for environmental compliance; and authorized punishment for violating the environmental regulations.

3.3 ENVIRONMENT PROTECTION RULES 1997 (amended in 1998 and 1999)

The Environmental Protection Rules are more comprehensive and added some additional requirements for both IEEs and EIAs. These additional requirements include the approval of work schedules for IEE/EIAs;

new formats for reporting; public advertisement of the proposed projects to seek public opinions of any potential or perceived impacts; monitoring and evaluation procedures; emission permits; definition of the roles and responsibilities for environmental inspectors and laboratories; and compensation provisions. In addition, Schedule 1 and 2 of the 1993 Guidelines were categorized by sectors such as forest, industry, mining, road, water resources and energy, and agriculture. Other schedules were added to define the requirements for IEE/EIA work schedules and matters to be considered during the process. The Guidelines, Act, and Rules require that either an IEE or EIA is conducted for any development project and provide specific guidance for some sectors. However, none of the existing regulations have specific guidance or requirements for the construction of small to medium scale public buildings such as education or healthcare facilities (with the exception of a 25 bed hospital under Schedule 2). From the review of the above regulations and experience from other similar programs, it is concluded that small to medium scale public infrastructure facilities (as described in Section 1.3) are not likely to have significant environmental impacts. These activities could be covered by an IEE and the expected low to moderate level environmental impacts can be mitigated by sound environmental design, best management practices, and environmental monitoring.

3.4 ENVIRONMENTAL PROTECTION RULE, 2019

The act emphasizes new provisions such as Brief Environmental Studies, IEEs and EIAs being under the jurisdiction of local authorities, and provincial and central governments. Among the new requirements of this Rule are the need for a Strategic Environmental Assessment for policies/plans/programs, and climate change considerations for projects..

3.5 ENVIRONMENTAL PROTECTION RULE, 2020

Environment Protection Rules (EPR), 2020 defined thresholds for environmental assessment under 3 categories - Brief Environmental Study, IEE and EIA. It defined the roles of provincial and local governments as well as the process for the environmental assessment of development projects.

3.6 LOCAL GOVERNMENT OPERATIONS ACT, 20176

The Local Government Operations Act, 2017 empowers local authorities to conserve local natural resources, implement environmental conservation activities, and gives them prime responsibility for conducting development projects which include water supply, sanitation, and awareness activities.

3.7 WATER RESOURCES ACT, 19927

6https://www.dpnet.org.np/resource-detail/333#:~:text=Summary&text=This%20is%20the%20Act%20formulated,Disaster%20Ris k%20Reduction%20and%20Management.

The Act is a comprehensive law on the development, use and conservation of water resources in Nepal, aiming to minimize damage to water bodies by requiring EIA and preparation of an EIA report before granting a license to use water resources for any purpose.

Proponents shall make sure that the beneficial use of water resources does not cause damage to other water uses/users (Article 4). Article 17 requires proponents to apply for any necessary land acquisition accordingly; Article 18 requires compliance to quality standards in making use of water resources. Article 19 prohibits the pollution of water resources. Under the Act are two regulations for drinking water : (i) Water Resources Regulation 1993, setting out the implementation procedures for the Act; and (ii) Drinking Water Regulation, 1998, which specifies compliance with drinking water quality standards and control of water pollution (or sanitation) as it affects drinking water.

3.8 PUBLIC HEALTH SERVICE ACT, 2018

This Act is made to provide for public health service. Chapter 5 of the Act - Social, Cultural and Environmental Determinants for Protection, Promotion and Improvement of Public Health has made the following provisions for sanitation and waste management: 1) The Government of Nepal may, in order to control or cause to be controlled the adverse effect to the human health by environmental pollution and waste, make necessary standards in accordance with the prevailing Federal law, 2) The Government of Nepal shall make necessary standards for collecting, reusing, refining, disposing and regulating the health friendly waste, 3) It shall be the duty of the Provincial and Local Level to comply with the standards referred to in sub-section (1) and (2), 4) Each health institution shall manage the risk-free and risky waste by separating them pursuant to the prescribed standards, and 5) Each health institution shall provide the service providers with clean drinking water pursuant to the prescribed standards.

3.9 CONSTITUTION OF NEPAL 2015

Article 30: Right to the clean environment (Fundamental Right) 1. Every citizen shall have the right to live in a clean and healthy environment 2. The victim shall have the right to obtain compensation, in accordance with the law, for any injury caused by environmental pollution or degradation Article 51 (g):

Policies related to protection, promotion, and use of natural resources To make an advance warning, preparedness, rescue, relief, and rehabilitation to mitigate risks from natural disasters

4. ANALYSIS OF POTENTIAL ENVIRONMENTAL RISK ENVIRONMENTAL DETERMINATIONS

In order to achieve the above objectives and the activity will implement following surveys:

Table 1: Activity objectives and key activities.

Objectives Key activities Environmental Determination

2025 NHFS: To collect information from HFs in Nepal on the delivery of healthcare services and examine the preparedness of HFs to provide quality child health, family planning, maternal and newborn care, HIV, sexually transmitted infections, non-communicable diseases, and tuberculosis services.

