The World Bank Rwanda JSDF - Support to Community Health Workers Project (P175583) Concept Environmental and Social Review Summary Concept Stage (ESRS Concept Stage) Public Disclosure Date Prepared/Updated: 12/10/2021 | Report No: ESRSC02506 Jun 17, 2022 Page 1 of 8 The World Bank Rwanda JSDF - Support to Community Health Workers Project (P175583) BASIC INFORMATION A. Basic Project Data Country Region Project ID Parent Project ID (if any) Rwanda Eastern and Southern Africa P175583 Project Name Rwanda JSDF - Support to Community Health Workers Project Practice Area (Lead) Financing Instrument Estimated Appraisal Date Estimated Board Date Health, Nutrition & Investment Project 4/30/2022 Population Financing Borrower(s) Implementing Agency(ies) Ministry of Finance Rwanda Biomedical Center (MINECOFIN) Proposed Development Objective Public Disclosure Financing (in USD Million) Amount Total Project Cost 2.76 B. Is the project being prepared in a Situation of Urgent Need of Assistance or Capacity Constraints, as per Bank IPF Policy, para. 12? No C. Summary Description of Proposed Project [including overview of Country, Sectoral & Institutional Contexts and Relationship to CPF] D. Environmental and Social Overview D.1. Detailed project location(s) and salient physical characteristics relevant to the E&S assessment [geographic, environmental, social] The project will be located in Stunting Prevention and Reduction Project ( SPRP )interventions districts. The cooperatives to be supported will be located in the SPRP 13 district zone comprising Nyabihu, Ngororero, Karongi, Rubavu, Rutsiro, Rusizi, Nyamagabe, Huye, Nyaruguru, Ruhango, Gakenke, Kayonza and Bugesera, thus to not scatter Jun 17, 2022 Page 2 of 8 The World Bank Rwanda JSDF - Support to Community Health Workers Project (P175583) efforts and to maximize impact. Furthermore, Integrated the Disease Surveillance and Response System (IDSR) designates the districts of Nyabihu bordering Uganda, Karongi, Rubavu, Rutsiro and Rusizi bordering DRC; and Bugesera bordering Burundi among the most at risk of the Ebola Virus Disease (EVD) outbreak and the COVID-19 pandemic. It is important to take due consideration of potential project impacts on the more urbanized border districts as treated in the ES instruments of the SPRP and its derivative projects. Demonstration activities entailing small livestock production and production and sale of agricultural products may pose risks of human poisoning by direct contact or water and soil quality if chemicals and agricultural inputs are not properly handles and washed into water systems. Environmental management measures to avoid or mitigate these risks should be practices. The SPRP ES staff at PIU and decentralized levels will carry out the necessary training and awareness as appropriate. While CHW beneficiaries and trainers have not yet been vaccinated against COVID-19, JDSF demonstration activities may increase infection risk among themselves and the community. COVID-19 IPC measures should continue to me practiced during the project. D. 2. Borrower’s Institutional Capacity Under the overall responsibility of the Ministry of Health (MoH), the Rwanda Biomedical Centre (RBC) through its SPIU has experience and a good track record in managing WB financed projects comprising the SPRP, the Ebola Virus Disease CERC, the COVID-19 Emergency Response Project( ERP )and its Vaccine AF. The MoH mandated the Environmental Health Desk comprising and environmental health specialist and environmental officer with the supervision of the implementation of the SPRP-ESMP. The SPRP project manager took the responsibility of the social specialist in the project. Supervision of the implementation of SPRP-ESMP is led by the designated Environmental Health Specialist and Social Specialist in close collaboration with hospital level Environmental Health Officers (EHOs) and health center level Community Based Environmental Health. This arrangement has worked well in mitigating ES Public Disclosure risks and will be adopted for the mainly light impact activities of the JDSF project. Intensive training in Oct 2020 was carried out for hospital level Environmental Health Officers (EHO) and health center level Community and Environmental Health Officers (CEHO) in the 13 SPRP beneficiary districts 241 of these officers were trained on among others, water quality control. The officers, especially the Community Environment Health Officers (C-EHOs) worked closely with CHW and will be available to oversee ES requirements for the JSDF project, including training of beneficiary CHWs on environmental management in demonstration activities of kitchen gardens, small livestock production, production and sale of agricultural products to avoid of mitigate all types of pollution. However, community Environmental Health Officers, Ministry of Health Environmental Health Desk Officers and Community Health Workers have no experience working on any project prepared and under ESF. These staff will be trained in the ESF and relevant Environment and social standards (ESSs) to ensure proper implementation, monitoring and reporting as per the requirements in the ESCP. II. SCREENING OF POTENTIAL ENVIRONMENTAL AND SOCIAL (ES) RISKS AND IMPACTS A. Environmental and Social Risk Classification (ESRC) Moderate Environmental Risk Rating Moderate The project will not finance any construction works and hence will not lead to alteration of natural habitats. It will not lead to generation of any significant amount of pollutants. It will only finance goods for small scale income generating activities (IGAs). The IGAs to be financed by the small seed grants of $1,500-$2,000 include kitchen gardens, small livestock production, hygiene products sales and sale of agricultural products. Though very small in scale, potential Jun 17, 2022 Page 3 of 8 The World Bank Rwanda JSDF - Support to Community Health Workers Project (P175583) environment, health and safety risks associated with the IGAs include waste feed, animal waste, odors (e.g. animal housing & waste management), bioaerosols, animal diseases, exposure to physical hazards, overgrazing may contribute to soil losses, chemicals that may be applied to control pests, parasites and vectors, crop residue waste management, fertilizers. The anticipated risks could be readily addressed if appropriate environment, health, and safety (EHS) considerations are properly covered in each of the Business Plans to be prepared under Component I. To this end, an environmental and social management plan (ESMP) including a simple integrated pest management or a guideline on EHS risk management will be annexed to each Business Plans depending on the nature of the activities to be financed. This will also be reflected in the Environmental and Social Commitment Plan. The potential environmental risk of project is rated as moderate at this stage. Social Risk Rating Low The social risk rating of the project is Low. The project will support training in four areas under component one for cooperative led by Community Health Workers (CHW) to fill the skills gaps that include; training in a) business skills and financial management, b) coordinating and managing the cooperatives, c) designing and implementing new Income-Generating Activities (IGAs), and d) ICT tools and their use. These training are intended to strengthen the capacity of existing cooperatives and enable CHWs to become innovative and develop business plans and different demonstration projects. These will include small-scale crop production, livestock processing, and commercialization pharmacies, community ambulances, and health commodities like medicines, contraceptives, and feminine hygiene products. All these activities shall improve the income of the CHW-women-led cooperatives which is a positive social- economic contribution to the households of these health workers. The potential social risks are low for GBV and SEA/SH and the same applies to other social risks which include, exclusion of CHWs cooperatives beyond the 13 Districts. Rwanda has over 30 Districts and the project only targets 13 Districts which could potentially pose a sense of Public Disclosure exclusion of CHWs in other untargeted Districts. The Ministry of Health and RBC will undertake public awareness campaign among all CHWs in the untargeted Districts to ensure that they are aware that this is a pilot project that could be scaled up later. The ESCP to be prepared by the client shall cover both stakeholder engagement activities and labor-management procedures. B. Environment and Social Standards (ESSs) that Apply to the Activities Being Considered B.1. General Assessment ESS1 Assessment and Management of Environmental and Social Risks and Impacts Overview of the relevance of the Standard for the Project: No large-scale environment, health and safety risk could result from this project as indicated in Section A of the ESRS. The potential EHS risks are associated with goods/ income generating activities (IGAs) to be financed under Component II. Potential small-scale environment, health and safety risks include waste animal feed, animal waste, odors (e.g. animal housing), bioaerosols, animal diseases, physical hazards, overgrazing, chemicals handling risks. To manage these risks, an ESMP or guideline for management of environment, health, and safety (EHS) risks will be annexed to each of the Business Plans to be prepared under Component-I of the Project. The environmental and social commitment plan will clearly indicate that the Business Plans will have an ESMP section or a guideline on EHS risk management. Jun 17, 2022 Page 4 of 8 The World Bank Rwanda JSDF - Support to Community Health Workers Project (P175583) Depending on the nature of the IGA, Business Plans which may not have an ESMP or EHS guideline on how to manage environment, health, and safety risks of the IGA will not be eligible for the seed grant. The E&S experts in the implementing agency shall provide guidance on the preparation of the ESMPs or EHS risk management guidelines to be annexed to the Business Plans. The seed grant recipients (beneficiaries of the project) will be trained on management of EHS risks that may result from the IGAs. Areas where “Use of Borrower Framework” is being considered: None ESS10 Stakeholder Engagement and Information Disclosure ESS10 is relevant, as the project shall be implemented in 13 Districts and involves different stakeholders. Therefore, the project implementation shall engage various stakeholders through inclusive and consultative processes using technical meetings, workshops, and knowledge sharing forums, among others. The potential stakeholders include government organizations, including Districts, Rwanda Cooperative Agency (RCA), Ministry of Agriculture, Rwanda Agricultural Board (RAB), and local government offices; MoH, CSOs. A Stakeholder Engagement Plan shall be prepared as part of the ESCP, as participatory and inclusive stakeholder consultation process will be required to be part and parcel of all the project components. MoH and RBC will engage all