1. Survey design and finalization of SOW:

2. Questionnaire adaptation,pretest and questionnaire finalization:

3. Main training of field researchers:

4. Data collection:

5. Data entry, verification, and cleaning:

6. 2015 NHFS Key Indicators Report finalization and dissemination:

7. Data analysis and Tabulation Plan for 2025

NHFS Final Report:

8. Report finalization and dissemination:

9. Journalist Workshop:

10. Further analysis and data analysis workshop:

Categorical exclusion (CE)

2026 NDHS: To collect and disseminate accurate, nationally representative data on topics such as fertility, mortality, family planning, maternal and child health, gender, HIV/AIDS, nutrition, basic health services, and other priority topics. Information is collected through interviews with women and men, measurements of height and weight, and the collection of biological samples.

1. Survey design and finalization of SOW:

2. Questionnaire adaptation and computer assisted personal interviews programming:

3. Household Mapping and Listing:

4. Pretest and questionnaire finalization:

5. Main training of field researchers:

6. Data Collection:

7. Data entry, verification, and cleaning:

8. 2026 NDHS Key Indicators Report finalization and dissemination:

9. Data analysis and Tabulation Plan for 2026

NDHS final report:

10. Report finalization and dissemination:

11. Journalist Workshop:

12. Further Analysis of 2026 NDHS and Data

Analysis Workshop:

Categorical exclusion (CE)

5. CLIMATE RISK MANAGEMENT

In accordance with Executive Order (EO) 13677 and Mandatory Reference for ADS Chapter 201 on Climate Risk Management for USAID Projects and Activities,8 USAID conducts climate risk management (CRM) screening for all new strategies, projects, and activities. CRM is the process of assessing, addressing and adaptively managing climate risks; it helps to ensure USAID investments are resilient to weather events and climate impacts. It improves effectiveness and sustainability of USAID's results and ensures U.S.

taxpayer dollars are well spent.

5.1 CLIMATE RELATED RISK IN NEPAL

Climate change is among the top threats to public health, livelihoods, and productivity, affecting nutrition outcomes and learning and educational attainment.9 Climate change is best characterized as a risk multiplier for health affecting vulnerable groups, leading to vicious cycles of risk and impact. Climate affects health through interdependent pathways, including direct risks such as extreme heat or flooding leading to traumatic injury, exacerbating noncommunicable disease (NCD) and worsening mental health;

ecosystem-mediated risks including vector-borne diseases (VBDs) such as dengue and malaria; and indirect risks such as poverty, conflict, and migration. While Nepal has made notable progress in key health indicators, including reduced child mortality and improved health care coverage, climate and environmental threats still loom large.

Four key emerging climate-related health threats should be considered:

1. Heat-related morbidity and mortality.

2. Nutrition risks

3. VBDs.

4. Waterborne diseases.

Climate change risks exacerbate existing disparities in health service delivery, particularly in remote regions. Despite significant improvements in health coverage, gaps remain between policy and practice, especially at the subnational level. The Ministry of Health and Population (MoHP) has not completed the full assessments of climate readiness of the health care infrastructure and workforce. There is also a need to put in place adequate contingency planning for anticipated climate-related hazards such as heat, 9 https://openknowledge.worldbank.org/handle/10986/38012 8 https://www.usaid.gov/sites/default/files/documents/1868/201mal_042817.pdf floods, and landslides. Minimum standards for climate-sensitive health care infrastructure have also not been developed further impeding refurbishment efforts of existing health care facilities.

Nepal has a Health-National Action Plan which is incorporated within the National Health Sector Strategy.

The strategy acknowledges the climate-related burden of disease and impacts on health system capacities; however, a lack of resource allocation and integration wiDespite significant improvements of the early warning system (EWS), there is insufficient integration with health information systems across a sufficient breadth of climate-related health risks. Since its establishment in 1997, the flow of information to the EWS on VBDs and certain other outbreak-prone diseases has been strengthened. However, there is limited inclusion of climate-related information focused on aspects of health risks. EWS mechanisms do exist for several climate- related disasters such as community-based EWS for floods; however, no comprehensive approach to a fully climate informed health EWS exists. Health information systems are currently not integrated with hydromet services, and there is limited collaboration between entities across the health and environmental sectors. Strengthening a shock-responsive social protection (SRSP) system is another key area of risk management and preparedness.

USAID’s new Climate Strategy10and the USAID/ Nepal Country Development Cooperation Strategy (CDCS) recognizes and addresses climate Vulnerabilities, hazards and mitigation measures as summarized herein.

Nepal’s Climate Risk Profile Fact Sheet can be found here. A factsheet on Greenhouse Gas Emissions in Nepal can be found here. Nepal’s climate risk country profile can be found here.

5.2 CLIMATE RISK SCREENING

Table 2: Climate Risk Screening

Objectives/ interventions

Climate Risks Risk Rating

How Risks are Addressed and further analysis

Opportunities to Strengthen Climate

Resilience

2025 NHFS Interventions will focus on collecting data from health facilities on health care services availability, readiness, and quality of care, and analysis of the data set to produce reports. The NHFS will also include HF indicators on disaster preparedness, mitigation measures for communicable diseases, and waste disposal systems. This 2025 NHFS will also monitor the health system’s preparedness and capacity to recover from shocks.