relevant stakeholders, including vulnerable and disadvantaged CHWs in designing project activities in all components shall be reflected in the ESCP. Public Disclosure The stakeholder engagement process and related information will be documented in the project deliverables and implementation progress reports. B.2. Specific Risks and Impacts A brief description of the potential environmental and social risks and impacts relevant to the Project. ESS2 Labor and Working Conditions Occupational health and safety risks such as exposure to biological, physical, or chemical hazards may result from IGAs such as small livestock production and kitchen gardens. The project shall mainly imploye direct workers and consultants. The ESMP or guideline to be annexed to the Business Plans will include clear guidance on the management of occupational health and safety that may result from the IGAs. The seed grant recipients will be trained on the management of OHS risks that may result from the IGAs. The HCW will be trained on COVID-19 protocols and will follow the World Bank Technical Note: Public Consultations and Stakeholder Engagement in WB- supported operations when there are constraints on conducting public meetings ( March 2020) to minimize the spread of COVId-19. ESS3 Resource Efficiency and Pollution Prevention and Management As indicated in section A, some of the IGAs such as small livestock production and kitchen gardens could result in small scale waste animal feed, animal waste, odors, bioaerosols, animal diseases, soil losses, chemicals handling risks, crop residue waste. An ESMP including a simple plan about integrated pest management or guidance on the Jun 17, 2022 Page 5 of 8 The World Bank Rwanda JSDF - Support to Community Health Workers Project (P175583) management of chemicals and pollutants /wastes will be annexed to each Business Plan. The seed grant recipients (beneficiaries of the project) will be trained on management of pollutants/wastes that may result from the IGAs. ESS4 Community Health and Safety No community health and safety risk is anticipated at this stage. ESS5 Land Acquisition, Restrictions on Land Use and Involuntary Resettlement ESS 5 is not relevant as there is no anticipated involuntary land acquisition under this project. ESS6 Biodiversity Conservation and Sustainable Management of Living Natural Resources No alteration of habitats or degradation of biodiversity is anticipated from the small-scale income generation activities. However, for precautionary reasons, the ESMPs to be annexed to the Business Plans will include measures and actions that need to be taken to avoid potential risks to biodiversity depending on the nature of the IGA. Beneficiaries of the project will be trained on management of potential biodiversity risks that may result from the IGAs where relevant. The Project will follow measures outlined in the IFC Good Practice Note on Improving Animal Welfare in Livestock Operations. This would entail among others that genetic selection should always take into account the health and welfare of animals; animals chosen for introduction into new environments should be suited to the local climate and Public Disclosure able to adapt to local diseases, parasites and nutrition; the physical environment should allow comfortable resting, safe and comfortable movement, including normal postural changes, and the opportunity to perform types of natural behavior that animals are motivated to perform; etc. For further details are available in the Good Practice Note. ESS7 Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities ESS 7 is not relevant for this project as this project is targeting CHWs women led cooperatives that are already operating. ESS8 Cultural Heritage No impacts on cultural heritage are expected as no physical construction is foreseen. ESS9 Financial Intermediaries FI will not be involved in this operation. C. Legal Operational Policies that Apply OP 7.50 Projects on International Waterways No Project activities are not going to interfere with international waterways. Jun 17, 2022 Page 6 of 8 The World Bank Rwanda JSDF - Support to Community Health Workers Project (P175583) OP 7.60 Projects in Disputed Areas No Project activities will not be conducted in disputed areas. III. WORLD BANK ENVIRONMENTAL AND SOCIAL DUE DILIGENCE A. Is a common approach being considered? No Financing Partners none B. Proposed Measures, Actions and Timing (Borrower’s commitments) Actions to be completed prior to Bank Board Approval: Preparation of an Environmental and Social Commitment Plan Possible issues to be addressed in the Borrower Environmental and Social Commitment Plan (ESCP): i) maintaining the existing implementation arrangement for the management of the anticipated environmental and social risks including the E&S experts ii) preparation of ESMPs for income-generating activities (IGAs) and annexing them to each Business Plan IV. CONTACT POINTS Public Disclosure World Bank Contact: Naoko Ohno Title: Senior Operations Officer Telephone No: +1-202-473-9103 Email: nohno@worldbank.org Borrower/Client/Recipient Borrower: Ministry of Finance (MINECOFIN) Implementing Agency(ies) Implementing Agency: Rwanda Biomedical Center V. FOR MORE INFORMATION CONTACT Jun 17, 2022 Page 7 of 8 The World Bank Rwanda JSDF - Support to Community Health Workers Project (P175583) The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 473-1000 Web: http://www.worldbank.org/projects VI. APPROVAL Task Team Leader(s): Naoko Ohno Public Disclosure Jun 17, 2022 Page 8 of 8