Climate change is not anticipated to impact this set of interventions.

No Risk

Not applicable. There are opportunities to discuss/enhance awareness about climate change impact and environmental and natural resource management wherever relevant during survey design, data analysis, and knowledge management activities.2026 NDHS Interventions will focus on collecting data from households on health care services utilization, knowledge, and behaviors related to maternal, child health, reproductive health, family planning, nutrition among others. The NDHS will include indicators on household food security, men and women’s knowledge and practices of

No Risk

Not applicable.

10 https://www.climatelinks.org/climate-strategy food consumption, air pollution mitigation measures, etc.

Climate change is not anticipated to impact this set of interventions.

*Climate Risk Ratings are defined as:

● Low climate risk: Climate change is unlikely to significantly impact achievement of development outcomes relative to other stressors and development challenges.

● Moderate or high climate risk: Climate change is likely or highly likely to significantly impact achievement of development outcomes.

NOTE: Low climate risk does not require the development of specific plans to address climate risk.

Moderate to high climate risk requires appropriate consideration and response to the risk and therefore requires an IEE. In some cases, the program may decide to accept the risk.

Screening of the USAID Nepal Health Surveys activity showed no climate risk and hence a “No Risk” or “Low climate risk” rating was issued. Hence, the activity does not require the development of any specific climate change mitigation plans.

6. RECOMMENDED ENVIRONMENTAL ACTIONS

● In line with objectives, the activity joint monitoring, evaluation, and verification tools should address environmental and social issues, and potential impacts on health and spread of diseases as these relate to the scope of work

● The activity should use opportunities to discuss/enhance awareness about climate change impact and environmental and natural resource management wherever relevant.

● IP should exercise good planning and caution when visiting areas vulnerable to effects of climate change and natural disasters

● The COR and MEO/CIL shall explain the Request for Categorical Exclusion (RCE) to the IP (and/or executing agencies/beneficiaries.)

7. LIMITATIONS OF THE CATEGORICAL EXCLUSION

The categorical exclusions recommended in this document apply only to projects/activities and sub-activities described herein.

Other projects/activities that may arise must be subject to an environmental analysis and the appropriate documentation prepared and approved, whether it be a new RCE, an amendment, or other type of 22 CFR 216 document.

It is confirmed that the projects/activities described herein do not involve actions normally having a significant effect on the environment, including those described in 22 CFR 216.2(d).

As current USAID Nepal CDCS expires in 2025 this RCE shall be updated when a new CDCS is approved.

7.1 MANDATORY INCLUSION OF ENVIRONMENTAL COMPLIANCE REQUIREMENTS IN SOLICITATIONS, FIXED-PRICE CONTRACTS a, BUDGETS, ANDWORK PLANS

USAID will ensure the environmental compliance requirements are incorporated into solicitations, awards, budgets, and work plans, including the relevant limitations of Section 3 above. In addition, climate risk management requirements will also be incorporated.

7.2 GENERAL IMPLEMENTATION &MONITORING REQUIREMENTS

USAID will ensure that the following requirements are met:

● Provide briefings for the IP on environmental compliance responsibilities;

● Ensure integration of compliance responsibilities in prime and sub-awards and grant agreements;

● Ensure compliance with applicable partner country requirements;

● Review project activities annually to ensure that scope is still covered by Categorical Exclusion.

● COR and MEO/CIL will explain this RCE to the IP

8. REVISIONS

As with all USAID-funded projects and pursuant to 22 CFR 216.3 (a)(9), if new information becomes available which indicates that any of the proposed actions to be funded under this activity might be "major" and their effects "significant," the threshold decisions for those actions will be reviewed and revised by the MEO and an environmental assessment prepared, as appropriate. It is the responsibility of the COR to inform, in a timely manner, the MEO/Nepal and BEO/Asia of any changes in the scope and nature of the approved activities that may require the revision of the approved Categorical Exclusion Threshold Decision.

APPROVAL OF REQUEST FOR CATEGORICAL EXCLUSION (RCE) RECOMMENDED

APPROVED DATE DISAPPROVED DATE

Karen Welch Karen Welch Acting Mission Director Acting Mission Director

CONCURRENCE:

APPROVED DATE DISAPPROVED DATE

Will Gibson Will Gibson Bureau Environmental Officer Bureau Environmental Officer

CLEARANCES:

Clearance: Clear April 05, 2024

Sabita Tuladhar, AOR Date

Clearance: Clear April 12, 2024

Deepana Shanthan, MEO/CIL, USAID/Nepal Date

Clearance: Cleared with comments April 23, 2024

Andrei Barannik, Regional Environmental Adviser for Central & South Asia, and for Afghanistan and Pakistan

Date

Clearance: Cleared April 26, 2024

Cassandre Theano, RLO (RDMA) Date

Clearance: Cleared April 29, 2024

Beth Hogan, Acting Deputy Mission Director Date

Karen Welch

Digitally signed by Karen Welch Date: 2024.05.02 10:07:18 +05'45'